Key result
Glenzocimab plus aspirin and ticagrelor reduces atherosclerotic plaque-induced platelet aggregation by ~95% versus control.
Why the study?
Ticagrelor suboptimally inhibits microvascular thrombosis during STEMI, and while GPIIb/IIIa inhibitors further inhibit thrombosis they cause excessive bleeding, prompting evaluation of the GPVI inhibitor glenzocimab.
Does glenzocimab added to aspirin and ticagrelor reduce atherosclerotic plaque-induced platelet activation in human blood samples?
Does glenzocimab added to aspirin and ticagrelor reduce atherosclerotic plaque-induced platelet activation in human blood samples?
Glenzocimab added to dual antiplatelet therapy profoundly inhibits plaque-induced platelet aggregation with potentially less bleeding risk than GPIIb/IIIa inhibitors.
Answers are grounded in this paper and cite their sources.
Ex vivo findings support testing glenzocimab atop DAPT in atherothrombosis; leaves open clinical efficacy and safety.
BACKGROUND: inhibitors, such as ticagrelor, suboptimally inhibit microvascular thrombosis during ST-elevation myocardial infarction. Glycoprotein (GP) IIb/IIIa inhibitors may further inhibit this but cause excessive bleeding. OBJECTIVES: We investigated whether combination of glenzocimab, a GPVI inhibitor, with aspirin and ticagrelor provides additional antithrombotic effects, as GPVI has a critical role in atherothrombosis but minimal involvement in hemostasis. METHODS: We investigated the effects of glenzocimab (monoclonal antibody Fab fragment) using blood from healthy donors and patients with acute coronary syndrome treated with aspirin and ticagrelor. Platelets were stimulated with multiple agonists, including atherosclerotic plaque, from patients undergoing carotid endarterectomy. RESULTS: Aspirin and ticagrelor partially inhibited atherosclerotic plaque-induced platelet aggregation by 48% compared with control (34 ± 3 vs 65 ± 4 U; P < .001). Plaque-induced platelet aggregation, adhesion, secretion, and activation were critically dependent on GPVI activation. Glenzocimab alone reduced plaque-induced aggregation by 75% compared with control (16 ± 4 vs 65 ± 4 U; P < .001) and by >95% when combined with aspirin and ticagrelor (3 ± 1 vs 65 ± 4 U; P < .001). Glenzocimab reduced platelet aggregation, adhesion, and thrombin generation when added to blood of aspirin- and ticagrelor-treated patients with acute coronary syndrome. Glenzocimab shared several antithrombotic effects with the GPIIb/IIIa inhibitor eptifibatide with less effect on general hemostasis assessed by rotational thromboelastometry. In a murine intravital model of ST-elevation myocardial infarction, genetic depletion of GPVI reduced microvascular thrombosis. CONCLUSION: Addition of glenzocimab to aspirin and ticagrelor enhances platelet inhibition via multiple mechanisms of atherothrombosis. Compared with a GPIIb/IIIa inhibitor, glenzocimab shares multiple antithrombotic effects, with less inhibition of mechanisms involved in general hemostasis.
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Alenazy et al. (2023) studied Acute coronary syndrome. Glenzocimab combined with aspirin and ticagrelor vs. Control was evaluated on Atherosclerotic plaque-induced platelet aggregation (>95% reduction, p=<.001). Glenzocimab combined with aspirin and ticagrelor reduced atherosclerotic plaque-induced platelet aggregation by >95% compared with control (3 vs 65 U; P<.001).
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