Introduction: There is an ongoing need for additional interventions in idiopathic pulmonary fibrosis (IPF) as antifibrotic drugs currently available only inhibit and do not stall disease progression. Vitamin K is a co-factor for the activation of coagulation factors. However, it is also required to activate proteins with functions outside of the coagulation cascade, such as matrix Gla protein (MGP), a defender against soft tissue calcification. Vitamin K antagonists are anticoagulants that are, for unknown reasons, associated with increased mortality in IPF. Areas covered: We advance the hypothesis that modulation of vitamin K-dependent MGP activation in IPF patients by either vitamin K antagonism or administration may result in acceleration and deceleration of fibrosis progression, respectively. Furthermore, shortfall in vitamin K could be suspected in IPF based on the high prevalence of certain co-morbidities, such as vascular calcification and lung cancer. Expert commentary: We hypothesize that vitamin K status is reduced in IPF patients. This, in combination with studies suggesting that vitamin K may play a role in lung fibrosis pathogenesis, would provide a rationale for conducting a clinical trial assessing the potential mitigating effects of vitamin K administration on progression of lung fibrosis, prevention of co-morbidities and mortality in IPF.

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Keywords Coagulation, idiopathic pulmonary fibrosis, matrix Gla protein, pulmonary ossifications, vitamin K antagonists, vitamin K supplementation
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Journal Expert Review of Respiratory Medicine
De Brouwer, B. (Bart), Piscaer, I. (Ianthe), von der Thusen, J, Grutters, J.C, Schutgens, R.E. (Roger EG.), Wouters, E.F. (Emiel FM.), & Janssen, R. (Rob). (2018). Should vitamin K be supplemented instead of antagonised in patients with idiopathic pulmonary fibrosis?. Expert Review of Respiratory Medicine, 1–7. doi:10.1080/17476348.2018.1424544