Increased activity of coagulation factor XII (Hageman Factor) causes hereditary angioedema type III

Sven Cichon, Ludovic Martin, Hans Christian Hennies, Felicitas Müller, Karen Van Driessche, Anna Karpushova, Wim Stevens, Roberto Colombo, Thomas Renné, Christian Drouet, Konrad Bork, Markus M. Nöthen

Research output: Contribution to journalArticlepeer-review

285 Citations (Scopus)


Hereditary angioedema (HAE) is characterized clinically by recurrent acute skin swelling, abdominal pain, and potentially life-threatening laryngeal edema. Three forms of HAE have been described. The classic forms, HAE types I and II, occur as a consequence of mutations in the C1-inhibitor gene. In contrast to HAE types I and II, HAE type III has been observed exclusively in women, where it appears to be correlated with conditions of high estrogen levels - for example, pregnancy or the use of oral contraceptives. A recent report proposed two missense mutations (c.1032C→A and c.1032C→G) in F12, the gene encoding human coagulation factor XII (FXII, or Hageman factor) as a possible cause of HAE type III. Here, we report the occurrence of the c.1032C→A (p.Thr328Lys) mutation in an HAE type III-affected family of French origin. Investigation of the F12 gene in a large German family did not reveal a coding mutation. Haplotype analysis with use of microsatellite markers is compatible with locus heterogeneity in HAE type III. To shed more light on the pathogenic relevance of the HAE type III-associated p.Thr328Lys mutation, we compared FXII activity and plasma levels in patients carrying the mutation with that of healthy control individuals. Our data strongly suggest that p.Thr328Lys is a gain-of-function mutation that markedly increases FXII amidolytic activity but that does not alter FXII plasma levels. We conclude that enhanced FXII enzymatic plasma activity in female mutation carriers leads to enhanced kinin production, which results in angioedema. Transcription of F12 is positively regulated by estrogens, which may explain why only women are affected with HAE type III. The results of our study represent an important step toward an understanding of the molecular processes involved in HAE type III and provide diagnostic and possibly new therapeutic opportunities.

Original languageEnglish
Pages (from-to)1098-1104
Number of pages7
JournalAmerican Journal of Human Genetics
Issue number6
Publication statusPublished - 1 Jan 2006
Externally publishedYes


Dive into the research topics of 'Increased activity of coagulation factor XII (Hageman Factor) causes hereditary angioedema type III'. Together they form a unique fingerprint.

Cite this