title: GPIIb/IIIa inhibitors: from bench to bedside and back to bench again.
abstract: From the discovery of the platelet glycoprotein (GP) IIb/IIIa and identification of its central role in haemostasis, the integrin GPIIb/IIIa (αIIbβ3, CD41/CD61) was destined to be an anti-thrombotic target. The subsequent successful development of intravenous ligand-mimetic inhibitors occurred during a time of limited understanding of integrin physiology. Although efficient inhibitors of ligand binding, they also mimic ligand function. In the case of GPIIb/IIIa inhibitors, despite strongly inhibiting platelet aggregation, paradoxical fibrinogen binding and platelet activation can occur. The quick progression to development of small-molecule orally available inhibitors meant that this approach inherited many potential flaws, which together with a short half-life resulted in an increase in mortality and a halt to the numerous pharmaceutical development programs. Limited clinical benefits, together with the success of other anti-thrombotic drugs, in particular P2Y12 ADP receptor blockers, have also led to a restrictive use of intravenous GPIIb/IIIa inhibitors. However, with a greater understanding of this key platelet-specific integrin, GPIIb/IIIa remains a potentially attractive target and future drug developments will be better informed by the lessons learnt from taking the current inhibitors back to the bench. This overview will review the physiology behind the inherent problems of a ligand-based integrin inhibitor design and discuss novel promising approaches for GPIIb/IIIa inhibition.
authors.affiliation: Atherothrombosis & Vascular Biology, Baker IDI Heart & Diabetes Institute, Melbourne, VC, Australia.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Armstrong
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Peter
mesh_terms: D000284:Administration, Oral; D000818:Animals; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D015195:Drug Design; D006801:Humans; D008024:Ligands; D015394:Molecular Structure; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D018570:Risk Assessment; D013329:Structure-Activity Relationship; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy*; D017211:Treatment Failure
chemical_list: D008024:Ligands; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex