A combined deficiency of tissue factor and PAR-4 is associated with fatal pulmonary hemorrhage in mice

•Mice with a deficiency of TF and PAR-4 survive to wean.•Combining low levels of TF with a deficiency of PAR-4 leads to premature death.•The primary cause of death of Low-TF,PAR-4−/− mice is pulmonary hemorrhage.

IntroductionMice with a complete absence of tissue factor (TF) die during embryonic development whereas mice with low levels of TF (Low-TF mice) survive to adulthood. Low-TF mice exhibit spontaneous hemorrhage in various organs, including the lung. In contrast, mice can survive without protease-activated receptor (PAR)-4, which is the major thrombin receptor on mouse platelets. We determined the effect of combining a deficiency PAR-4 (primary hemostasis) with a deficiency in TF (secondary hemostasis) on embryonic development and survival of adult mice.Materials and methodsLow-TF mice (mTF−/−, hTF+/+) were crossed with PAR-4−/− mice to generate heterozygous mice (mTF+/−, hTF+/−, PAR-4+/−). These mice were intercrossed to generate Low-TF mice lacking PAR-4. Mice surviving to wean were genotyped and survival was monitored for 6 months.ResultsWe observed the expected number of Low-TF,PAR-4−/− mice at wean indicating survival in utero and after birth. However, an absence of PAR-4 was associated with premature death of all Low-TF,PAR-4−/− mice in the 6 month observational period. This compares with 40% death of the Low-TF,PAR-4+/+ mice (p = 0.003). Low-TF,PAR-4+/− mice had an intermediate phenotype with 55% of the mice dying within 6 months. The primary cause of mortality of Low-TF,PAR-4−/− mice was pulmonary hemorrhage.ConclusionsLow-TF,PAR-4−/− mice survive into adulthood, but combining a deficiency of primary hemostasis (PAR-4 deficiency) with secondary hemostasis (low levels of TF) leads to premature death primarily due to pulmonary hemorrhage.