VKORC1: a warfarin-sensitive enzyme in vitamin K metabolism and biosynthesis of vitamin K-dependent blood coagulation factors.

The recently discovered enzyme VKORC1 of the vitamin K cycle, which is the target for the anticoagulant drug warfarin, has opened new opportunities to understand warfarin resistance and biosynthesis of vitamin K-dependent blood coagulation factors and other members of this protein family. Furthermore, it has opened new opportunities to study the vitamin K-dependent posttranslational gamma-carboxylational system in the endoplasmic reticulum in greater detail and its molecular operation in vivo. Other accomplishments resulting from this discovery are: (1) the finding that VKORC1 is the rate-limiting step in biosynthesis of functional vitamin K-dependent proteins, and (2) engineering of recombinant intracellular gamma-carboxylation systems in cell lines producing recombinant coagulation factor used clinically to treat bleeding disorders. The engineered cells significantly enhance production of the fraction of fully functional gamma-carboxylated proteins compared to cell lines only overexpressing the specific coagulation factor. The first described inhibitor of the gamma-carboxylation system has been identified as calumenin, a resident chaperone in the endoplasmic reticulum (ER). Together, the new information gained about the vitamin K-dependent gamma-carboxylation system will stimulate new research which will benefit medicine and our understanding of the molecular mechanisms involved in this protein modification reaction.