Original Articles
Vol. 5 No. 3 (2026): In memory of Armando D’Angelo

The LIKT sequence in C-terminus of tissue factor pathway inhibitor (TFPIα) crucially important for the synergistic TFPIα-cofactor activity of protein S and FV-short

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 28 August 2026
0
Views
0
Downloads

Authors

Background: Inhibition of factor Xa (FXa) by tissue factor pathway inhibitor α (TFPIα) is potentiated by FV-Short and protein S. The C-terminus of TFPIα is important for formation of the TFPIα/protein S/FV-Short complex. It contains a hydrophobic sequence (LIKT). The purpose was to investigate the importance of the LIKT sequence.

Methods: Two TFPIα C-terminal peptides were synthesized, one wild-type and the other with LIKT replaced by AAKA. The effect of the peptides on TFPIα function was tested. An AAKA-mutant TFPIα was created and compared with wild-type TFPIα. AlphaFold was used to elucidate a mechanism for the role of the LIKT sequence.

Results: The wild-type peptide efficiently inhibited the FXa-inhibitory activity of TFPIα/protein S/FV-Short complex, whereas the AAKA peptide did not. The LIKT sequence in TFPIα was crucially important for the synergistic TFPIα-cofactor activity between protein S and FV-Short. AlphaFold (DeepMind, London, UK) suggested an interaction between LIKT and FV-Short B-loop 1510-1517 mediated through a network of hydrogen bonds and hydrophobic interactions.

Conclusions: The C-terminal TFPIα-peptide induced complex formation between protein S and FV-Short. The LIKT sequence in TFPIα was crucially important for the ability of protein S and FV-Short to function as synergistic TFPIα cofactors.

Downloads

Download data is not yet available.

Citations

1. Broze GJ, Jr., Girard TJ. Tissue factor pathway inhibitor: structure-function. Front Biosci (Landmark Ed) 2012;17:262-80.
2. Mast AE, Ruf W. Regulation of coagulation by tissue factor pathway inhibitor: Implications for hemophilia therapy. J Thromb Haemost 2022;20:1290-300.
3. Wood JP, Ellery PE, Maroney SA, et al. Biology of tissue factor pathway inhibitor. Blood 2014;123:2934-43.
4. Ahnstrom J, Petri A, Crawley JTB. Tissue factor pathway inhibitor - cofactor-dependent regulation of the initiation of coagulation. Curr Opin Hematol 2024;31:315-20.
5. Dahlback B. Natural anticoagulant discovery, the gift that keeps on giving: finding FV-Short. J Thromb Haemost 2023;21:716-27.
6. Vincent LM, Tran S, Livaja R, et al. Coagulation factor V(A2440G) causes east Texas bleeding disorder via TFPIαlpha. J Clin Invest 2013;123:3777-87.
7. Dahlback B. Novel insights into the regulation of coagulation by factor V isoforms, tissue factor pathway inhibitoralpha, and protein S. J Thromb Haemost 2017;15:1241-50.
8. Santamaria S, Reglinska-Matveyev N, Gierula M, et al. Factor V anticoagulant cofactor activity that targets the early phase of coagulation. J Biol Chem 2017;292:9335-44.
9. Camire RM. Rethinking events in the haemostatic process: role of factor V and TFPI. Haemophilia 2016;22:3-8.
10. Ahnstrom J, Andersson HM, Hockey V, et al. Identification of functionally important residues in TFPI Kunitz domain 3 required for the enhancement of its activity by protein S. Blood 2012;120:5059-62.
11. Dahlback B, Tran S. The preAR2 region (1458-1492) in factor V-Short is crucial for the synergistic TFPIαlpha-cofactor activity with protein S and the assembly of a trimolecular factor Xa-inhibitory complex comprising FV-Short, protein S, and TFPIαlpha. J Thromb Haemost 2022;20:58-68.
12. Dahlback B, Tran S, Draczkowski P. Importance of individual residues in hydrophobic patch PLVIVGL (1481-1487) in FV-Short for synergistic TFPIαlpha cofactor activity with protein S, an alanine-scanning study: AlphaFold-mediated prediction of FV-Short/TFPIαlpha/protein S trimolecular complex structure. J Thromb Haemost 2025;23:849-62.
13. Petrillo T, Ayombil F, Van't Veer C, et al. Regulation of factor V and factor V-short by TFPIαlpha: Relationship between B-domain proteolysis and binding. J Biol Chem 2021;296:100234.
14. Wood JP, Bunce MW, Maroney SA, et al. Tissue factor pathway inhibitor-alpha inhibits prothrombinase during the initiation of blood coagulation. Proc Natl Acad Sci USA 2013;110:17838-43.
15. Mohapatra AK, Todaro AM, Castoldi E. Factor V variants in bleeding and thrombosis. Res Pract Thromb Haemost 2024;8:102330.
16. Peterson JA, Gupta S, Martinez ND, et al. Factor V east Texas variant causes bleeding in a three-generation family. J Thromb Haemost 2021;20:565-73.
17. Zimowski KL, Petrillo T, Ho MD, et al. F5-Atlanta: a novel mutation in F5 associated with enhanced East Texas splicing and FV-short production. J Thromb Haemost 2021;19:1653-65.
18. Gierula M, Ahnstrom J. Anticoagulant protein S-New insights on interactions and functions. J Thromb Haemost 2020;18:2801-11.
19. Dahlback B. Vitamin K-Dependent Protein S: Beyond the Protein C Pathway. Semin Thromb Hemost 2018;44:176-84.
20. Teraz-Orosz A, Gierula M, Petri A, et al. Laminin G1 residues of protein S mediate its TFPI cofactor function and are competitively regulated by C4BP. Blood Adv 2021;6:704-15.
21. Wood JP, Petersen HH, Yu B, et al. TFPIαlpha interacts with FVa and FXa to inhibit prothrombinase during the initiation of coagulation. Blood Adv 2017;1:2692-702.
22. Wood JP, Baumann Kreuziger LM, Ellery PER, et al. Reduced prothrombinase inhibition by tissue factor pathway inhibitor contributes to the Factor V Leiden hypercoagulable state. Blood Adv 2017;1:386-95.
23. Dahlback B, Hildebrand B, Malm J. Characterization of functionally important domains in human vitamin K-dependent protein S using monoclonal antibodies. J Biol Chem 1990;265:8127-35.
24. Dahlback B. Purification of human vitamin K-dependent protein S and its limited proteolysis by thrombin. Biochem J 1983;209:837-46.
25. Dahlbäck B, Tran S. A hydrophobic patch (PLVIVG; 1481-1486) in the B-domain of Factor V-Short is crucial for its synergistic TFPIα-cofactor activity with protein S and for the formation of the FXa-inhibitory complex comprising FV-Short, TFPIα and protein S. J Thromb Haemost 2022;20:1146-57.
26. Abramson J, Adler J, Dunger J, et al. Accurate structure prediction of biomolecular interactions with AlphaFold 3. Nature 2024;630:493-500.
27. Jumper J, Evans R, Pritzel A, et al. Highly accurate protein structure prediction with AlphaFold. Nature 2021;596:583-9.
28. Mohammed BM, Pelc LA, Rau MJ, et al. Cryo-EM structure of coagulation factor V short. Blood 2023;141:3215-25.
29. Pettersen EF, Goddard TD, Huang CC, et al. UCSF ChimeraX: structure visualization for researchers, educators, and developers. Protein Sci 2021;30:70-82.
30. Gierula M, Noakes VM, Salles C, II, et al. The TFPIαlpha C-terminal tail is essential for TFPIαlpha-FV-short-protein S complex formation and synergistic enhancement of TFPIαlpha. J Thromb Haemost 2023;21:3568-80.
31. Dahlback B. Pro- and anticoagulant properties of factor V in pathogenesis of thrombosis and bleeding disorders. Int J Lab Hematol 2016;38:4-11.

Ethics Approval

Not applicable

CRediT authorship contribution

BD initiated, designed and supervised the study, analyzed data and wrote the manuscript. ST performed experiments, analyzed data and participated in writing of the paper. PD performed the structural analysis using AlphaFold and participated in writing the paper 

Supporting Agencies

The study is supported by grants from the Swedish Research Council, the Swedish Heart-Lung Foundation, the Österlund’s Foundation, the SciLifeLab & Wallenberg Data Driven Life Science Program, Knut and Alice Wallenberg Foundation (grants: KAW 2020.0239 and KAW 2017.0003), and by the National Bioinformatics Infrastructure Sweden (NBIS) at SciLifeLab.

Data Availability Statement

Available upon request 

How to Cite



1.
Dahlbäck B, Tran S, Draczkowski P. The LIKT sequence in C-terminus of tissue factor pathway inhibitor (TFPIα) crucially important for the synergistic TFPIα-cofactor activity of protein S and FV-short. Bleeding Thromb Vasc Biol [Internet]. 2026 Aug. 28 [cited 2026 Aug. 28];5(3). Available from: https://www.btvb.org/btvb/article/view/414

Most read articles by the same author(s)