Journal of Thrombosis and Haemostasis, 5: 2323–2329
The plasma kallikrein–kinin system: its evolution from contact
A . H . S C H M A I E R and K . R . M C C R A E
Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University and University Hospitals Case Medical Center,
Cleveland, OH, USA
To cite this article: Schmaier AH, McCrae KR. The plasma kallikrein–kinin system: its evolution from contact activation. J Thromb Haemost 2007; 5:
review will outline physiologic activities of the plasma KKS
Summary. The plasma kallikrein–kinin system consists of the that are not emphasized in other recent reviews [1,2].
proteins factor XII (FXII), prekallikrein (PK), and high FXII deﬁciency (Hageman trait) was discovered by Ratnoff
molecular weight kininogen. It was ﬁrst recognized as a sur- and Colopy in an individual who had prolonged blood clotting
face-activated coagulation system that is activated when blood times without bleeding . Activation of FXII results in FXI
or plasma interacts with artiﬁcial surfaces. Although surface- activation, giving rise to the coagulation cascade . As result
activated contact activation occurs in vivo in the case of tissue of elucidating non-FXII-deﬁcient etiologies for isolated pro-
destruction or a developing thrombus, the physiologic basis for longed activated partial thromboplastin times (APTT), plasma
the activation and function of this system has not been PK and HK were discovered [5,6]. These proteins inﬂuence the
delineated. New investigations indicate that there is a proteo- 200 million surface-activated coagulation tests, APTTs and
lytic pathway on cells for PK activation independent of FXII. activated clotting times performed annually in the USA. New
This pathway for PK with subsequent FXII activation indicates interest in FXII has arisen since it has been observed that FXII-
physiologic activities. These activities include blood pressure deﬁcient mice have reduced thrombus compared to the wild
regulation and modulation of thrombosis risk independently of type . Furthermore, bradykinin (BK) B2 receptor (B2R)-
hemostasis. Furthermore, they include regulation of endothelial deﬁcient mice also have reduced thrombosis risk . C1 esterase
cell proliferation, angiogenesis and apoptosis through a cellular- inhibitor (C1INH), the SERPIN inhibitor of the enzymes of
based, outside-in signaling system. The present characteriza- this system, accounts for 90% of inhibition of FXIIa and 50%
tions of this system, which incorrectly had been thought to of inhibition of plasma kallikrein [9,10] (Table 2). Although
initiate coagulation, represent an evolution of understanding in plasminogen activator inhibitor-1 and protein C inhibitor,
this ﬁeld. mole for mole, may be more potent inhibitors of plasma
kallikrein than C1INH, the intravascular concentration of
Introduction C1INH is highest, making it the most important (Table 2).
C1INH deﬁciency is the etiology of hereditary angioedema, a
Appreciation of the plasma kallikrein–kinin system (KKS) has
disorder associated with unregulated BK formation, producing
grown. The KKS consists of two zymogens, factor XII (FXII)
secondary angioedema in humans and mice .
and prekallikrein (PK), and one substrate/cofactor, high
molecular weight kininogen (HK) (Table 1). These proteins
inﬂuence surface-activated in vitro coagulation assays, but Contact activation of FXII and the proteins of the plasma
deﬁciencies are not associated with bleeding. Recent studies KKS
indicate activities in vascular biology, including modulation of
The three proteins (FXII, PK, and HK) of the plasma KKS are
thrombosis risk independently of blood coagulation. This
called Ôcontact factorsÕ because, until recently (see next section),
there was no known mechanism for their initiation of activation
other than FXII autoactivation on surfaces [2,3]. Autoactiva-
Correspondence: Alvin H. Schmaier, Case Western Reserve
tion is the event where zymogen FXII becomes an enzyme in the
University, University Hospital Case Medical Center, Division of
presence of a negatively charged surface, a process twentynine-
Hematology and Oncology, 10900 Euclid Avenue WRB2-130,
Cleveland, OH 44106-7284, USA.
fold less efﬁcient than activation by plasma kallikrein 
Tel.: +1 216 368 1172; fax: +1 216 368 3014; e-mail: (Table 1). The biochemistry of this phenomenon is not under-
email@example.com stood, but recent studies using sum frequency generation
vibrational spectroscopy indicate that FXII autoactivation at
Received 3 August 2007, accepted 14 September 2007 the molecular level occurs by imposing speciﬁc orientation and
Ó 2007 International Society on Thrombosis and Haemostasis
2324 A. H. Schmaier and K. R. McCrae
Table 1 Enzymes/substrates of the plasma kallikrein–kinin system
Enzyme Substrate Kinetics Reference
a-Factor (F) XIIa Prekallikrein 1.8 lM Km; kcat/Km = 0.57 lM 
FXI – 
Complement C1 – 
FVII – 
Plasminogen – 
High-Mr kininogen – 
b-FXIIa Prekallikrein 2.1 lM Km; kcat/Km = 1.67 lM 
Autoactivation of FXII FXII 2.4 lM Km; kcat/Km = 0.02 lM 
Plasma kallikrein FXII 11 lM Km; kcat/Km = 0.57 lM 
Single-chain urokinase 0.064 lM Km 
High-Mr kininogen 1.4 lM Km; kcat/Km = 0.46 lM 
Prolylcarboxypeptidase Prekallikrein 0.007 lM Km 
Table 2 Inhibitors of the enzymes of the plasma kallikrein–kinin system independently of HK [22–24]. FXI also binds to prothrombin
Enzyme Inhibitor Inhibition constant+ Reference and the glycoprotein Iba–IX–V complex on platelets [24,25].
Membrane-binding proteins of HK include gC1qR, urokinase
a-Factor C1 inhibitor 222.0 · 103 M)1 min)1  plasminogen activator receptor (u-PAR), and cytokeratin 1
(F) XIIa a2-Antiplasmin 11.0 · 103 M)1 min)1 
(CK1) (Fig. 1) [26–29]. When HK is proteolyzed by plasma
a2-Macroglobulin 5.3 · 103 M)1 min)1 
Antithrombin 1.3 · 103 M)1 min)1  kallikrein or other proteases to form cleaved HK (HKa),
Plasma C1 inhibitor 102.0 · 104 M)1 min)1  membrane tropomysin also functions as a binding site uniquely
kallikrein a2-Macroglobulin 69.0 · 104 M)1 min)1  for this form of kininogen . FXII also has been shown to
Antithrombin 1.8 · 104 M)1 min)1  bind to gC1qR, u-PAR, and CK1 [27,31]. Both PK and FXI
a1-Antitrypsin 0.025 · 104 M)1 min)1 
circulate in plasma almost completely bound to HK, but PK
PAI-1 360.0 · 104 M)1 min)1 
Protein C inhibitor 600.0 · 104 M)1 min)1  binding to endothelial cells predominates . The reasons for
this are as follows: (i) the concentration of PK (450 nM) is more
PAI-1, plasminogen activator inhibitor-1.
+ than tenfold greater than that of FXI (30 nM) in plasma; and
The values are second-order rate constants.
(ii) the free Zn2+ concentration required for PK binding is only
0.3 lM, whereas that for FXI binding is 7 lM .
ordering of the adsorbed protein molecules that lead to When HK and PK assemble on endothelial cells and matrix,
expression of its active site . Negatively charged surfaces plasma kallikrein activity arises independently of added FXIIa.
consist of artiﬁcial materials as found in coagulation assays such This event occurs in the presence of neutralizing antibody to
as kaolin, celite, and glass surfaces. Several physiologic
substances, such as articular cartilage, skin, fatty acids, endo-
toxin, sodium urate crystals, calcium pyrophosphate, L-homo-
cysteine, hematin, protoporphyrin, sulfatides, heparins,
chondrotin sulfates, and amyloid b-protein, also support
autoactivation of FXII. Formation of activated FXII by
autoactivation results in PK activation with reciprocal activa-
tion of FXII and PK and activation ampliﬁcation of the system.
In vivo, FXII autoactivation occurs on developing thrombus,
contributing to its extent . Substances that contribute to
Ôcontact activationÕ on a developing thrombus include RNA
from degrading cells, polysomes from platelet membranes, and
ﬁbrin itself [14,15]. FXII activation also occurs under conditions
of sepsis, where bacteria provide a negatively charged surface,
proteases to activate FXII, or a binding site [16,17].
Fig. 1. Physiologic assembly and activation of the plasma kallikrein–kinin
system. The high molecular weight kininogen (HK)–prekallikrein (PK)
Constitutive activation of the plasma KKS in the complex binds to its HUVEC receptor complex, which includes cytoker-
atin 1 (CK1), urokinase plasminogen activator receptor (u-PAR) and
intravascular compartment gC1qR. Prolylcarboxypeptidase (PRCP) bound to the complex activates
It has been recognized that HK, FXII and PK speciﬁcally, PK to form plasma kallikrein (KAL). The KAL cleaves HK and acti-
vates FXII and single-chain urokinase plasminogen activator (Scu-PA).
saturably and reversibly bind to endothelial cells, platelets Cleaved HK liberates bradykinin (BK), which is a potent activator of
and granulocytes [18–21]. HK serves as the major binding site tissue-type plasminogen activator (t-PA), NO (nitric oxide) and prosta-
for PK and FXI, although both bind to endothelial cells cyclin (PGI2) liberation from endothelial cells. HKa, cleaved HK.
Ó 2007 International Society on Thrombosis and Haemostasis
The changing kallikrein–kinin system 2325
FXII and FXII-deﬁcient plasma, but not PK-deﬁcient plasma
Vascular activities of the plasma KKS
[22,32]. The plasma kallikrein formed results in kinetically
favorable single-chain urokinase activation (Km = 64 nM) Regulation of blood pressure and ﬂow Local BK formation
(Table 1) . The plasma kallikrein on endothelial cells also is known to inﬂuence blood pressure. BK is liberated from HK
results in kinetically favorable FXII activation . These data by plasma or tissue kallikrein cleavage. The nine amino acid
provide an alternative hypothesis to contact activation for BK peptide, RPPGFSPFR, has two intravascular receptors:
FXIIa formation in vivo. The increased requirements for free B2R, which is constitutively expressed, and the BK B1 receptor
Zn2+ for FXII binding to endothelial cells suggest that FXIIÕs (B1R), which becomes expressed in inﬂammatory states. BK
association and activation on endothelial cells follows HK and binds to B2R, a seven-transmembrane G-protein-coupled
PK assembly and activation [24,31]. This proposed mechanism receptor, and stimulates its G-proteins to release nitric oxide
for PK activation in vivo may be occurring constitutively. (NO), prostaglandin I2 (prostacyclin), smooth muscle
Firstly, C1INH knockout mice have constitutive tissue edema hyperpolarization factor, and superoxide [43–46]. In sepsis,
due to increased BK, as it is blocked by a B2R antagonist or by excessive BK release contributes to hypotension.
mating C1INH and B2R knockout mice . As plasma BK BK produced by the plasma and tissue KKS inﬂuences
only arises from plasma kallikrein formation and C1INH only cardiovascular physiology. B2R knockout mice are not consti-
inhibits plasma kallikrein, not tissue kallikein, BK must be tutively hypertensive; however, upon being subjected to a salt
constantly formed in vivo to give the paw edema seen . load, they have early-onset salt-sensitive hypertension . B2R
Secondly, FXII knockout mice also have plasma BK formation is involved in the control of regional vascular tone in the coro-
without the presence of FXII . nary arteries and the kidneys. The cardioprotective effects of
A PK activator was puriﬁed from endothelial cells . On angiotensin-converting enzyme (ACE) inhibition, which inhibits
amino acid sequencing, it was identiﬁed as the serine protease BK degradation, is lost in B2R knockout mice. In diabetic mice,
prolylcarboxypeptidase (PRCP) . The Km of PRCP activa- the absence of B2R increases oxidative stress, mitochondrial
tion of plasma PK (Km = 7 nM) is two hundred and ﬁfty- to DNA damage, and senescence-associated phenotypes . In
three hundredfold higher than that for activated forms of FXII tissue kallikrein knockout mice, with reduced tissue BK
(Table 1). This suggests that PRCP activation of PK is favored formation, there is thinning of the septum and posterior wall
over that of a-FXIIa or b-FXIIa in vivo (Table 1). It is of note of the heart, resulting in ventricular dilatation and reduced left
that C1INH is a tighter inhibitor of plasma kallikrein than of ventricular mass . Furthermore, genetic kininogen deﬁciency
activated FXII, suggesting that plasma kallikrein regulation is in rats contributes to aortic aneurysm formation .
more important than that of FXIIa (Table 2). PRCP was ﬁrst
recognized as a degrading enzyme for BK and angiotensin II Thrombosis risk Emerging information indicates that the
(Ki 1 and 0.15 mM, respectively) by cleaving Pro-X bonds on plasma KKS inﬂuences thrombosis risk independently of
the C-terminus of the protein . Both puriﬁed and hemostasis [7,8]. Patients with FXII, PK and HK deﬁciency are
recombinant PRCP activate PK with a Km 7–17 nM exceedingly rare, and although they do not bleed, there are too
[35,37]. Although thought to be lysosomal in origin, PRCP is few patients to characterize a common clinical phenotype.
a membrane and matrix protein, as it can be demonstrated to be FXII deﬁciency is more common than HK or PK deﬁciency.
there functionally and immunochemically and it was interrupted Clinical investigations for venous thrombosis risk or on
by a gene trap targeted to membrane proteins [35,37–39]. PRCP polymorphisms of FXII and their inﬂuence on cardiovascular
is a risk factor for metabolic syndrome in men, and a PRCP disease have been conﬂicting (see below). The clearest
polymorphism is associated with pre-eclampsia in women information on thrombosis risk or risk amelioration has been
[40,41]. CHO cells with overexpressed PRCP have increased derived from animal models, which demonstrate unexpected
PK-activating activity over controls; treatment of these cells ﬁndings.
with small interfering RNA reduces the PK activation on these
cells . Finally, transfected CHO cells mostly express PRCP BK and kininogen BK infusion is a potent stimulant for tissue-
on their membranes. These combined studies indicate that there type plasminogen activator (t-PA) release in rabbits and humans
is a constitutive, physiologic endothelial cell mechanism for PK . Kininogen itself has been shown to have antithrombin
activation independent of FXII autoactivation by contact. activities. Both HK and low molecular weight kininogen at 5%
of their physiologic concentrations block thrombin-induced
platelet aggregation and serotonin release by inhibiting
Activities of the plasma KKS
thrombin binding to platelets . The thrombin inhibitory
The studies described above reveal a means for KKS assembly regions of kininogen have been associated with domains 3 and 4,
and activation by physiologic and pathophysiologic mecha- the BK region [53,54]. A peptide comprising the ﬁrst ﬁve amino
nisms. Several vascular and cellular activities derive from these acids of BK, RPPGF, was found to bind weakly to the active site
pathways. KKS vascular activities include regulation of blood of thrombin upon cocrystallization, and to bind the exodomains
pressure and ﬂow and thrombosis risk; the cellular activities of protease-activated receptor (PAR)1 and PAR4 to prevent
include cellular proliferation, growth, angiogenesis, apoptosis, thrombin cleavage [55,56]. RPPGF inhibits in vitro and, when
and inﬂammation. infused in dogs and humans, ex vivo thrombin-induced platelet
Ó 2007 International Society on Thrombosis and Haemostasis
2326 A. H. Schmaier and K. R. McCrae
aggregation [57,58]. RPPGF in pharmacologic doses prevents binds to the overexpressed angiotensin receptor 2 to increase
carotid artery thrombosis in mice and coronary artery NO and prostacyclin, and prolong the bleeding time of the
thrombosis in dogs [57,59,60]. animal  (Fig. 2). Thirdly, RPPGF is elevated in these animals,
As BK induces NO, prostacyclin and t-PA release from due to increased BK degradation by ACE . The elevation of
endothelial cells, we hypothesized that the B2R knockout mouse RPPGF levels may also contribute to the thrombosis protection.
would be prothrombotic. To our surprise, B2R knockout mice These combined studies indicate that BK and its receptor system
have delayed carotid artery occlusion times in the Rose Bengal indirectly inﬂuence thrombosis risk by inﬂuencing endothelial
model (Fig. 2) . The mechanism for thrombosis protection is cell biology through cross-talk with components of the plasma
dependent on this systemÕs interaction with the renin–angioten- RAS. Such a pathway for risk modiﬁcation of intra-arterial
sin system (RAS) . In the RAS, angiotensinogen is converted thrombosis has not been previously appreciated.
to angiotensin I by renin and then converted to angiotensin II by
ACE. ACE also is the major enzyme that degrades BK to BK FXII There are conﬂicts between human clinical and
1–5 (RPPGF) in the intravascular compartment (Fig. 2). experimental animal data for the role of FXII in thrombosis
Angiotensin II usually binds to angiotensin receptor 1 to induce risk. A polymorphism in FXII (46C/T) is associated with
vasoconstriction and salt retention, and elevate blood pressure. increased risk for arterial thrombosis [63–65]. Individuals
However, if angiotensin receptor 2 is overexpressed, angiotensin homozygous for the 46C/T polymorphism have lowered FXII
II will preferentially bind to it to induce vasodilatation and and FXIIa levels. Reduced activated forms of FXII may be
blood pressure reduction. The mechanism by which the B2R associated with reduced total ﬁbrinolytic activity, resulting in
knockout mice are protected from thrombosis is 3-fold. Firstly, increased thrombosis risk. This interpretation is opposite to
in the absence of B2R, angiotensin receptor 2 is overexpressed what is demonstrated in FXII-deﬁcient mice . FXII-deﬁcient
(Fig. 2). B2R and angiotensin receptor 2 colocalize in cells, and mice have reduced thrombus after induction of arterial clots
there is an as yet unrecognized mechanism whereby the presence [7,66]. The mechanism for the increased size of thrombus in
of one GPCR receptor regulates the expression of the other mice that have normal levels of FXII may be related to
[8,62]. Secondly, there is increased angiotensin II as a result of increased contact activation occurring on a developing platelet
reduced BK uptake into cells with reﬂexive increased ACE thrombus [14,15]. Therapeutic inhibition of FXII may result in
degradative activity  (Fig. 2). The increased angiotensin II reduced thrombus formation without bleeding. These
observations were not predicted by in vitro investigations on
the biochemistry and cell biology of FXII and clinical studies
on populations with polymorphisms or defects in FXII.
Cellular activities of the plasma KKS
Cell proliferation and angiogenesis Investigations have
shown that kininogen and related proteins inﬂuence cellular
activities of endothelial and other cells. These investigations
were prompted by the observation that HKa induces selective
apoptosis of proliferating endothelial cells and inhibits
angiogenesis [67,68]. HKa inhibits neovascularization of s.c.
planted Matrigel plugs, as well as ﬁbroblast growth factor
2-induced angiogenesis in the chick chorioallantoic membrane
Fig. 2. Mechanisms for thrombosis protection in bradykinin B2 receptor assay [67,68]. Moreover, peptides from domain 5 of HK (D5),
(B2R) knockout mice. In the absence of B2R, there is increased plasma which subsumes the HK cell-binding region, induce endothelial
bradykinin, as B2R accounts for 40% of the metabolism of bradykinin.
cell apoptosis, inhibit angiogenesis, and are antibacterial
Increased bradykinin results in increased conversion to bradykinin 1–5
(peptide RPPGF) (Blood 2006; 108: 192–99). As a byproduct of increased [69–71]. Kininogen-deﬁcient Brown Norway Katholiek rats,
RPPGF formation, there are increased levels of angiotensin II (Blood alternatively, display decreased angiogenesis, possibly resulting
2006; 108: 192–99). Angiotensin-converting enzyme (ACE) also converts from deﬁcient BK release that is ameliorated by a BK analog or
angiotensin I to angiotensin II. In the absence of B2R, there is increased kininogen replacement [72,73]. The mechanism(s) by which
expression of the angiotensin receptor 2 (AT2R). The increased angio-
these activities occur is not known, but may involve the anti-
tensin II is shunted to overexpressed AT2R, as angiotensin II has the same
binding aﬃnity for angiotensin receptor 1 and AT2R. This leads to a adhesive function of HKa towards cells on vitronectin, the
paradoxical eﬀect in comparison to the usual angiotensin II elevation. kininogen multiprotein receptor complex, or tropomyosin
Increased stimulation of AT2R produces vasodilatation and increased [30,74,75].
plasma nitric oxide (NO) and prostacyclin (PGI2) (Blood 2006; 108: 192–
99). The increased NO and PGI2 prolong the bleeding time, and these Outside-in signaling mediated by the KKS Although the
animals have delayed thrombosis risk on the Rose Bengal model for
carotid artery thrombosis. These investigations indicate that thrombosis proangiogenic activities of the KKS are mediated by B1R and
risk can be modiﬁed by factors independent of coagulation, ﬁbrinolytic or B2R, a different receptor system(s) may be involved in the
anticoagulant proteins. inhibition of cell proliferation, adhesion, anti-apoptosis and
Ó 2007 International Society on Thrombosis and Haemostasis
The changing kallikrein–kinin system 2327
angiogenesis. u-PAR has been shown to mediate intracellular 4 Ratnoﬀ OD, Davie EW. Waterfall sequence for intrinsic blood clot-
signaling. u-PA binding to u-PAR triggers a cascade of ting. Science 1964; 145: 1310–2.
5 Weuppers KD, Cochrane CG. Plasma prekallikrein:isolation, charac-
intracellular tyrosine phosphorylation that includes src-type
terization, and mechanism of action. J Exp Med 1972; 135: 1–20.
protein kinases, focal adhesion proteins, p38, and extracellular 6 Colman RW, Bagdasarian A, Talamos RC, Seavey M, Scott CF,
signal-related kinase 1/2 (ERK1/2) [76–78]. When HKa or D5 Kaplan AP. Williams trait. Human kininogen deﬁciency with dimin-
peptides bind to cultured endothelial cells after basic ﬁbroblast ished levels of plasminogen proactivator and prekallikrein associated
growth factor-induced cell proliferation, there is a reduction of with abnormalities of the Hageman factor-dependent pathways. J Clin
Invest 1975; 56: 1650–62.
cyclin D1 expression and an upregulation of Cdc2 and cyclin A
7 Renne T, Pozgajova M, Gruner S, Schuh K, Pauer HU, Burfeind P,
[79,80]. HKa also inhibits adhesion of endothelial cells to Gailani D, Nieswandt B. Defective thrombus formation in mice
vitronectin (90%) and gelatin (40%) without any effect on lacking coagulation factor XII. J Exp Med 2005; 280: 28572–80.
adhesion to ﬁbronectin, on which it induces endothelial cell 8 Shariat-Madar Z, Mahdi F, Warnock M, Homeister JW, Srikanth S,
apoptosis. Endothelial cell migration induced by sphingosine Krijanovski Y, Murphey LJ, Jaﬀa AA, Schmaier AH. Bradykinin B2
receptor knockout mice are protected from thrombosis by increased
1-phosphate and vascular endothelial growth factor is blocked
nitric oxide and prostacyclin. Blood 2006; 108: 192–9.
by HKa and D5 and may be associated with inhibition of 9 Pixley RA, Schapira M, Colman RW. The regulation of human
phosphorylation of phosphinositide 3 (PI3)-kinase-Akt and factor XIIa by plasma proteinase inhibitors. J Biol Chem 1985; 260:
glycogen synthase kinase (GSK)-3a . 1723–9.
u-PAR is known to upregulate Mac-1 adhesion to ﬁbrinogen, 10 Schapira M, Scott CF, Colman RW. Protection of human plasma
kallikrein from inactivation by C1 inhibitor and other proteases. The
and focal adhesion kinase (FAK) and mitogen-activated protein
role of high molecular weight kininogen. Biochemistry 1981; 20: 2738–
kinase are involved in this process . Furthermore, u-PAR 43.
binds vitronectin and HKa, and D5 disrupts u-PAR–integrin 11 Han ED, MacFarlane RC, Mulligan AN, Scaﬁdi J, Davis AE III.
and u-PAR–vitronectin interactions [74,83]. FXII activates Increased vascular permeability in C1 inhibitor-deﬁcient mice medi-
ERK1/2 in HEPG2 cells and cultured vascular smooth muscle ated by the bradykinin type 2 receptor. J Clin Invest 2002; 109: 1057–
cells . Vitronectin binds to the same region on u-PAR as HK,
12 Wiggins RC, Cochran CG. The autoactivation of rabbit Hageman
HKa, single-chain urokinase plasminogen activator (Scu-PA), factor. J Exp Med 1979; 150: 1122–33.
and FXII (unpublished) [75,85,86]. Preliminary studies indicate 13 Chen X, Wang J, Paszti Z, Wang F, Schrauben JN, Tarabara VV,
that Scu-PA or FXII upregulate ERK1/2 and Akt on cultured Schmaier AH, Chen Z. Ordered adsorption of coagulation factor XII
endothelial cells, whereas HKa and D5-derived peptides as well on negatively charged polymer surfaces probed by sum frequency gen-
eration vibrational spectroscopy. Anal Bioanal Chem 2007; 388: 65–72.
as peptides from domain 2 of u-PAR block this interaction .
14 Kannemeier C, Shibamiya A, Nakazawa F, Trusheim H, Ruppert C,
The upregulation of ERK1/2 and Akt is mediated by a Markart P, Song Y, Tzima E, Kennerknecht E, Niepmann M, von
b1-integrin, is independent of lipid rafts, and is associated with Bruehl ML, Sedding D, Massberg S, Gunther A, Engelmann B,
increased endothelial cell proliferation and incorporation of Preissner KT. Extracellular RNA constitutes a natural procoagulant
5-bromo-2¢-deoxy-uridine . A u-PAR-mediated signaling cofactor in blood coagulation. Proc Natl Acad Sci USA 2007; 104:
system may be the additional pathway leading to cell prolifer-
15 Smith SA, Mutch NJ, Baskar D, Rohloﬀ P, Docampo R, Morrissey
ation, growth and, perhaps, apoptosis and angiogenesis JH. Polyphosphate modulates blood coagulation and ﬁbrinolysis. Proc
modulated by HK and its cleavage products. Natl Acad Sci USA 2006; 103: 903–8.
16 Matsumoto K, Yamamoto T, Kamata R, Maeda H. Pathogenesis of
serratial infection: activation of the Hageman–prekallikrein cascade by
Acknowledgements serratial protease. J Biochem 1984; 96: 739–49.
17 Herwald H, Morgelin M, Olsen A, Rhen M, Dahlback B, Muller-
This work was supported in part by grants HL052779, Esterl W. Activation of the contact-phase system on bacterial surfaces
HL055709 and HL086038 to A. H. Schmaier, and grants is a clue to serious complications in factious disease. Nat Med 1998; 4:
HL076810, CA83134 and P50HL081011 to K. R. McCrae. 298–302.
18 Gustafson EG, Schutsky D, Knight L, Schmaier AH. High molecular
weight kininogen binds to unstimulated platelets. J Clin Invest 1986;
Disclosure of Conﬂict of Interests 78: 310–8.
19 Gustafson EJ, Schmaier AH, Wachtfogel YT, Kaufman N, Kucich U,
The authors state that they have no conﬂict of interest. Colman RW. Human neutrophils contain and bind high molecular
weight kininogen. J Clin Invest 1989; 84: 28–25.
20 Schmaier AH, Kuo A, Lundberg D, Murray SC, Cines DB. Expres-
References sion of high molecular weight kininogen on human umbilical vein
endothelial cells. J Biol Chem 1988; 263: 16327–33.
1 Sainz IM, Pixley RA, Colman RA. Fifty years of research on the
21 Reddigari SR, Shibayama Y, Brunnee T, Kaplan AP. Human Hag-
plasma kallikrein–kinin system: from protein structure and function to
eman factor (factor XII) and high molecular weight kininogen compete
cell biology and in-vivo pathophysiology. Thromb Haemost 2007; 98:
for the same binding site on human umbilical vein endothelial cells.
J Biol Chem 1993; 268: 11982–7.
2 Gailani D, Renne T. The intrinsic pathway of coagulation: a target for
22 Motta G, Rojkjaer R, Hasan AAK, Cines DB, Schmaier AH. High
treating thromboembolic disease. J Thromb Haemost 2007; 5: 1106–12.
molecular weight kininogen regulates prekallikrein assembly and
3 Ratnoﬀ OD, Colopy JE. A familial hemorrhagic trait associated with a
activation on endothelial cells: a novel mechanism for contact activa-
deﬁciency of a clot promoting fraction of plasma. J Clin Invest 1955;
tion. Blood 1998; 91: 516–28.
Ó 2007 International Society on Thrombosis and Haemostasis
2328 A. H. Schmaier and K. R. McCrae
23 Shariat-Madar Z, Mahdi F, Schmaier AH. Factor XI assembly and 42 Shariat-Madar Z, Rahimi E, Mahdi F, Schmaier AH. Over-expression
activation on human umbilical vein endothelial cells in culture. Thromb of prolylcarboxypeptidase enhances plasma prekallikrein activation on
Haemost 2001; 85: 544–51. Chinese hamster ovary cells. Am J Physiol Heart Circ Physiol 2005;
24 Mahdi F, Shariat-Madar Z, Schmaier AH. The relative priority of 289: H2697–703.
prekallikrein and factors XI/XIa assembly on cultured endothelial 43 Palmer RMJ, Ferrige AG, Moncada S. Nitric oxide release accounts
cells. J Biol Chem 2003; 278: 43983–90. for the biologic activity of endothelium-derived relaxing factor. Nature
25 Yun TH, Baglia FA, Myles T, Navaneetham D, Lopez JA, Walsh PN, 1987; 372: 524–6.
Leung LL. Thrombin activation of factor XI on activated platelets 44 Hong SL. Eﬀect of bradykinin and thrombin on prostacyclin synthesis
requires the interaction of factor XI and platelet glycoprotein Ib alpha in endothelial cells from calf and pig aorta and human umbilical cord
with thrombin anion-binding exosites I and II, respectively. J Biol vein. Thromb Res 1980; 18: 787–95.
Chem 2003; 278: 48112–9. 45 Feletou M, Vanhoutte PM. Endothelium-derived hyperpolarization
26 Herwald H, Dedio J, Kellner R, Loos M, Muller-Esterl W. Isolation factor: where are we now? Arterioscler Thromb Vasc Biol 2006; 26:
and characterization of the kininogen binding protein p33 from 1215–25.
endothelial cells. J Biol Chem 1996; 271: 13040–7. 46 Holland JA, Pritchard KA, Pappolla MA. Bradykinin induces
27 Joseph K, Ghebrehiwet B, Peerschke EIB, Reid KBM, Kaplan AP. superoxide anion release from human endothelial cells. J Cell Physiol
Identiﬁcation of the zinc-dependent endothelial cell binding protein for 1990; 143: 21–5.
high molecular weight kininogen and factor XII: identity with the 47 Cervenka L, Harrison-Bernard LM, Dipp S, Primrose G, Imig JD, El-
receptor that binds to the globular ÔheadsÕ of C1q (qC1qR). Proc Natl Dahr SS. Early onset salt-sensitive hypertension in bradykinin B2
Acad Sci USA 1996; 93: 8552–7. receptor null mice. Hypertension 1999; 34: 176–80.
28 Colman RW, Pixley RA, Najamunnisa S, Yan W, Wang J, Mazar A, 48 Kakoki M, Kizer CM, Yi X, Takahashi N, Kim H-S, Bagnell CR,
McCrae KR. Binding of high molecular weight kininogen to human Edgell C-J, Maeda N, Jennette JC, Smithies O. Senescence-associated
endothelial cells is mediated via a site within domains 2 and 3 of the phenotypes in Akita diabetic mice are enhanced by absence of
urokinase receptor. J Clin Invest 1997; 100: 1481–7. bradykinin B2 receptors. J Clin Invest 2006; 116: 1302–9.
29 Hasan AAK, Zisman T, Schmaier AH. Identiﬁcation of cytokeratin 1 49 Meneton P, Bloch-Faure M, Hagege AA, Ruetten H, Huang W,
as a binding protein and presentation receptor for kininogens on Bergaya S, Ceiler D, Gehring D, Martins I, Salmon G, Boulanger C,
endothelial cells. Proc Natl Acad Sci USA 1998; 95: 3615–20. Nussberger J, Crozatier B, Gasc J-M, Heudes D, Bruneval P,
30 Zhang J-C, Donate F, Qi X, Ziats NP, Juarez JC, Mazar AP, Pang Y- Doetschman T, Menard J, Alhenc-Gelas F. Cardiovascular
P, McCrae KR. The antiangiogenic activity of cleaved high molecular abnormalities with normal blood pressure in tissue kallikrein-deﬁcient
weight kininogen is mediated through binding to endothelial cell mice. Proc Natl Acad Sci USA 2001; 98: 2634–9.
tropomyosin. Proc Natl Acad Sci USA 2002; 99: 12224–9. 50 Kaschina E, Stoll M, Sommerfeld M, Steckelings UM, Kreutz R,
31 Mahdi F, Shariat-Madar Z, Figueroa CD, Schmaier AH. Factor XII Unger T. Genetic kininogen deﬁciency contributes to aortic aneu-
interacts with the multiprotein assembly of urokinase plasminogen rysm formation but not to atherosclerosis. Physiol Genomics 2004; 19:
activator receptor, gC1qR, and cytokeratin on endothelial cell mem- 41–9.
branes. Blood 2002; 99: 3585–96. 51 Brown NJ, Gainer JV, Stein CM, Vaughan DE. Bradykinin stimulates
32 Motta G, Shariat-Madar Z, Mahdi F, Sampaio CAM, Schmaier AH. tissue plasminogen activator release in human vasculature. Hyperten-
Assembly and activation of high molecular weight kininogen and sion 1999; 33: 1431–5.
prekallikrein on cell matrix. Thromb Haemost 2001; 86: 840–7. 52 Meloni FJ, Schmaier AH. Low molecular weight kininogen binds to
33 Rojkjaer R, Hasan AAK, Motta G, Schousboe I, Schmaier AH. platelets to modulate thrombin-induced platelet activation. J Biol
Factor XII does not initiate prekallikrein activation on endothelial Chem 1991; 266: 6786–94.
cells. Thromb Haemost 1998; 80: 74–81. 53 Jiang Y, Muller-Esterl W, Schmaier AH. Domain 3 of kininogens
34 Iwaki T, Castellino FJ. Plasma levels of bradykinin are suppressed in contains a cell binding site and a site that modiﬁes thrombin activation
factor XII-deﬁcient mice. Thromb Haemost 2006; 95: 1003–10. of platelets. J Biol Chem 1992; 267: 3712–7.
35 Shariat-Madar Z, Mahdi F, Schmaier AH. Identiﬁcation and char- 54 Hasan AAK, Amenta S, Schmaier AH. Bradykinin and its metabolite
acterization of prolylcarboxypeptidase as an endothelial cell prekal- ARG-PRO-PRO-GLY-PHE are selective inhibitors of a-thrombin-
likrein activator. J Biol Chem 2002; 277: 17962–9. induced platelet activation. Circulation 1996; 94: 517–28.
36 Oyda CE, Marinkovic DV, Hammon KJ, Stewart TA, Erdos EG. 55 Hasan AAK, Warnock M, Nieman M, Srikanth S, Mahdi F, Krish-
Puriﬁcation and properties of prolylcarboxypeptidase (angiotensinase nan R, Tulinsky A, Schmaier AH. The mechanisms of Arg-Pro-Pro-
C) from human kidney. J Biol Chem 1978; 253: 5927–31. Gly-Phe inhibition of thrombin. Amer J Physiol Heart and Circ Physiol
37 Shariat-Madar Z, Mahdi F, Schmaier AH. Recombinant prolyl- 2003; 285: H183–93.
carboxypeptidase activates plasma prekallikrein. Blood 2004; 103: 56 Nieman MT, Pagan-Ramos E, Warnock M, Krijanovski Y, Hasan
4554–61. AAK, Schmaier AH. Mapping the interaction of bradykinin 1–5 with
38 Moreira CR, Schmaier AH, Mahdi F, da Motta G, Nader HB, Sha- the exodomain of protease activated receptor 4 (PAR4). FEBS Lett
riat-Madar Z. Identiﬁcation of prolylcarboxypeptidase as the cell 2005; 579: 25–9.
matrix-associated prekallikrein activator. FEBS Lett 2002; 523: 167– 57 Hasan AAK, Rebello SS, Smith E, Srikanth S, Werns S, Driscoll E,
70. Faul J, Brenner D, Normolle D, Lucchesi BR, Schmaier AH.
39 Skarnes WC. Gene trapping methods for the identiﬁcation and func- Thrombostatin inhibits induced canine coronary thrombosis. Thromb
tional analysis of cell surface proteins in mice. Methods Enzymol 2000; Haemost 1999; 82: 1182–7.
328: 592–615. 58 Murphey LJ, Malave HA, Petro J, Biaggioni I, Byrne DW, Vaughan
40 McCarthy JJ, Meyer J, Moliterno DJ, Newby LK, Rogers WJ, Topol DE, Luther JM, Pretorius M, Brown NJ. Bradykinin and its metab-
EJ, GenQuest multicenter study. Evidence for substantial eﬀect mod- olite bradykinin 1–5 inhibit thrombin-induced platelet aggregation in
iﬁcation by gender in a large scale genetic association study of the humans. J Pharm Exp Ther 2006; 318: 1287–92.
metabolic syndrome among coronary heart disease patients. Hum 59 Nieman MT, Warnock M, Hasan AAK, Mahdi F, Lucchesi BR,
Genet 2003; 114: 87–98. Brown NJ, Murphey LJ, Schmaier AH. The preparation and char-
41 Wang L, Feng Y, Zhang Y, Zhou H, Jiang S, Niu T, Wei LJ, Xu X, Xu acterization of novel peptide antagonists to thrombin, factor VIIa and
X, Wang X. Prolylcarboxypeptidase gene, chronic hypertension, and activation of protease activates receptor 1. J Pharm Exp Ther 2004;
risk of preeclampsia. Am J Obstet Gynecol 2006; 195: 162–71. 311: 492–501.
Ó 2007 International Society on Thrombosis and Haemostasis
The changing kallikrein–kinin system 2329
60 Hasan AAK, Schmaier AH, Warnock M, Normolle D, Driscoll E, tion of focal adhesion proteins and activation of mitogen-activated
Lucchesi BR, Werns SW. Thrombostatin inhibits cyclic ﬂow variations protein kinase in cultured endothelial cells. J Biol Chem 1998; 273:
in stenosed canine coronary arteries. Thromb Haemost 2001; 86: 1296– 18268–72.
304. 78 Nguyen DHD, Webb DJ, Catling AD, Song Q, Dhakephalkar A,
61 Schmaier AH. The kallikrein–kinin and the rennin–angiotensin sys- Weber MJ, Ravichandran KS, Gonias SL. Urokinase-type plasmin-
tems have a multilayered interaction. Am J Physiol Regul Integr Comp ogen activator stimulates the Ras/Extracellular signal-regulated kinase
Physiol 2003; 285: R1–13. (ERK) signaling pathway and MCF-7 cell migration by a mechanism
62 Abadir PM, Periasamy A, Carey RM, Siragy HM. Angiotensin II type that requires focal adhesion kinase, Src, and Shc. J Biol Chem 2000;
2 receptor–bradykinin B2 receptor functional heterodimerization. 275: 19382–8.
Hypertension 2006; 48: 316–22. 79 Guo Y-L, Wang S, Colman RW. Kininostatin, an angiogenic inhibi-
63 Soria JM, Almasy L, Souto JC, Bacq D, Buil A, Faure A, Martinez- tor, inhibits proliferation and induces apoptosis of human endothelial
Marchan E, Mateo J, Borrell M, Stone W, Lathrop M, Fontcuberta J, cells. Arterioscler Thromb Vasc Biol 2001; 21: 1427–33.
Blangero J. A quantitative-trait locus in the human factor XII gene 80 Wang S, Hasham MG, Isordia-Salas I, Tsygankov AY, Colman RW,
inﬂuences both plasma factor XII levels and susceptibility to throm- Guo Y-L. Upregulation of Cdc2 and cyclin A during apoptosis of
botic disease. Am J Hum Genet 2002; 70: 567–74. endothelial cells induced by cleaved high-molecular-weight kininogen.
64 Zito F, Lowe GDO, Rumley A, McMahon AD, Humphries SE. Am J Physiol Heart Circ Physiol 2003; 284: H1917–23.
Association of the factor XII 46CT polymorphism with risk of 81 Katkade V, Soyombo AA, Isordia-Salas I, Bradford HN, Gaughan
coronary heart disease in the WOSCOPS study. Atherosclerosis 2002; JP, Colman RW, Panetti TS. Domain 5 of cleaved high molecular
165: 153–8. weight kininogen inhibits endothelial cell migration through Akt.
65 Colhoun HM, Zito F, Chan NN, Rubens MB, Fuller JH, Humphries Thromb Haemost 2005; 94: 606–14.
SE. Activated factor XII levels and factor XII 46CT genotype in 82 Zhang H, Colman RW, Sheng N. Regulation of CD11b/CD18 (Mac-
relation to coronary artery calciﬁcation in patients with type 1 diabetes 1) adhesion to ﬁbrinogen by urokinase receptor (uPAR). Inﬂamm Res
and healthy subjects. Atherosclerosis 2002; 163: 363–9. 2003; 52: 86–93.
66 Kleinschnitz C, Stoll G, Bendszuz M, Schuh K, Pauer HU, Burfeind P, 83 Cunningham O, Andolfo A, Santovito ML, Iuzzolino L, Blasi F,
Renne C, Gailani D, Nieswandt B, Renne T. Targeting coagulation Sidenius N. Dimerization controls the lipid raft partitioning of uPAR/
factor XII provides protection from pathologic thrombosis in cerebral CD87 and regulates its biologic functions. EMBO J 2003; 22: 5994–
ischemia without interfering with hemostasis. J Exp Med 2006; 203: 6003.
513–8. 84 Gordon EM, Venkatesan N, Salazat R, Tang H, Schmeidler-Sapiro K,
67 Zhang J-C, Claﬀey K, Sakthivel R, Darzynkiewicz Z, Shaw DE, Leal Buckley S, Warburton D, Hall FL. Factor XII-induced mitogenesis is
J, Wang Y-C, Lu F-M, McCrae KR. Two-chain high molecular weight mediated via a distinct signal transduction pathway that activates a
kininogen induces endothelial cell apoptosis and inhibits angiogenesis: mitogen-activated protein kinase. Proc Natl Acad Sci USA 1996; 93:
partial activity within domain 5. FASEB J 2000; 14: 2589–600. 2174–9.
68 Colman RW, Jameson BA, Lin Y, Johnson D, Mousa SA. Domain 5 85 Li Y, Lawrence DA, Zhang L. Sequences within domain II of the
of high molecular weight kininogen (kininostatin) down-regulates urokinase receptor critical for diﬀerential ligand recognition. J Biol
endothelial cell proliferation and migration and inhibits angiogenesis. Chem 2003; 278: 29925–32.
Blood 2000; 95: 543–50. 86 Schmaier AH, Mahdi F, Sitrin R. The urokinase plasminogen acti-
69 Zhang J-C, Qi X, Juarez J, Plunkett M, Donate F, Sakthivel R, Mazar vator receptor mediates ScuPA- or FXII-induced cell growth and
AP, McCrae KR. Inhibition of angiogenesis by two-chain high proliferation. Blood 2006; 108(Suppl.): 1817 (abstract).
molecular weight kininogen (HKa) and kininogen-derived polypep- 87 Tankersley DL, Finlayson JS. Kinetics of activation and autoactiva-
tides. Can J Physiol Pharmacol 2002; 80: 85–90. tion of human factor XII. Biochemistry 1984; 23: 273–9.
70 Hasan AAK, Cines DB, Herwald H, Schmaier AH, Muller-Esterl W. 88 Kurachi K, Fujikawa K, Davie EW. Mechanism of activation of bo-
Mapping the cell binding site on high molecular weight kininogenÕs vine factor XI by factor XII and factor XIIa. Biochemistry 1980; 19:
domain 5. J Biol Chem 1995; 270: 19256–61. 1330–8.
71 Nordahl EA, Rydengard V, Morgelin M, Schmidtchen A. Domain 5 89 Ghrbrehiwet B, Randazzo BP, Dunn JT, Silverberg M, Kaplan AP.
of high molecular weight kininogen is antibacterial. J Biol Chem 2005; Mechanisms of activation of the classical pathway of complement by
280: 34832–9. Hageman factor fragment. J Clin Invest 1983; 71: 1450–6.
72 Hu DE, Fan TP. [Leu8]des-Arg9-bradykinin inhibits the angiogenic 90 Seligsohn U, Osterud B, Brown SF, Rappaport SI. Activation of hu-
eﬀect of bradykinin and interleukin-1 in rats. Br J Pharmacol 1993; man factor VII in human plasma and puriﬁed systems. J Clin Invest
109: 14–7. 1979; 64: 239–43.
73 Hayashi I, Amano H, Yoshida S, Kamata K, Kamata M, Inukai M, 91 Goldsmith GH, Saito H, Ratnoﬀ OD. The activation of plasminogen
Fujita T, Kumagai Y, Furudat S, Majima M. Suppressed angiogenesis by Hageman factor (Factor XII) and Hageman Factor fragments. J
in kininogen-deﬁciencies. Lab Invest 2002; 82: 871–80. Clin Invest 1978; 62: 54–60.
74 Chavakis T, Kanse SM, Lupu F, Hammes H-P, Muller-Esterl W, 92 Bernardo MM, Day DE, Olson ST, Shore JD. Surface-independent
Pixley RA, Colman RW, Preissner KT. Diﬀerent mechanisms deﬁne acceleration of factor XII activation by zinc ions. I Kinetic charac-
the antiadhesive function of high molecular weight kininogen in inte- terization of the metal ion rate enhancement. J Biol Chem 1993; 268:
grin- and urokinase receptor-dependent interactions. Blood 2000; 96: 12468–76.
514–22. 93 Tayeh MA, Olson ST, Shore JD. Surface-induced alterations in the
75 Mahdi F, Shariat-Madar Z, Kuo A, Carinato M, Cines DB, Schmaier kinetic pathway for cleavage of human high molecular weight kinin-
AH. Mapping the interaction between high molecular weight kinino- ogen by plasma kallikrein. J Biol Chem 1994; 269: 16318–25.
gen and the urokinase plasminogen activator receptor. J Biol Chem 94 Berrettini M, Schleef RR, Espana F, Loskutoﬀ DJ, Griﬃn JH.
2004; 279: 16621–8. Interaction of type 1 plasminogen activator inhibitor with the
76 Konakova M, Hucho F, Schleuning W-D. Downstream targets of enzymes of the contact activation system. J Biol Chem 1989; 264:
urokinase-type plasminogen-activator-mediated signal transduction. 11738–43.
Eur J Biochem 1998; 253: 421–9. 95 Meijers JCM, Kanters DHA, Vlooswijk RRA, van Erp HE, Hessing
77 Tang H, Kerins DM, Hao Q, Inagami T, Vaughan DE. The urokinase- M, Bouma BN. Inactivation of human plasma kallikrein and factor
type plasminogen activator receptor mediates tyrosine phosphoryla- Xia by protein C inhibitor. Biochemistry 1988; 27: 4231–7.
Ó 2007 International Society on Thrombosis and Haemostasis