A polymorphism in complement factor H has recently been associated with age-related macular degeneration (AMD), the leading cause of blindness in the elderly. A histidine rather than a tyrosine at residue position 384 in the mature protein increases the risk of AMD. Here, using a recombinant construct, we show that amino acid 384 is adjacent to a heparin-binding site in CCP7 of factor H and demonstrate that the allotypic variants differentially recognize heparin. This functional alteration may affect binding of factor H to polyanionic patterns on host surfaces, potentially influencing complement activation, immune complex clearance, and inflammation in the macula of AMD patients.
Age-related macular degeneration (AMD)4 is the leading cause of natural blindness in the Western world, and its prevalence may become greater with an increasing elderly population (1, 2). AMD manifests itself by the progressive destruction of the macula, causing central vision loss. The dry form of AMD, which accounts for 90% of cases, is associated with the presence of small yellow "drusen" deposits between the choroid and the retinal pigment epithelium that result in gradual vision loss; about 10 -20% of patients with dry AMD go on to develop the more severe wet form. Recently, a common allelic variant of human complement factor H (3) has been linked to an increased risk of developing dry AMD (4 -6). This variant arises from a tyrosine/histidine polymorphism at amino acid 384 in the mature protein (referred to as residue 402 in Refs. 4 -6), where ϳ35% of individuals of European descent carry the disease-associated His-384 allele. This increases the likelihood of developing AMD by 2.7-fold and may account for 50% of the attributable risk of AMD (4). In individuals who are homozygous for the risk allele, the likelihood of AMD is increased by a factor of 7.4 (5). Recently, the His-384 allele has also been associated with an increased risk of myocardial infarction, where it has been suggested that atherosclerosis could contribute to macular degeneration (7).Factor H is a 155-kDa plasma protein that acts as a cofactor for the breakdown of complement C3b by factor I (8). It is composed of 20 complement control protein (CCP; also termed short consensus repeats) modules (9), each of ϳ60 amino acids with a compact structure (10). The Y384H polymorphism is located within CCP7 (3). Factor H is believed to discriminate self from non-self by recognizing polyanionic structures on the former, such as sialic acid and the glycosaminoglycan (GAG) chains of proteoglycans (e.g. heparan sulfate (HS) and dermatan sulfate (DS)) and thus inhibits complement activation on host surfaces (11,12). Factor H has been shown to be present in retinal blood vessels in the choroid (5) and is associated with the drusen of AMD patients (2, 13). In addition, markers of complement activation (e.g. C5b-9 and C3 fragments, including iC3b) have been detected in the Bruch's membrane and drusen of AMD patients, leading to the hypothesis that AMD results from an aberrant inflamm...