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.
【저자키워드】 COVID-19, vitamin K, Matrix Gla Protein, prothrombin, protein S, 【초록키워드】 Treatment, public health, Coronavirus disease 2019, coronavirus, Respiratory failure, Trial, thrombosis, Pneumonia, Local, Symptoms, Coagulation, Coagulopathy, outcomes, Protein, Patient, Mild, Vitamin, Degradation, inhibitor, liver, moderate, patients, mechanism, administration, observation, matrix, endothelial, acute respiratory syndrome, Activation, Factor, These data, infected individual, pulmonary damage, Effect, decrease, develop, caused, proportion, conducted, activated, majority, contribute, demonstrated, inactive, Taking, transported, MGP, procoagulant factors, soft tissue calcification, synthesised, 【제목키워드】 Coronavirus disease 2019, metabolism, Thromboembolism, Vitamin, lung damage,