Future Antithrombotic Therapies in Cardiology

Thrombi are composed of activated platelets and fibrin, the latter being the final product of the blood coagulation system. Therefore, antithrombotic therapies may either interfere with adhesion, aggregation, secretion or signalling of platelets or with fibrin formation. Established drugs potently inhibit clot formation, but also increase the risk of bleeding. In this review article, we discuss novel strategies for the inhibition of pathological thrombosis while enabling normal haemostasis, thus minimizing the risk of bleeding.

A ligand-specific blockade of the integrin Mac-1 selectively targets pathologic inflammation while maintaining protective host-defense

Integrin-based therapeutics have garnered considerable interest in the medical treatment of inflammation. Integrins mediate the fast recruitment of monocytes and neutrophils to the site of inflammation, but are also required for host defense, limiting their therapeutic use. Here, we report a novel monoclonal antibody, anti-M7, that specifically blocks the interaction of the integrin Mac-1 with its pro-inflammatory ligand CD40L, while not interfering with alternative ligands. Anti-M7 selectively reduces leukocyte recruitment in vitro and in vivo. In contrast, conventional anti-Mac-1 therapy is not specific and blocks a broad repertoire of integrin functionality, inhibits phagocytosis, promotes apoptosis, and fuels a cytokine storm in vivo. Whereas conventional anti-integrin therapy potentiates bacterial sepsis, bacteremia, and mortality, a ligand-specific intervention with anti-M7 is protective. These findings deepen our understanding of ligand-specific integrin functions and open a path for a new field of ligand-targeted anti-integrin therapy to prevent inflammatory conditions.