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 (PCI) and may cause arterial thrombosis with consequent myocardial necrosis. Given the high incidence of adverse effects in patients with acute coronary syndromes (ACS), 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 ACS patients.
Methods and Results—We report the development of a first-in-class intracellular PAR1 inhibitor with optimized pharmacokinetic properties for use during PCI in ACS patients. PZ-128 is a cell-penetrating 'pepducin' inhibitor of PAR1 which 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 h. Importantly, PZ-128 had no effect on bleeding or coagulation parameters in primates or in blood from PCI patients.
Conclusions—Based on the efficacy data in non-human 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 PCI and may provide an alternative to long-acting small molecule inhibitors of PAR1.
- Received January 9, 2012.
- Accepted May 4, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited