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Rengasamy KRR, Khan H, Ahmad I, Lobine D, Mahomoodally F, Suroowan S, Hassan STS, Xu S, Patel S, Daglia M, Nabavi SM, Pandian SK. Bioactive peptides and proteins as alternative antiplatelet drugs. Med Res Rev 2019; 39:2153-2171. [PMID: 31006878 DOI: 10.1002/med.21579] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/28/2019] [Accepted: 03/16/2019] [Indexed: 12/12/2022]
Abstract
Antiplatelet drugs reduce the risks associated with atherothrombotic events and show various applications in diverse cardiovascular diseases including myocardial infarctions. Efficacy of the current antiplatelet medicines including aspirin, clopidogrel, prasugrel and ticagrelor, and the glycoprotein IIb/IIIa antagonists, are limited due to their increased risks of bleeding, and antiplatelet drug resistance. Hence, it is important to develop new effective antiplatelet drugs, with fewer side-effects. The vast repertoire of natural peptides can be explored towards this goal. Proteins and peptides derived from snake venoms and plants represent exciting candidates for the development of novel and potent antiplatelet agents. Consequently, this review discusses multiple peptides that have displayed antiplatelet aggregation activity in preclinical drug development stages. This review also describes the antiplatelet mechanisms of the peptides, emphasizing the signaling pathways intervened by them. Also, the hurdles encountered during the development of peptides into antiplatelet drugs have been listed. Finally, hitherto unexplored peptides with the potential to prevent platelet aggregation are explored.
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Affiliation(s)
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Imad Ahmad
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Devina Lobine
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Fawzi Mahomoodally
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Shanoo Suroowan
- Department of Health Sciences, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Sherif T S Hassan
- Department of Natural Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Suowen Xu
- Aab Cardiovascular Research Institute, University of Rochester, Rochester, New York
| | - Seema Patel
- Bioinformatics and Medical Informatics Research Center, San Diego State University, San Diego, California
| | - Maria Daglia
- Department of Drug Sciences, Medicinal Chemistry and Pharmaceutical Technology Section, Pavia University, Pavia, Italy
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Ueshima D, Yoshikawa S, Sasaoka T, Hatano Y, Kurihara K, Maejima Y, Isobe M, Ashikaga T. The Hypercholesterolemia Paradox in Percutaneous Coronary Intervention: An Analysis of a Multicenter PCI Registry. Intern Med 2019; 58:345-353. [PMID: 30210130 PMCID: PMC6395118 DOI: 10.2169/internalmedicine.1553-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this study was to assess the relationship between hypercholesterolemia (HC) and clinical events through a percutaneous coronary intervention (PCI) registry. HC is a well-known independent risk factor for long-term cardiovascular events after PCI. However, it has been reported to be associated with a lower risk of adverse events in patients with cancer or acute coronary syndrome. Methods We analyzed the relationship between HC and adverse events in patients treated with everolimus-eluting stents (EESs) through the Tokyo-MD PCI study (an all-comer, multicenter, observational registry). The propensity score method was applied to select two groups with similar baseline characteristics. Results The unadjusted population included 1,536 HC patients and 330 non-HC patients. Propensity score matching yielded 314 matched pairs. After baseline adjustment, the outcomes of HC patients were significantly better than those of the non-HC patients with respect to the primary endpoint, which was a combination of mortality from all causes, nonfatal myocardial infarction (MI), nonfatal neurological events, and major bleeding [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.39-0.81; p=0.002], and the secondary endpoints, which included a combination of mortality from all causes, nonfatal MI, and nonfatal neurological events (HR 0.59, 95% CI 0.39-0.88; p=0.01), and major bleeding (HR 0.42, 95% CI 0.20-0.88; p=0.02). A subgroup analysis showed age as an interaction factor for the primary endpoint (interaction p=0.035). Conclusion HC was associated with better outcomes in patients who underwent EES implantation, even after baseline adjustment.
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Affiliation(s)
- Daisuke Ueshima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | | | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Yu Hatano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Ken Kurihara
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | | | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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Ueshima D, Yoshikawa S, Sasaoka T, Hatano Y, Kurihara K, Maejima Y, Isobe M, Ashikaga T. Obesity paradox in the era of percutaneous coronary intervention with 2nd-generation drug-eluting stents: an analysis of a multicenter PCI registry. Heart Vessels 2018; 34:218-226. [PMID: 30066238 DOI: 10.1007/s00380-018-1234-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
Abstract
Being overweight has been identified as independent risk factors for coronary artery disease. However, overweight patients have been reported frequently to have better mortality outcomes, and there is little data showing they are at a disadvantage regarding secondary prevention of cardiovascular events. We analyzed the influence of being overweight (defined as body mass index > 25 kg/m2) on adverse events in patients who underwent everolimus-eluting stent (EES) implantation using a multicenter registry with a maximum follow-up of 3 years. Propensity score matching was done for adjusting baseline characteristics. We defined primary end points as major adverse cardiac and cerebrovascular events (MACCE: a composite of mortality from all causes, nonfatal myocardial infarction, and nonfatal stroke) and "MACCE excluding non-cardiac mortality". Other adverse events were analyzed as key secondary end points. Out of 1918 patients, 450 pairs were obtained through propensity score matching. Overweight patients were superior to non-overweight patients regarding MACCE (event rates: 8.2 vs. 13.8% in overweight vs. non-overweight, respectively; log-rank p = 0.009) and "MACCE excluding non-cardiac mortality" (5.9 vs. 10.1%, p = 0.03). On secondary end points, not only did overweight patients have significantly fewer major bleeding events (2.2 vs. 4.8%, p = 0.02), but they also had smaller adverse event rates for almost all such events; the differences were not statistically significant. Overweight patients had better outcomes for MACCE, even on excluding non-cardiac mortalities. No result was supportive of an evident advantage to non-overweight EES-implanted patients in terms of secondary prevention of cardiovascular events.
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Affiliation(s)
- Daisuke Ueshima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima-cho, Bunkyo-ku, Tokyo, 113-8519, Japan
| | | | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima-cho, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yu Hatano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima-cho, Bunkyo-ku, Tokyo, 113-8519, Japan
| | | | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima-cho, Bunkyo-ku, Tokyo, 113-8519, Japan
| | | | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima-cho, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Fujimoto W, Sawada T, Toba T, Takahashi Y, Miyata T, Oishi S, Osue T, Onishi T, Takaya T, Shimane A, Taniguchi Y, Kawai H, Yasaka Y. Comparison of the 9-month intra-stent conditions and 2-year clinical outcomes after Resolute zotarolimus-eluting stent implantation between 3-month and standard dual antiplatelet therapy. J Cardiol 2018; 72:66-73. [PMID: 29456058 DOI: 10.1016/j.jjcc.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of short-duration dual antiplatelet therapy (DAPT) remains controversial. To investigate efficacy and safety of short-duration DAPT, we performed a detailed comparison of intra-stent conditions by optical coherence tomography (OCT) after second-generation drug-eluting stent implantation with short-term and standard DAPT. METHODS AND RESULTS Eighty-two consecutive patients with stable angina pectoris who received Resolute zotarolimus-eluting stents (R-ZESs; Medtronic Cardiovascular, Santa Rosa, CA, USA) were enrolled. Patients were assigned to 3-month (3M group: 41 patients) and standard (standard group: 41 patients) DAPT. In the 3M group, clopidogrel was discontinued 3 months after stent implantation. In the standard group, DAPT was maintained until follow-up OCT. At 9 months, neointimal proliferation was significantly larger in the 3M group, but there were no significant between-group differences in the proportion of uncovered and malapposed strut. The prevalence of abnormal intra-stent tissue (AIT) at 9 months was equivalent between groups. A multiple regression analysis revealed malapposition at 9 months as the strongest independent predictor of AIT at 9 months, and the prevalence of AIT was not associated with DAPT duration. Over 2 years, cardiac events were equal between groups; however, major bleeding was higher tendency in the standard group than in the 3M group. CONCLUSION This OCT study indicated that reducing DAPT's duration may provide acceptable arterial healing in patients with implanted R-ZESs.
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Affiliation(s)
- Wataru Fujimoto
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Takahiro Sawada
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan.
| | - Takayoshi Toba
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Yu Takahashi
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Taishi Miyata
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Shogo Oishi
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Tsuyoshi Osue
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Tetsuari Onishi
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Tomofumi Takaya
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Akira Shimane
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Yasuyo Taniguchi
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Hiroya Kawai
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
| | - Yoshinori Yasaka
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, Himeji, Hyogo, Japan
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