P2X(1) receptor inhibition and soluble CD39 administration as novel approaches to widen the cardiovascular therapeutic window.
Thrombus formation at sites of disrupted atherosclerotic plaques is a leading cause of death and disability worldwide. Although the platelet is now recognized to be a central regulator of thrombus formation, development of antiplatelet reagents that selectively target thrombosis over hemostasis represents a challenge. Existing prophylactic antiplatelet therapies are centered on the use of aspirin, an irreversible cyclooxygenase inhibitor, and a thienopyridine such as clopidogrel, which inactivates the adenosine diphosphate-stimulated P2Y(12) receptor. Although these compounds are widely used and have beneficial effects for patients, their antithrombotic benefit is complicated by an elevated bleeding risk and substantial or partial "resistance." Moreover, combination therapy with these two drugs increases the hemorrhagic risk even further. This review explores the possibility of inhibiting the platelet-surface ionotropic P2X(1) receptor and/or elevating CD39/NTPDase1 activity as new therapeutic approaches to reduce overall platelet reactivity and recruitment of surrounding platelets at prothrombotic locations. Because both proteins affect platelet activation at an early stage in the events leading to thrombosis but are less crucial in hemostasis, they provide new strategies to widen the cardiovascular therapeutic window without compromising safety.
Fung
C Y E
CY
Department of Cell Physiology and Pharmacology, University of Leicester, LE19HN Leicester, United Kingdom.
Marcus
Aaron J
AJ
Broekman
M Johan
MJ
Mahaut-Smith
Martyn P
MP
D000255:Adenosine Triphosphate / Q000627:therapeutic use; D015703:Antigens, CD / Q000187:drug effects / Q000378:metabolism*; D001081:Apyrase / Q000187:drug effects / Q000378:metabolism*; D001241:Aspirin / Q000627:therapeutic use; D035843:Biomedical Research; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018048:Receptors, Purinergic P2 / Q000187:drug effects*; D058469:Receptors, Purinergic P2X; D058925:Receptors, Purinergic P2Y12; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D015703:Antigens, CD; D016861:Cyclooxygenase Inhibitors; C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D018048:Receptors, Purinergic P2; D058469:Receptors, Purinergic P2X; D058925:Receptors, Purinergic P2Y12; D000255:Adenosine Triphosphate; D000077144:Clopidogrel; D001081:Apyrase; C067869:CD39 antigen; D013988:Ticlopidine; D001241:Aspirin