(American Journal of Pathology. 2000;157:75-81.)
© 2000 American Society for Investigative Pathology
PECAM-1 (CD31) Expression Modulates Bleeding Time in Vivo
Sepi Mahooti*,
Donnasue Graesser*,
Sonali Patil
,
Peter Newman
,
Gordon Duncan
,
Tak Mak
and
Joseph A. Madri*
From the Department of Pathology,*
Yale University
School of Medicine, New Haven, Connecticut; the Blood Research
Institute,
Blood Center of Southeastern
Wisconsin, Milwaukee, Wisconsin; and the AMGEN
Institute,
University of Toronto, Toronto,
Ontario, Canada
 |
Abstract
|
|---|
PECAM-1 is a 130-kd member of the Ig superfamily present on
endothelial cells, platelets, polymorphonuclear
leukocytes, monocytes, and lymphocytes. Its expression
begins early in development and persists through adulthood. PECAM-1
functions as an adhesion and signaling molecule between adjacent
endothelial cells and between endothelial cells and circulating blood
elements. Antibodies directed against PECAM-1 have been shown to affect
angiogenesis, endothelial cell migration, and
polymorphonuclear leukocyte transmigration. Furthermore, its
dimerization is associated with the modulation of integrin affinity.
Antibody inhibition studies suggest that PECAM-1 plays a role in
modulating thrombosis; however, recent in vitro
aggregation studies performed on platelets harvested from
PECAM-1-deficient mice revealed no abnormalities. In this report we
demonstrate prolonged in vivo bleeding times in
PECAM-1-deficient mice. This abnormality was not corrected when
wild-type hematopoietic precursors were engrafted into marrow-ablated
PECAM-1-deficient mice. Furthermore, normal bleeding times were
observed when marrow-ablated wild-type mice were engrafted with
hematopoietic precursors harvested from PECAM-1-deficient mice. These
studies are consistent with a role for PECAM-1 in modulating thrombosis
in the vasculature, which is potentially mediated by
endothelial cell PECAM-1 expression.
 |
Introduction
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|---|
The expression of PECAM-1 (CD31), a 130-kd member of the Ig
superfamily, begins early in development at the stage of hemangioblast
formation and persists through adulthood.1-3
It is
expressed on endothelial cells, platelets, polymorphonuclear
leukocytes, monocytes, and T and B lymphocytes and is thought to serve
several functions, including that of an adhesion molecule mediating
cell-cell adhesion between adjacent endothelial cells and between
endothelial cells and polymorphonuclear leukocytes, platelets,
monocytes, and lymphocytes.1-5
It has been shown to be a
modulator of in vitro and in vivo angiogenesis,
endothelial cell migration, and polymorphonuclear leukocyte
transmigration. PECAM-1 localization and phosphorylation state are
known to be affected by integrin engagement, hypoxia, hyperglycemia,
and osmolarity.4-13
In addition to its adhesive functions,
PECAM-1 has been shown to be a participant in signaling
pathways.3,8,11,14
After engagement of PECAM-1, integrin
affinity changes have been noted on platelets and
lymphocytes,15-19
and changes in intracellular calcium
localization have been documented.20
PECAM-1-mediated
signaling is thought to occur, in part, via its cytoplasmic ITIM
(immunoregulatory tyrosine inhibitory motif) domain. This domain is
known to mediate binding of signaling and adapter molecules having one
or tandem SH2 domains, when the tyrosine residues residing in the
PECAM-1 ITIM domain are phosphorylated.3,11,12
Specifically, the phosphatase SHP-2 has been shown to bind to
tyrosine-phosphorylated PECAM-1.19,21
Recently we have
found that in addition to its interactions with SHP-2, PECAM-1 can
serve as a reservoir for and a modulator of ß-catenin, binding
tyrosine-phosphorylated ß-catenin, and, if PECAM-1 is tyrosine
phosphorylated, bringing ß-catenin into close proximity to SHP-2,
facilitating dephosphorylation of the bound ß-catenin.22
These observations prompted the generation of PECAM-1-deficient mice.
The animals were found to be viable and exhibited an abnormal transit
of polymorphonuclear leukocytes across vascular basement membranes as
their only demonstrable phenotype.23
Other recent
investigations using vital microscopy techniques have revealed delays
in leukocyte transmigration in PECAM-1-deficient mice.24
In this manuscript we report further analyses of the PECAM-1-deficient
mice. Specifically, we have demonstrated a prolongation in bleeding
time in PECAM-1-deficient mice. Furthermore, we have shown that this
phenotype persists when the PECAM-1-deficient mice are engrafted with
wild-type hematopoietic precursors.
 |
Materials and Methods
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PECAM-1-deficient mice were generated as described.23
The colony was bred at the Yale University Animal Care Facility (New
Haven, CT) and the Blood Research Institute (Milwaukee, WI), in
accordance with established protocols. Phenotype was assessed by flow
cytometric analysis (FACS) of peripheral blood elements as
described.23
Platelet, RBC, and WBC counts were performed on blood collected by
retroorbital bleeding with a heparinized capillary tube. Two hundred
microliters of blood was immediately transferred to Eppendorf tubes
containing K3 EDTA (2.0 mg/ml). Samples were
diluted in saline and counted on a Baker System
9110+CP Hematology Analyzer (Biochem
Immunosystems, Allentown, PA) or sent to a commercial laboratory
(ANTECH Diagnostics, Farmingdale, NY) for analysis.
Bleeding times were assessed using an adaptation of the method used by
Kung et al.25
Deep anesthesia was induced with metofane
gas. The mice were then secured into a tabletop holder, with their
tails taped downward and perpendicular to their bodies. After being
pulled through a 1.5-mm-diameter template, the tails were transected
with a scalpel blade and bled onto a Whatman filter paper. The filter
was dabbed to the wound every 30 seconds without disrupting the forming
clot. Any blood dripping during the 30-second intervals was allowed to
drop freely onto the filter. The experiment was continued until
bleeding stopped completely (wild type and heterozygous). The bleeding
of PECAM-1-deficient animals was stopped by cauterization at 20 minutes
to prevent hypovolemic shock.
Hematopoietic precursor engraftment of PECAM-1-deficient and wild-type
mice was performed as described.26
Recipient mice were
irradiated (500 Rads twice, separated by 2 hours) using a cesium 127
irradiator. Donor animals were euthanized by cervical dislocation.
Femur, tibia, and iliac crest were aseptically removed and cleaned free
of muscle, and the ends were cut off with a scalpel blade. The marrow
was flushed into a 50-ml tube, using a 22-gauge needle attached to a
5-ml syringe containing 10% fetal bovine serum in 1x
phosphate-buffered saline. Cells from multiple animals were pooled,
filtered through a 40-µm cell strainer (Beckton Dickinson, Franklin
New Jersey), washed, and counted. Marrow precursor cells were diluted
to 2.5 x 106/200 µl and injected
retroorbitally into each irradiated recipient deficient or wild-type
mouse. After 30 days recipients were tested for platelet number and
bleeding time.
Statistics (averages, standard deviations, Students
t-test) were performed on a Power Macintosh 9600/300
computer using Excel 4.0. Statistical differences were assessed
by one-way analysis of variance and the Student-Newman-Keuls method for
post hoc analysis, with SigmaStat software (Jandel
Corporation, San Rafael, CA).
 |
Results
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PECAM-1 Expression Is Reduced in Heterozygous Mice and Is Not
Detectable in Homozygous Null Mice
As previously described,19
PECAM-1 expression in
circulating blood elements is not detectable in PECAM-1 homozygous null
mice (-/-, KO), whereas it is present in reduced amounts in
heterozygotes (+/-, Het) compared to wild-type (+/+, WT) littermates.
The presence or absence of PECAM-1 expression was confirmed by
immunofluorescence of tissue sections (data not shown).
PECAM-1 Null Mice Exhibit Prolonged Bleeding Times
During our harvests of blood for FACS analysis of phenotype we
noticed a difference (prolongation) in bleeding times of some of the
mice. When the FACS data were correlated with this observation we
determined that the animals exhibiting prolonged bleeding times were
the PECAM-1-deficient (-/-) mice. This finding prompted us to perform
standardized bleeding times on all of our litters. Bleeding times were
performed in a blinded fashion at two sites by separate investigators
over a 2-year period. At the Yale University School of Medicine the
mice wre bled at 3 weeks of age. In all of the mice studied to date (60
mice of varying ages spanning a 2-year period), all of the homozygous
null (-/-, KO) mice exhibited a prolonged bleeding time of more than
20 minutes (the test was arbitrarily stopped at this time point to
avoid possible death due to hypovolemic shock). The heterozygous
animals(+/-, Het) exhibited bleeding times similar to those of
wild-type (+/+, WT) littermates (11 ± 1.5 minutes
versus 12 ± 1.4 minutes) (Figure 1)
. Repeat bleedings of the same mice
yielded similar results. At the Blood Research Institute at the Blood
Center of Southeastern Wisconsin, mice were bled at 89 weeks of age.
Similar to the findings noted at Yale University, the homozygous null
(-/-, KO) mice exhibited prolonged bleeding times (16.6 ± 3.2
minutes) compared to wild-type littermates (12.1 ± 6.9 minutes)
(n = 15, P = 0.03). In addition,
when the area of blood deposited on the filter paper was analyzed, a
significant increase in area was noted for the homozygous null (-/-,
KO) mice (1097.2 ± 390.7 mm2) compared to
wild-type littermates (689.1 ± 382.3 mm2)
(n = 15, P = 0.01). Differences
in the bleeding times obtained at Yale University and the Blood
Research Center are most likely the result of subtle differences in
technique of particular individuals. It should be noted, however, that
at both sites the knockout animals exhibited prolonged bleeding times
compared to wild-type mice.

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Figure 1. PECAM-1-deficient mice exhibit prolonged bleeding times. Bleeding times
were determined with a standardized filter paper test
(see Materials and
Methods). A: Representative bleeding
times of wild-type (+/+,
WT), heterozygous (+/-,
Het), and PECAM-1-deficient
(-/-, KO) mice. The
arrows at the 12 oclock position denote the start of the assay. Each
dot represents a 30-second time point. The arrowheads denote
the cessation of bleeding. B: Average bleeding times
obtained from a typical experiment consisting of 13
(+/+), 5
(+/-), and 17
(-/-) mice. The
vertical bars represent standard deviations. * P
value of <0.05 comparing KO and both WT and Het mice.
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Platelet counts performed on blood from wild-type (+/+), heterozygotes
(+/-), and homozygotes (-/-) revealed similar platelet numbers
(1.03 x 106
± 1.21 x
105, 1.01 x 106
±
3.53 x 104, and 9.93 x
105
± 4.72 x 104,
respectively) in all of the mice tested (see Figures 2A and 4B
). Transmission electron
microscopy of circulating platelets harvested from wild type (+/+),
heterozygotes (+/-), and homozygotes (-/-) revealed no detectable
morphological differences (data not shown). Similarly, RBC and WBC
counts performed on wild-type and homozygous null mice revealed similar
cell numbers. RBC counts were 8.1 x 106
±
1.3 x 105
for WT (+/+) mice
versus 6.9 x 106
± 1.8 x
105
for KO (-/-) mice (Figure 2B)
, and WBC
counts were 3.25 x 103
± 3.5 x
102
for WT mice versus 4.0
x 103
± 1.0 x 102
for KO mice (Figure 2C)
. Further analysis of the WBC fraction revealed
no statistically significant differences in polymorphonuclear leukocyte
or lymphocyte fractions (Figure 2, D and E)
.

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Figure 2. PECAM-1-deficient mice exhibit similar platelet, RBC, and WBC numbers
and differing percentages of PMNs and lymphocytes similar to those of
wild-type mice. Blood from wild-type
(WT) and knockout
(KO) mice was withdrawn,
and platelet, RBC, and WBC counts and differential counts were
performed. Platelet (n =
8)
(A), RBC
(n =
4)
(B), and WBC
(n = 3)
(C) levels and
differential blood cell counts (D, %
PMN; E, % lymphocytes) were
determined to be similar for WT and KO mice (P
> 0.1).
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Figure 4. Bleeding times correlate with the recipient after marrow ablation and
subsequent engraftment. Groups of WT and KO mice underwent marrow
ablation and engraftment with donor bone marrow. Thirty days after
engraftment bleeding times and platelet numbers were assessed.
A: WT (n = 12)
and KO (n = 17) mice
exhibited the expected bleeding times (see
Figure 2
). KO mice engrafted with WT bone marrow
(WT >> KO, n =
7) exhibited prolonged bleeding times
(>20 minutes), whereas
WT mice engrafted with either KO (KO >> WT,
n = 6) or WT
(WT >> WT, n =
5) bone marrow exhibited bleeding times
indistinguishable from WT mice. The vertical lines denote standard
deviations. When compared, bleeding times of WT, KO >> WT, and WT >>
WT mice were not statistically different from each other but were
statistically different (P <
0.05) from KO and WT >> KO mice. Bleeding times
for KO and WT >> KO mice were not statistically different from each
other. B: Platelet counts in the same groups of WT, KO, WT
>> KO, KO >> WT, and WT >> WT mice. All mice had appreciable levels
of platelets, and there was no correlation between the modest
differences in platelet numbers and bleeding times.
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Engraftment of Wild-Type Hematopoietic Precursors into
Homozygous PECAM-1 Null Mice Does Not Correct the Prolonged
Bleeding Time
In light of recent findings suggesting that modulation of platelet
PECAM-1 interactions can influence platelet
function,16,27-30
we embarked on a stem cell therapy
approach to attempt a correction of the prolonged bleeding time and to
gain a better understanding of the role of PECAM-1 roles in thrombosis.
As illustrated in Figure 3, A and B
,
engraftment of wild-type bone marrow stem cells in marrow-ablated
PECAM-1-deficient mice resulted in reconstitution of the bone marrow
with PECAM-1-positive hematopoietic precursors and circulating blood
elements. Platelet counts obtained from these engrafted mice were
essentially indistinguishable from those of wild-type mice (1.03
x 106
± 1.21 x 105
versus 8.2 x 105
± 2.25 x
105, respectively) (Figure 4B)
. Surprisingly, bleeding times in
these mice remained prolonged (more than 20 minutes) (Figure 4A)
,
despite the presence of PECAM-1-positive platelets (Figure 3B)
.

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Figure 3. FACS analysis of wild-type
(WT) and
PECAM-1-deficient (KO)
mice before and 30 days after marrow ablation and engraftment with
donor bone marrow. A and B: PECAM-1 expression on
circulating blood elements of five KO mice before
(A) and after
(B)
engraftment with WT marrow (WT >
KO). Note that after ablation and engraftment
there is expression of PECAM-1 at wild-type levels
(rightmost
arrowheads). C and D:
PECAM-1 expression on circulating blood elements of five WT mice before
(C) and after
(D)
engraftment with KO marrow (KO >
WT). Note that after ablation and engraftment
there is a substantial reduction in the expression of PECAM-1, well
below heterozygous levels (leftmost
arrowheads). E and F:
PECAM-1 expression on circulating blood elements of five WT mice before
(E) and after
(F)
engraftment with WT marrow (WT >
WT). Note that after ablation and engraftment
there is expression of PECAM-1 at wild-type levels
(rightmost
arrowheads), essentially at preablation
levels. This pair serves as a control. The dark leftmost tracing in all
of the panels represents the baseline fluorescence without primary
antibody. Rightmost arrowheads, wild-type levels;
leftmost arrowheads, heterozygous levels.
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As illustrated in Figure 3, C and D
, engraftment of PECAM-1-deficient
bone marrow stem cells in marrow-ablated wild-type mice resulted in
reconstitution of the bone marrow with PECAM-1-negative hematopoietic
precursors and circulating blood elements. Platelet counts obtained
from these engrafted mice were also similar to those of wild-type mice
(1.03 x 106
± 1.21 x
105
versus 8.31 x
105
± 1.77 x 104,
respectively) (Figure 4B)
. Bleeding times in these animals remained
normal (11 ± 1.6 minutes) (Figure 4A)
, despite the presence of
PECAM-1-negative platelets (Figure 3D)
. Figure 3, E and F
, illustrates
engraftment of WT bone marrow stem cells in marrow-ablated wild-type
mice, which resulted in reconstitution of the bone marrow with
PECAM-1-positive hematopoietic precursors and circulating blood
elements.
Taken together, these data suggest that the prolonged bleeding in
PECAM-1-deficient animals is due to a vascular rather than a platelet
defect.
 |
Discussion
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PECAM-1 (CD31) has been implicated as a modulator of a
variety of vascular endothelial, polymorphonuclear leukocyte, monocyte,
lymphocyte, and platelet functions.2,3,8,11,14,27
Until
recently the conclusions drawn regarding the role of PECAM-1 in many of
these diverse processes were based on overexpression of dominant
negative and dominant positive constructs and antibody blocking and
activation studies.28-31
The generation of
PECAM-1-deficient mice now provides the means to study the a
priori significance of the molecule and its physiological
relevance from implantation through adulthood. It was expected that
knocking out PECAM-1 would produce obvious and catastrophic changes
affecting the developing animal. However, likely because of redundancy,
PECAM-1-deficient mice are viable, with seemingly subtle functional
irregularities. To date the most obvious of these has been a delay at
the basal lamina after polymorphonuclear leukocytes migrate through the
endothelium, after an inflammatory stimulus.23
Our observation of prolonged bleeding times in PECAM-1-deficient mice
and data implicating PECAM-1 as a participant in platelet/platelet and
platelet/endothelial associations16,28-33
prompted us to
study these interactions in the PECAM-1-deficient mice. In our initial
attempt to characterize this deficiency, we assessed
platelet numbers and morphological characteristics and noted no major
differences between PECAM-1-deficient and wild-type mice. In this
study, our approach has been to quantify differences in bleeding time.
Wild-type mice reconstituted with PECAM-1-deficient marrow,
PECAM-1-deficient mice reconstituted with wild-type marrow,
and wild-type mice reconstituted with wild-type marrow hematopoietic
precursors were generated and used to further characterize the
PECAM-1-deficient phenotype.
The techniques used to measure tail bleeding time vary and can often
contribute to disparate findings between laboratories.34
We achieved the most consistent results by using a variation of the
methods described by Kung et al,25
combined with
principles outlined by the template method developed by
Mielke,35
which uses a pressure cuff and standardized
incisions when bleeding times in humans are taken. We anesthetized the
animals and normalized the tail transection diameters, using a 1.5-mm
template. The tail was positioned downward and perpendicular to the
animals body, corresponding the application of a pressure cuff in
humans34
and contributing less to inconsistent clotting
kinetics due to collapsing capillaries.36
To minimize
investigator bias and unrecognized differences in technique, bleeding
times were performed in a blinded fashion at two distinct sites by
different investigators over a long time period. In all instances the
homozygous null mice were found to exhibit significantly prolonged
bleeding times.
PECAM-1 on the surface of platelets has been shown to act as a
costimulatory agonist receptor capable of modulating integrin function
in human platelets during adhesion and aggregation.16
PECAM-1 expression is not limited to the surface of platelets, as
2030% is contained in the
-granules.37
Furthermore,
thrombin-activated degranulated platelets show increased PECAM-1
expression at the surface. Blocking studies using a monoclonal antibody
against PECAM-1 inhibited ADP-, collagen-, and epinephrine-induced
platelet aggregation. However, pooled PECAM-1-deficient and wild-type
platelets aggregate at nearly the same rate after ADP
stimulation.23
This apparent disparity may be explained by
the following: 1) Recent studies have shown that hemodynamic forces as
well as substrate characteristics influence platelet adhesion pathways,
further addressing the need for more physiologically relevant
assays.38,39
2) Increased expression or surface
redistribution of PECAM-1 expression concomitantly on platelets and
endothelial cells may, in a thrombogenic microenvironment, augment
adhesion and potentiate signal transduction through platelet/platelet
as well as through heterotypic interactions with endothelial
cells.40,41
Furthermore, Rosenblum et al showed in
vivo that two different antibodies directed against PECAM-1
delayed platelet aggregation after light/dye energy transferring,
nondenuding injury to endothelium.28-30
However,
platelets harvested from mice after systemic infusion with the same
antibodies and activated with arachidonate and ADP did not exhibit
delayed aggregation.29
Taken together, these data implicate a potential role for PECAM-1 on
the endothelium in mediating signaling cascades and adhesive functions
during thrombosis. Bombeli et al have demonstrated that adhesion
molecules on endothelial cells can act to tether secreted or soluble
plasma proteins, facilitating activated platelet adhesion and further
aggregation.42
Our finding that bleeding time
characteristics remain with the recipient animal after bone marrow
engraftment is consistent with a potential role for PECAM-1 on the
endothelium, mediating signaling cascades and/or adhesive functions
during thrombosis. Elucidation of the role(s) of PECAM-1 in modulating
thrombotic phenomena will require further investigation.39
We expected to correct the bleeding time anomaly in PECAM-1-deficient
mice through reconstitution with wild-type bone marrow stem cells and
to induce abnormal bleeding times in wild-type mice through
reconstitution with PECAM-1-deficient bone marrow stem cells. However,
although platelet numbers remained approximately equivalent, the
bleeding time of each recipient prevailed. These results suggest that
PECAM-1 on the endothelium and not necessarily on platelets is
important for normal thrombotic phenomena in the periphery. Previous
studies have shown that PECAM-1 on endothelial cells plays a role in
the transmigration of hematopoietic progenitor cells through the
vasculature and that PECAM-1 can undergo heterophilic interactions with
other molecules.43-47
The roles that endothelial
PECAM-PECAM and endothelial PECAM-heterophilic interactions play in
these processes and in modulating the bleeding time in the periphery
remain to be determined.
Taken together, our data and published
reports4,7-
9,14,15,43-45,47-52
suggest a
role of PECAM-1 on endothelial cells in signal transduction,
heterophilic/heterotypic interactions, and modulation of thrombosis in
the peripheral vasculature. Further studies are needed to further
elucidate the mechanism(s) involved in these processes.
 |
Footnotes
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Address reprint requests to Dr. Joseph A. Madri, Department of Pathology, Yale University School of Medicine, 310 Cedar Street, P.O. Box 208023, New Haven, CT 06520-8023. E-mail: joseph.madri{at}yale.edu
Supported in part by U.S. Public Health Service grants R37-HL-28373, RO1-HL-51018, and PO1-DK-38979 to J. A. M. and RO1-HL-40926 to J. P. N.
Accepted for publication April 20, 2000.
 |
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