Vitamin E in the reduced, a-tocopherol form shows very modest anticlotting activity. By contrast, vitamin E quinone is a potent anticoagulant. This observation may have significance for field trials in which vitamin E is observed to exhibit beneficial effects on ischemic heart disease and stroke. Vitamin E quinone is a potent inhibitor of the vitamin K-dependent carboxylase that controls blood clotting. A newly discovered mechanism for the inhibition requires attachment of the active site thiol groups of the carboxylase to one or more methyl groups on vitamin E quinone. The results from a series of model reactions support this interpretation of the anticlotting activity associated with vitamin E.With the success of recent field trials of vitamin E, and the attendant promise of forestalling the onset of heart attack and stroke (1, 2), it becomes important to understand the molecular mechanistic basis of this beneficent physiological activity. Since vitamin E is an excellent antioxidant (3-7) and radical inhibitor (8-11), these properties have been used, in general fashion, to interpret its physiological activity and its possible role in living systems (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).It is known that vitamin E has anticoagulant properties (13-18), but this attribute has not been applied to understanding its physiological action. The recent Finnish study of male heavy smokers (19) found little efficacy of vitamin E and 13-carotene in preventing the occurrence of cancer, but the study did show the positive potential of vitamin E in cardiovascular therapy. There were clear benefits among the participants for ischemic heart disease and ischemic stroke, but, significantly, vitamin E acted to the detriment of those prone to hemorrhagic stroke (19). Accordingly, we suggest that the anticoagulant properties of vitamin E be included when evaluating the results of such trials.What are the anticoagulant properties of vitamin E, and why have they not been used in interpreting its physiologic role? For one, there has been some confusion about which oxidation states of vitamin E are effective anticoagulants, or, alternatively, which derivatives of vitamin E interdict the vitamin K-dependent clotting cycle and how effectively (20)(21)(22)(23). In response to the second part of the question, no mechanistic underpinning for the anticlotting properties of vitamin E has been developed, nor has there been any speculation regarding molecular mechanisms by which vitamin E might act as an inhibitor of the vitamin K-dependent carboxylase that is required to activate the enzymes of the blood clotting cascade. This paper will address both issues.
ResultsThe vitamin K-dependent carboxylase and the other enzymes of the vitamin K cycle were obtained from rat liver microsomes (24,25). The uptake of 14C02 by the synthetic pentapeptide substrate FLEEI, as a function of inhibitor concentration, was used as a measure of carboxylase activity and its inhibition. The Vitamin E quinone 2 production of vitamin K oxide was conveniently monitor...