Quantification of human high molecular weight kininogen by immunoblotting with a monoclonal anti-light chain antibody

The Search for Biomarkers in Hereditary Angioedema

The unpredictable nature of attacks of tissue swelling in hereditary angioedema requires the identification of reliable biomarkers to monitor disease activity as well as response to therapy. At present, one can assess a C4 level (by ELISA) to assist in diagnosis but neither C4 nor C1 inhibitor levels reflect clinical course or prognosis. We will here review a collection of plasma proteins involved in blood coagulation, fibrinolysis, and innate immunity (Figure 1). A main focus is those proteins that are key to the formation of bradykinin (BK); namely, factor XII, plasma prekallikrein/kallikrein, high-molecular weight kininogen, and BK itself since overproduction of BK is key to the disease. Considerations include new approaches to measurement of active enzymes, ELISA methods that may supersede SDS gel analysis of bond cleavages, and examples of changes outside the BK cascade that may reflect when, where, and how an attack of swelling is initiated. We will discuss their usefulness as biomarker candidates, with pros and cons, and compare the analytical methods that are being developed to measure their levels or activity.

An essential role of high-molecular-weight kininogen in endotoxemia

High-molecular-weight kininogen (HK) is a plasma protein. Yang et al. show that HK binds LPS and supports endotoxemia. Blockade of their binding attenuates circulating LPS level. Therefore, HK is essential for endotoxemia and is a new target for LPS clearance and sepsis treatment.

In this study, we show that mice lacking high-molecular-weight kininogen (HK) were resistant to lipopolysaccharide (LPS)-induced mortality and had significantly reduced circulating LPS levels. Replenishment of HK-deficient mice with human HK recovered the LPS levels and rendered the mice susceptible to LPS-induced mortality. Binding of HK to LPS occurred through the O-polysaccharide/core oligosaccharide, consistent with the ability to bind LPS from K. pneumoniae, P. aeruginosa, S. minnesota, and different E. coli strains. Binding of LPS induced plasma HK cleavage to the two-chain form (HKa, containing a heavy chain [HC] and a light chain [LC]) and bradykinin. Both HKa and the LC, but not the HC, could disaggregate LPS. The light chain bound LPS with high affinity (K_d = 1.52 × 10⁻⁹ M) through a binding site in domain 5 (DHG15). A monoclonal antibody against D5 significantly reduced LPS-induced mortality and circulating LPS levels in wild-type mice. Thus, HK, as a major LPS carrier in circulation, plays an essential role in endotoxemia.

Human plasma protein N-glycosylation

Glycosylation is the most abundant and complex protein modification, and can have a profound structural and functional effect on the conjugate. The oligosaccharide fraction is recognized to be involved in multiple biological processes, and to affect proteins physical properties, and has consequentially been labeled a critical quality attribute of biopharmaceuticals. Additionally, due to recent advances in analytical methods and analysis software, glycosylation is targeted in the search for disease biomarkers for early diagnosis and patient stratification. Biofluids such as saliva, serum or plasma are of great use in this regard, as they are easily accessible and can provide relevant glycosylation information. Thus, as the assessment of protein glycosylation is becoming a major element in clinical and biopharmaceutical research, this review aims to convey the current state of knowledge on the N-glycosylation of the major plasma glycoproteins alpha-1-acid glycoprotein, alpha-1-antitrypsin, alpha-1B-glycoprotein, alpha-2-HS-glycoprotein, alpha-2-macroglobulin, antithrombin-III, apolipoprotein B-100, apolipoprotein D, apolipoprotein F, beta-2-glycoprotein 1, ceruloplasmin, fibrinogen, immunoglobulin (Ig) A, IgG, IgM, haptoglobin, hemopexin, histidine-rich glycoprotein, kininogen-1, serotransferrin, vitronectin, and zinc-alpha-2-glycoprotein. In addition, the less abundant immunoglobulins D and E are included because of their major relevance in immunology and biopharmaceutical research. Where available, the glycosylation is described in a site-specific manner. In the discussion, we put the glycosylation of individual proteins into perspective and speculate how the individual proteins may contribute to a total plasma N-glycosylation profile determined at the released glycan level.

Aspect multifactoriel des effets secondaires aigus des inhibiteurs de l′enzyme de conversion de l′angiotensine

Angiotensin converting enzyme inhibitors are a class of drugs successfully used in the treatment of cardiovascular diseases. Despite their effectiveness, treatment with these drugs is characterized by chronic and acute side effects with variable expression depending on the clinical context. Angioedema occurs in patients with hypertension or heart failure. Anaphylactoid reaction is also reported in hemodialysis patients and severe hypotensive reaction in patients receiving transfused blood products and plasmapheresis. In this paper, we describe the role of kinins and metallopeptidases in the pathophysiology of these acute side effects. We also propose different experimental and clinical evidences which plead for an ecogenetic nature of these rare but life-threatening events.

The kallikrein-kinin system: current and future pharmacological targets

The kallikrein-kinin system is an endogenous metabolic cascade, triggering of which results in the release of vasoactive kinins (bradykinin-related peptides). This complex system includes the precursors of kinins known as kininogens and mainly tissue and plasma kallikreins. The pharmacologically active kinins, which are often considered as either proinflammatory or cardioprotective, are implicated in many physiological and pathological processes. The interest of the various components of this multi-protein system is explained in part by the multiplicity of its pharmacological activities, mediated not only by kinins and their receptors, but also by their precursors and their activators and the metallopeptidases and the antiproteases that limit their activities. The regulation of this system by serpins and the wide distribution of the different constituents add to the complexity of this system, as well as its multiple relationships with other important metabolic pathways such as the renin-angiotensin, coagulation, or complement pathways. The purpose of this review is to summarize the main properties of this kallikrein-kinin system and to address the multiple pharmacological interventions that modulate the functions of this system, restraining its proinflammatory effects or potentiating its cardiovascular properties.

Effect of Neurotropin on the activation of the plasma kallikrein-kinin system

Bradykinin (BK), an important mediator of allergic reactions and pain induction, is released by the activation of the plasma kallikrein-kinin (K-K) cascade. Neurotropin is a biological material obtained from inflamed rabbit skin inoculated with vaccinia virus and is widely used clinically in Japan as an effective agent for these disorders. Since its mechanism of action is not clearly known, we have investigated the effects of Neurotropin on the human plasma K-K system. In dextran sulfate-activated plasma, Neurotropin inhibited the formation of BK, the cleavage of high molecular weight kininogen (HK) and the formation of kallikrein-C1 inhibitor and activated coagulation factor XII (FXIIa)-C1 inhibitor complexes. Experiments using purified enzyme of the K-K cascade indicated that Neurotropin inhibited surface-mediated activation of coagulation factor XII (FXII) and the activation of prekallikrein by FXIIa. Neurotropin also inhibited the binding of FXII and HK to the activating surface. These data suggest that the ameliorating effects of Neurotropin in allergic disorders and pain syndromes may be related to this ability to inhibit activation of the K-K cascade and consequently the formation of BK.

Contact activation factors in plasma from women using oral contraceptives--increased levels of factor XII, kinin-free high molecular weight kininogen and acetone-activated kallikrein

The plasma levels of FXII, prekallikrein (PK) and high- and low molecular weight kininogens (HK and LK) were measured in women on low estrogen dose (30-40 micrograms ethinylestradiol) oral contraceptives (OC) and in controls. FXIIa was assayed in acetone-treated citrated plasma (CPL) with PK and the tetrapeptide S-2222 as substrates, and in acetone-treated citrated plasma with benzamidine (BPL) with PK as substrate. The level of FXII was found to be about 20% higher in OC-plasma than in control plasma. Kallikrein was assayed in CPL with S-2222 as substrate and in BPL with the tripeptide S-2302 as substrate. No difference in PK-level was observed in the CPL-based method, whereas an increase in kallikrein activity of about 30% was registered in BPL. The levels of HK and LK were estimated both in rocket immunoassay and in bioassay of released kinin. No difference in HK-level could be registered in immunoassay, whereas the bioassay revealed a HK-level in OC-plasma of 40% of the control level. Immunoblot studies showed that a substantial part of HK in OC-plasma was present as kinin-free protein (mol. wt. 103 KD), assumed to possess a higher cofactor potency than that of native HK. Both in bioassay and immunoassay the level of LK was found to be 60% higher in OC-plasma than in control plasma. Considered together the observations on contact factors made in this study provide support for the assumption of an increased readiness for contact activation in plasma from women using OC.