5ALC

Ticagrelor antidote candidate Fab 72 in complex with ticagrelor

Summary for 5ALC

• Entry DOI: 10.2210/pdb5alc/pdb
• Related: 5ALB
• Descriptor: ANTI-TICAGRELOR FAB 72, HEAVY CHAIN, ANTI-TICAGRELOR FAB 72, LIGHT CHAIN, Ticagrelor, ... (4 entities in total)
• Functional Keywords: immune system, antibody fragment, antidote, drug
• Biological source: HOMO SAPIENS (HUMAN); More
• Total number of polymer chains: 2
• Total formula weight: 47823.10

Authors

Buchanan, A.,Newton, P.,Pehrsson, S.,Inghardt, T.,Antonsson, T.,Svensson, P.,Sjogren, T.,Oster, L.,Janefeldt, A.,Sandinge, A.,Keyes, F.,Austin, M.,Spooner, J.,Penney, M.,Howells, G.,Vaughan, T.,Nylander, S. (deposition date: 2015-03-07, release date: 2015-04-01, Last modification date: 2024-11-06)

Primary citation

Buchanan, A.,Newton, P.,Pehrsson, S.,Inghardt, T.,Antonsson, T.,Svensson, P.,Sjogren, T.,Oster, L.,Janefeldt, A.,Sandinge, A.,Keyes, F.,Austin, M.,Spooner, J.,Gennemark, P.,Penney, M.,Howells, G.,Vaughan, T.,Nylander, S.
Structural and Functional Characterisation of a Specific Antidote for Ticagrelor.
Blood, 125:3484-, 2015

PubMed Abstract: Ticagrelor is a direct-acting reversibly binding P2Y12 antagonist and is widely used as an antiplatelet therapy for the prevention of cardiovascular events in acute coronary syndrome patients. However, antiplatelet therapy can be associated with an increased risk of bleeding. Here, we present data on the identification and the in vitro and in vivo pharmacology of an antigen-binding fragment (Fab) antidote for ticagrelor. The Fab has a 20 pM affinity for ticagrelor, which is 100 times stronger than ticagrelor's affinity for its target, P2Y12. Despite ticagrelor's structural similarities to adenosine, the Fab is highly specific and does not bind to adenosine, adenosine triphosphate, adenosine 5'-diphosphate, or structurally related drugs. The antidote concentration-dependently neutralized the free fraction of ticagrelor and reversed its antiplatelet activity both in vitro in human platelet-rich plasma and in vivo in mice. Lastly, the antidote proved effective in normalizing ticagrelor-dependent bleeding in a mouse model of acute surgery. This specific antidote for ticagrelor may prove valuable as an agent for patients who require emergency procedures.

PubMed: 25788700
DOI: 10.1182/BLOOD-2015-01-622928

Experimental method

X-RAY DIFFRACTION (1.7 Å)