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Published on: November 15, 2015
Genetic deficiency of complement factor H in a patient with age-related macular degeneration and
Tamara Montes1, Elena Goicoechea de Jorge, Rosa Ramos
1Centro de Investigaciones Biológicas and Centro de Investigación Biomédica en Enfermedades Raras, Ramiro de Maeztu 9, Madrid, Spain.
Insights
Age-related macular degeneration and membranoproliferative glomerulonephritis type II share a genetic link to complement genes. A novel mutation in factor H was identified, suggesting a common pathway in these dense deposit diseases.
Area of Science:
- Genetics
- Immunology
- Ophthalmology
- Nephrology
Background:
- Age-related macular degeneration (AMD) and membranoproliferative glomerulonephritis type II (MPGN2) are rare, severe diseases characterized by dense deposits.
- Both conditions are linked to genetic factors involving the complement system, a crucial part of the immune system.
Observation:
- A 64-year-old male patient developed both AMD and MPGN2.
- He exhibited low plasma C3 levels, borderline low factor H, and traces of C3NeF.
- Genetic analysis revealed a novel mutation in the CFH gene (c.1292 G>A), leading to a Cys431Tyr substitution in factor H.
Findings:
- The patient was a carrier of multiple genetic risk factors for AMD and MPGN2.
- Proteomic and functional studies confirmed the absence of the mutated factor H allele in his plasma, indicating partial factor H deficiency.
- The identified mutation and other genetic factors create a profile consistent with complement dysregulation.
Implications:
- These findings support the hypothesis that AMD and MPGN2 share a common pathogenic mechanism.
- Dysregulation of the alternative pathway of complement activation is implicated as the underlying cause.
- Understanding this shared pathway could lead to new diagnostic and therapeutic strategies for dense deposit diseases.
Abstract:
Age-related macular degeneration (AMD) and membranoproliferative glomerulonephritis type II (MPGN2) are dense deposit diseases that share a genetic association with complement genes and have complement proteins as important components of the dense deposits. Here, we present the case of a 64-year-old smoker male who developed both AMD and MPGN2 in his late 50s. The patient presented persistent low plasma levels of C3, factor H levels in the lower part of the normal range and C3NeF traces. Genetic analyses of the CFH, CFB, C3, CFHR1-CFHR3 and LOC387715/HTRA1 genes revealed that the patient was heterozygote for a novel missense mutation in exon 9 of CFH (c.1292 G>A) that results in a Cys431Tyr substitution in SCR7 of the factor H protein. In addition, he was homozygote for the His402 CFH allele, heterozygote for the Ser69 LOC387715 allele, homozygote for the Arg32 (BFS) CFB allele, heterozygote for the Gly102 (C3F) C3 allele and carried no deletion of the CFHR1/CFHR3 genes. Proteomic and functional analyses indicate absence in plasma of the factor H allele carrying the Cys431Tyr mutation. As a whole, these data recapitulate a prototypical complement genetic profile, including a partial factor H deficiency and the presence of major risk factors for AMD and MPGN2, which support the hypothesis that these dense deposit diseases have a common pathogenic mechanism involving dysregulation of the alternative pathway of complement activation.
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