Abstract
Administration of the thienopyridine P2Y12 receptor antagonist, clopidogrel, increased the erosive arthritis induced by peptidoglycan polysaccharide (PG-PS) in rats or by injection of the arthritogenic K/BxN serum in mice. To determine if the detrimental effects are caused exclusively by clopidogrel, we evaluated prasugrel, a third-generation thienopyridine pro-drug, that contrary to clopidogrel is mostly metabolized into its active metabolite in the intestine. Prasugrel effects were examined on the PG-PS-induced arthritis rat model. Erosive arthritis was induced in Lewis rats followed by treatment with prasugrel for 21 days. Prasugrel treated arthritic animals showed a significant increase in the inflammatory response, compared with untreated arthritic rats, in terms of augmented macroscopic joint diameter associated with significant signs of inflammation, histomorphometric measurements of the hind joints and elevated platelet number. Moreover, fibrosis at the pannus, assessed by immunofluorescence of connective tissue growth factor, was increased in arthritic rats treated with prasugrel. In addition to the arthritic manifestations, hepatomegaly, liver granulomas and giant cell formation were observed after PG-PS induction and even more after prasugrel exposure. Cytokine plasma levels of IL-1 beta, IL-6, MIP1 alpha, MCP1, IL-17 and RANTES were increased in arthritis-induced animals. IL-10 plasma levels were significantly decreased in animals treated with prasugrel. Overall, prasugrel enhances inflammation in joints and liver of this animal model. Since prasugrel metabolites inhibit neutrophil function ex-vivo and the effects of both clopidogrel and prasugrel metabolites on platelets are identical, we conclude that the thienopyridines metabolites might exert non-platelet effects on other immune cells to aggravate inflammation.
Highlights
Decreasing platelet activation has been a target in the prevention of coronary artery disease [1] and an array of drugs have been discovered to selectively interfere with platelet function
Clopidogrel has been used as the gold standard treatment to reduce thrombus formation, and recently prasugrel has been added as a therapeutic tool [21]
We reported a detrimental effect of clopidogrel administration in inducedarthritis rats
Summary
Decreasing platelet activation has been a target in the prevention of coronary artery disease [1] and an array of drugs have been discovered to selectively interfere with platelet function. Among those are prasugrel and clopidogrel, thienopyridine compounds that antagonized the P2Y12 receptor in platelets. Prasugrel, a pro-drug that is considered more potent than clopidogrel, has been associated with an increased risk of primarily gastrointestinal bleeding [1]. Prasugrel is more metabolized than clopidogrel into its active and inactive metabolites, requiring fewer steps in the liver.
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