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Papanikolaou P, Antonopoulos AS, Mastorakou I, Angelopoulos A, Kostoula E, Mystakidi XV, Simantiris S, Galiatsatos N, Oikonomou E, Tousoulis D. Antithrombotic Therapy in Carotid Artery Disease. Curr Pharm Des 2020; 26:2725-2734. [PMID: 32418521 DOI: 10.2174/1381612826666200518111359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022]
Abstract
The management of asymptomatic atherosclerotic carotid artery disease and the role of antithrombotic therapy is of increasing importance for stroke prevention. Non-invasive imaging of carotid plaques can identify high-risk plaque features that are associated with the risk of plaque rupture. Carotid plaque necrosis, hemorrhage, fibrous cap thinning, and the presence of foam cells have all been correlated with the risk of rupture and onset of neurological symptoms in patients with carotid stenosis. Antiplatelets are currently recommended for patients with a history of ischemic stroke and/or significant carotid artery stenosis, with aspirin and clopidogrel being the most widely used and studied agents. The role of dual antiplatelet therapy remains controversial. Moreover, there is scarce evidence on the role of newer anticoagulant agents in stable patients with carotid artery stenosis. In this review article, we discuss the pathophysiology of carotid atherosclerosis, the use of non-invasive imaging for detecting the vulnerable carotid plaque and summarize the existing clinical evidence on the use of antiplatelet and antithrombotic agents in carotid artery disease.
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Affiliation(s)
- Paraskevi Papanikolaou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Irene Mastorakou
- Imaging Department - Onassis Cardiac Surgery Centre, Athens, Greece
| | - Andreas Angelopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Xara-Vasiliki Mystakidi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Spyros Simantiris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Nikolaos Galiatsatos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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Barbieri CM, Wang X, Wu W, Zhou X, Ogawa AM, O'Neill K, Chu D, Castriota G, Seiffert DA, Gutstein DE, Chen Z. Factor XIIa as a Novel Target for Thrombosis: Target Engagement Requirement and Efficacy in a Rabbit Model of Microembolic Signals. J Pharmacol Exp Ther 2017; 360:466-475. [PMID: 28035006 DOI: 10.1124/jpet.116.238493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/22/2016] [Indexed: 11/22/2022] Open
Abstract
Coagulation Factor XII (FXII) plays a critical role in thrombosis. What is unclear is the level of enzyme occupancy of FXIIa that is needed for efficacy and the impact of FXIIa inhibition on cerebral embolism. A selective activated FXII (FXIIa) inhibitor, recombinant human albumin-tagged mutant Infestin-4 (rHA-Mut-inf), was generated to address these questions. rHA-Mut-inf displayed potency comparable to the original wild-type HA-Infestin-4 (human FXIIa inhibition constant = 0.07 and 0.12 nM, respectively), with markedly improved selectivity against Factor Xa (FXa) and plasmin. rHA-Mut-inf binds FXIIa, but not FXII zymogen, and competitively inhibits FXIIa protease activity. Its mode of action is hence akin to typical small-molecule inhibitors. Plasma shift and aPTT studies with rHA-Mut-inf demonstrated that calculated enzyme occupancy for FXIIa in achieving a putative aPTT doubling target in human, nonhuman primate, and rabbit is more than 99.0%. The effects of rHA-Mut-inf in carotid arterial thrombosis and microembolic signal (MES) in middle cerebral artery were assessed simultaneously in rabbits. Dose-dependent inhibition was observed for both arterial thrombosis and MES. The ED50 of thrombus formation was 0.17 mg/kg i.v. rHA-Mut-inf for the integrated blood flow and 0.16 mg/kg for thrombus weight; the ED50 for MES was 0.06 mg/kg. Ex vivo aPTT tracked with efficacy. In summary, our findings demonstrated that very high enzyme occupancy will be required for FXIIa active site inhibitors, highlighting the high potency and exquisite selectivity necessary for achieving efficacy in humans. Our MES studies suggest that targeting FXIIa may offer a promising strategy for stroke prevention associated with thromboembolic events.
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Affiliation(s)
- Christopher M Barbieri
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Xinkang Wang
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Weizhen Wu
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Xueping Zhou
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Aimie M Ogawa
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Kim O'Neill
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Donald Chu
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Gino Castriota
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Dietmar A Seiffert
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - David E Gutstein
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
| | - Zhu Chen
- In Vitro Pharmacology (C.M.B., A.M.O., K.O., D.C.) and Cardiometabolic Diseases (X.W., W.W., X.Z., G.C., D.A.S., D.E.G., Z.C.), Merck & Co., Inc., Kenilworth, New Jersey
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3
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Wang X, Kurowski S, Wu W, Castriota GA, Zhou X, Chu L, Ellsworth KP, Chu D, Edmondson S, Ali A, Andre P, Seiffert D, Erion M, Gutstein DE, Chen Z. Inhibition of Factor XIa Reduces the Frequency of Cerebral Microembolic Signals Derived from Carotid Arterial Thrombosis in Rabbits. J Pharmacol Exp Ther 2017; 360:476-483. [PMID: 28035007 DOI: 10.1124/jpet.116.238600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/21/2016] [Indexed: 03/08/2025] Open
Abstract
Factor XI (FXI) is an integral component of the intrinsic pathway of the coagulation cascade and plays a critical role in thrombus formation. Because its role in the pathogenesis of cerebral microembolic signals (MES) is unclear, this study used a potent and selective small molecule inhibitor of FXIa, compound 1, to assess the effect of FXI blockade in our recently established preclinical model of cerebral MES induced by FeCl3 injury of the carotid artery in male New Zealand White rabbits. Ascending doses of compound 1 were evaluated simultaneously for both carotid arterial thrombosis by a Doppler flowmeter and MES in the middle cerebral artery by a transcranial Doppler. Plasma drug exposure and pharmacodynamic responses to compound 1 treatment were also assessed. The effective dose for 50% inhibition (ED50) of thrombus formation was 0.003 mg/kg/h compound 1, i.v. for the integrated blood flow, 0.004 mg/kg/h for reduction in thrombus weight, and 0.106 mg/kg/h for prevention of MES. The highest dose, 3 mg/kg/h compound 1, achieved complete inhibition in both thrombus formation and MES. In addition, we assessed the potential bleeding liability of compound 1 (5 mg/kg/h, i.v., >1250-fold ED50 levels in arterial thrombosis) in rabbits using a cuticle bleeding model, and observed about 2-fold (not statistically significant) prolongation in bleeding time. Our study demonstrates that compound 1 produced a robust and dose-dependent inhibition of both arterial thrombosis and MES, suggesting that FXIa blockade may represent a novel therapeutic strategy for the reduction in MES in patients at risk for ischemic stroke.
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Affiliation(s)
- Xinkang Wang
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Stan Kurowski
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Weizhen Wu
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Gino A Castriota
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Xueping Zhou
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Lin Chu
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Kenneth P Ellsworth
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Donald Chu
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Scott Edmondson
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Amjad Ali
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Patrick Andre
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Dietmar Seiffert
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Mark Erion
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - David E Gutstein
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
| | - Zhu Chen
- Cardiometabolic Disease Biology (X.W., S.K., W.W., G.A.C., X.Z., P.A., D.S., M.E., D.E.G., Z.C.), Discovery Pharmaceutical Sciences (L.C.), In Vitro Pharmacology (K.E., D.C.), and Discovery Chemistry (S.E.), Merck Research Laboratories, Kenilworth, New Jersey; Lead Optimization Chemistry, Merck Research Laboratories, Rahway, New Jersey (A.A.)
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