review article

Vitamin K and its Role in Diabetic Vascular Complications and Low-Grade Inflammation

Sofia Dahlberg1,2, Ulf Schott1,2*

1Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty, Lund University, Sweden

2Department of Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Sweden

*Corresponding author: Ulf Schott, Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, S-22185 Sweden and Institution of Clinical Science Lund, Medical faculty, Lund University, Sweden. Tel: +4646171319; +4646171000; Fax: +464617605; Email: ulf.schott@skane.se

Received Date: 12 December, 2017; Accepted Date: 16 January, 2018; Published Date: 24 January, 2018

Citation: Dahlberg S, Schott U (2018) Vitamin K and its Role in Diabetic Vascular Complications and Low-Grade Inflammation. J Diabetes Treat: 138. DOI: 10.29011/2574-7568.000038

1.      Abstract

This review summarizes the involvement of vitamin K and the extrahepatic Gla proteins matrix Gla protein (MGP), Osteocalcin (OC) and growth arrest-specific gene 6 protein (Gas6) in the development and progression of diabetes: in particular, complications related to angiopathy and inflammation. High vitamin K intake has been associated with a decreased risk of type 2 diabetes. Furthermore, in type 2 diabetic patients, the extent of artery calcification correlates to levels of the uncarboxylatedGla protein MGP, and supplementation with vitamin K has been shown to reduce oxidative stress markers as well as metabolic risk markers for diabetes.

2.      Keywords: Diabetes; Gas 6; Inflammation; MGP; Vitamin K; Vascular Disease




  1. Kerner W, Bruckel J (2014) Definition, classification and diagnosis of diabetes mellitus. Experimental and clinical endocrinology & diabetes:official journal, German Society of Endocrinology [and] German Diabetes Association 122: 384-386.
  2. DIAMOND Project Group (2006)Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999. Diabet Med 23: 857-866.
  3. Sharma M, Nazareth I, Petersen I (2016) Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study. BMJ open 6: e010210.
  4. Morgan CL, Currie CJ, Peters JR (2000) Relationship between diabetes and mortality: a population study using record linkage. Diabetes care 23: 1103-1107.
  5. Shearer MJ (1992)Vitamin K metabolism and nutriture. Blood reviews 6: 92-104.
  6. Tie JK, Stafford DW (2016) Structural and functional insights into enzymes of the vitamin K cycle. Journal of thrombosis and haemostasis JTH 14: 236-247.
  7. Vermeer C (1990) Gamma-carboxyglutamate-containing proteins and the vitamin K-dependent carboxylase. The Biochemical journal 266: 625-636.
  8. Luo G, Ducy P, McKee MD, Pinero GJ, Loyer E, et al. (1997) Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature 386: 78-81.
  9. Murshed M, Schinke T, McKee MD, Karsenty G (2004) Extracellular matrix mineralization is regulated locally; different roles of two gla-containing proteins. The Journal of cell biology 165: 625-630.
  10. Sweatt A, Sane DC, Hutson SM, Wallin R (2003) Matrix Gla protein (MGP) and bone morphogenetic protein-2 in aortic calcified lesions of aging rats. Journal of thrombosis and haemostasis JTH 1: 178-185.
  11. Wallin R, Schurgers L, Wajih N (2008) Effects of the blood coagulation vitamin K as an inhibitor of arterial calcification. Thromb Res 122: 411-417.
  12. Wajih N, Borras T, Xue W, Hutson SM, Wallin R (2004) Processing and transport of matrix gamma-carboxyglutamic acid protein and bone morphogenetic protein-2 in cultured human vascular smooth muscle cells: evidence for an uptake mechanism for serum fetuin. The Journal of biological chemistry 279: 43052-43060.
  13. Shea MK, O'Donnell CJ, Vermeer C, Magdeleyns EJ, Crosier MD, et al. (2011) Circulating uncarboxylated matrix gla protein is associated with vitamin K nutritional status, but not coronary artery calcium, in older adults. The Journal of nutrition 141: 1529-1534.
  14. Cranenburg EC, Koos R, Schurgers LJ, Magdeleyns EJ, Schoonbrood TH, et al. (2010) Characterisation and potential diagnostic value of circulating matrix Gla protein (MGP) species. Thrombosis and haemostasis 104: 811-822.
  15. Hunter GK, Hauschka PV, Poole AR, Rosenberg LC, Goldberg HA (1996) Nucleation and inhibition of hydroxyapatite formation by mineralized tissue proteins. The Biochemical journal 317: 59-64.
  16. Boskey AL, Gadaleta S, Gundberg C, Doty SB, Ducy P, et al. (1998) Fourier transform infrared microspectroscopic analysis of bones of osteocalcin-deficient mice provides insight into the function of osteocalcin. Bone 23: 187-196.
  17. Starup-Linde J, Eriksen SA, Lykkeboe S, Handberg A, Vestergaard P (2014) Biochemical markers of bone turnover in diabetes patients--a meta-analysis, and a methodological study on the effects of glucose on bone markers. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 25: 1697-1708.
  18. Manfioletti G, Brancolini C, Avanzi G, Schneider C (1993) The protein encoded by a growth arrest-specific gene (gas6) is a new member of the vitamin K-dependent proteins related to protein S, a negative coregulator in the blood coagulation cascade. Mol Cell Biol 13: 4976-4985.
  19. Fernandez-Fernandez L, Bellido-Martin L, Garcia de Frutos P (2008) Growth arrest-specific gene 6 (GAS6). An outline of its role in haemostasis and inflammation. Thrombosis and haemostasis 100: 604-610.
  20. Wu G, Ma Z, Hu W, Wang D, Gong B, et al. (2017) Molecular insights of Gas6/TAM in cancer development and therapy. Cell death & disease 8: e2700.
  21. Hung YJ, Lee CH, Chu NF, Shieh YS (2010) Plasma protein growth arrest-specific 6 levels are associated with altered glucose tolerance, inflammation, and endothelial dysfunction. Diabetes care 33: 1840-1844.
  22. Fouad NA, Eltaher SM, Abdullah OA, Metwally RA (2015) Serum Level of Growth Arrest-Specific 6 (Gas6) Protein and Genetic Variations in the Gas6 Gene in Patients with Type 2 Diabetes Mellitus. The Egyptian journal of immunology 22: 41-47.
  23. Sen P, Wallet MA, Yi Z, Huang Y, Henderson M, et al. (2007) Apoptotic cells induce Mer tyrosine kinase-dependent blockade of NF-kappaB activation in dendritic cells. Blood109: 653-660.
  24. Lemke G, Rothlin CV (2008) Immunobiology of the TAM receptors. Nature reviews Immunology 8: 327-336.
  25. Lee CH, Chu NF, Shieh YS, Hung YJ (2012) The growth arrest-specific 6 (Gas6) gene polymorphism c.834+7G>A is associated with type 2 diabetes. Diabetes research and clinical practice 95: 201-206.
  26. Wu KS, Hung YJ (2015) The Involvement of GAS6 Signaling in the Development of Obesity and Associated Inflammation: 202513.
  27. Kuo FC, Hung YJ, Shieh YS, Hsieh CH, Hsiao FC,et al. (2014) The levels of plasma growth arrest-specific protein 6 is associated with insulin sensitivity and inflammation in women. Diabetes research and clinical practice 103: 304-309.
  28. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD,et al. (2007) Endocrine regulation of energy metabolism by the skeleton. Cell 130: 456-469.
  29. Wei J, Hanna T, Suda N, Karsenty G, Ducy P (2014) Osteocalcin promotes beta-cell proliferation during development and adulthood through Gprc6a. Diabetes 63: 1021-1031.
  30. Knapen MH, Schurgers LJ, Shearer MJ, Newman P, Theuwissen E, et al. (2012) Association of vitamin K status with adiponectin and body composition in healthy subjects: uncarboxylated osteocalcin is not associated with fat mass and body weight. The British journal of nutrition 108: 1017-1024.
  31. Takeuchi Y, Suzawa M, Fukumoto S, Fujita T (2000) Vitamin K(2) inhibits adipogenesis, osteoclastogenesis, and ODF/RANK ligand expression in murine bone marrow cell cultures. Bone27: 769-776.
  32. Shearer MJ, Newman P (2008) Metabolism and cell biology of vitamin K. Thrombosis and haemostasis 100: 530-547.
  33. Yoshida M, Booth SL, Meigs JB, Saltzman E, Jacques PF (2008) Phylloquinone intake, insulin sensitivity, and glycemic status in men and women. The American journal of clinical nutrition 88: 210-215.
  34. Beulens JW, van der AD, Grobbee DE, Sluijs I, Spijkerman AM,et al. (2010) Dietary phylloquinone and menaquinones intakes and risk of type 2 diabetes. Diabetes care 33: 1699-1705.
  35. Ibarrola-Jurado N, Salas-Salvado J, Martinez-Gonzalez MA, Bullo M (2012) Dietary phylloquinone intake and risk of type 2 diabetes in elderly subjects at high risk of cardiovascular disease. The American journal of clinical nutrition 96: 1113-1118.
  36. Pan Y, Jackson RT (2009) Dietary phylloquinone intakes and metabolic syndrome in US young adults. Journal of the American College of Nutrition 28: 369-379.
  37. Dam V, Dalmeijer GW, Vermeer C,Drummen NE, Knapen MH, et al. (2015) Association Between Vitamin K and the Metabolic Syndrome: A 10-Year Follow-Up Study in Adults. The Journal of clinical endocrinology and metabolism 100: 2472-2479.
  38. Rasekhi H, Karandish M, Jalali MT, Mohammad-Shahi M, Zarei M, et al. (2015) The effect of vitamin K1 supplementation on sensitivity and insulin resistance via osteocalcin in prediabetic women: a double-blind randomized controlled clinical trial. European journal of clinical nutrition 69: 891-895.
  39. Yoshida M, Jacques PF, Meigs JB, et al. (2008) Effect of vitamin K supplementation on insulin resistance in older men and women. Diabetes care 31: 2092-2096.
  40. Kumar R, Binkley N, Vella A (2010) Effect of phylloquinone supplementation on glucose homeostasis in humans. The American journal of clinical nutrition 92: 1528-1532.
  41. Choi HJ, Yu J, Choi H, et al. (2011) Vitamin K2 supplementation improves insulin sensitivity via osteocalcin metabolism: a placebo-controlled trial. Diabetes care 34: e147.
  42. Koitaya N, Sekiguchi M, Tousen Y, Nishide Y, Morita A, et al. (2014) Low-dose vitamin K2 (MK-4) supplementation for 12 months improves bone metabolism and prevents forearm bone loss in postmenopausal Japanese women. Journal of bone and mineral metabolism 32: 142-150.
  43. Suksomboon N, Poolsup N, Darli KoKo H (2017) Effect of vitamin K supplementation on insulin sensitivity: a meta-analysis. Diabetes, metabolic syndrome and obesity: targets and therapy 10: 169-177.
  44. Knapen MHJ, Jardon KM, Vermeer C (2017) Vitamin K-induced effects on body fat and weight: results from a 3-year vitamin K2 intervention study. European journal of clinical nutrition 72:136-141.
  45. Rees K, Guraewal S, Wong YL, Majanbu DL, Mavrodaris A, et al. (2010) Is vitamin K consumption associated with cardio-metabolic disorders? A systematic review. Maturitas 67: 121-128.
  46. Valdes-Ramos R, Guadarrama-Lopez AL, Martinez-Carrillo BE, Benitez-Arciniega AD (2015) Vitamins and type 2 diabetes mellitus. Endocrine, metabolic & immune disorders drug targets 15: 54-63.
  47. Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, et al. (2007) Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (Aus Diab). Circulation 116: 151-157.
  48. Yang SL, Zhu LY, Han R, Sun LL, Li JX, et al. (2017) Pathophysiology of peripheral arterial disease in diabetes mellitus. Journal of diabetes 9: 133-140.
  49. Beulens JW, Bots ML, Atsma F,Bartelink ML, Prokop M, et al. (2009) High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis 203: 489-493.
  50. Dalmeijer GW, van der Schouw YT, Vermeer C, Magdeleyns EJ, Schurgers LJ, et al. (2013) Circulating matrix Gla protein is associated with coronary artery calcification and vitamin K status in healthy women. The Journal of nutritional biochemistry 24: 624-628.
  51. Liabeuf S, Bourron O, Vemeer C, Theuwissen E, Magdeleyns E, et al. (2014) Vascular calcification in patients with type 2 diabetes: the involvement of matrix Gla protein. Cardiovascular diabetology 13: 85.
  52. Dalmeijer GW, van der Schouw YT, Magdeleyns EJ, Vermeer C, Verschuren WM,et al. (2013) Matrix Gla protein species and risk of cardiovascular events in type 2 diabetic patients. Diabetes care 36: 3766-3771.
  53. Sardana M, Vasim I, Varakantam S, Kewan U, Tariq A, et al. (2017) Inactive Matrix Gla-Protein and Arterial Stiffness in Type 2 Diabetes Mellitus. American journal of hypertension 30: 196-201.
  54. Pivin E, Ponte B, Pruijm M, Ackermann D, Guessous I, et al. (2015) Inactive Matrix Gla-Protein Is Associated with Arterial Stiffness in an Adult Population-Based Study. Hypertension (Dallas, Tex : 1979) 66: 85-92.
  55. Tavridou A, Petridis I, Vasileiadis M, Ragia G, Heliopoulos I, et al. (2011) Association of VKORC1 -1639 G>A polymorphism with carotid intima-media thickness in type 2 diabetes mellitus. Diabetes research and clinical practice 94: 236-241.
  56. Knapen MH, Braam LA, Drummen NE, Bekers O, Hoeks A, et al. (2015) Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomised clinical trial. Thrombosis and haemostasis 113: 1135-1144.
  57. Caluwe R, Pyfferoen L, De Boeck K, De Vriese AS (2016) The effects of vitamin K supplementation and vitamin K antagonists on progression of vascular calcification: ongoing randomized controlled trials. Clinical kidney journal 9: 273-279.
  58. Domingueti CP, Dusse LM, Carvalho M, de Sousa LP, Gomes KB, et al. (2016) Diabetes mellitus: The linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. Journal of diabetes and its complications 30: 738-745.
  59. Korshunov VA (2012) Axl-dependent signalling: a clinical update. Clinical science (London, England: 1979) 122: 361-368.
  60. Dihingia A, Kalita J, Manna P (2017) Implication of a novel Gla-containing protein, Gas6 in the pathogenesis of insulin resistance, impaired glucose homeostasis, and inflammation: A review. Diabetes research and clinical practice 128: 74-82.
  61. Thong FS, Dugani CB, Klip A (2005) Turning signals on and off: GLUT4 traffic in the insulin-signaling highway. Physiology (Bethesda, Md) 20: 271-284.
  62. Lee CH, Shieh YS, Hsiao FC, Kuo FC, Lin CY,et al. (2014) High glucose induces human endothelial dysfunction through an Axl-dependent mechanism. Cardiovascular diabetology 13: 53.
  63. Rothlin CV, Ghosh S, Zuniga EI, Oldstone MB, Lemke G (2007) TAM receptors are pleiotropic inhibitors of the innate immune response. Cell 131: 1124-1136.
  64. Haase TN, Rasmussen M, Jaksch CA, Gaarn LW, Petersen CK, et al. (2013) Growth arrest specific protein (GAS) 6: a role in the regulation of proliferation and functional capacity of the perinatal rat beta cell. Diabetologia 56: 763-773.
  65. Hsiao FC, Lin YF, Hsieh PS, Chu NF, Shieh YS, et al. (2013) Circulating growth arrest-specific 6 protein is associated with adiposity, systemic inflammation, and insulin resistance among overweight and obese adolescents. The Journal of clinical endocrinology and metabolism 98: E267-E274.
  66. Juanola-Falgarona M, Salas-Salvado J, Estruch R, Portillo MP, Casas R, et al. (2013) Association between dietary phylloquinone intake and peripheral metabolic risk markers related to insulin resistance and diabetes in elderly subjects at high cardiovascular risk. Cardiovascular diabetology 12: 7.
  67. Mazzanti L, Battino M, Nanetti L, Raffaelli F, Alidori A, et al. (2015) Effect of 1-year dietary supplementation with vitaminized olive oil on markers of bone turnover and oxidative stress in healthy post-menopausal women. Endocrine 50: 326-334.
  68. Li J, Wang H, Rosenberg PA (2009) Vitamin K prevents oxidative cell death by inhibiting activation of 12-lipoxygenase in developing oligodendrocytes. Journal of neuroscience research 87: 1997-2005.
  69. Stage TB, Pottegard A, Henriksen DP, Christensen MM, Højlund K, et al. (2016) Initiation of glucose-lowering treatment decreases international normalized ratio levels among users of vitamin K antagonists: a self-controlled register study.J Thromb Haemost 14: 129-133.
  70. Johnson JA, Cavallari LH (2015) Warfarin pharmacogenetics. Trends in cardiovascular medicine 25: 33-41.

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