Coagulation factor XII (FXII, Hageman factor, EC ؍ 3.4.21.38) is the zymogen of the serine protease, factor XIIa (FXIIa). FXII is converted to FXIIa through autoactivation induced by "contact" to charged surfaces. FXIIa is of crucial importance for fibrin formation in vitro, but deficiency in the protease is not associated with excessive bleeding. For decades, FXII was considered to have no function for coagulation in vivo. Our laboratory developed the first murine knockout model of FXII. Consistent with their human counterparts, FXII ؊/؊ mice have a normal hemostatic capacity. However, thrombus formation in FXII ؊/؊ mice is largely defective, and the animals are protected from experimental cerebral ischemia and pulmonary embolism. This murine model has created new interest in FXII because it raises the possibility for safe anticoagulation, which targets thrombosis without influence on hemostasis. We recently have identified platelet polyphosphate (an inorganic polymer) and mast cell heparin as in vivo FXII activators with implications on the initiation of thrombosis and edema during hypersensitivity reactions. Independent of its protease activity, FXII exerts mitogenic activity with implications for angiogenesis. The goal of this review is to summarize the in vivo functions of FXII, with special focus to its functions in thrombosis and vascular biology. (Blood.
2012;120(22):4296-4303)The factor XII-driven plasma contact system Fibrin formation may be initiated by 2 distinct pathways, either triggered by exposure of blood to a damaged vessel wall (extrinsic) or to blood-borne (intrinsic) factors. The intrinsic pathway of coagulation is initiated by factor XII (FXII, Hageman factor), in a reaction involving high molecular weight kininogen (HK) and plasma kallikrein (PK). These factors are collectively referred to as the plasma contact system. [1][2][3][4][5][6] Contact with negatively charged surfaces induces a conformational change in zymogen FXII resulting in a small amount of active FXII (FXIIa). 7 FXIIa cleaves PK to generate active PK, which in turn reciprocally activates FXII. 8 FXIIa triggers fibrin formation through activation of factor XI (FXI) and also liberates the inflammatory mediator bradykinin (BK) from HK through cleavage by PK. 3 Binding of BK to the kinin B2 receptor (B2R) activates proinflammatory signaling pathways that dilate vessels, induce chemotaxis of neutrophils, and increase vascular permeability. 9 Thus, the FXIIa-driven contact system has proinflammatory and procoagulant activities via the kallikrein kinin-system and the intrinsic coagulation pathway, respectively ( Figure 1). The serpin C1 esterase inhibitor (C1INH) is the major plasma inhibitor of FXIIa and PK and controls proteolytic activity of the contact system. 10 Besides C1INH, antithrombin III (ATIII) and PAI-1 also have FXIIa-blocking activity. 11 In vitro, FXIIa triggers activation of the classic complement pathway and initiates the fibrinolytic system via PK-mediated urokinase activation. 5 Whether FXIIa has the capacity...