The GPIIbIIIa antagonist drugs eptifibatide and tirofiban do not induce activation of apoptosis executioner caspase-3 in resting platelets but inhibit caspase-3 activation in platelets stimulated with thrombin or calcium ionophore A23187Platelet surface receptor, glycoprotein (GP) IIbIIIa (integrin αIIbβ3), mediates platelet aggregation and plays a key role in hemostasis and thrombosis.
1,2Numerous GPIIbIIIa antagonists have been designed and tested as inhibitors of platelet aggregation.3 Two of these antagonists, eptifibatide (Integrilin) and tirofiban (Aggrastat), are approved by the US Food and Drug Administration (FDA) for clinical use for preventing and treating thrombotic complications in patients undergoing percutaneous coronary intervention and in patients with acute coronary syndromes.4 It has been reported, however, that some GPIIbIIIa antagonists, such as orbofiban and xemilofiban, promote apoptosis in cardiomyocytes by activation of the apoptosis executioner caspase-3, 5 raising the possibility that platelets also may be susceptible to pro-apoptotic effects of Integrilin and Aggrastat.Over the past decade it has been well-documented by us and others that apoptosis occurs not only in nucleated cells but also in anucleated platelets stimulated with thrombin, calcium ionophores, very high shear stresses and platelet storage (see references in [6][7][8] ). It has been further reported that platelet activation and apoptosis may be induced by different mechanisms and/or require different levels of triggering stumuli.9,10 Recently, we have shown that injection of anti-GPIIb antibody induced caspase-3 activation in mouse platelets, 11 suggesting that direct GPIIbIIIa-mediated pro-apoptotic signaling is able to trigger caspase-3 activation within platelets.The current study aimed to examine, for the first time, the effect of Integrilin and Aggrastat on caspase-3 activation in human platelets. We studied the effects of Integrilin and Aggrastat on caspase-3 activation in resting platelets which express GPIIbIIIa receptors in their nonactive (closed) conformation, and in platelets stimulated with thrombin and calcium ionophore A23187, which induce transition of GPIIbIIIa receptors into active (open) conformation. Table 1A shows that treatment of resting platelets with Integrilin and Aggrastat did not affect caspase-3 activation (p>0.05). In contrast, a 2.3-2.7-fold increase in caspase-3 activation was observed in platelets after thrombin and A23187 stimulation (Table 1B and C, p<0.01). However, when platelets were preincubated with Integrilin and Aggrastat before agonist treatment, these drugs significantly inhibited agonist-induced caspase-3 activation ( Figure 1 and Table 1B and C, p<0.05).The fact that Integrilin and Aggrastat do not promote caspase-3 activation in unstimulated platelets (Table 1A) suggests that these GPIIbIIIa antagonists do not induce transmission of pro-apoptotic transmembrane signals inside platelets through inactive GPIIbIIIa integrin. They also do not activate caspase-3 directly by inte...