Plasma kallikrein/kinin system: a revised hypothesis for its activation and its physiologic contributions

Recent studies indicate that assembly of high molecular weight kininogen on its multiprotein receptor allows for prekallikrein activation. On endothel ial cells, factor XII activation is secondary to prekallikrein activation a nd amplifies it. The immediate consequence of plasma prekallikrein activati on is the cleavage of high molecular weight kininogen (HK) with liberation of bradykinin. Cleaved high molecular weight kininiogen is antiangiogenic. Bradykinin stimulates tPA liberation and nitric oxide formation. In additio n, formed plasma kallikrein promotes single-chain urokinase activation and subsequent plasminogen activation. Kininogens and their breakdown products also are antithrombins. The angiotensin converting enzyme breakdown product of bradykinin prevents canine coronary thrombosis. The author presents a n ew hypothesis for physiologic assembly and activation of the plasma kallikr ein/kinin system and discusses its influence on vascular biology. (C) 2000 Lippincott Williams & Wilkins, Inc.