Abstract
Factor Xa (FXa) plays a key role in haemostasis, it is a central part of the blood coagulation cascade which catalyzes the production of thrombin and leads to clot formation and wound closure. Therefore, FXa is an attractive target for the development of new anticoagulant agents. In this review, we will first describe the molecular features of this fundamental protein in order to understand its mechanism of action, an essential background for the design of novel inhibitors by means of synthetic organic chemistry or using peptides obtained from recombinant methodologies. Then, we will review the current state of the synthesis of novel direct FXa inhibitors along with their mechanisms of action. Finally, approved reversal agents that aid in maintaining blood haemostasis by using these commercial drugs will also be discussed.
Keywords: Coagulation cascade, anticoagulants, FXa, synthetic inhibitors, direct FXa inhibitors, FXa reversal agents.
[http://dx.doi.org/10.1016/S1474-4422(03)00266-7] [PMID: 12849300]
[http://dx.doi.org/10.1161/ATVBAHA.114.304488] [PMID: 25304324]
[http://dx.doi.org/10.1161/01.STR.22.8.983] [PMID: 1866765]
[http://dx.doi.org/10.1038/nrd1466] [PMID: 15286732]
[http://dx.doi.org/10.2741/e383] [PMID: 22201878]
[http://dx.doi.org/10.1001/archinte.158.3.229] [PMID: 9472202]
[http://dx.doi.org/10.1055/s-0029-1234147] [PMID: 19739042]
[http://dx.doi.org/10.1016/j.arth.2015.03.040] [PMID: 25908335]
[http://dx.doi.org/10.1160/TH06-05-0234] [PMID: 16953267]
[http://dx.doi.org/10.1038/nrd3185] [PMID: 21164526]
[http://dx.doi.org/10.1111/j.1538-7836.2007.02872.x] [PMID: 18088349]
[http://dx.doi.org/10.1111/j.1538-7836.2006.02027.x] [PMID: 16839344]
[http://dx.doi.org/10.1016/j.ejphar.2007.05.043] [PMID: 17597608]
[http://dx.doi.org/10.1586/14779072.2016.1115344] [PMID: 26652975]
[http://dx.doi.org/10.1111/j.1600-0609.2011.01733.x] [PMID: 22077374]
[http://dx.doi.org/10.1093/eurheartj/suv062] [PMID: 28533706]
[http://dx.doi.org/10.1016/j.jmv.2010.11.005] [PMID: 21239127]
[http://dx.doi.org/10.1177/1753944710387808] [PMID: 21045018]
[http://dx.doi.org/10.1111/j.1538-7836.2005.01251.x] [PMID: 15869592]
[PMID: 13757796]
[http://dx.doi.org/10.1111/j.1365-2516.2008.01856.x] [PMID: 19141158]
[http://dx.doi.org/10.1111/j.1365-2141.1956.tb06703.x] [PMID: 13342365]
[PMID: 10498586]
[http://dx.doi.org/10.1378/chest.124.3_suppl.4S] [PMID: 12970118]
[http://dx.doi.org/10.1378/chest.124.3_suppl.11S] [PMID: 12970119]
[http://dx.doi.org/10.1046/j.1538-7836.2003.00298.x] [PMID: 12871286]
[PMID: 13763333]
[http://dx.doi.org/10.1161/01.ATV.18.3.458] [PMID: 9514415]
[http://dx.doi.org/10.1111/j.1538-7836.2007.02473.x] [PMID: 17635710]
[http://dx.doi.org/10.1007/s00018-002-8415-9] [PMID: 11915937]
[http://dx.doi.org/10.1161/01.ATV.17.7.1325] [PMID: 9261263]
[http://dx.doi.org/10.1185/030079906X89801] [PMID: 16574031]
[http://dx.doi.org/10.1182/blood.V97.8.2308] [PMID: 11290592]
[http://dx.doi.org/10.1172/JCI114723] [PMID: 2384594]
[http://dx.doi.org/10.1002/med.10058] [PMID: 14705167]
[http://dx.doi.org/10.1021/jm100146h] [PMID: 20503967]
[http://dx.doi.org/10.1098/rstb.1970.0024] [PMID: 4399049]
[http://dx.doi.org/10.1016/j.bmcl.2011.08.119] [PMID: 21955945]
[http://dx.doi.org/10.2147/VHRM.S39726] [PMID: 25673997]
[http://dx.doi.org/10.1016/j.thromres.2010.09.008] [PMID: 20888031]
[PMID: 3164720]
[PMID: 3689495]
[PMID: 2777803]
[http://dx.doi.org/10.1016/j.thromres.2011.10.037] [PMID: 22133273]
[http://dx.doi.org/10.1093/ajhp/58.suppl_2.S14] [PMID: 11715834]
[http://dx.doi.org/10.1182/blood-2004-05-2010] [PMID: 15388575]
[http://dx.doi.org/10.1111/j.1538-7836.2011.04487.x] [PMID: 21883878]
[http://dx.doi.org/10.1111/j.1527-3466.2002.tb00081.x] [PMID: 12070533]
[http://dx.doi.org/10.1160/TH09-08-0555] [PMID: 19888513]
[http://dx.doi.org/10.1021/jm030212h] [PMID: 14640539]
[http://dx.doi.org/10.1016/j.bmcl.2004.09.043] [PMID: 15501047]
[http://dx.doi.org/10.1016/j.ejmech.2012.10.005] [PMID: 23124211]
[http://dx.doi.org/10.1021/jm050101d] [PMID: 16161994]
[http://dx.doi.org/10.1016/j.bmcl.2010.06.126] [PMID: 20650636]
[http://dx.doi.org/10.3390/molecules22101588] [PMID: 28937618]
[http://dx.doi.org/10.1517/13543770903270532] [PMID: 19743898]
[http://dx.doi.org/10.1111/ijlh.12065] [PMID: 23590653]
[http://dx.doi.org/10.1111/j.1365-2125.2006.02776.x] [PMID: 17100983]
[http://dx.doi.org/10.1111/j.1538-7836.2008.02939.x] [PMID: 18315548]
[http://dx.doi.org/10.1111/j.1365-2125.2010.03753.x] [PMID: 21039764]
[http://dx.doi.org/10.2165/0003088-200948010-00001] [PMID: 19071881]
[http://dx.doi.org/10.1517/13543776.9.7.931]
[http://dx.doi.org/10.1007/s11239-011-0551-3] [PMID: 21318583]
[http://dx.doi.org/10.1055/s-0037-1617033] [PMID: 19644596]
[http://dx.doi.org/10.4081/itjm.2013.s8.1]
[http://dx.doi.org/10.1007/s11239-007-0017-9] [PMID: 17323133]
[http://dx.doi.org/10.1021/jm0497949] [PMID: 15771420]
[http://dx.doi.org/10.1161/ATVBAHA.110.202978] [PMID: 20139357]
[http://dx.doi.org/10.1007/s00228-005-0043-5] [PMID: 16328318]
[http://dx.doi.org/10.1160/TH09-09-0659] [PMID: 20135071]
[http://dx.doi.org/10.3390/molecules190914999] [PMID: 25237754]
[http://dx.doi.org/10.1161/STROKEAHA.113.002968] [PMID: 24763930]
[http://dx.doi.org/10.1053/j.seminhematol.2014.03.005] [PMID: 24861792]
[http://dx.doi.org/10.1111/nyas.12567] [PMID: 25377080]
[http://dx.doi.org/10.1111/j.1365-2125.2012.04369.x] [PMID: 22759198]
[http://dx.doi.org/10.1016/j.bmcl.2006.02.069] [PMID: 16730984]
[http://dx.doi.org/10.1080/00397911.2011.591956]
[http://dx.doi.org/10.1016/j.ijcard.2015.11.147] [PMID: 26649445]
[http://dx.doi.org/10.3109/00498254.2012.738045] [PMID: 23167531]
[http://dx.doi.org/10.1016/j.ejphar.2011.10.009] [PMID: 22040919]
[http://dx.doi.org/10.1093/eurheartj/ehr334] [PMID: 21878434]
[http://dx.doi.org/10.1016/j.thromres.2011.07.026] [PMID: 21851967]
[PMID: 27817212]
[http://dx.doi.org/10.1021/acs.oprd.8b00413]
[http://dx.doi.org/10.1007/s40262-015-0342-7] [PMID: 26620048]
[http://dx.doi.org/10.2146/ajhp150821] [PMID: 28122753]
[http://dx.doi.org/10.1093/eurheartj/ehu181] [PMID: 24810388]
[http://dx.doi.org/10.1016/j.bmcl.2009.02.111] [PMID: 19297154]
[http://dx.doi.org/[DOI: 10.1080/17474086.2016.1256194] [PMID: 27809616]
[http://dx.doi.org/10.1517/13543784.2013.825605] [PMID: 23964817]
[http://dx.doi.org/10.1016/j.jacc.2017.09.1093] [PMID: 29169486]
[http://dx.doi.org/10.3184/174751915X14400926401559]
[http://dx.doi.org/10.1016/j.sbi.2013.03.008] [PMID: 23731801]
[http://dx.doi.org/10.1186/s12934-016-0437-3] [PMID: 26861699]
[http://dx.doi.org/10.1007/s11738-016-2315-3]
[http://dx.doi.org/10.1002/bab.6] [PMID: 21446960]
[http://dx.doi.org/10.1007/s11248-016-9933-9] [PMID: 26820414]
[PMID: 23162075]
[http://dx.doi.org/10.1016/0378-1119(89)90382-X] [PMID: 2470652]
[http://dx.doi.org/10.1016/0003-9861(91)90325-D] [PMID: 1990979]
[http://dx.doi.org/10.1021/bk-1991-0477.ch008]
[http://dx.doi.org/10.1016/1046-5928(92)90014-N] [PMID: 1392615]
[http://dx.doi.org/10.1042/bj2870943] [PMID: 1445252]
[http://dx.doi.org/10.1006/jmbi.1993.1360] [PMID: 8515472]
[http://dx.doi.org/10.1016/0049-3848(94)90138-4] [PMID: 8073407]
[http://dx.doi.org/10.1006/prep.1995.0013] [PMID: 8746634]
[http://dx.doi.org/10.1107/S0907444901007272] [PMID: 11418776]
[http://dx.doi.org/10.1073/pnas.93.5.2149] [PMID: 8700900]
[http://dx.doi.org/10.1016/S0141-0229(98)00161-6]
[http://dx.doi.org/10.1073/pnas.92.13.6152] [PMID: 7597095]
[PMID: 9336312]
[http://dx.doi.org/10.1016/S0049-3848(00)00210-3] [PMID: 10899352]
[http://dx.doi.org/10.1016/j.bcp.2015.04.004] [PMID: 25887920]
[http://dx.doi.org/10.1023/A:1006198713791] [PMID: 9890144]
[http://dx.doi.org/10.1046/j.1365-2583.2002.00375.x] [PMID: 12421422]
[http://dx.doi.org/10.1016/j.amjmed.2016.06.010] [PMID: 27569673]
[http://dx.doi.org/10.1016/j.chest.2017.02.009] [PMID: 28219635]
[http://dx.doi.org/10.1016/j.jemermed.2016.08.023] [PMID: 27727040]
[http://dx.doi.org/10.1016/j.ahj.2015.03.010] [PMID: 26027611]
[http://dx.doi.org/10.1016/j.amjmed.2016.06.002] [PMID: 27521288]
[http://dx.doi.org/10.1038/s41598-017-00383-6] [PMID: 28325919]
[http://dx.doi.org/10.1182/blood-2012-11-468207] [PMID: 23476049]
[http://dx.doi.org/10.1007/s11239-015-1286-3] [PMID: 26476930]
[http://dx.doi.org/10.1016/j.amjmed.2016.06.007] [PMID: 27569674]
[http://dx.doi.org/10.1111/jth.13673] [PMID: 28294526]
[http://dx.doi.org/10.1056/NEJMoa1510991] [PMID: 26559317]
[http://dx.doi.org/10.1016/j.amj.2016.04.012]
[http://dx.doi.org/10.1039/c4cc00572d] [PMID: 24618788]
[http://dx.doi.org/10.1038/nm.2942] [PMID: 23023498]
[http://dx.doi.org/10.1111/jth.12270] [PMID: 23809113]
[PMID: 23819034]
[http://dx.doi.org/10.1111/hae.12428] [PMID: 24762271]
[http://dx.doi.org/10.1056/NEJMoa1511769] [PMID: 27223146]
[http://dx.doi.org/10.1080/10245332.2017.1319115] [PMID: 28441921]
[http://dx.doi.org/10.1111/hae.13157] [PMID: 28124406]
[http://dx.doi.org/10.1016/S0049-3848(16)30361-9] [PMID: 27207420]
[http://dx.doi.org/10.4161/19420862.2015.989028] [PMID: 25524207]
[http://dx.doi.org/10.1182/blood-2015-06-650226] [PMID: 26626991]
[http://dx.doi.org/10.1016/j.ihj.2015.11.023] [PMID: 27543482]
[http://dx.doi.org/10.1016/j.amjmed.2016.06.009] [PMID: 27575436]
[http://dx.doi.org/10.1053/j.jvca.2016.01.005] [PMID: 27080265]
[http://dx.doi.org/10.1016/j.enfcli.2017.02.003] [PMID: 28283255]
[http://dx.doi.org/10.20452/pamw.3547] [PMID: 27592622]
[http://dx.doi.org/10.1161/STROKEAHA.116.013343] [PMID: 28400486]
[http://dx.doi.org/10.1016/j.wneu.2015.10.030] [PMID: 26481339]
[http://dx.doi.org/10.1111/jth.13227] [PMID: 26911798]
[http://dx.doi.org/10.2146/ajhp150810] [PMID: 27895055]
[http://dx.doi.org/10.1007/978-1-62703-339-8_5]
[http://dx.doi.org/10.1007/978-1-62703-339-8]
[http://dx.doi.org/10.1007/978-1-4939-7196-1]
[PMID: 13439266]
[http://dx.doi.org/10.1093/ajcp/89.3.347] [PMID: 3348169]
[http://dx.doi.org/10.1111/ejh.12500] [PMID: 25560793]
[http://dx.doi.org/10.1007/s11239-011-0622-5] [PMID: 21811937]
[http://dx.doi.org/10.1111/j.1751-553X.2007.00998.x] [PMID: 19143869]
[http://dx.doi.org/10.1111/jth.13743] [PMID: 28656617]