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Vitamin K plays an essential role in the posttranslational conversion of specific glutamyl residues in a limited number of proteins to γ-carboxyglutamyl (Gla) residues (Suttie, 1993). These proteins include plasma prothrombin (coagulation factor II) and the plasma procoagulants, factors VII, IX, and X. Because under-γ-carboxylated forms of these proteins lack biological activity, the classical sign of a vitamin K deficiency has been a vitamin K-responsive increase in prothrombin time and, in severe cases, a hemorrhagic event. Two structurally related vitamin K-dependent proteins (Price, 1988), osteocalcin found in bone and matrix Gla protein originally found in bone but now known to be more widely distributed, have received recent attention as proteins with possible roles in the prevention of chronic disease (Ferland, 1998). No relationship between a decreased biological activity of any of the other vitamin K-dependent proteins and a disease-related physiological response has been postulated.

Physiology of Absorption, Metabolism, and Excretion

Phylloquinone, the major form of vitamin K in the diet, is absorbed in the jejunum and ileum in a process that is dependent on the normal flow of bile and pancreatic juice and is enhanced by dietary fat (Shearer et al., 1974). Absorption of free phylloquinone is nearly quantitative (Shearer et al., 1970), but recent studies (Garber et al., 1999; Gijsbers et al., 1996) suggest that the vitamin in food sources is less well absorbed. Absorbed phylloquinone is secreted into lymph as a component of chylomicrons and enters the circulation in this form. Circulating phylloquinone is present in the very low density triglyceride-rich lipoprotein fractions and chylomicrons (Kohlmeier et al., 1996; Lamon-Fava et al., 1998). A dependence of plasma phylloquinone concentrations (Kohlmeier et al., 1995) on the distribution of lipoprotein apoE isoforms suggests that the vitamin enters the liver through the endocytosis of chylomicron remnants. The liver rapidly accumulates ingested phylloquinone and contains the highest concentration. Skeletal muscle contains little phylloquinone, but significant concentrations are found in the heart and some other tissues (Davidson et al., 1998; Thijssen and Drittij-Reijnders, 1994). It is not known how or if hepatic phylloquinone is secreted and transported from the liver to peripheral tissues.

The vitamin is rapidly catabolized and excreted from the liver, mainly in bile. A smaller amount appears in urine (Shearer et al.,

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