Bradykinin-Mediated Angioedema: Pathways, Physiology, and Disease Mechanism

On the 29th May 2025 in Budapest, Hungary, leading experts discussed bradykinin-mediated angioedema (AE-BK). Henriette Farkas, Head of the Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, in Budapest, Hungary; Marc A. Riedl, Clinical Director of the US HAEA Angioedema Center, UC San Diego Health, California, USA; and Danny M. Cohn, Medical Specialist in Vascular Medicine at the Amsterdam University Medical Center, the Netherlands, elucidated the mechanisms underlying the bradykinin (BK) signalling cascade, associated pathways, and the role of BK in both AE-BK and broader inflammatory disorders. The role of BK B2 receptor (B2R) was discussed, as well as the consequences of B2R antagonism, exploring whether this antagonism might have an impact on pathophysiological processes. A key focus was on the unmet needs in AE-BK, notably for on-demand (ODT) and long-term prophylactic (LTP) treatment approaches to address needs in multiple types of AE-BK. For treatments to address individual patient expectations and needs, they should be effective, well-tolerated, and have a low treatment burden regarding portability, handling, and administration. The value of standardised guidelines to aid the classification of recurrent angioedema (AE) was also discussed. Additionally, the value of reliable and accurate biomarker-based testing aiding diagnosis was emphasised. Ongoing research aims to address these gaps by investigating novel biomarker testing approaches and exploring additional therapeutic approaches.