Structure-guided design of novel orthosteric inhibitors of integrin αIIbβ3 that prevent thrombosis but preserve hemostasis

Platelet integrin lIb{beta}3 plays a critical role in both hemostasis and thrombosis. Current IIb{beta}3 antagonists are potent anti-thrombotic drugs, but also cause adverse outcomes, which limited their clinical use. Drug-induced serious bleeding, thrombocytopenia and paradoxical thrombosis have been linked to impaired clot retraction and to conformational changes in IIb{beta}3 that promote binding of preformed antibodies, natural ligands or both to IIb{beta}3. We have used structure-guided design to generate the orthosteric inhibitor Hr10 that acts as a pure IIb{beta}3 antagonist, i.e. it does not induce the conformational changes in IIb{beta}3. Hr10 is as effective as the partial agonist drug eptifibatide in blocking platelet aggregation and arteriolar thrombosis in mice. In contrast to eptifibatide, however, Hr10 preserved thrombin-induced clot retraction, suggesting that it may not perturb hemostasis. Our structure-based approach can find general utility in designing pure orthosteric inhibitors for other integrins, in providing vital tools for dissecting structure-activity relationships in IIb{beta}3, and potentially in offering safer alternatives for human therapy.