Genetic manipulation of the kallikrein-kinin system (KKS) in mice, with either gain or loss of function, and study of human genetic variability in KKS components which has been well documented at the phenotypic and genomic level, have allowed recognizing the physiological role of KKS in health and in disease. This role has been especially documented in the cardiovascular system and the kidney.
Kinins are produced at slow rate in most organs in resting condition and/or inactivated quickly. Yet the KKS is involved in arterial function and in renal tubular function. In several pathological situations,
kinin production increases,
kinin receptor synthesis is upregulated, and
kinins play an important role, whether beneficial or detrimental, in disease outcome. In the setting of ischemic, diabetic or hemodynamic aggression,
kinin release by
tissue kallikrein protects against organ damage, through B2 and/or B1
bradykinin receptor activation, depending on organ and disease. This has been well documented for the ischemic or diabetic heart, kidney and skeletal muscle, where KKS activity reduces oxidative stress, limits
necrosis or
fibrosis and promotes angiogenesis. On the other hand, in some pathological situations where plasma
prekallikrein is inappropriately activated, excess
kinin release in local or systemic circulation is detrimental, through oedema or
hypotension. Putative therapeutic application of these clinical and experimental findings through current pharmacological development is discussed in the chapter.