Collagens constitute nearly 30% of all proteins in our body. Type IV collagen is a major and crucial component of basement membranes. Collagen chains undergo several posttranslational modifications that are indispensable for proper collagen function. One of these modifications, prolyl 3-hydroxylation, is accomplished by a family of prolyl 3-hydroxylases (P3H1, P3H2, and P3H3). The present study shows that P3H2-null mice are embryonic-lethal by embryonic day 8.5. The mechanism of the unexpectedly early lethality involves the interaction of non-3-hydroxylated embryonic type IV collagen with the maternal platelet-specific glycoprotein VI (GPVI). This interaction results in maternal platelet aggregation, thrombosis of the maternal blood, and death of the embryo. The phenotype is completely rescued by producing double KOs of P3H2 and GPVI. Double nulls are viable and fertile. Under normal conditions, subendothelial collagens bear the GPVI-binding sites that initiate platelet aggregation upon blood exposure during injuries. In type IV collagen, these sites are normally 3-hydroxylated. Thus, prolyl 3-hydroxylation of type IV collagen has an important function preventing maternal platelet aggregation in response to the early developing embryo. A unique link between blood coagulation and the ECM is established. The newly described mechanism may elucidate some unexplained fetal losses in humans, where thrombosis is often observed at the maternal/fetal interface. Moreover, epigenetic silencing of P3H2 in breast cancers implies that the interaction between GPVI and non-3-hydroxylated type IV collagen might also play a role in the progression of malignant tumors and metastasis.C ollagens constitute nearly 30% of all proteins in our body (1).Among the 29 collagen types, type IV collagen is a major and crucial component of basement membranes (2). Different collagen types assemble into different structures. Examples of these structures are fibrils (collagen types I, II, and III) and networks (collagen types IV and VI) (1). Proper posttranslational modifications of collagen chains are critical for ultimate quaternary structure formation and function. Posttranslational modifications of collagen include prolyl 4-hydroxylation, lysyl hydroxylation and glycosylation, and prolyl 3-hydroxylation (3). The prolyl 3-hydroxylase family (P3H1, P3H2, and P3H3) is responsible for the process of prolyl 3-hydroxylation. These enzymes modify specific prolines in GlyProHyp [Hyp is 4(R)-hydroxyproline] sequences into 3(S)-hydroxyproline (3Hyp) (4). Although prolyl 4-hydroxylation occurs at almost every Yaa position proline in the Gly-Xaa-Yaa repeated sequence of collagen, prolyl 3-hydroxylation happens only at a few specific Xaa position prolines.P3H1 is the main enzyme modifying type I collagen. Mutations in P3H1 have been found to cause severe osteogenesis imperfecta (OI) in both humans and mice (5, 6). The causative molecular mechanism of the OI phenotype remains speculative. Limited information is available about the substrate specificity of ...