At sites of vascular injury, platelets come into contact with subendothelial collagen, which triggers their activation and the formation of a hemostatic plug. Besides glycoprotein Ib (GPIb) and ␣ IIb  3 integrin, which indirectly interact with collagen via von Willebrand factor (VWF), several collagen receptors have been identified on platelets, most notably ␣ 2  1 integrin and the immunoglobulin (Ig) superfamily member GPVI. Within the last few years, major advances have been made in understanding platelet-collagen interactions including the molecular cloning of GPVI, the generation of mouse strains lacking individual collagen receptors, and the development of collagen receptor-specific antibodies and synthetic peptides. It is now recognized that platelet adhesion to collagen requires prior activation of integrins through "inside-out" signals generated by GPVI and reinforced by released second-wave mediators adenosine diphosphate (ADP) and thromboxane A 2 . These developments have led to revision of the original "2-site, 2-step" model, which now places GPVI in a central position in the complex processes of platelet tethering, activation, adhesion, aggregation, degranulation, and procoagulant activity on collagen. This review discusses these recent developments and proposes possible mechanisms for how GPVI acts in concert with other receptors and signaling pathways to initiate hemostasis and arterial thrombosis.
IntroductionVessel wall injury triggers sudden platelet activation and platelet plug formation, followed by coagulant activity and the formation of fibrin-containing thrombi that occlude the site of injury. These events are crucial to limit blood loss at sites of tissue trauma but may also block diseased vessels, leading to ischemia and infarction of vital organs. One of the major clinical problems in the developed world is arterial thrombosis caused by rupture or erosion of an atherosclerotic plaque, leading to platelet adhesion and subsequent thrombus formation in coronary and cerebral arteries causing myocardial infarction and stroke, respectively. Therefore, a detailed understanding of the mechanisms underlying the formation of the atherosclerotic plaque as well as (arterial) thrombosis is required in order to control ischemic cardiovascular diseases while retaining hemostasis.The first step in the hemostatic cascade is platelet interaction with the exposed extracellular matrix (ECM) at sites of injury. Among the macromolecular constituents of the ECM, collagen is considered to play a major role in this process, as in vitro it not only supports platelet adhesion through direct and indirect pathways but it also directly activates the cells initiating aggregation and coagulant activity. 1 Platelet adhesion and aggregation on collagen is an integrated process that involves several platelet agonists that act through a variety of surface receptors, including integrins, immunoglobulin (Ig)-like receptors, and G-protein-coupled receptors. Over the last 20 years, immense effort has been spent on the ident...