A novel vitamin K derived anticoagulant tolerant to genetic variations of vitamin K epoxide reductase

• Published in: Journal of thrombosis and haemostasis 2021-03, Vol.19 (3), p.689-700
• Main Authors: Chen, Xuejie, Liu, Yizhou, Furukawa, Natsuko, Jin, Da‐Yun, Paul Savage, G., Stafford, Darrel W., Suhara, Yoshitomo, Williams, Craig M., Tie, Jian‐Ke
• Format: Article
• Language: English
• Subjects: Animals; Antagonists; Anticoagulants; Blood Coagulation; Carboxylation; Clotting; coagulation factors carboxylation; cyclooctatetraene; Dosage; Enzymes; Genetic diversity; oral anticoagulant; Thromboembolism; Vitamin K; Vitamin K 1; vitamin K antagonist; vitamin K epoxide reductase; Vitamin K Epoxide Reductases - genetics; Warfarin
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.15209

Background Vitamin K antagonists (VKAs), such as warfarin, have remained the cornerstone of oral anticoagulation therapy in the prevention and treatment of thromboembolism for more than half a century. They function by impairing the biosynthesis of vitamin K‐dependent (VKD) clotting factors through the inhibition of vitamin K epoxide reductase (VKOR). The challenge of VKAs therapy is their narrow therapeutic index and highly variable dosing requirements, which are partially the result of genetic variations of VKOR. Objectives The goal of this study was to search for an improved VKA that is tolerant to the genetic variations of its target enzyme. Methods A series of vitamin K derivatives with benzyl and related side‐chain substitutions at the 3‐position of 1,4‐naphthoquinone were synthesized. The role of these compounds in VKD carboxylation was evaluated by mammalian cell‐based assays and conventional in vitro activity assays. Results Our results showed that replacing the phytyl side‐chain with a methylene cyclooctatetraene (COT) moiety at the 3‐position of vitamin K1 converted it from a substrate to an inhibitor for VKD carboxylation. Strikingly, this COT‐vitamin K derivative displayed a similar inhibition potency in warfarin‐resistant VKOR mutations whose warfarin resistance varied more than 400‐fold. Further characterization of COT‐vitamin K for the inhibition of VKD carboxylation suggested that this compound targets multiple enzymes in the vitamin K redox cycle. Importantly, the anticoagulation effect of COT‐vitamin K can be rescued with high doses of vitamin K1. Conclusion We discovered a vitamin K analogue that functions as a VKA and is tolerant to genetic variations in the target enzyme.