Storey Robert F, Melissa Thornton S, Lawrance Rachael, Husted Steen, Wickens Mark, Emanuelsson Håkan, Cannon Christopher P, Heptinstall Stan, Armstrong Martin
Cardiovascular Research Unit, University of Sheffield, Sheffield, UK.
Platelets. 2009 Aug;20(5):341-8. doi: 10.1080/09537100903075324.
The platelet P2Y(12) receptor is the target of clopidogrel therapy, which has been shown to reduce thromboembolic complications of atherosclerotic disease but has limitations in terms of variability of response and irreversibility of effect. This receptor is also a target for ticagrelor (AZD6140), the first reversibly binding oral P2Y(12) receptor antagonist that does not require metabolic activation and yields more consistent inhibition of platelet aggregation than clopidogrel therapy. Single nucleotide polymorphisms (SNPs) have been described in the gene for this receptor (P2RY12), some of which have been associated with variability in platelet reactivity. SNPs in P2RY1 and ITGB3 have also been reported by some groups to affect platelet reactivity to adenosine diphosphate (ADP). We assessed whether SNPs in these genes influenced the pharmacodynamic response to ticagrelor in patients enrolled in both the DISPERSE study (stable atherosclerotic disease) and the DISPERSE2 study (non-ST-segment elevation acute coronary syndromes). Platelet aggregation data (at baseline and 4 weeks) and DNA samples from clopidogrel-naive Caucasian patients treated with ticagrelor were available for 151 patients. Seventy four SNPs within three genes were genotyped. After adjustment for multiple comparisons, none of these SNPs were found to significantly influence inhibition of ADP-induced platelet aggregation by ticagrelor.
血小板P2Y(12)受体是氯吡格雷治疗的靶点,氯吡格雷已被证明可减少动脉粥样硬化疾病的血栓栓塞并发症,但在反应变异性和作用不可逆性方面存在局限性。该受体也是替格瑞洛(AZD6140)的作用靶点,替格瑞洛是首个可逆结合的口服P2Y(12)受体拮抗剂,无需代谢激活,且比氯吡格雷治疗对血小板聚集的抑制作用更一致。已在该受体(P2RY12)的基因中描述了单核苷酸多态性(SNP),其中一些与血小板反应性的变异性有关。一些研究小组还报告称,P2RY1和ITGB3基因中的SNP会影响血小板对二磷酸腺苷(ADP)的反应性。我们评估了在参加DISPERSE研究(稳定型动脉粥样硬化疾病)和DISPERSE2研究(非ST段抬高急性冠状动脉综合征)的患者中,这些基因中的SNP是否会影响对替格瑞洛的药效学反应。151例接受替格瑞洛治疗的未使用过氯吡格雷的白种人患者的血小板聚集数据(基线和4周时)和DNA样本可供分析。对三个基因中的74个SNP进行了基因分型。在对多重比较进行校正后,未发现这些SNP中的任何一个会显著影响替格瑞洛对ADP诱导的血小板聚集的抑制作用。