title: Assembly and activation of the plasma kallikrein/kinin system: a new interpretation.
abstract: Understanding the importance and physiologic activity of the plasma kallikrein/kinin system (KKS) has been thwarted by the absence of an inclusive theory for its assembly and activation. The contact activation hypothesis describes the assembly and activation of this system in test tubes and disease states, but not under physiologic circumstances. Recent investigations have indicated a new cohesive hypothesis for understanding physiologic activation of this system. Prekallikrein (PK) and factor XI (FXI) through high molecular weight kininogen (HK) assemble on a co-localized, multiprotein receptor complex on endothelial cells that consists of at least cytokeratin 1 (CKI), gClqR, and urokinase plasminogen activator receptor (muPAR). When assembled on these proteins, prekallikrein becomes activated to kallikrein by the membrane-expressed enzyme prolylcarboxypeptidase (PRCP). Formed kallikrein then activates factor XII (FXII) for amplification of its activation and single chain urokinase. The plasma kallikrein/kinin system may serve as a physiologic counterbalance to the plasma renin angiotensin system (RAS) by lowering blood pressure and preventing thrombosis. Insights into the integrated role of these two systems may afford the development of novel therapeutic drugs to manage hypertension and thrombosis.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0640, USA.
authors.forename: Zia
authors.initials: Z
authors.lastname: Shariat-Madar
authors.forename: Fakhri
authors.initials: F
authors.lastname: Mahdi
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Schmaier
mesh_terms: D000818:Animals; D001665:Binding Sites; D001667:Binding, Competitive; D002462:Cell Membrane / Q000378:metabolism / Q000502:physiology; D004727:Endothelium / Q000166:cytology / Q000378:metabolism / Q000502:physiology*; D005172:Factor XI / Q000378:metabolism / Q000502:physiology; D005174:Factor XII / Q000378:metabolism / Q000502:physiology; D006801:Humans; D016234:Kallikrein-Kinin System / Q000187:drug effects / Q000502:physiology*; D019679:Kininogen, High-Molecular-Weight / Q000378:metabolism / Q000502:physiology; D017038:Mannosyl-Glycoprotein Endo-beta-N-Acetylglucosaminidase; D020842:Plasma Kallikrein / Q000378:metabolism* / Q000502:physiology; D011288:Prekallikrein / Q000378:metabolism / Q000502:physiology
chemical_list: D019679:Kininogen, High-Molecular-Weight; D005174:Factor XII; D005172:Factor XI; D011288:Prekallikrein; D017038:Mannosyl-Glycoprotein Endo-beta-N-Acetylglucosaminidase; D020842:Plasma Kallikrein