The potential of enzastaurin to enhance platelet aggregation and growth factor secretion: implications for cancer cell survival

Summary Background Enzastaurin is a protein kinase C (PKC)β inhibitor with antiproliferative and proapoptotic effects that was in clinical development for the treatment of a variety of cancers. However, the primary endpoints in several clinical trials of enzastaurin were not met, and thrombosis was reported as an adverse effect in some trials. While investigating the role of PKC in regulating growth factor release from platelets, we found that, unlike other PKC inhibitors, enzastaurin may potentiate platelet aggregation. Objective To investigate the effects of enzastaurin on platelet aggregation, growth factor secretion from α‐granules and cancer cell apoptosis in the presence of platelets. Methods Prostacyclin‐washed platelets and platelet‐rich plasma were isolated from the blood of healthy human volunteers. Platelet light‐aggregometry was performed in the presence and absence of enzastaurin and acetylsalicylic acid (ASA). P‐selectin was measured by flow cytometry, and vascular endothelial growth factor (VEGF) release was measured by ELISA. A549 lung carcinoma cells were treated with releasates from enzastaurin‐titrated platelets. A cell death ELISA was performed to measure A549 apoptosis. Results and Conclusions Enzastaurin (10−8–10−6 m) potentiated aggregation of prostacyclin‐washed platelets and caused an increase in VEGF release from α‐granules that, in turn, promoted cancer cell survival. In platelet‐rich plasma, 10−6 m enzastaurin inhibited platelet aggregation, but not 10−7 m enzastaurin, which also failed to suppress VEGF secretion. ASA abrogated enzastaurin‐potentiated washed‐platelet aggregation and VEGF release. These findings indicate that, at high plasma protein‐free drug concentrations, enzastaurin potentiates platelet aggregation and growth factor secretion, an effect that may counteract its anticancer activity. ASA nullifies this effect.