Journal
JOURNAL OF CLINICAL INVESTIGATION
Volume 125, Issue 8, Pages 3132-3146Publisher
AMER SOC CLINICAL INVESTIGATION INC
DOI: 10.1172/JCI77139
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Funding
- Netherlands Organization for Scientific Research (NWO) [016-126-159]
- Ministerium fur Innovation, Wissenschaft, und Forschung des Landes Nordrhein-Westfalen
- Bundesministerium fur Bildung und Forschung
- Hjart Lungfonden [20140741]
- Stockholms lams landsting (ALF) [20140464]
- Vetenskapsradet [K2013-65X-21462-04-5]
- German Research Society [SFB877, SFB841]
- European Research Council [ERC-StG-2012-311575_F-12]
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Hereditary angioedema type III (HAEIII) is a rare inherited swelling disorder that is associated with point mutations in the gene encoding the plasma protease factor XII (FXII). Here, we demonstrate that HAEIII-associated mutant FXII, derived either from HAEIII patients or recombinantly produced, is defective in mucin-type Thr309-linked glycosylation. Loss of glycosylation led to increased contact-mediated autoactivation of zymogen FXII, resulting in excessive activation of the bradykinin-forming kallikrein-kinin pathway. In contrast, both FXII-driven coagulation and the ability of Cl-esterase inhibitor to bind and inhibit activated FXII were not affected by the mutation. Intravital laser-scanning microscopy revealed that, compared with control animals, both F12(-/-) mice reconstituted with recombinant mutant forms of FXII and humanized HAEIII mouse models with inducible liver-specific expression of Thr309Lys-mutated FXII exhibited increased contact-driven microvascular leakage. An FXII-neutralizing antibody abolished bradykinin generation in HAEIII patient plasma and blunted edema in HAEIII mice. Together, the results of this study characterize the mechanism of HAEIII and establish FXII inhibition as a potential therapeutic strategy to interfere with excessive vascular leakage in HAEIII and potentially alleviate edema due to other causes.
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