Abstract:
Clopidogrel (CLO) is a clinical antiplatelet agent, about which there are major concerns because its antiplatelet efficiency decreases with insufficient metabolic activation, leading to “clopidogrel resistance.” We aimed to determine the antiplatelet effects of W1, a novel molecule composed of 2-O-clopidogrel and aspirin (1:1 ratio), on platelet aggregation ex vivo and thrombus formation in vivo, and its susceptibility to CLO resistance in combination with other therapies in rats. Platelets were prepared, and an arteriovenous shunt thrombosis model was established using Wistar rats to measure platelet aggregation and thrombus formation, respectively. W1 markedly inhibited adenosine 5′-diphosphate (ADP)-induced platelet aggregation and thrombus formation dose dependently (0.3, 1, and 3 mg/kg). W1 (3 mg/kg) acted rapidly at 0.5 hours and lasted for 72 hours. W1 prolonged bleeding and clotting times in mice, confirming its antithrombotic properties. Compared with CLO 10 mg/kg, the positive control, W1 3 mg/kg exerted equivalent effects on the above specifications. In addition, cyclic adenosine monophosphate levels, measured in rat platelets, increased rapidly after prostaglandin E1 (alprostadil) stimulation of the vehicle control (0.5% methyl cellulose suspension) and W1 (3 mg/kg)-treated groups. ADP (50 μm) reduced the control levels more remarkably than W1 did (P < 0.05 in 3 minutes or P < 0.001 at 5 minutes), suggesting that W1 suppressed ADP-induced cyclic adenosine monophosphate reduction. This was associated with a significant platelet reactivity inhibition measured using the vasodilator-stimulated phosphoprotein assay. CLO or W1 coadministration with or without omeprazole and amlodipine to rats to investigate the pharmacodynamic interactions revealed that W1 exhibited more stable and potent antithrombotic effects than CLO did. In conclusion, both W1 and CLO showed antiplatelet and antithrombotic effects, while the former exhibited less CLO resistance in combination with omeprazole or amlodipine, 2 drugs that inhibit CLO metabolism. Therefore, this study implies that W1 may be a promising oral antiplatelet agent for reducing CLO resistance after percutaneous coronary intervention.
摘要
氯吡格雷(CLO)是一种临床抗血小板药物,由于其抗血小板效率会随着代谢活化不足而降低,从而导致 "氯吡格雷耐药",因此备受关注。我们旨在确定 W1(一种由 2-O- 氯吡格雷和阿司匹林(1:1 比例)组成的新型分子)对大鼠体内外血小板聚集和血栓形成的抗血小板作用,以及它与其他疗法联合使用时对 CLO 抗性的易感性。制备血小板,用 Wistar 大鼠建立动静脉分流血栓模型,分别测量血小板聚集和血栓形成。W1能明显抑制5′-二磷酸腺苷(ADP)诱导的血小板聚集和血栓形成,其抑制剂量与剂量有关(0.3、1和3 mg/kg)。W1(3 毫克/千克)在 0.5 小时内迅速发挥作用,并持续 72 小时。W1 延长了小鼠的出血和凝血时间,证实了其抗血栓形成的特性。与阳性对照组 CLO 10 毫克/千克相比,W1 3 毫克/千克对上述指标具有同等效果。此外,在前列腺素 E1(阿普芪地尔)刺激大鼠血小板后,载体对照组(0.5% 甲基纤维素悬浮液)和 W1(3 毫克/千克)处理组的环磷酸腺苷水平迅速升高。与 W1 相比,ADP(50 μm)更显著地降低了对照组的水平(3 分钟内 P < 0.05 或 5 分钟内 P < 0.001),这表明 W1 抑制了 ADP 诱导的环磷酸腺苷减少。这与使用血管扩张剂刺激磷蛋白测定法测量的血小板反应性明显抑制有关。为研究药效学相互作用,大鼠在服用或不服用奥美拉唑和氨氯地平的情况下同时服用 CLO 或 W1,结果表明 W1 比 CLO 表现出更稳定、更有效的抗血栓作用。总之,W1 和 CLO 都具有抗血小板和抗血栓作用,而前者与奥美拉唑或氨氯地平这两种抑制 CLO 代谢的药物合用时,CLO 的抗药性较低。因此,这项研究表明,W1 可能是一种很有前途的口服抗血小板药物,可减少经皮冠状动脉介入治疗后的 CLO 耐药性。