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Pharmacodynamic effects of EV-077 in patients with diabetes mellitus and coronary artery disease on aspirin or clopidogrel monotherapy: results of an in vitro pilot investigation

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An Erratum to this article was published on 08 October 2013

Abstract

Patients with diabetes mellitus (DM) have increased propensity to generate thromboxane A2 (TXA2) and other eicosanoids which can contribute to their heightened platelet reactivity. EV-077 is a potent thromboxane receptor antagonist and thromboxane synthase inhibitor and thus represents an attractive therapy in patients with DM. However, the effects of EV-077 on pharmacodynamic (PD) profiles in patients with DM and coronary artery disease (CAD) while on antiplatelet therapy is poorly explored and represented the aim of this in vitro pilot investigation. Patients with DM and stable CAD (n = 10) on low-dose aspirin (81 mg/day) were enrolled and then switched to clopidogrel (75 mg/day) monotherapy for 7–10 days. PD assessments were conducted while on aspirin and on clopidogrel using light transmittance aggregometry following stimuli with U-46619 [TXA2 stable analogue (7 μM)], arachidonic acid [AA (1 mM)], collagen (3 μg/mL) and adenosine diphosphate [ADP (5 μM and 20 μM)] with and without in vitro EV-077. EV-077 completely inhibited U-46619-stimulated platelet aggregation (p = 0.005 for both aspirin and clopidogrel) and also showed a significant reduction of collagen-induced aggregation (aspirin p = 0.008; clopidogrel p = 0.005). EV-077 significantly reduced AA-induced platelet aggregation in clopidogrel (p = 0.009), but not aspirin (p = 0.667) treated patients. Ultimately, EV-077 significantly reduced ADP-mediated platelet aggregation in both aspirin (ADP 5 μM p = 0.012; ADP 20 μM p = 0.032) and clopidogrel (ADP 5 μM p = 0.007; ADP 20 μM p = 0.008) treated patients. In conclusion, in DM patients with CAD on aspirin or clopidogrel monotherapy, in vitro EV-077 exerts potent platelet inhibitory effects on multiple platelet signaling pathways. These data support that EV-077 has only additive platelet inhibiting effects on top of standard antiplatelet therapies. These findings warrant further investigation in ex vivo settings.

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Acknowledgments

We thank Evolva SA, Reinach, Switzerland, for providing EV-077 and financial support.

Disclosures

Fabiana Rollini, Antonio Tello-Montoliu, Ronakkumar Patel, Andrew Darlington, Ryan E. Wilson, Francesco Franchi, Ana Muñiz-Lozano, Bhaloo Desai declare that they have no conflict of interest to report. Norbert Bender is previous Chief Medical Officer of Evolva SA. Kjell S. Sakariassen is previous Member of Cardiovascular Board of Evolva SA. Dominick J. Angiolillo received payment as an individual for: (a) Consulting fee or honorarium from Bristol Myers Squibb, Sanofi-Aventis, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Merck, Evolva, Abbott Vascular and PLx Pharma; (b) Participation in review activities from Johnson & Johnson, St. Jude, and Sunovion. Institutional payments for grants from Bristol Myers Squibb, Sanofi-Aventis, Glaxo Smith Kline, Otsuka, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Evolva; and has other financial relationships with Esther and King Biomedical Research Grant.

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Authors and Affiliations

  1. University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Fabiana Rollini, Antonio Tello-Montoliu, Ronakkumar Patel, Andrew Darlington, Ryan E. Wilson, Francesco Franchi, Ana Muñiz-Lozano, Bhaloo Desai & Dominick J. Angiolillo

  2. Evolva SA, Reinach, Switzerland

    Norbert Bender

  3. KellSa s.a.s., Biella, Italy

    Kjell S. Sakariassen

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  1. Fabiana Rollini
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  2. Antonio Tello-Montoliu
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  7. Ana Muñiz-Lozano
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  8. Bhaloo Desai
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  10. Kjell S. Sakariassen
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  11. Dominick J. Angiolillo
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Correspondence to Dominick J. Angiolillo.

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Rollini, F., Tello-Montoliu, A., Patel, R. et al. Pharmacodynamic effects of EV-077 in patients with diabetes mellitus and coronary artery disease on aspirin or clopidogrel monotherapy: results of an in vitro pilot investigation. J Thromb Thrombolysis 37, 131–138 (2014). https://doi.org/10.1007/s11239-013-0979-8

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