Nonstandard Factor VIIa Binding Mode Reveals S1 Pocket Plasticity in Trypsin‐Like Proteases

Factor VIIa (FVIIa) catalyzes the first step of the blood coagulation cascade. The expected wide therapeutic window between antithrombotic efficacy and bleeding risk makes FVIIa an attractive drug target. However, no FVIIa inhibitors have reached the market so far, mostly due to poor oral bioavailability. To date, in all ligand-bound X-ray crystal structures of FVIIa, the binding pocket of FVIIa is in an active, open form. Here, we present an X-ray crystal structure of the FVIIa-tissue factor complex with a bound oxazole-based inhibitor at 1.9 Å resolution, with an extensively remodeled active site and a collapsed S1 pocket. Using collectively 0.17 ms of atomistic molecular dynamics simulations, we observed conformational transitions between the collapsed and open forms of the S1 pockets of FVIIa and 12 other serine peptidases out of 16 studied, indicating an equilibrium of open and collapsed states of the S1 pocket in FVIIa and the majority of the serine proteases studied. Therefore, our results point to a general S1 pocket plasticity, which provides the basis for a completely new way of inhibiting FVIIa and other serine proteases.