BACKGROUND: Plasma kallikrein plays a major role in the contact 
(kallikrein-kinin) cascade producing bradykinin. Bradykinin is a vasodilator, 
which increases vascular permeability, activates inflammation and produces pain. 
Plasma kallikrein is also crosslinked to the coagulation system and the 
complement cascade.
OBJECTIVE: Ecallantide (DX-88) is a potent and specific inhibitor of plasma 
kallikrein. Ecallantide is a recombinantly produced and engineered small protein 
based on the first Kunitz domain of human tissue factor pathway inhibitor. It 
was identified through phage display technology.
METHODS: The search terms 'ecallantide', 'DX-88' and 'hereditary angioedema' 
were entered into Pubmed/Medline, ClinicalTrials and Google.
RESULTS/CONCLUSION: At present, the drug is being studied for two major 
indications. First, the results for the treatment of hereditary angioedema are 
promising. Second, a prospective randomised multi-centre trial for the reduction 
of blood loss during on-pump cardiothoracic surgery will be terminated in 
October 2008.