One Health: Animal Models of Heritable Human Bleeding Diseases

Animal models of human and animal diseases have long been used as the lynchpin of experimental and clinical research. With the discovery and implementation of novel molecular and nano-technologies, cellular research now has advanced to assessing signal transduction pathways, gene editing, and gene therapies. The contribution of heritable animal models to human and animal health as related to hemostasis is reviewed and updated with the advent of gene editing, recombinant and gene therapies.

Mice Expressing Low Levels of CalDAG-GEFI Exhibit Markedly Impaired Platelet Activation With Minor Impact on Hemostasis

OBJECTIVE

The tight regulation of platelet adhesiveness, mediated by the αIIbβ3 integrin, is critical for hemostasis and prevention of thrombosis. We recently demonstrated that integrin affinity in platelets is controlled by the guanine nucleotide exchange factor, CalDAG-GEFI (CD-GEFI), and its target, RAP1. In this study, we investigated whether low-level expression of CD-GEFI leads to protection from thrombosis without pathological bleeding in mice.

APPROACH AND RESULTS

Cdg1(low) mice were generated by knockin of human CD-GEFI cDNA into the mouse Cdg1 locus. CD-GEFI expression in platelets from Cdg1(low) mice was reduced by ≈90% when compared with controls. Activation of RAP1 and αIIbβ3 was abolished at low agonist concentrations and partially inhibited at high agonist concentrations in Cdg1(low) platelets. Consistently, the aggregation response of Cdg1(low) platelets was weaker than that of wild-type platelets, but more efficient than that observed in Cdg1(-/-) platelets. Importantly, Cdg1(low) mice were strongly protected from arterial and immune complex-mediated thrombosis, with only minimal impact on primary hemostasis.

CONCLUSIONS

Together, our studies suggest the partial inhibition of CD-GEFI function as a powerful new approach to safely prevent thrombotic complications.

Clinical characterization of canine platelet procoagulant deficiency (Scott syndrome)

BACKGROUND

Platelet function defects are rare causes of bleeding diatheses; however, disease prevalence might be underestimated because diagnosis requires assessment of specific parameters of platelet activation.

OBJECTIVES

The goal of this study was to characterize the clinical presentation of canine Scott syndrome (CSS), an intrinsic platelet function defect first identified in a closed colony of German Shepherds (GSD).

ANIMALS

Eleven (n = 6 female) client-owned GSD affected with CSS that sought veterinary care for one or more episodes of abnormal bleeding.

METHODS

Retrospective review of all cases of CSS diagnosed through the Comparative Coagulation Laboratory at Cornell University between 2005 and 2011. The diagnosis of CSS was based on 2 measures of platelet procoagulant activity: serum prothrombin consumption and flow cytometric detection of platelet phosphatidylserine externalization after in vitro activation.

RESULTS

Postoperative hemorrhage was the most common sign of CSS, whereas petechiae were not found in any dog. Although most GSD responded to platelet transfusion, refractory epistaxis in 2 GSD was managed by nasal arterial embolization. The CSS trait was not restricted to a single pedigree of related GSD or to a single geographic region.

CONCLUSIONS AND CLINICAL IMPORTANCE

Unlike thrombocytopenia and platelet aggregation defects, petechiae and other capillary hemorrhage are not typical features of CSS. After preliminary screening to rule out more common causes of hemorrhage, CSS should be considered in the differential diagnosis of recurrent hemorrhage in GSD, and potentially other breeds of dog. Definitive diagnosis of CSS requires specific tests of platelet procoagulant activity.

Platelet signaling-a primer

OBJECTIVE

To review the receptors and signal transduction pathways involved in platelet plug formation and to highlight links between platelets, leukocytes, endothelium, and the coagulation system.

DATA SOURCES

Original studies, review articles, and book chapters in the human and veterinary medical fields.

DATA SYNTHESIS

Platelets express numerous surface receptors. Critical among these are glycoprotein VI, the glycoprotein Ib-IX-V complex, integrin α(IIb) β(3) , and the G-protein-coupled receptors for thrombin, ADP, and thromboxane. Activation of these receptors leads to various important functional events, in particular activation of the principal adhesion receptor α(IIb) β(3) . Integrin activation allows binding of ligands such as fibrinogen, mediating platelet-platelet interaction in the process of aggregation. Signals activated by these receptors also couple to 3 other important functional events, secretion of granule contents, change in cell shape through cytoskeletal rearrangement, and procoagulant membrane expression. These processes generate a stable thrombus to limit blood loss and promote restoration of endothelial integrity.

CONCLUSIONS

Improvements in our understanding of how platelets operate through their signaling networks are critical for diagnosis of unusual primary hemostatic disorders and for rational antithrombotic drug design.

Evaluation and clinical application of platelet function testing in small animal practice

Tests that evaluate many aspects of platelet function have been applied in both human and veterinary medicine for the monitoring of treatment with platelet function inhibitors and for detection of platelet function abnormalities (inherited or acquired). Interspecies variation in the response to various platelet agonists is an important consideration when methods that have been developed for people are applied in other species. At the present time, many of these assays are not readily available in standard veterinary practice. Advanced platelet function testing for veterinary patients is offered at select academic institutions. Discussion with a specialist is recommended when considering the use of these tests, and the relative strengths and limitations of each assay should be considered in the interpretation of test results.

A genome-wide linkage scan in German shepherd dogs localizes canine platelet procoagulant deficiency (Scott syndrome) to canine chromosome 27

Scott syndrome is a rare hereditary bleeding disorder associated with an inability of stimulated platelets to externalize the negatively charged phospholipid, phosphatidylserine (PS). Canine Scott syndrome (CSS) is the only naturally occurring animal model of this defect and therefore represents a unique tool to discover a disease gene capable of producing this platelet phenotype. We undertook platelet function studies and linkage analyses in a pedigree of CSS-affected German shepherd dogs. Based on residual serum prothrombin and flow cytometric assays, CSS segregates as an autosomal recessive trait. An initial genome scan, performed by genotyping 48 dogs for 280 microsatellite markers, suggested linkage with markers on chromosome 27. Genotypes ultimately obtained for a total of 56 dogs at 11 markers on chromosome 27 revealed significant LOD scores for 2 markers near the centromere, with multipoint linkage indicating a CSS trait locus spanning approximately 14 cm. These results provide the basis for fine mapping studies to narrow the disease interval and target the evaluation of putative disease genes.