Vitamin K Supplementation for Prevention of Teratogenic Neurological Calcification in Fetuses with Congenital Zika Syndrome: A Research Protocol

Abstract

Introduction: Congenital Zika Syndrome (CZS) manifests in infants exposed to the Zika virus (ZIKV) in utero. Recent studies have documented the correlation between bone morphogenetic protein (BMP) and fetal brain calcification in these infants; however, potential treatment avenues remain unaccomplished. Unfortunately, the increase in ZIKV cases has engendered fetal neurodevelopmental defects including brain calcification which permanently impairs neurological function. The dominant pathogenic explanation results from osteogenic factor upregulation. Previous research has identified this underlying factor, highlighting the mechanism to combat the neurodegenerative impacts of ZIKV. Since the correlation between ZIKV and BMP is novel, studies addressing the mitigation of infant brain calcification are limited. Data from established ZIKV research was used to determine the potential utilization of matrix Gla protein (MGP) to inhibit the BMP pathway which calcifies fetal neural tissue. This rationale is founded on evidence showing (a) the efficacy of MGP in combating BMP-dependent calcification, and (b) the activation of MGP with Vitamin K2 (VK2). This study aims to establish a protocol for supplementing pregnant Zika patients with the VK2 derivative menaquinone-4 (MK-4), with the goal of preventing CZS-associated neurological calcification. Methods: A literature search was performed to evaluate the feasibility of VK2 injections for the prevention of neural calcification in CZS patients. The preventative potential of VK2 against CZS-related calcification will be tested using in vivo pregnant mouse (Mus musculus) models. Treatment groups will receive MK-4 administered with propylene glycol, while the control group will receive a placebo. Neurological calcification of fetuses and neonates will be monitored using pelvic ultrasound and micro-CT. Plasma and cerebral MK-4 content will be quantified using liquid chromatography-tandem mass spectrometry. Results: Anticipated results should demonstrate reduced subcortical calcification in the MK-4-treated murine cohort. Discussion: Protocol implementation precipitates the development of preventative CZS treatments. These findings indicate that low-dose maternal VK2 supplementation could provide a potential avenue for prevention of brain calcification in utero after vertical transmission of ZIKV. Conclusion: The proposed treatment would be the first of its kind, providing affected populations with a low-cost intervention for neurological damage caused by CZS, decreasing the burden of disease as ZIKV prevalence grows.