The Role of Complement in age-Related Macular Degeneration : Heparan Sulphate, a ZIP Code for Complement Factor H?

Age-related macular degeneration (AMD) is the leading cause of blindness in developed nations and has been associated with complement dysregulation in the central retina. The Y402H polymorphism in the complement regulatory protein factor H (CFH) can confer a >5-fold increased risk of developing AMD and is present in approximately 30% of people of European descent. CFH, in conjunction with other factors, regulates complement activation in host tissues, and the Y402H polymorphism has been found to alter the protein’s specificity for heparan sulphate (HS) – a complex polysaccharide found ubiquitously in mammals. HS, which is present on the cell surface and also in the extracellular matrix, exhibits huge structural diversity due to variations in the level/pattern of sulphation, where particular structures may act as ‘ZIP codes’ for different tissue/cellular locations. Recent work has demonstrated that CFH contains two HS-binding domains that each recognize specific HS ZIP codes, allowing differential recognition of Bruch’s membrane (in the eye) or the glomerular basement membrane (in the kidney). Importantly, the Y402H polymorphism impairs the binding of CFH to the HS in Bruch’s membrane, which could result in increased complement activation and chronic local inflammation (in 402H individuals) and thereby contribute to AMD pathology

Age-Dependent Changes in Heparan Sulfate in Human Bruch's Membrane: Implications for Age-Related Macular Degeneration

Citation: Keenan TDL, Pickford CE, Holley RJ, et al. Age-dependent changes in heparan sulfate in human Bruch's membrane: implications for age-related macular degeneration. Invest Ophthalmol Vis Sci. 2014;55:5370-5379. DOI:10.1167/ iovs.14-14126 PURPOSE. Heparan sulfate (HS) has been implicated in age-related macular degeneration (AMD), since it is the major binding partner for complement factor H (CFH) in human Bruch's membrane (BrM), and CFH has a central role in inhibiting complement activation on extracellular matrices. The aim was to investigate potential aging changes in HS quantity and composition in human BrM. METHODS. Postmortem human ocular tissue was obtained from donors without known retinal disease. The HS was purified from BrM and neurosensory retina, and after digestion to disaccharides, fluorescently labeled and analyzed by reverse-phase HPLC. The HS and heparanase-1 were detected by immunohistochemistry in macular tissue sections from young and old donors, and binding of exogenously applied recombinant CCP6-8 region of CFH (402Y and 402H variants) was compared. RESULTS. Disaccharide analysis demonstrated that the mean quantity of HS in BrM was 50% lower (P ¼ 0.006) in old versus young donors (average 82 vs. 32 years). In addition, there was a small, but significant decrease in HS sulfation in old BrM. Immunohistochemistry revealed approximately 50% (P ¼ 0.02) less HS in macular BrM in old versus young donors, whereas heparanase-1 increased by 24% in old macular BrM (P ¼ 0.56). In young donor tissue the AMD-associated 402H CCP6-8 bound relatively poorly to BrM, compared to the 402Y form. In BrM from old donors, this difference was significantly greater (P ¼ 0.019). CONCLUSIONS. The quantity of HS decreases substantially with age in human BrM, resulting in fewer binding sites for CFH and especially affecting the ability of the 402H variant of CFH to bind BrM. Keywords: Bruch's membrane, heparan sulfate, AMD A ge-related macular degeneration (AMD) is the leading cause of blindness in developed countries. 1,2 Genetic and biochemical evidence has strongly implicated dysregulation of the complement system in disease pathogenesis. 20 Importantly, the amount of MAC in human BrM/choroid is significantly higher in individuals who are homozygous for the CFH 402H polymorphism. 21 A novel potential mechanism linking the Y402H polymorphism and AMD risk was suggested by the finding that the main binding partner of CFH in human macular BrM is heparan sulfate (HS), and that the 402H form of CFH binds poorly to human BrM HS, in comparison with the 402Y form