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Karim L, Kwaczala A, Vashishth D, Judex S. Dose-dependent effects of pharmaceutical treatments on bone matrix properties in ovariectomized rats. Bone Rep 2021; 15:101137. [PMID: 34660852 PMCID: PMC8503587 DOI: 10.1016/j.bonr.2021.101137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023] Open
Abstract
As both anabolic and anti-catabolic osteoporosis drugs affect bone formation and resorption processes, they may contribute to bone's overall mechanical behavior by altering the quality of the bone matrix. We used an ovariectomized rat model and a novel fracture mechanics approach to investigate whether treatment with an anabolic (parathyroid hormone) or anti-catabolic (alendronate) osteoporosis drugs will alter the organic and mineral matrix components and consequently cortical bone fracture toughness. Ovariectomized (at 5 months age) rats were treated with either parathyroid hormone or alendronate at low and high doses for 6 months (age 6–12 months). Specifically, treatment groups included untreated ovariectomized controls (n = 9), high-dose alendronate (n = 10), low-dose alendronate (n = 9), high-dose parathyroid hormone (n = 10), and low-dose parathyroid hormone (n = 9). After euthanasia, cortical microbeams from the lateral quadrant were extracted, notched, and tested in 3-point bending to measure fracture toughness. Portions of the bone were used to measure changes in the 1) organic matrix through quantification of advanced glycation end-products (AGEs) and non-collagenous proteins, and 2) mineral matrix through assessment of mineral crystallinity. Compared to the ovariectomized group, rats treated with high doses of parathyroid hormone and alendronate had significantly increased cortical bone fracture toughness, which corresponded primarily to increased non-collagenous proteins while there was no change in AGEs. Additionally, low-dose PTH treatment increased matrix crystallinity and decreased AGE levels. In summary, ovariectomized rats treated with pharmaceutical drugs had increased non-collagenous matrix proteins and improved fracture toughness compared to controls. Further investigation is required for different doses and longer treatment periods. Alendronate increases non-collagenous proteins and improves fracture toughness. Parathyroid hormone also increases collagen maturity and mineral crystallinity. Both treatments minimize accumulation of advanced glycation end-products.
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Affiliation(s)
- Lamya Karim
- Department of Bioengineering, University of Massachusetts Dartmouth, Dartmouth, MA, USA
| | - Andrea Kwaczala
- Department of Biomedical Engineering, Western New England University, Springfield, MA, USA
| | - Deepak Vashishth
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Stefan Judex
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Effects of risedronate, alendronate, and minodronate alone or in combination with eldecalcitol on bone mineral density, quality, and strength in ovariectomized rats. Bone Rep 2021; 14:101061. [PMID: 33898659 PMCID: PMC8055548 DOI: 10.1016/j.bonr.2021.101061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
Combination therapy of active vitamin D3 with some bisphosphonates (BPs) has been reported to be clinically beneficial. However, combination therapy of eldecalcitol (ELD) with BP has to date not been validated as to whether it is beneficial in the clinical setting. Preclinical studies suggested that simultaneous treatment with ELD and some BPs is more effective than monotherapy. However, the relative potency of various BPs, when used in combination with ELD, is completely unknown. In this study, we examined and compared the effects of risedronate (RIS), alendronate (ALN), and minodronate (MIN) alone or in combination with ELD on bone mass, microarchitecture, strength, and material properties in ovariectomized Sprague-Dawley rats aged 13 weeks. RIS, ALN, MIN, and ELD were administered five times weekly for 16 weeks. Micro-computed tomography analysis, compression test, and Fourier transform infrared (FTIR) imaging analysis were performed 16 weeks after treatment initiation. Trabecular and cortical bone mineral density (BMD) in the fourth lumbar vertebra (L4) significantly increased in the RIS + ELD, ALN + ELD, and MIN + ELD groups compared with the vehicle group. Moreover, the bone microarchitecture of L4 in all the BP + ELD groups also significantly improved. On mechanical testing of L4, the maximum load was significantly increased in the RIS + ELD and ALN + ELD groups. FTIR analysis revealed that the mineral-to-collagen ratio of trabecular bone in L3 of all the BP + ELD groups was significantly increased compared with the vehicle group. By contrast, the carbonate-to-phosphate ratio, a parameter of mineral immaturity, was significantly decreased in the RIS + ELD and ALN + ELD groups. BP + ELD improved the BMD and structural properties of the bone to a similar extent. RIS + ELD and ALN + ELD also improved bone strength. Furthermore, treatment with BP + ELD improved the bone material. These results suggest that the combination therapy of BP and ELD is beneficial and warrants further clinical trials. Combination of bisphosphonates and eldecalcitol was superior to either monotherapy. Bone quality on FTIR imaging analysis correlated with bone strength. Combined bisphosphonate and eldecalcitol may be useful in the clinical setting.
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Key Words
- ALF, alfacalcidol
- ALN, alendronate
- Alendronate
- BMD, bone mineral density
- BPs, bisphosphonates
- Combination therapy
- ELD, eldecalcitol
- Eldecalcitol
- FTIR imaging
- FTIR, Fourier transform infrared
- MIN, minodronate
- Minodronate
- OVX, ovariectomized
- RIS, risedronate
- Risedronate
- micro-CT, micro-computed tomography
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Aveline P, Cesaro A, Mazor M, Best TM, Lespessailles E, Toumi H. Cumulative Effects of Strontium Ranelate and Impact Exercise on Bone Mass in Ovariectomized Rats. Int J Mol Sci 2021; 22:3040. [PMID: 33809778 PMCID: PMC8002366 DOI: 10.3390/ijms22063040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the effect of physical exercise (EXE), strontium ranelate (SR), or their combination on bone status in ovariectomized (OVX) rats. DESIGN Sixty female Wistar rats were randomized to one of five groups: sham (Sh), OVX (O), OVX+EXE (OE), OVX+SR (OSR), and OVX+EXE+SR (OESR). Animals in EXE groups were subjected to 10 drops per day (45 cm in height); rats in SR groups received 625 mg/kg/day of SR, 5 days/week for 8 weeks. Bone mineral density (BMD) and bone mineral content (BMC, dual-energy X-ray absorptiometry (DXA)), mechanical strength of the left femur (three-point bending test), and femur microarchitecture of (micro-computed tomography imaging, microCT) analyses were performed to characterize biomechanical and trabecular/cortical structure. Bone remodeling, osteocyte apoptosis, and lipid content were evaluated by ELISA and immunofluorescence tests. RESULTS In OVX rats, whole-body BMD, trabecular parameters, and osteocalcin (OCN) levels decreased, while weight, lean/fat mass, osteocyte apoptosis, and lipid content all increased. EXE after ovariectomy improved BMD and BMC, trabecular parameters, cross-sectional area (CSA), moment of inertia, and OCN levels while decreasing osteocyte apoptosis and lipid content. SR treatment increased BMD and BMC, trabecular parameters, CSA, stiffness, OCN, and alkaline phosphatase (ALP) levels. Furthermore, fat mass, N-telopeptide (NTX) level, osteocyte apoptosis, and lipid content significantly decreased. The combination of both EXE and SR improved bone parameters compared with EXE or SR alone. CONCLUSION EXE and SR had positive and synergistic effects on bone formation and resorption.
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Affiliation(s)
- Priscilla Aveline
- I3MTO, Université d’Orléans, 45000 Orléans, France; (P.A.); (A.C.); (E.L.)
| | - Annabelle Cesaro
- I3MTO, Université d’Orléans, 45000 Orléans, France; (P.A.); (A.C.); (E.L.)
| | - Marija Mazor
- Center for Proteomics University of Rijeka, Faculty of Medicine Branchetta, 51000 Rijeka, Croatia;
| | - Thomas M. Best
- UHealth Sports Medicine Institute, Department of Orthopedics, Division of Sports Medicine, University of Miami, Miami, FL 33136, USA;
| | - Eric Lespessailles
- I3MTO, Université d’Orléans, 45000 Orléans, France; (P.A.); (A.C.); (E.L.)
- Département de Rhumatologie, Centre Hospitalier d’Orleans, 45100 Orléans, France
- Plateforme Recherche Innovation Médicale Mutualisée d’Orléans, Centre Hospitalier d’Orleans, CEDEX 02, 45067 Orleans, France
| | - Hechmi Toumi
- I3MTO, Université d’Orléans, 45000 Orléans, France; (P.A.); (A.C.); (E.L.)
- Département de Rhumatologie, Centre Hospitalier d’Orleans, 45100 Orléans, France
- Plateforme Recherche Innovation Médicale Mutualisée d’Orléans, Centre Hospitalier d’Orleans, CEDEX 02, 45067 Orleans, France
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Fernandes TAP, Gonçalves LML, Brito JAA. Relationships between Bone Turnover and Energy Metabolism. J Diabetes Res 2017; 2017:9021314. [PMID: 28695134 PMCID: PMC5485508 DOI: 10.1155/2017/9021314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022] Open
Abstract
It is well established that diabetes can be detrimental to bone health, and its chronic complications have been associated with an increased risk of osteoporotic fracture. However, there is growing evidence that the skeleton plays a key role in a whole-organism approach to physiology. The hypothesis that bone may be involved in the regulation of physiological functions, such as insulin sensitivity and energy metabolism, has been suggested. Given the roles of insulin, adipokines, and osteocalcin in these pathways, the need for a more integrative conceptual approach to physiology is emphasized. Recent findings suggest that bone plays an important role in regulating intermediary metabolism, being possibly both a target of diabetic complications and a potential pathophysiologic factor in the disease itself. Understanding the relationships between bone turnover and glucose metabolism is important in order to develop treatments that might reestablish energy metabolism and bone health. This review describes new insights relating bone turnover and energy metabolism that have been reported in the literature.
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Affiliation(s)
- Tânia A. P. Fernandes
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal
- *Tânia A. P. Fernandes:
| | - Luísa M. L. Gonçalves
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
| | - José A. A. Brito
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário-Quinta da Granja, 2829-511 Monte de Caparica, Portugal
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Inhibition of osteoclast activation by phloretin through disturbing αvβ3 integrin-c-Src pathway. BIOMED RESEARCH INTERNATIONAL 2015; 2015:680145. [PMID: 25834823 PMCID: PMC4365379 DOI: 10.1155/2015/680145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/31/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
This study was to explore the sequential signaling of disorganization of the actin cytoskeletal architecture by phloretin. RAW 264.7 macrophages were incubated with 1–20 μM phloretin for 5 days in the presence of RANKL. C57BL/6 mice were ovariectomized (OVX) and orally treated with 10 mg/kg phloretin once a day for 8 weeks. Phloretin allayed RANKL stimulated formation of actin podosomes with the concomitant retardation of the vinculin activation. Oral administration of phloretin suppressed the induction of femoral gelsolin and vinculin in OVX mice. The RANK-RANKL interaction resulted in the αvβ3 integrin induction, which was demoted by phloretin. The RANKL induction of actin rings and vacuolar-type H+-ATPase entailed Pyk2 phosphorylation and c-Src and c-Cbl induction, all of which were blunted by phloretin. Similar inhibition was also observed in phloretin-exposed OVX mouse femoral bone tissues with decreased trabecular collagen formation. Phloretin suppressed the paxillin induction in RANKL-activated osteoclasts and in OVX epiphyseal bone tissues. Also, phloretin attenuated the Syk phosphorylation and phospholipase Cγ induction by RANKL in osteoclasts. These results suggest that phloretin was an inhibitor of actin podosomes and sealing zone, disrupting αvβ3 integrin-c-Src-Pyk2/Syk signaling pathway for the regulation of actin cytoskeletal organization in osteoclasts.
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Brito JAA, Costa IM, E Silva AM, Marques JMS, Zagalo CM, Cavaleiro IIB, Fernandes TAP, Gonçalves LL. Changes in bone Pb accumulation: cause and effect of altered bone turnover. Bone 2014; 64:228-34. [PMID: 24768754 DOI: 10.1016/j.bone.2014.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/16/2014] [Accepted: 04/19/2014] [Indexed: 02/06/2023]
Abstract
This paper assesses the magnitude of Pb uptake in cortical and trabecular bones in healthy animals and animals with altered balance in bone turnover, and the impact of exposure to Pb on serum markers of bone formation and resorption. The results reported herein provide physiological evidence that Pb distributes differently in central compartments in Pb metabolism, such as cortical and trabecular bones, in healthy animals and animals with altered balance in bone turnover, and that exposure to Pb does have an impact on bone resorption resulting in OC-dependent osteopenia. These findings show that Pb may play a role in the etiology of osteoporosis and that its concentration in bones varies as a result of altered bone turnover characteristic of this disease, a long standing question in the field. In addition, data collected in this study are consistent with previous observations of increased half-life of Pb in bone at higher exposures. This evidence is relevant for the necessary revision of current physiologically based kinetic models for Pb in humans.
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Affiliation(s)
- José A A Brito
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal.
| | - Isabel M Costa
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - Alexandra Maia E Silva
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - José M S Marques
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - Carlos M Zagalo
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - Inês I B Cavaleiro
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - Tânia A P Fernandes
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
| | - Luísa L Gonçalves
- WDXRFLab, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, Campus Universitário, Quinta da Granja-Monte de Caparica, 2829-511 Caparica, Portugal
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Saito M, Marumo K. Collagen cross-links as a determinant of bone quality: a possible explanation for bone fragility in aging, osteoporosis, and diabetes mellitus. Osteoporos Int 2010; 21:195-214. [PMID: 19760059 DOI: 10.1007/s00198-009-1066-z] [Citation(s) in RCA: 615] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/01/2009] [Indexed: 12/31/2022]
Abstract
Collagen cross-linking, a major post-translational modification of collagen, plays important roles in the biological and biomechanical features of bone. Collagen cross-links can be divided into lysyl hydroxylase and lysyloxidase-mediated enzymatic immature divalent cross-links,mature trivalent pyridinoline and pyrrole cross-links, and glycation- or oxidation-induced non-enzymatic cross-links(advanced glycation end products) such as glucosepane and pentosidine. These types of cross-links differ in the mechanism of formation and in function. Material properties of newly synthesized collagen matrix may differ in tissue maturity and senescence from older matrix in terms of crosslink formation. Additionally, newly synthesized matrix in osteoporotic patients or diabetic patients may not necessarily be as well-made as age-matched healthy subjects. Data have accumulated that collagen cross-link formation affects not only the mineralization process but also microdamage formation. Consequently, collagen cross-linking is thought to affect the mechanical properties of bone. Furthermore,recent basic and clinical investigations of collagen cross-links seem to face a new era. For instance, serum or urine pentosidine levels are now being used to estimate future fracture risk in osteoporosis and diabetes. In this review, we describe age-related changes in collagen cross-links in bone and abnormalities of cross-links in osteoporosis and diabetes that have been reported in the literature.
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Affiliation(s)
- M Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Brouwers JEM, van Rietbergen B, Huiskes R, Ito K. Effects of PTH treatment on tibial bone of ovariectomized rats assessed by in vivo micro-CT. Osteoporos Int 2009; 20:1823-35. [PMID: 19262974 PMCID: PMC2765647 DOI: 10.1007/s00198-009-0882-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 12/15/2008] [Indexed: 10/29/2022]
Abstract
UNLABELLED Using in vivo microcomputed tomography (micro-CT), we found in parathyroid hormone (PTH)-treated osteopenic rats linear increases in cortical and trabecular, due to increased trabecular thickness and number, bone mass. Bone was formed in cavities, leading to restoral of nearly cleaved trabeculae. For the first time, effects in PTH-treated rats were analyzed longitudinally. INTRODUCTION Our aims were to over time (1) determine changes in trabecular thickness and number after PTH, (2) compare responses to PTH between the meta- and epiphysis, (3) determine effects of PTH on mineralization and mechanical properties, (4) determine locations of new bone formation due to PTH on a microlevel, and (5) determine the predictive value of bone structural properties for gain in bone mass after PTH. METHODS Adult rats were divided into ovariectomy (OVX; n = 8), SHAM-OVX (n = 8), and OVX and PTH treatment (n = 9). Between weeks 8 and 14, PTH rats received daily subcutaneous PTH injections (60 microg/kg/day). At weeks 0, 8, 10, 12, and 14, in vivo micro-CT scans were made of the proximal and diaphyseal tibia. After sacrifice, all tibiae were tested in three-point bending. RESULTS PTH increased bone volume fraction linearly over time in meta- and epiphysis, accompanied by increased trabecular thickness in both and increased trabecular number only in the latter one. CT-estimated mineralization increased in trabecular and remained constant in cortical bone. Ultimate load and energy were increased and ultimate displacement and stiffness unaltered compared to SHAM rats. For those trabeculae analyzed, bone was formed initially on places where it was most beneficial for increasing their strength and later on to all surfaces.
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Affiliation(s)
- J. E. M. Brouwers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - B. van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Technische Universiteit Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - R. Huiskes
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K. Ito
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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McCann JC, Ames BN. Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging? Am J Clin Nutr 2009; 90:889-907. [PMID: 19692494 DOI: 10.3945/ajcn.2009.27930] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The triage theory posits that some functions of micronutrients (the approximately 40 essential vitamins, minerals, fatty acids, and amino acids) are restricted during shortage and that functions required for short-term survival take precedence over those that are less essential. Insidious changes accumulate as a consequence of restriction, which increases the risk of diseases of aging. For 16 known vitamin K-dependent (VKD) proteins, we evaluated the relative lethality of 11 known mouse knockout mutants to categorize essentiality. Results indicate that 5 VKD proteins that are required for coagulation had critical functions (knockouts were embryonic lethal), whereas the knockouts of 5 less critical VKD proteins [osteocalcin, matrix Gla protein (Mgp), growth arrest specific protein 6, transforming growth factor beta-inducible protein (Tgfbi or betaig-h3), and periostin] survived at least through weaning. The VKD gamma-carboxylation of the 5 essential VKD proteins in the liver and the 5 nonessential proteins in nonhepatic tissues sets up a dichotomy that takes advantage of the preferential distribution of dietary vitamin K1 to the liver to preserve coagulation function when vitamin K1 is limiting. Genetic loss of less critical VKD proteins, dietary vitamin K inadequacy, human polymorphisms or mutations, and vitamin K deficiency induced by chronic anticoagulant (warfarin/coumadin) therapy are all linked to age-associated conditions: bone fragility after estrogen loss (osteocalcin) and arterial calcification linked to cardiovascular disease (Mgp). There is increased spontaneous cancer in Tgfbi mouse knockouts, and knockdown of Tgfbi causes mitotic spindle abnormalities. A triage perspective reinforces recommendations of some experts that much of the population and warfarin/coumadin patients may not receive sufficient vitamin K for optimal function of VKD proteins that are important to maintain long-term health.
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Affiliation(s)
- Joyce C McCann
- Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA.
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