Bradykinin: Inflammatory Product of the Coagulation System.
Episodic and recurrent local cutaneous or mucosal swelling are key features of angioedema. The vasoactive agents histamine and bradykinin are highly implicated as mediators of these swelling attacks. It is challenging to assess the contribution of bradykinin to the clinical expression of angioedema, as accurate biomarkers for the generation of this vasoactive peptide are still lacking. In this review, we will describe the mechanisms that are responsible for bradykinin production in hereditary angioedema (HAE) and the central role that the coagulation factor XII (FXII) plays in it. Evidently, several plasma parameters of coagulation change during attacks of HAE and may prove valuable biomarkers for disease activity. We propose that these changes are secondary to vascular leakage, rather than a direct consequence of FXII activation. Furthermore, biomarkers for fibrinolytic system activation (i.e. plasminogen activation) also change during attacks of HAE. These changes may reflect triggering of the bradykinin-forming mechanisms by plasmin. Finally, multiple lines of evidence suggest that neutrophil activation and mast-cell activation are functionally linked to bradykinin production. We put forward the paradigm that FXII functions as a 'sensor molecule' to detect conditions that require bradykinin release via crosstalk with cell-derived enzymes. Understanding the mechanisms that drive bradykinin generation may help to identify angioedema patients that have bradykinin-mediated disease and could benefit from a targeted treatment.
Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.|Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Zonne
Z
Hofman
Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Steven
S
de Maat
Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
C Erik
CE
Hack
Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. c.maas-4@umcutrecht.nl.
Coen
C
Maas
D000799:Angioedema / Q000097:blood / Q000209:etiology / Q000378:metabolism; D000818:Animals; D015415:Biomarkers; D001777:Blood Coagulation; D001920:Bradykinin / Q000378:metabolism*; D004789:Enzyme Activation; D005174:Factor XII / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D008407:Mast Cells / Q000276:immunology / Q000378:metabolism; D018375:Neutrophil Activation / Q000276:immunology; D009504:Neutrophils / Q000276:immunology / Q000378:metabolism; D010958:Plasminogen / Q000378:metabolism
D015415:Biomarkers; D018836:Inflammation Mediators; D005174:Factor XII; D010958:Plasminogen; D001920:Bradykinin
Angioedema; Bradykinin; D-dimer; Factor XII; HAE; Histamine; Plasmin