Vascular permeability factors (PF/Nat and PF/Dil)--their relationship to Hageman factor and the kallikrein-kinin system

Hereditary angioedema: a current state-of-the-art review, II: historical perspective of non-histamine-induced angioedema

OBJECTIVE

To review the evolution of our understanding of hereditary angioedema (HAE) from the first historical reference to the present day.

DATA SOURCES

MEDLINE and PubMed were searched using the following keywords: history of HAE, C1 inhibitor, complements system, genetics of HAE, mechanisms of HAE, and treatment of HAE.

STUDY SELECTION

Information was selected that outlines the advances made in complementology, the first report of HAE, and subsequent studies that elucidated the underlying mechanisms of this disease, leading to current therapy of this orphan disease.

RESULTS

Generational research efforts in HAE have focused on the following: (1) several new clinical presentations, (2) acquired forms of non-histamine-induced angioedema, (3) the genetic basis for the inherited forms, (4) the effects of C1 inhibitor on contact phases of coagulation-fibrinolytic pathways, and (5) various therapies for short- and long-term control of the disease.

CONCLUSION

The progress made in understanding the pathogenesis and treatment of HAE is an excellent example of the "bench to the bedside" paradigm involving the collaboration between clinicians and researchers.

Roles for the kallikrein-kinin system in inflammatory exudation and pain: lessons from studies on kininogen-deficient rats

Roles for the kallikrein-kinin system in inflammation have been investigated extensively, and many reviews on this topic have been published during the 50 years since the discovery of bradykinin in 1949. Recent progress in the field has been remarkable with the help of experiments using gene-targetted transgenic or knockout mice, which have added further valuable information in addition to previous results obtained from pharmacological and biochemical studies using purified and isolated components of the system. Furthermore, much knowledge has been accumulated as a result of the development of various bradykinin agonists and antagonists. In this review, we focused on the data obtained from the kininogen-deficient rat, which is a natural mutant, and discuss the results in comparison with those from bradykinin receptor knockout mice. These data have clarified that endogenous bradykinin exerts a most important role in inflammatory exudation along with prostanoids, preferentially to histamine, serotonin, or neuropeptides. In inflammatory pain perception also, bradykinin produced in the local perivascular spaces stimulates polymodal pain receptors in conjunction with co-helpers such as prostanoids, vanilloids, and neuropeptides. These important roles are concluded based on consistent results obtained from experiments using several antagonists of bradykinin, kininogen-deficient rats, and bradykinin receptor knockout mice.

Assay of factors of the kinin system in plasma from patients with specific exogenous allergies

Factors of significance for the release of kinin were estimated in plasma from patients with specific, exogenous allergies and in that from healthy individuals. There was no evidence that the rapid initial kinin release in plasma from allergic patients caused by submaximum concentrations of hog pancreas kalikrein or by acetone-activated human plasma (2) was due to an increased level of prekallikrein activator (activated factor XII), to prekallikrein itself or to a factor possibly positioned between active factor XII and prekallikrein. In addition, the rapid halt in kinin release observed for the patient plasma could not be ascribed to an increased level of alpha2-macroglobulin, CI-inactivator or alpha1-antitrypsin. It is suggested that the differences in kinin release registered between the patient plasma and the normal plasma might reflect differences in the relative amounts of kininogen fractions present.

Inhibition of kinin formation by a kallikrein inhibitor during extracorporeal circulation in open-heart surgery

Involvement of the kinin system was studied in 58 patients during extracorporeal circulation in open heart surgery. At the onset of extracorporeal circulation, there was no increase of free kinin in blood and no reduction of plasma kininogen, when the latter was expressed as mug bradykinin/mg plasma protein. With the lapse of time, kinin in the blood increased significantly, and decrease of kininogen was also significant. The longer the circulation time, the greater the consumption of kininogen. The site of the kinin formation was presumed to be the heart-lung machine since the level of kinin increased slightly and kininogen decreased gradually in the blood leaving the machine, compared with those levels entering the machine. The difference in kininogen was significantly different from zero at termination of extracorporeal circulation. Administration of a kallikrein-trypsin inhibitor, trasylol (A. G. Bayer), infused into the heart-lung machine, prevented the decrease of kininogen. Reduction of the total peripheral resistance during this circulation was also prevented. The hemoconcentration, presumably the result of vascular permeability increase caused by increased kinin, was prevented by trasylol in cases in which extracorporeal circulation lasted over 60 minutes. Trasylol applied thus appears to be an effective counteragent for circulatory disturbances which occur during extracorporeal circulation.