Factors affecting the absorption of vitamin K-1 in vitro

Vitamin K - sources, physiological role, kinetics, deficiency, detection, therapeutic use, and toxicity

Vitamin K is traditionally connected with blood coagulation, since it is needed for the posttranslational modification of 7 proteins involved in this cascade. However, it is also involved in the maturation of another 11 or 12 proteins that play different roles, encompassing in particular the modulation of the calcification of connective tissues. Since this process is physiologically needed in bones, but is pathological in arteries, a great deal of research has been devoted to finding a possible link between vitamin K and the prevention of osteoporosis and cardiovascular diseases. Unfortunately, the current knowledge does not allow us to make a decisive conclusion about such a link. One possible explanation for this is the diversity of the biological activity of vitamin K, which is not a single compound but a general term covering natural plant and animal forms of vitamin K (K₁ and K₂) as well as their synthetic congeners (K₃ and K₄). Vitamin K₁ (phylloquinone) is found in several vegetables. Menaquinones (MK₄–MK₁₃, a series of compounds known as vitamin K₂) are mostly of a bacterial origin and are introduced into the human diet mainly through fermented cheeses. Current knowledge about the kinetics of different forms of vitamin K, their detection, and their toxicity are discussed in this review.

Hydrolysed formula is a risk factor for vitamin K deficiency in infants with unrecognised cholestasis

OBJECTIVES

Vitamin K deficiency (VKD) may cause life-threatening haemorrhages, especially in breast-fed infants with unrecognised cholestasis. Interestingly, hypoallergenic formulas appear overrepresented in reported cases of VKD bleeding (VKDB) in formula-fed infants. We therefore assessed whether the risk of VKD in formula-fed infants with cholestasis is associated with hypoallergenic formulas.

PATIENTS AND METHODS

Infants born in the Netherlands between January 1991 and December 2006 with cholestatic jaundice due to biliary atresia (BA) or to α-1-antitrypsin deficiency (A1ATD) were identified in the Netherlands Study Group for Biliary Atresia Registry and the A1ATD registry, respectively. The relative risk (RR) of VKDB in patients with BA or A1ATD was calculated for different formula types. The influence of prior or ongoing breast-feeding on the RR of VKDB was also assessed.

RESULTS

A total of 179 infants with either BA (139) or A1ATD (40) were included. One hundred eighteen infants were formula fed; 8 presented with VKD. Six of these 8 infants (75%) received hypoallergenic formula (whey-based hydrolysate in 4). One infant on whey-based hydrolysed formula presented with VKDB. Risk factor analysis revealed that infants receiving hydrolysed, especially whey-based, formula, had a strongly increased risk of VKD (RR 25.0 [6.4-97.2], P < 0.001)) compared with infants receiving regular formula. Prior or ongoing breast-feeding was not significantly associated with VKD.

CONCLUSIONS

Infants with cholestasis receiving (whey-based) hydrolysed formula are at increased risk of developing VKD, compared with infants receiving regular formula. Because VKD may lead to serious haemorrhages, infants receiving whey-based hydrolysed formulas may need additional vitamin K supplementation.

The effect of different meals on the absorption of stable isotope-labelled phylloquinone

Few studies have investigated the absorption of phylloquinone (vitamin K1). We recruited twelve healthy, non-obese adults. On each study day, fasted subjects took a capsule containing 20 microg of 13C-labelled phylloquinone with one of three meals, defined as convenience, cosmopolitan and animal-oriented, in a three-way crossover design. The meals were formulated from the characteristics of clusters identified in dietary pattern analysis of data from the National Diet and Nutrition Survey conducted in 2000-1. Plasma phylloquinone concentration and isotopic enrichment were measured over 8 h. Significantly more phylloquinone tracer was absorbed when consumed with the cosmopolitan and animal-oriented meals than with the convenience meal (P = 0.001 and 0.035, respectively). Estimates of the relative availability of phylloquinone from the meals were: convenience meal = 1.00; cosmopolitan meal = 0.31; animal-oriented meal = 0.23. Combining the tracer data with availability estimates for phylloquinone from the meals provides overall relative bioavailability values of convenience = 1.00, cosmopolitan = 0.46 and animal-oriented = 0.29. Stable isotopes provide a useful tool to investigate further the bioavailability of low doses of phylloquinone. Different meals can affect the absorption of free phylloquinone. The meal-based study design used in the present work provides an approach that reflects more closely the way foods are eaten in a free-living population.

Factors affecting intestinal absorption of highly lipophilic food microconstituents (fat-soluble vitamins, carotenoids and phytosterols)

Highly lipophilic food microconstituents (HLFMs) with octanol-water partition coefficients log10 P(c) > 8 include the fat-soluble vitamins (A, E, D and K) and phytochemicals with potential health benefits, the carotenoids and phytosterols. It has been assumed that these compounds have the same metabolism in the human upper gastrointestinal tract and that they follow the same fate as lipids. However, a literature review shows that the metabolism of HLFMs in the upper gastrointestinal tract depends on each HLFM species. For example, some HLFM esters are hydrolyzed mainly by pancreatic lipase, others by bile salt-stimulated lipase; some HLFMs are apparently absorbed by passive diffusion, others by a transporter. Also, although some factors (HLFM molecular species, fat, food matrix) affect absorption efficiency of most HLFMs, other factors (fibers, microconstituents) apparently affect absorption only of some HLFMs. The mnemonic acronym SLAMENGHI, previously proposed to list the factors affecting the bioavailability of carotenoids, was used here to review current knowledge of the factors suspected to affect the intestinal absorption of HLFMs. The available data reveal numerous gaps in the knowledge of the metabolism of HLFMs and the factors that affect their absorption. These gaps need to be filled to be able to formulate HLFMs so as to promote greater absorption efficiency.

Effect of luminal constituents on vitamin K1 absorption into thoracic duct lymph

Lymphatic appearance rate of [3H] phylloquinone was studied in unanesthetized rats with cannulated bile and lymph ducts. A linear relationship (y= -44.9 + 10.2x, r=0.99) was found between the rate of the compound's infusion into the duodenum and its appearance rate in the lymph. Increasing the taurocholate infusate concentrations from 5 to 15 mM increased phylloquinone appearance rate in the lymph from 6.47 +/- 1.82 to 24.14 +/- 1.20 pmol/min (P less than .01). Varying the infusate pH from 4.35 to 8.0 did not change lymphatic appearance rate of vitamin K1 or lymphatic flow rate. Addition of short-chain fatty acid (butyrate) to the infusate enhanced the total absorption of vitamin K1 into the bile and lymph, whereas the addition of polyunsaturated fatty acids inhibited the total absorption of the vitamin. These experiments delineate some factors that modify the extrusion rate of vitamin K1 out of the enterocyte into the lymphatic circulation and add information regarding this phase of the absorptive pathway of lipids.

Vitamin K1 intestinal absorption in vivo: influence of luminal contents on transport

Intestinal absorption of [3H]phylloquinone was investigated in the unanesthetized rat by the use of a technique of recirculating perfused isolated intestinal segments. Apparent saturation kinetics were found as the concentration of the vitamin in the perfusate was increased in a stepwise fashion from 15 nM to 300 muM. Alkalinization of the perfusate or the addition of 2.5 mM linoleic acid to the perfusate caused a significant (P less than 0.05) decrease in the absorption rate of phylloquinone. Modifications in the perfusate concentration of sodium taurocholate, the substitution of a nonionic detergent (Pluronic F-68) for sodium taurocholate, the addition of medium- and long-chain saturated fatty acids, or the addition of vitamins K2 and K3 to the perfusate did not alter the absorption rate of the vitamin. Decreasing the thickness of the unstirred water layer by increasing the perfusion rate caused a significant increase in phylloquinone absorption rate. In vivo absorption of vitamin K1 appears to be mediated by an energy requiring saturable transport mechanism. The composition of the perfusate, its pH, and its rate of flow are all important determinants of vitamin K1 absorption rate.