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Marasco E, Mucke J, Suurmond J. Editorial: Advances in systemic lupus erythematosus: The promises and pitfalls of personalized medicine and patient stratification. Front Med (Lausanne) 2022; 9:1085719. [PMID: 36561719 PMCID: PMC9764004 DOI: 10.3389/fmed.2022.1085719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Emiliano Marasco
- Department of Rheumatology, Bambino Gesù Children's Hospital, Rome, Italy,*Correspondence: Emiliano Marasco
| | - Johanna Mucke
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Jolien Suurmond
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands
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Relvas M, Tavares I, Fidalgo T, Mendonça L, Coentrão L. Reviewing thrombotic thrombocytopenic purpura diagnosis and treatment in a Portuguese hospital. Eur J Intern Med 2020; 71:95-97. [PMID: 31735543 DOI: 10.1016/j.ejim.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Miguel Relvas
- Nephrology Department, Centro Hospitalar Universitário São João, Oporto, Portugal.
| | - Isabel Tavares
- Nephrology Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - Teresa Fidalgo
- Clinical Hematology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luís Mendonça
- Nephrology Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - Luís Coentrão
- Nephrology Department, Centro Hospitalar Universitário São João, Oporto, Portugal
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Hanna RM, Merin N, Burwick RM, Abdelnour L, Selamet U, Yanny B, Bui P, Fouad M, Kurtz I. Successful use of eculizumab to treat atypical hemolytic uremic syndrome in patients with inflammatory bowel disease. Thromb J 2019; 17:18. [PMID: 31516395 PMCID: PMC6732828 DOI: 10.1186/s12959-019-0207-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/31/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Atypical hemolytic uremic syndrome is a rare group of disorders that have in common underlying complement amplifying conditions. These conditions can accelerate complement activation that results in a positive feedback cycle. The known triggers for complement activation can be diverse and include, infection, autoimmune disease, and malignancy. Recent reports suggest that certain autoimmune and rheumatological triggers of complement activation may result in atypical hemolytic uremic syndrome that does not resolve despite treating the underlying disorder. Specifically, patients with systemic lupus erythematosus and microangiopathic hemolysis may not respond to treatment of their underlying rheumatological trigger but responded to complement blockade. CASE PRESENTATIONS We report two patients with inflammatory bowel disease complicated by development of atypical hemolytic uremic syndrome. In both cases, patients were on treatment for inflammatory bowel disease, that was not well controlled/flaring at the time. The first patient is a male who developed Crohn's disease and microangiopathic hemolysis at age 5 and was treated with eculizumab successfully. Discontinuation of the medication led to multiple relapses, and the patient currently is being treated with eculizumab and has normal hematological and stable renal parameters. The second patient is a 49-year-old female with Ulcerative Colitis treated with 6-Mercaptopurine. She developed acute kidney injury and microangiopathic hemolysis. Prompt diagnosis and treatment with eculizumab resulted in the recovery of kidney injury along with a complete hematological response. CONCLUSIONS These two cases are the fifth and sixth patients to be published in the literature with atypical hemolytic uremic syndrome and inflammatory bowel disease treated with complement blockade. This confirms that C5 complement blockade is effective in treating complement mediated thrombotic microangiopathy/atypical hemolytic uremic syndrome when it is triggered in patients with inflammatory bowel disease.
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Affiliation(s)
- Ramy M. Hanna
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Room 7-155, Factor Bldg. 700 Tiverton Ave, Los Angeles, CA 90095 USA
- Department of Medicine, Division of Nephrology, University of California Irvine School of Medicine, Irvine CA, USA
| | - Noah Merin
- Department of Medicine, Division of Hematology Oncology, Cedars Sinai Medical Center, Los Angeles, USA
| | - Richard M. Burwick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center, Los Angeles, USA
| | - Lama Abdelnour
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Room 7-155, Factor Bldg. 700 Tiverton Ave, Los Angeles, CA 90095 USA
| | - Umut Selamet
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Room 7-155, Factor Bldg. 700 Tiverton Ave, Los Angeles, CA 90095 USA
| | - Beshoy Yanny
- Department of Medicine, Division of Digestive Diseases, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Patrick Bui
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Mary Fouad
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Ira Kurtz
- Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Room 7-155, Factor Bldg. 700 Tiverton Ave, Los Angeles, CA 90095 USA
- UCLA Brain Research Institute, Los Angeles, USA
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Baghbanian SM, Moghadasi AN. Thrombotic microangiopathy associated with interferon-beta treatment in patients with multiple sclerosis. Iran J Neurol 2018; 17:89-90. [PMID: 30210735 PMCID: PMC6131330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Aijazi I, Shama FA, Raman LG, Mukhtiar S. Malignant Hypertension Complicated By Renal Thrombotic Micro Angiopathy: Role Of Adam 13 Mutational Analyses. J Ayub Med Coll Abbottabad 2017; 29:502-505. [PMID: 29076694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a case of a 38-year-old U.A.E national who presented with malignant hypertension and features of thrombotic microangiopathy. He presented with oliguria, renal failure, thrombocytopenia and haemolytic anaemia. He required several sessions of renal replacement therapy. ADAM 13 mutational analysis was sent to differentiate Thrombotic micro angiopathy due to thrombotic thrombocytopenic purpura (TTP) or malignant hypertension. Renal biopsy revealed histopathological features of malignant arteriolar nephrosclerosis (MANS). Haemolytic parameters improved after control of blood pressure and he was subsequently discharged with early nephrology follow up.
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Affiliation(s)
- Ishma Aijazi
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
| | - Fadhil Al Shama
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
| | | | - Sara Mukhtiar
- Department of Internal Medicine and Histopathology, Dubai Hospital, Dubai, U.A.E
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Bu F, Borsa NG, Jones MB, Takanami E, Nishimura C, Hauer JJ, Azaiez H, Black-Ziegelbein EA, Meyer NC, Kolbe DL, Li Y, Frees K, Schnieders MJ, Thomas C, Nester C, Smith RJH. High-Throughput Genetic Testing for Thrombotic Microangiopathies and C3 Glomerulopathies. J Am Soc Nephrol 2015; 27:1245-53. [PMID: 26283675 DOI: 10.1681/asn.2015040385] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/01/2015] [Indexed: 11/03/2022] Open
Abstract
The thrombotic microangiopathies (TMAs) and C3 glomerulopathies (C3Gs) include a spectrum of rare diseases such as atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, C3GN, and dense deposit disease, which share phenotypic similarities and underlying genetic commonalities. Variants in several genes contribute to the pathogenesis of these diseases, and identification of these variants may inform the diagnosis and treatment of affected patients. We have developed and validated a comprehensive genetic panel that screens all exons of all genes implicated in TMA and C3G. The closely integrated pipeline implemented includes targeted genomic enrichment, massively parallel sequencing, bioinformatic analysis, and a multidisciplinary conference to analyze identified variants in the context of each patient's specific phenotype. Herein, we present our 1-year experience with this panel, during which time we studied 193 patients. We identified 17 novel and 74 rare variants, which we classified as pathogenic (11), likely pathogenic (12), and of uncertain significance (68). Compared with controls, patients with C3G had a higher frequency of rare and novel variants in C3 convertase (C3 and CFB) and complement regulator (CFH, CFI, CFHR5, and CD46) genes (P<0.05). In contrast, patients with TMA had an increase in rare and novel variants only in complement regulator genes (P<0.01), a distinction consistent with differing sites of complement dysregulation in these two diseases. In summary, we were able to provide a positive genetic diagnosis in 43% and 41% of patients carrying the clinical diagnosis of C3G and TMA, respectively.
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Affiliation(s)
- Fengxiao Bu
- Interdisciplinary PhD Program in Genetics, Molecular Otolaryngology and Renal Research Laboratories
| | | | | | - Erika Takanami
- Molecular Otolaryngology and Renal Research Laboratories
| | - Carla Nishimura
- Molecular Otolaryngology and Renal Research Laboratories, Iowa Institute of Human Genetics
| | | | - Hela Azaiez
- Molecular Otolaryngology and Renal Research Laboratories
| | | | - Nicole C Meyer
- Molecular Otolaryngology and Renal Research Laboratories
| | | | - Yingyue Li
- Molecular Otolaryngology and Renal Research Laboratories
| | - Kathy Frees
- Molecular Otolaryngology and Renal Research Laboratories
| | | | - Christie Thomas
- Molecular Otolaryngology and Renal Research Laboratories, Division of Nephrology, Department of Internal Medicine and Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Carla Nester
- Molecular Otolaryngology and Renal Research Laboratories, Division of Nephrology, Department of Internal Medicine and Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, Iowa Institute of Human Genetics, Division of Nephrology, Department of Internal Medicine and Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Dashti-Khavidaki S, Shojaie L, Hosni A, Khatami MR, Jafari A. Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient. Nephrourol Mon 2015; 7:e27073. [PMID: 26034746 PMCID: PMC4450162 DOI: 10.5812/numonthly.7(3)2015.27073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Antibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intravenous immunoglobulin (IVIG) and rituximab. Objectives: This study was designed to assess the efficacy of routine treatment of AMR/TMA in Iranian kidney transplant recipients, which comprises of plasmapheresis and IVIG. Patients and Methods: This one-year cross-sectional study was performed in the Kidney Transplantation Ward of Imam-Khomeini Hospital Complex, Tehran, Iran. All kidney transplant recipients who were administered plasmapheresis and IVIG to treat definite or suggested AMR or TMA were assessed clinically and also evaluated on laboratory data. Results: During 2014, we encountered five patients with suspicious AMR or TMA at our kidney transplant center. Renal biopsy was performed for two of them, suggesting AMR for one patient and TMA for another patient. All patients were treated with plasmapheresis plus IVIG. In this center, as a routine practice, the cumulative dose of 2 g/kg of IVIG was divided to 300 - 400 mg/kg after each plasmapheresis. Only one out of the five patients showed response, albeit not completely. Conclusions: Due to daily plasmapheresis within the first several days after AMR or TMA, administering high amounts of the cumulative dose of IVIG after plasmapheresis may result in high amounts of IVIG withdrawal by plasmapheresis and response failure. Our suggestion is to reduce the IVIG dose after each plasmapheresis to 100 mg/kg (i.e. replacement dose) to reach a cumulative dose of 2 g/Kg. If plasmapheresis treatment is initiated sooner than the completion of the IVIG cumulative dose of 2 g/kg, the remaining dose can be administered during one injection.
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Affiliation(s)
- Simin Dashti-Khavidaki
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Simin Dashti-Khavidaki, Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2166581568, Fax: +98-2166581568, E-mail:
| | - Lida Shojaie
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Hosni
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Atefeh Jafari
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Bhattacharjee A, Reuter S, Trojnár E, Kolodziejczyk R, Seeberger H, Hyvärinen S, Uzonyi B, Szilágyi Á, Prohászka Z, Goldman A, Józsi M, Jokiranta TS. The major autoantibody epitope on factor H in atypical hemolytic uremic syndrome is structurally different from its homologous site in factor H-related protein 1, supporting a novel model for induction of autoimmunity in this disease. J Biol Chem 2015; 290:9500-10. [PMID: 25659429 PMCID: PMC4392255 DOI: 10.1074/jbc.m114.630871] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Indexed: 01/26/2023] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is characterized by complement attack against host cells due to mutations in complement proteins or autoantibodies against complement factor H (CFH). It is unknown why nearly all patients with autoimmune aHUS lack CFHR1 (CFH-related protein-1). These patients have autoantibodies against CFH domains 19 and 20 (CFH19–20), which are nearly identical to CFHR1 domains 4 and 5 (CFHR14–5). Here, binding site mapping of autoantibodies from 17 patients using mutant CFH19–20 constructs revealed an autoantibody epitope cluster within a loop on domain 20, next to the two buried residues that are different in CFH19–20 and CFHR14–5. The crystal structure of CFHR14–5 revealed a difference in conformation of the autoantigenic loop in the C-terminal domains of CFH and CFHR1, explaining the variation in binding of autoantibodies from some aHUS patients to CFH19–20 and CFHR14–5. The autoantigenic loop on CFH seems to be generally flexible, as its conformation in previously published structures of CFH19–20 bound to the microbial protein OspE and a sialic acid glycan is somewhat altered. Cumulatively, our data suggest that association of CFHR1 deficiency with autoimmune aHUS could be due to the structural difference between CFHR1 and the autoantigenic CFH epitope, suggesting a novel explanation for CFHR1 deficiency in the pathogenesis of autoimmune aHUS.
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Affiliation(s)
- Arnab Bhattacharjee
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland, the Institute of Biotechnology and
| | - Stefanie Reuter
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany
| | - Eszter Trojnár
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Robert Kolodziejczyk
- the Institute of Biotechnology and Division of Biochemistry and Biotechnology, Department of Biosciences, University of Helsinki, 00014 University of Helsinki, Finland
| | - Harald Seeberger
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany
| | - Satu Hyvärinen
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland
| | | | - Ágnes Szilágyi
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Zoltán Prohászka
- the Research Laboratory, 3rd Department of Internal Medicine, Semmelweis University, 1125 Budapest, Hungary, and
| | - Adrian Goldman
- the Institute of Biotechnology and Division of Biochemistry and Biotechnology, Department of Biosciences, University of Helsinki, 00014 University of Helsinki, Finland
| | - Mihály Józsi
- the Junior Research Group for Cellular Immunobiology, Leibniz Institute for Natural Product, Research and Infection Biology-Hans Knöll Institute, 07745 Jena, Germany, MTA-ELTE "Lendület" Complement Research Group, Department of Immunology, Eötvös Loránd University, 1117 Budapest, Hungary
| | - T Sakari Jokiranta
- From the Department of Bacteriology and Immunology, Medicum, and Immunobiology Research Program Unit, University of Helsinki and Helsinki University Hospital, 00014 University of Helsinki, Finland
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Ardalan M, Rezaeifar P. Von Willebrand factor-cleaving protease activity in thrombotic microangiopathy: first report from iran. Nephrourol Mon 2014; 6:e18900. [PMID: 25738110 PMCID: PMC4330667 DOI: 10.5812/numonthly.18900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Thrombotic microangiopathy (TMA) is a rare but devastating small vessels disorder that is characterized by intravascular platelet thrombi, thrombocytopenia, and various degrees of organ ischemia and anemia, which is due to erythrocyte fragmentation in microcirculation. OBJECTIVES The Aim of this study was to determine the von Willebrand factor-cleaving protease (ADAMTS13) activity during the acute phase of TMA. We also investigated inhibiting antibodies against ADAMTS13 in these patients. PATIENTS AND METHODS In a collaborative work with Mario-Negro institute of pharmacological research in Bergamo-Italy, we registered the clinical and laboratory data, collected the serum samples, and transferred the samples to the laboratories. Serum samples were taken before the start of plasmapheresis or at least 15 days after the final exchange. RESULTS We recruited 40 patients (14 males and 26 females) with the mean age of 46.12 ± 17.26 years. The mean activity of ADAMTS13 was 34.58% ± 21.83%. Two patients had inhibitory antibodies against ADAMTS13 with profound deficiency of ADAMTS13 activity (< 6%). Infectious diseases were the most common underlying condition, followed by systemic lupus erythematous. CONCLUSIONS Majority of patients had an underlying condition and had various ADAMTS13 activity. The presence of inhibiting antibodies and accompanied complete deficiency of ADAMTS13 activity is an indicator of severity.
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Affiliation(s)
- Mohammadreza Ardalan
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Mohammadreza Ardalan, Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9141168518, Fax: +98-4113366579, E-mail:
| | - Parisa Rezaeifar
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Hyvärinen S, Uchida K, Varjosalo M, Jokela R, Jokiranta TS. Recognition of malondialdehyde-modified proteins by the C terminus of complement factor H is mediated via the polyanion binding site and impaired by mutations found in atypical hemolytic uremic syndrome. J Biol Chem 2013; 289:4295-306. [PMID: 24344133 DOI: 10.1074/jbc.m113.527416] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a severe thrombotic microangiopathy characterized by uncontrolled complement activation against endothelial and blood cells. Mutations in the C-terminal target recognition domains 19-20 of complement regulator factor H (FH) are strongly associated with aHUS, but the mechanisms triggering disease onset have remained unresolved. Here we report that several aHUS-related mutations alter the binding of FH19-20 to proteins where lysines have reacted with malondialdehyde (MDA). Although FH19-20 did not interact with MDA-modified hexylamine, lysine-containing peptides, or a proteolytically degraded protein, it bound to MDA-modified polylysine. This suggests that FH19-20 recognizes only clustered MDA adducts. Binding of MDA-modified BSA to FH19-20 was ionic by nature, depended on positive residues of FH19-20, and competed with the polyanions heparin and DNA. This could not be explained with the mainly neutral adducts known to form in MDA modification. When positive charges of lysines were eliminated by acetic anhydride instead of MDA, the acetylated BSA started to bind FH19-20. Together, these results indicate that negative charges on the modified proteins dominate the interaction with FH19-20. This is beneficial for the physiological function of FH because by binding to the negative charges of the modified target, FH could prevent excess complement activation initiated by naturally occurring antibodies recognizing MDA epitopes with multiple different structures. We propose that oxidative stress leading to formation of MDA adducts is a common feature for triggers of aHUS and that failure of FH in protecting MDA-modified surfaces from complement activation is involved in the pathogenesis of the disease.
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Affiliation(s)
- Satu Hyvärinen
- From the Department of Bacteriology and Immunology, Haartman Institute, and Research Programs Unit, Immunobiology, University of Helsinki, FIN-00290 Helsinki, Finland
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