Although estrogens are known to have a deleterious effect on the venous thrombosis risk and a preventive action on the development of arterial atheroma, their effect on platelet function in vivo remains unclear. Here, we demonstrate that a chronic high physiologic level of estradiol (E2) in mice leads to a marked decrease in platelet responsiveness ex vivo and in vivo compared with ovariectomized controls. E2 treatment led to increased bleeding time and a resistance to thromboembolism. Hematopoietic chimera mice harboring a selective deletion of estrogen receptors (ERs) ␣ or  were used to demonstrate that the effects of E2 were exclusively because of hematopoietic ER␣. Within ER␣ the activation function-1 domain was not required for resistance to thromboembolism, as was previously shown for atheroprotection. This domain is mandatory for E2-mediated reproductive function and suggests that this role is controlled independently. Differential proteomics indicated that E2 treatment modulated the expression of platelet proteins including 1 tubulin and a few other proteins that may impact platelet production and activation. Overall, these data demonstrate a previously unrecognized role for E2 in regulating the platelet proteome and platelet function, and point to new potential antithrombotic and vasculoprotective therapeutic strategies. (Blood. 2012;120(8):1703-1712)
IntroductionEstradiol-17 (E2) and estrogen receptors (ERs) are well known for their pivotal role in sexual development and reproduction. However, they can also modulate cardiovascular and metabolic risk, autoimmune disease progression, and cancer growth. These pleiotropic effects are a consequence of both the widespread expression of ER in many cell populations within the body as well as possibly reflecting the ancestral status of ER in the steroid receptor family. 1 Epidemiologic and experimental studies now support an atheroprotective effect of both endogenous and exogenous estrogens. The Women's Health Initiative study did not show a coronary protective effect of estrogen in postmenopausal women, 2 but subsequent studies have shown that this was because of both inappropriate timing (ie, administering the hormone therapy too late) and the identity of the associated progestin. 3,4 The route of administration of estrogens (oral versus transdermal) has also been shown to have a major impact on the risk of venous thromboembolism. 5 Together these studies indicate that the beneficial or deleterious action of estrogens are strongly influenced by the dose, route, and timing of the hormonal treatment alongside age, genetic, and environmental factors.Although the impact of estrogens on coagulation and venous thromboembolism risk has received much attention, their effect on platelet function remains poorly characterized in vivo. After estrogen treatment, one study reported reduced platelet activation 6 whereas 2 others found increased activation. 7,8 Platelet activation markers were also found at higher levels in postmenopausal compared with premenopausal women...