Targeted inhibition of the serotonin 5HT2A receptor improves coronary patency in an in vivo model of recurrent thrombosis |
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| Authors: | K PRZYKLENK A L FRELINGER III M D LINDEN P WHITTAKER Y LI M R BARNARD J ADAMS M MORGAN H AL‐SHAMMA A D MICHELSON |
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| Institution: | 1. Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester, MA;2. Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA;3. Department of Anesthesiology, University of Massachusetts Medical School, Worcester, MA;4. Present addresses: Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA.;5. Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA;6. Children’s Hospital and Harvard Medical School, Boston, MA, USA.;7. Royal Melbourne Institute of Technology, Melbourne, Australia.;8. Arena Pharmaceuticals Inc., San Diego, CA, USA |
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| Abstract: | Summary. Background: Release of serotonin and activation of serotonin 5HT2A receptors on platelet surfaces is a potent augmentative stimulus for platelet aggregation. However, earlier‐generation serotonin receptor antagonists were not successfully exploited as antiplatelet agents, possibly owing to their lack of specificity for the 5HT2A receptor subtype. Objective: To assess whether targeted inhibition of the serotonin 5HT2A receptor attenuates recurrent thrombosis and improves coronary patency in an in vivo canine model mimicking unstable angina. Methods: In protocol 1, anesthetized dogs were pretreated with a novel, selective inverse agonist of the 5HT2A receptor (APD791) or saline. Recurrent coronary thrombosis was then initiated by coronary artery injury + stenosis, and coronary patency was monitored for 3 h. Protocol 2 was similar, except that: (i) treatment with APD791 or saline was begun 1 h after the onset of recurrent thrombosis; (ii) template bleeding time was measured; and (iii) blood samples were obtained for in vitro flow cytometric assessment of platelet responsiveness to serotonin. Results: APD791 attenuated recurrent thrombosis, irrespective of the time of treatment: in both protocols, flow–time area (index of coronary patency; normalized to baseline coronary flow) averaged 58–59% (P < 0.01) following administration of APD791 vs. 21–28% in saline controls. Moreover, the in vivo antithrombotic effect of APD791 was not accompanied by increased bleeding, but was associated with significant and selective inhibition of serotonin‐mediated platelet activation. Conclusion: 5HT2A receptor inhibition with APD791, even when initiated after the onset of recurrent thrombosis, improves coronary patency in the in vivo canine model. |
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| Keywords: | angina platelets serotonin thrombosis |
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