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Han X, Knauss EA, Fuente MDL, Li W, Conlon RA, LePage DF, Jiang W, Renna SA, McKenzie SE, Nieman MT. A mouse model of the protease-activated receptor 4 Pro310Leu variant has reduced platelet reactivity. J Thromb Haemost 2024; 22:1715-1726. [PMID: 38508397 DOI: 10.1016/j.jtha.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Protease-activated receptor 4 (PAR4) mediates thrombin signaling on platelets and other cells. Our recent structural studies demonstrated that a single nucleotide polymorphism in extracellular loop 3 and PAR4-P310L (rs2227376) leads to a hyporeactive receptor. OBJECTIVES The goal of this study was to determine how the hyporeactive PAR4 variant in extracellular loop 3 impacts platelet function in vivo using a novel knock-in mouse model (PAR4-322L). METHODS A point mutation was introduced into the PAR4 gene F2rl3 via CRISPR/Cas9 to create PAR4-P322L, the mouse homolog to human PAR4-P310L. Platelet response to PAR4 activation peptide (AYPGKF), thrombin, ADP, and convulxin was monitored by αIIbβ3 integrin activation and P-selectin translocation using flow cytometry or platelet aggregation. In vivo responses were determined by the tail bleeding assay and the ferric chloride-induced carotid artery injury model. RESULTS PAR4-P/L and PAR4-L/L platelets had a reduced response to AYPGKF and thrombin measured by P-selectin translocation or αIIbβ3 activation. The response to ADP and convulxin was unchanged among genotypes. In addition, both PAR4-P/L and PAR4-L/L platelets showed a reduced response to thrombin in aggregation studies. There was an increase in the tail bleeding time for PAR4-L/L mice. The PAR4-P/L and PAR4-L/L mice both showed an extended time to arterial thrombosis. CONCLUSION PAR4-322L significantly reduced platelet responsiveness to AYPGKF and thrombin, which is in agreement with our previous structural and cell signaling studies. In addition, PAR4-322L had prolonged arterial thrombosis time. Our mouse model provides a foundation to further evaluate the role of PAR4 in other pathophysiological contexts.
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Affiliation(s)
- Xu Han
- Case Western Reserve University School of Medicine, Department of Pharmacology, Cleveland, Ohio, USA
| | - Elizabeth A Knauss
- Case Western Reserve University School of Medicine, Department of Pharmacology, Cleveland, Ohio, USA
| | - Maria de la Fuente
- Case Western Reserve University School of Medicine, Department of Pharmacology, Cleveland, Ohio, USA
| | - Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Ronald A Conlon
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, Ohio, USA
| | - David F LePage
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, Ohio, USA
| | - Weihong Jiang
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephanie A Renna
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven E McKenzie
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marvin T Nieman
- Case Western Reserve University School of Medicine, Department of Pharmacology, Cleveland, Ohio, USA.
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2
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Andrianova I, Kowalczyk M, Denorme F. Protease activated receptor-4: ready to be part of the antithrombosis spectrum. Curr Opin Hematol 2024:00062752-990000000-00079. [PMID: 38814792 DOI: 10.1097/moh.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is a major cause of death worldwide. Platelets play a key role in this pathological process. The serine protease thrombin is a critical regulator of platelet reactivity through protease activated receptors-1 (PAR1) and PAR4. Since targeting PAR4 comes with a low chance for bleeding, strategies blocking PAR4 function have great antithrombotic potential. Here, we reviewed the literature on platelet PAR4 with a particular focus on its role in thromboinflammation. RECENT FINDINGS Functional PAR4 variants are associated with reduced venous thrombosis risk (rs2227376) and increased risk for ischemic stroke (rs773902). Recent advances have allowed for the creation of humanized mouse lines in which human PAR4 is express instead of murine PAR4. This has led to a better understanding of the discrepancies between human and murine PAR4. It also made it possible to introduce single nucleotide polymorphisms (SNPs) in mice allowing to directly test the in vivo functional effects of a specific SNP and to develop in vivo models to study mechanistic and pharmacologic alterations induced by a SNP. SUMMARY PAR4 plays an important role in cardiovascular diseases including stroke, myocardial infarction and atherosclerosis. Targeting PAR4 hold great potential as a safe antithrombotic strategy.
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Affiliation(s)
- Izabella Andrianova
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mia Kowalczyk
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA
| | - Frederik Denorme
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
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3
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Han X, Knauss EA, de la Fuente M, Li W, Conlon RA, LePage DF, Jiang W, Renna SA, McKenzie SE, Nieman MT. A Mouse Model of the Protease Activated Receptor 4 (PAR4) Pro310Leu Variant has Reduced Platelet Reactivity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.01.569075. [PMID: 38077081 PMCID: PMC10705540 DOI: 10.1101/2023.12.01.569075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background Protease activated receptor 4 (PAR4) mediates thrombin signaling on platelets and other cells. Our recent structural studies demonstrated a single nucleotide polymorphism in extracellular loop 3 (ECL3), PAR4-P310L (rs2227376) leads to a hypo-reactive receptor. Objectives The goal of this study was to determine how the hypo-reactive PAR4 variant in ECL3 impacts platelet function in vivo using a novel knock-in mouse model (PAR4-322L). Methods A point mutation was introduced into the PAR4 gene, F2rl3, via CRISPR/Cas9 to create PAR4-P322L, the mouse homolog to human PAR4-P310L. Platelet response to PAR4 activation peptide (AYPGKF), thrombin, ADP, and convulxin was monitored by αIIbβ3 integrin activation and P-selectin translocation using flow cytometry or platelet aggregation. In vivo responses were determined by the tail bleeding assay and the ferric chloride-induced carotid artery injury model. Results PAR4-P/L and PAR4-L/L platelets had a reduced response to AYPGKF and thrombin measured by P-selectin translocation or αIIbβ3 activation. The response to ADP and convulxin was unchanged among genotypes. In addition, both PAR4-P/L and PAR4-L/L platelets showed a reduced response to thrombin in aggregation studies. There was an increase in the tail bleeding time for PAR4-L/L mice. The PAR4-P/L and PAR4-L/L mice both showed an extended time to arterial thrombosis. Conclusions PAR4-322L significantly reduced platelet responsiveness to AYPGKF and thrombin, which is in agreement with our previous structural and cell signaling studies. In addition, PAR4-322L had prolonged arterial thrombosis time. Our mouse model provides a foundation to further evaluate the role of PAR4 in other pathophysiological contexts.
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Affiliation(s)
- Xu Han
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH United States
| | - Elizabeth A. Knauss
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH United States
| | - Maria de la Fuente
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH United States
| | - Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV United States
| | - Ronald A Conlon
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, OH United States
| | - David F. LePage
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, OH United States
| | - Weihong Jiang
- Case Transgenic and Targeting Facility, Case Western Reserve University, Cleveland, OH United States
| | - Stephanie A. Renna
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA United States
| | - Steven E. McKenzie
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA United States
| | - Marvin T. Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH United States
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4
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Barrett TJ. Targeting PAR4 to Reduce Atherosclerosis. Arterioscler Thromb Vasc Biol 2023; 43:2179-2182. [PMID: 37767705 PMCID: PMC10772896 DOI: 10.1161/atvbaha.123.320046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Tessa J Barrett
- New York University Grossman School of Medicine, Department of Medicine, Department of Pathology, New York
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5
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Renna SA, Zhao X, Kunapuli SP, Ma P, Holinstat M, Boxer MB, Maloney DJ, Michael JV, McKenzie SE. Novel Strategy to Combat the Procoagulant Phenotype in Heparin-Induced Thrombocytopenia Using 12-LOX Inhibition. Arterioscler Thromb Vasc Biol 2023; 43:1808-1817. [PMID: 37345522 DOI: 10.1161/atvbaha.123.319434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a major concern for all individuals that undergo cardiac bypass surgeries or require prolonged heparin exposure. HIT is a life- and limb-threatening adverse drug reaction with an immune response following the formation of ultra-large immune complexes that drive platelet activation through the receptor FcγRIIA. Thrombotic events remain high following the standard of care treatment with anticoagulants, while increasing risk of bleeding complications. This study sought to investigate a novel approach to treatment of HIT. Recent reports demonstrate increased procoagulant activity in HIT; however, these reports required analysis ex vivo, and relevance in vivo remains unclear. METHODS Using human and mouse model systems, we investigated the cooperativity of PARs (protease-activated receptors) and FcγRIIA in HIT. We challenged humanized FcγRIIA transgenic mice with or without endogenous mouse Par4 (denoted as IIA-Par4+/+ or IIA-Par4-/-, respectively) with a well-established model IgG immune complex (anti [α]-CD9). Furthermore, we assessed the procoagulant phenotype and efficacy to treat HIT utilizing inhibitor of 12-LOX (12[S]-lipoxygenase), VLX-1005, previously reported to decrease platelet activation downstream of FcγRIIA and PAR4, using the triple allele HIT mouse model. RESULTS IIA-Par4+/+ mice given αCD9 were severely thrombocytopenic, with extensive platelet-fibrin deposition in the lung. In contrast, IIA-Par4-/- mice had negligible thrombocytopenia or pulmonary platelet-fibrin thrombi. We observed that pharmacological inhibition of 12-LOX resulted in a significant reduction in both platelet procoagulant phenotype ex vivo, and thrombocytopenia and thrombosis in our humanized mouse model of HIT in vivo. CONCLUSIONS These data demonstrate for the first time the need for dual platelet receptor (PAR and FcγRIIA) stimulation for fibrin formation in HIT in vivo. These results extend our understanding of HIT pathophysiology and provide a scientific rationale for targeting the procoagulant phenotype as a possible therapeutic strategy in HIT.
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Affiliation(s)
- Stephanie A Renna
- The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (S.A.R., X.Z., P.M., J.V.M., S.E.M.)
| | - Xuefei Zhao
- The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (S.A.R., X.Z., P.M., J.V.M., S.E.M.)
| | - Satya P Kunapuli
- Sol Sherry Thrombosis Center and the Department of Physiology, Temple University School of Medicine, Philadelphia, PA (S.P.K.)
| | - Peisong Ma
- The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (S.A.R., X.Z., P.M., J.V.M., S.E.M.)
| | - Michael Holinstat
- Department of Pharmacology, University of Michigan, Ann Arbor (M.H.)
| | | | | | - James V Michael
- The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (S.A.R., X.Z., P.M., J.V.M., S.E.M.)
| | - Steven E McKenzie
- The Cardeza Foundation for Hematologic Research, Center for Hemostasis, Thrombosis and Vascular Biology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (S.A.R., X.Z., P.M., J.V.M., S.E.M.)
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6
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Denorme F, Armstrong ND, Stoller ML, Portier I, Tugolukova EA, Tanner RM, Montenont E, Bhatlekar S, Cody M, Rustad JL, Ajanel A, Tolley ND, Murray DC, Boyle JL, Nieman MT, McKenzie SE, Yost CC, Lange LA, Cushman M, Irvin MR, Bray PF, Campbell RA. The predominant PAR4 variant in individuals of African ancestry worsens murine and human stroke outcomes. J Clin Invest 2023; 133:e169608. [PMID: 37471144 PMCID: PMC10503801 DOI: 10.1172/jci169608] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
Protease-activated receptor 4 (PAR4) (gene F2RL3) harbors a functional dimorphism, rs773902 A/G (encoding Thr120/Ala120, respectively) and is associated with greater platelet aggregation. The A allele frequency is more common in Black individuals, and Black individuals have a higher incidence of ischemic stroke than White individuals. However, it is not known whether the A allele is responsible for worse stroke outcomes. To directly test the in vivo effect of this variant on stroke, we generated mice in which F2rl3 was replaced by F2RL3, thereby expressing human PAR4 (hPAR4) with either Thr120 or Ala120. Compared with hPAR4 Ala120 mice, hPAR4 Thr120 mice had worse stroke outcomes, mediated in part by enhanced platelet activation and platelet-neutrophil interactions. Analyses of 7,620 Black subjects with 487 incident ischemic strokes demonstrated the AA genotype was a risk for incident ischemic stroke and worse functional outcomes. In humanized mice, ticagrelor with or without aspirin improved stroke outcomes in hPAR4 Ala120 mice, but not in hPAR4 Thr120 mice. P selectin blockade improved stroke outcomes and reduced platelet-neutrophil interactions in hPAR4 Thr120 mice. Our results may explain some of the racial disparity in stroke and support the need for studies of nonstandard antiplatelet therapies for patients expressing PAR4 Thr120.
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Affiliation(s)
- Frederik Denorme
- Program in Molecular Medicine and
- Department of Neurology, Division of Vascular Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Nicole D. Armstrong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Rikki M. Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | | | | | | | | | - Julie L. Boyle
- Bioinformatics Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Marvin T. Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Steven E. McKenzie
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christian Con Yost
- Program in Molecular Medicine and
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, Utah, USA
| | - Leslie A. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Marguerite R. Irvin
- Department of Neurology, Division of Vascular Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Paul F. Bray
- Program in Molecular Medicine and
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, and
| | - Robert A. Campbell
- Program in Molecular Medicine and
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, and
- Department of Pathology, Division of Microbiology and Immunology, University of Utah, Salt Lake City, Utah, USA
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7
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Tamang HK, Stringham EN, Tourdot BE. Platelet Functional Testing Via High-Throughput Microtiter Plate-Based Assays. Curr Protoc 2023; 3:e668. [PMID: 36786557 PMCID: PMC9983762 DOI: 10.1002/cpz1.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Platelets play a critical role in hemostasis and thrombosis; therefore, in vitro assays that measure platelet reactivity are fundamental tools to gain insight into these physiologic processes, to diagnose platelet disorders, and to develop antithrombotic therapies. However, conventional platelet assays such as aggregometry, the clinical gold standard for assessing platelet function, are low throughput and require specialized equipment. Since platelets have a finite life span ex vivo, processes to miniaturize and multiplex assays allow a much broader overview of platelet function in significantly less time than conventional assays. Several groups have developed simplified, high-throughput approaches to quantify platelet activation with standard laboratory equipment to lower the barrier of entry to study platelet biology. This article describes a panel of optimized and validated high-throughput microplate assays to comprehensively assess platelet functionality, independently or in combination, to increase throughput and reduce costs. Specifically, following stimulation of platelets, a plate reader can be used to measure light transmission aggregation via absorbance; dense-granule secretion based on ATP-dependent luminescence generation; and cytosolic calcium levels with a cell-permeant, fluorescent Ca2+ -sensitive dye. Additionally, platelets are an easily accessible component of the blood that share signaling pathways with other cells, making them ideal for high-throughput drug screens. The highly adaptable and complementary assays presented in this article can be used to decipher the molecular mechanism underlying platelet activation or to identify novel inhibitors. © 2023 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Microtiter plate-based light transmission aggregometry Basic Protocol 2: Measuring dense-granule secretion in high-throughput microplate assays Basic Protocol 3: Microtiter plate-based calcium mobilization Support Protocol: Platelet isolation and enumeration.
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Affiliation(s)
- Hem Kumar Tamang
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH 45229, USA
| | - Emily N. Stringham
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH 45229, USA
| | - Benjamin E. Tourdot
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center; Cincinnati, OH 45229, USA
- University of Cincinnati College of Medicine; Cincinnati, OH 45229, USA
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8
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Gnanenthiran SR, Pennings GJ, Reddel CJ, Campbell H, Kockx M, Hamilton JR, Chen V, Kritharides L. Identification of a Distinct Platelet Phenotype in the Elderly: ADP Hypersensitivity Coexists With Platelet PAR (Protease-Activated Receptor)-1 and PAR-4-Mediated Thrombin Resistance. Arterioscler Thromb Vasc Biol 2022; 42:960-972. [PMID: 35708029 DOI: 10.1161/atvbaha.120.316772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thrombin (via PAR [protease-activated receptor]-1 and PAR-4) and ADP (via P2Y12 receptors) are potent endogenous platelet activators implicated in the development of cardiovascular disease. We aimed to assess whether platelet pathways alter with aging. METHODS We characterized platelet activity in community-dwelling volunteers (n=174) in the following age groups: (1) 20 to 30 (young); (2) 40 to 55 (middle-aged); (3) ≥70 years (elderly). Platelet activity was assessed by aggregometry; flow cytometry (surface markers [P-selectin: alpha granule release, CD63: dense granule release, PAC-1 (measure of conformationally active GPIIb/IIIa at the fibrinogen binding site): GPIIb/IIIa conformational activation] measured under basal conditions and after agonist stimulation [ADP, thrombin, PAR-1 agonist or PAR-4 agonist]); receptor cleavage and quantification; fluorometry; calcium flux; ELISA. RESULTS The elderly had higher basal platelet activation than the young, evidenced by increased expression of P-selectin, CD63, and PAC-1, which correlated with increasing inflammation (IL [interleukin]-1β/IL-6). The elderly demonstrated higher P2Y12 receptor density, with greater ADP-induced platelet aggregation (P<0.05). However, elderly subjects were resistant to thrombin, achieving less activation in response to thrombin (higher EC50) and to selective stimulation of both PAR-1 and PAR-4, with higher basal PAR-1/PAR-4 cleavage and less inducible PAR-1/PAR-4 cleavage (all P<0.05). Thrombin resistance was attributable to a combination of reduced thrombin orienting receptor GPIbα, reduced secondary ADP contribution to thrombin-mediated activation, and blunted calcium flux. D-Dimer, a marker of in situ thrombin generation, correlated with platelet activation in the circulation, ex vivo thrombin resistance, and circulating inflammatory mediators (TNF [tumor necrosis factor]-α/IL-6). CONCLUSIONS Aging is associated with a distinctive platelet phenotype of increased basal activation, ADP hyperreactivity, and thrombin resistance. In situ thrombin generation associated with systemic inflammation may be novel target to prevent cardiovascular disease in the elderly.
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Affiliation(s)
- Sonali R Gnanenthiran
- Cardiology Department, Concord Repatriation General Hospital, NSW, Australia (S.R.G., M.K., L.K.).,ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
| | - Gabrielle J Pennings
- ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
| | - Caroline J Reddel
- ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
| | - Heather Campbell
- ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
| | - Maaike Kockx
- Cardiology Department, Concord Repatriation General Hospital, NSW, Australia (S.R.G., M.K., L.K.).,ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
| | - Justin R Hamilton
- Australian Centre of Blood Diseases, Monash University, Victoria, Australia (J.R.H.)
| | - Vivien Chen
- ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.).,Haematology Department, Concord Repatriation General Hospital, NSW, Australia (V.C.)
| | - Leonard Kritharides
- Cardiology Department, Concord Repatriation General Hospital, NSW, Australia (S.R.G., M.K., L.K.).,ANZAC Research Institute, Concord Repatriation General Hospital, and University of Sydney, Sydney, NSW, Australia (S.R.G., G.J.P., C.J.R., H.C., M.K., V.C., L.K.)
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9
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Renna SA, Michael JV, Kong X, Ma L, Ma P, Nieman MT, Edelstein LC, McKenzie SE. Human and mouse PAR4 are functionally distinct receptors: Studies in novel humanized mice. J Thromb Haemost 2022; 20:1236-1247. [PMID: 35152546 DOI: 10.1111/jth.15669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 08/31/2023]
Abstract
BACKGROUND Human and mouse platelets both express protease-activated receptor (PAR) 4 but sequence alignment reveals differences in several functional domains. These differences may result in functional disparities between the receptors which make it difficult to translate PAR4 studies using mice to human platelet physiology. OBJECTIVES To generate transgenic mice that express human, but not mouse, PAR4 and directly compare human and mouse PAR4 function in the same platelet environment. METHODS Transgenic mice were made using a genomic clone of the F2RL3 gene (encoding PAR4) and backcrossed with Par4 KO mice. For certain experiments, mice were bred with GRK6 KO mice. Tail bleeding time and platelet function in response to PAR4-activating peptide were assessed. RESULTS Human F2RL3 was successfully integrated into the mouse genome, transgenic mice were crossed to the mPar4 KO background (PAR4 tg/KO), and PAR4 was functionally expressed on platelets. Compared to WT, PAR4 tg/KO mice exhibited shortened tail bleeding time and their platelets were more responsive to PAR4-AP as assessed by α-granule release and integrin activation. The opposite was observed with thrombin. Knocking out GRK6 had no effect on human PAR4-expressing platelets, unlike mouse Par4-expressing platelets. PAR4 tg/KO platelets exhibited greater Ca2+ area under the curve and more robust extracellular vesicle release than WT stimulated with PAR4-AP. CONCLUSION These data suggest that (1) human PAR4- and mouse Par4-mediated signaling are different and (2) the feedback regulation mechanisms of human and mouse PAR4 are different. These functional differences are important to consider when interpreting PAR4 studies done with mice.
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Affiliation(s)
- Stephanie A Renna
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James V Michael
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Xianguo Kong
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lin Ma
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peisong Ma
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marvin T Nieman
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leonard C Edelstein
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Steven E McKenzie
- Department of Medicine, The Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA
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10
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Stoller ML, Basak I, Denorme F, Rowley JW, Alsobrooks J, Parsawar K, Nieman MT, Yost CC, Hamilton JR, Bray PF, Campbell RA. Neutrophil cathepsin G proteolysis of protease-activated receptor 4 generates a novel, functional tethered ligand. Blood Adv 2022; 6:2303-2308. [PMID: 34883511 PMCID: PMC9006282 DOI: 10.1182/bloodadvances.2021006133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
Platelet-neutrophil interactions regulate ischemic vascular injury. Platelets are activated by serine proteases that cleave protease-activated receptor (PAR) amino termini, resulting in an activating tethered ligand. Neutrophils release cathepsin G (CatG) at sites of injury and inflammation, which activates PAR4 but not PAR1, although the molecular mechanism of CatG-induced PAR4 activation is unknown. We show that blockade of the canonical PAR4 thrombin cleavage site did not alter CatG-induced platelet aggregation, suggesting CatG cleaves a different site than thrombin. Mass spectrometry analysis using PAR4 N-terminus peptides revealed CatG cleavage at Ser67-Arg68. A synthetic peptide, RALLLGWVPTR, representing the tethered ligand resulting from CatG proteolyzed PAR4, induced PAR4-dependent calcium flux and greater platelet aggregation than the thrombin-generated GYPGQV peptide. Mutating PAR4 Ser67or Arg68 reduced CatG-induced calcium flux without affecting thrombin-induced calcium flux. Dog platelets, which contain a conserved CatG PAR4 Ser-Arg cleavage site, aggregated in response to human CatG and RALLLGWVPTR, while mouse (Ser-Gln) and rat (Ser-Glu) platelets were unresponsive. Thus, CatG amputates the PAR4 thrombin cleavage site by cleavage at Ser67-Arg68 and activates PAR4 by generating a new functional tethered ligand. These findings support PAR4 as an important CatG signaling receptor and suggest a novel therapeutic approach for blocking platelet-neutrophil-mediated pathophysiologies.
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Affiliation(s)
- Michelle L. Stoller
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
| | - Indranil Basak
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Frederik Denorme
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
| | - Jesse W. Rowley
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
- Division of Pulmonary, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - James Alsobrooks
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Krishna Parsawar
- Analytical and Biological Mass Spectrometry Core Facility, University of Arizona, Tucson, AZ
| | - Marvin T. Nieman
- Department of Pharmacology, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Christian Con Yost
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
- Division of Neonatology, Department of Pediatric Medicine, University of Utah, Salt Lake City, UT
| | - Justin R. Hamilton
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia; and
| | - Paul F. Bray
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
- Division of Hematology and Hematologic Malignancies, and
| | - Robert A. Campbell
- University of Utah Molecular Medicine Program, University of Utah, Salt Lake City, UT
- Division of General Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
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11
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Corbin LJ, White SJ, Taylor AE, Williams CM, Taylor K, van den Bosch MT, Teasdale JE, Jones M, Bond M, Harper MT, Falk L, Groom A, Hazell GG, Paternoster L, Munafò MR, Nordestgaard BG, Tybjærg-Hansen A, Bojesen SE, Relton C, Min JL, Davey Smith G, Mumford AD, Poole AW, Timpson NJ. Epigenetic Regulation of F2RL3 Associates With Myocardial Infarction and Platelet Function. Circ Res 2022; 130:384-400. [PMID: 35012325 PMCID: PMC8812435 DOI: 10.1161/circresaha.121.318836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND DNA hypomethylation at the F2RL3 (F2R like thrombin or trypsin receptor 3) locus has been associated with both smoking and atherosclerotic cardiovascular disease; whether these smoking-related associations form a pathway to disease is unknown. F2RL3 encodes protease-activated receptor 4, a potent thrombin receptor expressed on platelets. Given the role of thrombin in platelet activation and the role of thrombus formation in myocardial infarction, alterations to this biological pathway could be important for ischemic cardiovascular disease. METHODS We conducted multiple independent experiments to assess whether DNA hypomethylation at F2RL3 in response to smoking is associated with risk of myocardial infarction via changes to platelet reactivity. Using cohort data (N=3205), we explored the relationship between smoking, DNA hypomethylation at F2RL3, and myocardial infarction. We compared platelet reactivity in individuals with low versus high DNA methylation at F2RL3 (N=41). We used an in vitro model to explore the biological response of F2RL3 to cigarette smoke extract. Finally, a series of reporter constructs were used to investigate how differential methylation could impact F2RL3 gene expression. RESULTS Observationally, DNA methylation at F2RL3 mediated an estimated 34% of the smoking effect on increased risk of myocardial infarction. An association between methylation group (low/high) and platelet reactivity was observed in response to PAR4 (protease-activated receptor 4) stimulation. In cells, cigarette smoke extract exposure was associated with a 4.9% to 9.3% reduction in DNA methylation at F2RL3 and a corresponding 1.7-(95% CI, 1.2-2.4, P=0.04) fold increase in F2RL3 mRNA. Results from reporter assays suggest the exon 2 region of F2RL3 may help control gene expression. CONCLUSIONS Smoking-induced epigenetic DNA hypomethylation at F2RL3 appears to increase PAR4 expression with potential downstream consequences for platelet reactivity. Combined evidence here not only identifies F2RL3 DNA methylation as a possible contributory pathway from smoking to cardiovascular disease risk but from any feature potentially influencing F2RL3 regulation in a similar manner.
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Affiliation(s)
- Laura J. Corbin
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Stephen J. White
- Department of Life Sciences, Manchester Metropolitan University, United Kingdom (S.J.W.)
| | - Amy E. Taylor
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, United Kingdom (A.E.T.)
| | - Christopher M. Williams
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
- School of Physiology, Pharmacology and Neuroscience (C.M.W., M.T.v.d.B., A.W.P.), University of Bristol, United Kingdom
| | - Kurt Taylor
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
- School of Physiology, Pharmacology and Neuroscience (C.M.W., M.T.v.d.B., A.W.P.), University of Bristol, United Kingdom
- Translational Health Sciences, Bristol Medical School (J.E.T., M.J., M.B.), University of Bristol, United Kingdom
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology (M.R.M.), University of Bristol, United Kingdom
- School of Cellular and Molecular Medicine (A.D.M.), University of Bristol, United Kingdom
- Department of Life Sciences, Manchester Metropolitan University, United Kingdom (S.J.W.)
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, United Kingdom (A.E.T.)
- Department of Pharmacology, University of Cambridge, Tennis Court Road (M.T.H., G.G.J.H.)
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital (B.G.N., S.E.B.), Copenhagen University Hospital, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital (B.G.N., A.T.-H., S.E.B.), Copenhagen University Hospital, Denmark
- Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (B.G.N., A.T.-H., S.E.B.)
| | - Marion T. van den Bosch
- School of Physiology, Pharmacology and Neuroscience (C.M.W., M.T.v.d.B., A.W.P.), University of Bristol, United Kingdom
| | - Jack E. Teasdale
- Translational Health Sciences, Bristol Medical School (J.E.T., M.J., M.B.), University of Bristol, United Kingdom
| | - Matthew Jones
- Translational Health Sciences, Bristol Medical School (J.E.T., M.J., M.B.), University of Bristol, United Kingdom
| | - Mark Bond
- Translational Health Sciences, Bristol Medical School (J.E.T., M.J., M.B.), University of Bristol, United Kingdom
| | - Matthew T. Harper
- Department of Pharmacology, University of Cambridge, Tennis Court Road (M.T.H., G.G.J.H.)
| | - Louise Falk
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Alix Groom
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Georgina G.J. Hazell
- Department of Pharmacology, University of Cambridge, Tennis Court Road (M.T.H., G.G.J.H.)
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology (M.R.M.), University of Bristol, United Kingdom
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital (B.G.N., S.E.B.), Copenhagen University Hospital, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital (B.G.N., A.T.-H., S.E.B.), Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (B.G.N., A.T.-H., S.E.B.)
| | - Anne Tybjærg-Hansen
- The Copenhagen City Heart Study, Frederiksberg Hospital (B.G.N., A.T.-H., S.E.B.), Copenhagen University Hospital, Denmark
- Department of Clinical Biochemistry, Rigshospitalet (A.T.-H.), Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (B.G.N., A.T.-H., S.E.B.)
| | - Stig E. Bojesen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital (B.G.N., S.E.B.), Copenhagen University Hospital, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital (B.G.N., A.T.-H., S.E.B.), Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (B.G.N., A.T.-H., S.E.B.)
| | - Caroline Relton
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Josine L. Min
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine (A.D.M.), University of Bristol, United Kingdom
| | - Alastair W. Poole
- School of Physiology, Pharmacology and Neuroscience (C.M.W., M.T.v.d.B., A.W.P.), University of Bristol, United Kingdom
| | - Nicholas J. Timpson
- MRC Integrative Epidemiology Unit at University of Bristol, United Kingdom (L.J.C., L.F., A.G., L.P., M.R.M., C.R., J.L.M., G.D.S., N.J.T.)
- Population Health Sciences, Bristol Medical School (L.J.C., A.E.T., K.T., L.F., A.G., L.P., C.R., J.L.M., G.D.S., N.J.T.), University of Bristol, United Kingdom
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12
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Yu X, Li S, Zhu X, Kong Y. Inhibitors of protease activated receptor 4 (PAR4): a review of recent patents (2013-2021). Expert Opin Ther Pat 2022; 32:153-170. [PMID: 35081321 DOI: 10.1080/13543776.2022.2034786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Protease-activated receptor 4 (PAR4), belonging to a subfamily of G-protein-coupled receptors (GPCR), is expressed on the surface of Human platelets, and the activation of it can lead to platelets aggregation. Studies demonstrated that PAR4 inhibition protect mice from arterial/arteriolar thrombosis, pulmonary embolism and cerebral infarct, while do not affect the haemostatic responses integrity. Therefore, PAR4 has been a promising target for the development of anti-thrombotic agents. AREAS COVERED This review covers recent patents and literature on PAR4 and their application published between 2013 and 2021. EXPERT OPINION PAR4 is a promising anti-thrombotic target and PAR4 inhibitors are important biologically active compounds for the treatment of thrombosis. Most the recent patents and literature focus on PAR4 selective inhibitors, and BMS-986120 and BMS-986141, which were developed by BMS, have entered clinical trials. With the deep understanding of the crystal structures and biological functions of PAR4, we believe that many other novel types of molecules targeting PAR4 would enter the clinical studies or the market.
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Affiliation(s)
- Xiangying Yu
- School of Life & Technology, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Shanshan Li
- Institute of Medicinal & Chemistry, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Xiong Zhu
- Institute of Medicinal & Chemistry, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Yi Kong
- School of Life & Technology, China Pharmaceutical University, Nanjing, 210009, PR China
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13
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Jourdi G, Lordkipanidzé M, Philippe A, Bachelot-Loza C, Gaussem P. Current and Novel Antiplatelet Therapies for the Treatment of Cardiovascular Diseases. Int J Mol Sci 2021; 22:ijms222313079. [PMID: 34884884 PMCID: PMC8658271 DOI: 10.3390/ijms222313079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022] Open
Abstract
Over the last decades, antiplatelet agents, mainly aspirin and P2Y12 receptor antagonists, have significantly reduced morbidity and mortality associated with arterial thrombosis. Their pharmacological characteristics, including pharmacokinetic/pharmacodynamics profiles, have been extensively studied, and a significant number of clinical trials assessing their efficacy and safety in various clinical settings have established antithrombotic efficacy. Notwithstanding, antiplatelet agents carry an inherent risk of bleeding. Given that bleeding is associated with adverse cardiovascular outcomes and mortality, there is an unmet clinical need to develop novel antiplatelet therapies that inhibit thrombosis while maintaining hemostasis. In this review, we present the currently available antiplatelet agents, with a particular focus on their targets, pharmacological characteristics, and patterns of use. We will further discuss the novel antiplatelet therapies in the pipeline, with the goal of improved clinical outcomes among patients with atherothrombotic diseases.
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Affiliation(s)
- Georges Jourdi
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada;
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence: (G.J.); (P.G.)
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada;
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Aurélien Philippe
- INSERM, Innovations Thérapeutiques en Hémostase, Université de Paris, F-75006 Paris, France; (A.P.); (C.B.-L.)
- Service d’Hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Christilla Bachelot-Loza
- INSERM, Innovations Thérapeutiques en Hémostase, Université de Paris, F-75006 Paris, France; (A.P.); (C.B.-L.)
| | - Pascale Gaussem
- INSERM, Innovations Thérapeutiques en Hémostase, Université de Paris, F-75006 Paris, France; (A.P.); (C.B.-L.)
- Service d’Hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
- Correspondence: (G.J.); (P.G.)
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14
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Selvadurai MV, Riaz M, Xie S, Tonkin A, McNeil JJ, Lacaze P, Hamilton J. The PAR4 platelet thrombin receptor variant rs773902 does not impact the incidence of thrombotic or bleeding events in a healthy older population. Thromb Haemost 2021; 122:1130-1138. [PMID: 34852379 DOI: 10.1055/a-1711-1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Protease-activated receptor 4 (PAR4) is a platelet thrombin receptor important for thrombosis and a target of anti-platelet drug development. A frequently occurring single nucleotide polymorphism (SNP; rs773902) causes a PAR4 sequence variant (NC_000019.10:p.Ala120Thr) whereby platelets from Thr120-expressing individuals are hyper-responsive to PAR4 agonists versus platelets from Ala120-expressing individuals. However, whether this enhanced platelet responsiveness translates to increased thrombotic risk or decreased bleeding risk remains unknown. OBJECTIVES To examine the association of rs773902 with adjudicated cardiovascular events and aspirin use in a randomized trial population of healthy older individuals. PATIENTS/METHODS We analyzed 13,547 participants in the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Participants had no previous cardiovascular events at enrollment and were randomized to either 100 mg daily aspirin or placebo for a median follow-up of 4.7 years. Total genotypes were 8,761 (65%) GG (Ala120 variant), 4,303 (32%) heterozygotes, and 483 (4%) AA (Thr120 variant). Cox proportional hazard regression tested the relationship between rs773902 and thrombotic events (major adverse cardiovascular events [MACE] and ischemic stroke [IS]) and bleeding (major hemorrhage [MHEM] and intracranial bleeding [ICB]). RESULTS No statistically significant association was observed overall or by treatment group between rs773902 and any thrombotic or bleeding event examined. Further, there was no significant interaction between rs773902 and treatment for any of MACE, IS, MHEM, or ICB. CONCLUSIONS This post-hoc analysis of a prospective cohort study suggests that, despite sensitizing platelet activation, the rs773902 PAR4 variant is not associated with thrombotic cardiovascular or bleeding events in a healthy older population.
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Affiliation(s)
- Maria V Selvadurai
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Moeen Riaz
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Sophia Xie
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | | | | | - Justin Hamilton
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
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15
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Lund M, Macwan AS, Tunströmer K, Lindahl TL, Boknäs N. Effects of Heparin and Bivalirudin on Thrombin-Induced Platelet Activation: Differential Modulation of PAR Signaling Drives Divergent Prothrombotic Responses. Front Cardiovasc Med 2021; 8:717835. [PMID: 34660719 PMCID: PMC8511449 DOI: 10.3389/fcvm.2021.717835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Heparin and bivalirudin are widely used as anticoagulants in the setting of acute thrombosis. In this study, we investigated how these drugs affect the ability of thrombin to generate a prothrombotic platelet response via activation of the protease-activated receptors (PARs) 1 and 4. We examined the effects of heparin/antithrombin and bivalirudin on PAR1- and PAR4-mediated intracellular calcium mobilization, aggregation, α-granule release, and procoagulant membrane exposure in platelets exposed to thrombin concentrations likely to be encountered in the thrombus microenvironment during thrombosis. At physiological antithrombin levels, heparin treatment resulted in complete and sustained inhibition of thrombin-induced PAR4-mediated platelet activation, but transient PAR1 signaling was sufficient to elicit significant α-granule release and platelet aggregation. In contrast, bivalirudin treatment resulted in rapid and profound inhibition of signaling from both PAR receptors, followed by a delayed phase of PAR4-mediated platelet activation, resulting in a robust prothrombotic response. Combination treatment with bivalirudin and subtherapeutic concentrations of heparin completely inhibited the residual platelet activation observed with single drug treatment at all time-points. Our results show that heparin and bivalirudin have different and complementary inhibitory effects on the activation of PAR1 and PAR4 by thrombin.
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Affiliation(s)
- Mikael Lund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ankit S Macwan
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kjersti Tunströmer
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas L Lindahl
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Niklas Boknäs
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Hematology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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16
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Li S, Tarlac V, Christanto RBI, French SL, Hamilton JR. Determination of PAR4 numbers on the surface of human platelets: no effect of the single nucleotide polymorphism rs773902. Platelets 2021; 32:988-991. [PMID: 32819173 DOI: 10.1080/09537104.2020.1810654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The thrombin receptor, protease-activated receptor 4 (PAR4), is important for platelet activation and is the target of emerging anti-thrombotic drugs. A frequently occurring single nucleotide polymorphism (SNP; rs773902) causes a function-altering PAR4 sequence variant (NC_000019.10:p.Ala120Thr), whereby platelets from Thr120-expressing individuals are hyper-responsive to PAR4 agonists and hypo-responsive to some PAR4 antagonists than platelets from Ala120-expressing individuals. This altered pharmacology may impact PAR4 inhibitor development, yet the underlying mechanism(s) remain unknown. We tested whether PAR4 surface expression contributes to the altered receptor function. Quantitative flow cytometry was used to determine the absolute number of PAR4 on platelets from individuals subsequently genotyped at rs773902. We detected 539 ± 311 PAR4 per platelet (mean ± SD, n = 84). This number was not different across rs773902 genotypes. This first determination of cellular PAR4 numbers indicates variations in platelet surface expression do not explain the altered pharmacology of the rs773902 PAR4 sequence variant.
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Affiliation(s)
- Simeng Li
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Volga Tarlac
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | - Shauna L French
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Justin R Hamilton
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
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17
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Abraham S, Ma L, Kong X, Askari S, Edelstein LC, McKenzie SE. PCTP contributes to human platelet activation by enhancing dense granule secretion. Thromb Res 2021; 202:67-73. [PMID: 33770537 DOI: 10.1016/j.thromres.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
Abstract
PCTP (phosphatidylcholine transfer protein) was discovered recently to regulate aggregation of human platelets stimulated with PAR4 activating peptide (PAR4AP). However, the role of PCTP following thrombin stimulation, the mechanisms by which PCTP contributes to platelet activation, and the role of PCTP with other receptors remained unknown. As mouse platelets do not express PCTP, we treated human platelets with various agonists in the presence of the specific PCTP inhibitor A1. We observed that PCTP inhibition significantly reduced dense granule secretion in response to thrombin, PAR1AP, PAR4AP, convulxin (GPVI agonist) and FcγRIIA crosslinking. In contrast, among these agonists, PCTP inhibition reduced aggregation only to low dose thrombin and PAR4AP. Unlike its effects on dense granule secretion, PCTP inhibition did not reduce alpha granule secretion in response to thrombin or PAR4AP. PCTP inhibition reduced both the increase in cytoplasmic Ca2+ as well as PKC activity downstream of thrombin. These data are consistent with PCTP contributing to secretion of dense granules, and to being particularly important to human PAR4 early signaling events. Future studies will address further these molecular mechanisms and consequences for hemostasis and thrombosis.
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Affiliation(s)
- Shaji Abraham
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA
| | - Lin Ma
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA
| | - Xianguo Kong
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA
| | - Shayan Askari
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA
| | - Leonard C Edelstein
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA
| | - Steven E McKenzie
- Cardeza Foundation for Hematological Research, Thomas Jefferson University, Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, USA.
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18
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Fernández DI, Kuijpers MJE, Heemskerk JWM. Platelet calcium signaling by G-protein coupled and ITAM-linked receptors regulating anoctamin-6 and procoagulant activity. Platelets 2020; 32:863-871. [PMID: 33356720 DOI: 10.1080/09537104.2020.1859103] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Most agonists stimulate platelet Ca2+ rises via G-protein coupled receptors (GPCRs) or ITAM-linked receptors (ILRs). Well studied are the GPCRs stimulated by the soluble agonists thrombin (PAR1, PAR4), ADP (P2Y1, P2Y12), and thromboxane A2 (TP), signaling via phospholipase (PLC)β isoforms. The platelet ILRs glycoprotein VI (GPVI), C-type lectin-like receptor 2 (CLEC2), and FcγRIIa are stimulated by adhesive ligands or antibody complexes and signal via tyrosine protein kinases and PLCγ isoforms. Marked differences exist between the GPCR- and ILR-induced Ca2+ signaling in: (i) dependency of tyrosine phosphorylation; (ii) oscillatory versus continued Ca2+ rises by mobilization from the endoplasmic reticulum; and (iii) smaller or larger role of extracellular Ca2+ entry via STIM1/ORAI1. Co-stimulation of both types of receptors, especially by thrombin (PAR1/4) and collagen (GPVI), leads to a highly enforced Ca2+ rise, involving mitochondrial Ca2+ release, which activates the ion and phospholipid channel, anoctamin-6. This highly Ca2+-dependent process causes swelling, ballooning, and phosphatidylserine expression, establishing a unique platelet population swinging between vital and necrotic (procoagulant 'zombie' platelets). Additionally, the high Ca2+ status of procoagulant platelets induces a set of additional events: (i) Ca2+ dependent cleavage of signaling proteins and receptors via calpain and ADAM isoforms; (ii) microvesiculation; (iii) enhanced coagulation factor binding; and (iv) fibrin-coat formation involving transglutaminases. Given the additive roles of GPCR and ILR in Ca2+ signal generation, high-throughput screening of biomolecules or small molecules based on Ca2+ flux measurements provides a promising way to find new inhibitors interfering with prolonged high Ca2+, phosphatidylserine expression, and hence platelet procoagulant activity.
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Affiliation(s)
- Delia I Fernández
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marijke J E Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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19
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Rodriguez BA, Bhan A, Beswick A, Elwood PC, Niiranen TJ, Salomaa V, Trégouët DA, Morange PE, Civelek M, Ben-Shlomo Y, Schlaeger T, Chen MH, Johnson AD, Johnson AD. A Platelet Function Modulator of Thrombin Activation Is Causally Linked to Cardiovascular Disease and Affects PAR4 Receptor Signaling. Am J Hum Genet 2020; 107:211-221. [PMID: 32649856 DOI: 10.1016/j.ajhg.2020.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
Dual antiplatelet therapy reduces ischemic events in cardiovascular disease, but it increases bleeding risk. Thrombin receptors PAR1 and PAR4 are drug targets, but the role of thrombin in platelet aggregation remains largely unexplored in large populations. We performed a genome-wide association study (GWAS) of platelet aggregation in response to full-length thrombin, followed by clinical association analyses, Mendelian randomization, and functional characterization including iPSC-derived megakaryocyte and platelet experiments. We identified a single sentinel variant in the GRK5 locus (rs10886430-G, p = 3.0 × 10-42) associated with increased thrombin-induced platelet aggregation (β = 0.70, SE = 0.05). We show that disruption of platelet GRK5 expression by rs10886430-G is associated with enhanced platelet reactivity. The proposed mechanism of a GATA1-driven megakaryocyte enhancer is confirmed in allele-specific experiments. Utilizing further data, we demonstrate that the allelic effect is highly platelet- and thrombin-specific and not likely due to effects on thrombin levels. The variant is associated with increased risk of cardiovascular disease outcomes in UK BioBank, most strongly with pulmonary embolism. The variant associates with increased risk of stroke in the MEGASTROKE, UK BioBank, and FinnGen studies. Mendelian randomization analyses in independent samples support a causal role for rs10886430-G in increasing risk for stroke, pulmonary embolism, and venous thromboembolism through its effect on thrombin-induced platelet reactivity. We demonstrate that G protein-coupled receptor kinase 5 (GRK5) promotes platelet activation specifically via PAR4 receptor signaling. GRK5 inhibitors in development for the treatment of heart failure and cancer could have platelet off-target deleterious effects. Common variants in GRK5 may modify clinical outcomes with PAR4 inhibitors, and upregulation of GRK5 activity or signaling in platelets may have therapeutic benefits.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew D Johnson
- National Heart, Lung, and Blood Institute, Division of Intramural Research, Population Sciences Branch, The Framingham Heart Study, Framingham, MA 01702, USA.
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20
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Abstract
Acute coronary syndromes (ACS) are a global cause of mortality and morbidity that affect millions of lives worldwide. Following atherosclerotic plaque rupture, platelet activation and aggregation are the two major elements that initiate thrombus formation inside a coronary artery, which can obstruct blood flow and cause myocardial ischemia; ergo, antiplatelet therapy forms a major part of the treatment strategy for ACS. Patients with ACS routinely receive dual antiplatelet therapy (DAPT), which consists of aspirin and a platelet P2Y12 inhibitor to both treat and prevent atherothrombosis. Use of platelet glycoprotein (GP) IIb/IIIa inhibitors is now limited due to the risk of severe bleeding and thrombocytopenia. Thus, administration of GPIIb/IIIa inhibitors is generally restricted to bail out thrombotic events associated with PCI. Furthermore, current antiplatelet medications mainly rely on thromboxane A2 and P2Y12 inhibition, which have broad-acting effects on platelets and are known to cause bleeding, which especially limits the long-term use of these agents. In addition, not all ACS patients treated with current antiplatelet treatments are protected from recurrence of arterial thrombosis, since many platelet mechanisms and activation pathways remain uninhibited by current antiplatelet therapy. Pharmacological antagonism of novel targets involved in platelet function could shape future antiplatelet therapies that could ultimately lead to more effective or safer therapeutic approaches. In this article, we focus on inhibitors of promising targets that have not yet been introduced into clinical practice, including inhibitors of GPVI, protease-activated receptor (PAR)-4, GPIb, 5-hydroxytryptamine receptor subtype 2A (5-HT2A), protein disulfide isomerase, P-selectin and phosphoinositide 3-kinase β.
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Affiliation(s)
- Fawaz O Alenazy
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham, UK
| | - Mark R Thomas
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham, UK.,UHB and SWBH NHS Trusts , Birmingham, UK
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21
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Therapeutic strategies for thrombosis: new targets and approaches. Nat Rev Drug Discov 2020; 19:333-352. [PMID: 32132678 DOI: 10.1038/s41573-020-0061-0] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
Antiplatelet agents and anticoagulants are a mainstay for the prevention and treatment of thrombosis. However, despite advances in antithrombotic therapy, a fundamental challenge is the side effect of bleeding. Improved understanding of the mechanisms of haemostasis and thrombosis has revealed new targets for attenuating thrombosis with the potential for less bleeding, including glycoprotein VI on platelets and factor XIa of the coagulation system. The efficacy and safety of new agents are currently being evaluated in phase III trials. This Review provides an overview of haemostasis and thrombosis, details the current landscape of antithrombotic agents, addresses challenges with preventing thromboembolic events in patients at high risk and describes the emerging therapeutic strategies that may break the inexorable link between antithrombotic therapy and bleeding risk.
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22
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Li S, Tarlac V, Hamilton JR. Using PAR4 Inhibition as an Anti-Thrombotic Approach: Why, How, and When? Int J Mol Sci 2019; 20:ijms20225629. [PMID: 31717963 PMCID: PMC6888008 DOI: 10.3390/ijms20225629] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/28/2022] Open
Abstract
Protease-activated receptors (PARs) are a family of four GPCRs with a variety of cellular functions, yet the only advanced clinical endeavours to target these receptors for therapeutic gain to date relates to the impairment of platelet function for anti-thrombotic therapy. The only approved PAR antagonist is the PAR1 inhibitor, vorapaxar—the sole anti-platelet drug against a new target approved in the past 20 years. However, there are two PARs on human platelets, PAR1 and PAR4, and more recent efforts have focused on the development of the first PAR4 antagonists, with first-in-class agents recently beginning clinical trial. Here, we review the rationale for this approach, outline the various modes of PAR4 inhibition, and speculate on the specific therapeutic potential of targeting PAR4 for the prevention of thrombotic conditions.
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23
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Mitrugno A, Tassi Yunga S, Sylman JL, Zilberman-Rudenko J, Shirai T, Hebert JF, Kayton R, Zhang Y, Nan X, Shatzel JJ, Esener S, Duvernay MT, Hamm HE, Gruber A, Williams CD, Takata Y, Armstrong R, Morgan TK, McCarty OJT. The role of coagulation and platelets in colon cancer-associated thrombosis. Am J Physiol Cell Physiol 2018; 316:C264-C273. [PMID: 30462538 DOI: 10.1152/ajpcell.00367.2018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cancer-associated thrombosis is a common first presenting sign of malignancy and is currently the second leading cause of death in cancer patients after their malignancy. However, the molecular mechanisms underlying cancer-associated thrombosis remain undefined. In this study, we aimed to develop a better understanding of how cancer cells affect the coagulation cascade and platelet activation to induce a prothrombotic phenotype. Our results show that colon cancer cells trigger platelet activation in a manner dependent on cancer cell tissue factor (TF) expression, thrombin generation, activation of the protease-activated receptor 4 (PAR4) on platelets and consequent release of ADP and thromboxane A2. Platelet-colon cancer cell interactions potentiated the release of platelet-derived extracellular vesicles (EVs) rather than cancer cell-derived EVs. Our data show that single colon cancer cells were capable of recruiting and activating platelets and generating fibrin in plasma under shear flow. Finally, in a retrospective analysis of colon cancer patients, we found that the number of venous thromboembolism events was 4.5 times higher in colon cancer patients than in a control population. In conclusion, our data suggest that platelet-cancer cell interactions and perhaps platelet procoagulant EVs may contribute to the prothrombotic phenotype of colon cancer patients. Our work may provide rationale for targeting platelet-cancer cell interactions with PAR4 antagonists together with aspirin and/or ADP receptor antagonists as a potential intervention to limit cancer-associated thrombosis, balancing safety with efficacy.
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Affiliation(s)
- Annachiara Mitrugno
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,Division of Hematology & Medical Oncology, Oregon Health & Science University , Portland, Oregon
| | - Samuel Tassi Yunga
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon.,Cancer Early Detection & Advanced Research Center, Oregon Health & Science University , Portland, Oregon
| | - Joanna L Sylman
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,VA Palo Alto Health Care System, Palo Alto, California.,Canary Center at Stanford, Department of Radiology, Stanford University School of Medicine , Stanford, California
| | - Jevgenia Zilberman-Rudenko
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Toshiaki Shirai
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Jessica F Hebert
- Department of Pathology, Oregon Health & Science University , Portland, Oregon
| | - Robert Kayton
- Department of Pathology, Oregon Health & Science University , Portland, Oregon
| | - Ying Zhang
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Xiaolin Nan
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | - Joseph J Shatzel
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,Division of Hematology & Medical Oncology, Oregon Health & Science University , Portland, Oregon
| | - Sadik Esener
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon.,Cancer Early Detection & Advanced Research Center, Oregon Health & Science University , Portland, Oregon
| | - Matthew T Duvernay
- Department of Pharmacology, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Heidi E Hamm
- Department of Pharmacology, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - András Gruber
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon
| | | | - Yumie Takata
- College of Public Health & Human Science, Oregon State University , Corvallis, Oregon
| | - Randall Armstrong
- Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon.,Cancer Early Detection & Advanced Research Center, Oregon Health & Science University , Portland, Oregon
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University , Portland, Oregon
| | - Owen J T McCarty
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University , Portland, Oregon.,Division of Hematology & Medical Oncology, Oregon Health & Science University , Portland, Oregon
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