Adhesion of platelets to exposed collagen at the site of vessel injury is mediated by the protein von Willebrand factor (VWF). VWF binds to collagen, and platelets bind to VWF via glycoprotein Ib (GPIb), a component of a membrane receptor complex (GPIb–V–IX) on the platelet surface (Fig. 35.21). Binding to VWF stops the forward movement of platelets. [Note: Deficiency in the receptor for VWF results in Bernard-Soulier syndrome, a disorder of decreased platelet adhesion.] VWF is a glycoprotein that is released from platelets. It also is made and secreted by endothelial cells. In addition to mediating the binding of platelets to collagen, VWF also binds to and stabilizes FVIII in the blood. Deficiency of VWF results in von Willebrand disease (VWD), the most common inherited coagulopathy. VWD results from decreased binding of platelets to collagen and a deficiency in FVIII (due to increased degradation). Platelets can also bind directly to collagen via the membrane receptor glycoprotein VI (GPVI). Once adhered, platelets get activated. [Note: Damage to the endothelium also exposes FIII, initiating the extrinsic pathway of blood clotting and activation of FX (see Fig. 35.8).]
B. Activation
Once adhered to areas of injury, platelets get activated. Platelet activation involves morphologic (shape) changes and degranulation, the process by which platelets secrete the contents of their α and δ (or, dense) storage granules. Activated platelets also expose PS on their surface. The externalization of PS is mediated by a Ca2+-activated enzyme known as scramblase that disrupts the membrane asymmetry created by flippases (see p. 205). Thrombin is the most potent platelet activator. FIIa binds to and activates protease-activated receptors, a type of G protein–coupled receptor (GPCR), on the surface of platelets (Fig. 35.22). FIIa is primarily associated with Gq proteins (see p. 205), resulting in activation of phospholipase C and a rise in diacylglycerol (DAG) and inositol trisphosphate (IP3). [Note: Thrombomodulin, through its binding of FIIa, decreases the availability of FIIa for platelet activation (see Fig. 35.18).] 1. Degranulation: DAG activates protein kinase C, a key event for degranulation. IP3 causes the release of Ca2+ (from dense granules). The Ca2+ activates phospholipase A2, which cleaves membrane phospholipids to release arachidonic acid, the substrate for the synthesis of thromboxane A2 (TXA2) in activated platelets by cyclooxygenase-1 (COX-1) (see p. 214). TXA2 causes vasoconstriction, augments degranulation, and binds to platelet GPCR, causing activation of additional platelets. Recall that aspirin irreversibly inhibits COX and, consequently, TXA2 synthesis and is referred to as an antiplatelet drug.