Antithrombin-heparin cofactor: An inhibitor of plasma kallikrein

Human antithrombin-heparin cofactor is a naturally occurring plasma inhibitor of serine proteases generated during activation of the coagulation and fibrinolytic systems. We have demonstrated that purified preparations of this inhibitor also neutralize the esterolytic activity of human kallikrein as well as the ability of the enzyme to release kinins. When an excess of inhibitor is present, the inactivation process follows pseudo-first-order kinetics. Furthermore, the addition of heparin to mixtures of kallikrein and antithrombin-heparin cofactor results in a doubling of the rate and extent of enzyme neutralization. Disc gel analysis of incubation mixtures of kallikrein and excess antithrombin-heparin cofactor, with and without heparin, revealed that the enzyme band had vanished in conjunction with the emergence of two new electrophoretic species. These two new components probably represent stoichiometric complexes of kallikrein and antithrombin-heparin cofactor since a twofold increase in the concentration of enzyme doubled the concentration of these new molecular species. In plasmas which contain adequate levels of other protease inhibitors, antithrombin-heparin cofactor does not appear to be a quantitatively important inactivator of kallikrein. This is suggested by our finding that the addition of heparin at concentrations as high as 50 units/ml did not increase the inhibitory capacity of normal plasma directed against this enzyme. However, plasma from patients with hereditary angioedema had little neutralizing activity directed against kallikrein and revealed a marked increase in this inhibitory capacity when therapeutic concentrations of heparin were added. Our observation suggests that this acidic mucopolysaccharide may prove useful in controlling acute attacks of this disorder.