The major platelet integrin, ␣IIb3, is required for platelet interactions with proteins in plasma and the extracellular matrices (ECMs) that are essential for platelet adhesion and aggregation during hemostasis and arterial thrombosis. Ligand binding to ␣IIb3 is controlled by insideout signals that modulate receptor conformation and clustering. In turn, ligand binding triggers outside-in signals through ␣IIb3 that, when disrupted, can cause a bleeding diathesis. In the past 5 years there has been an explosion of knowledge about the structure and function of ␣IIb3 and the related integrin, ␣V3. These developments are discussed here, and current models of bidirectional ␣IIb3 signaling are presented as frameworks for future investigations. An understanding that ␣IIb3 functions as a dynamic molecular scaffold for extracellular and intracellular proteins has translated into diagnostic and therapeutic insights relevant to hematology and cardiovascular medicine, and further advances can be anticipated. (
IntroductionThe platelet is a tightly regulated adhesion machine. Restrained in its functions while in the bloodstream, its adhesive, hemostatic, and proinflammatory capabilities are unleashed at sites of vessel injury to generate the primary hemostatic plug, catalyze fibrin formation, and supply soluble and membrane-bound factors that promote wound healing. 1 While platelets can adhere to damaged endothelial cells, 2 their principle adhesive surface is the extracellular matrix (ECM), which becomes exposed in injured vessels and offers a panoply of ligands for platelet adhesion receptors. 3 Within this context, integrin adhesion receptors, and ␣IIb3 in particular, play critical roles in platelet function.Integrins are heterodimeric (␣) type I transmembrane receptors, each subunit typically containing a relatively large extracellular domain, a single-pass transmembrane domain, and a short cytoplasmic tail composed of 20 to 60 amino acids. 4 Platelets express several integrins (␣IIb3, also called glycoprotein IIb-IIIa [GPIIb-IIIa]; ␣V3; ␣21; ␣51; ␣61). Integrins are, in effect, "2-faced" receptors, one face oriented to the extracellular space and interactive with cognate ECM ligands and the other oriented to the cell interior and interactive with cytoplasmic proteins. Ligand binding to either face can trigger information transfer, or signaling, across the plasma membrane to "activate" cellular functions at the other face. Figure 1 illustrates this bidirectional signaling using ␣IIb3 as an example.Basic research conducted in the past 3 decades on many facets of ␣IIb3 structure and function has led to remarkable breakthroughs culminating in the development of a chimeric anti-␣IIb3 monoclonal antibody and small-molecule receptor antagonists now used parenterally to limit the formation of occlusive platelet thrombi in acute cardiovascular indications. 5,6 On the other hand, clinical trials of oral ␣IIb3 antagonists have been disappointing and suggest that long-term extracellular blockade of ligand binding ...