TY - JOUR
T1 - Warfarin resistance associated with genetic polymorphism of VKORC1: linking clinical response to molecular mechanism using computational modeling.
AU - Lewis, Benjamin C
AU - Nair, Pramod
AU - Heran, Subash
AU - Somogyi, Andrew
AU - Bowden, Jeffrey
AU - Doogue, Matthew
AU - Miners, John
PY - 2016/1/1
Y1 - 2016/1/1
N2 - The variable response to warfarin treatment often has a genetic basis. A protein homology model of human Vitamin K epoxide reductase, subunit 1 (VKORC1), was generated to elucidate the mechanism of warfarin resistance observed in a patient with the Val66Met mutation. The VKORC1 homology model comprises four transmembrane (TM) helical domains and a half helical lid domain. Cys132 and Cys135, located in the N-terminal end of TM-4, are linked through a disulfide bond. Two distinct binding sites for warfarin were identified. Site-1, which binds Vitamin K epoxide (KO) in a catalytically favorable orientation, shows higher affinity for S-warfarin compared with R-warfarin. Site-2, positioned in the domain occupied by the hydrophobic tail of KO, binds both warfarin enantiomers with similar affinity. Displacement of Arg37 occurs in the Val66Met mutant, blocking access of warfarin (but not KO) to Site-1, consistent with clinical observation of warfarin resistance.
AB - The variable response to warfarin treatment often has a genetic basis. A protein homology model of human Vitamin K epoxide reductase, subunit 1 (VKORC1), was generated to elucidate the mechanism of warfarin resistance observed in a patient with the Val66Met mutation. The VKORC1 homology model comprises four transmembrane (TM) helical domains and a half helical lid domain. Cys132 and Cys135, located in the N-terminal end of TM-4, are linked through a disulfide bond. Two distinct binding sites for warfarin were identified. Site-1, which binds Vitamin K epoxide (KO) in a catalytically favorable orientation, shows higher affinity for S-warfarin compared with R-warfarin. Site-2, positioned in the domain occupied by the hydrophobic tail of KO, binds both warfarin enantiomers with similar affinity. Displacement of Arg37 occurs in the Val66Met mutant, blocking access of warfarin (but not KO) to Site-1, consistent with clinical observation of warfarin resistance.
KW - CYP2C9
KW - cytochrome P450 2C9
KW - genetic polymorphism
KW - Vitamin K epoxide reductase subunit 1
KW - VKORC1
KW - warfarin resistance
UR - http://www.scopus.com/inward/record.url?scp=84983135386&partnerID=8YFLogxK
U2 - 10.1097/FPC.0000000000000184
DO - 10.1097/FPC.0000000000000184
M3 - Article
SN - 1744-6872
VL - 26
SP - 44
EP - 50
JO - Pharmacogenetics and Genomics
JF - Pharmacogenetics and Genomics
IS - 1
ER -