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The bradykinin pathway centers around bradykinin, a small peptide that binds to two main G protein-coupled receptors: the bradykinin B1 receptor (BDKRB1), which is inducible upon tissue injury or inflammation, and the bradykinin B2 receptor (BDKRB2), which is constitutively expressed in most tissues[1][3]. Activation of these receptors leads to downstream signaling that triggers the release of second messengers, nitric oxide, prostaglandins, and upregulation of inflammatory cytokines (e.g., IL-6, IL-1β, IL-8, IL-2)[1][3]. The bradykinin pathway is critically involved in mediating pain (nociception), vasodilation, increased vascular permeability, and a broad range of inflammatory responses[3]. Overactivation, as seen in hereditary angioedema or during adverse drug reactions (e.g., ACE inhibitor-induced angioedema), causes excessive tissue swelling and inflammation[2][4]. The pathway is implicated in diverse diseases including cardiovascular disease, inflammatory disorders, certain types of cancer, and may contribute to severe manifestations of infections like COVID-19 by amplifying cytokine signaling and vascular leak[1][4]. Therapeutic agents targeting this pathway include bradykinin receptor antagonists, kallikrein inhibitors, and C1 esterase inhibitors[2][3][4].
Drugs targeting this pathway primarily act through antagonism of the B2 bradykinin receptor to treat bradykinin-mediated angioedema, inhibition of kallikrein to prevent the generation of bradykinin, or, preclinically, inhibition of the B1 receptor for chronic pain/inflammatory conditions.
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