2019
DOI: 10.1055/s-0039-1687877
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Btk Inhibitors as First Oral Atherothrombosis-Selective Antiplatelet Drugs?

Abstract: Bruton's tyrosine kinase (Btk) is essential for B cell differentiation and proliferation, but also platelets express Btk. Patients with X-linked agammaglobulinemia due to hereditary Btk deficiency do not show bleeding, but a mild bleeding tendency is observed in high dose therapy of B-cell malignancies with ibrutinib and novel second-generation irreversible Btk inhibitors (acalabrutinib and ONO/GS-4059). This review discusses recent studies that may explain this apparent paradox and gives mechanistic insights … Show more

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Cited by 32 publications
(52 citation statements)
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“…As we reported recently, FcγRIIA-stimulated platelet activation (aggregation, secretion, and P-selectin expression) and formation of platelet-neutrophil aggregates were completely suppressed by low concentrations of various Btk-inhibitors in vitro and by a single low oral dose of ibrutinib for several days ex vivo [13]. Further platelet-mediated mechanisms of vascular thrombosis, that are also blocked by Btk-inhibitors, are the activation of platelet glycoprotein (GP) VI by collagen exposed after endothelial injury and of GPIb by von Willebrand factor expressed on inflamed endothelium [14,15,16,17,18,19,20].…”
Section: Dear Sirmentioning
confidence: 99%
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“…As we reported recently, FcγRIIA-stimulated platelet activation (aggregation, secretion, and P-selectin expression) and formation of platelet-neutrophil aggregates were completely suppressed by low concentrations of various Btk-inhibitors in vitro and by a single low oral dose of ibrutinib for several days ex vivo [13]. Further platelet-mediated mechanisms of vascular thrombosis, that are also blocked by Btk-inhibitors, are the activation of platelet glycoprotein (GP) VI by collagen exposed after endothelial injury and of GPIb by von Willebrand factor expressed on inflamed endothelium [14,15,16,17,18,19,20].…”
Section: Dear Sirmentioning
confidence: 99%
“…One must, however, be aware that patients treated with the irreversible covalent Btk-inhibitors ibrutinib, acalabrutinib, or zanubrutinib for B-cell malignancies show adverse reactions such as infections (grade 3 and higher in 18%-24% of the treated patients, mostly pneumonia) and frequently (50%) mild bleeding events [33,34,35]. One explanation for the latter might be the inhibition of the homologous kinase Tec in addition to Btk in platelets by these Btk-inhibitors [14,15].…”
Section: Dear Sirmentioning
confidence: 99%
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“…An alternative option is orally available inhibitors of the Bruton's tyrosine kinase that interfere with the downstream signaling of GPVI and GPIb. [36][37][38]…”
Section: Glycoprotein VImentioning
confidence: 99%
“…It is noteworthy that statins can not only reduce the cholesterol level, but also play an anti-inflammatory role ( 3 ). This study, therefore, aims to more specifically reduce inflammatory activities during atherosclerosis using colchicine and interleukin (IL)-1β antibodies or other modes targeting IL-6 or IL-1 receptors ( 4 ).…”
Section: Introductionmentioning
confidence: 99%