Summary
Thrombin is a multifunctional serine protease generated at the site of vascular injury
that transforms fibrinogen into fibrin, activates blood platelets and elicits multiple
effects on a variety of cell types including endothelial cells, vascular smooth muscle
cells (VSMC), monocytes,T lymphocytes and fibroblasts. Cellular effects of thrombin
are mediated by protease-activated receptors (PARs), members of the G protein-coupled
receptors that carry their own ligand which remains cryptic until unmasked by proteolytic
cleavage. Thrombin signalling in platelets contributes to haemostasis and thrombosis.
In normal arteries PARs are mainly expressed in endothelial cells, while their expression
in VSMC is limited. Endothelial PARs participate in the regulation of vascular tone,
vascular permeability and endothelial secretory activity while in VSMC they mediate
contraction, migration, proliferation, hypertrophy and production of extra-cellular
matrix. PARs contribute to the pro-inflammatory phenotype observed in endothelial
dysfunction and their up-regulation inVSMC seems to be a key element in the pathogenesis
of atherosclerosis and restenosis. In the last years a myriad of studies have emphasized
the critical role of PAR signalling in thrombin mediated effects in haemostasis, inflammation,
cancer and embryonic development. Lately, PARs have become a therapeutic target to
inhibit platelet aggregation and thrombosis. Early data from a clinical trial (TRA-PCI)
to evaluate safety and efficacy of a potent new oral thrombin receptor antagonist
(TRA) have promisingly indicated that overallTRA treatment reduces adverse event rates
without an increase in bleeding risk. In this paper we review cellular responses triggered
by thrombin and their implication in vascular pathophysiology.
Keywords
Atherothombosis - thrombin - protease-activated receptors - gene expression