title: Low serum vitamin K in PXE results in defective carboxylation of mineralization inhibitors similar to the GGCX mutations in the PXE-like syndrome.
abstract: Soft-tissue mineralization is a tightly regulated process relying on the activity of systemic and tissue-specific inhibitors and promoters of calcium precipitation. Many of these, such as matrix gla protein (MGP) and osteocalcin (OC), need to undergo carboxylation to become active. This post-translational modification is catalyzed by the gammaglutamyl carboxylase GGCX and requires vitamin K (VK) as an essential co-factor. Recently, we described a novel phenotype characterized by aberrant mineralization of the elastic fibers resulting from mutations in GGCX. Because of the resemblance with pseudoxanthoma elasticum (PXE), a prototype disorder of elastic fiber mineralization, it was coined the PXE-like syndrome. As mutations in GGCX negatively affect protein carboxylation, it is likely that inactive inhibitors of calcification contribute to ectopic mineralization in PXE-like syndrome. Because of the remarkable similarities with PXE, we performed a comparative study of various forms of VK-dependent proteins in serum, plasma (using ELISA), and dermal tissues (using immunohistochemistry) of PXE-like and PXE patients using innovative, conformation-specific antibodies. Furthermore, we measured VK serum concentrations (using HPLC) in PXE-like and PXE samples to evaluate the VK status. In PXE-like patients, we noted an accumulation of uncarboxylated Gla proteins, MGP, and OC in plasma, serum, and in the dermis. Serum levels of VK were normal in these patients. In PXE patients, we found similar, although not identical results for the Gla proteins in the circulation and dermal tissue. However, the VK serum concentration in PXE patients was significantly decreased compared with controls. Our findings allow us to conclude that ectopic mineralization in the PXE-like syndrome and in PXE results from a deficient protein carboxylation of VK-dependent inhibitors of calcification. Although in PXE-like patients this is due to mutations in the GGCX gene, a deficiency of the carboxylation co-factor VK is at the basis of the decreased activity of calcification inhibitors in PXE.
authors.affiliation: Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanakker
authors.forename: Ludovic
authors.initials: L
authors.lastname: Martin
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Schurgers
authors.forename: Daniela
authors.initials: D
authors.lastname: Quaglino
authors.forename: Laura
authors.initials: L
authors.lastname: Costrop
authors.forename: Cees
authors.initials: C
authors.lastname: Vermeer
authors.forename: Ivonne
authors.initials: I
authors.lastname: Pasquali-Ronchetti
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Coucke
authors.forename: Anne
authors.initials: A
authors.lastname: De Paepe
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D002114:Calcinosis / Q000235:genetics / Q000517:prevention & control; D002135:Calcium-Binding Proteins / Q000235:genetics; D016326:Extracellular Matrix Proteins / Q000235:genetics; D006801:Humans; D051379:Mice; D018345:Mice, Knockout; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics; D009154:Mutation; D011506:Proteins / Q000235:genetics; D011561:Pseudoxanthoma Elasticum / Q000209:etiology* / Q000235:genetics; D013577:Syndrome; D014812:Vitamin K / Q000097:blood / Q000378:metabolism; D014813:Vitamin K Deficiency / Q000235:genetics / Q000503:physiopathology*; D064417:Vitamin K Epoxide Reductases; D000097568:Matrix Gla Protein
chemical_list: D002135:Calcium-Binding Proteins; D016326:Extracellular Matrix Proteins; D006899:Mixed Function Oxygenases; D011506:Proteins; D014812:Vitamin K; D064417:Vitamin K Epoxide Reductases; D000097568:Matrix Gla Protein; C039391:granuloma protein, mouse