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Ortega-Paz L, Franchi F, Rollini F, Galli M, Been L, Ghanem G, Shalhoub A, Ossi T, Rivas A, Zhou X, Pineda AM, Suryadevara S, Soffer D, Zenni MM, Jennings LK, Angiolillo DJ. Switching from Dual Antiplatelet Therapy with Aspirin Plus a P2Y12 Inhibitor to Dual Pathway Inhibition with Aspirin Plus Vascular-Dose Rivaroxaban: The Switching Anti-Platelet and Anti-Coagulant Therapy (SWAP-AC) Study. Thromb Haemost 2024; 124:263-273. [PMID: 37224883 DOI: 10.1055/a-2098-6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND To date, there are no data on switching to dual pathway inhibition (DPI) patients who have completed a guideline-recommended dual antiplatelet therapy (DAPT) regimen. OBJECTIVES To assess the feasibility of switching from DAPT to DPI and to compare the pharmacodynamic (PD) profiles of these treatments. METHODS This was a prospective, randomized, PD study conducted in 90 patients with chronic coronary syndrome (CCS) on DAPT with aspirin (81 mg/qd) plus a P2Y12 inhibitor (clopidogrel [75 mg/qd; n = 30], ticagrelor [90 mg/bid; n = 30], or prasugrel [10 mg/qd; n = 30]). Patients in each cohort were randomized to maintain DAPT or switch to DPI (aspirin 81 mg/qd plus rivaroxaban 2.5 mg/bid). PD assessments included: VerifyNow P2Y12 reaction units; light transmittance aggregometry following stimuli with adenosine diphosphate (ADP), tissue factor (TF), and a combination of collagen, ADP, and TF (maximum platelet aggregation %); thrombin generation (TG). Assays were performed at baseline and 30 days postrandomization. RESULTS Switching from DAPT to DPI occurred without major side effects. DAPT was associated with enhanced P2Y12 inhibition, while DPI with reduced TG. Platelet-mediated global thrombogenicity (primary endpoint) showed no differences between DAPT and DPI in the ticagrelor (14.5% [0.0-63.0] vs. 20.0% [0.0-70.0]; p = 0.477) and prasugrel (20.0% [0.0-66.0] vs. 4.0% [0.0-70.0]; p = 0.482), but not clopidogrel (27.0% [0.0-68.0] vs. 53.0% [0.0-81.0]; p = 0.011), cohorts. CONCLUSION In patients with CCS, switching from different DAPT regimens to DPI was feasible, showing enhanced P2Y12 inhibition with DAPT and reduced TG with DPI, with no differences in platelet-mediated global thrombogenicity between DPI and ticagrelor- and prasugrel-, but not clopidogrel-, based DAPT. CLINICAL TRIAL REGISTRATION http://www. CLINICALTRIALS gov Unique Identifier: NCT04006288.
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Affiliation(s)
- Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Mattia Galli
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
- Departmet of Cardiology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Latonya Been
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Ghussan Ghanem
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Awss Shalhoub
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Tiffany Ossi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Andrea Rivas
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Andres M Pineda
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Siva Suryadevara
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daniel Soffer
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Martin M Zenni
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | | | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
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Curry BJ, Rikken AOFS, Gibson CM, Granger CB, van 't Hof AWJ, Ten Berg JM, Jennings LK. Comparison of the effects of the GPIIb-IIIa antagonist Zalunfiban and the P2Y12 antagonist Selatogrel on Platelet Aggregation. J Thromb Thrombolysis 2023; 56:499-510. [PMID: 37563502 PMCID: PMC10550877 DOI: 10.1007/s11239-023-02867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
Understanding the pharmacodynamic effects of platelet inhibitors is standard for developing more effective antithrombotic therapies. An example is the antithrombotic treatment of acute coronary syndrome (ACS), in particular ST-elevated myocardial infarction (STEMI) patients who are in need for rapid acting strong antithrombotic therapy despite the use of aspirin and oral P2Y12-inhibitors. In this study, we evaluated two injectable platelet inhibitors under clinical development (the P2Y12 antagonist selatogrel and the GPIIb-IIIa antagonist zalunfiban) that may be amenable to pre-hospital treatment of STEMI patients. Platelet reactivity was assessed at inhibitor concentrations that represent clinically relevant levels of platelet inhibition (IC20-50%, 1/2Cmax, and Cmax). Light transmission aggregometry (LTA), was used to evaluate the initial rate of aggregation (primary slope, PS) and maximal aggregation (MA). Both adenosine diphosphate (ADP) and thrombin receptor agonist peptide (TRAP) were used as agonists. Zalunfiban demonstrated similar inhibition of platelet aggregation when blood was collected in PPACK or TSC, whereas selatogrel demonstrated greater inhibition in PPACK. In this study, using PPACK anticoagulant, selatogrel and zalunfiban affected PS in response to ADP equivalently at all drug concentrations tested. In contrast, zalunfiban had significantly greater potency at its Cmax concentration compared to selatogrel using TRAP as agonist. Upon evaluation of MA responses at lower doses, selatogrel had greater inhibition of MA in response to ADP than zalunfiban; however, at concentrations that represent Cmax, the drugs were equivalent. Zalunfiban also had greater inhibition of MA in response to TRAP at the Cmax dose. These data suggest that zalunfiban may provide greater protection in reducing thrombus formation than selatogrel, especially since thrombin is an early, key primary agonist in the pathophysiology of thrombotic events.
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Affiliation(s)
| | - A O F Sem Rikken
- St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | | | | - Arnoud W J van 't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- MUMC+, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jurriën M Ten Berg
- St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- MUMC+, Maastricht, The Netherlands
| | - Lisa K Jennings
- MLM Medical Labs, 140 Collins Street, Memphis, TN, 38117, USA.
- University of Tennessee Health Science Center, Memphis, TN, USA.
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Giordano S, Ortega-paz L, Franchi F, Rollini F, Galli M, Been L, Ghanem G, Shalhoub A, Ossi T, Rivas A, Zhou X, Pineda AM, Suryadevara S, Soffer D, Zenni MM, Jennings LK, Angiolillo DJ. 1157 WITCHING FROM DUAL ANTIPLATELET THERAPY WITH ASPIRIN PLUS A P2Y12 INHIBITOR TO DUAL PATHWAY INHIBITION WITH ASPIRIN PLUS VASCULAR-DOSE RIVAROXABAN: THE SWITCHING ANTI-PLATELET AND ANTI-COAGULANT THERAPY (SWAP-AC) STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
To assess the feasibility of switching from dual antiplatelet therapy (DAPT) to dual pathway inhibition (DPI) and to compare the pharmacodynamic (PD) profiles of these treatment regimens.
Methods and results
This was a prospective, randomized, PD study conducted in 90 patients with chronic coronary syndrome (CCS) on DAPT with aspirin (81 mg/qd) plus a P2Y12 inhibitor [clopidogrel (75 mg/qd; n = 30), ticagrelor (90 mg/bid; n = 30), or prasugrel (10 mg/qd; n = 30)]. Patients in each cohort were randomized to maintain DAPT or switch to DPI (aspirin 81 mg/qd plus rivaroxaban 2.5 mg/bid). PD assessments included: VerifyNow P2Y12 reaction units; light transmittance aggregometry following stimuli with adenosine diphosphate (ADP), tissue factor, and a combination of collagen, ADP, and TF (CATF, maximum platelet aggregation %); thrombelastograph coagulation analyzer; thrombin generation (TG). Assays were performed at baseline (on DAPT) and 30 days post-randomization (trough and peak). Switching from DAPT to DPI occurred without major side effects. DAPT was associated with enhanced P2Y12 inhibition, while DPI with reduced TG. Platelet-mediated global thrombogenicity (primary endpoint) showed no differences between DAPT and DPI in the ticagrelor (14.5% [0.0–63.0] vs. 20.0% [0.0–70.0]; p = 0.477) and prasugrel (20.0% [0.0–66.0] vs. 4.0% [0.0–70.0]; p = 0.482), but not clopidogrel (27.0% [0.0–68.0] vs. 53.0% [0.0–81.0]; p = 0.011), cohorts.
Conclusion
In patients with CCS, switching from different DAPT regimens to DPI was feasible, showing enhanced P2Y12 inhibition with DAPT and reduced TG with DPI, with no differences in platelet-mediated global thrombogenicity between DPI and ticagrelor- and prasugrel, but not clopidogrel-, based DAPT.
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Affiliation(s)
- Salvatore Giordano
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro , Italy
| | - Luis Ortega-paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Mattia Galli
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
- Maria Cecilia Hospital, Gvm Care and Research, Cotignola , Italy
| | - Latonya Been
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Ghussan Ghanem
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Awss Shalhoub
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Tiffany Ossi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Andrea Rivas
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Andres M. Pineda
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Siva Suryadevara
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Daniel Soffer
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | - Martin M. Zenni
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
| | | | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville , FL , USA
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Galli M, Franchi F, Rollini F, Been L, Jaoude PA, Rivas A, Zhou X, Jia S, Maaliki N, Lee CH, Pineda AM, Suryadevara S, Soffer D, Zenni MM, Geisler T, Jennings LK, Bass TA, Angiolillo DJ. Platelet P2Y12 inhibiting therapy in adjunct to vascular dose of rivaroxaban or aspirin: A pharmacodynamic study of dual pathway inhibition versus dual antiplatelet therapy. Eur Heart J Cardiovasc Pharmacother 2022; 8:728-737. [PMID: 35353154 DOI: 10.1093/ehjcvp/pvac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/27/2022] [Indexed: 12/25/2022]
Abstract
AIM Dual-pathway inhibition (DPI) by adding a vascular dose of rivaroxaban to a single antiplatelet agent has emerged as a promising antithrombotic strategy. However, in most studies the antiplatelet agent of choice used in adjunct to a vascular dose of rivaroxaban was aspirin, and data with a P2Y12 inhibitor and how this DPI regimen compares with standard dual antiplatelet therapy (DAPT) is limited. METHODS AND RESULTS This investigation was a sub-study analysis conducted in selected cohorts of patients with stable atherosclerotic disease enrolled from a larger prospective, open-label, parallel-group pharmacodynamics (PD) study. We analyzed data from 40 patients treated with either clopidogrel or ticagrelor-based DAPT first, and clopidogrel or ticagrelor-based DPI thereafter. PD measures explored key pathways involved in thrombus formation and included markers of: 1) P2Y12 reactivity, 2) platelet-mediated global thrombogenicity, 3) cyclooxygenase-1 activity, 3) TRAP-induced platelet aggregation; 4) tissue factor (TF)-induced platelet aggregation, and 5) thrombin generation. As compared to DAPT, on a background of the same P2Y12 inhibitor (clopidogrel or ticagrelor), DPI was associated with reduced thrombin generation, increased markers of cyclooxygenase-1 activity and TRAP-induced platelet aggregation and no differences in markers of P2Y12 signaling, platelet-mediated global thrombogenicity and TF-induced platelet aggregation. In an analysis according to P2Y12 inhibitor type, ticagrelor reduced markers of platelet-mediated global thrombogenicity, P2Y12 signaling and rates of high platelet reactivity compared to clopidogrel. CONCLUSIONS Compared to DAPT with aspirin and a P2Y12 inhibitor, the use of a P2Y12 inhibitor in adjunct to a vascular dose of rivaroxaban as part of a DPI strategy is associated with similar effects on platelet-mediated global thrombogenicity but reduced thrombin generation. A DPI strategy with ticagrelor is associated with enhanced antithrombotic efficacy, the clinical implications of which warrant larger scale investigations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03718429.
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Affiliation(s)
- Mattia Galli
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Latonya Been
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Patrick Abou Jaoude
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Andrea Rivas
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Sida Jia
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Naji Maaliki
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Chang Hoon Lee
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Andres M Pineda
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Siva Suryadevara
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daniel Soffer
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Martin M Zenni
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Tobias Geisler
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Lisa K Jennings
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Theodore A Bass
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
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Bhatt DL, Pollack CV, Mazer CD, Angiolillo DJ, Steg PG, James SK, Weitz JI, Ramnath R, Arnold SE, Mays MC, Umstead BR, White B, Hickey LL, Jennings LK, Curry BJ, Lee JS, Verma S. Bentracimab for Ticagrelor Reversal in Patients Undergoing Urgent Surgery. NEJM Evid 2022; 1:EVIDoa2100047. [PMID: 38319214 DOI: 10.1056/evidoa2100047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Bentracimab for Ticagrelor Reversal in Patients Undergoing Urgent SurgeryTicagrelor is a reversible oral P2Y12 platelet inhibitor used in patients with many forms of heart and vascular disease. Because patients receiving ticagrelor may bleed or need emergent surgery, bentracimab was studied as a ticagrelor reversal agent. In this study in 150 patients, treatment had a significant salutary impact on laboratory measured platelet function. Adjudicated hemostasis was achieved in over 90% of patients, most of whom had cardiac surgery; thrombotic events occurred in just over 5% of treated patients.
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Charles V Pollack
- Department of Emergency Medicine, University of Mississippi School of Medicine, Jackson
| | | | | | - Ph Gabriel Steg
- INSERM UMR1148, University of Paris, Paris
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris
| | - Stefan K James
- Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | - John S Lee
- PhaseBio Pharmaceuticals, Inc., Malvern, PA
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Galli M, Franchi F, Rollini F, Been L, Abou Jaoude P, Rivas A, Zhou X, Sida J, Maaliki N, Hoon Lee C, Pineda Maldonado AM, Suryadevara S, Soffer D, Zenni MM, Geisler T, Jennings LK, Bass TA, Angiolillo D. Pharmacodynamic profiles of dual-pathway inhibition with or without clopidogrel vs dual antiplatelet therapy in patients with atherosclerotic disease. Thromb Haemost 2022; 122:1341-1351. [PMID: 34983074 DOI: 10.1055/a-1730-8725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM Inhibition of thrombin-mediated signaling processes using a vascular dose of rivaroxaban in adjunct to antiplatelet therapy, known as dual-pathway inhibition (DPI), reduces atherothrombotic events in patients with stable atherosclerotic disease. However, there are limited data on the pharmacodynamic (PD) effects of this strategy. METHODS AND RESULTS This investigation was conducted in selected cohorts of patients (n=40) with stable atherosclerotic disease enrolled within a larger prospective PD study who were treated with either aspirin plus clopidogrel (DAPT), aspirin plus rivaroxaban 2.5 mg/bid (DPI) or DAPT plus rivaroxaban 2.5 mg/bid. Multiple PD assays assessing of markers of thrombosis were used. PD endpoints included platelet-mediated global thrombogenicity measured by light transmittance aggregometry (LTA) following stimuli with CATF [collagen-related peptide +adenosine diphosphate (ADP) +tissue factor (TF)], markers of P2Y12 reactivity, markers of platelet aggregation using LTA following several stimuli (arachidonic acid, ADP, collagen, TF, and TRAP), thrombin generation and thrombus formation. There was no difference in platelet-mediated global thrombogenicity between groups. Rivaroxaban significantly reduced thrombin generation and was associated with a trend towards reduced TF-induced platelet aggregation. Clopidogrel-based treatments reduced markers of P2Y12 signaling and TRAP-induced platelet aggregation. There were no differences between groups on markers of cyclooxygenase-1 mediated activity. CONCLUSIONS Compared with DAPT, DPI does not result in any differences in platelet-mediated global thrombogenicity, but reduces thrombin generation. These PD observations support that modulating thrombin generation by means of factor Xa inhibition in adjunct to antiplatelet therapy provides effective antithrombotic effects, supporting the efficacy and safety findings of DPI observed in clinical.
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Affiliation(s)
- Mattia Galli
- Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Francesco Franchi
- University of Florida College of Medicine-Jacksonville, Division of Cardiology, Jacksonville, United States
| | - Fabiana Rollini
- Division of Cardiology, University of Florida, Jacksonville, United States
| | - Latonya Been
- University of Florida College of Medicine-Jacksonville, Division of Cardiology, Jacksonville, United States
| | - Patrick Abou Jaoude
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Andrea Rivas
- University of Florida College of Medicine-Jacksonville, Division of Cardiology, Jacksonville, United States
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Jia Sida
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Naji Maaliki
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Chang Hoon Lee
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Andres M Pineda Maldonado
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Siva Suryadevara
- Division of Cardiology, University of Florida, Jacksonville, United States
| | - Daniel Soffer
- University of Florida College of Medicine-Jacksonville, Division of Cardiology, Jacksonville, United States
| | - Martin M Zenni
- Division of Cardiology, University of Florida, Jacksonville, United States
| | - Tobias Geisler
- Cardiology and Angiology, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Lisa K Jennings
- University of Tennessee Health Science Center, Memphis, United States.,CirQuest Labs, Memphis, United States
| | - Theodore A Bass
- Division of Cardiology, University of Florida, Jacksonville, United States
| | - Dominick Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
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Bonilla F, Bunce MW, Alleman R, Kotha J, Jennings LK, Chintala M. Comparison of the sensitivity of commercial aPTT tests in measurement of the pharmacodynamic response of milvexian, a novel FXIa inhibitor. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The activated partial thromboplastin time (aPTT) assay is a test routinely used to evaluate abnormalities or deficiencies in coagulation factors of the intrinsic and common pathways. The composition of the surface activator and phospholipids in the aPTT reagent is known to influence the response of heparin and direct FXa or thrombin inhibitors.
Milvexian (formerly referred to as BMS-986177/JNJ-70033093) is an investigational small-molecule Factor XIa (FXIa) inhibitor being studied for the prevention and treatment of major thrombotic conditions. Clinical pharmacology evaluation of milvexian includes aPTT as the primary pharmacodynamic assay, thus underscoring the need for a sensitive reagent to evaluate its anticoagulant activity.
Purpose
This study evaluated the sensitivity of six commercially available aPTT reagents in plasma from individual donors spiked with milvexian, at concentrations spanning the anticipated clinically relevant exposures.
Methods
Platelet-poor plasma (PPP) prepared from citrated whole blood collected from consenting, healthy adult volunteers (n=12) was spiked with vehicle (DMSO, 0.5% v/v) or 0.1–10 μM milvexian. The aPTT was measured using six commercially available aPTT reagent kits which included silica; kaolin, or ellagic acid as the contact activator, in combination with natural or synthetic phospholipids. The coagulation automated analysers used for testing were matched to the kit's manufacturer recommendations. All reagents and respective normal or abnormal controls were prepared as instructed by the manufacturer.
Results
Milvexian exhibited dose-dependent prolongation of aPTT with all reagents tested. Assays performed with aPTT reagents containing kaolin or ellagic acid demonstrated the highest sensitivity, as measured by the concentration that achieved a 2-fold aPTT prolongation (EC2x), and showed the widest dynamic range of response. Coefficient of variability of aPTT measurements in plasma from 12 individual donors was between 5.6–7.9% for Dade® Actin® FS, and 7.1–8% for STA®-C.K. Prest® 5.
Conclusions
Prolongation of aPTT in PPP spiked with milvexian exhibited a dose-dependent relationship, with statistically significant differences observed among reagents at milvexian concentrations above 0.3 μM. The highest sensitivity measured by changes in the ratio to baseline was obtained with aPTT reagents containing an activator/procoagulant phospholipid combination of ellagic acid + purified soy phosphatides or kaolin + cephalin, which performed similarly. Identification of the reagents with the best combination of sensitivity, precision, and dynamic range may help guide the selection of reagent for assessing milvexian activity.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Janssen Research & Development, LLC
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Affiliation(s)
- F Bonilla
- Janssen Research & Development LLC, Cardiovascular & Metabolism Therapeutic Area, Spring House, Pennsylvania, United States of America
| | - M W Bunce
- Janssen Research & Development LLC, Cardiovascular & Metabolism Therapeutic Area, Spring House, Pennsylvania, United States of America
| | - R Alleman
- MLM Medical Labs, Memphis, Tennessee, United States of America
| | - J Kotha
- MLM Medical Labs, Memphis, Tennessee, United States of America
| | - L K Jennings
- MLM Medical Labs, Memphis, Tennessee, United States of America
| | - M Chintala
- Janssen Research & Development LLC, Cardiovascular & Metabolism Therapeutic Area, Spring House, Pennsylvania, United States of America
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Franchi F, Rollini F, Faz G, Rivas JR, Rivas A, Agarwal M, Briceno M, Wali M, Nawaz A, Silva G, Shaikh Z, Maaliki N, Fahmi K, Been L, Pineda AM, Suryadevara S, Soffer D, Zenni MM, Baber U, Mehran R, Jennings LK, Bass TA, Angiolillo DJ. Pharmacodynamic Effects of Vorapaxar in Prior Myocardial Infarction Patients Treated With Potent Oral P2Y 12 Receptor Inhibitors With and Without Aspirin: Results of the VORA-PRATIC Study. J Am Heart Assoc 2020; 9:e015865. [PMID: 32306797 PMCID: PMC7428520 DOI: 10.1161/jaha.120.015865] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022]
Abstract
Background Vorapaxar as an adjunct to dual antiplatelet therapy (DAPT) reduces thrombotic events in patients with prior myocardial infarction at the expense of increased bleeding. Withdrawal of aspirin has emerged as a bleeding reduction strategy. The pharmacodynamic effects of vorapaxar with potent P2Y12 inhibitors as well as the impact of dropping aspirin is unexplored and represented the aim of the VORA-PRATIC (Vorapaxar Therapy in Patients With Prior Myocardial Infarction Treated With Newer Generation P2Y12 Receptor Inhibitors Prasugrel and Ticagrelor) study. Methods and Results Post-myocardial infarction patients (n=130) on standard DAPT (aspirin+prasugrel or ticagrelor) were randomized to 1 of 3 arms: (1) triple therapy: aspirin+prasugrel/ticagrelor+vorapaxar; (2) dual therapy (drop aspirin): prasugrel/ticagrelor+vorapaxar; (3) DAPT: aspirin+prasugrel/ticagrelor. Pharmacodynamic assessments were performed at 3 time points (baseline and 7 and 30 days). Vorapaxar reduced CAT (collagen-ADP-TRAP)-induced platelet aggregation, a marker of platelet-mediated global thrombogenicity (triple therapy versus DAPT at 30 days: mean difference=-27; 95% CI,-35 to -19; P<0.001; primary end point). This effect was attenuated but still significant in the absence of aspirin (dual therapy versus DAPT at 30 days: mean difference=-15; 95% CI,-23 to -7; P<0.001; between-group comparisons, P<0.05). Vorapaxar abolished TRAP-induced aggregation (P<0.001), without affecting thrombin generation and clot strength. There were no differences in markers of P2Y12 reactivity. Markers sensitive to aspirin-induced effects increased (P<0.001) in the dual-therapy arm. Conclusions In post-myocardial infarction patients treated with potent P2Y12 inhibitors, vorapaxar reduces platelet-driven global thrombogenicity, an effect that persisted, albeit attenuated, in the absence of aspirin and without affecting markers of P2Y12 reactivity or clot kinetics. The clinical implications of these PD observations warrant future investigation. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02545933.
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Affiliation(s)
| | | | - Gabriel Faz
- University of Florida College of Medicine–JacksonvilleFL
| | | | - Andrea Rivas
- University of Florida College of Medicine–JacksonvilleFL
| | - Malhar Agarwal
- University of Florida College of Medicine–JacksonvilleFL
| | | | - Mustafa Wali
- University of Florida College of Medicine–JacksonvilleFL
| | - Ahmed Nawaz
- University of Florida College of Medicine–JacksonvilleFL
| | - Gabriel Silva
- University of Florida College of Medicine–JacksonvilleFL
| | - Zubair Shaikh
- University of Florida College of Medicine–JacksonvilleFL
| | - Naji Maaliki
- University of Florida College of Medicine–JacksonvilleFL
| | - Kerolos Fahmi
- University of Florida College of Medicine–JacksonvilleFL
| | - Latonya Been
- University of Florida College of Medicine–JacksonvilleFL
| | | | | | - Daniel Soffer
- University of Florida College of Medicine–JacksonvilleFL
| | | | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
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9
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d'Alessandro E, Becker C, Bergmeier W, Bode C, Bourne JH, Brown H, Buller HR, Ten Cate-Hoek AJ, Ten Cate V, van Cauteren YJM, Cheung YFH, Cleuren A, Coenen D, Crijns HJGM, de Simone I, Dolleman SC, Klein CE, Fernandez DI, Granneman L, van T Hof A, Henke P, Henskens YMC, Huang J, Jennings LK, Jooss N, Karel M, van den Kerkhof D, Klok FA, Kremers B, Lämmle B, Leader A, Lundstrom A, Mackman N, Mannucci PM, Maqsood Z, van der Meijden PEJ, van Moorsel M, Moran LA, Morser J, van Mourik M, Navarro S, Neagoe RAI, Olie RH, van Paridon P, Posma J, Provenzale I, Reitsma PH, Scaf B, Schurgers L, Seelig J, Siegbahn A, Siegerink B, Soehnlein O, Soriano EM, Sowa MA, Spronk HMH, Storey RF, Tantiwong C, Veninga A, Wang X, Watson SP, Weitz J, Zeerleder SS, Ten Cate H. Thrombo-Inflammation in Cardiovascular Disease: An Expert Consensus Document from the Third Maastricht Consensus Conference on Thrombosis. Thromb Haemost 2020; 120:538-564. [PMID: 32289858 DOI: 10.1055/s-0040-1708035] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Thrombo-inflammation describes the complex interplay between blood coagulation and inflammation that plays a critical role in cardiovascular diseases. The third Maastricht Consensus Conference on Thrombosis assembled basic, translational, and clinical scientists to discuss the origin and potential consequences of thrombo-inflammation in the etiology, diagnostics, and management of patients with cardiovascular disease, including myocardial infarction, stroke, and peripheral artery disease. This article presents a state-of-the-art reflection of expert opinions and consensus recommendations regarding the following topics: (1) challenges of the endothelial cell barrier; (2) circulating cells and thrombo-inflammation, focused on platelets, neutrophils, and neutrophil extracellular traps; (3) procoagulant mechanisms; (4) arterial vascular changes in atherogenesis; attenuating atherosclerosis and ischemia/reperfusion injury; (5) management of patients with arterial vascular disease; and (6) pathogenesis of venous thrombosis and late consequences of venous thromboembolism.
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Affiliation(s)
- Elisa d'Alessandro
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Christian Becker
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Wolfgang Bergmeier
- Department of Biochemistry and Biophysics, McAllister Heart Institute, University of North Carolina, Chapel Hill, United States
| | - Christoph Bode
- Department of Cardiology and Angiology I, Medical Center - University of Freiburg, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Joshua H Bourne
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Helena Brown
- Rudolf-Virchov-Zentrum, DFG Forschungszentrum fur Experimentelle Biomedizin, Wurzburg, Germany
| | - Harry R Buller
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arina J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Vincent Ten Cate
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yvonne J M van Cauteren
- Department of Cardiology, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Yam F H Cheung
- Leibniz-Institut für Analytische Wissenschaften - ISAS, Dortmund, Germany
| | - Audrey Cleuren
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, United States
| | - Danielle Coenen
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Ilaria de Simone
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Sophie C Dolleman
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Experimental Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Christine Espinola Klein
- Center of Cardiology/Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Delia I Fernandez
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Lianne Granneman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arnoud van T Hof
- Department of Cardiology, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Peter Henke
- Michigan Medicine Vascular Surgery Clinic, Cardiovascular Center, Ann Arbor, Michigan, United States
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Jingnan Huang
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Lisa K Jennings
- CirQuest Labs, LLC and the University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Natalie Jooss
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Mieke Karel
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Danique van den Kerkhof
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Frederik A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Bram Kremers
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Bernhard Lämmle
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Haemostasis Research Unit, University College London, London, United Kingdom
| | - Avi Leader
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Annika Lundstrom
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Nigel Mackman
- Department of Medicine, UNC McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Pier M Mannucci
- Scientific Direction, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Zahra Maqsood
- Rudolf-Virchov-Zentrum, DFG Forschungszentrum fur Experimentelle Biomedizin, Wurzburg, Germany
| | - Paola E J van der Meijden
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Marc van Moorsel
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luis A Moran
- CiMUS, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - John Morser
- Division of Hematology, Stanford University School of Medicine and Palo Alto Veterans Administration Health Care System, California, United States
| | - Manouk van Mourik
- Department of Cardiology, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Stefano Navarro
- Rudolf-Virchov-Zentrum, DFG Forschungszentrum fur Experimentelle Biomedizin, Wurzburg, Germany
| | - Raluca A I Neagoe
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Renske H Olie
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Pauline van Paridon
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Jens Posma
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Isabella Provenzale
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Pieter H Reitsma
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Experimental Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Billy Scaf
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Leon Schurgers
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Jaap Seelig
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Department of Cardiology, Rijnstate ziekenhuis, Arnhem, The Netherlands
| | - Agneta Siegbahn
- Department of Medical Sciences, Clinical Chemistry and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Bob Siegerink
- Center for Stroke research Berlin, Charité Universitätamedizin, Berlin, Germany
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention, Ludwig Maximilian University Munich, Munich, Germany
| | - Eva Maria Soriano
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Marcin A Sowa
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Henri M H Spronk
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Chukiat Tantiwong
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Alicia Veninga
- Department of Biochemistry, Maastricht University and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Xueqing Wang
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Steve P Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeff Weitz
- Division of Hematology and Thromboembolism, Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sacha S Zeerleder
- Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, University of Bern, and Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Biochemistry and Internal Medicine and Thrombosis Expert Center, Maastricht University Medical Center and CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
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10
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Abstract
BACKGROUND Ticagrelor is an oral P2Y12 inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful. METHODS In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in healthy volunteers before and after 48 hours of ticagrelor pretreatment and again after the administration of PB2452 or placebo. Platelet function was assessed with the use of light transmission aggregometry, a point-of-care P2Y12 platelet-reactivity test, and a vasodilator-stimulated phosphoprotein assay. RESULTS Of the 64 volunteers who underwent randomization, 48 were assigned to receive PB2452 and 16 to receive placebo. After 48 hours of ticagrelor pretreatment, platelet aggregation was suppressed by approximately 80%. PB2452 administered as an initial intravenous bolus followed by a prolonged infusion (8, 12, or 16 hours) was associated with a significantly greater increase in platelet function than placebo, as measured by multiple assays. Ticagrelor reversal occurred within 5 minutes after the initiation of PB2452 and was sustained for more than 20 hours (P<0.001 after Bonferroni adjustment across all time points for all assays). There was no evidence of a rebound in platelet activity after drug cessation. Adverse events related to the trial drug were limited mainly to issues involving the infusion site. CONCLUSIONS In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays. (Funded by PhaseBio Pharmaceuticals; ClinicalTrials.gov number, NCT03492385.).
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Affiliation(s)
- Deepak L Bhatt
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Charles V Pollack
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Jeffrey I Weitz
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Lisa K Jennings
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Sherry Xu
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Susan E Arnold
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Bret R Umstead
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - Michael C Mays
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
| | - John S Lee
- From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (D.L.B.); the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia (C.V.P.); McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.); CirQuest Labs and the University of Tennessee Health Science Center, Memphis (L.K.J.); and PhaseBio Pharmaceuticals, Malvern, PA (S.X., S.E.A., B.R.U., M.C.M., J.S.L.)
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11
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Borst O, Muenzer P, Alnaggar N, Geue S, Tegtmeyer R, Rath D, Heemskerk JWM, Jennings LK, Angiolillo D, Spronk H, Ten Cate H, Gawaz M, Geisler T. P4403Inhibitory mechanisms of very low dose rivaroxaban in non-ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Borst
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - P Muenzer
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - N Alnaggar
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - S Geue
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - R Tegtmeyer
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - D Rath
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - J W M Heemskerk
- Cardiovascular Research Institute Maastricht (CARIM), Dept. of Biochemistry, Maastricht, Netherlands
| | - L K Jennings
- University of Tennessee Health Science Center, Vascular Biology Center of Excellence and Dept. of Internal Medicine, Memphis, United States of America
| | - D Angiolillo
- University of Florida College of Medicine-Jacksonville, Dept. of Cardiology, Jacksonville, United States of America
| | - H Spronk
- Maastricht University, Medical Center, Dept. of Internal Medicine, Maastricht, Netherlands
| | - H Ten Cate
- Maastricht University, Medical Center, Dept. of Internal Medicine, Maastricht, Netherlands
| | - M Gawaz
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - T Geisler
- Dept. of Cardiology and Cardiovascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
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12
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Tricoci P, Neely M, Whitley MJ, Edelstein LC, Simon LM, Shaw C, Fortina P, Moliterno DJ, Armstrong PW, Aylward P, White H, Van de Werf F, Jennings LK, Wallentin L, Held C, Harrington RA, Mahaffey KW, Bray PF. Effects of genetic variation in protease activated receptor 4 after an acute coronary syndrome: Analysis from the TRACER trial. Blood Cells Mol Dis 2018; 72:37-43. [PMID: 30055940 DOI: 10.1016/j.bcmd.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/05/2023]
Abstract
Variation in platelet response to thrombin may affect the safety and efficacy of PAR antagonism. The Thr120 variant of the common single nucleotide polymorphism (SNP) rs773902 in the protease-activated receptor (PAR) 4 gene is associated with higher platelet aggregation compared to the Ala120 variant. We investigated the relationship between the rs773902 SNP with major bleeding and ischemic events, safety, and efficacy of PAR1 inhibition in 6177 NSTE ACS patients in the TRACER trial. There was a lower rate of GUSTO moderate/severe bleeding in patients with the Thr120 variant. The difference was driven by a lower rate in the smaller homozygous group (recessive model, HR 0.13 [0.02-0.92] P = 0.042). No significant differences were observed in the ischemic outcomes. The excess in bleeding observed with PAR1 inhibition was attenuated in patients with the Thr120 variant, but the interactions were not statistically significant. In summary, lower major bleeding rates were observed in the overall TRACER cohort with the hyperreactive PAR4 Thr120 variant. The increase in bleeding with vorapaxar was attenuated with the Thr120 variant, but we could not demonstrate an interaction with PAR1 inhibition. These findings warrant further exploration, including those of African ancestry where the A allele (Thr120) frequency is ~65%.
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Affiliation(s)
| | - Megan Neely
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael J Whitley
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Leonard C Edelstein
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Lukas M Simon
- Department of Human & Molecular Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chad Shaw
- Department of Human & Molecular Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Statistics, Rice University, Houston, TX, USA
| | - Paolo Fortina
- Cancer Genomics and Bioinformatics Laboratory, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Philip Aylward
- Division of Medicine, Cardiac & Critical Care Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lisa K Jennings
- CirQuest Labs, LLC, and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lars Wallentin
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala, Sweden
| | | | | | - Paul F Bray
- Division of Hematology and Hematologic Malignancies in the Department of Internal Medicine and the Molecular Medicine Program, University of Utah, Salt Lake City, UT, USA.
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Jennings LK, White MM, Mandrell TD. Interspecies Comparison of Platelet Aggregation, LIBS Expression and Clot Retraction: Observed Differences in GPIIb-IIIa Functional Activity. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649981] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe examined interspecies differences in the function of the platelet fibrinogen receptor, GPIIb-IIIa, by comparing platelet aggregation responses to adenosine diphosphate (ADP) added alone or in combination with a GPIIIa specific monoclonal antibody (mAb), D3. D3 can activate the GPIIb-IIIa receptor in the absence of platelet activation, and it preferentially binds to a region on the GPIIIa subunit after the GPIIb-IIIa complex is occupied by ligand. Using human, monkey, dog, rabbit and pig platelets, we examined whether all species’ platelets bound the D3 mAb similarly, and if the binding of Arg-Gly-Asp-Ser (RGDS) peptides induced the exposure of the anti-LIBS (D3) epitope as previously described for human platelets. We also evaluated how blocking of this neoantigenic region by the D3 mAb affected clot retraction, a process that requires linkage of GPIIb-IIIa with fibrin(ogen) and the platelet cytoskeleton. We found that all species tested bound the D3 mAb. Only in human and monkey platelets did D3 cause aggregation as well as inhibit clot retraction. However, in all species tested, except for pig, D3 prevented disaggregation of platelets typically observed when platelets are treated with low dose ADP. With the exception of pig platelets, there was increased D3 binding to platelets in the presence of RGDS peptides. We propose that this region of GPIIIa is important in the conformational changes that GPIIb-IIIa undergoes during the binding of ligand in most species tested. Our studies suggest 1) there are measurable inter-species differences in GPIIb-IIIa mediated platelet aggregation and clot retraction, 2) LIBS expression due to receptor occupancy is a common but not all-inclusive response and 3) interspecies comparisons may be useful in understanding structural and functional aspects of platelet GPIIb-IIIa.
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Affiliation(s)
- Lisa K Jennings
- The Department of Medicine, The University of Tennessee, Memphis, TN, USA
- The Department of Biochemistry, The University of Tennessee, Memphis, TN, USA
| | - Melanie M White
- The Department of Medicine, The University of Tennessee, Memphis, TN, USA
| | - Timothy D Mandrell
- The Department of Comparative Medicine, The University of Tennessee, Memphis, TN, USA
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White MM, Siders L, Jennings LK, White FL. The Effect of Residual Heparin on the Interpretation of Heparin-Induced Platelet Aggregation in the Diagnosis of Heparin-Associated Thrombocytopenia. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
SummaryPlatelet aggregometry is often used to help diagnose storage pool disease (SPD-reduced amounts of granule nucleotides) and release defects (abnormal release of granule nucleotides). The general assumption that normal aggregation patterns are sufficient to rule out the diagnosis of one of these disorders has been invalidated by the recent publication of two papers describing patients with clinical bleeding, prolonged bleeding times and normal aggregation patterns in spite of defective release. The lumiaggregometer provides a tool for measuring platelet release and aggregation simultaneously. This paper presents a standardized, reproducible method for the use of the lumiaggregometer based on a “standard curve”. Data obtained during the development of the procedure are presented including normal ranges of release at different concentrations of agonists, release measured in intrinsic disorders as well as in patients on aspirin, and values for release relative to varying platelet counts. A monoclonal antibody (anti-p24/CD9; MAb7) which activates platelets similarly to thrombin and may be a useful reagent for distinguishing SPD and release defects is also introduced.
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Affiliation(s)
- Melanie McCabe White
- The Department of Medicine, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
- The Department of Neurosurgery, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
| | - John T Foust
- The Department of Medicine, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
| | - Alvin M Mauer
- The Department of Medicine, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
| | - James T Robertson
- The Department of Neurosurgery, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
| | - Lisa K Jennings
- The Department of Medicine, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
- The Department of Biochemistry, The University of Tennessee and Baptist Health Care Systems, Memphis, Tennessee, USA
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16
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Gibson CM, Jennings LK, Chi G, Yee MK, Halaby R, Nafee T, AlKhalfan F, Kerneis M, Korjian S, Daaboul Y, Goldhaber SZ, Hull RD, Hernandez AF, Cohen AT, Harrington RA. Association of D-dimer Levels with Clinical Event Rates and the Efficacy of Betrixaban versus Enoxaparin in the APEX Trial. TH Open 2018; 2:e16-e24. [PMID: 31249924 PMCID: PMC6524856 DOI: 10.1055/s-0037-1615288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background Elevated D-dimer concentrations are associated with an increased risk of venous thromboembolism (VTE). However, they may also provide prognostic value. The present analysis sought to study the association of D-dimer levels with VTE event rates and the efficacy of betrixaban versus enoxaparin in the APEX trial. Methods Hospitalized acutely medically ill subjects ( n = 7,513) were randomized in a double-dummy double-blind fashion to either extended-duration oral betrixaban (80 mg once daily for 35-42 days) or standard dose subcutaneous enoxaparin (40 mg once daily for 10 ± 4 days) for venous thromboprophylaxis. D-dimer was assessed using a central core laboratory measurement. Results For every 0.25 µg/mL increase in D-dimer concentration, there was a 2% increase in the relative risk of experiencing the primary efficacy endpoint (asymptomatic deep vein thrombosis [DVT], symptomatic DVT, nonfatal pulmonary embolism, or VTE-related death) in both the betrixaban ( p < 0.001) and enoxaparin ( p < 0.001) treatment arms. Among D-dimer-positive (≥ 2 × upper limit of normal; corresponding to ≥ 1.00 µg/mL) subjects, extended-duration betrixaban reduced the risk of experiencing the primary efficacy outcome (5.4% [ n = 124] vs. 7.6% [ n = 170]; odds ratio = 0.69; 95% confidence interval: 0.55-0.88; absolute risk reduction = 2.2%, number needed to treat = 46, p = 0.003). There was no interaction between D-dimer and the treatment effect ( p int = 0.53). Conclusion Extended-duration betrixaban was superior to standard-duration enoxaparin, irrespective of D-dimer level at baseline. To prevent one VTE event, 46 D-dimer-positive patients would need to be treated with betrixaban.
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Affiliation(s)
- C. Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Lisa K. Jennings
- CirQuest Labs, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Gerald Chi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Megan K. Yee
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Tarek Nafee
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Fahad AlKhalfan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mathieu Kerneis
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Serge Korjian
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yazan Daaboul
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Samuel Z. Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Russel D. Hull
- Division of Cardiology, Faculty of Medicine, University of Calgary, Alberta, Canada
| | - Adrian F. Hernandez
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, North Carolina, United States
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guy's and St. Thomas' Hospitals, King's College London, London, United Kingdom
| | - Robert A. Harrington
- Department of Medicine, Stanford University, Stanford, California, United States
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17
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Jackson D, White M, Jennings LK, Newman P. A Ser162→ Leu Mutation within Glycoprotein (GP) IIIa (Integrin β3) Results in an Unstable αIIbβ3 Complex that Retains Partial Function in a Novel Form of Type II Glanzmann Thrombasthenia. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPlatelets from Glanzmann thrombasthenia patient BL express approximately 30% of the normal αIIbβ3 content and support fibrin-mediated clot retraction, but fail to bind fibrinogen or aggregate following cellular activation. BL platelets bind neither activation-dependent nor activation-independent ligands. DNA sequence analysis of BL platelet mRNA revealed a homozygous C583→T point mutation in a conserved region of β3, resulting in a Ser162Leu amino acid substitution. This mutation appears to produce destabilizing effects on the αIIbβ3 complex, as evidenced by the fact that (1) the BL αIIbβ3 complex exhibited altered sedimentation velocity through sucrose gradients, (2) αIIb and β3 was not recognized by complex-dependent monoclonal antibodies or co-precipitated by integrin subunit-specific antibodies, and (3) biosynthesis and trafficking of the αIIbβ3Leu162 complex was delayed relative to that of the wild-type control. Taken together, these data implicate the region encompassing Ser162 in the stabilization and ligand binding properties of the αIIbβ3 complex.
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18
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Dyke CM, Jennings LK, Maier G, Andreou C, Daly R, Tamberella MR. Preoperative Platelet Inhibition With Eptifibatide During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass. J Cardiovasc Pharmacol Ther 2016; 12:54-60. [PMID: 17495258 DOI: 10.1177/1074248406299068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Platelet glycoprotein IIb-IIIa antagonists reduce cardiac events in acute coronary syndromes (ACSs), but their use is limited during coronary artery bypass grafting (CABG) because of bleeding concerns. Patients with ACS, however, are at increased risk for cardiac events after CABG. The use of short-acting glycoprotein IIbIIIa inhibitor eptifibatide in patients with ACS undergoing CABG was investigated. Fifteen patients with ACS and undergoing CABG with cardiopulmonary bypass were enrolled. One withdrew before surgery. Patients received heparin and eptifibatide preoperatively. Eptifibatide concentration and receptor occupancy (RO) at termination of infusion were similar in the two groups. Immediately before surgery, eptifibatide levels in the 2-hour group were twice that in the 4-hour group, and platelet RO was higher. Cessation of eptifibatide 4 hours before surgery results in less bleeding and transfusions than 2 hours before surgery. The optimal balance between bleeding and platelet inhibition is approximately 60% platelet RO. Further investigation of upstream therapy should target this threshold.
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Affiliation(s)
- Cornelius M Dyke
- Carolina Cardiovascular and Thoracic Surgery Associates, Gaston Memorial Hospital, 2555 Court Drive, Gastonia, NC 28043, USA.
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19
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Garner JM, Herr MJ, Hodges KB, Jennings LK. The utility of tetraspanin CD9 as a biomarker for metastatic clear cell renal cell carcinoma. Biochem Biophys Res Commun 2016; 471:21-5. [DOI: 10.1016/j.bbrc.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/03/2016] [Indexed: 01/02/2023]
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20
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Kotha J, Dixon ML, Jalenak JM, Dunphy PS, Tcheng JE, Saucedo JF, Jennings LK. CRT-200.52 Dynamic Regulation of Aggregate Formation and Stability in Response to Platelet Inhibition Via GP 2b-3a vs. P2Y12. JACC Cardiovasc Interv 2016. [DOI: 10.1016/j.jcin.2015.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Bhal V, Herr MJ, Dixon M, Akins S, Hord E, White MM, Seiffert D, Kotha J, Jennings LK. Platelet function recovery following exposure to triple anti-platelet inhibitors using an in vitro transfusion model. Thromb Res 2015; 136:1216-23. [PMID: 26412559 DOI: 10.1016/j.thromres.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/28/2015] [Accepted: 09/07/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Dual anti-platelet therapy (DAPT) with aspirin and a P2Y12 antagonist is standard of care to reduce risk of thrombosis, but does not directly target thrombin-dependent platelet activation. Therefore, PAR-1 antagonist addition to DAPT (i.e., triple anti-platelet therapy; TAPT) may improve the efficacy of treatment, though at the expense of an increase in bleeding risk. Using an in vitro transfusion model, we evaluated if platelet function loss associated with TAPT can be remedied by the addition of drug-naïve platelets. METHODS To mimic TAPT, platelet-rich plasma (PRP) prepared from consented DAPT patients (DPRP) was incubated with a vorapaxar at therapeutic plasma levels (TPRP). To simulate platelet transfusions, TPRP was mixed with increasing proportions of drug-naïve PRP (NPRP). Platelet function recovery was assessed by light transmission aggregometry (LTA), aggregate morphology, and P-selectin expression. RESULTS LTA results demonstrated that 20% NPRP was required to restore the ADP aggregation response in TPRP to the response observed in DPRP and 40% NPRP recovered aggregation to >65%. Higher NPRP fractions (60%) were required to restore the platelet reactivity using TRAP-6 (SFLLRN) or arachidonic acid (AA). PAR-4 aggregation was unaffected by platelet antagonists. A decrease in single, free platelets and incorporation of mepacrine-labeled naïve platelets into aggregates occurred with increasing NPRP portions. Upon agonist activation, the surface density and percent of P-selectin positive platelets increased linearly upon addition of NPRP. CONCLUSION This in vitro model demonstrated that administration of drug-naïve platelets can be a useful strategy for reversing overall platelet inhibition observed with TAPT.
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Affiliation(s)
| | | | | | - Steve Akins
- Sutherland Cardiology Clinic, Memphis, TN, USA
| | - Ed Hord
- CirQuest Labs, Memphis, TN, USA
| | | | | | | | - Lisa K Jennings
- CirQuest Labs, Memphis, TN, USA.; The University of Tennessee Health Science Center, Memphis, TN, USA..
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22
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Giri S, Jennings LK. The Spectrum of Thrombin in Acute Coronary Syndromes. Thromb Res 2015; 135:782-7. [DOI: 10.1016/j.thromres.2015.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/25/2022]
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Abstract
Studies have shown that gay men are at increased risk for anxiety and depression due to social oppression; research suggests that self-compassion is positively associated with life-satisfaction and emotional resilience. In a sample of 68 gay men (M age = 39.7 yr., SD = 16.3), the influence of self-compassion on satisfaction with life was examined while controlling for age, income, and openness about sexual orientation. Analysis of the data revealed that self-compassion was a significant predictor of satisfaction with life. Implications of this finding were discussed.
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Tricoci P, Lokhnygina Y, Huang Z, Van de Werf F, Cornel JH, Chen E, Wallentin L, Held C, Aylward PE, Moliterno DJ, Jennings LK, White HD, Armstrong PW, Harrington RA, Strony J, Mahaffey KW. Vorapaxar with or without clopidogrel after non-ST-segment elevation acute coronary syndromes: results from the thrombin receptor antagonist for clinical event reduction in acute coronary syndrome trial. Am Heart J 2014; 168:869-77.e1. [PMID: 25458650 DOI: 10.1016/j.ahj.2014.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/10/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Protease-activated receptor 1 antagonism with vorapaxar represents a novel strategy for platelet inhibition. In TRACER, vorapaxar was compared with placebo plus standard of care among 12,944 patients with non-ST-segment elevation acute coronary syndromes. We anticipated that most patients would have received clopidogrel as part of standard care. We investigated the modification of vorapaxar's effect associated with clopidogrel use over time. METHODS The marginal structural model method was used to estimate causal modification of vorapaxar effect by use of clopidogrel over time. The primary outcomes were the composite of cardiovascular death, myocardial infarction, or stroke and Global Use of Strategies to Open Occluded Coronary Arteries moderate or severe bleeding. The event accrual period excluded the time during which clopidogrel was clinically warranted. RESULTS Among 12,887 patients who received study medication, 11,117 (86.3%) received clopidogrel before randomization, of whom 38.5% stopped later in the trial (median time to stoppage 200 days with placebo; interquartile range [IQR] 14-367) (186 days with vorapaxar; IQR 17-366). In total, 1,770 (13.7%) patients were not on clopidogrel at randomization, of whom 47.8% started afterward (median time to start 2 days; IQR 2-4). During the period of event accrual, vorapaxar was associated with a 26% reduction in the composite of cardiovascular death, myocardial infarction, or stroke when used with clopidogrel (hazard ratio [HR] 0.74; 95% CI 0.60-0.91) and a 24% reduction when used without clopidogrel (HR 0.76; 95% CI 0.56-1.02) (interaction; P = .89). The hazard of Global Use of Strategies to Open Occluded Coronary Arteries bleeding with vorapaxar was not significantly different without clopidogrel (HR 1.33; 95% CI 0.81-2.20) or with clopidogrel (HR 1.09; 95% CI 0.76-1.56) (interaction; P = .53). CONCLUSIONS We observed no interaction between vorapaxar and clopidogrel after non-ST-segment elevation acute coronary syndromes on efficacy or safety outcomes, supporting a complementary role of protease-activated receptor 1 and P2Y12 antagonism.
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Affiliation(s)
| | | | - Zhen Huang
- Duke Clinical Research Institute, Durham NC
| | | | - Jan H Cornel
- Medisch Centrum Alkmaar, Alkmaar, the Netherlands
| | | | - Lars Wallentin
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Philip E Aylward
- SAHMRI, Flinders University and Medical Centre, Adelaide, Australia
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY
| | - Lisa K Jennings
- CirQuest Labs, LLC and University of Tennessee Health Science Center, Memphis, TN
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City, Auckland, New Zealand
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Chen J, Wang J, Schwab LP, Park KT, Seagroves TN, Jennings LK, Miller DD, Li W. Benzimidazole analogs as potent hypoxia inducible factor inhibitors: synthesis, biological evaluation, and profiling drug-like properties. Anticancer Res 2014; 34:3891-3904. [PMID: 25075010 PMCID: PMC5346463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To develop potent HIF-1α inhibitors for potential treatment of cancer. MATERIALS AND METHODS Chemical synthesis, HIF-luciferase assay, cytotoxic assay, platelet aggregation assay, western blot analysis, quantitative real-time PCR, aqueous solubility, protein binding, metabolic stability, and metabolic pathways. RESULTS Thirteen novel benzimidazole analogs were synthesized. Compounds 3a and 3k showed the highest anti-HIF-1α activity. They are significantly more effective than YC-1 in the suppression of HIF-1α protein expression based on western blot assay. They show comparable potency in inhibition of cancer cell migration. They are less potent in the inhibition of platelet aggregation. 3k had the most favorable drug-like properties, including long half-life in human liver microsomes, medium protein binding level and reasonable aqueous solubility. CONCLUSION The potent anti-HIF-1α activity and favorable drug-like properties of compound 3k suggest that it may hold great potential as an adjuvant therapy for cancer treatment through repression of HIF-1α protein expression.
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Affiliation(s)
- Jianjun Chen
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, U.S.A. Department of Pharmaceutical Sciences, School of Pharmacy, South College, Knoxville, TN, U.S.A
| | - Jin Wang
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Luciana P Schwab
- Center for Cancer Research, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Kyung-Tae Park
- Center for Cancer Research, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Tiffany N Seagroves
- Center for Cancer Research, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Lisa K Jennings
- Vascular Biology Center, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Duane D Miller
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, U.S.A
| | - Wei Li
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, U.S.A.
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Judge HM, Jennings LK, Moliterno DJ, Hord E, Ecob R, Tricoci P, Rorick T, Kotha J, Storey RF. PAR1 antagonists inhibit thrombin-induced platelet activation whilst leaving the PAR4-mediated response intact. Platelets 2014; 26:236-42. [DOI: 10.3109/09537104.2014.902924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Herr MJ, Longhurst CM, Baker B, Homayouni R, Speich HE, Kotha J, Jennings LK. Tetraspanin CD9 modulates human lymphoma cellular proliferation via histone deacetylase activity. Biochem Biophys Res Commun 2014; 447:616-20. [PMID: 24747564 DOI: 10.1016/j.bbrc.2014.04.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022]
Abstract
Non-Hodgkin Lymphoma (NHL) is a type of hematological malignancy that affects two percent of the overall population in the United States. Tetraspanin CD9 is a cell surface protein that has been thoroughly demonstrated to be a molecular facilitator of cellular phenotype. CD9 expression varies in two human lymphoma cell lines, Raji and BJAB. In this report, we investigated the functional relationship between CD9 and cell proliferation regulated by histone deacetylase (HDAC) activity in these two cell lines. Introduction of CD9 expression in Raji cells resulted in significantly increased cell proliferation and HDAC activity compared to Mock transfected Raji cells. The increase in CD9-Raji cell proliferation was significantly inhibited by HDAC inhibitor (HDACi) treatment. Pretreatment of BJAB cells with HDAC inhibitors resulted in a significant decrease in endogenous CD9 mRNA and cell surface expression. BJAB cells also displayed decreased cell proliferation after HDACi treatment. These results suggest a significant relationship between CD9 expression and cell proliferation in human lymphoma cells that may be modulated by HDAC activity.
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Affiliation(s)
- Michael J Herr
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Molecular Sciences, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Celia M Longhurst
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Benjamin Baker
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Ramin Homayouni
- Department of Biology, Bioinformatics Program, University of Memphis, Memphis, TN 38152, United States
| | - Henry E Speich
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Jayaprakash Kotha
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Lisa K Jennings
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Molecular Sciences, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, United States; Department of Biology, Bioinformatics Program, University of Memphis, Memphis, TN 38152, United States.
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28
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Mahaffey KW, Huang Z, Wallentin L, Storey RF, Jennings LK, Tricoci P, White HD, Armstrong PW, Aylward PE, Moliterno DJ, Van de Werf F, Chen E, Leonardi S, Rorick T, Held C, Strony J, Harrington RA. Association of aspirin dose and vorapaxar safety and efficacy in patients with non-ST-segment elevation acute coronary syndrome (from the TRACER Trial). Am J Cardiol 2014; 113:936-44. [PMID: 24444781 DOI: 10.1016/j.amjcard.2013.11.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 11/26/2022]
Abstract
Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial compared vorapaxar and placebo in 12,944 high-risk patients with non-ST-segment elevation acute coronary syndrome. We explored aspirin (ASA) use and its association with outcomes. Kaplan-Meier event rates were compared in groups defined by ASA dose (low, medium, and high). Landmark analyses with covariate adjustment were performed for 0 to 30, 31 to 180, and 181 to 365 days. Of 12,515 participants, 7,523, 1,049, and 3,943 participants were treated with low-, medium-, and high-dose ASA at baseline, respectively. Participants enrolled in North America versus elsewhere were more often treated with a high dose at baseline (66% vs 19%) and discharge (60% vs 3%). Unadjusted cardiovascular death, myocardial infarction, stroke, hospitalization for ischemia, or urgent revascularization event rates tended to be higher with higher baseline ASA (18.45% low, 19.13% medium, and 20.27% high; p for trend = 0.15573). Unadjusted and adjusted hazard ratios (95% confidence intervals) for effect of vorapaxar on cardiovascular (unadjusted p for interaction = 0.065; adjusted p for interaction = 0.140) and bleeding (unadjusted p for interaction = 0.915; adjusted p for interaction = 0.954) outcomes were similar across groups. Landmark analyses showed similar safety and efficacy outcomes with vorapaxar and placebo by ASA dose at each time point except for 0 to 30 days, when vorapaxar tended to be worse for efficacy (hazard ratio 1.13, 95% confidence interval 0.89 to 1.44, p for interaction = 0.0157). In conclusion, most TRACER participants were treated with low-dose ASA, although a high dose was common in North America. High-dose participants tended to have higher rates of ischemic and bleeding outcomes. Although formal statistical testing did not reveal heterogeneity in vorapaxar's effect across dose subgroups, consistent trends support use of low-dose ASA with other antiplatelet therapies.
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Abstract
Glycoprotein IIb-IIIa (GPIIb-IIIa) antagonists have the capacity to destabilize coronary thrombi and restore vessel patency. Antagonist concentration and residence time, which can be increased by local intracoronary (LIC) administration, and thrombus age may be key factors that influence thrombus stability. Light transmission aggregometry was used to examine the effects of exposing human platelet aggregates to extremely high local levels of GPIIb-IIIa antagonists versus conventional therapeutic levels in vitro. Freshly-formed or aged platelet aggregates were subjected to GPIIb-IIIa antagonists (abciximab, eptifibatide) or direct thrombin inhibitor bivalirudin at concentrations simulating either conventional intravenous (IV) or LIC administration. The degree of antagonist-induced disaggregation was significantly higher using elevated (LIC) doses versus conventional (IV) doses (60.1 % vs. 7.4 % for abciximab, 41.6 % or 45.3 % vs. 17.6 % for eptifibatide, p < 0.01). Bivalirudin did not promote disaggregation. Microscopy confirmed noticeably smaller, more dispersed aggregates for antagonist LIC treatments. Dosing at LIC levels also induced more disaggregation than IV levels when aggregates were aged for 30 min prior to exposure. An in vitro perfusion model was used to simulate the fluid dynamics of IV or LIC administration of abciximab using a microporous local drug delivery balloon catheter such as the Atrium ClearWay™ RX. The perfusion model resulted in more rapid thrombus clearance with LIC dosing levels compared to IV. In summary, boosting the concentration of GPIIb-IIIa antagonists enhances dispersal of human platelet aggregates in vitro. These data provide a foundation for investigating increased local concentrations of GPIIb-IIIa antagonists in patients, as with LIC administration.
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Affiliation(s)
- Henry E Speich
- Department of Internal Medicine, Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, 956 Court Avenue Coleman H300, Memphis, TN 38163, USA.
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Storey RF, Kotha J, Smyth SS, Moliterno DJ, Rorick TL, Moccetti T, Valgimigli M, Dery JP, Cornel JH, Thomas GS, Huber K, Harrington RA, Hord E, Judge HM, Chen E, Strony J, Mahaffey KW, Tricoci P, Becker RC, Jennings LK. Effects of vorapaxar on platelet reactivity and biomarker expression in non-ST-elevation acute coronary syndromes. The TRACER Pharmacodynamic Substudy. Thromb Haemost 2014; 111:883-91. [PMID: 24402559 DOI: 10.1160/th13-07-0624] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/22/2013] [Indexed: 01/05/2023]
Abstract
Vorapaxar is an antagonist of the protease activated receptor-1 (PAR-1), the principal platelet thrombin receptor. The Thrombin Receptor Antagonist for Clinical Event Reduction (TRACER) trial evaluated vorapaxar compared to placebo in non-ST-elevation (NSTE)-acute coronary syndrome (ACS) patients. It was the study's objective to assess the pharmacodynamic effects of vorapaxar versus placebo that included aspirin or a thienopyridine or, frequently, a combination of both agents in NSTE-ACS patients. In a substudy involving 249 patients, platelet aggregation was assessed by light transmittance aggregometry (LTA) in 85 subjects (41 placebo, 44 vorapaxar) using the agonists thrombin receptor activating peptide (TRAP, 15 μM), adenosine diphosphate (ADP, 20 μM), and the combination of collagen-related peptide (2.5 μg/ml) + ADP (5 μM) + TRAP (15 μM) (CAT). VerifyNow® IIb/IIIa and vasodilator-stimulated phosphoprotein (VASP) phosphorylation assays were performed, and platelet PAR-1 expression, plasma platelet/endothelial and inflammatory biomarkers were determined before and during treatment. LTA responses to TRAP and CAT and VerifyNow results were markedly inhibited by vorapaxar. Maximal LTA response to TRAP (median, interquartile range) 2 hours post loading dose: placebo 68% (53-75%) and vorapaxar 3% (2-6%), p<0.0001. ADP inhibition was greater in the vorapaxar group at 4 hours and one month (p<0.01). In contrast to the placebo group, PAR-1 receptor number in the vorapaxar group at one month was significantly lower than the baseline (179 vs 225; p=0.004). There were significant changes in selected biomarker levels between the two treatment groups. In conclusion, vorapaxar caused a potent inhibition of PAR-1-mediated platelet aggregation. Further studies are needed to explore vorapaxar effect on P2Y12 inhibition, PAR-1 expression and biomarkers and its contribution to clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lisa K Jennings
- Lisa K. Jennings, PhD, 20 S. Dudley, Suite 900, Memphis, TN 38103, USA, Tel.: +1 901 866 1700, Fax: +1 901 866 1702, E-mail:
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Herr MJ, Mabry SE, Jameson JF, Jennings LK. Pro-MMP-9 upregulation in HT1080 cells expressing CD9 is regulated by epidermal growth factor receptor. Biochem Biophys Res Commun 2013; 442:99-104. [PMID: 24246676 DOI: 10.1016/j.bbrc.2013.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
Abstract
Degradation of the surrounding extracellular matrix (ECM) by matrix metalloproteinases (MMPs) drives invasion and metastasis of cancer cells. We previously demonstrated that tetraspanin CD9 expression upregulates pro-MMP-9 expression and release and promotes cellular invasion in a human fibrosarcoma cell line (HT1080). These events were dependent upon the highly functional second extracellular loop of CD9. We report here that the epidermal growth factor receptor (EGFR) tyrosine kinase expression and activity are involved in the CD9-mediated increase in pro-MMP-9 release and cellular invasion. Pro-MMP-9 expression was significantly decreased in a dose-dependent manner using first a broad spectrum receptor tyrosine kinase inhibitor and multiple specific EGFR inhibitors in CD9-HT1080 cells. Furthermore, gefitinib treatment of CD9-HT1080 cells reduced invasion through matrigel. EGFR knockdown using short interfering RNA resulted in decreased pro-MMP-9 expression and release into the media and subsequent cellular invasion without affecting CD9 expression or localization. Conclusively, this study points to EGFR as a key mediator between CD9-mediated pro-MMP-9 release and cellular invasion of HT1080 cells.
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Affiliation(s)
- Michael J Herr
- The Vascular Biology Center of Excellence, Department of Internal Medicine, USA; Department of Microbiology, Immunology, and Biochemistry, USA
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Jennings LK, Kotha J. The Utility of Platelet and Coagulation Testing of Antithrombotics: Fusing Science with Patient Care. Drug Dev Res 2013; 74:587-593. [PMID: 24489427 PMCID: PMC3902984 DOI: 10.1002/ddr.21119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Indexed: 01/09/2023]
Abstract
[Table: see text] There is an increasing need for the standardization of platelet function and coagulation testing for the assessment of antithrombotic therapies. Investigators continue to strive to identify ideal laboratory testing and monitoring procedures for acquired and inherited platelet function defects as well as for evaluating patient status when treated with existing or emerging antithrombotics. These therapies are used primarily in the treatment of ischemic complications. In patients receiving antithrombotic therapy, the balance between hemostasis and thrombosis is a challenge as there is an ongoing risk for bleeding when patients are receiving antiplatelet agents or anticoagulants to lessen their risk for secondary thrombotic events. There are several diverse tests for monitoring anticoagulant therapy; however, as new agents are developed, more specific tests will be required to directly assess these agents in relationship to overall coagulation status. Research in the platelet biology field is ongoing to provide point-of-care methodologies for the assessment of platelet reactivity in terms of both bleeding and thrombosis risk. Currently there are no instruments that reliably assess the risk of bleeding. The challenges that routinely faced are the complexity of physiology, the need for standardization of platelet testing methodology, and the necessity for appropriate interpretation of the test results.
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Affiliation(s)
- Lisa K Jennings
- The University of Tennessee Health Science Center and CirQuest Labs Memphis, TN, USA
| | - Jayaprakash Kotha
- The University of Tennessee Health Science Center and CirQuest Labs Memphis, TN, USA
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Mills RM, Berkowitz RD, Damaraju C, Jennings LK, Wildgoose P. Initiation of rivaroxaban following low molecular weight heparin for thromboprophylaxis after total joint replacement: The Safe, Simple Transitions (SST) study. Thromb Res 2012; 130:709-15. [DOI: 10.1016/j.thromres.2012.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/06/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Rowley JW, Finn AV, French PA, Jennings LK, Bluestein D, Gross PL, Freedman JE, Steinhubl SR, Zimmerman GA, Becker RC, Dauerman HL, Smyth SS. Cardiovascular devices and platelet interactions: understanding the role of injury, flow, and cellular responses. Circ Cardiovasc Interv 2012; 5:296-304. [PMID: 22511738 DOI: 10.1161/circinterventions.111.965426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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McCanless JD, Jennings LK, Bumgardner JD, Cole JA, Haggard WO. Hematoma-inspired alginate/platelet releasate/CaPO4 composite: initiation of the inflammatory-mediated response associated with fracture repair in vitro and ex vivo injection delivery. J Mater Sci Mater Med 2012; 23:1971-1981. [PMID: 22588505 DOI: 10.1007/s10856-012-4672-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/02/2012] [Indexed: 05/31/2023]
Abstract
A clinical need continues for consistent bone remodeling within problematic sites such as those of fracture nonunion, avascular necrosis, or irregular bone formations. In attempt to address such needs, a biomaterial system is proposed to induce early inflammatory responses after implantation and to provide later osteoconductive scaffolding for bone regeneration. Biomaterial-induced inflammation would parallel the early stage of hematoma-induced fracture repair and allow scaffold-promoted remodeling of osseous tissue to a healthy state. Initiation of the wound healing cascade by two human concentrated platelet releasate-containing alginate/β-tricalcium phosphate biocomposites has been studied in vitro using the TIB-71™ RAW264.7 mouse monocyte cell line. Inflammatory responses inherent to the base material were found and could be modulated through incorporation of platelet releasate. Differences in hydrogel wt% (2 vs. 8 %) and/or calcium phosphate granule vol.% (20 vs. 10 %) allowed for tuning the response associated with platelet releasate-associated growth factor elution. Tunability from completely suppressing the inflammatory response to augmenting the response was observed through varied elution profiles of both releasate-derived bioagents and impurities inherent to alginate. A 2.5-fold upregulation of inducible-nitric oxide synthase gene expression followed by a tenfold increase in nitrite media levels was induced by inclusion of releasate within the 8 wt%/10 vol.% formulation and was comparable to an endotoxin positive control. Whereas, near complete elimination of inflammation was seen when releasate was included within the 2 wt%/20 vol.% formulation. These in vitro results suggested tunable interactions between the multiple platelet releasate-derived bioagents and the biocomposites for enhancing hematoma-like fracture repair. Additionally, minimally invasive delivery for in situ curing of the implant system via injection was demonstrated in rat tail vertebrae using microcomputed tomography.
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Affiliation(s)
- Jonathan D McCanless
- Biomedical Engineering Department, Herff College of Engineering, The University of Memphis, Memphis, TN 38152, USA.
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Jennings LK, Moliterno D, Storey R, Hord E, Kotha J, Becker R, Smyth S, Providencia L, Moccetti T, Valgimigli M, Dery JP, Cornel J, Thomas G, Huber K, Chen E, Strony J, Rorick T, Tricoci P, Mahaffey K. PHARMACODYNAMICS OF VORAPAXAR, A PLATELET PAR-1 ANTAGONIST, AND ITS INTERACTION WITH P2Y12 RECEPTOR PATHWAY IN THE TRACER TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McCanless JD, Jennings LK, Cole JA, Bumgardner JD, Haggard WO. Induction of the early inflammatory-mediated cellular responses of fracture healing in vitro using platelet releasate-containing alginate/CaPO4 biomaterials for early osteoarthritis prevention. J Biomed Mater Res A 2012; 100:1107-14. [PMID: 22337563 DOI: 10.1002/jbm.a.34038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/29/2011] [Indexed: 12/18/2022]
Abstract
A significant gap exists in our understanding of subchondral and cancellous bone changes that may regulate osteoarthritis progression. Herein, we complement our prior osteochondrogenesis work with growth factor elution and monocyte and endothelial cell activation using two biomaterial formulations. The design of these biomaterials was inspired by the roles of a fracture hematoma, more specifically, the potential of significant cross-talk among cells and cellular factors that affect bone remodeling. Biomaterials, referred to herein as F1+ and F2+, are human concentrated platelet releasate-containing alginate/beta-tricalcium phosphate composites. F1+ has a higher calcium phosphate volume percentage and lower alginate polymer weight percent hydrogel versus F2+. The majority of releasate-derived platelet-derived growth factor eluted over 24 h for F1+ and 48 h for F2+, suggesting sustained release with an increase in alginate weight percentage. Simple monocyte and endothelial cell migration studies demonstrated 650% and 900% increases with F1+ eluate over medium alone, respectively. Induction of endothelial cell invasion over supplemented medium positive control was also shown for F2+ eluate (p = 0.03) with F1+ eluate being similar to the control. Monocyte transendothelial migration was increased over 300% and 400% for F1+ and F2+ eluates compared with medium alone, respectively. In addition, F1+ and F2+ eluates induced spontaneous endothelial tube formations similar to supplemented medium, demonstrating a well-formed network of capillary-like structures. This work demonstrated our biomaterial formulations ability to induce characteristics in vitro that parallel the in vivo behavior of fracture hematomas and potential to induce bone remodeling for the early treatment of osteoarthritic joints.
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Affiliation(s)
- Jonathan D McCanless
- Biomedical Engineering Department, Herff College of Engineering, The University of Memphis, Memphis, Tennessee 38152-3210, USA
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Kosoglou T, Kraft WK, Kumar B, Statkevich P, Xuan F, Ma L, Jennings LK, Schiller JE, Langdon RB, Cutler DL. Pharmacokinetics and pharmacodynamics of the novel PAR-1 antagonist vorapaxar in patients with end-stage renal disease. Eur J Clin Pharmacol 2012; 68:1049-56. [PMID: 22315147 DOI: 10.1007/s00228-012-1217-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine whether impaired renal function alters the pharmacokinetics (PK) of vorapaxar or its ability to inhibit thrombin receptor agonist peptide (TRAP)-induced platelet aggregation. METHODS This was an open-label study in which 8 patients with end-stage renal disease (ESRD) on hemodialysis and 7 matched (based on age, gender, weight, and height) healthy controls were administered a single 10-mg oral dose of vorapaxar. Blood samples for vorapaxar PK and pharmacodynamic analysis were collected predose and at frequent intervals up to 6 weeks postdose. RESULTS Mean vorapaxar bioavailability (based on area under the curve of plasma vorapaxar concentration over time) was identical in the two subject groups; the ESRD/healthy geometric mean ratio (GMR, expressed in percent) was 98. Mean maximum observed plasma concentration (77.4-98.2 ng/mL) was numerically lower in patients with ESRD compared with matched controls (GMR=76; 90% confidence interval=48 to 118). Median time of maximum observed plasma concentration was 2 h in both subject groups. The observed means for elimination half-life were 186 and 231 h in the ESRD and control groups, respectively. Inhibition of platelet aggregation was similar in the two groups. Four out of 15 (27%) subjects reported adverse events, all of which were characterized by the investigator as mild and unrelated to treatment. CONCLUSIONS ESRD had no clinically relevant effect on the PK profile of vorapaxar or its ability to inhibit TRAP-induced platelet aggregation.
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Jennings LK, Michelson AD, Jacoski MV, Tyagi A, Grgurevich S, Li JS, Picolo Investigators. Pharmacodynamic effects of clopidogrel in pediatric cardiac patients: a comparative study of platelet aggregation response. Platelets 2012; 23:430-8. [PMID: 22309046 DOI: 10.3109/09537104.2011.650244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little data on pediatric percent platelet aggregation (%PA) exist in the literature, particularly in cardiac patients and in response to clopidogrel. The objectives were to estimate the %PA range expected in pediatric patients and to measure the clopidogrel effect on %PA in the PICOLO (Platelet Inhibition in Children on Clopidogrel) trial. To estimate a neonatal/infant %PA response range, %PA induced by 5 µM adenosine diphosphate (ADP) was assessed using light transmission aggregometry in 16 cord and 11 normal adult blood samples and prior to clopidogrel therapy in 49 neonatal and 49 infant/toddler cardiac patients enrolled in PICOLO. The %PA induced by 5 µM thrombin receptor-activating peptide (TRAP) was also assessed for 10 neonates and 21 infants/toddlers enrolled in PICOLO and compared with 11 adult samples. Percent inhibition of platelet aggregation (%IPA) induced by 5 µM ADP at steady-state clopidogrel levels was assessed in 33 neonates and 39 infants/toddlers. ADP-induced %PA was lowest in cord blood samples, intermediate in study neonates and infants/toddlers, and highest in adults. Similarly, TRAP-induced platelet aggregation was lower in neonates and infants/toddlers than adults. For all groups, %PA and %IPA were highly variable, with 11% of neonates and 13% of infants/toddlers showing <10% IPA. In conclusion, ADP- and TRAP-induced %PA is lower in pediatric cardiac patients than normal adults, but highly variable in both. The lower baseline %PA may explain why the pediatric clopidogrel dose providing 30-50% IPA (0.20 mg/kg/day) is lower than a simple weight-based extrapolation of the adult dose (75 mg/day) providing similar inhibition.
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Affiliation(s)
- Lisa K Jennings
- Vascular Biology Center of Excellence, University of Tennessee Health Science Center , Memphis, TN 38163, USA.
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McCanless JD, Jennings LK, Cole JA, Bumgardner JD, Haggard WO. In vitro differentiation and biocompatibility of mesenchymal stem cells on a novel platelet releasate-containing injectable composite. J Biomed Mater Res A 2011; 100:220-9. [DOI: 10.1002/jbm.a.33256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/02/2011] [Accepted: 09/06/2011] [Indexed: 12/30/2022]
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Pasquali SK, Yow E, Jennings LK, Li JS. Platelet activity associated with concomitant use of clopidogrel and proton pump inhibitors in children with cardiovascular disease. CONGENIT HEART DIS 2011; 5:552-5. [PMID: 21106014 DOI: 10.1111/j.1747-0803.2010.00461.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT In adults with acute coronary syndrome, decreased platelet inhibition associated with concomitant use of clopidogrel and proton pump inhibitors (PPI) has been reported. OBJECTIVE To evaluate platelet activity associated with PPI + clopidogrel vs. clopidogrel alone in children enrolled in the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial of clopidogrel in children with a cardiac condition at risk for arterial thrombosis. DESIGN Patients 0-24 m randomized to active therapy in the PICOLO trial were included in the present analysis. Platelet aggregation inhibition at baseline and steady state were evaluated in patients taking clopidogrel + PPI vs. clopidogrel only in the overall cohort and sub-group of clopidogrel responders. RESULTS A total of 49 patients were included (44 clopidogrel only, five clopidogrel + PPI); median age 38 days (interquartile range [IQR] 17-157 days). The majority of patients in each group had undergone systemic-to-pulmonary artery shunt. Compared with the clopidogrel group, patients in the clopidogrel + PPI group had a trend toward lower percent inhibition of maximum extent of platelet aggregation overall (median 6%, IQR 0-44% vs. 49%, IQR 19-63%, P= 0.09), and a significant reduction in the clopidogrel responders sub-group (median 25%, IQR 3-45% vs. 53%, IQR 38-65%, P= 0.04). There was no difference in percent inhibition of rate of platelet aggregation. CONCLUSIONS Concomitant use of PPI + clopidogrel may be associated with decreased platelet inhibition in children with cardiac disease. Further study in a larger population and assessment of associated clinical outcomes is warranted.
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Affiliation(s)
- Sara K Pasquali
- Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 27715, USA.
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Hudson JQ, McNeely EB, Green CA, Jennings LK. Assessment of Eptifibatide Clearance by Hemodialysis Using an in vitro System. Blood Purif 2010; 30:266-71. [DOI: 10.1159/000320766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 08/29/2010] [Indexed: 11/19/2022]
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Abstract
The platelet is central to the pathogenesis of acute coronary syndromes (ACS), and antiplatelet therapy has demonstrated a significant reduction in the risk for ischemic events in patients with ACS. For patients with unstable angina or non-ST elevation myocardial infarctions, regardless of whether a conservative or invasive (i.e., percutaneous intervention) treatment approach is used, current guidelines recommend combination antiplatelet therapies, including aspirin with the thienopyridines clopidogrel or prasugrel and/or a glycoprotein IIb/IIIa inhibitor. However, there remains a significant incidence of arterial thrombosis in patients receiving currently available antiplatelet therapy, indicating the need for improved and/or alternative agents and targets. Recent landmark clinical trials of new oral antiplatelet therapies, including the thienopyridine prasugrel and the investigational reversible oral adenosine diphosphate antagonist ticagrelor, indicate they have a faster onset of action, result in a more predictable response, and provide improved efficacy compared to clopidogrel, the current standard of care. Other promising potential targets under investigation to reduce the contribution of the platelet to ACS pathophysiology include von Willebrand factor, thromboxane A(2), and protease-activated receptor-1. Of these, the protease-activated receptor-1 antagonist vorapaxar (SCH 530348) is furthest along in clinical development, with phase II data showing profound inhibition of platelet aggregation and a large phase III development program under way. A fundamental lingering issue is whether improved prevention and treatment of thrombosis can be separated from an increase in hemorrhage or bleeding, and clinicians must continue to consider the potential risks and benefits when individualizing antiplatelet therapy for patients with ACS.
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Affiliation(s)
- Richard C Becker
- Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA.
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Bonello L, Tantry US, Marcucci R, Blindt R, Angiolillo DJ, Becker R, Bhatt DL, Cattaneo M, Collet JP, Cuisset T, Gachet C, Montalescot G, Jennings LK, Kereiakes D, Sibbing D, Trenk D, Van Werkum JW, Paganelli F, Price MJ, Waksman R, Gurbel PA. Consensus and Future Directions on the Definition of High On-Treatment Platelet Reactivity to Adenosine Diphosphate. J Am Coll Cardiol 2010; 56:919-33. [PMID: 20828644 DOI: 10.1016/j.jacc.2010.04.047] [Citation(s) in RCA: 893] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/30/2010] [Accepted: 04/05/2010] [Indexed: 12/17/2022]
Affiliation(s)
- Laurent Bonello
- Department of Cardiology, Institut National de la Santè et de la Recherche Médicale Unité Mixte de Recherche 608, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France
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Deibele AJ, Jennings LK, Tcheng JE, Neva C, Earhart AD, Gibson CM. Intracoronary Eptifibatide Bolus Administration During Percutaneous Coronary Revascularization for Acute Coronary Syndromes With Evaluation of Platelet Glycoprotein IIb/IIIa Receptor Occupancy and Platelet Function. Circulation 2010; 121:784-91. [DOI: 10.1161/circulationaha.109.882746] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Eptifibatide reduces major adverse cardiac events in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). Intracoronary bolus administration of eptifibatide may result in higher levels of platelet glycoprotein IIb/IIIa receptor occupancy in the local coronary bed, disaggregate thrombus in the epicardial artery and microvasculature, and thereby improve coronary flow.
Methods and Results—
Patients undergoing PCI for an acute coronary syndrome were randomized to either intracoronary or intravenous bolus administration of eptifibatide. The primary end point was the local glycoprotein IIb/IIIa receptor occupancy measured in the coronary sinus. There were no angiographic, electrophysiological, or other adverse findings attributable to intracoronary eptifibatide. Platelet glycoprotein IIb/IIIa receptor occupancy was significantly greater with intracoronary versus intravenous administration: first bolus, 94±9% versus 51±15% (
P
<0.001); and second bolus, 99±2% versus 91±4% (
P
=0.001), respectively. Microvascular perfusion was significantly improved as measured by the corrected thrombolysis in myocardial infarction frame count (cTFC) with intracoronary versus intravenous administration: pre-PCI, 36 (median) (25th and 75th percentiles, 16 and 64) versus 31 (25th and 75th percentiles, 23 and 45;
P
=0.8); and post-PCI, 18 (25th and 75th percentiles, 10 and 22) versus 25 (25th and 75th percentiles, 22 and 35;
P
=0.007), respectively. The only multivariate predictor associated with a post-PCI cTFC rank score was the first bolus glycoprotein IIb/IIIa receptor occupancy (
P
<0.001).
Conclusions—
Intracoronary bolus administration of eptifibatide during PCI in patients with acute coronary syndromes results in higher local platelet glycoprotein IIb/IIIa receptor occupancy, which is associated with improved microvascular perfusion demonstrated by an improved cTFC.
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Affiliation(s)
- Albert J. Deibele
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
| | - Lisa K. Jennings
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
| | - James E. Tcheng
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
| | - Cathy Neva
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
| | - Angela D. Earhart
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
| | - C. Michael Gibson
- From the Duluth Clinic, Division of Cardiology, Duluth, Minn (A.J.D., C.N.); University of Tennessee, Vascular Biology Center of Excellence, Memphis (L.K.J., A.D.E.); Duke University Medical Center, Division of Cardiology, Durham, NC (J.E.T.); and Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Mass (C.M.G.)
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46
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Abstract
Platelets are central mediators of haemostasis at sites of vascular injury, but they also mediate pathologic thrombosis. Activated platelets stimulate thrombus formation in response to rupture of an atherosclerotic plaque or endothelial cell erosion, promoting atherothrombotic disease. They also interact with endothelial cells and leukocytes to promote inflammation, which contributes to atherosclerosis. Multiple pathways contribute to platelet activation, and current oral antiplatelet therapy with aspirin and a P2Y(12) adenosine diphosphate (ADP) receptor antagonist target the thromboxane A(2) and ADP pathways, respectively. Both can diminish activation by other factors, but the extent of their effects depends upon the agonist, agonist strength, and platelet reactivity status. Although these agents have demonstrated significant clinical benefit, residual morbidity and mortality remain high. Neither agent is effective in inhibiting thrombin, the most potent platelet activator. This lack of comprehensive inhibition of platelet function allows continued thrombus formation and exposes patients to risk for recurrent thrombotic events. Moreover, bleeding risk is a substantial limitation of antiplatelet therapy, because these agents target platelet activation pathways critical for both protective haemostasis and pathologic thrombosis. Novel antiplatelet therapies that provide more complete inhibition of platelet activation without increasing bleeding risk could considerably decrease residual risk for ischemic events. Inhibition of the protease-activated receptor (PAR)-1 platelet activation pathway stimulated by thrombin is a novel, emerging approach to achieve more comprehensive inhibition of platelet activation when used in combination with current oral antiplatelet agents. PAR-1 inhibition is not expected to increase bleeding risk, as this pathway does not interfere with haemostasis.
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Affiliation(s)
- Lisa K Jennings
- University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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47
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Speich HE, Earhart AD, Hill SN, Cholera S, Kueter TJ, Smith JN, White MM, Jennings LK. Variability of platelet aggregate dispersal with glycoprotein IIb-IIIa antagonists eptifibatide and abciximab. J Thromb Haemost 2009; 7:983-91. [PMID: 19548907 DOI: 10.1111/j.1538-7836.2009.03432.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Utilization of glycoprotein IIb-IIIa (GPIIb-IIIa) inhibitors improves outcomes of patients with acute coronary syndromes (ACS), including those undergoing percutaneous coronary intervention (PCI). These results may be related to the ability of the inhibitors to destabilize coronary thrombi, reduce microembolization, and restore vessel patency. OBJECTIVE To evaluate in vitro the ability of GPIIb-IIIa antagonists, abciximab and eptifibatide, to promote the disaggregation of platelet-rich thrombus. METHODS Antagonist-induced disaggregation was assayed in plasma by aggregometry, as well as in whole blood by point of care and capillary perfusion systems. Fibrinogen dissociation from the platelet surface was quantified by flow cytometry. RESULTS Significant disaggregation of 5 microm ADP-induced aggregates was observed after addition of either agent. The maximum extent and rate of disaggregation were significantly higher with eptifibatide than with abciximab. Both antagonists also dispersed 2 microg mL(-1) collagen-induced aggregates, again with eptifibatide having a greater effect. Eptifibatide, but not abciximab (up to 10 microg mL(-1)), was efficient at dissociating aggregates to single platelets in whole blood and dispersing aggregates that had been aged for 30 min before treatment. Eptifibatide also reduced existing thrombus burden in the perfusion model under arterial flow conditions. A key mechanism of aggregate dispersal was antagonist-induced displacement of platelet-bound fibrinogen, which was greater with eptifibatide, a competitive inhibitor of fibrinogen binding, than with the noncompetitive inhibitor, abciximab. CONCLUSIONS These results suggest that drug concentration and residence time, along with thrombus extent and age, may be critical determinants in promoting timely recanalization.
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Affiliation(s)
- H E Speich
- Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
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48
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Chandler AB, Earhart AD, Speich HE, Kueter TJ, Hansen J, White MM, Jennings LK. Regulation of CD40L (CD154) and CD62P (p-selectin) surface expression upon GPIIb-IIIa blockade of platelets from stable coronary artery disease patients. Thromb Res 2009; 125:44-52. [PMID: 19487018 DOI: 10.1016/j.thromres.2009.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/20/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to further characterize the effect of the antiplatelet agents, aspirin and eptifibatide, on the surface expression of CD40L and CD62P on platelets from patients with stable coronary artery disease. MATERIALS AND METHODS Platelet function was evaluated using standard light transmission aggregometry. Measurements of CD62P and CD40L were carried out by flow cytometry and ELISA assays. RESULTS All patients had the expected level of platelet aggregation inhibition in response to 20 muM ADP in the presence of increasing eptifibatide concentrations. Platelet activation by adenosine diphosphate (ADP) or thrombin agonist peptide (TRAP) increased CD62P and CD40L surface density in the presence of aspirin by 1.9 - 2.8 -fold. Aspirin treatment did not prevent either CD62P or CD40L expression. Eptifibatide pretreatment at pharmacologically relevant concentrations blocked agonist-induced increases in CD62P platelet surface density. A marked percentage of platelets still expressed low levels of surface CD62P suggesting slight platelet activation even with potent platelet inhibition. Eptifibatide also blocked agonist-induced increases in CD40L surface expression and decreased the percent of platelets positive for surface CD40L. Decreased expression of CD40L was due to an inhibition of CD40L translocation and not caused by enhanced shedding from the surface, as soluble CD40L (sCD40L). Eptifibatide concentrations that effectively blocked platelet aggregation correlated with total inhibition of increased CD62P and CD40L surface density. CONCLUSION Blockade of the GPIIb-IIIa receptor on platelets from coronary artery disease patients may have significant bearing on reducing proinflammatory and procoagulant events mediated by CD62P and sCD40L.
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Affiliation(s)
- A Bleakley Chandler
- University Health Care System, 1348 Walton Way Suite #5100, Augusta, GA 30901, USA.
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49
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Becker RC, Moliterno DJ, Jennings LK, Pieper KS, Pei J, Niederman A, Ziada KM, Berman G, Strony J, Joseph D, Mahaffey KW, Van de Werf F, Veltri E, Harrington RA. Safety and tolerability of SCH 530348 in patients undergoing non-urgent percutaneous coronary intervention: a randomised, double-blind, placebo-controlled phase II study. Lancet 2009; 373:919-28. [PMID: 19286091 DOI: 10.1016/s0140-6736(09)60230-0] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND An antithrombotic drug is needed that safely reduces cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). We therefore assessed the tolerability and safety of SCH 530348-an oral platelet protease-activated receptor-1 antagonist. METHODS We randomly assigned patients aged 45 years or older and undergoing non-urgent PCI or coronary angiography with planned PCI to an oral loading dose of SCH 530348 (10 mg, 20 mg, or 40 mg) or matching placebo in a 3:1 ratio in a multicentre international study. Those in the SCH 530348 group who subsequently underwent PCI (primary PCI cohort) continued taking an oral maintenance dose (0.5 mg, 1.0 mg, or 2.5 mg per day), and patients in the placebo group continued placebo for 60 days. The primary endpoint was the incidence of clinically significant major or minor bleeding according to the thrombolysis in myocardial infarction (TIMI) scale. Both investigators and patients were unaware of treatment allocation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00132912. FINDINGS 257 patients were assigned to placebo and 773 to SCH 530348. The primary endpoint occurred in 2 (2%) of 129, 3 (3%) of 120, and 7 (4%) of 173 patients, respectively, in the SCH 530348 10 mg, 20 mg, and 40 mg groups compared with 5 (3%) of 151 patients in the placebo group (p=0.5786). TIMI major plus minor bleeding occurred in 3 (2%) of 136, 5 (4%) of 139, and 4 (3%) of 138 patients given SCH 530348 0.5 mg, 1.0 mg, and 2.5 mg once per day, respectively (p=0.7561). INTERPRETATION Oral SCH 530348 was generally well tolerated and did not cause increased TIMI bleeding, even when administered concomitantly with aspirin and clopidogrel. Further testing in phase III trials to accurately define the safety and efficacy of SCH 530348 is warranted.
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50
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Abstract
Tetraspanins are multiple membrane-spanning proteins that likely function as the organizers of membrane microdomains. Tetraspanins associate with other membrane-bound molecules such as cell-adhesion proteins, growth factor receptors, and Ig superfamily members and regulate key cellular processes such as adhesion, migration, and fusion. Tetraspanins are widely expressed in vascular and haematopoietic cells and are involved in both physiological and pathological processes related to angiogenesis, vascular injury, thrombosis, and haemostasis. A wide body of evidence suggests that tetraspanins directly regulate the development and functions of the vascular system and the pathogenesis of vascular diseases. This article reviews current understanding of the roles of tetraspanins in vascular functions.
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Affiliation(s)
- Feng Zhang
- Vascular Biology Center of Excellence, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN 38163, USA
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