Thromb Haemost 2009; 101: 222–224 The scientist Emil-Karl Frey, a scholar of the famous surgeon ‘Geheimrat’ Ferdinand Sauerbruch, observed in 1925 a considerable reduction in arterial blood pressure when he injected human urine into dogs, an until then unknown cardioactive and vasoactive effect which he attributed to an unspecified substance with potential biological functions (1, 2). This then uncharacterized kininogenase was named kallikrein (Greek synonym for pancreas: kallikreas) by the three German scientists H. Kraut, E.-K. Frey and E. Werle, who in 1930 reported that the pancreas is a rich source of this endogenous hypotensive substance (3). A few years later, E.-K. Werle identified kallikrein as a proteolytic enzyme (KLK1 [EC 3.4.21.35] initially named tissue kallikrein, glandular kallikrein, kallikrein 1 or hk1) that liberates the biologically highly active, basic polypeptide ‘DK’ or kallidin (i.e. lys-bradykinin) from the blood plasma protein kallidinogen (now termed highand low-molecular-weight kininogen, HMWKand LMWK-kininogen) (4). The serine protease KLK1 is different from the later discovered plasma serine protease kallikrein (KLKB1 or Fletcher factor [EC 3.4.21.34], located on chromosome 4q34-q35) which is part of the plasma contact activation system and structurally related to coagulation factor XI (5), whereas KLK1 located on chromosome 19q13.4 is structurally related to the serine protease trypsin (5–7). Later on, two more glandular kallikreins were identified in humans: KLK2 (initially named human glandular kallikrein 1, hGK1, and later human kallikrein 2, hK2) (8) and KLK3 (also known as prostate-specific antigen [PSA]) (9, 10), both located on chromosome 19q13.4 as well (6). Some time later, before the turn of the millenium, 12 additional serine protease genes were independently discovered by three major research groups to be tandemly located on chromosome 19q13.4 and therefore assigned to the glandular kallikrein family as well, based on their localization to chromosome locus 19q13.4 and sequence/structural similarities with the three traditional glandular kallikrein genes (11–13), thus forming a new, “extended” kallikrein gene family (6, 7). Hence, a new comprehensive nomenclature was needed, and since 2006 of the 15 tissue-related kallikreins 14 are denoted kallikrein-related peptidases (KLK2 to KLK15) (14), except for kallikrein 1, since this is the only serine protease in the KLK-family with significant kininogenase activity (15). Now, with the comprehensive description of the human KLK gene locus available, one of the main bio-medical research endeavors is focused on the clarification of the (patho)physiological functions of the KLK (16). KLK are expressed in a wide range of tissues, although individual KLK do have quite restricted expression patterns suggesting a functional role in diverse (patho)physiological processes (17), e.g. skin desquamation and other skin diseases, tooth development and enamel defects, Alzheimer’s disease, Parkinson’s disease, and cancer (6, 15). Besides KLK3 (PSA), a well known biomarker for prostate cancer, other members of the KLK family are now considered as potential biomarkers in malignant disease states as well. Recently, several of the kallikrein-related peptidases have shown promise as prognostic and predictive cancer biomarkers, e.g. for cancer of the prostate, testis, kidney, breast, ovary, lung, colon, pancreas, and brain (6, 18). Interestingly, some of the KLK can auto-activate, while others activate each other, suggesting that the KLK may be part of an enzymatic cascade similar to the urokinase/plasminogen system or the matrix metalloprotease family, which are associated with the malignant potential of multiple malignant diseases (19, 20). Currently, three well-established technologies are in use to quantify kallikrein-related peptidase expression: RT-PCR (mRNA), ELISA (protein) and DNA-methylation (epigenetic modification of CpG islands in genomic DNA) (6, 21). From these assays, it can be assumed that certain members of the kallikrein-related peptidase gene family are differentially expressed in a wide variety of carcinomas. Although still under investigation, it has been shown that these factors can serve as new biomarkers for diagnosis, prognosis, and monitoring of cancer (6, 7, 15, 16). In Figure 1A the number of citations per year are displayed with reference to KLK3 (PSA) and cancer, encompassing investigations in human and animal tissues and cell lines, respectively. Between 1982 and 2008, 12,135 articles were published in MedLine including 1,631 reviews. Most of the experiments were conducted with human tumor tissues, tumor cell lines or blood components (12,047); 1,523 considering clinical trials. Only a small portion of the published articles dealing with the clinical impact of kallikrein-related peptidases (556, includ© 2009 Schattauer GmbH, Stuttgart
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