Antidotes for factor Xa inhibitors and methods of using the same
The present invention relates antidotes to anticoagulants targeting factor Xa. The antidotes are factor X and factor Xa protein derivatives that bind to the factor Xa inhibitors thereby substantially neutralizing them but do not assemble into the prothrombinase complex. The derivatives describe herein lack or have reduced intrinsic coagulant activity. Disclosed herein are methods of reversing anticoagulation, stopping or preventing bleeding in a patient that is currently undergoing anticoagulant therapy with a factor Xa inhibitor.
1. A two-chain polypeptide comprising a first chain and a second chain, wherein:
the first chain consists of (i) amino acid residues 1-105 of SEQ ID NO:20, or consists of an amino acid sequence having at least 90% sequence identity to (i); and
the second chain consists of (ii) amino acid residues 112-346 of SEQ ID NO:20, or consists of an amino acid sequence having at least 95% sequence identity to (ii), and
wherein the two-chain polypeptide can bind to a factor Xa inhibitor, cannot assemble into a prothrombinase complex and has reduced catalytic activity as compared to a wildtype fXa.
2. A pharmaceutical composition comprising a carrier and a two-chain polypeptide of claim 1 .
3. The two-chain polypeptide of claim 1 , wherein:
the first chain consists of an amino acid sequence having at least 95% sequence identity to (i); and
the second chain consists of an amino acid sequence having at least 95% sequence identity to (ii).
4. The two-chain polypeptide of claim 1 , wherein:
the first chain consists of an amino acid sequence having at least 98% sequence identity to (i); and
the second chain consists of an amino acid sequence having at least 98% sequence identity to (ii).
5. The two-chain polypeptide of claim 1 , wherein the first chain consists of amino acid residues 1-105 of SEQ ID NO:20 and the second chain consists of amino acid residues 112-346 of SEQ ID NO:20.
6. A polypeptide consisting of the amino acid sequence of SEQ ID NO:20, or an amino acid sequence having at least 95% sequence identity to SEQ ID NO:20, wherein the polypeptide, upon cleavage at the -RKRRKR- linker (amino acid residues 106-111 of SEQ ID NO:20), forms a two-chain polypeptide that can bind to a fXa inhibitor, cannot assemble into a prothrombinase complex and has reduced catalytic activity as compared to a wildtype fXa.
7. The polypeptide of claim 6 , wherein the polypeptide consists of the amino acid sequence of SEQ ID NO:20.
8. A method of neutralizing or reversing anticoagulation in a subject undergoing anticoagulant therapy with a factor Xa inhibitor, comprising administering to the subject an effective amount of a two-chain polypeptide of claim 1 .
9. The method of claim 8 , wherein the factor Xa inhibitor is selected from the group consisting of fondaparinux, idraparinux, biotinylated idraparinux, enoxaparin, fragmin, NAP-5, rNAPc2, tissue factor pathway inhibitor, DX-9065a, YM-60828, YM-150, apixaban, rivaroxaban, PD-348292, otamixaban, DU-176b, LY517717, GSK913893, razaxaban, low molecular weight heparin, betrixaban or a pharmaceutically acceptable salt thereof, and combinations thereof.
10. The method of claim 8 , wherein the factor Xa inhibitor is betrixaban, rivaroxaban, apixaban, enoxaparin, fondaparinux, or a low molecular weight heparin.
11. The method of claim 8 , wherein the administration comprises intravenous injection.
12. The method of claim 11 , wherein the injection comprises a bolus intravenous injection followed by a continuous infusion.