Platelets from patients with diabetes are hyperreactive and demonstrate increased adhesiveness, aggregation, degranulation, and thrombus formation, processes that contribute to the accelerated development of vascular disease. Part of the problem seems to be dysregulated platelet Ca 2؉ signaling and the activation of calpains, which are Ca 2؉ -activated proteases that result in the limited proteolysis of substrate proteins and subsequent alterations in signaling. In the present study, we report that the activation of -and m-calpain in patients with type 2 diabetes has profound effects on the platelet proteome and have identified septin-5 and the integrin-linked kinase (ILK) as novel calpain substrates. The calpain-dependent cleavage of septin-5 disturbed its association with syntaxin-4 and promoted the secretion of ␣-granule contents, including TGF- and CCL5. Calpain was also released by platelets and cleaved CCL5 to generate a variant with enhanced activity. Calpain activation also disrupted the ILK-PINCH-Parvin complex and altered platelet adhesion and spreading. In diabetic mice, calpain inhibition reversed the effects of diabetes on platelet protein cleavage, decreased circulating CCL5 levels, reduced plateletleukocyte aggregate formation, and improved platelet function. The results of the present study indicate that diabetesinduced platelet dysfunction is mediated largely by calpain activation and suggest that calpain inhibition may be an effective way of preserving platelet function and eventually decelerating atherothrombosis development. (Blood. 2012;120(2): 415-423)
IntroductionCalpains are Ca 2ϩ -regulated cysteine proteases that are responsible for the limited proteolysis of target proteins, resulting in their modification (eg, activation, inhibition, or altered sensitivity to intracellular signals) rather than in their degradation. 1 In contrast to promiscuous degradative proteases, calpains cleave a relatively restricted set of protein substrates and use complex substrate recognition mechanisms involving primary and secondary structural features of target proteins to alter protein function and cellular signaling. 2 Platelets express -calpain (calpain 1) and m-calpain (calpain 2); named for the micro-and millimolar Ca 2ϩ concentrations, respectively, that are required to activate them in vitro. 3 Although Ca 2ϩ is the main regulator of calpain activity, protease activation does not simply occur in response to any stimuli that increases platelet Ca 2ϩ . Indeed, the regulation of proteolytic activity is complex and involves the association of calpain with a regulatory subunit, the endogenous inhibitor calpastatin, 4 other interacting proteins, 5 and binding to phospholipids. 6,7 Genetic deletion of m-calpain results in embryonic lethality, 8,9 but -calpain Ϫ/Ϫ mice are viable and demonstrate attenuated aggregation and clot retraction but normal bleeding times. 10 Mechanistically, the latter effects were attributed to the tyrosine dephosphorylation of platelet proteins because -calpain Ϫ/Ϫ platelets exh...