BH3 mimetics are a new class of proapoptotic anticancer agents that have shown considerable promise in preclinical animal models and early-stage human trials. These agents act by inhibiting the prosurvival function of one or more Bcl-2-related proteins. Agents that inhibit Bcl-x L 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 Ib␣ and glycoprotein VI, and functional downregulation of integrin ␣ IIb  3 . 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 timedependent defect in platelet aggregation at sites of vascular injury that correlated with an increase in tail bleeding time.Overall, these studies demonstrate that Bcl-x L -inhibitory BH3 mimetics not only induce thrombocytopenia but also a transient thrombocytopathy that can undermine the hemostatic function of platelets. (Blood. 2011;118(6):1663-1674)
IntroductionApoptosis is an evolutionarily conserved process important for mammalian development, tissue homeostasis, and immune tolerance. Apoptosis also acts as an important barrier against malignant transformation. Resistance to apoptosis is a hallmark feature of cancer, and several pathways regulating apoptosis are commonly altered in human malignancies. 1,2 For example, Ͼ 50% of all human cancers contain mutations in the p53 tumor suppressor gene, with nearly all of these mutations preventing p53 from triggering apoptosis. 3 Furthermore, the overexpression or enhanced function of certain prosurvival proteins, such as Bcl-2, 2 Bcl-x L , 2 PI3K/Akt/mTOR, 4 and nuclear factor-B, 5 is found in many types of human cancers. As a consequence, strategies targeting specific prosurvival pathways have gained prominence as novel anticancer therapies.Progress unraveling the complex pathways underlying apoptosis and cell survival, and elucidation of their roles in human cancers, has led to the development of several potential anticancer drugs, such as inhibitors of the Bcl-2 protein family, 6 inhibitors of apoptosis (IAPs), 7 MDM2, 8 PI3K/Akt/mTOR, 9 as well as TNFrelated apoptosis-inducing ligand. 10 A particularly promising approach is the ability to inhibit tumor cell survival through the use of agents that mimic the proapoptotic Bcl-2 homology 3 (BH3) domain proteins. BH3 proteins play an important role in inducing apoptosis by antagonizing the function of prosurvival Bcl-2 family proteins. Preclinical studies with the BH3 mimetic ABT-737, which selectively antagonizes Bcl-2, Bcl-x L , and Bcl-w, have demonstrated potent cytotoxic activity a...