We have characterized 2 distinct mechanisms through which infectious agents may promote platelet adhesion and thrombus formation in flowing blood, thus contributing to the progression of disease. In one case, the process initiates when the integrin ␣ IIb  3 mediates platelet arrest onto immobilized bacterial constituents that have bound plasma fibrinogen. If blood contains antibodies against the bacteria, immunoglobulin (Ig) G may cluster on the same surface and activate adherent platelets through the Fc␥RIIA receptor, leading to thrombus growth. As an alternative, bacteria that cannot bind fibrinogen may attach to substrates, such as immobilized plasma proteins or components of the extracellular matrix, which also support platelet adhesion. As a result of this colocalization, IgG bound to bacteria can activate neighboring platelets and induce thrombus growth regard-
IntroductionPlatelet adhesion and aggregation at sites of tissue trauma involve interactions of membrane receptors with constituents of extracellular matrices, such as collagen, and circulating macromolecules, such as von Willebrand factor (VWF) and fibrinogen, 1 which contribute to arrest bleeding during hemostasis. Bacteria, too, can induce platelet aggregation [2][3][4] or uncontrolled clotting with disseminated intravascular coagulation (DIC), 5,6 which may become disease mechanisms when the causative agent intermittently invades the bloodstream. For example, coagulation and hemostasis are activated in some localized infections, such as necrotizing fasciitis, resulting in extensive thrombosis of arterioles and veins in and around lesions. 7,8 Moreover, experimental and clinical observations have demonstrated that platelets play a key pathogenetic role when certain microorganisms establish infection in the bloodstream, as in the case of bacterial endocarditis. 4,9 In particular, platelet aggregates may allow bacteria to settle and remain at the site of infection withstanding the shear forces of flowing arterial blood. In experimental models of this disease, early vegetations grow by accretion of layers of fibrin and platelets with bacterial colonies sandwiched between them. 10 Similar mechanisms may facilitate the establishment of bacteria on artificial devices, such as arterial grafts. 11 The number of strains that can settle in the arterial circulation is limited, but an array of different species can cause septic venous thrombosis, 12,13 a condition in which platelet activation may be involved.In these studies, we have used 2 invasive species, Streptococcus pyogenes (also designated group A streptococcus) and Staphylococcus aureus, as models to examine the mechanisms involved in bacteria-induced thrombus formation under conditions mimicking the macromolecular, cellular, and hemodynamic complexity of blood circulating in different vessels. Only bacteria capable of binding a platelet-reactive factor from blood, such as fibrinogen, could initiate adhesion on a surface not intrinsically conducive to platelet deposition. This step, however, was n...