Patent Publication Number: US-2010130618-A1

Title: Treatment of human disease conditions and disorders using vitamin k analogues and derivatives

Description:
FIELD OF THE INVENTION 
     The present invention is related to the therapeutic uses of vitamin K, its analogues and derivatives and vitamin K activity synthesized molecules to improve blood perfusion and ameliorate hypoxia for the prevention and/or treatment of chronic venous insufficiencies and consequent diverse complications such as venous and lymphatic oedema, melanization, paper-money skin, desquamation, restless leg syndrome, muscle cramps, purpuric petechiae, spider-web phlebomegaly, heaviness of legs, paresthesiae and lower limb nerve pain, pooling of blood in inferior limbs and reduced venous return, venous stasis, orthostatic intolerance, thrombophlebitis and thrombus formation in veins and embolism thereof resulting in cardio pulmonary vascular events. The principle extends similarly through microcirculatory dysfunction in other organs also such as lung, heart, liver, brain, kidney retina, pancreas, testis, rectum, spinal cord, muscles, sympathetic and parasympathetic ganglia, and nerves. The invention also encompasses administering vitamin K analogues for—improving skin, hair and nail health in subjects in need thereof. The invention further extends to pharmaceutical compositions of vitamin K, its analogues and derivatives either alone or in combination with active agents for use in the disease or conditions encompassed by the invention. 
     BACKGROUND 
     In 1929, the Danish Nutritional scientist Dr. Henrik Dam discovered that feeding chicks a totally fat-free diet caused uncontrolled bleeding under their skin [1]. Dr. Dam quickly discovered the reason for this disturbing effect: the diet was missing a previously unknown fat-soluble nutrient, which he appropriately named “koagulationsvitamin”—literally, the “clotting vitamin”. The English name for the new vitamin was taken from Dr. Dam&#39;s Danish: “K”, for “Koagulation”. 
     Science was established that the gamma-glutamyl carboxylase is an integral cellular glycoprotein that uses vitamin K, a cofactor, to modify clusters of glutamyl residues (glu&#39;s) to γ-carboxylated glutamyl residues (gla&#39;s) post-translationally in vitamin K-dependent (VKD) proteins as they pass through the endoplasmic reticulum. Carboxylation is required for VKD protein functions in hemostasis. The VKD proteins, in the coagulation cascade, needing vitamin K to transact from the Glu status to Gla, to be biologically active, were proteins II, VII, IX, X, C, S and Z. It is interesting to note the surprising fact that the carboxylase itself has been shown to be a VKD protein [2]. 
     For over fifty years, nearly everyone thought that the vitamin K story began and ended with blood clotting. If doctors paid attention to it at all, it was only to make sure that it didn&#39;t interfere with the blood-thinning, anticoagulant drug warfarin (Coumadin®). But even as nutrition textbooks and mainstream medicine continued to think of vitamin K as a one-act show, a paradigm shift had been forced onto researchers in the late 1970&#39;s when new vitamin K-dependent protein associated with bone-building osteoblast cells was discovered [3, 4]. Lian et al [4] named it osteocalcin. 
     Vitamin K Analogues—Vitamin K is, in fact, a family of structurally similar, fat-soluble, 2-methyl-1,4-naphthoquinones, including phylloquinone (K1), menaquinones (K2), and menadione (K3). The structural difference is in the substituent side chain at the gamma position (Schematic A). 
     
       
         
         
             
             
         
       
     
     The best-known member of the vitamin K family is phylloquinone (K1), also known as phytonadione because of its relationship with photosynthesis. Phylloquinone is found in higher plants and algae, with the highest concentrations found in green leafy vegetables [5]. Vitamin K1.derived from the food intake is selectively distributed in hepatic and non-hepatic tissues. 
     Menaquinones (K2) also occur naturally, but are produced by an array of bacteria, generally not by higher plants, except for K2-4. Recent studies have determined menaquinones are produced in limited quantities by animals, and by humans, from the conversion of other forms of vitamin K [6, 7] The most common form of vitamin K2 in animals is menaquinone 4 (menatetrenone; MK-4), produced by the processing of exogenous and bacterial naphthoquinones [8]. Vitamins K1 and K2 differ only in the side chain in gamma position. Vitamin K1 possesses a phytyl group (partially saturated polyisoprenoid group) at position 3, while vitamin K2 possesses a repeating, unsaturated trans-poly-isoprenyl group. The IUPAC-IUB Commission on Biochemical Nomenclature abbreviates phylloquinone (K1) as “K” while menaquinone (K2) is abbreviated as “MK-n.” The “n” signifies the number of unsaturated isoprene units that compose the side chain at the 3-position which may vary between 1 and 14. Here on we shall denote phylloquinone as PK and menaquinones as MK-n. 
     Menadione (K3) is not considered a natural vitamin K, but a synthetic analogue that acts as a provitamin. It possesses a much simpler structure, with no aliphatic side chain at position 3. Billeter et al [9] reported that phylloquinone can be cleaved to form menadione by bacteria in the intestine. Here on we shall denote menadione as K3. 
     Biochemistry—Only known function of vitamin K is that it serves as a cofactor for γ-glutamylcarboxylase, an endoplasmic enzyme involved in the posttranslational carboxylation of glutamate residues into γ-carboxyglutamate (Gla). Hence, the vitamin K-dependent step is a carboxylation reaction taking place during the later stages of protein biosynthesis. Vitamin K hydroquinone (KH 2 ) is the active coenzyme, the oxidation of which to vitamin K 2, 3 epoxide (KO) provides the energy to drive the carboxylation reaction. The resulting Gla-residues are found in a limited number of proteins, and in these proteins only at certain well-defined positions [10]. Specific staining techniques or HPLC detection (after hydrolysis) identify the Gla-proteins as unique products of vitamin K action. In vitamin K-deficiency the carboxylation reaction cannot proceed, hence the Gla-proteins are released in an undercarboxylated form. Gla-residues form calcium-binding groups in proteins. So the main physico-chemical difference between normal and decarboxy proteins is their large difference in both binding of calcium from solution and the adsorption of these proteins to insoluble calcium salts. 
     Bioavailibilty—Booth et al [11] quotes Gijsbers et al [12] reported that the bioavailability (the area under an absorption curve) in human subjects of 1 mg phylloquinone in spinach was only 4% that of pure phylloquinone. Adding butter to the spinach increased this to 13%. Schurgers et al [13], through their experimental studies of PK absorption from spinach and MK-7 absorption from Natto, one week apart to exclude mutual interference of absorption, and also broccoli as source for PK and curd cheese and egg yolk as sources for higher menaquinones (MK-8 and MK-9) and MK-4 respectively, conclude that “In all cases it was found that PK absorption from vegetables was very poor (5-10% without concomitant fat intake and 10-15% if taken together with 30 g fat), whereas menaquinone absorption from dairy produce and natto was much better, probably almost complete.” This fact makes a large section of the population susceptible to vitamin K deficiency, when these vitamins are lacking in the diet. 
     In absolute amounts PK forms well over 80% of the total amount of vitamin K in the human diet [13]. However, it must be noted that due to different bioavailability, MK&#39;s absolute absorption in the system will be higher. Considering 10% bioavailability for PK and 80% bioavailability for MK, ratio of PK/MK absorbed by the body is 8/16 i.e. 1 as to 2. 
     Bioactivity—Ushiroyama et al [14] state that compared to other vitamin K analogues, MK&#39;s have the most potent gamma-carboxylation activity. 
     Pharmacokinetics—Schurgers et al [13] studied pharmacokinetics of PK and MK vitamins. Their findings are that PK has an elimination half life of 1.5 hrs whereas the long chain menaquinones (but not MK-4) had more complex disappearance curves with a long half-life. MK-7 remains detectable even at 72 hrs and the concentration at that time is greater than the 50% of the peak value concentration, (Cmax), of that achieved by PK. 
     Toxicity—Even in high doses, the natural forms of vitamin K have not produced symptoms of toxicity. For this reason, the Institute of Medicine at the National Academy of Sciences chose not to set a Tolerable Upper Limit (UL) for vitamin K when it revised its public health recommendations for this vitamin in year 2000 AD. Consuming more than the body&#39;s needs for dietary vitamin K does not cause the blood to clot excessively in healthy people. 
     Distribution and Metabolism—PK is selectively distributed in hepatic and non-hepatic tissues; the heart contains as much as the liver but the brain has low concentrations in experimental rats. Thijssen et al [7], with a study in postmortem human tissues, have shown that in man there are tissue-specific, vitamin-K distribution patterns comparable to those in the rat. Ronden et al [15] comment that since the heart contains no gamma-glutamylcarboxylase, the function of vitamin K in this tissue remains obscure and is worth exploring. MK-4 is found in every tissue and is at a higher concentration than PK except in liver, where MK-4 has relatively low levels. MK-4 is nevertheless in large amounts in the exocrine organs such as the pancreas and the salivary gland. The brain also contains high concentrations of MK-4. Similar patterns of the tissue-specific distribution of members of the vitamin K group are observed in animals and humans [7, 16] The livers of chicks, irrespective of the fact that the sole source of vitamin K was PK, contained as much MK-4 as PK [17]. 
     Gut flora produces higher amounts of MK-6 to MK-9 and very little MK-4. Therefore, MK-4 concentrations are not significantly different between normal rats and germ free rats. Further, MK-4 is hardly present in common food products. Thijssen et al.&#39;s [18] observations that extra hepatic tissues contained more MK-4 in rats fed a PK-rich diet than in rats fed an MK-4-enriched diet; are consistent with the earlier results of germ free rats. Hence, it would appear that MK-4 may originate from the conversion of PK in the body [6, 19]. 
     The speculation as to the variations has been put to rest by Okano et al [20] who, in an excellent study in mice with labeled and multi-route administration of menadione (K3) and PK, have shown that menadione is consistently converted to MK-4 irrespective of the route of administration. However, PK is converted to K3 following an oral or enteral administration, but not by parenteral or intracerebroventricular administration. This implies that PK is converted to MK-4 via integral side-chain removal in the intestine. In summary, their study “shows for the first time that MK-4 existing in cerebra of mice originates from PK and/or menadione intake, and suggest that there are two routes of cerebral MK-4 accumulation, one is the release of menadione from PK in the intestine, followed by prenylation of menadione into MK-4 in the tissue, and another is the release and prenylation of menadione both within the cerebrum.”[20]. 
     Glu Proteins—The discovery of osteocalcin brought forth the importance of carboxylation of Glu-osteocalcin in the body and the role of vitamin K. Osteocalcin is involved in calcium uptake and bone mineralization. Around the same time, it was also recognized that vitamin PK is more specific to carboxylation in the liver whereas vitamin MK is spread out throughout the body. Thus, vitamin MK has a greater importance as a cofactor in the carboxylation of osteocalcin. A number of clinical trials have proven the importance of vitamin MK supplementation for the bone health. Cockayne et al [21] have reviewed these trials in a meta-analysis and concluded that the supplementation with vitamin K reduces bone loss. Similarly, MGP (Matrix Gla Protein) has protective significance in the vascular calcification and resultant cardio vascular events. 
     Epidemiology—Epidemiological population-based Rotterdam study [22] examined the correlation between dietary intakes of vitamin K and aortic calcification and coronary heart disease (CHD). Their follow-up of 4807 subjects, with no history of myocardial infarction, over a period of 10 years showed a significant 50% reduction in CHD mortality and aortic calcification and 25% reduction in all cause mortality for those who were in the 45 μg per day, of dietary intake of vitamin MK-7 in the upper tertile and 25% reduction in 24 μg per day mid tertile compared to the 12 μg per day lower tertile. Such a population dose-response relationship was impressive for the new role of vitamin K. 
     The Japanese natto(soy) fermented food contains approximately 998 μg of vitamin K2-7 per 100 gms (882 to 1034 μg per 100 gms) [13]. Kamao et al [23] report vitamin MK-7 content of various fermented natto&#39;s: Natto(fermented soybeans) 939±753 (μg/100 g), Hikiwari natto (chopped natto) 827±194 (μg/100 g), Black Bean Natto 796±93 (μg/100 g). He also reports that the typical intake of fermented natto in Japan is approximately 80 gms per day. Kaneki et al [24] report that serum MK-7 concentrations were 5.26±6.13 ng/mL (mean±SD) in the Japanese women in Tokyo, 1.22±1.85 ng/mL in the Japanese women in Hiroshima and 0.37±0.20 ng/mL in the British women. Natto is eaten more frequently in Eastern Japan, Tokyo, but less frequently in Hiroshima and is not at all a food item in Britain. Kaneki et al [24] discovered a statistically significant inverse correlation between incidence of hip fracture, natto consumption and serum MK-7 levels between the three groups. Tskamoto et al [25], in a prospective study, administered 50 gms of natto per day to three groups. The concentration of MK-7 was either 865, 1295 or 1730 μg of MK-7 per 100 g. General population in Eastern Japan has 100 gms of natto for breakfast at a time. Tsakamoto [25] found that the serum MK-7 concentration and γ-carboxylated osteocalcin concentration were both elevated parallel to the administered level of MK-7. 
     Other Uses—Recent advances in the field of vitamin K have resulted in attributing novel functions for the molecule that are relatively less known. Traditionally, vitamin K has been associated with blood coagulation where it serves as a cofactor for the carboxylation of vitamin K-dependent proteins of coagulation cascade to render them active. It is now known that vitamin K is present in every tissue and by the virtue of its ubiquitous nature, the molecule plays an important role in bone mineralization, arterial calcification, apoptosis, phagocytosis, growth control, chemotaxis and signal transduction [26]. There is abundant literature and supportive data highlighting the role of vitamin K in bone mineralization as in osteoporosis [21]. Recent studies have provided support on the role of vitamin K nutriture on atherosclerosis. However, for several tissues the role of vitamin K is yet to be discovered. 
     US20020015762 provides teachings of menaquinone addition to food products to promote human bone health and cardiovascular health. US20050123603 teaches pharmaceutical compositions and nutritional supplements with MK-7 for human health. Vermeer (US 20060166948) discloses arterial effects of vitamin K giving relief to age-related stiffening of the arteries. Consequently, the application claims, vitamin K for use in combating various cardiovascular events including hypertension, congestive heart failure and stroke. US20050176778 claims uses for osteoporosis and arterial calcification, with no coverage of chronic venous insufficiency. 
     US20050107472 teaches that naphthoquinone-type compounds including vitamin K can modulate aggregation of protein associated with neurodegenerative disease such as Alzheimer&#39;s disease. Furthermore, US20060058398 claims vitamin K to have an effect for the nervous system and an effect of potentiating nerve growth factor activity and treatment of diseases associated with dementia. However, there are no claims on the venous tonal health and perfusion effect of vitamin K on brain, spinal cord, sympathetic and parasympathetic ganglia and nerves. 
     Horrobin, in the US20020025983, claims that mixture of Essential Fatty Acid (EFA) and artificially elevated vitamin K have synergistic effect in treating and preventing a variety of diseases including menstrual disorders, osteoporosis, arthritis and mental disorders. But there are no claims on chronic venous insufficiency related problem. 
     SUMMARY 
     The present invention provides therapeutic method of use of vitamin K, especially PK and MK, their analogues and derivatives as well as novel vitamin K-like molecules that exhibit vitamin K activity, to improve blood perfusion and ameliorate hypoxia in prevention and treatment of certain disease conditions and abnormalities observed in subjects (humans) including chronic venous insufficiency with consequent diverse complications of venous, lymph and nerve abnormalities. 
     In one aspect, the invention provides use of vitamin K and its analogues in improving blood perfusion and ameliorating hypoxia in venous insufficiency and its manifestations. Venous insufficiency manifestations are selected from the group consisting of varicose veins, oedema, telangiectasiae, venous ectasia, hyperpigmentation, redness, paresthesiae, swelling, itching, cramps, lipodermatosclerosis, ulcers, Venous Thromboembolism (VTE), heaviness of leg and pain. Features of post thrombotic syndrome (PTS) are common to the symptoms which respond to vitamin K, preferably MK-7. 
     In one aspect, the invention provides administering vitamin K analogues for the reduction in increased blackness of skin due to melanization. The conditions that exhibit such a reduction in melanin include but are not limited to freckles, age spots, melasama and Melanesia, and also paper-money skin, desquamation related roughness of the skin, puffiness due to oedema and dark circles around the eyes. In a related aspect, vitamin K and its analogues also provide relief in actinic and iatrogenic purpura, lentigines, spider angiomas, spider veins of face and legs and other vascular problems of skin and subcutaneous tissues when administered orally. 
     The invention also encompasses treatment of hyperpigmentation that arises as an associated symptom in diseases or conditions such as chronic venous insufficiency, diabetes (acanthosis nigra), scleroderma—and local melanization due to sunlight, UV exposure or mechanical irritation by administering vitamin K, its analogues, derivatives or vitamin K-like compound either alone or combination with one or more therapeutically effective active agents to enhance or facilitate their action. 
     In another aspect, vitamin K analogues when administered as phlebodynamic agents provide relief from the signs and symptoms of chronic venous insufficiencies. In one embodiment vitamin K treatment is beneficial in relieving heaviness of legs, paresthesiae (tingling and numbness sensation), cramps and stasis in varicose veins. In a related embodiment vitamin K treatment can be extended to venous and lymphatic oedema, melanization, paper-money skin, desquamation, restless leg syndrome, purpuric petechiae, spider-web phelebomegaly, lower limb nerve pain, pooling of blood in the venous system and reduced venous return to the heart, venous stasis, orthostatic intolerance, venous thrombophlebitis, and thrombus formation in veins 
     Yet another aspect of the invention is to prevent muscle cramps in subjects by administering vitamin K analogues. 
     Therapeutic use of vitamin K analogues to increase the overall energy level, or in other words to reduce chronic fatigue is encompassed by the invention. 
     The invention provides pharmaceutically effective doses of oral vitamin K analogues for prevention and/or treatment of disease conditions. In another aspect, oral doses of vitamin K formulations can be effectively combined with topical application of vitamin K, for the skin-related uses, to achieve the desired effect. In certain instances, a cumulative effect is observed in the combination treatment regimen. 
     The invention further provides pharmaceutical compositions comprising vitamin K, its analogues, derivatives or vitamin K-like compounds either alone or in combination with one or more therapeutically effective active agents (as provided in Table 1) for the diseases/conditions that are encompassed by this invention. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1 : Effect of test samples PK-400 μg/ml and MK4-400 μg/ml on guinea pig ileum induced by 50 μg/ml of acetylcholine. 
         FIG. 2 : Effect of test samples PK-400 μg/ml and MK4-400 μg/ml on guinea pig ileum induced by 1% Barium Chloride. 
         FIG. 3 : Effect of test samples PK-400 μg/ml and MK4-400 uμm/ml on guinea pig ileum induced by 25 μg/ml of histamine. 
         FIG. 4 : Effect of test samples PK-400 μg/ml and MK4-400 μm/ml on Frog rectus abdominus muscle contractions induced by 100 μg/ml of acetylcholine 
         FIG. 5 : Effect of test samples PK-400 μg/ml and MK4-400 μg/ml on frog heart induced by 40 μg/ml of adrenaline. 
         FIG. 6 : Effect of propanolol on adrenaline inhibition. 
     
    
    
     DESCRIPTION OF THE INVENTION 
     Various conditions for which therapeutic use of vitamin K analogues are encompassed by the present invention are disclosed in the foregoing discussion. 
     Chronic Venous Insufficiency 
     The heart pumps blood through the arteries, arterioles, through a network of capillaries, than venules and veins. The capillaries have very thin walls that allow nutrients to pass through into the tissues and waste products to filter back into the capillaries. The venous tone and flow are important for return of blood back to the right heart, lungs and then to the left atrium and left ventricle. 
     Commonly the diseases affecting arteries and veins are often different. ‘Atherosclerosis’, plaques in the inner layer of aorta and arteries, narrows and blocks arteries with thrombosis, causing heart attacks, strokes and gangrene, but it does not cause problems in the veins. However, ‘Thrombosis’ means clotting of blood in a blood vessel and can occur in either veins or arteries, but the causes and consequences are different. Thrombosis in the deep veins of the legs can be quite dangerous (Thrombosis, phlebitis and embolism). 
     Chronic venous insufficiency is a syndromic term covering a wide variety of symptoms which may severely impair the patient&#39;s physical well-being or even lead to partial or complete invalidism persisting for years. Also involved on a large scale in these disturbances is the microcirculation. “Histangic”factor (interface between vessels and tissues) plays a basic role in the venous insufficiency and more in all venous disorders. 
     Evans et al in the Edinburg Vein Study [27, 28] have noted that telangiectasis and reticular veins were each present in approximately 80% of men and 85% of women. Varicose veins were present in 40% of men and 16% of women, whereas ankle edema was present in 7% of men and 16% of women. Active or healed venous ulcers occur in approximately 1% of the general population. These are often recalcitrant to treat. In the Framingham Study [29], the annual incidence of varicose veins was 2.6% among women and 1.9% among men. There is also a significant impact on the quality of life by the severity of venous disease. With age, the venous insufficiency gets aggravated. 
     It was serendipitously discovered that when vitamin K is administered, preferably vitamin MK-7, the features of the syndrome due to varicose veins diminishes. We also claim vitamin K&#39;s therapeutic use in diseases involving the venous system of the lower extremities, testes (varicocele), rectum (haemorrhoids) and retina (venous tortuosity) and elephantiasis. 
     It is not obvious that it&#39;s the vasa vasora, vasa nervosa and vasa cutis, where these processes are the most important, result in restricting blood supplies temporarily and leading to plethora of symptoms that is observed and surprisingly resolve the symptoms to a great extent through administration of vitamin K. Vitamin K improves blood supply by improving blood perfusion and brings about homeostasis. Yet another improvement is muscle tone. 
     The current invention indicates the central role played by vitamin K in improving blood perfusion and ameliorating hypoxia in the venous insufficiency and its manifestations. Owing to microcirculatory disturbances, the damaged vessels produce a detrimental effect on the surrounding tissues. The therapeutically evidence fully supports the mechanism that clinical resolution is dependent upon vasculo-tissular (histangic) compensation by an improvement in venous tone and flow. The applicants claim histangic compensation of venous insufficiency which per se can lead to reverse cardiovascular and pulmonary events, due to reasons other than the earlier reported claims of calcification in the patent literature. Vitamin K can enhance tissue perfusion, microcirculation and relieves hypoxia by action on the venous system. Manifestations of venous insufficiency as meant here includes but not limited to varicose veins, oedema, telangiectasis, venous ectasia, hyperpigmentation, redness, paresthesiae, swelling, itching, cramps, lipodermatosclerosis, ulcers, heaviness of limb, unsteadiness due to venous pooling and pain. 
     It should also be noted that Chronic venous insufficiency encompasses wide range of diverse symptoms. There are many diseases such as Diabetes Mellitus, Post thrombotic syndrome, Hypothyroidism, Scleroderma, Chronic renal failure, Hyperparathyroidism where similar symptoms can be noticed. Vitamin K is effective in ameliorating the symptoms through its ability to improve venous tone and flow. It is also the observed by the applicants of the present invention that vitamin K&#39;s effect can be further enhanced by several agents across various disease conditions with similar symptoms. These active agents include but are not limited to the list provided in Table 1. Some of these agents are already used as conventional therapeutic for some of the conditions, e.g. vitamin B12, and its derivatives in paresthesiae. Typically, as per the current invention, one or more of these agents are administered in combination with vitamin K for the disease/conditions encompassed by this invention. 
     
       
         
           
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 Therapeutically effective Active Agents 
               
               
                 Name of the Agent 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
            
               
                   
                 Vitamin K 
               
               
                   
                 Glucofuranoside (Glyvenol) 
               
               
                   
                 Vitamin D2 and D3 
               
               
                   
                 Vitamin B12 and its salts. (hydroxo, methyl and adenosil) 
               
               
                   
                 Folic Acid 
               
               
                   
                 Vitamin C 
               
               
                   
                 Vitamin E 
               
               
                   
                 MSM 
               
               
                   
                 Betaine 
               
               
                   
                 Warfarin, 
               
               
                   
                 L-Dopa Formulations 
               
               
                   
                 Ropinirole Hydrochloride 
               
               
                   
                 Horse Chest-Nut 
               
               
                   
                 Nattokinase 
               
               
                   
                   Trigonella foenum graecum Linn . (Fenugreek) 
               
               
                   
                 Bioflavonoids 
               
               
                   
                 Electrolytes 
               
               
                   
                 Quinine 
               
               
                   
                 Magnesium Citrate 
               
               
                   
                 Choline 
               
               
                   
                 Selenium 
               
               
                   
                 Baclofen 
               
               
                   
                 Coenzyme Q10(CoQ10) 
               
               
                   
                 Acetyl-L-Carnitine 
               
               
                   
                 Shilajit 
               
               
                   
                 Dehydroepiandrosterone (DHEA) 
               
               
                   
                 Phosphatidylserine (PS) 
               
               
                   
                 Melatonin 
               
               
                   
                 Omega-3,6 and 9 Polyunsaturated Fatty Acids, 
               
               
                   
                 Niacin 
               
               
                   
                 Inositol hexaniacinate (IHN) 
               
               
                   
                   Centella Asiatica , (Gotu Kola) 
               
               
                   
                   Hamamelis Virginiana  (Witch Hazel) 
               
               
                   
                 Lipoic Acid 
               
               
                   
                 Linolenic Acid and α Linolenic Acid 
               
               
                   
                 Diosmin 
               
               
                   
                 Hesperidins 
               
               
                   
                 Calcium and it salts 
               
               
                   
                 Calcium Fructoborate 
               
               
                   
                 Idebenone 
               
               
                   
                 Riboflavin 
               
               
                   
                 Kinetin 
               
               
                   
                 Proanthocyanidins 
               
               
                   
                 Vitamin A 
               
               
                   
                   Lactobacillus  GG (Probiotics) 
               
               
                   
                 
                   Bacillus Subtilis 
                 
               
               
                   
                 
                   Bacillus Licheniformis 
                 
               
               
                   
                 Yeast sacc.  Cerevisiae   
               
               
                   
                 Yeast sacc.  Boulardii   
               
               
                   
                 Celery and its derivatives 
               
               
                   
                   
               
            
           
         
       
     
     Cramps 
     Chronic, persistent leg cramps are a common and distressing problem. Christine Roffe et al [30] quotes that the prevalence of leg cramps increases with age, affecting 30% of &gt;60 year olds and 50% over the age of 80 [31, 32]. Cramps may be precipitated by changes in water and electrolyte homoeostasis or by drugs such as diuretics, laxatives, beta2-agonists, cimetidine, and phenothiazines. But the fundamental mechanism of cramp is not well understood. That is why the adjective “Idiopathic” is used. 
     Idiopathic nocturnal cramps are painful involuntary muscle spasms that commonly disrupt sleep. More than a third of people aged over 60 years experience them, their prevalence increases with age and they occur most commonly in the leg [31, 32]. Such a wide spread distress has no adequate therapeutic intervention. There are six basic causes of cramping: hyperflexion; inadequate oxygenation; exposure to large changes in temperature; dehydration; low blood supply; or low blood calcium. Most of muscle cramps are due to hypoxia and inadequate perfusion. 
     Current modalities commonly used in the treatment of muscle cramps are electrolyte supplementation and muscle relaxants. These treatments frequently fail to produce desirable and lasting effects. We have discovered that vitamin K daily administration not only relieves but also prevents recurrence of cramps. Daily dose of vitamin K needs to be titrated as per the severity and frequency of cramps. 
     Half life of vitamin MK-7 is high (MK-7: 50 hrs) [13]. So MK-7 can be gainfully used due to its presence in the body for a longer duration. Thus the invention also provides the use of vitamin K as a safe prophylactic for muscle cramps. Vitamin K also improves the muscle strength as evident by relief of fatigue. 
     The inventors have discovered relief from cramps when a sufficient dose of vitamin K is administered systematically daily once or more. Dose will depend on the vitamin K analogue and the pharmacokinetic profile of the particular analogue used for the treatment. The preferred range is 10 μg to 1000 μg per day, and the preferred vitamin K is vitamin MK-7. We have found that vitamin K reduces and even eliminates condition of cramps. 
     Hyperpigmentation 
     The formation of melanin or the process of melanogenesis is based on the enzymatic conversion of the amino acid tyrosine, through a series of intermediates, to melanin pigments—the reddish brown pheomelanins or brown black eumelanins. 
     The tyrosinase enzyme is regarded as the key rate limiting enzyme involved in melanin synthesis Tyrosinase enzyme is a bifunctional enzyme in that it catalyzes the oxidation of tyrosine into L-DOPA (3,4-dihydroxyphenylalanine and further catalyzes L-DOPA into DOPA-quinone. DOPA-quinones are transformed, through a series of intermediates, to reddish or brown-black polymeric melanin components that are responsible for skin pigmentation. Copper, in the bivalent Cu ++  state, is part of metalloenzyme-tyrosinase. 
     Tyrosinase is widely distributed in microorganisms, animals and plants and is a key enzyme in melanin biosynthesis, involved in determining the color of mammalian skin and hair. The sequence of melanin formation from tyrosine by the action of tyrosinase is depicted by Raper [33] and Mason [34]. The control, modulation and regulation of the tyrosinase enzyme thus play a key role in melanin synthesis and skin pigmentation. Tyrosinase inhibitors are widely used in cosmetic, cosmeceutical and pharmaceutical products for their skin-whitening effects. 
     Skin-whitening agents are widely used to even out skin dark tone, and to depigment hyperpigmented skin, such as melasma, freckles, or age spots. Ultraviolet light stimulates melanocytes, producing greater quantities of melanin contributing to hyperpigmentation. 
     Common skin lightening/whitening agents used include hydroquinone, kojic acid, vitamin C and its derivatives, turmeric extract, and extracts of natural plants such as rumex and licorice. Natural compounds and vitamins are considered a good choice as pharmacological ingredients due to their relative freedom from side effects. Although the efficacy of some of these products has been demonstrated, in several cases mechanism of action is unknown or unconfirmed. Most skin whitening agents work by inhibition of tyrosinase enzyme but other mechanisms such as reduction of melanoblast or destruction of melanocytes is also possible. Inhibition of tyrosinase enzyme may vary among skin whitening agents. The said compound may either interact directly with the tyrosinase or control its activity indirectly by complexing with copper ions or bring about the said lightening effect by regulating calcium ions.[35, 36] 
     U.S. 5,510,391 provides the use of vitamin K mixture as a topical application for the treatment of blood vessel disorders of the skin including actinic and iatrogenic purpura, lentigines and other vascular problems of the skin and subcutaneous tissue. Furthermore, Shah et al [37] have described the effect of topical vitamin K on bruising after laser treatment. This study particularly elaborates the beneficial effects of topical application of vitamin K after the laser therapy. Shah et al&#39;s study has been challenged by Kovacs et al [38] who have indicated a lack of effect of topical vitamin K on bruising after mechanical injury. They differ from Shah et al in their finding and conclude that vitamin K cream application in post laser bruising did not help in the cleaning of petechiae. In all of the above studies, vitamin K has been administered topically, and not systemically. 
     It is the objective of the skin lightening/whitening agent to interfere with the melanin synthesis or enhances its catabolism. The mechanism of action underlying the present invention is that the molecules with vitamin K activity, including PK and MK, activate Glu proteins through carboxylation and conversion of Glu to Gla, in the vicinity of the melanocytes. These Gla proteins interfere with several bivalent metallic ions involved in the biopathway of the melanin formation. 
     De Boer-van den Berg et al [36] have reported carboxylase enzymes in skin of humans, rats rabbits, and mice. Carboxylase converts Glu proteins to Gla proteins and are known to interact with bivalent ions, particularly Ca ++ ions. It is reported that the carboxylase enzymatic activity in skin is about 20% of that in liver. The enzymatic activity present in both the epidermal and dermal tissues, may be related to melanin metabolism. 
     The inventors of the present invention have observed lightening of the skin and even disappearance of hyperpigmentation when a sufficient dose of vitamin K is administered systematically daily once a day or preferably twice a day. Dose will depend on the vitamin K analogue and the pharmacokinetic profile of the particular analogue used for the treatment. The preferred range is 10 to 1000 μg per day, and preferred vitamin K is vitamin MK-7. Furthermore, the applicants observe that systemic vitamin K-provides relief of actinic and iatrogenic purpura, lentigines, spider angiomas, spider veins of face and legs and other vascular problems of the skin. 
     Hyperpigmentation is an associated symptom in many of the diseases like, chronic venous insufficiency, Diabetes, Scleroderma etc. The most common factor attributed to this condition is poor tissue perfusion. The applicants have found that vitamin K reduces and even eliminates condition of hyperpigmentation, which is generally due to poor perfusion. 
     Varicose Veins 
     The veins of legs affected are either the superficial veins or the deeper veins. The superficial veins are the ones that can become varicose. The superficial veins and deep veins are linked in a number of places by perforating veins (or ‘perforators’) and they are equipped with valves which when function improperly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial vein and can be a cause of varicose veins. The varicose veins are not just limited to legs but can also be found in testes, rectum and retina. Both the poor venous tone and impaired valves reduce the upward venous blood flow toward the heart. 
     It was serendipitously discovered that when vitamin K is administered, preferably vitamin MK-7, varicose veins and its pain diminishes. The applicants also claim vitamin K&#39;s therapeutic use in diseases involving the venous system of the lower extremities and varicose veins of the testes, rectum and retina 
     Desquamation 
     The skin consists of two primary layers: the deeper layer called the dermis, composed largely of adipose and connective tissue, and the superficial layer called epidermis. The epidermis contains cells that determine skin color and the pigment that protects from damage. Epidermal keratinized cells are constantly being worn away and replaced by new epidermal cells. In normal circumstances, injury to this layer of skin rarely causes problems because it usually repairs itself so quickly. For a person with some organic diseases like, diabetes, however, this can be a problem because once the outer layer of skin is atrophic and if tampered with; it may not heal as quickly or normally as in healthy subjects. 
     The epidermis consists of five strata; from outer to inner they are: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale. The deepest layer of the epidermis, the stratum basale, is a single layer of cells resting on a basement membrane (layer between the dermis and epidermis). The stratum basale cells divide continuously. As new cells form, older ones are pushed towards the skin surface. Those cells die that are pushed away from this layer. When the cells reach the skin surface, they are sloughed off in a process called desquamation. The stratum granulosum, the thin middle layer, initiates keratinization (production of keratin). This process starts the death of epithelial cells. 
     During desquamation, keratinocytes are pushed towards the surface. When these cells reach the outer layer of epidermis, they are keratin-filled. Millions of these dead cells are worn off daily, creating a new epidermis every 35 to 45 days. 
     There are many modalities available for the treatment of this particular problem, but yet they fail to achieve the complete cure i.e. smooth skin of heel and are also reported to have side effects. Some of the non medicinal treatments for desquamation include application of a moisturizing cream, use of a pumice stone to reduce the thickness of the hard skin, avoiding wearing open backed shoes or thin soled shoes, wearing shoes with a good shock absorbing sole. Medications such as, retinoic acid (isotretinoin, tretinoin, acitretin, tazarotene, etc.), zinc pyrithionate and methyl athyl sulfate, sucralfate, for moist skin desquamation by radiation, carbohydrate derivative, β-hydroxy acids and salicylic acid, ceramides are also suggested to provide relief for desquamation. 
     As per the present invention, vitamin K and preferably MK-7 plays a major role in reducing desquamation. That is noted in several conditions and in aging. The applicants have found that vitamin MK-7 relieves and resolves desquamation conditions whether the patient is suffering from diabetes or other causes. Use of MK-7 on regular basis in sufficient quantity, leaves the skin smooth at the heel where there was earlier rough and exfoliating skin. 
     Fatigue 
     In blood vessels, the function of Gla-proteins are associated with the local inhibition of thrombosis, inhibition of mineralization and stimulation of normal cell growth and prevention of apoptosis in growth arrested cells. Role of vitamin K as a therapeutic in cardiac conditions by improving microcirculation at the level of vasa vasora is also encompassed by the present invention. 
     Chronic fatigue is a common symptom of several chronic metabolic and neuromuscular disorders. The major determinants of fatigue are the perfusion-dependent reduced oxygen supply, inadequate supply of energy for actin-myosin interaction, from glycolysis, and higher lactate level in muscles. According to the present invention, MK-7 relieves fatigue by improved perfusion and increased oxygenation and energy supply. 
     Paresthesiae 
     Paresthesiae is common in many diseases including diabetic neuropathy. Tingling/numbness, burning feet, causalgia and proprioceptive imbalance are more commonly arises due to diabetes mellitus, aging and smoking/tobacco intake Common and often successful modality is administration of vitamin B12. Though vitamin B12 reduces the tingling and numbness in the extremities, there can be still residual numbness and tingling which can be quite irritating. There is no known remedy for this and it remains as a problem. 
     The applicants have found that MK-7 is very effective in overcoming the residual neuropathy in the extremities after administering cyanocobalamine and its derivatives. Furthermore as per the present invention, it is seen that in patients who are on vitamin B12 medication, administering vitamin MK-7 relieves numbness and tingling sensation more rapidly. 
     When vitamin B12 levels fall in the body, for example, due to Metformin in diabetics, there is appearance of numbness and tingling. At this point, if either dose of vitamin K or dose of vitamin B12 is increased then the symptoms of numbness and tingling disappear. 
     The applicants herein claim the use of vitamin K alone or with vitamin B12 for reducing and eliminating the condition of paresthesiae arising due to several causes, by an improvement in perfusion and stabilizing membrane potentials. 
     Thrombophlebitis and Venous Thromboembolism (VTE), Venous Stasis 
     Through the studies presented in the instant specification, the applicants indicate that as endothelial function deteriorates with aging and diabetes this phenomenon in turn changes the venous tone and reduces venous flow, leading to venous stasis. This is an antecedent of hypoxia and inflammation, thrombophlebitis may ensue with a chance of embolization which can be life threatening. 
     Current invention is an improvement by vitamin K in venous tone, resulting in improvement of venous perfusion and flow resulting in diminishing of stasis, and chance of inflammation and thrombosis. The hazards of venous thrombosis and embolism during air travel can be controlled by MK-7. 
     Post Thrombotic Syndrome (PTS) 
     PTS is a corollary to Venous Thromboembolism (VTE). PTS is a chronic condition that develops in 20-50% of the patients after Deep vein thrombosis (DVT) [39-42]. Patients with PTS have persistent venous insufficiency and experience pain, heaviness, swelling, cramps, itching, or tingling in the affected limbs. These symptoms are further enhanced by standing or walking and relieved with rest, leg elevation and lying down. Kurz et al [43] mention that “Signs that may be noted on physical examination of the limb include oedema, telangiectasias, hyperpigmentation, eczema, varicose collateral veins and, in severe cases, lipodermatosclerosis and ulceration” 
     These features of PTS are common to the symptoms which respond to vitamin K, preferably MK-7. The beneficial effects are modulated by an improvement in the venous tone and flow due to better endothelial function. 
     Oedema 
     The current invention indicates the central role played by vitamin K and its analogues in improving integrity of the capillary wall and tonicity of veins and lymphatic&#39;s. In one embodiment, the invention provides that vitamin K and its analogues especially vitamin MK-7 act on smooth muscles and help in reducing oedematus condition by improved fluid drainage by lymphatic and venous return. 
     Generation of interstitial fluid is dependent on the balance of osmotic pressure of the plasma and of hydrostatic (intravascular) pressure which act in opposite directions across the semi-permeable capillary walls. Consequently, anything that increases oncotic pressure outside blood vessels or reduces oncotic pressure in the blood will cause oedema. Increased hydrostatic pressure inside the blood vessel will have the same effect. If the permeability of the capillary walls increases, more fluid will tend to escape out of the capillary, by venous and lymphatic stasis. 
     In another embodiment the invention provides evidence for inadequate perfusion that plays a key role in the mechanism of development of oedema which can be due to many causes. MK-7 helps in improving tissue perfusion and thus can reduce the oedematus condition. The current invention thus provides vitamin K as a therapeutic for lymphatic and venous oedema. 
     DEFINITIONS 
     As used herein, the term “PK” refers to phylloquinone (K1) or vitamin K1, also known as phytonadione because of its relationship with photosynthesis. 
     As used herein, the term “MK-n” refers to Menaquinones (K2) or vitamin K2, abbreviated as “MK-n.” The “n” signifies the number of unsaturated isoprene units that compose the side chain at the 3-position which may vary between 1 and 14. 
     As used herein, the term “K3” refers to menadione or vitamin K3. 
     As used herein, the term “Glu” refers to glutamyl residues in uncarboxylated VKD proteins. 
     As used herein, the term “Gla” refers to γ-carboxylated glutamyl residues (gla&#39;s) post-translationally in VKD proteins. 
     As used herein, the term “VKD” refers to Glu proteins that require carboxylase along with co-factor vitamin K to carboxylate to Gla protein. 
     As used herein, the term “vitamin K” refers to any molecule having vitamin K activity whether natural, e.g. PK, MK-n, or synthetically derived or analogues, derivatives or vitamin K-like compound. 
     As used herein, the term “histangic” refers to morpho-functional connections existing between vessels and tissues. 
     By ‘combination’ it is meant that vitamin K is administered with one or more of active agents that are conventionally used for a disease/condition encompassed by the current invention. Administration of the active agent(s) in combination with vitamin K may be simultaneous or sequential. Illustrative lists of active agents are provided in Table 1 of this specification. 
     Therapeutically effective active agents as used herein means, those agents that are therapeutically effective and conventionally or unconventionally used for diseases or conditions encompassed by the current invention. 
     The invention is more fully understood by reference to the following examples. These examples should not, however, be construed as limiting the scope of the invention. 
     Examples 1-10 enumerate clinical case studies data and Examples 11 and 12 provide in vitro experiments. 
     Case Studies 
     Example 01 
     Female, age 64 years, a known case of type 2 diabetes mellitus of 14 years duration complained about increasing darkening of the skin on the nape of the neck and also little below the neck region. The skin hyper pigmentation was noticed by her 3 years ago. She was disturbed about her cosmetic discomfort as she could not wear low neck tops. She has been a fairly well controlled diabetic taking Metformin 1000 mgs twice daily, Dionil® twice daily, Aspirin 100 mg per day and vitamin B-complex. She started taking MK-7 one and a half years ago. Gradually the hyper pigmentation started clearing and now it has almost subsided. In between in this year and a half either she had discontinued when she would not have received the vitamin almost for a month or more. During these periods she had noticed reappearance of the pigmentation in a milder form. Currently she has been on the MK-7 in a dose of 100 μg per day for now 2 months. However tingling and numbness had been her main complaints. During the periods when she is on MK-7 she gets a major relief from tingling and numbness. During periods of discontinuation of the vitamin tingling reappears within a couple of days. Not only these complaints are noticeable by her but they are also very disturbing as often there is a fair degree of burning of feet along with tingling and numbness. Currently she has complete relief from tingling, numbness and burning of feet. 
     Example 02 
     Male, aged 70, a physician and a clinical pharmacologist by profession with a history of type 2 diabetes mellitus for four years and hypertension for fourteen years complained of the following (a) Tingling and numbness of both the feet, intermittently for one year, (b) muscle cramps, at night, waking him up from sleep, 2 to 3 times in a week and (c) thinning of the skin of the lower limbs, with easy traumatibility and paper-money skin changes in the area below the inner malleolus. He was on standard antihypertensive drug (Candesartan 8 mg AM and 4 mg PM), Metformin (500-250-250 mg) and Centrum® once a day. MK-7 was taken p.o. every day. The severity and frequency of muscle cramps steadily decreased over the next two weeks. The frequency of mild cramps dropped to one or two in a month over the next four months. The tingling and numbness reduced markedly over the period. The paper-money skin appearance was much reduced. Then MK-7 was discontinued for a month and gradually all the features described above returned with the same basal severity and frequency. MK-7 was restarted in the same dose schedule. Relief of the features was again experienced as before. The same dose was continued for a year. Meanwhile the subject was shifted to higher dose of Metformin (1000, 250, 250 mg.) and developed vitamin B12 deficiency (MCV=105). Although tingling and numbness returned, muscle cramps stayed controlled along with paper-money skin. After injections of vitamin B12 (500 μg) over 2 weeks, there was a significant relief in tingling and numbness again. The subject also reported higher energy levels and less fatigue with added MK-7 to his schedule. There were no major changes in diet or exercise during the period. 
     Example 03 
     Female, aged 59 yrs, with Height of 5′5″ and weight of 60 kgs, on strict vegetarian diet. For many years of at least 30 years and above she had been experiencing severe cramps during the night. These cramps used to be experienced any time during the night which would make her get up from the sleep due to severity of pain. The conditions was such that normally she had to wake up her husband to massage the area where the cramps were experienced, and then after several minutes pain used to subside. She had to be extremely careful about her body movement during sleep especially stretching of legs. There were times when similar situation used to occur more than once during the night. Sometimes the pain used to subside by walking around the room and in the corridor. She was experiencing similar condition many times during the day also especially during long walks in shopping malls. The condition used to be more severe or aggravated if there was even slight over exertion like longer walk or standing for a long time. She started taking MK-7 100 μg one tablet per day about one year ago. After taking MK-7 within few days the incidence of cramps started to reduce. She has also experienced that whenever she had cramps, the duration and the severity of pain were reduced. Within 2 to 3 months it appeared that the cramps have already gone. After taking the tablet for six months the cramps had disappeared. However after that she stopped the tablet and within two weeks the cramps reappeared, but at this time the severity was relatively less. She again restarted taking doses regularly. Her cramps had disappeared again. Now she is on regular dosage of the tablet i.e. one every day and she experienced practically no cramps during the night or during the day. She concluded that regular usage of MK-7 tablets has definitely helped her during time of cramps. 
     Example 04 
     Male, ages 68 years with hypercholesterolemia (Lipid Profile; 200 mg—Total cholesterol) for which he is taking Atorvastatin 5 mg one per day and 75 mg of Aspirin one per/day since last five years. At the age of 64 undergoes angioplasty. He is also having mild blood pressure. He complained of having irritating rough skin on both the heels. He started taking daily dose of vitamin MK-7 200 μg. Within 10-15 days he observed that, his skin had completely lost roughness and became smooth. 
     Example 05 
     Female, aged 70, a gynecologist with a history of hypertension for nine years complained of paper-money skin and hyper pigmentation changes in the lower limbs. She has mild to moderate varicose veins. She has been on antihypertensive drug (Candesartan, 8 mg PM), Atorvastatin 10 mg and Aspirin-50 mg once a day. She also took vitamin B-complex off and on. She was a known case of Primary Hypothyroidism and has been on Thyroid replacement therapy for more than 25 years. Vitamin MK-7 was taken p.o. every day in 100 μg per day dosage. Hyper pigmentation and the paper-money skin gradually reduced to a bare minimum. On discontinuation for a few months the skin changes reappeared. She went back to taking of MK-7. Within a few days time she started observing diminution of the pigmentation. She continues to follow life style where there is a daily walk of half an hour and avoidance of heavy fried or dense food. There were no major changes in diet or exercise during the period. Currently she continues to take the MK-7 in a daily dose of 100 μg per day. She had also experienced smoothness of skin of her feet, diminution of cracks in the feet and scalp hair-loss has stopped distinctly. These changes were observed independently and verbalized by her beautician also. 
     Example 06 
     Mrs. S. S. aged 78 years had complaint of severe leg cramps for the past 10 to 12 years. She described that her pain in legs was excruciating that accompanied her leg cramps. Frequency of the cramps was 4 to 5 times in a day and 2 to 3 times at night. These cramps were of long duration, between 10 to 30 minutes, and time gap between recurrences was variable. These cramps woke her up from her sleep. Her daughter described this vividly. She said that her mother had to stretch her leg this way and that way but nothing relieved her cramps. She said usually a cramp gets terminated once you flex/extend the cramped part and change positions or cover with a blanket or so. But none such measure or pain killers or multivitamin or drinking electoral (hydrating fluids) relieved her severe cramps. On 12 Apr. 2007 she started taking MK-7 in a dose of 100 μg two times a day. Some positive effect was noticed in the severity of the cramps during the first nine days but cramps were present. After this for three days there were no cramps but very next day when there was physical strain (climbing of stairs, long time standing and had to walk) she relapsed into two days with severe cramps in both the legs for half an hour at a stretch. From here on cramps occurred off and on until 5th of May 2007. After the 5 th  May there were no cramps except occasionally when there was severe physical strain due to climbing of the stairs or walking long distances or standing for a long time. As she continued taking MK-7 not only the frequency and duration as well as the severity of her cramps decreased but also triggering factors (long time standing, climbing stairs etc.) had less impact. She had taken the vitamin till August 2007. After stopping MK-7 there were no cramps for the next six days. After that the cramps restarted but with less severity, time duration, and there were no more than 4 times in 30 days. She was more than happy to have obtained MK-7 again and restart at the end of 30 days and continues with a dose of 100 μg two times a day and enjoys cramp free days and nights. 
     Example 07 
     Sixty Four year old, female Homoeopathic Physician had complained of darkening of skin of her face and exposed parts of her arms and neck about 3 years ago. This hyperpigmentation deepened over time and she noticed that burning and itching got worse as the pigmentation increased. From March 2007 she felt cosmetically so compromised as to lose confidence and felt embarrassed and socially defendant. She has not had any chronic disease like diabetes mellitus or hypertension. She has been having chronic insomnia for several years. There is no history of any medication other then occasional intake of homeopathy medicine for minor complaints of cold or cough. She took homeopathic medicine for 4 months for her hyper pigmentation. She noticed that though burning and itching had decreased there was no change in her hyper pigmentation. At this stage she received MK-7 in a dose of 100 μg twice a day. Hyper pigmentation decreased after 2 to 3 months of intake of the vitamin. She continued the medication for another 3 months and noticed that there was considerable lightening of the skin. She stopped taking the vitamin after a total duration of intake of 6 months. Pigmentation darkened gradually once again on withdrawal of MK-7. Currently she is on the medication again for the past one month where she has found a noticeable change in her skin with lightening of hyper pigmented areas. 
     Example 08 
     Female, age 32 years ethnic American, with no other known medical conditions except for cramps. She is an athlete and jogger and runs marathon. She would experience cramps few hours after the marathon. In March 2008, we put her on 200 μg per day of MK-7. After starting on treatment within 2 months, she observed that her severity of cramps was lowered. Serendipitously over a period of 2 months, she also observed that her nail grows faster and her trimming time reduced. Further she found similar effect in the hair growth. 
     Example 09 
     Female aged 68 yrs, with a history of colitis at the age of 17 yrs and got cured at the age of 18 by nature-cure treatment. Had undergone 3 caesarian sections in the year 1970, 1971, and in 1972. In the year 1979, she was suffering from intestinal obstruction because of which she could not have even consumed 2 table spoon of water, and got operated. In the year 2000 again operated for gall Bladder. In the year 2006 February, detected to have Intestinal T.B. Detected as a diabetic in 1997 and then onward on the glycol red plus three times a day. She is also taking two Tab. Nurobian per day and one tab. of folic acid per day. She was experiencing the symptoms of residual neuropathy such as tingling, numbness, paresthesiae, burning sensation. MK-7, 100 μg per day: within 15 days reduces gradually and disappears completely. MK-7 was stopped after 2 months and was under observation then after. She observed that tingling and numbness returned within 1 week. 
     Example 10 
     Male aged 64 complaining of angina problem controlled by Nattokinase and found that there was good control in Hypertension as well as in cardiac pain. He is taking Nattokinase form last three years two capsule per day 50 mg. He takes general vitamins from last 10 years suffering from restless legs syndrome every night and sometime during the day also. He used to get attack of restless legs syndrome at any time. He then started taking MK-7 200 μg per day from last 1 year. After starting with MK-7 within 2 weeks restless legs syndrome reduced considerably and now it is once or twice a month. 
     Pharmacological Antagonism: In Vitro Studies in Smooth and Skeletal Muscle 
     Example 11 
     Muscle Relaxant Activity Against Known Agents 
     Muscle relaxant activity was evaluated of pure test samples PK and MK-4 with Frog Rectus Abdominus Muscle and Guinea Pig ileum. 
     Methodology 
     A) Guinea Pig Ileum 
     To evaluate the effect of test samples on smooth muscle contraction induced by (a) Acetylcholine (Neurotransmitter) which acts on nicotinic receptors, (b) Histamine that causes a transient rise of cytosolic calcium, which is mediated by H1 receptor coupling that triggers release of internal calcium stores and (c) Barium that enters the cell through a voltage dependent calcium channel and, either directly or indirectly, interacts with calmodulin. 
     B) Frog Rectus Abdominus Muscle Preparation 
     To evaluate the effect of test samples on skeletal muscle contraction induced by Acetylcholine (Neurotransmitter). 
     A) Guinea Pig Ileum 
     Acetylcholine: 50 μg/ml 
     Test Samples were PK-400 μg/ml and MK-4-400 μg/ml 
     Conclusion: The compound MK-4 exhibited 21.62%, 40% and 81.81% inhibition of acetylcholine induced smooth muscle contraction at the dose of 80 μg (0.2 ml), 160 μg (0.4 ml) and 320 μg (0.8 ml ) respectively. The compound PK exhibited 38.46% and 46.15% inhibition of acetylcholine induced smooth muscle contraction at the dose of 320 μg (0.8 ml) and 640 μg (1.6 ml) respectively ( FIG. 1 ). 
     Barium Chloride: 1% 
     Test Samples were PK-400 μg/ml and MK-4-400 μg/ml 
     Conclusion: Test sample PK and MK-4 exhibited 31% and 29% inhibition of barium chloride induces smooth muscle contraction respectively at the dose of 640 μg (1.6 ml) ( FIG. 2 ). 
     Histamine: 25 μg/ml 
     Test Samples were PK-400 μg/ml and MK-4-400 μg/ml 
     Conclusion: The test compounds MK-4 and PK exhibited 29.4% and 37.16% inhibition of histamine induced smooth muscle contraction respectively at the dose of 640 μg (1.6 ml) ( FIG. 3 ). 
     B) Frog Rectus Abdominus Muscle Preparation 
     Acetylcholine: 100 mcg/ml 
     Test Samples were PK-400 μg/ml and MK-4-400 μg/ml 
     Conclusion: Contraction induced by acetylcholine (40 μg) was not antagonized by PK and MK-4 at the dose of 400 μg. As 80 μg of Acetylcholine could only marginally increase the amplitude of contraction as compared to 40 μg of Acetylcholine. This in vitro study may not be extrapolated to in vivo situation, as vitamin K being a fat soluble substance. Refer to  FIG. 4 . 
     Example 12 
     Frog Heart 
     Adrenaline: 40 μg/ml 
     Conclusion: 
     The test sample PK at 0.1 ml (40 μg), 0.2 ml (80 μg) and 0.4 ml (160 μg) failed to inhibit adrenaline-induced contractions ( FIG. 5 ). However Propanolol a competitive inhibitor of adrenaline was found to inhibit adrenaline response ( FIG. 6 ). 
     The test sample MK-4 at 0.1 ml (40 μg), 0.2 ml (80 μg) and 0.4 ml (160 μg) failed to inhibit adrenaline induced contractions ( FIG. 5 ). However propanolol a competitive inhibitor of adrenaline was found to inhibit adrenaline response ( FIG. 6 ). 
     Inference:
         The data accumulated reveal that the test compounds PK and MK-4 demonstrate a smooth muscle relaxant activity.   However, both the compounds failed to exhibit activity on skeletal muscle contraction.   The test samples did not show inhibition of the adrenalic (beta receptor agonist) response, which indicated that both PK and MK-4 do not exhibit beta blocker activity. Thus suggesting that the peripheral perfusion effect is not due to a reduction in the arteriolar tone viz. decreasing peripheral resistance.   Mechanism of action studies revealed that both PK and MK-4 could be demonstrating muscle relaxant activity via chelating the calcium ions and by blocking the calcium channels.       

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