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Monitoring of platelet ADP receptor P2Y(12) inhibition may be performed by a variety of platelet function assays. Given the lack of sensitivity of the existing PFA-100® cartridge formulations to detect P2Y(12) inhibition, a new cartridge for the PFA-100 (INNOVANCE® PFA P2Y) has recently been developed. The performance of the new PFA-100 test cartridge was compared with standard collagen/ADP (CADP) and collagen/epinephrine (CEPI) cartridges, light transmission aggregometry, vasodilator-stimulated phosphoprotein, the VerifyNow® P2Y(12) assay and multiple electrode aggregometry. In this study, 20 normal blood samples anticoagulated with either citrate or hirudin were spiked with two different clinically relevant concentrations (1 and 10 µM final concentration) of the prasugrel active metabolite (R-138727, Lilly/Daiichi Sankyo) for 30 min at 37°C. Comparison of the platelet function tests demonstrated that all tests (except CADP and CEPI) were substantially inhibited by 10 µM R-138727. Intermediate results were typically obtained with 1 µM R-138727 in citrated blood. However, both MEA ADP and ADPHS tests were highly sensitive to 1 µM R-138727 in hirudin anticoagulated blood. Further comparison of citrate or hirudin blood samples (N = 5) revealed that all platelet tests (except CEPI) became more sensitive to 1 µM R-138727 in hirudinized blood. The INNOVANCE PFA P2Y cartridge proved to be sensitive to P2Y(12) inhibition and was comparable to other currently available platelet function tests. The sensitivity of all platelet function tests for detecting in vitro inhibition of P2Y(12) is markedly different depending on the anticoagulant used.

The aim of these studies was to investigate the extent of platelet P2Y(12) receptor inhibition by the thienopyridine active metabolite of prasugrel, R-138727. Blood was taken from healthy volunteers and pre-incubated with R-138727 or cangrelor (AR-C66931MX). Platelet aggregation was assessed in platelet rich plasma (PRP) and whole blood (WB). Vasodilator stimulated phosphoprotein (VASP) phosphorylation, platelet procoagulant activity (annexin V binding and microparticle formation) and calcium mobilisation were measured by flow cytometry. Platelet-leukocyte co-aggregate formation and sCD40L release, both pro-inflammatory responses of platelets, were measured by flow cytometry and ELISA, respectively. P2Y(12) receptor antagonism was determined using a radioligand binding assay ((33)P 2-MeSADP) in resting and stimulated platelets and the effects of clopidogrel administration were also assessed. R-138727 yielded concentration-dependent inhibition of platelet aggregation, VASP phosphorylation inhibition, procoagulant activity and pro-inflammatory responses. In the presence of R-138727 or cangrelor there was increased calcium reuptake following agonist stimulation. R-138727 30 micromol/L and cangrelor 1 micromol/L completely inhibited (33)P 2-MeSADP binding, compared to partial inhibition following clopidogrel administration. Platelet activation and granule secretion did not expose an additional pool of P2Y(12) receptors. Prasugrel's active metabolite effectively blocks the P2Y(12) receptor with the highest concentrations tested yielding complete inhibition of P2Y(12)-mediated amplification of several important platelet responses.

The VerifyNow® P2Y12 (VN-P2Y12) test reports thienopyridine-mediated platelet inhibition relative to a "BASE" channel, potentially eliminating the need for predrug patient assessment, by activating platelets through a P2Y(12)-independent pathway. The original formulation of the BASE channel used a protease activated receptor-1 (PAR-1) peptide as agonist. However, more potent P2Y(12) antagonism required more complete activation of platelet thrombin receptors for the BASE measurement in order to negate any contribution of the P2Y(12) receptor. Accordingly, the current BASE channel formulation consists of both PAR-1 and protease activated receptor-4 (PAR-4) activating peptides to facilitate a higher degree of platelet activation. The aim of this study was to compare the performance of PAR-1 versus PAR-1/PAR-4 activating peptides as the BASE channel formulation using prasugrel's active metabolite, R-138727, in vitro to achieve high-grade P2Y(12) inhibition. Blood samples from 20 healthy donors were spiked in vitro with R-138727 at concentrations that include plasma levels achieved following prasugrel administration and were incubated for 30 minutes at 37°C. All samples were run in triplicate using both the PAR-1 and the PAR-1/PAR-4 BASE formulation in the VN-P2Y12 test device. The data confirmed the sensitivity of the original BASE formulation to high-grade P2Y(12) inhibition as reflected in the concentration-dependent decrease in values. Incorporation of PAR-4 activating peptide eliminated the effect of P2Y(12) blockade at all concentrations of R-138727. Thus, the use of PAR-1/PAR-4 in the BASE channel of the VN-P2Y12 cartridge addresses the impact of high grade P2Y(12) blockade and may allow more accurate reporting of "% inhibition" in patients treated with more effective P2Y(12) antagonists.

[Ca(2+)](i) and pH(i) were measured in unstimulated and thrombin-stimulated platelets from young (3 months) and aged (24 months) rats in the presence and absence of external Ca(2+). There was no difference in the basal level of [Ca(2+)](i) between young and aged rat platelets in the presence of external Ca(2+). On the other hand, thrombin-induced Ca(2+) mobilization was markedly increased in aged rat platelets compared to young rat platelets in the presence of external Ca(2+). This difference in Ca(2+) mobilization was more pronounced in the absence of external Ca(2+), suggesting that Ca(2+) release from intracellular storages was enhanced in aged rat platelets. In contrast to what was observed for Ca(2+), the basal level of pH(i) in aged rat platelets was higher than that in young rat platelets whereas thrombin-induced pH(i) increases (ΔpH) were similar in both groups in the presence and absence of external Ca(2+). These results indicate that age-associated changes occur in thrombin-induced Ca(2+) release from intracellular storages in rat platelets. These changes seem to be related to those in basal pH(i) levels.

We previously reported that thrombin-induced Ca(2+) mobilization was enhanced in aged rat platelets. Since Ca(2+) mobilization in platelets is believed to be closely associated with platelet activation, we examined Ca(2+) mobilization and the aggregatory response to ADP and thrombin in young (3 months) and aged (24 months) rat platelets. Blood levels of fibrinogen and Ca(2+) in aged rats were higher than those in young rats. ADP-induced platelet aggregation in aged rats was significantly enhanced in platelet rich plasma and in washed platelet suspension, suggesting that age-associated hyperaggregability to ADP is attributable to changes in platelets themselves. On the other hand, thrombin (0.03-0.3 unit/ml)-induced aggregation in washed platelet suspension from aged rats was comparable to that from young rats. But, thrombin (0.3 unit/ml)-induced intracellular Ca(2+)mobilization was enhanced in aged rat platelets in the presence of extracellular Ca(2+). Likewise, ADP-induced Ca(2+) mobilization was enhanced in aged rat platelets. These results suggest that enhanced Ca(2+) mobilization in aged rat platelets is associated with hyperaggregability to ADP but not to thrombin.