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Puzantian H, Akers SR, Oldland G, Javaid K, Miller R, Ge Y, Ansari B, Lee J, Suri A, Hasmath Z, Townsend R, Chirinos JA. Circulating Dephospho-Uncarboxylated Matrix Gla-Protein Is Associated With Kidney Dysfunction and Arterial Stiffness. Am J Hypertens 2018; 31:988-994. [PMID: 29788226 PMCID: PMC6077812 DOI: 10.1093/ajh/hpy079] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Large artery stiffening is increased in advanced chronic kidney disease (CKD) but likely develops progressively in earlier stages of CKD. Active matrix Gla-protein (MGP) is a potent vitamin K-dependent inhibitor of vascular calcification. A recent animal model demonstrated intrinsic abnormalities in vitamin K metabolism even in early CKD, but whether early human CKD is associated with vascular vitamin K deficiency is unknown. METHODS We enrolled 137 adults without HF with varying degrees of renal function: normal estimated glomerular filtration rate (eGFR; >90 ml/min; n = 59), mildly reduced eGFR (stage 2 CKD: eGFR = 60-89 ml/min; n = 53) or at least moderately reduced eGFR (stage 3-5 CKD; eGFR < 60 ml/min; n = 25). Carotid-femoral pulse wave velocity (CF-PWV) was measured with carotid and femoral tonometry. Dephospho-uncarboxylated matrix gla-protein (dp-ucMGP) was measured with enzyme-linked immunosorbent assay (ELISA) (VitaK; Maastricht University; The Netherlands). RESULT Dp-ucMGP levels were progressively increased with decreasing renal function (eGFR ≥ 90: 247 pmol/l; eGFR 60-89: 488 pmol/l; eGFR < 60: 953 pmol/l; P < 0.0001). These differences persisted after adjustment for multiple potential confounders (eGFR ≥ 90: 314 pmol/l; eGFR 60-89: 414 pmol/l; eGFR < 60: 770 pmol/l; P < 0.0001). In a multivariable model adjusted for various confounders, dp-ucMGP was a significant independent predictor of CF-PWV (β = 0.21; P = 0.019). In formal mediation analyses, dp-ucMGP mediated a significant relationship between eGFR and higher CF-PWV (β = -0.16; P = 0.005), whereas no significant dp-ucMGP-independent relationship was present (β = -0.02; P = 0.80). CONCLUSIONS CKD is associated with increased (inactive) dp-ucMGP, a vitamin K-dependent inhibitor of vascular calcification, which correlates with large artery stiffness. Further studies are needed to assess whether vitamin K2 supplementation represents a suitable therapeutic strategy to prevent or reduce arterial stiffening in CKD.
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Affiliation(s)
- Houry Puzantian
- Department of Biobehavioral Health Science, University of Illinois, Chicago, Illinois, USA
| | - Scott R Akers
- Department of Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Garrett Oldland
- Department of Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Khuzaima Javaid
- Department of Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachana Miller
- Department of Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yueya Ge
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bilal Ansari
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan Lee
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arpita Suri
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeba Hasmath
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond Townsend
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julio A Chirinos
- Department of Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Péter S, Navis G, de Borst MH, von Schacky C, van Orten-Luiten ACB, Zhernakova A, Witkamp RF, Janse A, Weber P, Bakker SJL, Eggersdorfer M. Public health relevance of drug-nutrition interactions. Eur J Nutr 2018; 56:23-36. [PMID: 28748481 PMCID: PMC5559559 DOI: 10.1007/s00394-017-1510-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug–nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug–nutrition interactions. Experts and stakeholders should advocate for the integration of drug–nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.
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Affiliation(s)
- Szabolcs Péter
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.
| | - Gerjan Navis
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Martin H de Borst
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Clemens von Schacky
- Preventive Cardiology, Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität München, Ziemssenstr. 15, 80336, Munich, Germany.,Omegametrix GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Anne Claire B van Orten-Luiten
- Division of Human Nutrition, Wageningen University, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.,Department of Geriatric Medicine, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Alexandra Zhernakova
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Renger F Witkamp
- Division of Human Nutrition, Wageningen University, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - André Janse
- Department of Geriatric Medicine, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.,University of Hohenheim, Schloß Hohenheim 1, 70599, Stuttgart, Germany
| | - Stephan J L Bakker
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Manfred Eggersdorfer
- DSM Nutritional Products Ltd., Wurmisweg 576, 4303, Kaiseraugst, Switzerland.,University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Wei FF, Trenson S, Thijs L, Huang QF, Zhang ZY, Yang WY, Moliterno P, Allegaert K, Boggia J, Janssens S, Verhamme P, Vermeer C, Staessen JA. Desphospho-uncarboxylated matrix Gla protein is a novel circulating biomarker predicting deterioration of renal function in the general population. Nephrol Dial Transplant 2018; 33:1122-1128. [PMID: 28992263 PMCID: PMC6030862 DOI: 10.1093/ndt/gfx258] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background Recent studies showing an inverse association between estimated glomerular filtration rate (eGFR), a microvascular trait, and inactive desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) support the hypothesis that after vitamin K-dependent activation, matrix Gla protein (MGP) is renoprotective, but these were limited by their cross-sectional design. Methods In 1009 randomly recruited Flemish (50.6% women), we assessed the association between eGFR and plasma dp-ucMGP, using multivariable-adjusted analyses. Results From baseline to follow-up 8.9 years later (median), dp-ucMGP increased by 23.0% whereas eGFR decreased by 4.05 mL/min/1.73 m2 (P < 0.001). In 938 participants with baseline eGFR ≥60 mL/min/1.73 m2, the incidence of eGFR <60 mL/min/1.73 m2 at follow-up was 8.0% versus 4.1% in the top versus the bottom halve of baseline dp-ucMGP. For a 5-fold higher plasma dp-ucMGP at baseline, eGFR at follow-up decreased by 3.15 mL/min/1.73 m2 [95% confidence interval (CI) 1.26-5.05; P = 0.001]. The hazard ratio expressing the risk of progression to eGFR <60 mL/min/1.73 m2 was 3.49 (95% CI 1.45-8.40; P = 0.005). The hazard ratio relating the presence of microalbuminuria at follow-up to baseline dp-ucMGP was 4.70 (95% CI 1.57-14.1; P = 0.006). Conclusions In conclusion, circulating inactive dp-ucMGP, a biomarker of poor vitamin K status, predicts renal dysfunction. Possible underlying mechanisms include protection by activated MGP against calcification and inhibition of the bone morphogenetic protein-signalling pathway.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Paula Moliterno
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Karel Allegaert
- Research Unit Organ Systems, KU Leuven Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Stefan Janssens
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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Undercarboxylated Osteocalcin: Experimental and Human Evidence for a Role in Glucose Homeostasis and Muscle Regulation of Insulin Sensitivity. Nutrients 2018; 10:nu10070847. [PMID: 29966260 PMCID: PMC6073619 DOI: 10.3390/nu10070847] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022] Open
Abstract
Recent advances have indicated that osteocalcin, and in particular its undercarboxylated form (ucOC), is not only a nutritional biomarker reflective of vitamin K status and an indicator of bone health but also an active hormone that mediates glucose metabolism in experimental studies. This work has been supported by the putative identification of G protein-coupled receptor, class C, group 6, member A (GPRC6A) as a cell surface receptor for ucOC. Of note, ucOC has been associated with diabetes and with cardiovascular risk in epidemiological studies, consistent with a pathophysiological role for ucOC in vivo. Limitations of existing knowledge include uncertainty regarding the underlying mechanisms by which ucOC interacts with GPRC6A to modulate metabolic and cardiovascular outcomes, technical issues with commonly used assays for ucOC in serum, and a paucity of clinical trials to prove causation and illuminate the scope for novel health interventions. A key emerging area of research is the role of ucOC in relation to expression of GPRC6A in muscle, and whether exercise interventions may modulate metabolic outcomes favorably in part via ucOC. Further research is warranted to clarify potential direct and indirect roles for ucOC in human health and cardiometabolic diseases.
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Fain ME, Kapuku GK, Paulson WD, Williams CF, Raed A, Dong Y, Knapen MHJ, Vermeer C, Pollock NK. Inactive Matrix Gla Protein, Arterial Stiffness, and Endothelial Function in African American Hemodialysis Patients. Am J Hypertens 2018; 31:735-741. [PMID: 29635270 DOI: 10.1093/ajh/hpy049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 04/06/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Matrix Gla protein (MGP) is a vascular calcification inhibitor dependent upon vitamin K for activation. Evidence suggests that elevated plasma inactive MGP levels (desphospho-uncarboxylated MGP, dp-ucMGP; indicating poorer vascular vitamin K status) are associated with greater cardiovascular disease (CVD) risk. Despite African Americans experiencing highest rates of kidney failure and CVD events, relationships between dp-ucMGP and CVD risk markers have not been examined in this population. We investigated vascular vitamin K status (via plasma dp-ucMGP) between African American hemodialysis (HD) patients and healthy controls, and the associations of dp-ucMGP with arterial stiffness and endothelial function in HD patients only. METHODS In 37 African American HD patients and 37 age- and race-matched controls, plasma dp-ucMGP was measured by enzyme immunoassay as a marker of vascular vitamin K status. Carotid-femoral pulse wave velocity (PWV; arterial stiffness measurement) and brachial artery flow-mediated dilation (FMD; endothelial function measurement) were assessed by applanation tonometry and ultrasound, respectively, in HD patients only. RESULTS Mean dp-ucMGP levels were 5.6 times higher in HD patients vs. controls (2,139 ± 1,102 vs. 382 ± 181 pmol/l, P < 0.01). Multiple linear regression, adjusting for age, sex, dialysis vintage, diabetes mellitus, CVD history, body mass index, and blood pressure, revealed that dp-ucMGP was independently related to PWV (standardized β = 0.49) and FMD (standardized β = -0.53) (both P < 0.01). CONCLUSIONS Our data suggest that the higher plasma dp-ucMGP concentrations found in African American HD patients may be associated with greater arterial stiffness and endothelial dysfunction.
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Affiliation(s)
- Mary Ellen Fain
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Gaston K Kapuku
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - William D Paulson
- Division of Nephrology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Celestine F Williams
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Anas Raed
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Marjo H J Knapen
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Norman K Pollock
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Vermeer C, Raes J, van 't Hoofd C, Knapen MHJ, Xanthoulea S. Menaquinone Content of Cheese. Nutrients 2018; 10:E446. [PMID: 29617314 PMCID: PMC5946231 DOI: 10.3390/nu10040446] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 01/07/2023] Open
Abstract
Vitamin K₂ (menaquinone) concentrations were measured in a wide range of cheeses and the effects of fat content, ripening and origin of the cheeses were investigated. Moreover, the menaquinone content of cheese was compared with that of other foods known to contain vitamin K₂. It was found that cheese and curd are the most important sources of long-chain menaquinones in the Western diet and, in general, hard cheeses are richer in menaquinones than soft cheeses. However, the actual menaquinone content varies substantially and is dependent on the type of cheese, the time of ripening, the fat content and the geographic area where the cheeses are produced. Given the fact that poor vitamin K status has been mentioned as a risk factor for cardiovascular disease and mortality, while there is no clear evidence for adverse cardiovascular effects of dairy fats, cheese should be considered as a recommendable component in a heart-healthy diet.
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Affiliation(s)
- Cees Vermeer
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Joyce Raes
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Cynthia van 't Hoofd
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Marjo H J Knapen
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
| | - Sofia Xanthoulea
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 EV Maastricht, The Netherlands.
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Serum calcification propensity is associated with renal tissue oxygenation and resistive index in patients with arterial hypertension or chronic kidney disease. J Hypertens 2018; 35:2044-2052. [PMID: 28562422 DOI: 10.1097/hjh.0000000000001406] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Arterial calcifications increase arterial stiffness and are associated with a faster decline of kidney function in patients with arterial hypertension (AH) and/or chronic kidney disease (CKD). Yet the underlying mechanisms linking arterial calcifications, vascular stiffness and renal function decline are incompletely understood. A novel in-vitro blood test evaluates the propensity of patient's serum to prevent the formation of calcifications by measuring the maturation time of calciprotein particles (CPP) [transformation time of amorphous calcium phosphate-containing primary CPP to crystalline hydroxyapatite-containing secondary CPP (T50)]. We hypothesized that a high arterial stiffness and a high propensity to calcify may be associated with high renal vascular resistance and low renal tissue oxygenation. METHODS T50 was measured in patients with AH and a preserved renal function, in CKD patients and in healthy controls, a lower T50 indicating a higher risk of calcification. Pulse wave velocity (PWV) was assessed as a measure of arterial stiffness, and renal resistive index was measured by renal Doppler ultrasound. Renal tissue oxygenation was measured by blood oxygenation level-dependent MRI using the mean R2 values of the cortex, the medulla and layers of renal parenchyma. A high R2 value corresponds to a low tissue oxygenation. RESULTS Mean T50 was 246 ± 129 min in 58 CKD patients, 275 ± 111 min in 48 AH patients and 324 ± 96 min in 39 healthy controls (Panova = 0.008). In multivariable adjusted linear regression analysis, serum T50 correlated negatively with circulating calcium and phosphate levels, mean cortical and medullary R2, PWV, renal resistive index and being hypertensive. PWV was positively associated with R2 levels of outer and inner layers of renal parenchyma. CONCLUSION The current study shows that hypertensive patients with preserved renal function as well as CKD patients have a higher risk of calcification than controls. High arterial stiffness and calcification propensity are linked to low renal tissue oxygenation and perfusion in hypertensive and CKD patients. These results provide new insights on the relationships among arterial stiffness, renal tissue oxygenation and the risk of developing CKD.
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Wei FF, Trenson S, Monney P, Yang WY, Pruijm M, Zhang ZY, Bouatou Y, Huang QF, Ponte B, Martin PY, Thijs L, Kuznetsova T, Allegaert K, Janssens S, Vermeer C, Verhamme P, Burnier M, Bochud M, Ehret G, Staessen JA. Epidemiological and histological findings implicate matrix Gla protein in diastolic left ventricular dysfunction. PLoS One 2018; 13:e0193967. [PMID: 29529056 PMCID: PMC5846787 DOI: 10.1371/journal.pone.0193967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/22/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES A novel paradigm of diastolic left ventricular (LV) dysfunction proposes involvement of the cardiac microvasculature. Vitamin K dependent matrix Gla protein (MGP) plays a role in preserving microcirculatory integrity. We hypothesized that LV filling pressure-a measure of diastolic LV dysfunction-increases with higher plasma level of inactive desphospho-uncarboxylated MGP (dp-ucMGP). We also studied the distribution of active and inactive MGP in human myocardium. METHODS We measured echocardiographic diastolic LV function and plasma dp-ucMGP (ELISA) in 668 Flemish and for replication in 386 Swiss. RESULTS Among Flemish and Swiss, E/e' (6.78 vs. 6.73) and dp-ucMGP (3.94 μg/L vs. 4.20 μg/L) were similarly distributed. In multivariable-adjusted models, for each doubling of dp-ucMGP, E/e' increased by 0.26, 0.33 and 0.31 in Flemish, Swiss and both cohorts combined (P≤0.026); the odds ratios for having E/e' ≥ 8.5 were 1.99, 3.29 and 2.36, respectively (P≤0.017). Cardiac biopsies from patients with ischemic or dilated cardiomyopathy and healthy hearts (n = 4 for each) were stained with conformation-specific MGP antibodies. In diseased compared with normal hearts, uncarboxylated inactive MGP was more prevalent (P≤0.004) in the perivascular matrix and interstitium (204.4 vs. 8.6 μm2 per field) and phosphorylated active MGP in and around capillaries and interstitial cells (31.3 vs. 6.6 number of positive capillaries and cells per field). CONCLUSIONS Our study supports a role of activated MGP in maintaining myocardial integrity and diastolic LV performance and can potentially be translated into new strategies for managing diastolic LV dysfunction and preventing its progression to heart failure.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Monney
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Menno Pruijm
- Department of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yassine Bouatou
- Department of Pathology, Academisch Medisch Centrum, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Belen Ponte
- Department of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Pierre-Yves Martin
- Department of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Allegaert
- Research Unit Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Stefan Janssens
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Peter Verhamme
- Research Unit Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Michel Burnier
- Department of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Division of Chronic Disease, Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Georg Ehret
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, John Hopkins University, Baltimore, Maryland, United States of America
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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Marles RJ, Roe AL, Oketch-Rabah HA. US Pharmacopeial Convention safety evaluation of menaquinone-7, a form of vitamin K. Nutr Rev 2018; 75:553-578. [PMID: 28838081 DOI: 10.1093/nutrit/nux022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Vitamin K plays important biological roles in maintaining normal blood coagulation, bone mineralization, soft tissue physiology, and neurological development. Menaquinone-7 is a form of vitamin K2 that occurs naturally in some animal-derived and fermented foods. It is also available as an ingredient of dietary supplements. Menaquinone-7 has greater bioavailability than other forms of vitamin K, which has led to increasing sales and use of menaquinone-7 supplements. This special article reviews the chemistry, nomenclature, dietary sources, intake levels, and pharmacokinetics of menaquinones, along with the nonclinical toxicity data available and the data on clinical outcomes related to safety (adverse events). In conclusion, the data reviewed indicate that menaquinone-7, when ingested as a dietary supplement, is not associated with any serious risk to health or with other public health concerns. On the basis of this conclusion, US Pharmacopeia monographs have been developed to establish quality standards for menaquinone-7 as a dietary ingredient and as a dietary supplement in various dosage forms.
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Affiliation(s)
- Robin J Marles
- US Pharmacopeial Convention's Dietary Supplements Admission Evaluations Joint Standard Setting Subcommittee, US Pharmacopeial Convention, Rockville, Maryland, USA. US Pharmacopeial Convention, Rockville, Maryland, USA
| | - Amy L Roe
- US Pharmacopeial Convention's Dietary Supplements Admission Evaluations Joint Standard Setting Subcommittee, US Pharmacopeial Convention, Rockville, Maryland, USA. US Pharmacopeial Convention, Rockville, Maryland, USA
| | - Hellen A Oketch-Rabah
- US Pharmacopeial Convention's Dietary Supplements Admission Evaluations Joint Standard Setting Subcommittee, US Pharmacopeial Convention, Rockville, Maryland, USA. US Pharmacopeial Convention, Rockville, Maryland, USA
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Popov Aleksandrov A, Mirkov I, Ninkov M, Mileusnic D, Demenesku J, Subota V, Kataranovski D, Kataranovski M. Effects of warfarin on biological processes other than haemostasis: A review. Food Chem Toxicol 2018; 113:19-32. [PMID: 29353071 DOI: 10.1016/j.fct.2018.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/29/2017] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
Warfarin is the world's most widely used anticoagulant drug. Its anticoagulant activity is based on the inhibition of the vitamin K-dependent (VKD) step in the complete synthesis of a number of blood coagulation factors that are required for normal blood coagulation. Warfarin also affects synthesis of VKD proteins not related to haemostasis including those involved in bone growth and vascular calcification. Antithrombotic activity of warfarin is considered responsible for some aspects of its anti-tumour activity of warfarin. Some aspects of activities against tumours seem not to be related to haemostasis and included effects of warfarin on non-haemostatic VKD proteins as well as those not related to VKD proteins. Inflammatory/immunomodulatory effects of warfarin indicate much broader potential of action of this drug both in physiological and pathological processes. This review provides an overview of the published data dealing with the effects of warfarin on biological processes other than haemostasis.
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Affiliation(s)
- Aleksandra Popov Aleksandrov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Ivana Mirkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Marina Ninkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Dina Mileusnic
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Jelena Demenesku
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Vesna Subota
- Institute for Medical Biochemistry, Military Medical Academy, 17 Crnotravska, 11000 Belgrade, Serbia
| | - Dragan Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia; Institute of Zoology, Faculty of Biology, University of Belgrade, 16 Studentski trg, 11000 Belgrade, Serbia
| | - Milena Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia; Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, 16 Studentski trg, 11000 Belgrade, Serbia.
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Affiliation(s)
- Gary L Pierce
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), and UIHC Center for Hypertension Research (G.L.P.), The University of Iowa, Iowa City.
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Mansour AG, Hariri E, Daaboul Y, Korjian S, El Alam A, Protogerou AD, Kilany H, Karam A, Stephan A, Bahous SA. Vitamin K2 supplementation and arterial stiffness among renal transplant recipients-a single-arm, single-center clinical trial. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2017; 11:589-597. [PMID: 28756183 DOI: 10.1016/j.jash.2017.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/26/2017] [Accepted: 07/08/2017] [Indexed: 01/07/2023]
Abstract
Subclinical vitamin K deficiency is prevalent among renal transplant recipients and is associated with an increased risk of cardiovascular disease. However, the association between vitamin K supplementation and improvement of arterial stiffness has not been explored in the renal transplant population. The KING trial (vitamin K2 In reNal Graft) is a single-arm study that evaluated the association between the change in vitamin K status and indices of arterial stiffness following 8 weeks of menaquinone-7 (vitamin K2) supplementation (360 μg once daily) among renal transplant recipients (n = 60). Arterial stiffness was measured using carotid-femoral pulse wave velocity (cfPWV). Subclinical vitamin K deficiency was defined as plasma concentration of dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP) >500 pmol/L.At baseline, 53.3% of the study subjects had subclinical vitamin K deficiency. Supplementation was associated with a 14.2% reduction in mean cfPWV at 8 weeks (cfPWV pre-vitamin K2 = 9.8 ± 2.2 m/s vs. cfPWV post-vitamin K2 = 8.4 ± 1.5 m/s; P < .001). Mean dp-ucMGP concentrations were also significantly reduced by 55.1% following menaquinone-7 supplementation with a reduction in the prevalence of subclinical deficiency by 40% (P = .001). When controlled for age, durations of hemodialysis and transplantation, and the change in 24-hour mean arterial pressure, the improvement in arterial stiffness was independently associated with the reduction in dp-ucMGP concentration (P = .014).Among renal transplant recipients with stable graft function, vitamin K2 supplementation was associated with improvement in subclinical vitamin K deficiency and arterial stiffness. (Clinicaltrials.gov: NCT02517580).
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Affiliation(s)
| | - Essa Hariri
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Yazan Daaboul
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Serge Korjian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Andrew El Alam
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, "Laiko" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Hala Kilany
- Lebanese American University School of Medicine, Byblos, Lebanon; Division of Nephrology and Transplantation, Department of Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Albert Karam
- Lebanese American University School of Medicine, Byblos, Lebanon; Division of Nephrology and Transplantation, Department of Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Antoine Stephan
- Lebanese American University School of Medicine, Byblos, Lebanon; Division of Nephrology and Transplantation, Department of Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon; Division of Nephrology and Transplantation, Department of Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
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Mayer O, Seidlerová J, Wohlfahrt P, Filipovský J, Cífková R, Černá V, Kučerová A, Pešta M, Fuchsová R, Topolčan O, Jardon KMC, Drummen NEA, Vermeer C. Synergistic effect of low K and D vitamin status on arterial stiffness in a general population. J Nutr Biochem 2017; 46:83-89. [PMID: 28486172 DOI: 10.1016/j.jnutbio.2017.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/07/2023]
Abstract
Both vitamins K and D are nutrients with pleiotropic functions in human tissues. The metabolic role of these vitamins overlaps considerably in calcium homeostasis. We analyzed their potential synergetic effect on arterial stiffness. In a cross-sectional study, we analyzed aortic pulse wave velocity (aPWV) in 1023 subjects from the Czech post-MONICA study. Desphospho-uncarboxylated matrix γ-carboxyglutamate protein (dp-ucMGP), a biomarker of vitamin K status, was measured by sandwich ELISA and 25-hydroxyvitamin D3 (25-OH-D3) by a commercial immunochemical assay. In a subsample of 431 subjects without chronic disease or pharmacotherapy, we detected rs2228570 polymorphism for the vitamin D receptor. After adjustment for confounders, aPWV was independently associated with both factors: dp-ucMGP [β-coefficient(S.E.M.)=13.91(4.87); P=.004] and 25-OH-D3 [0.624(0.28); P=.027]. In a further analysis, we divided subjects according to dp-ucMGP and 25-OH-D3 quartiles, resulting in 16 subgroups. The highest aPWV had subjects in the top quartile of dp-ucMGP plus bottom quartile of 25-OH-D3 (i.e., in those with insufficient status of both vitamin K and vitamin D), while the lowest aPVW had subjects in the bottom quartile of dp-ucMGP plus top quartile of 25-OH-D3 [9.8 (SD2.6) versus 6.6 (SD1.6) m/s; P<.0001]. When we compared these extreme groups of vitamin K and D status, the adjusted odds ratio for aPWV≥9.3 m/s was 6.83 (95% CI:1.95-20.9). The aPWV was also significantly higher among subjects bearing the GG genotype of rs2228570, but only in those with a concomitantly poor vitamin K status. In conclusion, we confirmed substantial interaction of insufficient K and D vitamin status in terms of increased aortic stiffness.
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Affiliation(s)
- Otto Mayer
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jitka Seidlerová
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Jan Filipovský
- 2(nd) Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Václava Černá
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Alena Kučerová
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martin Pešta
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic; Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radka Fuchsová
- Department of Immunodiagnostics, University Hospital, Pilsen; Czech Republic
| | - Ondřej Topolčan
- Department of Immunodiagnostics, University Hospital, Pilsen; Czech Republic
| | | | | | - Cees Vermeer
- R&D Group VitaK, Maastricht University, The Netherlands
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van Ballegooijen AJ, Beulens JW. The Role of Vitamin K Status in Cardiovascular Health: Evidence from Observational and Clinical Studies. Curr Nutr Rep 2017; 6:197-205. [PMID: 28944098 PMCID: PMC5585988 DOI: 10.1007/s13668-017-0208-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Vitamin K is a fat-soluble vitamin required for the activation of several vitamin K-dependent proteins to confer functioning. A growing body of evidence supports that vitamin K has beneficial effects on bone and cardiovascular health. This review summarizes key evidence on vitamin K status as measured by circulating measures and cardiovascular outcomes. RECENT FINDINGS Overall, observational studies indicate that low vitamin K status as measured by high dephosphorylated uncarboxylated matrix gla protein concentrations plays a potential role in cardiovascular disease development, particularly in high-risk and chronic kidney disease populations. Very few vitamin K intervention trials have been conducted with cardiovascular-related outcomes. A couple of intervention trials studied the effect of the combination of vitamin D + K supplementation, which might have synergistic effects compared to vitamin K supplementation alone. SUMMARY Assessing vitamin K status in prospective studies and well-designed randomized trials would provide important insight whether vitamin K is causally related to vascular calcification and cardiovascular disease.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - J W Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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van Ballegooijen AJ, Cepelis A, Visser M, Brouwer IA, van Schoor NM, Beulens JW. Joint Association of Low Vitamin D and Vitamin K Status With Blood Pressure and Hypertension. Hypertension 2017; 69:1165-1172. [DOI: 10.1161/hypertensionaha.116.08869] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/21/2016] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
Low vitamin D and K status are both associated with an increased cardiovascular risk. New evidence from experimental studies on bone health suggest an interaction between vitamin D and K; however, a joint association with vascular health outcomes is largely unknown. To prospectively investigate whether the combination of low vitamin D and K status is associated with higher systolic and diastolic blood pressure in 402 participants and with incident hypertension in 231 participants free of hypertension at baseline. We used data from a subsample of the Longitudinal Aging Study Amsterdam, a population-based cohort of Dutch participants aged 55 to 65 years. Vitamin D and K status were assessed by 25-hydroxyvitamin D and dp-ucMGP (dephosphorylated uncarboxylated matrix gla protein) concentrations (high dp-ucMGP is indicative for low vitamin K status) in stored samples from 2002 to 2003. Vitamin D and K status were categorized into 25-hydroxyvitamin D <50/≥50 mmol/L and median dp-ucMGP <323/≥323 pmol/L. During a median follow-up of 6.4 years, 62% of the participants (n=143) developed hypertension. The combination of low vitamin D and K status was associated with increased systolic 4.8 mm Hg (95% confidence interval, 0.1–9.5) and diastolic 3.1 mm Hg (95% confidence interval, 0.5–5.7) blood pressure compared with high vitamin D and K status (
P
for interaction =0.013 for systolic blood pressure and 0.068 for diastolic blood pressure). A similar trend was seen for incident hypertension: hazard ratio=1.62 (95% confidence interval, 0.96–2.73) for the low vitamin D and K group. The combination of low vitamin D and K status was associated with increased blood pressure and a trend for greater hypertension risk.
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Affiliation(s)
- Adriana J. van Ballegooijen
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
| | - Aivaras Cepelis
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
| | - Marjolein Visser
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
| | - Ingeborg A. Brouwer
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
| | - Natasja M. van Schoor
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
| | - Joline W. Beulens
- From the Department of Health Sciences, and the EMGO+ Institute for Health and Care Research (A.J.v.B., A.C., M.V., I.A.B.), Department of Internal Medicine, Section of Nutrition and Dietetics (M.V.), and Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research (N.M.v.S., J.W.B.), VU University Medical Center, Amsterdam; and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (J.W.B.)
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Borrás T. A single gene connects stiffness in glaucoma and the vascular system. Exp Eye Res 2017; 158:13-22. [PMID: 27593913 PMCID: PMC6067113 DOI: 10.1016/j.exer.2016.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 12/13/2022]
Abstract
Arterial calcification results in arterial stiffness and higher systolic blood pressure. Arterial calcification is prevented by the high expression of the Matrix-Gla gene (MGP) in the vascular smooth muscle cells (VSMC) of the arteries' tunica media. Originally, MGP, a gene highly expressed in cartilage and VSMC, was found to be one of the top expressed genes in the trabecular meshwork. The creation of an Mgp-lacZ Knock-In mouse and the use of mouse genetics revealed that in the eye, Mgp's abundant expression is localized and restricted to glaucoma-associated tissues from the anterior and posterior segments. In particular, it is specifically expressed in the regions of the trabecular meshwork and of the peripapillary sclera that surrounds the optic nerve. Because stiffness in these tissues would significantly alter outflow facility and biomechanical scleral stress in the optic nerve head (ONH), we propose MGP as a strong candidate for the regulation of stiffness in glaucoma. MGP further illustrates the presence of a common function affecting key glaucomatous parameters in the front and back of the eye, and thus offers the possibility for a sole therapeutic target for the disease.
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Affiliation(s)
- Teresa Borrás
- Department of Ophthalmology, University of North Carolina School of Medicine, 4109C Neuroscience Research Building CB 7041, 105 Mason Farm Road, Chapel Hill, NC 27599-7041, USA.
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle HJ, Naska A, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Lamberg-Allardt C, Przyrembel H, Tetens I, Dumas C, Fabiani L, Ioannidou S, Neuhäuser-Berthold M. Dietary reference values for vitamin K. EFSA J 2017; 15:e04780. [PMID: 32625486 PMCID: PMC7010012 DOI: 10.2903/j.efsa.2017.4780] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) derives dietary reference values (DRVs) for vitamin K. In this Opinion, the Panel considers vitamin K to comprise both phylloquinone and menaquinones. The Panel considers that none of the biomarkers of vitamin K intake or status is suitable by itself to derive DRVs for vitamin K. Several health outcomes possibly associated with vitamin K intake were also considered but data could not be used to establish DRVs. The Panel considers that average requirements and population reference intakes for vitamin K cannot be derived for adults, infants and children, and therefore sets adequate intakes (AIs). The Panel considers that available evidence on occurrence, absorption, function and content in the body or organs of menaquinones is insufficient, and, therefore, sets AIs for phylloquinone only. Having assessed additional evidence available since 1993 in particular related to biomarkers, intake data and the factorial approach, which all are associated with considerable uncertainties, the Panel maintains the reference value proposed by the Scientific Committee for Food (SCF) in 1993. An AI of 1 μg phylloquinone/kg body weight per day is set for all age and sex population groups. Considering the respective reference body weights, AIs for phylloquinone are set at 70 μg/day for all adults including pregnant and lactating women, at 10 μg/day for infants aged 7-11 months, and between 12 μg/day for children aged 1-3 years and 65 μg/day for children aged 15-17 years.
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Sardana M, Vasim I, Varakantam S, Kewan U, Tariq A, Koppula MR, Syed AA, Beraun M, Drummen NEA, Vermeer C, Akers SR, Chirinos JA. Inactive Matrix Gla-Protein and Arterial Stiffness in Type 2 Diabetes Mellitus. Am J Hypertens 2017; 30:196-201. [PMID: 27927630 DOI: 10.1093/ajh/hpw146] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Large artery stiffness is increased in diabetes mellitus and causes an excessive pulsatile load to the heart and to the microvasculature. The identification of pathways related to arterial stiffness may provide novel therapeutic targets to ameliorate arterial stiffness in diabetes. Matrix Gla-Protein (MGP) is an inhibitor of vascular calcification. Activation of MGP is vitamin K dependent. We hypothesized that levels of inactive MGP (dephospho-uncarboxylated MGP; dp-ucMGP) are related to arterial stiffness in type 2 diabetes. METHODS We enrolled a multiethnic cohort of 66 participants with type 2 diabetes. Carotid-femoral pulse wave velocity (CF-PWV) was measured with high-fidelity arterial tonometry (Sphygmocor Device). Dp-ucMGP was measured with ELISA (VitaK; The Netherlands). RESULTS The majority of the participants were middle-aged (62 ± 12 years), male (91%), and had a history of hypertension (82%). Average hemoglobin A1C was 7.2% (55 mmol/mol). Mean dp-ucMGP was 624 ± 638 pmol/l and mean CF-PWV was 11 ± 4 m/sec. In multivariable analyses, dp-ucMGP was independently related to African American ethnicity (β = -0.24, P = 0.005), warfarin use (β = 0.56, P < 0.001), and estimated glomerular filtration rate (eGFR, β = -0.32, P < 0.001). Dp-ucMGP predicted CF-PWV (β = 0.40, P = 0.011), even after adjustment for age, gender, ethnicity, mean arterial pressure, eGFR, and warfarin use. CONCLUSIONS In our cross-sectional analysis, circulating dp-ucMGP was independently associated with CF-PWV in type 2 diabetes. This suggests that deficient vitamin K-dependent activation of MGP may lead to large artery stiffening and could be targeted with vitamin K supplementation in the patients with diabetes.
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Affiliation(s)
- Mayank Sardana
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Izzah Vasim
- Department of Medicine, Corporal Michael J. Crescenz VA MC, Philadelphia, Pennsylvania, USA
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Swapna Varakantam
- Department of Medicine, Corporal Michael J. Crescenz VA MC, Philadelphia, Pennsylvania, USA
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Uzma Kewan
- Department of Medicine, Corporal Michael J. Crescenz VA MC, Philadelphia, Pennsylvania, USA
| | - Ali Tariq
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maheshwara R Koppula
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amer Ahmed Syed
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Beraun
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadja E A Drummen
- R&D Group, VitaK, Maastricht University, Maastricht, The Netherlands
| | - Cees Vermeer
- R&D Group, VitaK, Maastricht University, Maastricht, The Netherlands
| | - Scott R Akers
- Department of Medicine, Corporal Michael J. Crescenz VA MC, Philadelphia, Pennsylvania, USA
| | - Julio A Chirinos
- Department of Medicine, Corporal Michael J. Crescenz VA MC, Philadelphia, Pennsylvania, USA;
- Cardiology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Crosstalk between Vitamins A, B12, D, K, C, and E Status and Arterial Stiffness. DISEASE MARKERS 2017; 2017:8784971. [PMID: 28167849 PMCID: PMC5266829 DOI: 10.1155/2017/8784971] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
Abstract
Arterial stiffness is associated with cardiovascular risk, morbidity, and mortality. The present paper reviews the main vitamins related to arterial stiffness and enabling destiffening, their mechanisms of action, providing a brief description of the latest studies in the area, and their implications for primary cardiovascular prevention, clinical practice, and therapy. Despite inconsistent evidence for destiffening induced by vitamin supplementation in several randomized clinical trials, positive results were obtained in specific populations. The main mechanisms are related to antiatherogenic effects, improvement of endothelial function (vitamins A, C, D, and E) and metabolic profile (vitamins A, B12, C, D, and K), inhibition of the renin-angiotensin-aldosterone system (vitamin D), anti-inflammatory (vitamins A, D, E, and K) and antioxidant effects (vitamins A, C, and E), decrease of homocysteine level (vitamin B12), and reversing calcification of arteries (vitamin K). Vitamins A, B12, C, D, E, and K status is important in evaluating cardiovascular risk, and vitamin supplementation may be an effective, individualized, and inexpensive destiffening therapy.
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Vassalle C, Mazzone A. Bone loss and vascular calcification: A bi-directional interplay? Vascul Pharmacol 2016; 86:77-86. [DOI: 10.1016/j.vph.2016.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
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Renal tissue oxygenation in children with chronic kidney disease due to vesicoureteral reflux. Pediatr Nephrol 2016; 31:2103-11. [PMID: 27230512 DOI: 10.1007/s00467-016-3419-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is a frequent cause of chronic kidney disease (CKD) in children. Using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), we measured cortical and medullary oxygenation in children with CKD due to VUR and compared the results to those obtained on healthy controls. METHOD The study population comprised 37 children (19 with CKD due to VUR and 18 healthy age-matched controls). BOLD-MRI was performed before and after furosemide treatment. MR images were analyzed with the region-of-interest (ROI) technique to assess the mean R2* values (=1/T2*) of the cortex and medulla of each kidney and with the concentric object (CO) technique that divides renal parenchyma in 12 equal layers. RESULTS R2* values were significantly lower (corresponding to higher oxygenation) in the cortex and medulla of kidneys of children with CKD due to VUR than in those of the healthy controls (cortex 16.4 ± 1.4 vs. 17.2 ± 1.6 s(-1) , respectively; medulla 28.4 ± 3.2 vs. 30.3 ± 1.9 s(-1) , respectively; P < 0.05), and furosemide-induced changes in medullary R2* were smaller in the former than in the latter (-5.7 ± 3.0 vs. -6.9 ± 3.4 s(-1), respectively; P < 0.05). Similar results were found with the CO technique. In children with a history of unilateral reflux (n = 9), the non-affected contralateral kidneys presented similar R2* values as the diseased kidneys, but their response to furosemide was significantly larger (-7.4 ± 3.2 vs. -5.7 ± 3.0, respectively; P = 0.05). CONCLUSIONS Chronic kidney disease due to VUR is not associated with kidney tissue hypoxia in children. The significantly larger furosemide-induced decrease in medullary R2* levels in the healthy group and unaffected contralateral kidneys of the VUR group points towards more intense renal sodium transport in these kidneys.
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Danziger J, Young RL, Shea KM, Duprez DA, Jacobs DR, Tracy RP, Ix JH, Jenny NS, Mukamal KJ. Circulating Des-gamma-carboxy prothrombin is not associated with cardiovascular calcification or stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016; 252:68-74. [PMID: 27508317 DOI: 10.1016/j.atherosclerosis.2016.07.924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/09/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Vitamin K-dependent protein (VKDP) activity may have a role in preventing cardiovascular calcification, but has not previously been studied in large, generally healthy populations. METHODS Using an elevated ankle-brachial index (ABI) as a measure of medial vascular calcification, we performed a case-cohort analysis within the Multi-Ethnic Study of Atherosclerosis, measuring Des-gamma-carboxy prothrombin (DCP) to estimate VKDP activity. In secondary analyses of the weighted subcohort, we examined the cross-sectional associations between DCP and prevalent vascular calcification of the coronary vessels, aortic and mitral valves, and aortic wall, and with vascular stiffness. RESULTS In adjusted analysis, cases (n = 104) had 0.21 ng/ml (-0.94-0.52) lower DCP concentrations than the subcohort (n = 613). Furthermore, amongst the 717 participants in the weighted cohort, VKDP activity was not associated with coronary artery, mitral valve, aortic valve or aortic wall calcification, nor was it associated with vascular stiffness. CONCLUSIONS Our negative results do not support a role of circulating VKDP activity in cardiovascular calcification in community-dwelling adults.
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Affiliation(s)
- John Danziger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | - Kyla M Shea
- Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Daniel A Duprez
- Division of Cardiology, University of Minnesota, United States
| | - David R Jacobs
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, United States
| | - Russell P Tracy
- College of Medicine, University of Vermont, Burlington, VT, United States
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Nancy S Jenny
- Department of Pathology, University of Vermont, Burlington, VT, United States
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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73
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Harshman SG, Shea MK. The Role of Vitamin K in Chronic Aging Diseases: Inflammation, Cardiovascular Disease, and Osteoarthritis. Curr Nutr Rep 2016; 5:90-98. [PMID: 27648390 DOI: 10.1007/s13668-016-0162-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vitamin K is an enzyme cofactor required for the carboxylation of vitamin K dependent proteins, several of which have been implicated in diseases of aging. Inflammation is recognized as a crucial component of many chronic aging diseases and evidence suggests vitamin K has an anti-inflammatory action that is independent of its role as an enzyme co-factor. Vitamin K-dependent proteins and inflammation have been implicated in cardiovascular disease and osteoarthritis, which are leading causes of disability and mortality in older adults. The purpose of this review is to summarize observational studies and randomized trials focused on vitamin K status and inflammation, cardiovascular disease, and osteoarthritis. Although mechanistic evidence suggests a protective role for vitamin K in these age-related conditions, the benefit of vitamin K supplementation is controversial because observational data are equivocal and the number of randomized trials is few.
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Affiliation(s)
- Stephanie G Harshman
- Jean Mayer Human Nutrition Research Center on Aging, Tufts University 711 Washington Street, Boston, MA 02111, Phone number: 617-556-3151, Fax number: 617 556 3149
| | - M Kyla Shea
- Jean Mayer Human Nutrition Research Center on Aging, Tufts University 711 Washington Street, Boston, MA 02111, Phone number: 617-556-3073, fax number: 617 556 3344
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Wei FF, Drummen NE, Schutte AE, Thijs L, Jacobs L, Petit T, Yang WY, Smith W, Zhang ZY, Gu YM, Kuznetsova T, Verhamme P, Allegaert K, Schutte R, Lerut E, Evenepoel P, Vermeer C, Staessen JA. Vitamin K Dependent Protection of Renal Function in Multi-ethnic Population Studies. EBioMedicine 2016; 4:162-9. [PMID: 26981580 PMCID: PMC4776057 DOI: 10.1016/j.ebiom.2016.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Following activation by vitamin K (VK), matrix Gla protein (MGP) inhibits arterial calcification, but its role in preserving renal function remains unknown. METHODS In 1166 white Flemish (mean age, 38.2 years) and 714 South Africans (49.2% black; 40.6 years), we correlated estimated glomerular filtration (eGFR [CKD-EPI formula]) and stage of chronic kidney disease (CKD [KDOQI stages 2-3]) with inactive desphospho-uncarboxylated MGP (dp-ucMGP), using multivariable linear and logistic regression. RESULTS Among Flemish and white and black Africans, between-group differences in eGFR (90, 100 and 122 mL/min/1.73 m(2)), dp-ucMGP (3.7, 6.5 and 3.2 μg/L), and CKD prevalence (53.5, 28.7 and 10.5%) were significant, but associations of eGFR with dp-ucMGP did not differ among ethnicities (P ≥ 0.075). For a doubling of dp-ucMGP, eGFR decreased by 1.5 (P = 0.023), 1.0 (P = 0.56), 2.8 (P = 0.0012) and 2.1 (P < 0.0001) mL/min/1.73 m(2) in Flemish, white Africans, black Africans and all participants combined; the odds ratios for moving up one CKD stage were 1.17 (P = 0.033), 1.03 (P = 0.87), 1.29 (P = 0.12) and 1.17 (P = 0.011), respectively. INTERPRETATION In the general population, eGFR decreases and CKD risk increases with higher dp-ucMGP, a marker of VK deficiency. These findings highlight the possibility that VK supplementation might promote renal health.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Aletta E. Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- MRC Research Unit on Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Thibaut Petit
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Wayne Smith
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Yu-Mei Gu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Karel Allegaert
- Research Unit Organ Systems, KU Leuven Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Rudolph Schutte
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
- MRC Research Unit on Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Evelyne Lerut
- Department of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Cees Vermeer
- R & D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
- R & D Group VitaK, Maastricht University, Maastricht, The Netherlands
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Shea MK, Booth SL. Concepts and Controversies in Evaluating Vitamin K Status in Population-Based Studies. Nutrients 2016; 8:E8. [PMID: 26729160 PMCID: PMC4728622 DOI: 10.3390/nu8010008] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
A better understanding of vitamin K's role in health and disease requires the assessment of vitamin K nutritional status in population and clinical studies. This is primarily accomplished using dietary questionnaires and/or biomarkers. Because food composition databases in the US are most complete for phylloquinone (vitamin K1, the primary form in Western diets), emphasis has been on phylloquinone intakes and associations with chronic diseases. There is growing interest in menaquinone (vitamin K2) intakes for which the food composition databases need to be expanded. Phylloquinone is commonly measured in circulation, has robust quality control schemes and changes in response to phylloquinone intake. Conversely, menaquinones are generally not detected in circulation unless large quantities are consumed. The undercarboxylated fractions of three vitamin K-dependent proteins are measurable in circulation, change in response to vitamin K supplementation and are modestly correlated. Since different vitamin K dependent proteins are implicated in different diseases the appropriate vitamin K-dependent protein biomarker depends on the outcome under study. In contrast to other nutrients, there is no single biomarker that is considered a gold-standard measure of vitamin K status. Most studies have limited volume of specimens. Strategic decisions, guided by the research question, need to be made when deciding on choice of biomarkers.
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Affiliation(s)
- M Kyla Shea
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
| | - Sarah L Booth
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
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Affiliation(s)
- Dwight A Towler
- From the Endocrine Division, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
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