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Impaired control of the contact system in hereditary angioedema with normal C1‐inhibitor
Author(s) -
Bova Maria,
Suffritti Chiara,
Bafunno Valeria,
Loffredo Stefania,
Cordisco Giorgia,
Del Giacco Stefano,
De Pasquale Tiziana Maria Angela,
Firinu Davide,
Margaglione Maurizio,
Montinaro Vincenzo,
Petraroli Angelica,
Radice Anna,
Brussino Luisa,
Zanichelli Andrea,
Zoli Alessandra,
Cicardi Marco
Publication year - 2020
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.14160
Subject(s) - hereditary angioedema , c1 inhibitor , factor xii , angioedema , bradykinin , kallikrein , kininogen , immunology , medicine , enzyme , endocrinology , chemistry , biochemistry , receptor , coagulation
Background Hereditary angioedema (HAE) comprises HAE with C1‐inhibitor deficiency (C1‐INH‐HAE) and HAE with normal C1‐INH activity (nl‐C1‐INH‐HAE), due to mutations in factor XII (FXII‐HAE), plasminogen (PLG‐HAE), angiopoietin 1 (ANGPT1‐HAE), kininogen 1 genes (KNG1‐HAE), or angioedema of unknown origin (U‐HAE). The Italian network for C1‐INH‐HAE (ITACA) created a registry including different forms of angioedema without wheals. Objective We analyzed clinical and laboratory features of a cohort of Italian subjects with nl‐C1‐INH‐HAE followed by ITACA to identify specific biomarkers. Methods A total of 105 nl‐C1‐INH‐HAE patients were studied. Plasma concentrations of cleaved high‐molecular‐weight kininogen (cHK), vascular endothelial growth factors (VEGFs), angiopoietins (Angs), and secreted phospholipase A 2 enzymes (sPLA 2 ) were evaluated. Results We identified 43 FXII‐HAE patients, 58 U‐HAE, and 4 ANGPT1‐HAE. We assessed a prevalence of 1:1.4 × 10 6 for FXII‐HAE and 1:1.0 × 10 6 for U‐HAE. cHK levels in U‐HAE patients were similar to controls in plasma collected using protease inhibitors cocktail (PIC), but they significantly increased in the absence of PIC. In FXII‐HAE patients, cHK levels, in the absence of PIC, were significantly higher than in controls. We found a significant increase of VEGF‐A, VEGF‐C, and Ang1 levels in U‐HAE patients compared to controls. In FXII‐HAE, only VEGF‐C levels were increased. Ang2 concentrations and sPLA 2 activity were not modified. The levels of these mediators in ANGPT1‐HAE patients were not altered. Conclusions Our results suggest that pathogenesis of FXII‐, ANGPT1‐, and U‐HAE moves through an unbalanced control of kallikrein activity, with bradykinin as most likely mediator. VEGFs and Ang1 participate in the pathophysiology of U‐HAE increasing the basal vascular permeability.