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Xie Y, Li S, Wu D, Wang Y, Chen J, Duan L, Li S, Li Y. Vitamin K: Infection, Inflammation, and Auto-Immunity. J Inflamm Res 2024; 17:1147-1160. [PMID: 38406326 PMCID: PMC10893789 DOI: 10.2147/jir.s445806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Vitamin K (VK) comprises a group of substances with chlorophyll quinone bioactivity and exists in nature in the form of VK1 and VK2. As its initial recognition originated from the ability to promote blood coagulation, it is known as the coagulation vitamin. However, based on extensive research, VK has shown potential for the prevention and treatment of various diseases. Studies demonstrating the beneficial effects of VK on immunity, antioxidant capacity, intestinal microbiota regulation, epithelial development, and bone protection have drawn growing interest in recent years. This review article focuses on the mechanism of action of VK and its potential preventive and therapeutic effects on infections (eg, asthma, COVID-19), inflammation (eg, in type 2 diabetes mellitus, Alzheimer's disease, Parkinson's disease, cancer, aging, atherosclerosis) and autoimmune disorders (eg, inflammatory bowel disease, type 1 diabetes mellitus, multiple sclerosis, rheumatoid arthritis). In addition, VK-dependent proteins (VKDPs) are another crucial mechanism by which VK exerts anti-inflammatory and immunomodulatory effects. This review explores the potential role of VK in preventing aging, combating neurological abnormalities, and treating diseases such as cancer and diabetes. Although current research appoints VK as a therapeutic tool for practical clinical applications in infections, inflammation, and autoimmune diseases, future research is necessary to elucidate the mechanism of action in more detail and overcome current limitations.
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Affiliation(s)
- Yuanyuan Xie
- The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Shifang Li
- The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Dinan Wu
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, People’s Republic of China
| | - Yining Wang
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, People’s Republic of China
| | - Jiepeng Chen
- Sungen Bioscience Co., Ltd, Guangdong, People’s Republic of China
| | - Lili Duan
- Sungen Bioscience Co., Ltd, Guangdong, People’s Republic of China
| | - Shuzhuang Li
- College of Basic Medical Science, Dalian Medical University, Dalian, People’s Republic of China
| | - Yuyuan Li
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian, People’s Republic of China
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2
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Malhotra R, Nicholson CJ, Wang D, Bhambhani V, Paniagua S, Slocum C, Sigurslid HH, Cardenas CLL, Li R, Boerboom SL, Chen YC, Hwang SJ, Yao C, Ichinose F, Bloch DB, Lindsay ME, Lewis GD, Aragam JR, Hoffmann U, Mitchell GF, Hamburg NM, Vasan RS, Benjamin EJ, Larson MG, Zapol WM, Cheng S, Roh JD, O’Donnell CJ, Nguyen C, Levy D, Ho JE. Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction. Arterioscler Thromb Vasc Biol 2022; 42:e61-e73. [PMID: 34809448 PMCID: PMC8792238 DOI: 10.1161/atvbaha.121.316664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Arterial stiffness is a risk factor for cardiovascular disease, including heart failure with preserved ejection fraction (HFpEF). MGP (matrix Gla protein) is implicated in vascular calcification in animal models, and circulating levels of the uncarboxylated, inactive form of MGP (ucMGP) are associated with cardiovascular disease-related and all-cause mortality in human studies. However, the role of MGP in arterial stiffness is uncertain. Approach and Results: We examined the association of ucMGP levels with vascular calcification, arterial stiffness including carotid-femoral pulse wave velocity (PWV), and incident heart failure in community-dwelling adults from the Framingham Heart Study. To further investigate the link between MGP and arterial stiffness, we compared aortic PWV in age- and sex-matched young (4-month-old) and aged (10-month-old) wild-type and Mgp+/- mice. Among 7066 adults, we observed significant associations between higher levels of ucMGP and measures of arterial stiffness, including higher PWV and pulse pressure. Longitudinal analyses demonstrated an association between higher ucMGP levels and future increases in systolic blood pressure and incident HFpEF. Aortic PWV was increased in older, but not young, female Mgp+/- mice compared with wild-type mice, and this augmentation in PWV was associated with increased aortic elastin fiber fragmentation and collagen accumulation. CONCLUSIONS This translational study demonstrates an association between ucMGP levels and arterial stiffness and future HFpEF in a large observational study, findings that are substantiated by experimental studies showing that mice with Mgp heterozygosity develop arterial stiffness. Taken together, these complementary study designs suggest a potential role of therapeutically targeting MGP in HFpEF.
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Affiliation(s)
- Rajeev Malhotra
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Christopher J. Nicholson
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Dongyu Wang
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Vijeta Bhambhani
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Samantha Paniagua
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Charles Slocum
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Haakon H. Sigurslid
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Christian L. Lino Cardenas
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca Li
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sophie L. Boerboom
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Yin-Ching Chen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA, and Schepens Eye Research Institute/Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Chen Yao
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Fumito Ichinose
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Donald B. Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Mark E. Lindsay
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gregory D. Lewis
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Naomi M. Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Ramchandran S. Vasan
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health & Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health & Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Warren M. Zapol
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Cheng
- Framingham Heart Study, Framingham, MA
- Barbara Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason D. Roh
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Christopher Nguyen
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA, and Schepens Eye Research Institute/Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Daniel Levy
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer E. Ho
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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3
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Hariri E, Kassis N, Iskandar JP, Schurgers LJ, Saad A, Abdelfattah O, Bansal A, Isogai T, Harb SC, Kapadia S. Vitamin K 2-a neglected player in cardiovascular health: a narrative review. Open Heart 2021; 8:openhrt-2021-001715. [PMID: 34785587 PMCID: PMC8596038 DOI: 10.1136/openhrt-2021-001715] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Vitamin K2 serves an important role in cardiovascular health through regulation of calcium homeostasis. Its effects on the cardiovascular system are mediated through activation of the anti-calcific protein known as matrix Gla protein. In its inactive form, this protein is associated with various markers of cardiovascular disease including increased arterial stiffness, vascular and valvular calcification, insulin resistance and heart failure indices which ultimately increase cardiovascular mortality. Supplementation of vitamin K2 has been strongly associated with improved cardiovascular outcomes through its modification of systemic calcification and arterial stiffness. Although its direct effects on delaying the progression of vascular and valvular calcification is currently the subject of multiple randomised clinical trials, prior reports suggest potential improved survival among cardiac patients with vitamin K2 supplementation. Strengthened by its affordability and Food and Drug Adminstration (FDA)-proven safety, vitamin K2 supplementation is a viable and promising option to improve cardiovascular outcomes.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jean-Pierre Iskandar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leon J Schurgers
- Biochemistry, Maastricht University CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Anas Saad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C Harb
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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4
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Mayer O, Bruthans J, Seidlerová J, Gelžinský J, Kučera R, Karnosová P, Mateřánková M, Rychecká M, Wohlfahrt P, Cífková R, Filipovský J, Vermeer C. Low vitamin K status, high sclerostin and mortality risk of stable coronary heart disease patients. Biomark Med 2021; 15:1465-1477. [PMID: 34668399 DOI: 10.2217/bmm-2021-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aim: We explored whether matrix Gla protein (MGP, natural calcification inhibitor) and sclerostin (glycoprotein responsible for osteoblast differentiation) interact in terms of mortality risk in coronary patients. Methods: 945 patients after myocardial infarction and/or coronary revascularization were followed in a prospective study. All-cause death, fatal or nonfatal cardiovascular events and heart failure hospitalizations were registered. Results: Either high desphospho-uncarboxylated MGP (dp-ucMGP) or high sclerostin were independently associated with 5-year all-cause/cardiovascular mortality. However, we observed an additional mortality risk in the coincidence of both factors. Concomitantly high dp-ucMGP (≥884 pmol/l) plus sclerostin (≥589 ng/l) were associated with increased all-cause mortality risk compared with 'normal' concentrations of both factors (HRR 3.71 [95% CI: 2.07-6.62, p < 0.0001]), or if only one biomarker has been increased. A similar pattern was observed for fatal, but not for nonfatal cardiovascular events. Conclusion: Concomitantly high MGP and sclerostin indicate increased mortality risk, which probably reflects their role in cardiovascular calcifications.
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Affiliation(s)
- Otto Mayer
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Jan Bruthans
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Jitka Seidlerová
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Julius Gelžinský
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Radek Kučera
- Department of Immunochemistry Diagnostics, University Hospital, Pilsen, 301 00, Czech Republic
| | - Petra Karnosová
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Markéta Mateřánková
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Martina Rychecká
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University & Thomayer Hospital, Prague, 140 00, Czech Republic
| | - Jan Filipovský
- Second Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, 301 00, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, 301 00, Czech Republic
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, Maastricht, 6200, The Netherlands
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5
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Beulens JWJ, Canto ED, Stehouwer CDA, Rennenberg RJMW, Elders PJM, van Ballegooijen AJ. High vitamin K status is prospectively associated with decreased left ventricular mass in women: the Hoorn Study. Nutr J 2021; 20:85. [PMID: 34666769 PMCID: PMC8524956 DOI: 10.1186/s12937-021-00742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background Vitamin K is associated with reduced cardiovascular disease risk such as heart failure, possibly by carboxylation of matrix-gla protein (MGP), a potent inhibitor of vascular calcification. The relationship of vitamin K intake or status with cardiac structure and function is largely unknown. Therefore this study aims to investigate the prospective association of vitamin K status and intake with echocardiographic measures. Methods This study included 427 participants from the Hoorn Study, a population-based cohort. Vitamin K status was assessed at baseline by plasma desphospho-uncarboxylated MGP (dp-ucMGP) with higher concentrations reflecting lower vitamin K status. Vitamin K intake was assessed at baseline with a validated food-frequency questionnaire. Echocardiography was performed at baseline and after a mean follow-up time of 7.6, SD=±0.7 years. We used linear regression for the association of vitamin K status and intake with left ventricular ejection fraction (LVEF), left atrial volume index (LAVI) and left ventricular mass index (LVMI), adjusted for potential confounders. Results The mean age was 66.8, SD=±6.1 years (51% were male). A high vitamin K status was prospectively associated with decreased LVMI (change from baseline to follow-up: -5.0, 95% CI: -10.5;0.4 g/m2.7) for the highest quartile compared to the lowest in women (P-interaction sex=0.07). No association was found in men. Vitamin K status was not associated with LVEF or LAVI. Vitamin K intake was not associated with any of the echocardiographic measures. Conclusions This study showed a high vitamin K status being associated with decreased LVMI only in women, while intakes of vitamin K were not associated with any cardiac structure or function measures. These results extend previous findings for a role of vitamin K status to decrease heart failure risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00742-0.
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Affiliation(s)
- Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. .,Medical Faculty, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Elisa Dal Canto
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands.,Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Roger J M W Rennenberg
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands
| | - Adriana Johanne van Ballegooijen
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands.,Department of Nephrology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC-location VUmc, Amsterdam, The Netherlands
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6
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Role of Matrix Gla Protein in the Complex Network of Coronary Artery Disease: A Comprehensive Review. Life (Basel) 2021; 11:life11080737. [PMID: 34440481 PMCID: PMC8398385 DOI: 10.3390/life11080737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary artery disease (CAD) is widely recognized as one of the most important clinical entities. In recent years, a large body of accumulated data suggest that coronary artery calcification, a process highly prevalent in patients with CAD, occurs via well-organized biologic processes, rather than passively, as previously regarded. Matrix Gla protein (MGP), a vitamin K-dependent protein, emerged as an important inhibitor of both intimal and medial vascular calcification. The functionality of MGP hinges on two post-translational modifications: phosphorylation and carboxylation. Depending on the above-noted modifications, various species of MGP may exist in circulation, each with their respective level of functionality. Emerging data suggest that dysfunctional species of MGP, markedly, dephosphorylated-uncarboxylated MGP, might find its application as biomarkers of microvascular health, and assist in clinical decision making with regard to initiation of vitamin K supplementation. Hence, in this review we summarized the current knowledge with respect to the role of MGP in the complex network of vascular calcification with concurrent inferences to CAD. In addition, we discussed the effects of warfarin use on MGP functionality, with concomitant implications to coronary plaque stability.
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7
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Bilalic A, Kurir TT, Borovac JA, Kumric M, Supe-Domic D, Vilovic M, Martinovic D, Bozic J. Association of Dephosphorylated-Uncarboxylated Matrix Gla Protein and Risk of Major Bleeding in Patients Presenting with Acute Myocardial Infarction. Life (Basel) 2021; 11:733. [PMID: 34440477 PMCID: PMC8400588 DOI: 10.3390/life11080733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
The "Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines" (CRUSADE) score emerged as a predictor of major bleeding in patients presenting with the acute coronary syndrome. On the other hand, previous studies established the association of dephosphorylated-uncarboxylated Matrix Gla protein (dp-ucMGP) and vitamin K, as well as their subsequent impact on coagulation cascade and bleeding tendency. Therefore, in the present study, we explored if dp-ucMGP plasma levels were associated with CRUSADE bleeding score. In this cross-sectional study, physical examination and clinical data, including plasma dp-ucMGP levels, were obtained from 80 consecutive patients with acute myocardial infarction (AMI). A significant positive correlation was found between CRUSADE bleeding score and both dp-ucMGP plasma levels (r = 0.442, p < 0.001) and risk score of in-hospital mortality (r = 0.520, p < 0.001), respectively. In comparing the three risk groups of risk for in-hospital bleeding, the high/very high-risk group had significantly higher dp-ucMGP levels from both very low/low group (1277 vs. 794 pmol/L, p < 0.001) and the moderate group (1277 vs. 941 pmol/L, p = 0.047). Overall, since higher dp-ucMGP levels were associated with elevated CRUSADE score and prolonged hemostasis parameters, this may suggest that there is a biological link between dp-ucMGP plasma levels and the risk of bleeding in patients who present with AMI.
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Affiliation(s)
- Admira Bilalic
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (A.B.); (J.A.B.)
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Split, 21000 Split, Croatia
| | - Josip A. Borovac
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (A.B.); (J.A.B.)
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
| | - Daniela Supe-Domic
- Department of Health Studies, University of Split, 21000 Split, Croatia;
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (M.V.); (D.M.)
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8
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The Role of Vitamin K in Humans: Implication in Aging and Age-Associated Diseases. Antioxidants (Basel) 2021; 10:antiox10040566. [PMID: 33917442 PMCID: PMC8067486 DOI: 10.3390/antiox10040566] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 12/17/2022] Open
Abstract
As human life expectancy is rising, the incidence of age-associated diseases will also increase. Scientific evidence has revealed that healthy diets, including good fats, vitamins, minerals, or polyphenolics, could have antioxidant and anti-inflammatory activities, with antiaging effects. Recent studies demonstrated that vitamin K is a vital cofactor in activating several proteins, which act against age-related syndromes. Thus, vitamin K can carboxylate osteocalcin (a protein capable of transporting and fixing calcium in bone), activate matrix Gla protein (an inhibitor of vascular calcification and cardiovascular events) and carboxylate Gas6 protein (involved in brain physiology and a cognitive decline and neurodegenerative disease inhibitor). By improving insulin sensitivity, vitamin K lowers diabetes risk. It also exerts antiproliferative, proapoptotic, autophagic effects and has been associated with a reduced risk of cancer. Recent research shows that protein S, another vitamin K-dependent protein, can prevent the cytokine storm observed in COVID-19 cases. The reduced activation of protein S due to the pneumonia-induced vitamin K depletion was correlated with higher thrombogenicity and possibly fatal outcomes in COVID-19 patients. Our review aimed to present the latest scientific evidence about vitamin K and its role in preventing age-associated diseases and/or improving the effectiveness of medical treatments in mature adults ˃50 years old.
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9
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Bilalic A, Ticinovic Kurir T, Kumric M, Borovac JA, Matetic A, Supe-Domic D, Bozic J. Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome. Molecules 2021; 26:1108. [PMID: 33669806 PMCID: PMC7922740 DOI: 10.3390/molecules26041108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.
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Affiliation(s)
- Admira Bilalic
- Department of Cardiology, University Hospital of Split, Split 21000, Croatia; (A.B.); (A.M.)
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
- Endocrinology Clinic, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
| | - Josip A. Borovac
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
- Institute of Emergency Medicine of Split-Dalmatia County (ZHM SDZ), 21000 Split, Croatia
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split 21000, Croatia; (A.B.); (A.M.)
| | - Daniela Supe-Domic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (T.T.K.); (M.K.); (J.A.B.)
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10
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Mayer O, Bruthans J, Seidlerová J, Karnosová P, Mateřánková M, Gelžinský J, Rychecká M, Opatrný J, Wohlfahrt P, Kučera R, Trefil L, Cífková R, Filipovský J, Vermeer C. The coincidence of low vitamin K status and high expression of growth differentiation factor 15 may indicate increased mortality risk in stable coronary heart disease patients. Nutr Metab Cardiovasc Dis 2021; 31:540-551. [PMID: 33257192 DOI: 10.1016/j.numecd.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Matrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). METHODS AND RESULTS 894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status. Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with "normal" concentrations of both biomarkers [HR 5.51 (95% CI 2.91-10.44), p < 0.0001 and 6.79 (95% CI 3.06-15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. CONCLUSIONS The individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.
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Affiliation(s)
- Otto Mayer
- 2nd 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.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd 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
| | - Petra Karnosová
- 2nd 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
| | - Markéta Mateřánková
- 2nd 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
| | - Julius Gelžinský
- 2nd 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
| | - Martina Rychecká
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Jan Opatrný
- Department of Cardiology, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Radek Kučera
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd 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
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, the Netherlands
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11
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Roumeliotis S, Roumeliotis A, Stamou A, Leivaditis K, Kantartzi K, Panagoutsos S, Liakopoulos V. The Association of dp-ucMGP with Cardiovascular Morbidity and Decreased Renal Function in Diabetic Chronic Kidney Disease. Int J Mol Sci 2020; 21:E6035. [PMID: 32839405 PMCID: PMC7504709 DOI: 10.3390/ijms21176035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
We aimed to investigate the possible association of the inactive, dephosphorylated, uncarboxylated matrix Gla protein (dp-ucMGP) with oxidized low-density lipoprotein (ox-LDL) and all-cause/cardiovascular (CV) mortality and renal function in diabetic chronic kidney disease (CKD). Ox-LDL and dp-ucMGP were determined in 66 diabetic CKD patients. All patients were prospectively followed for seven years, or until the occurrence of death, or a composite renal outcome of 30% estimated glomerular filtration rate (eGFR) reduction or progression to end-stage renal disease (ESRD) requiring dialysis occurred. Secondary outcomes were the occurrence of CV events. Kaplan-Meier curves showed that patients with plasma dp-ucMGP levels above the median (≥656 pM) had a significantly higher risk for all study endpoints. After adjustment for several well-known cofounders, multivariate Cox analysis showed that high plasma dp-ucMGP levels were associated with all-cause mortality (Hazard ratio-HR = 2.63, 95% Confidence Interval-CI = 1.17-5.94, p = 0.02), CV mortality (HR = 2.82, 95% CI = 1.07-7.49, p = 0.037) and progression of CKD (HR = 4.02, 95% CI = 1.20-13.46, p = 0.024). Circulating dp-ucMGP is associated with mortality and decreased renal function in diabetic CKD.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.R.); (A.R.); (K.L.)
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.R.); (A.R.); (K.L.)
| | - Aikaterini Stamou
- Department of Microbiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.R.); (A.R.); (K.L.)
| | - Konstantia Kantartzi
- Department of Nephrology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.K.); (S.P.)
| | - Stylianos Panagoutsos
- Department of Nephrology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.K.); (S.P.)
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.R.); (A.R.); (K.L.)
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12
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Roumeliotis S, Dounousi E, Salmas M, Eleftheriadis T, Liakopoulos V. Vascular Calcification in Chronic Kidney Disease: The Role of Vitamin K- Dependent Matrix Gla Protein. Front Med (Lausanne) 2020; 7:154. [PMID: 32391368 PMCID: PMC7193028 DOI: 10.3389/fmed.2020.00154] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
Arterial calcification is highly prevalent in chronic kidney disease (CKD) patients and is associated with cardiovascular (CV) morbidity and mortality. Patients at early CKD stages are more likely to suffer a fatal CV event than to develop end-stage renal disease and require hemodialysis treatment. The heavy CV burden of these patients cannot be solely explained by traditional calcification risk factors. Moreover, the pathophysiologic mechanisms underlying this association are complex and yet not fully understood. Although vascular calcification was regarded as a passive degenerative process for over a century, this theory changed by recent evidence that pointed toward an active process, where calcification promoters and inhibitors were involved. Matrix Gla Protein (MGP) has been established as a strong inhibitor of calcification both in vitro and in vivo. Not only it prevents mineralization of the arterial wall, but it is the only factor that can actually reverse it. To become fully active, MGP must undergo carboxylation of specific protein bound glutamate residues, a process fully dependent on the availability of vitamin K. Low vitamin K status leads to inactive, uncarboxylated forms of MGP and has been repeatedly associated with accelerated vascular calcification. Aim of this review is to present the pathophysiologic mechanisms underlying the activation and function of MGP and review the existing, accumulating data regarding the association between vitamin K, MGP and vascular calcification/CV disease in CKD patients.
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Affiliation(s)
- Stefanos Roumeliotis
- Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vassilios Liakopoulos
- Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Jaminon AMG, Dai L, Qureshi AR, Evenepoel P, Ripsweden J, Söderberg M, Witasp A, Olauson H, Schurgers LJ, Stenvinkel P. Matrix Gla protein is an independent predictor of both intimal and medial vascular calcification in chronic kidney disease. Sci Rep 2020; 10:6586. [PMID: 32313061 PMCID: PMC7171129 DOI: 10.1038/s41598-020-63013-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/17/2020] [Indexed: 11/08/2022] Open
Abstract
Matrix Gla protein (MGP) is a potent inhibitor of vascular calcification (VC) and requires carboxylation by vitamin K to exert calcification inhibition. Chronic kidney disease (CKD) patients undergo early vascular aging often involving extensive VC. The present cross-sectional study investigated the association between circulating dp-ucMGP levels, MGP expression in vascular tissue and MGP polymorphisms. In 141 CKD stage 5 patients, CAC score was significantly increased in the highest tertile of dp-ucMGP (p = 0.002), and a high medial VC score was associated with elevated dp-ucMGP levels. MGP vascular expression was associated with increased circulating dp-ucMGP and CAC scores. MGP SNP analysis revealed that patients homozygous for the C allele of the rs1800801 variant had a higher CAC score (median 15 [range 0-1312]) compared to patients carrying a T allele (median 0 [range 0-966] AU). These results indicate that plasma levels of dp-ucMGP are an independent predictor of increased VC in CKD5 patients and correlate with both higher CAC scores and degree of medial calcification. Additionally, high vascular expression of MGP was associated with higher CAC scores and plasma dp-ucMGP levels. Taken together, our results support that MGP is involved in the pathogenesis of VC.
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Affiliation(s)
- Armand M G Jaminon
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Lu Dai
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Pieter Evenepoel
- Department of Immunology and Microbiology, Laboratory of Nephrology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jonaz Ripsweden
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Magnus Söderberg
- Pathology, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Witasp
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Olauson
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden.
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14
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Machado-Fragua MD, Hoogendijk EO, Struijk EA, Rodriguez-Artalejo F, Lopez-Garcia E, Beulens JW, van Ballegooijen AJ. High dephospho-uncarboxylated matrix Gla protein concentrations, a plasma biomarker of vitamin K, in relation to frailty: the Longitudinal Aging Study Amsterdam. Eur J Nutr 2020; 59:1243-1251. [PMID: 31069456 DOI: 10.1007/s00394-019-01984-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE No previous study has evaluated the relationship between vitamin K and frailty. Thus, we assessed the relationship between vitamin K status and frailty over 13 years in the Longitudinal Aging Study Amsterdam (LASA). METHODS Prospective cohort study with 644 community-dwelling adults ≥ 55 years from the LASA cohort. In 2002-2003, plasma desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) was measured as marker of vitamin K status through a sandwich ELISA. Frailty was measured at baseline and in four follow-up examinations with the LASA Frailty Index (LASA-FI), which was used as both a continuous and a dichotomous measure (FI ≥ 0.25), as indicator of the degree of frailty and frailty risk, respectively. Statistical analyses were performed with multivariable generalized estimating equations using the lowest dp-ucMGP tertile, reflecting a high vitamin K status, as reference. RESULTS The mean (SD) age was 59.9 (2.9) years, and 54% were female. Compared with the lowest tertile, the medium and highest dp-ucMGP tertile were associated with a higher degree of frailty [1.40, 95% confidence interval (0.01-2.81) and 1.62, (0.18-3.06), respectively. P trend: 0.03]. Additionally, the medium and highest dp-ucMGP tertile had a higher odds ratio of frailty [1.75 (1.11-2.77) and 1.63 (1.04-2.57), respectively]. The degree of frailty increased over time, but the differences by dp-ucMGP tertiles existed since baseline and remained stable during follow-up. CONCLUSIONS Baseline plasma low vitamin K status was associated with a greater degree of frailty and frailty risk in this cohort of older adults, which highlights the importance of ensuring an optimal nutritional status of this vitamin to prevent frailty in later life.
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Affiliation(s)
- Marcos D Machado-Fragua
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, and the Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Joline W Beulens
- Department of Epidemiology and Biostatistics, and the Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, and the Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands
- Department of Nephrology, and Amsterdam Cardiovascular Science, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands
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15
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Griffin TP, Islam MN, Wall D, Ferguson J, Griffin DG, Griffin MD, O'Shea PM. Plasma dephosphorylated-uncarboxylated Matrix Gla-Protein (dp-ucMGP): reference intervals in Caucasian adults and diabetic kidney disease biomarker potential. Sci Rep 2019; 9:18452. [PMID: 31804541 PMCID: PMC6895103 DOI: 10.1038/s41598-019-54762-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Recent studies suggest a possible association between dephosphorylated-uncarboxylated MGP (dp-ucMGP) and glomerular filtration rate (GFR). This study aimed to establish normative data in an adult Caucasian population and to explore the potential utility of dp-ucMGP in patients with diabetes mellitus (DM) with and without diabetic kidney disease (DKD). Healthy volunteers (HVs) (cross-sectional study) and participants with DM (prospective cohort study) were recruited. Plasma dp-ucMGP was measured using the IDS®-iSYS Ina Ktif (dp-ucMGP) assay. Of the HVs recruited (n = 208), 67(32.2%) were excluded leaving a reference population of 141(67.8%) metabolically healthy participants with normal kidney function. Plasma dp-ucMGP RIs were <300-532 pmol/L. There were 100 eligible participants with DKD and 92 with DM without DKD. For the identification of participants with DKD, the area under the receiver operating characteristic curve (AUC) for dp-ucMGP was 0.842 (95%CI:0.799-0.880; p < 0.001). Plasma dp-ucMGP demonstrated similar ability to urine albumin:creatinine ratio (uACR) to detect participants with DM and renal function decline. Among patients with DM, there was a negative correlation between natural log (LN) dp-ucMGP and eGFR (r = -0.7041; p < 0.001) and rate of change in renal function [%change (r = -0.4509; p < 0.001)] and a positive correlation between LN dp-ucMGP and LN uACR (r = 0.3392; p < 0.001). These results suggest the potential for plasma dp-ucMGP with well-defined RIs to identify adults at high risk for vascular disease in the context of progressive DKD.
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Affiliation(s)
- Tomás Patrick Griffin
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Md Nahidul Islam
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Deirdre Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - John Ferguson
- Health Research Board (HRB), Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Damian Gerard Griffin
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Matthew Dallas Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland.
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Wei FF, Trenson S, Verhamme P, Vermeer C, Staessen JA. Vitamin K-Dependent Matrix Gla Protein as Multifaceted Protector of Vascular and Tissue Integrity. Hypertension 2019; 73:1160-1169. [PMID: 31006332 PMCID: PMC6510326 DOI: 10.1161/hypertensionaha.119.12412] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences (F.-F.W., J.A.S.), University Hospitals Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology (S.T.), University Hospitals Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Belgium (P.V.)
| | - Cees Vermeer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (C.V., J.A.S.)
| | - Jan A. Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences (F.-F.W., J.A.S.), University Hospitals Leuven, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (C.V., J.A.S.)
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17
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Roumeliotis S, Dounousi E, Eleftheriadis T, Liakopoulos V. Association of the Inactive Circulating Matrix Gla Protein with Vitamin K Intake, Calcification, Mortality, and Cardiovascular Disease: A Review. Int J Mol Sci 2019; 20:E628. [PMID: 30717170 PMCID: PMC6387246 DOI: 10.3390/ijms20030628] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/07/2023] Open
Abstract
Matrix Gla Protein (MGP), a small Gla vitamin K-dependent protein, is the most powerful natural occurring inhibitor of calcification in the human body. To become biologically active, MGP must undergo vitamin K-dependent carboxylation and phosphorylation. Vitamin K deficiency leads to the inactive uncarboxylated, dephosphorylated form of MGP (dpucMGP). We aimed to review the existing data on the association between circulating dpucMGP and vascular calcification, renal function, mortality, and cardiovascular disease in distinct populations. Moreover, the association between vitamin K supplementation and serum levels of dpucMGP was also reviewed.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
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18
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Hashmath Z, Lee J, Gaddam S, Ansari B, Oldland G, Javaid K, Mustafa A, Vasim I, Akers S, Chirinos JA. Vitamin K Status, Warfarin Use, and Arterial Stiffness in Heart Failure. Hypertension 2019; 73:364-370. [PMID: 30580682 PMCID: PMC6326852 DOI: 10.1161/hypertensionaha.118.12157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 01/01/2023]
Abstract
Large artery stiffening contributes to the pathophysiology of heart failure (HF) and associated comorbidities. MGP (matrix Gla-protein) is a potent inhibitor of vascular calcification. MGP activation is vitamin K-dependent. We aimed (1) to compare dp-ucMGP (dephospho-uncarboxylated MGP) levels between subjects with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) and subjects without HF; (2) to assess the relationship between dp-ucMGP levels and arterial stiffness; and (3) to assess the relationship between warfarin use, dp-ucMGP levels, and arterial stiffness in HF. We enrolled 348 subjects with HFpEF (n=96), HFrEF (n=53), or no HF (n=199). Carotid-femoral pulse wave velocity, a measure of large artery stiffness, was measured with arterial tonometry. Dp-ucMGP was measured with ELISA. Dp-ucMGP levels were greater in both HFrEF (582 pmol/L; 95% CI, 444-721 pmol/L) and HFpEF (549 pmol/L; 95% CI, 455-643 pmol/L) compared with controls (426 pmol/L; 95% CI, 377-475 pmol/L; ANCOVA P=0.0067). Levels of dp-ucMGP were positively associated with carotid-femoral pulse wave velocity (standardized β, 0.31; 95% CI, 0.19-0.42; P<0.0001), which was also true in analyses restricted to patients with HF (standardized β, 0.34; 95% CI, 0.16-0.52; P=0.0002). Warfarin use was significantly associated with carotid-femoral pulse wave velocity (standardized β, 0.13; 95% CI, 0.004-0.26; P=0.043), but this relationship was eliminated after adjustment for dp-ucMGP. In conclusion, levels of dp-ucMGP are increased in HFpEF and HFrEF and are independently associated with arterial stiffness. Future studies should investigate whether vitamin K supplementation represents a suitable therapeutic strategy to prevent or reduce arterial stiffness in HFpEF and HFrEF.
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Affiliation(s)
| | - Jonathan Lee
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Swetha Gaddam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Bilal Ansari
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Garrett Oldland
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | | | - Anique Mustafa
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Izzah Vasim
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Scott Akers
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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19
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Hou Y, Guo H, Guo Y, Zhang Y, Han H. [Preliminary Study on the Biological Markers for I-IIb Stage Non-small Cell Lung Cancer Based on a Serum-peptidomics]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:20-25. [PMID: 30674389 PMCID: PMC6348161 DOI: 10.3779/j.issn.1009-3419.2019.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
背景与目的 非小细胞肺癌是发病率最高的一种肺恶性肿瘤,早发现、早诊断、早治疗是其治疗原则,因其发病隐匿,缺乏早期筛查的特异性标志物,多数患者就诊时已处于晚期阶段,导致其5年生存率较低,预后不理想。探索一种敏感的生物学标志物,是目前肺癌诊疗的重点。本文基于差异多肽组学技术,旨在筛选Ⅰ期-Ⅱb期非小细胞肺癌的血清生物标志物。 方法 利用纳升超高效液相色谱联合四级杆轨道阱质谱技术,比较和筛选正常健康人群、肺部良性病变患者、非小细胞肺癌患者血清中的差异多肽片段,通过对目标肽段的鉴别和定量分析,探寻非小细胞肺癌早期诊断的肿瘤生物标志物。 结果 通过与人类蛋白质组数据库进行比对,共鉴定到545个多肽,分别来自118个蛋白。将各组样本中肽段的谱图数进行比较,共筛选出201个差异多肽,经定量分析发现峰面积的变异系数(coefficient of variation, CV)≤30%的目标肽段共计7个,其中在各组间呈趋势变化的有2条肽段,分别是肺癌组中表达下调的肽段QGAKIPKPEASFSPR和肺癌组中表达上调的肽段CDDYRLC,它们分别来自于中间α球蛋白抑制因子H4蛋白(ITIH4)和基质γ-羧基谷氨酸蛋白(MGP)。 结论 将血清多肽组学用于筛选肿瘤标志物的研究,可为非小细胞肺癌的早期诊断提供新线索,其中ITIH4与MGP蛋白水解的特异性肽段是潜在早期非小细胞肺癌患者的血清标志物。
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Affiliation(s)
- Yuelong Hou
- Department of Thoracic Surgery, Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease; Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Hongqi Guo
- Department of Thoracic Surgery, Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease; Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Yongkuan Guo
- Department of Thoracic Surgery, Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease; Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Yukun Zhang
- Department of Thoracic Surgery, Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease; Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
| | - Hongli Han
- Department of Thoracic Surgery, Third Central Hospital of Tianjin; Tianjin Institute of Hepatobiliary Disease; Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
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20
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Barrett H, O'Keeffe M, Kavanagh E, Walsh M, O'Connor EM. Is Matrix Gla Protein Associated with Vascular Calcification? A Systematic Review. Nutrients 2018; 10:E415. [PMID: 29584693 PMCID: PMC5946200 DOI: 10.3390/nu10040415] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 12/19/2022] Open
Abstract
Specific patient cohorts are at increased risk of vascular calcification. Functional matrix-gla protein (MGP), a tissue-derived vitamin K dependent protein, is reported to be an important inhibitor of vascular calcification and may have clinical potential to modify the progression of vascular calcification through regulation of functional MGP fractions. This systematic review examines twenty-eight studies which assess the relationship between circulating protein expressions of MGP species and vascular calcification in different arterial beds. The included studies examined participants with atherosclerosis, chronic kidney disease (CKD), diabetes, healthy participants, vitamin K supplementation, measured plasma vitamin K levels and vitamin K antagonist usage. The current review reports conflicting results regarding MGP fractions with respect to local calcification development indicating that a multifaceted relationship exists between the MGP and calcification. A primary concern regarding the studies in this review is the large degree of variability in the calcification location assessed and the fraction of MGP measured. This review suggests that different underlying molecular mechanisms can accelerate local disease progression within the vasculature, and specific circulating fractions of MGP may be influenced differently depending on the local disease states related to vascular calcification development. Further studies examining the influence of non-functional MGP levels, with respect to specific calcified arterial beds, are warranted.
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Affiliation(s)
- Hilary Barrett
- Centre for Applied Biomedical Engineering Research (CABER), School of Engineering, Bernal Institute, University of Limerick, Limerick V94 F858, UK.
| | - Mary O'Keeffe
- School of Natural Sciences and Department of Biological Sciences, University of Limerick, Limerick V94 F858, UK.
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Limerick V94 F858, UK.
| | - Michael Walsh
- Centre for Applied Biomedical Engineering Research (CABER), School of Engineering, Bernal Institute, University of Limerick, Limerick V94 F858, UK.
- Health Research Institute (HRI), University of Limerick, Limerick V94 F858, UK.
| | - Eibhlís M O'Connor
- School of Natural Sciences and Department of Biological Sciences, University of Limerick, Limerick V94 F858, UK.
- Health Research Institute (HRI), University of Limerick, Limerick V94 F858, UK.
- Alimentary Pharmabiotic Centre, Microbiome Institute, University College Cork, Cork T12 YN60, UK.
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21
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Vitamin K: Redox-modulation, prevention of mitochondrial dysfunction and anticancer effect. Redox Biol 2018; 16:352-358. [PMID: 29597144 PMCID: PMC5953218 DOI: 10.1016/j.redox.2018.03.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 12/21/2022] Open
Abstract
This review is directed to the redox-modulating properties and anticancer effect of vitamin K. The concept is focused on two aspects: (i) redox-cycle of vitamin K and its effect on the calcium homeostasis, “oncogenic” and “onco-suppressive” reactive oxygen species and the specific induction of oxidative stress in cancer; (ii) vitamin K plus C as a powerful redox-system, which forms a bypass between mitochondrial complexes II and III and thus prevents mitochondrial dysfunction, restores oxidative phosphorylation and aerobic glycolysis, modulates the redox-state of endogenous redox-pairs, eliminates the hypoxic environment of cancer cells and induces cell death. The analyzed data suggest that vitamin C&K can sensitize cancer cells to conventional chemotherapy, which allows achievement of a lower effective dose of the drug and minimizing the harmful side-effects. The review is intended for a wide audience of readers - from students to specialists in the field.
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22
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Dahlberg S, Ede J, Schurgers L, Vermeer C, Kander T, Klarin B, Schött U. Desphospho-Uncarboxylated Matrix-Gla Protein Is Increased Postoperatively in Cardiovascular Risk Patients. Nutrients 2018; 10:E46. [PMID: 29303985 PMCID: PMC5793274 DOI: 10.3390/nu10010046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Matrix Gla protein (MGP) is an extrahepatic protein that is dependent on glutamate carboxylation, a vitamin K-dependent process. Its dysfunctional form, desphospho-uncarboxylated-MGP, has been associated with increased arterial calcification and stiffness. The aim of this study was to measure the degree of postoperative carboxylation of MGP and two other Gla proteins in patients scheduled for abdominal or orthopaedic surgery. METHODS Forty patients undergoing abdominal or orthopaedic surgery were included. Blood samples were collected preoperatively and four days after the surgery. Desphospho-carboxylated MGP (dp-cMGP), desphospho-uncarboxylated MGP (dp-ucMGP), carboxylated osteocalcin (OC) (cOC), uncarboxylated OC (ucOC), and uncarboxylated prothrombin (PIVKA-II) were analysed. RESULTS Preoperatively, 29 patients had dp-ucMGP levels above the reference values. Patients with pre-existing cardiovascular comorbidities had higher dp-ucMGP preoperatively compared with patients with no record of cardiovascular disease. Postoperatively, this number increased to 36 patients, and median dp-ucMGP levels increased (p < 0.0001) and correlated to a PIVKA-II increase (r = 0.44). On the other hand, dp-cMGP levels did not significantly alter. Decreased levels of ucOC and cOC were seen after surgery (p = 0.017 and p = 0.0033, respectively). Comorbidities, possible nutritional defects, and complications affecting Gla protein activity and function were identified. CONCLUSIONS Dp-ucMGP was high preoperatively, and had further increased postoperatively. This pattern was linked to several comorbidities, possible nutritional defects, and postoperative complications, which motivates further research about potential interactions between perioperative corrective treatments with vitamin K supplements, cardiovascular biomarkers, and incidents of stroke and myocardial infarction events.
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Affiliation(s)
- Sofia Dahlberg
- Institution of Clinical Science Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden.
| | - Jacob Ede
- Institution of Clinical Science Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden.
| | - Leon Schurgers
- Department of Biochemistry, CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands.
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Oxfordlaan 55, 6229 ER Maastricht, The Netherlands.
| | - Thomas Kander
- Institution of Clinical Science Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden.
- Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University and Skane University Hospital, S-22185 Lund, Sweden.
| | - Bengt Klarin
- Institution of Clinical Science Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden.
- Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University and Skane University Hospital, S-22185 Lund, Sweden.
| | - Ulf Schött
- Institution of Clinical Science Lund, Medical Faculty, Lund University, S-22185 Lund, Sweden.
- Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University and Skane University Hospital, S-22185 Lund, Sweden.
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23
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Roumeliotis S, Roumeliotis A, Panagoutsos S, Giannakopoulou E, Papanas N, Manolopoulos VG, Passadakis P, Tavridou A. Matrix Gla protein T-138C polymorphism is associated with carotid intima media thickness and predicts mortality in patients with diabetic nephropathy. J Diabetes Complications 2017; 31:1527-1532. [PMID: 28734846 DOI: 10.1016/j.jdiacomp.2017.06.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/13/2017] [Accepted: 06/24/2017] [Indexed: 01/07/2023]
Abstract
AIMS We sought to determine the predictive value of Matrix Gla Protein MGP T-138C polymorphism in relation to all-cause mortality, cardiovascular mortality and cardiovascular events in patients with diabetic nephropathy (DN). METHODS MGP T-138C polymorphism was assessed in 40 diabetic patients without nephropathy and 118 patients at different stages of DN, including patients on hemodialysis. Measurement of carotid intima-media thickness (cIMT) was performed using real-time B-mode ultrasonography. Plasma levels of dephoshorylated uncarboxylated Matrix Gla Protein (dp-ucMGP) were determined in a subgroup of 67 patients by ELISA. Mortality and cardiovascular events were assessed during a 7year follow-up. RESULTS TT homozygotes for the MGP T-138C polymorphism had higher values of cIMT compared to combined TC and CC genotypes (P=0.006) whereas no association was observed between cIMT and dp-ucMGP levels. MGP T-138C polymorphism was a strong independent predictor of cIMT (P<0.0001), after adjustment for several well-known atherosclerosis risk factors. Patients with TT genotype presented a significantly higher all-cause and cardiovascular mortality risk compared to patients with TC and CC genotypes (P=0.01 and P=0.04 respectively), after adjustment for several traditional risk factors. CONCLUSIONS MGP T-138C polymorphism is a strong and independent predictor of increased cIMT as well as all-cause and cardiovascular mortality in DN patients.
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Affiliation(s)
- Stefanos Roumeliotis
- Department of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Roumeliotis
- Department of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stylianos Panagoutsos
- Department of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstathia Giannakopoulou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vangelis G Manolopoulos
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ploumis Passadakis
- Department of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna Tavridou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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24
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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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25
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Knapen MHJ, Braam LAJLM, Teunissen KJ, Van't Hoofd CM, Zwijsen RML, van den Heuvel EGHM, Vermeer C. Steady-state vitamin K2 (menaquinone-7) plasma concentrations after intake of dairy products and soft gel capsules. Eur J Clin Nutr 2016; 70:831-6. [PMID: 26908424 DOI: 10.1038/ejcn.2016.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND In a previous human intervention study, we observed an improved vitamin K status after 8 weeks of intake of a yogurt that was fortified with vitamin K2 (as menaquinone-7, MK-7) and enriched with vitamins C and D3, magnesium and polyunsaturated fatty acids. It was hypothesized that the added nutrients contributed to this improvement. Here we report on a study in which we compared the fasting plasma concentrations of MK-7 from (a) yogurt enriched with MK-7, vitamins D3 and C, magnesium, n-3 poly unsaturated fatty acids (n-3 PUFA) and fish oil (yogurt Kplus), (b) yogurt fortified with MK-7 only (yogurt K) and (c) soft gel capsules containing only MK-7. SUBJECTS/METHODS For 42 days, healthy men and postmenopausal women between 45 and 65 years of age daily consumed either yogurt K, yogurt Kplus or capsules. Circulating MK-7, 25-hydroxy vitamin D (25(OH)D) and markers for vitamin K status (uncarboxylated osteocalcin (ucOC) and desphospho-uncarboxylated matrix Gla-protein (dp-ucMGP)) were assessed. Plasma MK-7 was also measured during the washout period of 2 weeks. MK-7 and dp-ucMGP were measured in citrated plasma, and 25(OH)D3 and ucOC were measured in the serum. RESULTS The increase in plasma MK-7 with the yogurt Kplus product was more pronounced than the increase in MK-7 with the capsules. Circulating dp-ucMGP and ucOC were significantly lowered after consumption of the yogurt products and the MK-7 capsules, reflecting vitamin K status improvement. No significant differences in fasting plasma concentrations of various biomarkers between the yogurts were found. CONCLUSIONS Dairy matrix and nutrient composition may affect MK-7 delivery and improvement of vitamin K status. Yogurt fortified with MK-7 is a suitable matrix to improve the nutritional status of the fat-soluble vitamins.
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Affiliation(s)
- M H J Knapen
- R&D Group VitaK, Biopartner Center Maastricht, Maastricht University, Maastricht, The Netherlands
| | - L A J L M Braam
- R&D Group VitaK, Biopartner Center Maastricht, Maastricht University, Maastricht, The Netherlands
| | - K J Teunissen
- R&D Group VitaK, Biopartner Center Maastricht, Maastricht University, Maastricht, The Netherlands
| | - C M Van't Hoofd
- R&D Group VitaK, Biopartner Center Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | | | - C Vermeer
- R&D Group VitaK, Biopartner Center Maastricht, Maastricht University, Maastricht, The Netherlands
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26
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Mayer O, Seidlerová J, Vaněk J, Karnosová P, Bruthans J, Filipovský J, Wohlfahrt P, Cífková R, Windrichová J, Knapen MHJ, Drummen NEA, Vermeer C. The abnormal status of uncarboxylated matrix Gla protein species represents an additional mortality risk in heart failure patients with vascular disease. Int J Cardiol 2016; 203:916-22. [PMID: 26618253 DOI: 10.1016/j.ijcard.2015.10.226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Matrix Gla protein (MGP) is a natural inhibitor of tissue calcification. In a previous study, we observed the positive association between abnormal concentrations of uncarboxylated MGP species and increased mortality risk in stable vascular patients. We explore whether co-incidence of abnormal status of uncarboxylated MPG and heart failure (HF) affects the mortality risk. METHODS We examined 799 patients (mean age 65.1 years) with stable vascular disease and followed them in a prospective study. Both, desphospho-uncarboxylated and total uncarboxylated MGP (dp-ucMGP or t-ucMGP) were quantified by pre-commercial ELISA assays. RESULTS Elevated (>100 ng/L) circulating brain natriuretic peptide (BNP) and abnormal status of plasma uncarboxylated MGP species (i.e.: dp-ucMGP ≥ 977 pmol/L or t-ucMGP ≤ 2825 nmol/L) were all identified as robust predictors of all-cause 5-year mortality. However, their co-incidence represented a substantial additional risk. We observed the highest mortality risk in patients with elevated BNP plus high dp-ucMGP compared to those with normal BNP plus low dp-ucMGP; fully adjusted HRR's were 4.86 (3.15-7.49). Likewise, the risk was increased when compared with patients with elevated BNP plus low dp-ucMGP; HRR 2.57 (1.60-4.10). Similar result we observed when co-incidence of elevated BNP and low t-ucMGP was analyzed [corresponding HRR's were 4.16 (2.62-6.61) and 1.96 (1.24-3.12)]. CONCLUSIONS The concomitant abnormality of uncarboxylated MGP and mild elevation of BNP leads in chronic patients with vascular disease to about two-fold increase of the relative mortality risk. We hypothesize that abnormal homeostasis of MGP is involved in the pathophysiology of HF.
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Affiliation(s)
- Otto Mayer
- 2nd 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
- 2nd 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
| | - Jiří Vaněk
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Petra Karnosová
- 2nd 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
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd 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
- First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Renata Cífková
- First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Jindra Windrichová
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Marjo H J Knapen
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Nadja E A Drummen
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Cees Vermeer
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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27
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Schurgers LJ, Burgmaier M, Ueland T, Schutters K, Aakhus S, Hofstra L, Gullestad L, Aukrust P, Hellmich M, Narula J, Reutelingsperger CP. Circulating annexin A5 predicts mortality in patients with heart failure. J Intern Med 2016. [PMID: 26223343 DOI: 10.1111/joim.12396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Natriuretic peptides are currently used to predict mortality in patients with heart failure (HF). However, novel independent biomarkers are needed to improve risk stratification in these patients. We hypothesized that annexin A5 (anxA5) would be highly expressed by organs which are generally affected by HF and that circulating anxA5 levels would predict mortality in HF patients. METHODS We prospectively determined the diagnostic value of anxA5, N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and estimated glomerular filtration rate (eGFR) to predict mortality in 180 HF patients during a median follow-up of 3.6 years. Studies were conducted with anxA5(-/-) mice to investigate the underlying mechanisms. RESULTS AnxA5 levels were significantly elevated in HF patients compared to healthy control subjects. Cox regression analysis demonstrated that anxA5, NT-proBNP and eGFR all predict mortality independently. AnxA5 significantly improved the diagnostic efficiency of NT-proBNP alone (improvement of c-statistic from 0.662 to 0.705, P < 0.001) and also combined with eGFR and CRP (improvement of c-statistic from 0.675 to 0.738, P < 0.001) to predict mortality in the Cox regression model. Receiver operating characteristic curve analysis showed that anxA5 predicted 3-year survival (area under curve 0.708) with an optimal cut-off value of 2.24 ng mL(-1) . Using anxA5(-/-) mice, we demonstrated that anxA5 is highly expressed in organs that are often affected by HF including lung, kidney, liver and spleen. Lysis of these organs in vitro resulted in a marked and significant increase in anxA5 concentrations. CONCLUSION AnxA5 improves the diagnostic efficiency of conventional biomarkers to predict mortality in HF patients. Whereas natriuretic peptides originate from the myocardium, high circulating anxA5 levels in patients with HF are likely to reflect peripheral organ damage secondary to HF.
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Affiliation(s)
- L J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - M Burgmaier
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, University Hospital of the RWTH Aachen, Aachen, Germany
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - K Schutters
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - S Aakhus
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - L Hofstra
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Narula
- Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - C P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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28
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van Gorp RH, Schurgers LJ. New Insights into the Pros and Cons of the Clinical Use of Vitamin K Antagonists (VKAs) Versus Direct Oral Anticoagulants (DOACs). Nutrients 2015; 7:9538-57. [PMID: 26593943 PMCID: PMC4663607 DOI: 10.3390/nu7115479] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/28/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022] Open
Abstract
Vitamin K-antagonists (VKA) are the most widely used anticoagulant drugs to treat patients at risk of arterial and venous thrombosis for the past 50 years. Due to unfavorable pharmacokinetics VKA have a small therapeutic window, require frequent monitoring, and are susceptible to drug and nutritional interactions. Additionally, the effect of VKA is not limited to coagulation, but affects all vitamin K-dependent proteins. As a consequence, VKA have detrimental side effects by enhancing medial and intimal calcification. These limitations stimulated the development of alternative anticoagulant drugs, resulting in direct oral anticoagulant (DOAC) drugs, which specifically target coagulation factor Xa and thrombin. DOACs also display non-hemostatic vascular effects via protease-activated receptors (PARs). As atherosclerosis is characterized by a hypercoagulable state indicating the involvement of activated coagulation factors in the genesis of atherosclerosis, anticoagulation could have beneficial effects on atherosclerosis. Additionally, accumulating evidence demonstrates vascular benefit from high vitamin K intake. This review gives an update on oral anticoagulant treatment on the vasculature with a special focus on calcification and vitamin K interaction.
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Affiliation(s)
- Rick H van Gorp
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
- Nattopharma ASA, 1363 Høvik, Norway.
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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29
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Knapen MHJ, Braam LAJLM, Teunissen KJ, Zwijsen RML, Theuwissen E, Vermeer C. Yogurt drink fortified with menaquinone-7 improves vitamin K status in a healthy population. J Nutr Sci 2015; 4:e35. [PMID: 26495126 PMCID: PMC4611080 DOI: 10.1017/jns.2015.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023] Open
Abstract
Population-based studies have shown an inverse association between dietary menaquinones (MK-n, vitamin K2) intake, coronary calcification and CHD risk, suggesting a potential role of vitamin K in vascular health. To date, the effects of increased menaquinone intake on (markers of) vascular health have been investigated using predominantly food supplements. Dairy products contain many essential nutrients and can serve as a good matrix for food fortification in order to support health. We were therefore interested to study the effects of a menaquinone-fortified yogurt drink (menaquinone as menaquinone-7 (MK-7); 28 µg MK-7/yogurt drink) on vitamin K status and markers of vascular health. The yogurt drink was also fortified with n-3 PUFA, vitamin D, vitamin C, Ca and Mg to support vascular and/or general health. Healthy men (n 32) and postmenopausal women (n 28) with a mean age of 56 (sd 5) years received either basic or fortified yogurt drink twice per d for 12 weeks. MK-7 was efficiently absorbed from the fortified yogurt drink. Levels of circulating MK-7 were significantly increased from 0·28 to 1·94 ng/ml. In accordance, intake of the fortified yogurt drink improved vitamin K status, as measured by significant decreases in uncarboxylated osteocalcin and desphospho-uncarboxylated matrix Gla-protein. No effects were, however, seen on markers of inflammation, endothelial dysfunction and lipid metabolism. In summary, consumption of a yogurt drink fortified with low doses of among others MK-7 for 3 months significantly improved vitamin K status in a healthy population.
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Affiliation(s)
- Marjo H. J. Knapen
- R&D Group VitaK, Maastricht University, Oxfordlaan 70, 6229 EV Maastricht, The Netherlands
| | | | - Kirsten J. Teunissen
- R&D Group VitaK, Maastricht University, Oxfordlaan 70, 6229 EV Maastricht, The Netherlands
| | | | - Elke Theuwissen
- R&D Group VitaK, Maastricht University, Oxfordlaan 70, 6229 EV Maastricht, The Netherlands
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Oxfordlaan 70, 6229 EV Maastricht, The Netherlands
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30
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Scheiber D, Veulemans V, Horn P, Chatrou ML, Potthoff SA, Kelm M, Schurgers LJ, Westenfeld R. High-Dose Menaquinone-7 Supplementation Reduces Cardiovascular Calcification in a Murine Model of Extraosseous Calcification. Nutrients 2015; 7:6991-7011. [PMID: 26295257 PMCID: PMC4555157 DOI: 10.3390/nu7085318] [Citation(s) in RCA: 43] [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: 05/15/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular calcification is prevalent in the aging population and in patients with chronic kidney disease (CKD) and diabetes mellitus, giving rise to substantial morbidity and mortality. Vitamin K-dependent matrix Gla-protein (MGP) is an important inhibitor of calcification. The aim of this study was to evaluate the impact of high-dose menaquinone-7 (MK-7) supplementation (100 µg/g diet) on the development of extraosseous calcification in a murine model. Calcification was induced by 5/6 nephrectomy combined with high phosphate diet in rats. Sham operated animals served as controls. Animals received high or low MK-7 diets for 12 weeks. We assessed vital parameters, serum chemistry, creatinine clearance, and cardiac function. CKD provoked increased aortic (1.3 fold; p < 0.05) and myocardial (2.4 fold; p < 0.05) calcification in line with increased alkaline phosphatase levels (2.2 fold; p < 0.01). MK-7 supplementation inhibited cardiovascular calcification and decreased aortic alkaline phosphatase tissue concentrations. Furthermore, MK-7 supplementation increased aortic MGP messenger ribonucleic acid (mRNA) expression (10-fold; p < 0.05). CKD-induced arterial hypertension with secondary myocardial hypertrophy and increased elastic fiber breaking points in the arterial tunica media did not change with MK-7 supplementation. Our results show that high-dose MK-7 supplementation inhibits the development of cardiovascular calcification. The protective effect of MK-7 may be related to the inhibition of secondary mineralization of damaged vascular structures.
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Affiliation(s)
- Daniel Scheiber
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf 40225, Germany.
| | - Verena Veulemans
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf 40225, Germany.
| | - Patrick Horn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf 40225, Germany.
| | - Martijn L Chatrou
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht 6229 ER, The Netherlands.
| | - Sebastian A Potthoff
- Department of Nephrology, University Duesseldorf, Medical Faculty, Duesseldorf 40225, Germany.
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf 40225, Germany.
- Cardiovascular Research Institute Duesseldorf, University Duesseldorf, Medical Faculty, Duesseldorf 40225, Germany.
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht 6229 ER, The Netherlands.
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf 40225, Germany.
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31
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Trøseid M, Ueland T, Hov JR, Svardal A, Gregersen I, Dahl CP, Aakhus S, Gude E, Bjørndal B, Halvorsen B, Karlsen TH, Aukrust P, Gullestad L, Berge RK, Yndestad A. Microbiota-dependent metabolite trimethylamine-N-oxide is associated with disease severity and survival of patients with chronic heart failure. J Intern Med 2015; 277:717-26. [PMID: 25382824 DOI: 10.1111/joim.12328] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Recent metabolomic, experimental and clinical studies have demonstrated that trimethylamine-N-oxide (TMAO), a microbiota-dependent metabolite from dietary phosphatidylcholine and carnitine, is a strong predictor of coronary artery disease (CAD). This finding suggests a link between the gut microbiota and atherosclerosis. The potential impact of TMAO in chronic heart failure (HF) is unknown. We hypothesized that TMAO levels would provide prognostic information about adverse outcomes in chronic HF. DESIGN Prospective, observational study including 155 consecutive patients with chronic HF. In addition, 100 patients with stable CAD without HF and 33 matched healthy individuals were included as controls. Plasma levels of TMAO and its precursors choline and betaine were measured, and associations with symptoms, aetiology and transplant-free survival in the patients with HF were explored. RESULTS Plasma levels of TMAO (P = 0.01), choline (P < 0.001) and betaine (P < 0.001) were elevated in patients with chronic HF compared to control subjects, with the highest levels in patients with New York Heart Association (NYHA) classes III and IV. Furthermore, TMAO levels were highest in individuals with ischaemic HF, followed by those with stable CAD and nonischaemic HF. TMAO, but not choline or betaine, was associated with reduced transplant-free survival: approximately 50% of patients in the upper tertile of TMAO levels died or received a heart transplant during 5.2 years of follow-up (unadjusted Cox-regression: hazard ratio 2.24, 95% confidence interval 1.28-3.92, P = 0.005). CONCLUSIONS TMAO levels were elevated in patients with HF and associated with NYHA class, ischaemic aetiology and adverse outcomes. Future studies should focus on gut microbiota, dietary composition and intestinal dysfunction in relation to TMAO levels and clinical outcome in HF.
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Affiliation(s)
- M Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Ullevål, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - J R Hov
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Norway.,Norwegian PSC Research Center, Norway
| | - A Svardal
- Department of Clinical Science, University of Bergen, Norway
| | - I Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - C P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway
| | - S Aakhus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - E Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - B Bjørndal
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - B Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - T H Karlsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Norway.,Norwegian PSC Research Center, Norway.,Division of Gastroenterology, Institute of Medicine, University of Bergen, Bergen, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - L Gullestad
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Clinical Science, University of Bergen, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,K.G. Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - R K Berge
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - A Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway.,K.G. Jebsen Centre for Inflammation Research, Norway.,Institute of Clinical Medicine, University of Oslo, Norway.,Centre for Heart Failure Research, Oslo University Hospital, Norway
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32
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Knapen MHJ, Braam LAJLM, Drummen NE, Bekers O, Hoeks APG, Vermeer C. Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomised clinical trial. Thromb Haemost 2015; 113:1135-44. [PMID: 25694037 DOI: 10.1160/th14-08-0675] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/31/2014] [Indexed: 12/19/2022]
Abstract
Observational data suggest a link between menaquinone (MK, vitamin K2) intake and cardiovascular (CV) health. However, MK intervention trials with vascular endpoints are lacking. We investigated long-term effects of MK-7 (180 µg MenaQ7/day) supplementation on arterial stiffness in a double-blind, placebo-controlled trial. Healthy postmenopausal women (n=244) received either placebo (n=124) or MK-7 (n=120) for three years. Indices of local carotid stiffness (intima-media thickness IMT, Diameter end-diastole and Distension) were measured by echotracking. Regional aortic stiffness (carotid-femoral and carotid-radial Pulse Wave Velocity, cfPWV and crPWV, respectively) was measured using mechanotransducers. Circulating desphospho-uncarboxylated matrix Gla-protein (dp-ucMGP) as well as acute phase markers Interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), tumour necrosis factor-α (TNF-α) and markers for endothelial dysfunction Vascular Cell Adhesion Molecule (VCAM), E-selectin, and Advanced Glycation Endproducts (AGEs) were measured. At baseline dp-ucMGP was associated with IMT, Diameter, cfPWV and with the mean z-scores of acute phase markers (APMscore) and of markers for endothelial dysfunction (EDFscore). After three year MK-7 supplementation cfPWV and the Stiffness Index βsignificantly decreased in the total group, whereas distension, compliance, distensibility, Young's Modulus, and the local carotid PWV (cPWV) improved in women having a baseline Stiffness Index β above the median of 10.8. MK-7 decreased dp-ucMGP by 50 % compared to placebo, but did not influence the markers for acute phase and endothelial dysfunction. In conclusion, long-term use of MK-7 supplements improves arterial stiffness in healthy postmenopausal women, especially in women having a high arterial stiffness.
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Affiliation(s)
| | | | | | | | | | - Cees Vermeer
- Cees Vermeer, PhD, VitaK, Maastricht University, Biopartner Center Maastricht, Oxfordlaan 70, 6229 EV Maastricht, The Netherlands, Tel: +31 43 388 5865, Fax: +31 43 388 5889, E-mail:
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33
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Liu YP, Gu YM, Thijs L, Knapen MHJ, Salvi E, Citterio L, Petit T, Carpini SD, Zhang Z, Jacobs L, Jin Y, Barlassina C, Manunta P, Kuznetsova T, Verhamme P, Struijker-Boudier HA, Cusi D, Vermeer C, Staessen JA. Inactive matrix Gla protein is causally related to adverse health outcomes: a Mendelian randomization study in a Flemish population. Hypertension 2015; 65:463-70. [PMID: 25421980 DOI: 10.1161/hypertensionaha.114.04494] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Matrix Gla-protein is a vitamin K-dependent protein that strongly inhibits arterial calcification. Vitamin K deficiency leads to production of inactive nonphosphorylated and uncarboxylated matrix Gla protein (dp-ucMGP). The risk associated with dp-ucMGP in the population is unknown. In a Flemish population study, we measured circulating dp-ucMGP at baseline (1996-2011), genotyped MGP, recorded adverse health outcomes until December 31, 2012, and assessed the multivariable-adjusted associations of adverse health outcomes with dp-ucMGP. We applied a Mendelian randomization analysis using MGP genotypes as instrumental variables. Among 2318 participants, baseline dp-ucMGP averaged 3.61 μg/L. Over 14.1 years (median), 197 deaths occurred, 58 from cancer and 70 from cardiovascular disease; 85 participants experienced a coronary event. The risk of death and non-cancer mortality curvilinearly increased (P≤0.008) by 15.0% (95% confidence interval, 6.9-25.3) and by 21.5% (11.1-32.9) for a doubling of the nadir (1.43 and 0.97 μg/L, respectively). With higher dp-ucMGP, cardiovascular mortality log-linearly increased (hazard ratio for dp-ucMGP doubling, 1.14 [1.01-1.28]; P=0.027), but coronary events log-linearly decreased (0.93 [0.88-0.99]; P=0.021). dp-ucMGP levels were associated (P≤0.001) with MGP variants rs2098435, rs4236, and rs2430692. For non-cancer mortality and coronary events (P≤0.022), but not for total and cardiovascular mortality (P≥0.13), the Mendelian randomization analysis suggested causality. Higher dp-ucMGP predicts total, non-cancer and cardiovascular mortality, but lower coronary risk. For non-cancer mortality and coronary events, these associations are likely causal.
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Affiliation(s)
- Yan-Ping Liu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Yu-Mei Gu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Marjo H J Knapen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Erika Salvi
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lorena Citterio
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Thibault Petit
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Simona Delli Carpini
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Zhenyu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lotte Jacobs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Yu Jin
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Cristina Barlassina
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Paolo Manunta
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Tatiana Kuznetsova
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Peter Verhamme
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Harry A Struijker-Boudier
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Daniele Cusi
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Cees Vermeer
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy.
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Mayer O, Seidlerová J, Vaněk J, Kielbergerová L, Bruthans J, Filipovský J, Wohlfahrt P, Cífková R, Trefil L, Knapen MHJ, Drummen NEA, Vermeer C. The association between uncarboxylated matrix Gla protein and lipoprotein-associated phospholipase A2. Maturitas 2015; 80:82-8. [PMID: 25458708 DOI: 10.1016/j.maturitas.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2) is independently associated with cardiovascular risk, probably via inflammatory activity in sclerotic plaque. We speculated whether Lp-PLA2 has a role in the aetiology of vascular calcifications, estimated from circulating uncarboxylated matrix Gla protein (MGP) species and whether we could find a potential interaction of Lp-PLA2 and MGP in terms of mortality. MATERIALS AND METHODS We examined 798 patients (mean age 65.1 years) with stable vascular disease and followed them in a prospective study. Both, desphospho-uncarboxylated and total MGP (dp-ucMGP or t-ucMGP) were quantified by pre-commercial ELISA assays, developed by VitaK (Maastricht, The Netherland) RESULTS Lp-PLA2 activity was independently positively associated with desphospho-uncarboxylated MGP (dp-ucMGP) [β coeff = 0.098, p=0.006]. 1SD of Lp-PLA2 activity was associated with 37% increased risk (p=0.001) of elevated dp-ucMGP (≥977 pmol/L, top quartile). In the Cox proportional hazard model adjusted for conventional risk factors, the patients in the highest quartile of dp-ucMGP or lowest quintile of total-uncarboxylated ucMGP (<2660 nmol/L) had higher risk of all-cause mortality [HRR 2.79 (95% CI 1.97-3.94) and HRR 1.69 (95% CI 1.18-2.42), respectively]. We observed no effect of high Lp-PLA2 activity (≥195 nmol/min/mL) on total mortality. CONCLUSIONS We assume that Lp-PLA2 is involved in vascular calcification and that dp-ucMGP is a more appropriate biomarker of residual risk than Lp-PLA2 itself.
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Affiliation(s)
- Otto Mayer
- 2nd 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
- 2nd 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
| | - Jiří Vaněk
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | | | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd 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 Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Marjo H J Knapen
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Nadja E A Drummen
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Cees Vermeer
- VitaK & Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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Lanham SA, Cagampang FR, Oreffo ROC. Maternal high-fat diet and offspring expression levels of vitamin K-dependent proteins. Endocrinology 2014; 155:4749-61. [PMID: 25279792 DOI: 10.1210/en.2014-1188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Studies suggest that bone growth and development and susceptibility to vascular disease in later life are influenced by maternal nutrition during intrauterine and early postnatal life. There is evidence for a role of vitamin K-dependent proteins (VKDPs) including osteocalcin, matrix Gla protein, periostin, and growth-arrest specific- protein 6, in both bone and vascular development. We have examined whether there are alterations in these VKDPs in bone and vascular tissue from offspring of mothers subjected to a nutritional challenge: a high-fat diet during pregnancy and postnatally, using 6-week-old mouse offspring. Bone site-specific and sex-specific differences across femoral and vertebral bone in male and female offspring were observed. Overall a high-fat maternal diet and offspring diet exacerbated the bone changes observed. Sex-specific differences and tissue-specific differences were observed in VKDP levels in aorta tissue from high-fat diet-fed female offspring from high-fat diet-fed mothers displaying increased levels of Gas6 and Ggcx compared with those of female controls. In contrast, differences were seen in VKDP levels in femoral bone of female offspring with lower expression levels of Mgp in offspring of mothers fed a high-fat diet compared with those of controls. We observed a significant correlation in Mgp expression levels within the femur to measures of bone structure of the femur and vertebra, particularly in the male offspring cohort. In summary, the current study has highlighted the importance of maternal nutrition on offspring bone development and the correlation of VKDPs to bone structure.
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Affiliation(s)
- S A Lanham
- Bone and Joint Research Group (S.A.L., R.O.C.O.) and Maternal, Pregnancy, and Child Research Group (F.R.C.), Human Development and Health, Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, United Kingdom
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Cancela ML, Laizé V, Conceição N. Matrix Gla protein and osteocalcin: from gene duplication to neofunctionalization. Arch Biochem Biophys 2014; 561:56-63. [PMID: 25068814 DOI: 10.1016/j.abb.2014.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 12/31/2022]
Abstract
Osteocalcin (OC or bone Gla protein, BGP) and matrix Gla protein (MGP) are two members of the growing family of vitamin K-dependent (VKD) proteins. They were the first VKD proteins found not to be involved in coagulation and synthesized outside the liver. Both proteins were isolated from bone although it is now known that only OC is synthesized by bone cells under normal physiological conditions, but since both proteins can bind calcium and hydroxyapatite, they can also accumulate in bone. Both OC and MGP share similar structural features, both in terms of protein domains and gene organization. OC gene is likely to have appeared from MGP through a tandem gene duplication that occurred concomitantly with the appearance of the bony vertebrates. Despite their relatively close relationship and the fact that both can bind calcium and affect mineralization, their functions are not redundant and they also have other unrelated functions. Interestingly, these two proteins appear to have followed quite different evolutionary strategies in order to acquire novel functionalities, with OC following a gene duplication strategy while MGP variability was obtained mostly by the use of multiple promoters and alternative splicing, leading to proteins with additional functional characteristics and alternative gene regulatory pathways.
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Affiliation(s)
- M Leonor Cancela
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, 8005-139 Faro, Portugal.
| | - Vincent Laizé
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal
| | - Natércia Conceição
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal
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Mayer O, Seidlerová J, Bruthans J, Filipovský J, Timoracká K, Vaněk J, Cerná L, Wohlfahrt P, Cífková R, Theuwissen E, Vermeer C. Desphospho-uncarboxylated matrix Gla-protein is associated with mortality risk in patients with chronic stable vascular disease. Atherosclerosis 2014; 235:162-8. [PMID: 24835435 DOI: 10.1016/j.atherosclerosis.2014.04.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/25/2014] [Accepted: 04/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin K is the essential co-factor for activation of matrix Gla-protein (MGP), the natural inhibitor of tissue calcification. Biologically inactive, desphospho-uncarboxylated MGP (dp-ucMGP) is a marker of vascular vitamin K status and is described to predict mortality in patients with heart failure and aortic stenosis. We hypothesized that increased dp-ucMGP might be associated with mortality risk in clinically stable patients with chronic vascular disease. MATERIALS AND METHODS We examined 799 patients (mean age 65.1 ± 9.3 years) who suffered from myocardial infarction, coronary revascularization or first ischemic stroke (pooled Czech samples of EUROASPIRE III and EUROASPIRE-stroke surveys), and followed them in a prospective cohort study. To estimate the 5-year all-cause and cardiovascular mortality we ascertained vital status and declared cause of death. Circulating dp-ucMGP and desphospho-carboxylated MGP (dp-cMGP) were measured by ELISA methods (IDS and VitaK). RESULTS During a median follow-up of 2050 days (5.6 years) 159 patients died. In the fully adjusted multivariate Cox proportional hazard model, the patients in the highest quartile of dp-ucMGP (≥ 977 pmol/L) had higher risk of all-cause and cardiovascular 5-year mortality [HRR 1.89 (95% CI, 1.32-2.72) and 1.88 (95% CI, 1.22-2.90)], respectively. Corresponding HRR for dp-cMGP were 1.76 (95% CI, 1.18-2.61) and 1.79 (95% CI, 1.12-2.57). CONCLUSIONS In patients with overt vascular disease, circulating dp-ucMGP and dp-cMGP were independently associated with the risk of all-cause and cardiovascular mortality. Since published results are conflicting regarding the dp-cMGP, we propose only circulating dp-ucMGP as a potential biomarker for assessment of additive cardiovascular risk.
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Affiliation(s)
- Otto Mayer
- 2nd 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
- 2nd 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
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd 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
| | - Katarina Timoracká
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Jiří Vaněk
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Lenka Cerná
- Department of Neurology, University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Elke Theuwissen
- VitaK, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Cees Vermeer
- VitaK, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Dalmeijer GW, van der Schouw YT, Magdeleyns EJ, Vermeer C, Verschuren WMM, Boer JMA, Beulens JWJ. Circulating desphospho-uncarboxylated matrix γ-carboxyglutamate protein and the risk of coronary heart disease and stroke. J Thromb Haemost 2014; 12:1028-34. [PMID: 24826813 DOI: 10.1111/jth.12609] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 05/08/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND High vitamin K intake is associated with a reduced risk of coronary heart disease (CHD). This is thought to be mediated by increased activation of the vitamin K-dependent matrix γ-carboxyglutamate protein (MGP). Desphospho-uncarboxylated MGP (dp-ucMGP) is associated with both vitamin K status and vascular calcification. However, the association of dp-ucMGP with CHD and stroke in the general population has not been investigated to date. OBJECTIVE To investigate the association of dp-ucMGP with incident CHD or stroke. METHODS A prospective case-cohort study with a representative baseline sample of 1406 participants and 1154 and 380 incident cases of CHD and stroke, respectively, was nested within the EPIC-NL study. Circulating dp-ucMGP levels were measured with ELISA in baseline plasma samples. The incidence rates of fatal and non-fatal CHD and stroke were obtained by linkage to national registers. Cox proportional hazard models were used to calculate hazard ratios (HRs) per standard deviation (SD) and per quartile of circulating dp-ucMGP levels. RESULTS AND CONCLUSION The average follow-up was 11.5 years. Levels of dp-ucMGP were not associated with CHD risk, with an HR per SD of 1.00 (95% confidence interval [CI] 0.93-1.07) and an HRQ4 vs. Q1 of 0.94 (95% CI 0.79-1.13) after adjustment for cardiovascular risk factors. There was no association of dp-ucMGP stroke risk (HRSD 0.98, 95% CI 0.90-1.08; and HRQ4 vs. Q1 1.09, 95% CI 0.78-1.51). This study could not confirm that high dp-ucMGP levels, reflecting poor vitamin K status, are associated with increased CHD or stroke risk in the general population.
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Affiliation(s)
- G W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Vassalle C, Iervasi G. New insights for matrix Gla protein, vascular calcification and cardiovascular risk and outcome. Atherosclerosis 2014; 235:236-8. [PMID: 24861727 DOI: 10.1016/j.atherosclerosis.2014.04.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Cristina Vassalle
- Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124 Pisa, Italy; Institute of Clinical Physiology-CNR, Via Moruzzi, 1, 56124 Pisa, Italy.
| | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124 Pisa, Italy; Institute of Clinical Physiology-CNR, Via Moruzzi, 1, 56124 Pisa, Italy
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El Asmar MS, Naoum JJ, Arbid EJ. Vitamin k dependent proteins and the role of vitamin k2 in the modulation of vascular calcification: a review. Oman Med J 2014; 29:172-7. [PMID: 24936265 DOI: 10.5001/omj.2014.44] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/09/2014] [Indexed: 12/25/2022] Open
Abstract
Vascular calcification, a cause of cardiovascular morbidity and mortality, is an actively regulated process involving vitamin K dependent proteins (VKDPs) among others. Vitamin K is an essential micronutrient, present in plants and animal fermented products that plays an important role as a cofactor for the post-translational γ-carboxylation of glutamic acid residues in a number of proteins. These VKDPs require carboxylation to become biologically active, and they have been identified as having an active role in vascular cell migration, angiogenesis and vascular calcification. This paper will review the process of vascular calcification and delineate the role that vitamin K2 plays in the modulation of that process, through the activation of VKDPs. One such VKDP is Matrix Gla Protein (MGP), which when activated inhibits osteogenic factors, thereby inhibiting vascular and soft tissue calcification.
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Affiliation(s)
| | - Joseph J Naoum
- Department of Surgery, Section of Vascular and Endovascular Surgery, University Medical Center Rizk Hospital, Lebanese American University, P.O. Box 11-3288, Beirut, Lebanon
| | - Elias J Arbid
- Department of Surgery, Section of Vascular and Endovascular Surgery, University Medical Center Rizk Hospital, Lebanese American University, P.O. Box 11-3288, Beirut, Lebanon
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Abstract
This review centers on updating the active research area of vascular calcification. This pathology underlies substantial cardiovascular morbidity and mortality, through adverse mechanical effects on vascular compliance, vasomotion, and, most likely, plaque stability. Biomineralization is a complex, regulated process occurring widely throughout nature. Decades ago, its presence in the vasculature was considered a mere curiosity and an unregulated, dystrophic process that does not involve biological mechanisms. Although it remains controversial whether the process has any adaptive value or past evolutionary advantage, substantial advances have been made in understanding the biological mechanisms driving the process. Different types of calcific vasculopathy, such as inflammatory versus metabolic, have parallel mechanisms in skeletal bone calcification, such as intramembranous and endochondral ossification. Recent work has identified important regulatory roles for inflammation, oxidized lipids, elastin, alkaline phosphatase, osteoprogenitor cells, matrix γ-carboxyglutamic acid protein, transglutaminase, osteoclastic regulatory factors, phosphate regulatory hormones and receptors, apoptosis, prelamin A, autophagy, and microvesicles or microparticles similar to the matrix vesicles of skeletal bone. Recent work has uncovered fascinating interactions between matrix γ-carboxyglutamic acid protein, vitamin K, warfarin, and transport proteins. And, lastly, recent breakthroughs in inherited forms of calcific vasculopathy have identified the genes responsible as well as an unexpected overlap of phenotypes. Until recently, vascular calcification was considered a purely degenerative, unregulated process. Since then, investigative groups around the world have identified a wide range of causative mechanisms and regulatory pathways, and some of the recent developments are highlighted in this review.
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Affiliation(s)
- Linda L. Demer
- Department of Medicine (Cardiology), University of California, Los Angeles Los Angeles, CA 90095-1679
- Department of Physiology and Bioengineering, University of California, Los Angeles Los Angeles, CA 90095-1679
| | - Yin Tintut
- Department of Medicine (Cardiology), University of California, Los Angeles Los Angeles, CA 90095-1679
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42
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van den Heuvel EGHM, van Schoor NM, Lips P, Magdeleyns EJP, Deeg DJH, Vermeer C, den Heijer M. Circulating uncarboxylated matrix Gla protein, a marker of vitamin K status, as a risk factor of cardiovascular disease. Maturitas 2014; 77:137-41. [PMID: 24210635 DOI: 10.1016/j.maturitas.2013.10.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Vitamin K plays a pivotal role in the synthesis of Matrix Gla protein (MGP), a calcification inhibitor in vascular tissue. Vascular calcification has become an important predictor of cardiovascular disease. The aim of the current study was to examine the potential association of circulating desphospho-carboxylated and -uncarboxylated MGP (dp-cMGP and dp-ucMGP), reflecting vitamin K status, with the incidence of cardiovascular events and disease (CVD) in older individuals. STUDY DESIGN The study was conducted in 577 community-dwelling older men and women of the Longitudinal Aging Study Amsterdam (LASA), aged >55 year, who were free of cardiovascular disease at baseline. Multivariate Cox proportional hazards models were used to analyze the data. MAIN OUTCOME MEASURES Incidence of CVD. RESULTS After a mean follow-up of 5.6±1.2 year, we identified 40 incident cases of CVD. After adjustment for classical confounders and vitamin D status, we observed a more than 2-fold significantly higher risk of CVD for the highest tertile of dp-ucMGP with a HR of 2.69 (95% CI, 1.09-6.62) as compared with the lowest tertile. Plasma dp-cMGP was not associated with the risk of CVD. CONCLUSIONS Vitamin K insufficiency, as assessed by high plasma dp-ucMGP concentrations is associated with an increased risk for cardiovascular disease independent of classical risk factors and vitamin D status. Larger epidemiological studies on dp-ucMGP and CVD incidence are needed followed by clinical trials to test whether vitamin K-rich diets will lead to a decreased risk for cardiovascular events.
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Affiliation(s)
- Ellen G H M van den Heuvel
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Royal FrieslandCampina, Amersfoort, The Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Paul Lips
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Internal Medicine and Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Elke J P Magdeleyns
- VitaK and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Cees Vermeer
- VitaK and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Martin den Heijer
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Internal Medicine and Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands.
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Dalmeijer GW, van der Schouw YT, Magdeleyns EJ, Vermeer C, Verschuren WMM, Boer JMA, Beulens JWJ. Matrix Gla protein species and risk of cardiovascular events in type 2 diabetic patients. Diabetes Care 2013; 36:3766-71. [PMID: 23877986 PMCID: PMC3816877 DOI: 10.2337/dc13-0065] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/17/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship of circulating matrix Gla protein (MGP) species with incident cardiovascular disease (CVD) or coronary heart disease (CHD) in type 2 diabetic patients. RESEARCH DESIGN AND METHODS EPIC-NL is a prospective cohort study among 40,011 Dutch men and women. At baseline (1993-1997), 518 participants were known to have type 2 diabetes. MGP levels were measured by ELISA techniques in baseline plasma samples. The incidence of fatal and nonfatal CVD and CVD subtypes-CHD, peripheral arterial disease (PAD), heart failure, and stroke-were obtained by linkage to national registers. Cox proportional hazard models were used to calculate hazard ratios (HRs), adjusted for sex, waist-to-hip ratio, physical activity, and history of CVD. RESULTS During a median 11.2 years of follow-up, 160 cases of CVD were documented. Higher circulating desphospho-uncarboxylated MGP (dp-ucMGP) levels were significantly associated with higher risk of CVD, with an HR per SD (HRSD) of 1.21 (95% CI 1.06-1.38), PAD (HRSD 1.32 [95% CI 1.07-1.65]), and heart failure (HRSD 1.75 [95% CI 1.42-2.17]) after adjustment. Higher circulating dp-ucMGP levels were not related to risk of CHD (HRSD 1.12 [95% CI 0.94-1.34]) or stroke (HRSD 1.05 [95% CI 0.73-1.49]). Circulating desphospho-carboxylated MGP and circulating total-uncarboxylated MGP levels were not associated with CVD or CVD subtypes. CONCLUSIONS High dp-ucMGP levels were associated with increased CVD risk among type 2 diabetic patients, especially with the subtypes PAD and heart failure, while other MGP species were not related to CVD risk. These results suggest that a poor vitamin K status is associated with increased CVD risk.
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Disturbed carnitine regulation in chronic heart failure — Increased plasma levels of palmitoyl-carnitine are associated with poor prognosis. Int J Cardiol 2013; 167:1892-9. [DOI: 10.1016/j.ijcard.2012.04.150] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/28/2012] [Indexed: 11/18/2022]
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Schurgers LJ, Uitto J, Reutelingsperger CP. Vitamin K-dependent carboxylation of matrix Gla-protein: a crucial switch to control ectopic mineralization. Trends Mol Med 2013; 19:217-26. [PMID: 23375872 DOI: 10.1016/j.molmed.2012.12.008] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/30/2012] [Accepted: 12/28/2012] [Indexed: 01/13/2023]
Abstract
Vascular mineralization has recently emerged as a risk factor for cardiovascular morbidity and mortality. Previously regarded as a passive end-stage process, vascular mineralization is currently recognized as an actively regulated process with cellular and humoral contributions. The discovery that the vitamin K-dependent matrix Gla-protein (MGP) is a strong inhibitor of vascular calcification has propelled our mechanistic understanding of this process and opened novel avenues for diagnosis and treatment. This review focuses on molecular mechanisms of vascular mineralization involving MGP and discusses the potential for treatments and biomarkers to monitor patients at risk for vascular mineralization.
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Affiliation(s)
- Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands.
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Chatrou MLL, Winckers K, Hackeng TM, Reutelingsperger CP, Schurgers LJ. Vascular calcification: the price to pay for anticoagulation therapy with vitamin K-antagonists. Blood Rev 2012; 26:155-66. [PMID: 22520397 DOI: 10.1016/j.blre.2012.03.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vitamin K-antagonists (VKA) are the most widely used anti-thrombotic drugs with substantial efficacy in reducing risk of arterial and venous thrombosis. Several lines of evidence indicate, however, that VKA inhibit not only post-translational activation of vitamin K-dependent coagulation factors but also synthesis of functional extra-hepatic vitamin K-dependent proteins thereby eliciting undesired side-effects. Vascular calcification is one of the recently revealed side-effects of VKA. Vascular calcification is an actively regulated process involving vascular cells and a number of vitamin K-dependent proteins. Mechanistic understanding of vascular calcification is essential to improve VKA-based treatments of both thrombotic disorders and atherosclerosis. This review addresses vitamin K-cycle and vitamin K-dependent processes of vascular calcification that are affected by VKA. We conclude that there is a growing need for better understanding of the effects of anticoagulants on vascular calcification and atherosclerosis.
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Affiliation(s)
- Martijn L L Chatrou
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, MUMC, Maastricht, The Netherlands
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Shea MK, Holden RM. Vitamin K status and vascular calcification: evidence from observational and clinical studies. Adv Nutr 2012; 3:158-65. [PMID: 22516723 PMCID: PMC3648716 DOI: 10.3945/an.111.001644] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vascular calcification occurs when calcium accumulates in the intima (associated with atherosclerosis) and/or media layers of the vessel wall. Coronary artery calcification (CAC) reflects the calcium burden within the intima and media of the coronary arteries. In population-based studies, CAC independently predicts cardiovascular disease (CVD) and mortality. A preventive role for vitamin K in vascular calcification has been proposed based on its role in activating matrix Gla protein (MGP), a calcification inhibitor that is expressed in vascular tissue. Although animal and in vitro data support this role of vitamin K, overall data from human studies are inconsistent. The majority of population-based studies have relied on vitamin K intake to measure status. Phylloquinone is the primary dietary form of vitamin K and available supplementation trials, albeit limited, suggest phylloquinone supplementation is relevant to CAC. Yet observational studies have found higher dietary menaquinone, but not phylloquinone, to be associated with less calcification. Vascular calcification is highly prevalent in certain patient populations, especially in those with chronic kidney disease (CKD), and it is plausible vitamin K may contribute to reducing vascular calcification in patients at higher risk. Subclinical vitamin K deficiency has been reported in CKD patients, but studies linking vitamin K status to calcification outcomes in CKD are needed to clarify whether or not improving vitamin K status is associated with improved vascular health in CKD. This review summarizes the available evidence of vitamin K and vascular calcification in population-based studies and clinic-based studies, with a specific focus on CKD patients.
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Affiliation(s)
- M Kyla Shea
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem NC, USA.
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Abstract
Seventeen vitamin K-dependent proteins have been identified to date of which several are involved in regulating soft-tissue calcification. Osteocalcin, matrix Gla protein (MGP), and possibly Gla-rich protein are all inhibitors of soft-tissue calcification and need vitamin K-dependent carboxylation for activity. A common characteristic is their low molecular weight, and it has been postulated that their small size is essential for calcification inhibition within tissues. MGP is synthesized by vascular smooth muscle cells and is the most important inhibitor of arterial mineralization currently known. Remarkably, the extrahepatic Gla proteins mentioned are only partly carboxylated in the healthy adult population, suggesting vitamin K insufficiency. Because carboxylation of the most essential Gla proteins is localized in the liver and that of the less essential Gla proteins in the extrahepatic tissues, a transport system has evolved ensuring preferential distribution of dietary vitamin K to the liver when vitamin K is limiting. This is why the first signs of vitamin K insufficiency are seen as undercarboxylation of the extrahepatic Gla proteins. New conformation-specific assays for circulating uncarboxylated MGP were developed; an assay for desphospho-uncarboxylated matrix Gla protein and another assay for total uncarboxylated matrix Gla protein. Circulating desphospho-uncarboxylated matrix Gla protein was found to be predictive of cardiovascular risk and mortality, whereas circulating total uncarboxylated matrix Gla protein was associated with the extent of prevalent arterial calcification. Vitamin K intervention studies have shown that MGP carboxylation can be increased dose dependently, but thus far only 1 study with clinical endpoints has been completed. This study showed maintenance of vascular elasticity during a 3-y supplementation period, with a parallel 12% loss of elasticity in the placebo group. More studies, both in healthy subjects and in patients at risk of vascular calcification, are required before conclusions can be drawn.
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Ueland T, Smedbakken L, Hallén J, Atar D, Januzzi J, Halvorsen B, Jensen J, Aukrust P. Soluble CXCL16 and long-term outcome in acute ischemic stroke. Atherosclerosis 2012; 220:244-9. [DOI: 10.1016/j.atherosclerosis.2011.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/15/2011] [Accepted: 10/03/2011] [Indexed: 11/26/2022]
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