The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma
Background: Hereditary angioedema with C1-inhibitor deficiency (HAE-C1INH) is a rare autosomal disorder presenting with recurrent angioedema. Estrogen-containing medications trigger angioedema in some patients, and conversely, progesterone may decrease attack frequency. The mechanism by which estrog...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829324000225 |
| _version_ | 1827258498108358656 |
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| author | Janette M. Birmingham, MS Juan Wisnivesky, MD, DrPH Paula J. Busse, MD |
| author_facet | Janette M. Birmingham, MS Juan Wisnivesky, MD, DrPH Paula J. Busse, MD |
| author_sort | Janette M. Birmingham, MS |
| collection | DOAJ |
| description | Background: Hereditary angioedema with C1-inhibitor deficiency (HAE-C1INH) is a rare autosomal disorder presenting with recurrent angioedema. Estrogen-containing medications trigger angioedema in some patients, and conversely, progesterone may decrease attack frequency. The mechanism by which estrogen may exacerbate angioedema in HAE-C1INH is not well characterized. Objective: Our aim was to investigate the link between estrogen and bradykinin constituents to better understand the specific underlying triggers that may exacerbate angioedema in patients with HAE-C1INH. Methods: As estrogen is contraindicated for patients with HAE-C1INH, females without a history of angioedema were recruited to evaluate whether estrogen-containing oral contraceptive pills (OCPs) alter plasma protein levels of bradykinin, cleaved high-molecular-weight kininogen (cHK), and activated factor XII (FXIIa). Blood (plasma) was collected before initiation of OCP administration and 3 months thereafter. High-molecular-weight kininogen (HK) was measured by ELISA and FXIIa and cHK were analyzed by Western blot analysis. Results: A total of 12 adult females without HAE-CINH (aged <40 years) had a median baseline plasma HK level of 33,976 ng/mL. After 3 months of OCP therapy, their median HK level increased to 38,202 ng/mL. With OCPs, there was also a significant increase in level of FXIIa protein (P <.01), as well as an increase in cHK protein level. Conclusion: This preliminary study, performed in females without HAE-C1INH, suggests that estrogen may exacerbate angioedema by increasing the production of cHK and FXIIa. |
| first_indexed | 2024-04-25T01:19:51Z |
| format | Article |
| id | doaj.art-fb912624fa9b44638008cdd73c6010f7 |
| institution | Directory Open Access Journal |
| issn | 2772-8293 |
| language | English |
| last_indexed | 2025-03-22T02:11:39Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj.art-fb912624fa9b44638008cdd73c6010f72024-05-07T04:06:43ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932024-05-0132100226The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasmaJanette M. Birmingham, MS0Juan Wisnivesky, MD, DrPH1Paula J. Busse, MD2Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NYDivision of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NYDivision of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY; Corresponding author: Paula J. Busse, MD, Division of Allergy and Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madision Ave, Room 11-20, New York, NY 10029.Background: Hereditary angioedema with C1-inhibitor deficiency (HAE-C1INH) is a rare autosomal disorder presenting with recurrent angioedema. Estrogen-containing medications trigger angioedema in some patients, and conversely, progesterone may decrease attack frequency. The mechanism by which estrogen may exacerbate angioedema in HAE-C1INH is not well characterized. Objective: Our aim was to investigate the link between estrogen and bradykinin constituents to better understand the specific underlying triggers that may exacerbate angioedema in patients with HAE-C1INH. Methods: As estrogen is contraindicated for patients with HAE-C1INH, females without a history of angioedema were recruited to evaluate whether estrogen-containing oral contraceptive pills (OCPs) alter plasma protein levels of bradykinin, cleaved high-molecular-weight kininogen (cHK), and activated factor XII (FXIIa). Blood (plasma) was collected before initiation of OCP administration and 3 months thereafter. High-molecular-weight kininogen (HK) was measured by ELISA and FXIIa and cHK were analyzed by Western blot analysis. Results: A total of 12 adult females without HAE-CINH (aged <40 years) had a median baseline plasma HK level of 33,976 ng/mL. After 3 months of OCP therapy, their median HK level increased to 38,202 ng/mL. With OCPs, there was also a significant increase in level of FXIIa protein (P <.01), as well as an increase in cHK protein level. Conclusion: This preliminary study, performed in females without HAE-C1INH, suggests that estrogen may exacerbate angioedema by increasing the production of cHK and FXIIa.http://www.sciencedirect.com/science/article/pii/S2772829324000225Hereditary angioedemabradykininestrogenkininogenoral contraceptives |
| spellingShingle | Janette M. Birmingham, MS Juan Wisnivesky, MD, DrPH Paula J. Busse, MD The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma Journal of Allergy and Clinical Immunology: Global Hereditary angioedema bradykinin estrogen kininogen oral contraceptives |
| title | The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma |
| title_full | The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma |
| title_fullStr | The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma |
| title_full_unstemmed | The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma |
| title_short | The effect of estrogen-containing birth control pills on the constituents of bradykinin expression in plasma |
| title_sort | effect of estrogen containing birth control pills on the constituents of bradykinin expression in plasma |
| topic | Hereditary angioedema bradykinin estrogen kininogen oral contraceptives |
| url | http://www.sciencedirect.com/science/article/pii/S2772829324000225 |
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