Bcl-xL-inhibitory BH3 mimetics can induce a transient thrombocytopathy that undermines the hemostatic function of platelets

Blood. 2011 Aug 11;118(6):1663-74. doi: 10.1182/blood-2011-04-347849. Epub 2011 Jun 14.

Abstract

BH3 mimetics are a new class of proapo-ptotic anticancer agents that have shown considerable promise in preclinical animal models and early-stage human trials. These agents act by inhibiting the pro-survival function of one or more Bcl-2-related proteins. Agents that inhibit Bcl-x(L) induce rapid platelet death that leads to thrombocytopenia; however, their impact on the function of residual circulating platelets remains unclear. In this study, we demonstrate that the BH3 mimetics, ABT-737 or ABT-263, induce a time- and dose-dependent decrease in platelet adhesive function that correlates with ectodomain shedding of the major platelet adhesion receptors, glycoprotein Ibα and glycoprotein VI, and functional down-regulation of integrin α(IIb)β(3). Analysis of platelets from mice treated with higher doses of BH3 mimetics revealed the presence of a subpopulation of circulating platelets undergoing cell death that have impaired activation responses to soluble agonists. Functional analysis of platelets by intravital microscopy revealed a time-dependent defect in platelet aggregation at sites of vascular injury that correlated with an increase in tail bleeding time. Overall, these studies demonstrate that Bcl-x(L)-inhibitory BH3 mimetics not only induce thrombocytopenia but also a transient thrombocytopathy that can undermine the hemostatic function of platelets.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aniline Compounds / pharmacology
  • Animals
  • Apoptosis / drug effects
  • Biphenyl Compounds / pharmacology
  • Blood Platelets / metabolism
  • Blood Platelets / physiology*
  • Blood Platelets / ultrastructure
  • Blotting, Western
  • Collagen / metabolism
  • Dose-Response Relationship, Drug
  • Down-Regulation / drug effects
  • Hemostasis / drug effects
  • Hemostasis / physiology*
  • Membrane Glycoproteins / metabolism
  • Mice
  • Mice, Inbred C57BL
  • Microscopy, Electron, Scanning
  • Nitrophenols / pharmacology
  • Phosphatidylserines / metabolism
  • Piperazines / pharmacology
  • Platelet Adhesiveness / drug effects
  • Platelet Aggregation / drug effects
  • Platelet Count
  • Platelet Glycoprotein GPIIb-IIIa Complex / metabolism
  • Platelet Glycoprotein GPIb-IX Complex
  • Platelet Membrane Glycoproteins / metabolism
  • Sulfonamides / pharmacology
  • Thrombocytopenia / chemically induced
  • Thrombocytopenia / physiopathology*
  • Time Factors
  • bcl-X Protein / antagonists & inhibitors
  • bcl-X Protein / metabolism*

Substances

  • ABT-737
  • Aniline Compounds
  • Biphenyl Compounds
  • Membrane Glycoproteins
  • Nitrophenols
  • Phosphatidylserines
  • Piperazines
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Glycoprotein GPIb-IX Complex
  • Platelet Membrane Glycoproteins
  • Sulfonamides
  • adhesion receptor
  • bcl-X Protein
  • platelet membrane glycoprotein VI
  • Collagen
  • navitoclax