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Tryptase

Tryptase is a tetrameric neutral of the family, characterized by its trypsin-like activity in cleaving bonds after basic such as and , and it is predominantly produced and stored in the secretory granules of s. The enzyme forms a ~135 kDa complex of four identical or similar ~30-33 kDa monomer subunits, with active sites oriented toward a central pore that is stabilized by proteoglycans in an acidic environment within the granules. Upon , tryptase is released into tissues and circulation, where it plays key roles in physiological and pathological processes. Human tryptase exists in multiple isoforms encoded by genes clustered on 16p13.3, including the pro-forms α-tryptase (inactive, encoded by TPSAB1), the active β-tryptases (βI, βII, βIII, encoded by TPSAB1 and TPSB2), the membrane-anchored γ-tryptase (TPSG1), and the truncated δ-tryptase (inactive). Production occurs primarily in tissue mast cells derived from progenitors, with amounts varying by tissue—approximately 11 pg per mast cell and 35 pg per skin mast cell—and is regulated by factors such as (SCF), IL-3, IL-4, IL-6, and transcription factors like MITF. β-Tryptases, the most abundant active forms, are densely packed in semi-crystalline structures within granules alongside and other mediators, enabling rapid release during immune responses. In terms of function, tryptase contributes to host defense by inactivating allergens, neuropeptides, and certain toxins, while also promoting activity and remodeling through degradation of components like fibrinogen and . It drives by activating (PAR-2) on various cells, leading to release (e.g., IL-6, IL-8), recruitment, proliferation, and increased , which are central to allergic reactions and . Additionally, tryptase supports and modulates immune cell signaling, but excessive activity can exacerbate conditions like airway hyperresponsiveness. Clinically, tryptase levels serve as a for activation and burden. For acute events like , an increase of ≥20% + 2 ng/mL above baseline indicates activation. Basal levels >20 ng/mL are a minor diagnostic criterion for systemic , while hereditary alpha-tryptasemia (HαT), a common genetic trait affecting 4-6% of the population due to extra α-tryptase copies, often causes mildly elevated basal levels (typically 8–30 ng/mL). Peak levels during events help assess severity and guide management of disorders. As of 2025, tryptase aids in distinguishing HαT from , and context-dependent reference ranges (e.g., >11.4 ng/mL suggestive) refine interpretation of basal levels. Tryptase inhibitors are under investigation for treating diseases such as , highlighting its therapeutic potential.

Introduction and Nomenclature

Definition and Overview

Tryptase is a classified under EC 3.4.21.59, belonging to the S1 family of peptidases with -like specificity. It preferentially cleaves peptide bonds on the carboxyl side of basic amino acids such as and , though with more restricted substrate specificity than pancreatic . This enzymatic activity enables tryptase to process extracellular proteins and contribute to various biological processes, distinguishing it as a key mediator in immune and inflammatory responses. Primarily localized in the secretory granules of cells, tryptase represents the most abundant prestored in these cells, comprising a major portion of their total protein content—estimated at up to 25% in cells and particularly prominent in cells. Upon cell , tryptase is released in its mature form, where it exerts effects in the extracellular environment. Unlike typical monomeric trypsins, active tryptase exists as a heparin-stabilized tetramer composed of four subunits, each approximately 30-36 , forming a structure with active sites oriented toward a central that protects it from endogenous inhibitors. This tetrameric assembly, with a molecular weight of about 134-140 , is essential for its stability and enzymatic function at physiological , dissociating into inactive monomers in the absence of . Evolutionarily, tryptase is part of the chymotrypsin-related gene family (clan PA, family S1), sharing the characteristic (His-Asp-Ser) and overall fold with other trypsin-like peptidases, but adapted for specialized roles in biology through gene clustering on 16p13.3. Its development likely involved divergence from ancestral membrane-anchored forms, such as those resembling prostasins, to yield soluble, granule-stored variants in mammals.

Historical Naming and Classification

Tryptase was initially discovered in the as a mast cell-specific , with its first purification and characterization from obtained at reported in 1981. This was identified as a -like abundant in granules, marking it as a key component of mast cell secretory activity.86066-3/fulltext) Early nomenclature reflected its tissue-specific expressions and functional similarities to , leading to alternative names such as , , , and pituitary tryptase. These designations highlighted variations observed in different , including higher activity in and extracts compared to other organs like or liver. Tryptase is classified within the tryptase subfamily of the S1 family of serine peptidases, with the systematic EC 3.4.21.59 assigned in 1992. Its nomenclature evolved significantly in the 1990s through genetic studies that revealed multiple genes and cDNAs encoding distinct isoforms, shifting from broad terms like "trypsin-like enzyme" or "mast cell protease" to precise designations such as alpha-tryptase and beta-tryptase based on structural and functional differences.

Molecular Structure and Genetics

Protein Structure

Tryptase is a that assembles into a tetrameric structure, with each subunit approximately 30 in size. Active β-tryptases typically assemble into homotetramers arranged in a square-like formation with their active sites facing inward toward a central pore. In individuals with hereditary α-tryptasemia, α/β heterotetramers consisting of two α- and two β-subunits can form naturally. This oligomeric assembly is stabilized by , which binds along a positively charged groove on the tetramer surface, and by sodium and ions that occupy specific coordination sites, preventing dissociation and maintaining enzymatic stability at physiological pH. Without these stabilizers, the tetramer can dissociate into inactive monomers. The of tryptase features a classic composed of histidine 57 (His57), aspartic acid 102 (Asp102), and serine 195 (Ser195), numbered according to convention, which facilitates nucleophilic attack on bonds. Adjacent to this triad, the substrate-binding pockets, particularly the S1 specificity pocket, are lined with negatively charged residues such as aspartate 189 (Asp189), enabling selective binding and cleavage after basic like and , consistent with its trypsin-like activity. Tryptase is synthesized as an inactive , pro-tryptase, which undergoes proteolytic cleavage at specific sites—typically after or residues in the pro-peptide—to generate the active . In the isoforms (β-tryptases), complete removal of the N-terminal pro-peptide allows tetramerization and -dependent activity, whereas α-tryptase retains a portion of the pro-peptide, resulting in negligible enzymatic activity, heparin independence, and distinct stability properties. This activation process involves autocatalytic or exogenous protease-mediated steps, often facilitated by the acidic environment of granules. Tryptase activity is further modulated through following the morpheein model, where equilibrium between oligomeric states—such as active tetramers and inactive monomers—influences catalytic efficiency. In this framework, the tetrameric form promotes activity by aligning active sites, while monomeric dissociation leads to autoinhibition, potentially through conformational changes that occlude the substrate-binding region or disrupt the orientation. and ionic stabilizers shift this equilibrium toward the active oligomeric state, exemplifying how quaternary structure dynamics control tryptase function.

Gene Family and Isoforms

The human tryptase form a cluster on 16p13.3, consisting of several paralogous loci that arose from duplications and conversions. This cluster includes TPSAB1, which encodes both α-tryptase and β-tryptase-1 (βI); TPSB2, encoding β-tryptase-2 (βII) and the βIII variant ; TPSD1, encoding δ-tryptase; TPSG1, encoding γ-tryptase; and PRSS22, encoding ε-tryptase. These share high similarity in their coding regions but exhibit distinct regulatory elements and expression patterns, contributing to isoform diversity. Tryptase isoforms differ in stability, enzymatic activity, and cellular localization, reflecting adaptations for specific physiological roles. α-Tryptases, derived from TPSAB1, are pro-forms that remain transient and exhibit low proteolytic activity due to incomplete activation and sensitivity to degradation; they serve primarily as markers for burden rather than active mediators. In contrast, β-tryptases from TPSAB1 and TPSB2 form stable tetramers with high catalytic efficiency, promoting pro-inflammatory responses through substrate cleavage. δ-Tryptase, encoded by TPSD1, is a truncated isoform with demonstrated proteolytic activity in recombinant forms, though it shows limited expression and may have intermediate functional roles. γ-Tryptase, encoded by TPSG1, is unique as a membrane-bound isoform featuring a , enabling cell-surface retention and localized signaling in s and possibly other tissues. ε-Tryptase (PRSS22) is expressed in airway epithelial cells rather than cells, with unclear functional roles. Expression of tryptase isoforms varies by mast cell subtype and tissue context. β-Isoforms predominate in connective tissue mast cells (MCTC), which co-express chymase and reside in skin and submucosa, supporting robust inflammatory responses. α-Tryptases are more prominent in mucosal mast cells (MCT), found in gastrointestinal and respiratory tracts, aligning with their transient nature and role in early immune surveillance. Genetic variations further modulate isoform production; for instance, increased germline copy number of TPSAB1 leads to hereditary α-tryptasemia, elevating baseline serum α-tryptase levels and associating with heightened anaphylaxis risk. In comparative genetics, orthologs include Tpsab1 (encoding mMCP-7, α-like) and Tpsb2 (encoding mMCP-6, β-like), clustered on chromosome 17. Unlike human β-tryptases, counterparts exhibit differences, such as additional N-linked sites in mMCP-6, which enhance stability but alter substrate specificity and activity compared to human forms. These variations highlight evolutionary divergence in tryptase function across species.

Physiological Roles

Normal Function in Mast Cells

Tryptase is predominantly stored within the secretory granules of mast cells as the beta-isoform in a bound to heparin-containing serglycin proteoglycans. This association stabilizes the enzyme structure at the acidic granule , preventing autolysis and ensuring enzymatic activity is maintained until release. The heparin-dependent processing pathway involves of protryptase followed by dipeptidyl peptidase I activation, enabling formation of the active, heparin-stabilized tetramer that constitutes up to 20% of total granule protein in human mast cells. Mast cell degranulation triggers tryptase release via IgE-mediated pathways, such as antigen-induced cross-linking of IgE bound to the high-affinity FcεRI receptor, or non-IgE-mediated stimuli like neuropeptide substance P acting on MRGPRX2 receptors. These mechanisms result in rapid of granules, with over 90% of maximum tryptase release occurring within 15 minutes of activation. This swift kinetics allows tryptase to contribute promptly to local physiological responses. Under baseline conditions, tryptase exerts mitogenic effects on fibroblasts, stimulating their in a concentration-dependent manner and enhancing synthesis to support tissue repair and remodeling. It also modulates by activating (PAR-2) on endothelial cells, promoting the expression of angiogenic such as CCL2 and CXCL8 to facilitate vascular and . Tryptase expression is particularly abundant in mast cells residing in , , and , reflecting their roles in and mucosal barrier maintenance. In healthy adults, circulating baseline tryptase levels typically range from 1 to 15 ng/mL, with medians around 5 ng/mL, indicating minimal constitutive release under normal conditions.

Involvement in Immune Responses

Tryptase, primarily released from s during immune activation, plays a multifaceted role in modulating innate and adaptive immune responses, particularly in the context of and . Upon degranulation triggered by allergens or pathogens, tryptase acts as a that amplifies inflammatory cascades by processing complement components and neuropeptides, thereby enhancing the recruitment and activation of immune effectors. This involvement bridges immediate reactions with sustained immune signaling, contributing to both protective and potentially dysregulated responses. In allergic inflammation, tryptase amplifies responses by cleaving complement proteins and to generate bioactive anaphylatoxins C3a and C5a, which potently activate s and promote further and release. These tryptase-derived anaphylatoxins exhibit enhanced activity compared to their native forms, sustaining and immune cell infiltration at sites of allergic challenge. Additionally, tryptase degrades neuropeptides such as (VIP), a potent anti-inflammatory mediator that normally suppresses activation and promotes ; this degradation prolongs inflammatory signals by removing inhibitory checkpoints, allowing unchecked progression of reactions. Tryptase also contributes to antimicrobial defense, though its effects can be paradoxical. In viral infections, tryptase facilitates influenza A virus entry by cleaving and activating the viral hemagglutinin protein, enabling membrane fusion and enhancing infectivity in respiratory epithelia—a process observed in both porcine and human models. Conversely, in parasitic infections, tryptase-6 (a murine homolog, mMCP-6) bridges innate and adaptive immunity against by promoting recruitment and activation in infected , thereby limiting larval encystation and supporting long-term parasite clearance through Th2-skewed responses. Through modulation of immune cell trafficking, tryptase drives chemotaxis of eosinophils and neutrophils, key effectors in allergic and innate responses. It induces shape changes and migration in purified granulocytes via direct activity and by stimulating endothelial cells to produce like MCP-1, which further amplify recruitment to inflamed tissues. In adaptive immunity, tryptase promotes Th2 polarization by enhancing the release of cytokines such as IL-4 and IL-13 from cells and associated lymphocytes, fostering IgE production and activation essential for anti-parasitic and allergic defenses. Despite its pro-inflammatory dominance, tryptase exhibits negative regulatory functions in chronic immune settings by degrading pro-inflammatory chemokines like and RANTES, thereby abrogating their chemotactic activity and potentially dampening excessive influx. This selective , mediated by β-tryptase, helps resolve prolonged , highlighting tryptase's role as a bidirectional modulator that balances immune activation and termination.

Clinical Significance

Diagnostic Applications

Serum tryptase levels are measured using immunoassays that detect tryptase (comprising α- and β-isoforms) or specifically β-tryptase, with the most commonly employed being a noncompetitive two-site fluorescent , such as the ImmunoCAP system. These assays quantify tryptase released from activated s, providing a key for degranulation in clinical settings. For optimal diagnostic utility in acute events like , serum samples should be collected 1-4 hours after symptom onset, ideally between 30 minutes and 2 hours, as tryptase levels peak at 1-2 hours and decline rapidly due to its short of approximately 2 hours. A baseline sample is typically drawn 24 hours after resolution to establish the individual's normal level. Diagnostic thresholds for serum tryptase are well-established: an acute elevation exceeding 20 ng/mL, or more precisely an increase of at least 20% of the baseline value plus 2 ng/mL (the "20+2 rule"), supports activation, such as in . Basal levels persistently above 20 ng/mL indicate and warrant further evaluation, while levels between 2 and 20 ng/mL may suggest clonal disorders versus reactive conditions. However, elevations in this range are often due to hereditary alpha-tryptasemia (HαT), a common genetic trait involving increased TPSAB1 copies encoding alpha-tryptase, which is non-clonal and may predispose to more severe allergic reactions; for TPSAB1 copy number is recommended in such cases, in addition to evaluation for clonal disorders like . In , elevated acute tryptase levels aid in confirming involvement in conditions like acute urticaria and venom , where basal elevations above 11.4 ng/mL signal increased risk of severe reactions—particularly in those with HαT. Conversely, tryptase often remains normal in food allergies or non-immunologic anaphylactoid reactions, which do not primarily involve , helping to distinguish these from IgE-mediated . Limitations of tryptase measurement include its brevity in circulation, necessitating timely sampling, and lack of specificity, as elevations can occur in non-mast cell disorders such as chronic eosinophilic leukemia associated with FIP1L1-PDGFRA fusion, where levels are typically moderately raised but below 50 ng/mL.

Role in Diseases and Disorders

Tryptase serves as a critical mediator in and allergic reactions, where its release from activated s promotes . It induces and by activating protease-activated receptor-2 (PAR-2) on endothelial and smooth muscle cells, leading to increased and airway constriction, often in synergy with release from the same granules. In severe anaphylactic episodes, persistent elevation of serum tryptase levels beyond the acute phase reflects ongoing and correlates with delayed symptom resolution or biphasic reactions. In systemic mastocytosis, a clonal disorder characterized by abnormal proliferation, tryptase levels exceeding 200 ng/mL serve as a key indicator of high burden and extensive organ infiltration, fulfilling a B-finding in the (WHO) diagnostic criteria for advanced subtypes such as smoldering or aggressive systemic mastocytosis. These elevated levels reflect multifocal aggregates in or extracutaneous tissues, contributing to organ dysfunction through chronic mediator release. Tryptase elevations are also prominent in certain hematologic malignancies with mast cell involvement. In (AML), particularly subtypes with inv(16), t(15;17), or t(8;21) translocations, serum tryptase is raised in 30-40% of cases due to expression by myeloblasts, serving as a prognostic marker where persistent post-chemotherapy levels predict relapse. Similarly, in chronic eosinophilic leukemia (CEL) harboring PDGFRA mutations like FIP1L1-PDGFRA fusion, tryptase is frequently elevated owing to associated neoplastic expansion, aiding in diagnosis and monitoring response to targeted therapies such as . Beyond these, tryptase drives pathological in by stimulating proliferation and synthesis via PAR-2-dependent pathways, exacerbating skin and organ stiffening. In , tryptase released from meningeal s sensitizes trigeminal nociceptors, amplifying neurogenic through interactions with neuropeptides like CGRP, thereby intensifying pain. Furthermore, in severe , elevated tryptase from dysregulated activation correlates with disease progression, promoting vascular leakage, storms, and pulmonary complications.

Research and Future Directions

Current Studies

Recent research has highlighted tryptase's involvement in sustained activation contributing to post-viral syndromes. A 2023 study demonstrated that β-tryptase cleaves 4 (PRG4) in synovial joints, disrupting and exacerbating in models, providing new insights into tryptase's contributions to degenerative joint diseases. Additionally, in a 2023 three-dimensional model of , amyloid-beta peptides induced activation and degranulation, releasing tryptase and promoting neuroinflammatory responses, underscoring tryptase's potential role in neurodegenerative processes. Experimental models continue to elucidate tryptase's functions, with tryptase-deficient mice (lacking mouse mast cell protease-6, the ortholog of human β-tryptase) exhibiting reduced emphysema, airway remodeling, and inflammation in a short-term chronic obstructive pulmonary disease model induced by cigarette smoke, indicating tryptase's key role in protease-driven lung pathology. Humanized mouse models have been developed to study isoform-specific effects, such as engraftment of human mast cells expressing distinct tryptase isoforms to evaluate IgE-mediated anaphylaxis and allergic responses, revealing differences in activation thresholds and inflammatory outcomes compared to murine tryptases. These models have also been used to test anti-tryptase interventions, showing isoform-dependent modulation of acute allergic reactions. Despite progress, significant knowledge gaps persist in tryptase . Data on tryptase's involvement in , particularly links to progression via PAR-2 activation in the brain, are sparse and require further investigation beyond current mast cell activation models. Moreover, the need for isoform-specific is evident, as current methods often measure total tryptase without distinguishing active forms or subtypes, hindering precise clinical correlations. In 2025, studies have advanced understanding of tryptase , including confirmation of very long-term in frozen samples for reliable use in , and expanded applications of tryptase for screening, , and of mast cell disorders like systemic . Methodological advances include the development of activity-based probes for selective detection of active tryptase. A 2020 immunoassay incorporating an activity-based probe enables measurement of enzymatically active tryptase in biological fluids, distinguishing it from inactive forms and facilitating studies of release dynamics during allergic events. These probes, targeting catalytic sites, have been applied to profile secreted tryptases in inflammatory contexts, enhancing real-time imaging and quantification of tryptase activity in tissues.

Therapeutic Implications

Tryptase inhibitors represent a promising class of therapeutics for -mediated disorders, aiming to mitigate inflammation and allergic responses by blocking the enzyme's proteolytic activity. Synthetic compounds, such as APC366, act as selective inhibitors of tryptase with a Ki of 7.1 μM, demonstrating the ability to reduce allergen-induced acute airway responses and release in preclinical pig models sensitized to . Another synthetic inhibitor, avoralstat, a kallikrein inhibitor with reported tryptase inhibitory activity, has shown safety in phase III clinical trials for (HAE), with potential to attenuate activation and pathway effects. Natural inhibitors like bikunin, a Kunitz-type inhibitor, colocalize with tryptase in dermal mast cells and modulate its activity in allergic skin conditions such as and follicular eruptions, where bikunin-laden mast cells are significantly elevated compared to normal skin. Monoclonal antibodies targeting tryptase, such as the humanized IgG4 antibody 31A.v11, function as allosteric inhibitors by dissociating active β-tryptase tetramers into inactive monomers (: 1.4–4.0 nM), reducing IgE-mediated in models and airway tryptase levels by over 90% in cynomolgus monkeys, with potential applications in . Clinical trials of tryptase inhibitors have yielded mixed results. In a phase 2a trial (n=134) of the anti-tryptase MTPS9579A for refractory , the primary of time to first composite was not met ( 0.90; 95% CI: 0.55–1.47; p=0.6835), attributed to insufficient bronchial tryptase inhibition despite adequate nasal levels, suggesting higher dosing (e.g., 3800 mg IV every 4 weeks) may be needed. Conversely, avoralstat's III safety profile in HAE supports its exploration for bradykinin-mediated . Developing effective tryptase inhibitors faces significant challenges, including the enzyme's complex activation and regulation mechanisms, which complicate achieving isoform selectivity—particularly targeting active β-tryptase without affecting inactive α-tryptase. Delivery to granules requires inhibitors that penetrate bilayers, while off-target effects on other serine proteases remain a concern, necessitating highly specific designs. Future prospects include computational modeling to identify β-tryptase-selective small molecules, such as 3-chloro-4-methylbenzimidamide, which exhibit over 10-fold selectivity and provide a foundation for treating inflammatory diseases.

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