Activation of arginine and tyrosine esterase in serum from patients with hereditary angio-oedema.

1. The role of clotting factor XII in the activation of the complement subunit C1s to C1 esterase was examined.2. In sera from patients with hereditary angio-oedema who lack the alpha(2)-glycoglobulin C1 inhibitor, silicates and other potent activators of clotting factor XII induced far less C1 esterase activity than did the weaker factor XII activators, carrageenin and cellulose sulphate. In contrast, the intensity of the induced plasma kallikrein activity corresponded more closely to the clot-promoting effect of the factor XII activators.3. Spontaneous generation of C1 esterase activity was only slightly delayed in hereditary angio-oedema sera previously depleted of factor XII. In normal sera, C1 esterase did not develop spontaneously and could not be induced.4. Experiments with inhibitors suggested that the spontaneous activation of C1s may consist of two phases: factor XII and other plasma proteases first activate small amounts of C1s; the resulting C1 esterase then activates the bulk of C1s. The observed spontaneous activation suggests that when fully activated, the C1s present in 1 ml of human serum will hydrolyse 1-2 mumol of ATEe/minute.