Published online April 16, 2007
doi:10.1084/jem.20062566
The Journal of Experimental Medicine, Vol. 204, No. 5, 1049-1056
The Rockefeller University Press, 0022-1007 $30.00
© 2007 Sood et al.
Fetal gene defects precipitate platelet-mediated pregnancy failure in factor V Leiden mothers
Rashmi Sood1,
Mark Zogg1,
Randal J. Westrick2,
Yi-he Guo1,
Edward J. Kerschen1,
Guillermina Girardi3,
Jane E. Salmon3,
Shaun R. Coughlin4, and
Hartmut Weiler1
1 Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI 53226
2 University of Michigan, Ann Arbor, MI 48109
3 Hospital for Special Surgery and Weill Medical College, Cornell University, New York, NY 10021
4 Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143
CORRESPONDENCE Rashmi Sood: Rashmi.Sood{at}bcw.edu OR Hartmut Weiler: Hartmut.Weiler{at}bcw.edu
We describe a mouse model of fetal loss in factor V Leiden (FvL) mothers in which fetal loss is triggered when the maternal prothrombotic state coincides with fetal gene defects that reduce activation of the protein C anticoagulant pathway within the placenta. Fetal loss is caused by disruption of placental morphogenesis at the stage of labyrinth layer formation and occurs in the absence of overt placental thrombosis, infarction, or perfusion defects. Platelet depletion or elimination of protease-activated receptor 4 (Par4) from the mother allows normal placentation and prevents fetal loss. These findings establish a causeeffect relationship for the observed epidemiologic association between maternal FvL status and fetal loss and identify fetal gene defects as risk modifiers of pregnancy failure in prothrombotic mothers. Pregnancy failure is mediated by Par4-dependent activation of maternal platelets at the fetomaternal interface and likely involves a pathogenic pathway independent of occlusive thrombosis. Our results further demonstrate that the interaction of two given thrombosis risk factors produces markedly disparate consequences on disease manifestation (i.e., thrombosis or pregnancy loss), depending on the vascular bed in which this interaction occurs.
Abbreviations used: dpc, days post coitum; FvL, factor V Leiden; Par4, protease-activated receptor 4; Procr, endothelial protein C receptor; TAT, thrombinantithrombin; Tfpi, tissue factor pathway inhibitor; Thbd, thrombomodulin.

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