title: RNA aptamers as reversible antagonists of coagulation factor IXa.
abstract: Many therapeutic agents are associated with adverse effects in patients. Anticoagulants can engender acute complications such as significant bleeding that increases patient morbidity and mortality. Antidote control provides the safest means to regulate drug action. For this reason, despite its known limitations and toxicities, heparin use remains high because it is the only anticoagulant that can be controlled by an antidote, the polypeptide protamine. To date, no generalizable strategy for developing drug-antidote pairs has been described. We investigated whether drug-antidote pairs could be rationally designed by taking advantage of properties inherent to nucleic acids to make antidote-controlled anticoagulant agents. Here we show that protein-binding oligonucleotides (aptamers) against coagulation factor IXa are potent anticoagulants. We also show that oligonucleotides complementary to these aptamers can act as antidotes capable of efficiently reversing the activity of these new anticoagulants in plasma from healthy volunteers and from patients who cannot tolerate heparin. This generalizable strategy for rationally designing a drug-antidote pair thus opens up the way for developing safer regulatable therapeutics.
authors.affiliation: Department of Surgery, Program in Combinatorial Therapeutics, Duke University Medical Center, Durham, North Carolina 27710, USA. c.rusconi@cgt.duke.edu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Rusconi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Scardino
authors.forename: Juliana
authors.initials: J
authors.lastname: Layzer
authors.forename: George A
authors.initials: GA
authors.lastname: Pitoc
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: Dougald
authors.initials: D
authors.lastname: Monroe
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Sullenger
mesh_terms: D000925:Anticoagulants / Q000037:antagonists & inhibitors* / Q000737:chemistry / Q000378:metabolism / Q000494:pharmacology*; D000931:Antidotes / Q000737:chemistry / Q000378:metabolism / Q000494:pharmacology*; D001483:Base Sequence; D001667:Binding, Competitive / Q000187:drug effects; D000075202:Contraindications; D015195:Drug Design; D015949:Factor IXa / Q000037:antagonists & inhibitors* / Q000378:metabolism; D015944:Factor VIIIa / Q000378:metabolism; D005170:Factor X / Q000378:metabolism; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D008969:Molecular Sequence Data; D009690:Nucleic Acid Conformation; D009843:Oligoribonucleotides / Q000037:antagonists & inhibitors / Q000235:genetics / Q000378:metabolism / Q000494:pharmacology*; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012313:RNA / Q000037:antagonists & inhibitors / Q000235:genetics / Q000378:metabolism / Q000494:pharmacology*; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D000931:Antidotes; D009843:Oligoribonucleotides; D012313:RNA; D015944:Factor VIIIa; D005170:Factor X; D006493:Heparin; D015949:Factor IXa