Carboxypeptidase B2 and carboxypeptidase N in the crosstalk between coagulation, thrombosis, inflammation, and innate immunity

Summary Two basic carboxypeptidases, carboxypeptidase B2 ( CPB 2) and carboxypeptidase N ( CPN ) are present in plasma. CPN is constitutively active, whereas CPB 2 circulates as a precursor, procarboxypeptidase B2 (proCPB2), that needs to be activated by the thrombin–thrombomodulin complex or plasmin bound to glycosaminoglycans. The substrate specificities of CPB 2 and CPN are similar; they both remove C‐terminal basic amino acids from bioactive peptides and proteins, thereby inactivating them. The complement cascade is a cascade of proteases and cofactors activated by pathogens or dead cells, divided into two phases, with the second phase only being triggered if sufficient C3b is present. Complement activation generates anaphylatoxins: C3a, which stimulates macrophages; and C5a, which is an activator and attractant for neutrophils. Pharmacological intervention with inhibitors has shown that CPB 2 delays fibrinolysis, whereas CPN is responsible for systemic inactivation of C3a and C5a. Among mice genetically deficient in either CPB 2 or CPN , in a model of hemolytic–uremic syndrome, Cpb2 − / − mice had the worst disease, followed by Cpn − / − mice, with wild‐type ( WT ) mice being the most protected. This model is driven by C5a, and shows that CPB 2 is important in inactivating C5a. In contrast, when mice were challenged acutely with cobra venom factor, the reverse phenotype was observed; Cpn − / − mice had markedly worse disease than Cpb2 − / − mice, and WT mice were resistant. These observations need to be confirmed in humans. Therefore, CPB 2 and CPN have different roles. CPN inactivates C3a and C5a generated spontaneously, whereas proCPB2 is activated at specific sites, where it inactivates bioactive peptides that would overwhelm CPN .