CD36‐fibrin interaction propagates FXI‐dependent thrombin generation of human platelets

Thrombin converts fibrinogen to fibrin and activates blood and vascular cells in thrombo‐inflammatory diseases. Platelets are amplifiers of thrombin formation when activated by leukocyte‐ and vascular cell‐derived thrombin. CD36 on platelets acts as sensitizer for molecules with damage‐associated molecular patterns, thereby increasing platelet reactivity. Here, we investigated the role of CD36 in thrombin‐generation on human platelets, including selected patients with advanced chronic kidney disease (CKD). Platelets deficient in CD36 or blocked by anti‐CD36 antibody FA6.152 showed impaired thrombin generation triggered by thrombin in calibrated automated thrombography. Using platelets with congenital function defects, blocking antibodies, pharmacological inhibitors, and factor‐depleted plasma, CD36‐sensitive thrombin generation was dependent on FXI, fibrin, and platelet signaling via GPIbα and SFKs. CD36‐deficiency or blocking suppressed thrombin‐induced platelet αIIbβ3 activation, granule exocytosis, binding of adhesion proteins and FV, FVIII, FIX, FX, but not anionic phospholipid exposure determined by flow cytometry. CD36 ligated specifically soluble fibrin, which recruited distinct coagulation factors via thiols. Selected patients with CKD showed elevated soluble fibrin plasma levels and enhanced thrombin‐induced thrombin generation, which was normalized by CD36 blocking. Thus, CD36 is an important amplifier of platelet‐dependent thrombin generation when exposure of anionic phospholipids is limited. This pathway might contribute to hypercoagulability in CKD.