Diabetes mellitus has been associated with platelet hyperreactivity, which plays a central role in the hyperglycemiarelated prothrombotic phenotype. The mechanisms responsible for this phenomenon are not established. In the present study, we investigated the role of CD36, a class-B scavenger receptor, in this process. Using both in vitro and in vivo mouse models, we demonstrated direct and specific interactions of platelet CD36 with advanced glycation end products (AGEs) generated under hyperglycemic conditions. AGEs bound to platelet CD36 in a specific and dose-dependent manner, and binding was inhibited by the highaffinity CD36 ligand NO 2 LDL. Cd36-null platelets did not bind AGE. Using dietand drug-induced mouse models of diabetes, we have shown that cd36-null mice had a delayed time to the formation of occlusive thrombi compared with wildtype (WT) in a FeCl 3 -induced carotid artery injury model. Cd36-null mice had a similar level of hyperglycemia and a similar level of plasma AGEs compared with WT mice under this condition, but WT mice had more AGEs incorporated into thrombi. Mechanistic studies revealed that CD36-dependent JNK2 activation is involved in this prothrombotic pathway. Therefore, the results of the present study couple vascular complications in diabetes mellitus with AGE-CD36-mediated platelet signaling and hyperreactivity.
IntroductionDiabetes mellitus (DM) is associated with an increased risk of pathologic arterial thrombosis, including myocardial infarction and stroke. [1][2][3] Factors underlying this risk include accelerated atherosclerosis, endothelial dysfunction, and platelet hyperreactivity, but the mechanisms linking diabetes to platelet hyperreactivity are not well understood. 4,5 We and others have shown that platelets express receptors, including scavenger receptors and TLRs, that recognize endogenous and exogenous "danger signals," the so-called dangerassociated molecular patterns (DAMPs). 6,7 We hypothesized that endogenous DAMPs that are generated in hyperlipidemia, diabetes, obesity, and other chronic inflammatory conditions could interact with platelets through these receptors to mediate platelet activation and induce a prothrombotic state. Indeed, in mouse models of hyperlipidemia and oxidant stress, we showed that oxidized LDL, a lipid-based DAMP, induced a prothrombotic state via interactions with the platelet type 2 scavenger receptor CD36. [8][9][10] Similarly, oxidized phospholipids on the surface of cell-derived microparticles were shown to interact with platelet CD36 and promote thrombosis after oxidant injury to the arterial wall. 11 Chronic hyperglycemia is a common feature of diabetes and is an important initiator of vascular complications, many of which have been related to vascular and inflammatory cell interactions with advanced glycation end products (AGEs). 12,13 These heterogeneous, long-lived protein adducts are produced from a nonenzymatic chemical reaction between sugars and the amino groups of proteins. 14 Circulating levels of AGEs, detected most common...