Clopidogrel Resistance in a Murine Model of Diet-Induced Obesity Is Mediated by the Interleukin-1 Receptor and Overcome With DT-678

Arterioscler Thromb Vasc Biol. 2020 Jun;40(6):1533-1542. doi: 10.1161/ATVBAHA.120.314146. Epub 2020 Apr 9.


Objective: Clopidogrel is a commonly used P2Y12 inhibitor to treat and prevent arterial thrombotic events. Clopidogrel is a prodrug that requires bioactivation by CYP (cytochrome P450) enzymes to exert antiplatelet activity. Diabetes mellitus is associated with an increased risk of ischemic events, and impaired ability to generate the active metabolite (AM) from clopidogrel. The objective of this study is to identify the mechanism of clopidogrel resistance in a murine model of diet-induced obesity (DIO). Approach and Results: C57BL/6J mice and IL-1R-/- mice were given high-fat diet for 10 weeks to generate a murine model of diet-induced obesity. Platelet aggregation and carotid arterial thrombosis were assessed in response to clopidogrel treatment. Wild-type DIO mice exhibited resistance to antiplatelet and antithrombotic effects of clopidogrel that was associated with reduced hepatic expression of CYP genes and reduced generation of the AM. IL (Interleukin)-1 receptor-deficient DIO (IL1R-/- DIO) mice showed no resistance to clopidogrel. Lack of resistance was accompanied by increased exposure of the clopidogrel AM. This resistance was also absent when wild-type DIO mice were treated with the conjugate of the clopidogrel AM, DT-678.

Conclusions: These findings indicate that antiplatelet effects of clopidogrel may be impaired in the setting of diabetes mellitus due to reduced prodrug bioactivation related to IL-1 receptor signaling. Therapeutic targeting of P2Y12 in patients with diabetes mellitus using the conjugate of clopidogrel AM may lead to improved outcomes.

Keywords: clopidogrel; cytochromes; diabetes mellitus; obesity; thrombosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Carotid Artery Thrombosis / prevention & control
  • Clopidogrel / pharmacokinetics*
  • Clopidogrel / pharmacology
  • Clopidogrel / therapeutic use*
  • Cytochrome P-450 Enzyme System / genetics
  • Diabetes Mellitus
  • Diet, High-Fat
  • Disease Models, Animal
  • Drug Resistance*
  • Fibrinolytic Agents
  • Gene Expression
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Microsomes, Liver / enzymology
  • Obesity / complications*
  • Obesity / etiology
  • Obesity / metabolism
  • Platelet Aggregation / drug effects
  • Platelet Aggregation Inhibitors
  • Prodrugs / pharmacokinetics
  • Prodrugs / therapeutic use
  • Receptors, Interleukin-1 / deficiency
  • Receptors, Interleukin-1 / physiology*


  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Prodrugs
  • Receptors, Interleukin-1
  • Cytochrome P-450 Enzyme System
  • Clopidogrel