1
|
Kaesler N, Schreibing F, Speer T, Puente-Secades SDL, Rapp N, Drechsler C, Kabgani N, Kuppe C, Boor P, Jankowski V, Schurgers L, Kramann R, Floege J. Altered vitamin K biodistribution and metabolism in experimental and human chronic kidney disease. Kidney Int 2021; 101:338-348. [PMID: 34774554 DOI: 10.1016/j.kint.2021.10.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Chronic kidney disease (CKD) is accompanied with extensive cardiovascular calcification, in part correlating with functional vitamin K deficiency. Here, we sought to determine causes for vitamin K deficiency beyond reduced dietary intake. Initially, vitamin K uptake and distribution into circulating lipoproteins after a single administration of vitamin K1 plus K2 (menaquinone 4 and menaquinone 7, respectively) was determined in patients on dialysis therapy and healthy individuals. The patients incorporated very little menaquinone 7 but more menaquinone 4 into high density lipoprotein (HDL) and low-density lipoprotein particles than did healthy individuals. In contrast to healthy persons, HDL particles from the patients could not be spiked with menaquinone 7 in vitro and HDL uptake was diminished in osteoblasts. A reduced carboxylation activity (low vitamin K activity) of uremic HDL particles spiked with menaquinone 7 vs. that of controls was confirmed in a bioassay using human primary vascular smooth muscle cells. Kidney menaquinone 4 tissue levels were reduced in 5/6-nephrectomized versus sham-operated C57BL/6 mice after four weeks of a vitamin K rich diet. From the analyzed enzymes involved in vitamin K metabolism, kidney HMG-CoA reductase protein was reduced in both rats and patients with CKD. In a trial on the efficacy and safety of atorvastatin in 1051 patients with type 2 diabetes receiving dialysis therapy, no pronounced vitamin K deficiency was noted. However, the highest levels of PIVKA-II (biomarker of subclinical vitamin K deficiency) were noted when a statin was combined with a proton pump inhibitor. Thus, profound disturbances in lipoprotein mediated vitamin K transport and metabolism in uremia suggest that menaquinone 7 supplementation to patients on dialysis therapy has reduced efficacy.
Collapse
Affiliation(s)
- Nadine Kaesler
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany.
| | - Felix Schreibing
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thimoteus Speer
- Department of Internal Medicine, Nephrology and Hypertension and Cardio-Renal Medicine, Saarland University Medical Centre, Homburg, Saar, Germany; Translational Cardio-Renal Medicine, Saarland University, Homburg/Saar, Germany
| | | | - Nikolas Rapp
- Department of Biochemistry, Cardiovascular Research School Maastricht, Maastricht University, Maastricht, the Netherlands
| | | | - Nazanin Kabgani
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christoph Kuppe
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Vera Jankowski
- Institute of Molecular and Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Leon Schurgers
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany; Department of Biochemistry, Cardiovascular Research School Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Rafael Kramann
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University Hospital, Aachen, Germany; Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
2
|
Becker ML, Franken WPJ, Karapinar F, Verzijl-Zeegers R, Schalekamp T, van der Hoeven RTM. Possible drug-drug interaction between high-dose esomeprazole and phenprocoumon. Eur J Clin Pharmacol 2015; 71:1461-5. [DOI: 10.1007/s00228-015-1912-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022]
|