Key result
Selectively reducing circulating platelets by targeting Bcl-xL to promote platelet apoptosis significantly reduced atherosclerosis and promoted a more stable plaque phenotype in diabetic mice.
Why the study?
Patients with diabetes have increased numbers of activated, reactive platelets responding suboptimally to antiplatelet therapies, contributing to accelerated atherosclerosis.
Does targeting Bcl-x L to induce premature platelet apoptosis reduce atherosclerosis in diabetic mouse models?
Does targeting Bcl-x L to induce premature platelet apoptosis reduce atherosclerosis in diabetic mouse models?
Selectively reducing circulating platelets by targeting Bcl-x L to promote apoptosis reduces atherosclerosis and promotes a stable plaque phenotype in diabetic mouse models.
Inducing platelet apoptosis may attenuate diabetic atherosclerosis; leaves open clinical translation and requires prospective human studies.
Objective: People with diabetes are at a significantly higher risk of cardiovascular disease, in part, due to accelerated atherosclerosis. Diabetic subjects have increased number of platelets that are activated, more reactive, and respond suboptimally to antiplatelet therapies. We hypothesized that reducing platelet numbers by inducing their premature apoptotic death would decrease atherosclerosis. Approach and Results: This was achieved by targeting the antiapoptotic protein Bcl-x L (B-cell lymphoma-extra large; which is essential for platelet viability) via distinct genetic and pharmacological approaches. In the former, we transplanted bone marrow from mice carrying the Tyr15 to Cys loss of function allele of Bcl-x (known as Bcl-x Plt20 ) or wild-type littermate controls into atherosclerotic-prone Ldlr +/− mice made diabetic with streptozotocin and fed a Western diet. Reduced Bcl-x L function in hematopoietic cells significantly decreased platelet numbers, exclusive of other hematologic changes. This led to a significant reduction in atherosclerotic lesion formation in Bcl-x Plt20 bone marrow transplanted Ldlr +/− mice. To assess the potential therapeutic relevance of reducing platelets in atherosclerosis, we next targeted Bcl-x L with a pharmacological strategy. This was achieved by low-dose administration of the BH3 (B-cell lymphoma-2 homology domain 3) mimetic, ABT-737 triweekly, in diabetic Apoe −/− mice for the final 6 weeks of a 12-week study. ABT-737 normalized platelet numbers along with platelet and leukocyte activation to that of nondiabetic controls, significantly reducing atherosclerosis while promoting a more stable plaque phenotype. Conclusions: These studies suggest that selectively reducing circulating platelets, by targeting Bcl-x L to promote platelet apoptosis, can reduce atherosclerosis and lower cardiovascular disease risk in diabetes. Graphic Abstract: A graphic abstract is available for this article.
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Lee et al. (2021) studied Atherosclerosis in diabetes. Targeting Bcl-xL (genetic via Bcl-x Plt20 bone marrow transplant or pharmacological via ABT-737) vs. wild-type littermate controls / nondiabetic controls was evaluated on Atherosclerotic lesion formation. Selectively reducing circulating platelets by targeting Bcl-xL to promote platelet apoptosis significantly reduced atherosclerosis and promoted a more stable plaque phenotype in diabetic mice.
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