In contrast to other fat-soluble
vitamins, dietary
vitamin K is rapidly lost to the body resulting in comparatively low tissue stores. Deficiency is kept at bay by the ubiquity of
vitamin K in the diet, synthesis by gut microflora in some species, and relatively low
vitamin K cofactor requirements for γ-glutamyl carboxylation. However, as shown by fatal neonatal
bleeding in mice that lack
vitamin K epoxide reductase (VKOR), the low requirements are dependent on the ability of animals to regenerate
vitamin K from its
epoxide metabolite via the
vitamin K cycle. The identification of the genes encoding VKOR and its paralog VKOR-like 1 (VKORL1) has accelerated understanding of the enzymology of this salvage pathway. In parallel, a novel human
enzyme that participates in the cellular conversion of
phylloquinone to
menaquinone (MK)-4 was identified as UbiA
prenyltransferase-containing domain 1 (UBIAD1). Recent studies suggest that side-chain cleavage of oral
phylloquinone occurs in the intestine, and that
menadione is a circulating precursor of tissue MK-4. The mechanisms and functions of
vitamin K recycling and MK-4 synthesis have dominated advances made in
vitamin K biochemistry over the last five years and, after a brief overview of general metabolism, are the main focuses of this review.