Targeting the P-selectin/PSGL-1 pathway: discovery of disease-modifying therapeutics for disorders of thromboinflammation

P-selectin is a membrane glycoprotein and a member of the selectin family of cell adhesion molecules. It is pre-stored in α-granules of platelets and Weibel-Palade bodies of endothelial cells and is rapidly expressed on their surfaces upon activation during the course of an inflammatory response. While a critical component of the innate immune system, the interaction of P-selectin with its cognate ligand, P-selectin glycoprotein-1 (PSGL-1) may mediate maladaptive events central to the pathophysiology of venous thromboembolism (VTE), cardiovascular disease, stroke, metabolic syndrome, and sickle cell disease (SCD), among other disorders. As a consequence, a growing understanding of the significance of P-selectin and PSGL-1 in human disease has motivated the design of inhibitors that target the P-selectin/PSGL-1 pathway. Herein, we review the development and evaluation of both biologic and small molecule inhibitors, including preclinical studies and clinical trials that have evaluated therapeutic potential of these agents for a variety of diseases linked to dysregulated inflammatory and thrombotic responses.