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Protein disulfide isomerase-related protein (PDIr), also known as PDIA5, is an endoplasmic reticulum-resident enzyme belonging to the protein disulfide isomerase (PDI) family. Recombinant PDIr is being investigated as a novel antithrombotic and antiplatelet therapeutic agent for the treatment and prevention of arterial thrombosis. Mechanistically, PDIr acts as a disulfide reductase that dual-inhibits platelet function and coagulation activation. It physically interacts with integrin alpha-IIb/beta-3 (GPIIb/IIIa) on the platelet surface, reducing the alpha-IIb disulfide bond (Cys146-Cys167) to suppress integrin activation and platelet aggregation. Additionally, PDIr binds to and cleaves disulfide bonds within prothrombin, preventing its binding to platelet phosphatidylserine and thereby attenuating thrombin generation and procoagulant activity.
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