Key result
Parmodulins are small molecule allosteric modulators of PAR1 signaling that inhibit coagulation and platelet activation while maintaining cytoprotective effects.
Why the study?
Orthosteric PAR1 inhibitors increase hemorrhage risk, prompting interest in parmodulins that inhibit platelet activation while preserving cytoprotective signaling.
Parmodulins are emerging as potential therapeutic agents that inhibit platelet activation and coagulation while preserving cytoprotective PAR1 signaling, potentially avoiding the bleeding risks of orthosteric inhibitors.
May enable safer antithrombotic therapy via selective PAR1 modulation; leaves open confirmation in randomized trials.
The G protein-coupled receptor (GPCR) protease-activated receptor 1 (PAR1) is a therapeutic target that was originally pursued with the aim of restricting platelet activation and the burden of cardiovascular diseases. In clinical studies, the use of orthosteric PAR1 inhibitors was associated with an increased risk of hemorrhage, including intracranial hemorrhage. Because (1) PAR1 is expressed by various cell types, including endothelial cells, (2) conveys in mice a physiological indispensable function for vascular development during embryogenesis, and (3) is subject to biased signaling dependent on the activating proteases, orthosteric PAR1 inhibition may be associated with unwanted side effects. Alternatively, the protease-activated protein C (aPC) and its variants can promote valuable anti-inflammatory signaling via PAR1. Most recently, small molecule allosteric modulators of PAR1 signaling, called parmodulins, have been developed. Parmodulins inhibit coagulation and platelet activation yet maintain cytoprotective effects typically provoked by PAR1 signaling upon the activation by aPC. In this study, we review the discovery of parmodulins and their preclinical data, summarize the current knowledge about their mode of action, and compare the structural interaction of parmodulin and PAR1 with that of other intracellularly binding allosteric GPCR modulators. Thus, we highlight the pharmaceutical potential and challenges associated with the future development of parmodulins.
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Künze et al. (2023) conducted a review in Cardiovascular diseases. Parmodulins was evaluated. Parmodulins are small molecule allosteric modulators of PAR1 signaling that inhibit coagulation and platelet activation while maintaining cytoprotective effects.
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