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

SM Schoenwaelder, KE Jarman… - Blood, The Journal …, 2011 - ashpublications.org
SM Schoenwaelder, KE Jarman, EE Gardiner, M Hua, J Qiao, MJ White, EC Josefsson
Blood, The Journal of the American Society of Hematology, 2011ashpublications.org
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-xL 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 …
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-xL 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 αIIbβ3. 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-xL–inhibitory BH3 mimetics not only induce thrombocytopenia but also a transient thrombocytopathy that can undermine the hemostatic function of platelets.
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