PT  - JOURNAL ARTICLE
AU  - Helena Haberstock-Debic
AU  - Patrick Andre
AU  - Scott Mills
AU  - David R. Phillips
AU  - Pamela B. Conley
TI  - A Clopidogrel-Insensitive Inducible Pool of P2Y<sub>12</sub> Receptors Contributes to Thrombus Formation: Inhibition by Elinogrel, a Direct-Acting, Reversible P2Y<sub>12</sub> Antagonist
AID  - 10.1124/jpet.111.184143
DP  - 2011 Oct 01
TA  - Journal of Pharmacology and Experimental Therapeutics
PG  - 54--61
VI  - 339
IP  - 1
4099  - http://jpet.aspetjournals.org/content/339/1/54.short
4100  - http://jpet.aspetjournals.org/content/339/1/54.full
SO  - J Pharmacol Exp Ther2011 Oct 01; 339
AB  - It is known that hepatic metabolism limits the antiaggregatory activity of clopidogrel and, as a consequence, its clinical benefits. In this study, we investigated whether other factors exist that could account for clopidogrel's suboptimal antithrombotic activity. Using an in vivo murine FeCl3 thrombosis model coupled with intravital microscopy, we found that at equivalent, maximal levels of inhibition of ADP-induced platelet aggregation, clopidogrel (50 mg/kg p.o.) failed to reproduce the phenotype associated with P2Y12 deficiency. However, elinogrel (60 mg/kg p.o.), a direct-acting reversible P2Y12 antagonist, achieved maximal levels of inhibition in vivo, and its administration (1 mg/kg i.v.) abolished residual thrombosis associated with clopidogrel dosing. Because elinogrel is constantly present in the plasma, whereas the active metabolite of clopidogrel exists for ∼2 h, we evaluated whether an intracellular pool of P2Y12 exists that would be inaccessible to clopidogrel and contribute to its limited antithrombotic activity. Using saturation [3H]2-(methylthio)ADP ([3H]2MeSADP) binding studies, we first demonstrated that platelet stimulation with thrombin and convulxin (mouse) and thrombin receptor activating peptide (TRAP) (human) significantly increased surface expression of P2Y12 relative to that of resting platelets. We next found that clopidogrel dose-dependently inhibited ADP-induced aggregation, signaling (cAMP), and surface P2Y12 on resting mouse platelets, achieving complete inhibition at the highest dose (50 mg/kg), but failed to block this inducible pool. Thus, an inducible pool of P2Y12 exists on platelets that can be exposed upon platelet activation by strong agonists. This inducible pool is not blocked completely by clopidogrel, contributes to thrombosis in vivo, and can be blocked by elinogrel.