Suppression of arterial thrombosis without affecting hemostatic parameters with a cell-penetrating PAR1 pepducin.
BACKGROUND
Thrombin-dependent platelet activation is heightened in the setting of percutaneous coronary intervention and may cause arterial thrombosis with consequent myocardial necrosis. Given the high incidence of adverse effects in patients with acute coronary syndromes, there remains an unmet need for the development of new therapeutics that target platelet activation without unduly affecting hemostasis. The thrombin receptor, PAR1, has recently emerged as a promising new target for therapeutic intervention in patients with acute coronary syndromes.


RESULTS
We report the development of a first-in-class intracellular PAR1 inhibitor with optimized pharmacokinetic properties for use during percutaneous coronary intervention in patients with acute coronary syndromes. PZ-128 is a cell-penetrating pepducin inhibitor of PAR1 that targets the receptor-G-protein interface on the inside surface of platelets. The structure of PZ-128 closely resembles the predicted off-state of the corresponding juxtamembrane region of the third intracellular loop of PAR1. The onset of action of PZ-128 was rapid and suppressed PAR1 aggregation and arterial thrombosis in guinea pigs and baboons and strongly synergized with oral clopidogrel. There was full recovery of platelet function by 24 hours. Importantly, PZ-128 had no effect on bleeding or coagulation parameters in primates or in blood from patients undergoing percutaneous coronary intervention.


CONCLUSIONS
Based on the efficacy data in nonhuman primates with no noted adverse effects on hemostasis, we anticipate that the rapid onset of platelet inhibition and reversible properties of PZ-128 are well suited to the acute interventional setting of percutaneous coronary intervention and may provide an alternative to long-acting small-molecule inhibitors of PAR1.
Hemostasis & Thrombosis Laboratory, Tufts Medical Center, Box 7510, 750 Washington St, Boston, MA 02111, USA.
Ping
P
Zhang
András
A
Gruber
Shogo
S
Kasuda
Carey
C
Kimmelstiel
Katie
K
O'Callaghan
Daniel H
DH
Cox
Andrew
A
Bohm
James D
JD
Baleja
Lidija
L
Covic
Athan
A
Kuliopulos
D000818:Animals; D002462:Cell Membrane / Q000187:drug effects* / Q000378:metabolism; D006168:Guinea Pigs; D006487:Hemostasis / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use; D008252:Macaca fascicularis; D008297:Male; D048530:Papio anubis; D015539:Platelet Activation / Q000187:drug effects* / Q000502:physiology; D010975:Platelet Aggregation Inhibitors / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D044463:Receptor, PAR-1 / Q000378:metabolism; D013927:Thrombosis / Q000188:drug therapy* / Q000378:metabolism
C552958:F2pal-16 pepducin; D055666:Lipopeptides; D010975:Platelet Aggregation Inhibitors; D044463:Receptor, PAR-1