Selinexor, a selective inhibitor of nuclear export, inhibits human neutrophil extracellular trap formation in vitro

Neutrophils are central players in the innate immune system. To protect against invading pathogens, neutrophils can externalize chromatin to create neutrophil extracellular traps (NETs). While NETs are critical to host defense, they also have deleterious effects, and dysregulation of NETs formation has been implicated in autoimmune diseases, atherosclerosis and thrombotic conditions, cancer progression and dissemination, and acute respiratory distress syndrome. Here, we report that selinexor, a first-in-class selective inhibitor of nuclear export approved for the treatment of multiple myeloma and diffuse large B-cell lymphoma, markedly suppressed the release of NETs in vitro. Furthermore, we demonstrate a significant inhibitory effect of selinexor on NETs formation, but not on oxidative burst or enzymatic activities central to NETs release such as neutrophil elastase, myeloperoxidase or peptidyl arginine deiminase type IV. The inhibitory effect of selinexor was demonstrated in neutrophils activated by a variety of NETs-inducers, including PMA, TGF-β, TNF-α and IL-8. Maximal inhibition of NETs formation was observed using TGF-β, for which selinexor inhibited NETs release by 61.6%. These findings pave the way to the potential use of selinexor in an effort to reduce disease burden by inhibition of NETs.

Therapeutic potential of GP IIb/IIIa receptor antagonists in acute myocardial infarction

The management of acute myocardial infarction (AMI) has changed dramatically over the last two decades, with the addition of fibrinolytic agents and primary coronary intervention (PCI). The more recent development of the glycoprotein (GP) IIb/IIIa antagonists, a new class of potent antiplatelet drugs, has the potential to considerably enhance the treatment of AMI patients. A number of recent studies have highlighted the potential incremental benefits with adjunctive IIb/IIIa-targeted therapy. In this review, we will discuss the pathophysiology of myocardial infarction (MI), the physiology and role of platelets in thrombosis and describe the currently available drugs. We will briefly summarise the results of recent clinical trials, discuss some key forthcoming trials and attempt to describe how GP IIb/IIIa antagonists may directly impact the immediate and near future day-to-day care of patients with AMI.