Inhibition of vascular permeability by antisense-mediated inhibition of plasma kallikrein and coagulation factor 12

Nucleic Acid Ther. 2013 Jun;23(3):175-87. doi: 10.1089/nat.2013.0417. Epub 2013 Apr 12.


Hereditary angioedema (HAE) is a rare disorder characterized by recurrent, acute, and painful episodes of swelling involving multiple tissues. Deficiency or malfunction of the serine protease inhibitor C1 esterase inhibitor (C1-INH) results in HAE types 1 and 2, respectively, whereas mutations in coagulation factor 12 (f12) have been associated with HAE type 3. C1-INH is the primary inhibitor of multiple plasma cascade pathways known to be altered in HAE patients, including the complement, fibrinolytic, coagulation, and kinin-kallikrein pathways. We have selectively inhibited several components of both the kinin-kallikrein system and the coagulation cascades with potent and selective antisense oligonucleotides (ASOs) to investigate their relative contributions to vascular permeability. We have also developed ASO inhibitors of C1-INH and characterized their effects on vascular permeability in mice as an inducible model of HAE. Our studies demonstrate that ASO-mediated reduction in C1-INH plasma levels results in increased vascular permeability and that inhibition of proteases of the kinin-kallikrein system, either f12 or prekallikrein (PKK) reverse the effects of C1-INH depletion with similar effects on both basal and angiotensin converting enzyme (ACE) inhibitor-induced permeability. In contrast, inhibition of coagulation factors 11 (f11) or 7 (f7) had no effect. These results suggest that the vascular defects observed in C1-INH deficiency are dependent on the kinin-kallikrein system proteases f12 and PKK, and not mediated through the coagulation pathways. In addition, our results highlight a novel therapeutic modality that can potentially be employed prophylactically to prevent attacks in HAE patients.

MeSH terms

  • Angioedemas, Hereditary / drug therapy
  • Angioedemas, Hereditary / metabolism*
  • Angioedemas, Hereditary / pathology
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology
  • Animals
  • Blood Coagulation / drug effects
  • Capillary Permeability / drug effects*
  • Complement C1 Inhibitor Protein
  • Disease Models, Animal
  • Factor VII / metabolism
  • Factor XI / metabolism
  • Factor XII / antagonists & inhibitors
  • Factor XII / metabolism*
  • Humans
  • Injections, Subcutaneous
  • Kinins / metabolism
  • Male
  • Mice
  • Mice, Inbred BALB C
  • Oligonucleotides, Antisense / pharmacology*
  • Plasma Kallikrein / antagonists & inhibitors
  • Plasma Kallikrein / metabolism*
  • Prekallikrein / antagonists & inhibitors
  • Prekallikrein / metabolism*


  • Angiotensin-Converting Enzyme Inhibitors
  • Complement C1 Inhibitor Protein
  • Kinins
  • Oligonucleotides, Antisense
  • Factor VII
  • Factor XII
  • Factor XI
  • Prekallikrein
  • Plasma Kallikrein