Extracellular Matrix Proteins in Hemostasis and Thrombosis

The adhesion and aggregation of platelets during hemostasis and thrombosis represents one of the best-understood examples of cell–matrix adhesion. Platelets are exposed to a wide variety of extracellular matrix (ECM) proteins once blood vessels are damaged and basement membranes and interstitial ECM are exposed. Platelet adhesion to these ECM proteins involves ECM receptors familiar in other contexts, such as integrins. The major platelet-specific integrin, αIIbβ3, is the best-understood ECM receptor and exhibits the most tightly regulated switch between inactive and active states. Once activated, αIIbβ3 binds many different ECM proteins, including fibrinogen, its major ligand. In addition to αIIbβ3, there are other integrins expressed at lower levels on platelets and responsible for adhesion to additional ECM proteins. There are also some important nonintegrin ECM receptors, GPIb-V-IX and GPVI, which are specific to platelets. These receptors play major roles in platelet adhesion and in the activation of the integrins and of other platelet responses, such as cytoskeletal organization and exocytosis of additional ECM ligands and autoactivators of the platelets.The balance between hemostasis and thrombosis relies on a finely tuned adhesive response of blood platelets. Inadequate adhesion leads to bleeding, whereas excessive or inappropriate adhesion leads to thrombosis. Resting platelets are nonadhesive anuclear discs and do not interact with the vessel wall, but they have a plethora of receptors that sense activating signals (agonists) of various sorts. The activating signals include soluble factors such as thrombin, adenosine diphosphate (ADP), and epinephrine, all of which act on G-protein-coupled receptors (GPCRs) on the platelets. In addition, certain receptors for extracellular matrix (ECM) proteins (e.g., GPIb, GPVI, and some integrins) can also act as activating receptors. These diverse receptors trigger intracellular signaling pathways that activate (1) actin assembly leading to cell shape change and extension of filopodia; (2) exocytosis of secretory granules that release additional platelet agonists as well as adhesive ECM proteins; and (3) activation of additional cell-surface receptors such as the major platelet-specific integrin, αIIbβ3, that contribute further to the adhesion and aggregation of activated platelets. Thus, the interactions of platelet-ECM adhesion receptors with ECM proteins from the vessel wall, from the plasma, and from the platelets themselves, are central to both the initial adhesion and the subsequent activation and aggregation of platelets (Varga-Szabo et al. 2008). These adhesive interactions, together with coagulation (to which platelets also contribute), generate the fibrin clot, essentially a facultative ECM that forms the initial occlusion of the damaged vessel but also serves as a subsequent ECM substrate for wound healing. In this article, we will review what is known about the roles of ECM proteins and their receptors in platelet adhesion and aggregation, summarize the roles of the clot and provisional ECM in subsequent wound healing, point out various unanswered questions, and discuss briefly the contributions of the relevant cell–ECM interactions to disease and the potential for therapeutic interventions.