Warfarin resistance associated with genetic polymorphism of VKORC1: linking clinical response to molecular mechanism using computational modeling.

Benjamin Lewis, Pramod Nair, Subash Heran, Andrew Somogyi, Jeffrey Bowden, Matthew Doogue, John Miners

    Research output: Contribution to journalArticle

    9 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)44-50
    Number of pages7
    JournalPharmacogenetics and Genomics
    Volume26
    Issue number1
    DOIs
    Publication statusPublished - 2015

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