thienopyridine and Inflammation

The adenosine diphosphate (ADP) receptor antagonists, specifically the class of thienopyridines, have emerged as potent tools in the clinician's arsenal for the treatment of athero-thrombotic disease over the last two decades. Though these medications have been clearly demonstrated to have significant platelet-inhibiting effects, their potential positive impact on other systemic processes has been less well elucidated. Recent evidence points to a number of potential pleiotropic effects of these agents, most notably in the attenuation of several pro-inflammatory pathways, which may be independent of their anti-platelet-aggregating effect. Additionally, several new ADP receptor antagonists are under investigation; it remains to be seen if these agents possess any additional beneficial pleiotropic properties as well.

Topics: Humans; Inflammation; Platelet Aggregation Inhibitors; Purinergic P2 Receptor Antagonists; Pyridines

The present study examined the effects of prasugrel in a mouse model of thrombosis-induced neointimal hyperplasia. Following carotid artery injury by application of ferric chloride solution, thrombus formation was assessed on Day 1 and neointimal thickening was assessed on Day 21. Single administrations of prasugrel at 0.3-3mg/kg (p.o.) resulted in a dose-related and sustained inhibition of ADP-induced platelet aggregation through 24h. Single and multiple (1 and 3 weeks) administration of prasugrel (3mg/kg loading and 1mg/kg/day maintenance doses) resulted in a marked inhibition of neointimal thickening in the injured artery. In the dose-response study, a single administration of prasugrel at 0.3-3mg/kg (p.o.) dose-relatedly inhibited thrombus formation and neointimal thickening on Days 1 and 21, respectively. The degree of neointimal hyperplasia in the injured artery correlated significantly with the thrombus indices, time to occlusion and patency rate. To explore possible mechanisms of inhibition of neointimal hyperplasia by prasugrel, mRNA expression levels of inflammatory and fibrosis markers were determined in injured arteries. Prasugrel treatment resulted in reduced MCP-1, ICAM-1 and TGF-β mRNA levels on Day 2 (24h after the injury) and Day 8 (1 week after the injury) in the target arteries. In conclusion, we found that a single oral loading dose of prasugrel markedly prevented neointimal hyperplasia by inhibiting platelet activation and thrombus formation and was associated with inhibition of the expression of inflammatory and fibrosis markers, including MCP-1, ICAM-1 and TGF-β, in the injured arteries.

Topics: Adenosine Diphosphate; Animals; Aorta; Arterial Occlusive Diseases; Arteries; Carotid Arteries; Chemokine CCL2; Chlorides; Ferric Compounds; Hyperplasia; Inflammation; Intercellular Adhesion Molecule-1; Mice; Mice, Inbred C57BL; Neointima; Platelet Aggregation; Prasugrel Hydrochloride; Pyridines; RNA, Messenger; Thrombosis; Time Factors; Transforming Growth Factor beta1

This article focuses on lessons learned from clinical trials of antiplatelet therapies-in particular, that the degree of inhibition of ex vivo platelet aggregation does not necessarily directly translate into clinical efficacy. As an example, the case of the oral platelet glycoprotein IIb/IIIa inhibitors is presented, in which despite consistent evidence of substantial inhibition of platelet aggregation, this class of drugs provided no clinical benefit in Phase III trials and, in fact, was harmful. Several hypotheses for these unexpected findings have been proposed, but none has been confirmed. The connection between ex vivo inhibition of platelet aggregation and clinical benefit of platelet P2Y(12) antagonists is also not straightforward and is currently being tested in large clinical trials. A link between inflammatory status and clinical benefit from antiplatelet agents continues to emerge and highlights the fact that biomarkers beyond ex vivo platelet aggregation may predict the clinical benefit of antiplatelet agents that can reduce platelet activation (i.e., aspirin and thienopyridines). Results of past and ongoing trials hold valuable clues to determining the appropriate targets for maximizing antiplatelet efficacy, but the current lack of a proven ex vivo assay that correlates with clinical outcomes hampers clinical investigation, drug development programs, and clinical practice.

Topics: Administration, Oral; Biomarkers; Blood Platelets; Clinical Trials as Topic; Endpoint Determination; Humans; Inflammation; Patient Selection; Platelet Activation; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Function Tests; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Treatment Outcome

5-Methyl-6-phenyl-2-thioxothieno[2,3-d]pyrimidone derivative (2) reacted with hydrazonoyl chloride derivatives to afford triazolothienopyrimidones 4a-f. Also, acetone-1-(2-amino-5-isopropyl-thiophene-3-carbonitrile) (3) reacted with functional and bifunctional groups to yield the corresponding compounds 5-11. The new products showed anti-inflammatory, analgesic, and ulcerogenic activities comparable to that of indomethacin and acetylsalicylic acid, respectively.

Topics: Acetic Acid; Analgesics; Animals; Anti-Inflammatory Agents; Aspirin; Carrageenan; Disease Models, Animal; Female; Indomethacin; Inflammation; Male; Mice; Molecular Structure; Pain; Pain Measurement; Pain Threshold; Pyridines; Rats; Stomach Ulcer; Structure-Activity Relationship