Abstract
Coronavirus disease 2019 (Covid-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV)-2, exerts far-reaching effects on public health and socio-economic welfare. The majority of infected individuals have mild to moderate symptoms, but a significant proportion develops respiratory failure due to pneumonia. Thrombosis is another frequent manifestation of Covid-19 that contributes to poor outcomes. Vitamin K plays a crucial role in the activation of both pro- and anticlotting factors in the liver and the activation of extrahepatically synthesised protein S which seems to be important in local thrombosis prevention. However, the role of vitamin K extends beyond coagulation. Matrix Gla protein (MGP) is a vitamin K-dependent inhibitor of soft tissue calcification and elastic fibre degradation. Severe extrahepatic vitamin K insufficiency was recently demonstrated in Covid-19 patients, with high inactive MGP levels correlating with elastic fibre degradation rates. This suggests that insufficient vitamin K-dependent MGP activation leaves elastic fibres unprotected against SARS-CoV-2-induced proteolysis. In contrast to MGP, Covid-19 patients have normal levels of activated factor II, in line with previous observations that vitamin K is preferentially transported to the liver for activation of procoagulant factors. We therefore expect that vitamin K-dependent endothelial protein S activation is also compromised, which would be compatible with enhanced thrombogenicity. Taking these data together, we propose a mechanism of pneumonia-induced vitamin K depletion, leading to a decrease in activated MGP and protein S, aggravating pulmonary damage and coagulopathy, respectively. Intervention trials should be conducted to assess whether vitamin K administration plays a role in the prevention and treatment of severe Covid-19.
Original language | English |
---|---|
Article number | 0007114520003979 |
Pages (from-to) | 191-198 |
Number of pages | 8 |
Journal | British Journal of Nutrition |
Volume | 126 |
Issue number | 2 |
DOIs | |
Publication status | Published - 28 Jul 2021 |
Keywords
- ASSOCIATION
- CALCIFICATION
- COVID-19
- Covid-19
- DEFICIENCY
- ELASTIN DEGRADATION
- ELASTOLYSIS
- ENDOTHELIAL-CELLS
- MATRIX GLA-PROTEIN
- Matrix Gla protein
- Protein S
- Prothrombin
- RISK
- Vitamin K
- WARFARIN
- MORTALITY
- ANTICOAGULANT TREATMENT