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Complement Factor H Polymorphism, Complement Activators, and Risk of Age-Related Macular Degeneration
Open accessAbstract
CONTEXT: The evidence that inflammation is an important pathway in age-related macular degeneration (AMD) is growing. Recent case-control studies demonstrated an association between the complement factor H (CFH) gene, a regulator of complement, and AMD. OBJECTIVES: To assess the associations between the CFH gene and AMD in the general population and to investigate the modifying effect of smoking, serum inflammatory markers, and genetic variation of C-reactive protein (CRP). DESIGN, SETTING, AND PARTICIPANTS: Population-based, prospective cohort study of individuals aged 55 years or older (enrollment between March 20, 1990, and July 31, 1993, and 3 follow-up examinations that were performed between September 1, 1993, and December 31, 2004) in Rotterdam, the Netherlands. The CFH Y402H polymorphism was determined in a total of 5681 individuals. Information on smoking, erythrocyte sedimentation rate, CRP serum levels, and haplotypes of the CRP gene were assessed at baseline. MAIN OUTCOME MEASURES: All severity stages of prevalent and incident AMD, graded according to the international classification and grading system for AMD. RESULTS: The frequency of CFH Y402H was 36.2% (4116/11,362 alleles). At baseline, there were 2062 persons (36.3%) with any type of AMD (prevalent cases), including 78 (1.4%) with late AMD (stage 4). During follow-up (mean, 8 years; median, 10 years), 1649 (35.5%) of 4642 participants progressed to a higher stage of AMD (incident cases), including 93 (5.6%) who developed late AMD. The odds ratio (OR) of AMD increased in an allele-dose manner with 2.00 (95% confidence interval [CI], 1.56-2.55) for stage 2 AMD, 4.58 (95% CI, 2.82-7.44) for stage 3 AMD, and 11.02 (95% CI, 6.82-11.81) for stage 4 (late, vision threatening) AMD for homozygous persons. Cumulative risks calculated by Kaplan-Meier analysis of late AMD by age 95 years were 48.3% for homozygotes, 42.6% for heterozygotes, and 21.9% for noncarriers. The population-attributable risk for CFH Y402H was 54.0%. Elevated erythrocyte sedimentation rates further increased the OR to 20.2 (95% CI, 9.5-43.0), elevated serum CRP levels to 27.7 (95% CI, 10.7-72.0), and smoking to 34.0 (95% CI, 13.0-88.6) for homozygotes compared with noncarriers without these determinants. The CRP haplotypes conferring high levels of CRP significantly increased the effect of CFH Y402H (P<.01). CONCLUSIONS: The CFH Y402H polymorphism may account for a substantial proportion of AMD in individuals similar to those in the Rotterdam Study and may confer particular risk in the presence of environmental and genetic stimulators of the complement cascade.
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“We further confirmed the association with family history of AMD, consistent with the growing recognition of major genes involved in AMD (e.g., complement factor H and C3, LOCS 3877, HTRA 1) [21,83-86].”
From Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis (2010) · cites this paper as [21]
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“Multiple studies have assessed the role of genetic variants on AMD development and progression, especially with complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genes, the two major susceptibility genes for AMD [18].”
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“Data from the Rotterdam Eye Study population suggests that individuals who are homozygous for the gene coding for complement factor H Y4202H have a 48% risk of ARMD by age 95.(8) The data further suggested this gene may be a casual factor in more than 50% of cases of ARMD.”
MethodImplementation studies of ranibizumab for neovascular age‐related macular degeneration
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“Genetic variants may interact with behavioural and environmental risk factors such as smoking to enhance the probability of developing AMD (Despriet et al. 2006; Seddon et al. 2006).”
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“It had been considered the strongest risk factor for AMD prior to the introduction of genetic factors.(19) It has been shown to increase oxidative stress,(16) to up-regulate”
BackgroundPhotobiomodulation therapy in age-related macular degeneration
Muste, J. C., Kalur, A., Iyer, A. I., Valentim, C. C. S., & Singh, R. P. (2021) · Current Opinion in Ophthalmology · doi:10.1097/icu.0000000000000742 · Cited by 10
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“In these studies, and in accordance with our results, the CFH 1277C polymorphism has been associated with both forms of advanced AMD in comparison with the control population as the homozygous state for the C risk allele was more prevalent in both atrophic and neovascular AMD patients [11, 16, 24, 25].”
ResultMALONDIALDEHYDE LEVELS IN PATIENTS WITH AGE-RELATED MACULAR DEGENERATION
Pinna, A., Boscia, F., Paliogiannis, P., Carru, C., & Zinellu, A. (2019) · Retina · doi:10.1097/iae.0000000000002574 · Cited by 10
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“As a consequence, individuals who carry the at-risk polymorphism have higher concentrations of CRP both in plasma 24, 28 and in the RPE-choroid layer compared to those who are homozygous for the non-risk variant 29 .”
BackgroundResultMacrophages feel their age in macular degeneration
Jager, M. J., & Klaver, C. C. W. (2007) · Journal of Clinical Investigation · doi:10.1172/jci34070 · Cited by 9
Self-citationNew Technologies to Study Functional Genomics of Age-Related Macular Degeneration
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“The link between CFH and AMD suggests an inflammatory role in the pathogenesis of AMD, with increased complement cascade activity promoting AMD development in genetically predisposed individuals (Hageman et al., 2005; Despriet et al., 2006).”
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“Allele frequencies were in correspondence with previous reports from the Rotterdam Study.(19,21) We therefore consider selection bias due to selective nonparticipation of HisHis carriers unlikely.”
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“Withing a near 40% prevalence [15], the single nucleotide polymorphism predicting a Y402H replacement in the gene coding complement factor H (CFH) is an important risk factor for AMD [16].”
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“Yet less than 50% of people thought smoking could harm their eyes and an even smaller percentage had any awareness of AMD.”
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“Research investigating the link between smoking and genetic variants has shown that the effects of the Y402H variant and A69S variant are stronger among patients who smoke [63, 100].”
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“An over-active inflammasome, driven by oxidized lipids and perhaps a genetically induced over-activity of complement [32], leads to an increased IL-1β and IL18 [25,33] expression as well as the induction of other pro-inflammatory cytokines, such as IL-6 and TNF-α.”
BackgroundRole of inflammation in the pathogenesis of age-related macular degeneration
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“99) between the VEGF-C936T polymorphism and a different single nucleotide polymorphism (SNP) of the gene complement factor H (CFH - rs1061170) that has previously been shown to be associated with AMD((15)).”
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“Furthermore, four studies showed that there is no association between CRP gene expression and risk of AMD [38–41].”
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“This is considered an effective therapy for patients with neovascular AMD.”
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“The combination of genetic risk factors and smoking greatly increases the risk of developing AMD.(28,29) Ramlall et al observed an association between admission to a hospital because of COVID-19 and complement genes for CFH, C4BPB, C4BPA, and regulators of a complement suppressor, CD55.”
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Novel sequence elements define ancestral haplotypes of the region encompassing complement factor H
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“Smoking and ody mass index are important environmental factors ssociated with an increased risk of AMD, whereas the urden of genetic factors leads to attributable risk estimates p to 60%.(2) Prediction models based on known genetic nd environmental factors associated with AMD recently ere established.”
BackgroundWhat's new in the other general journals
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Sénéclauze, A., Goff, M. L., Cougnard‐Grégoire, A., Korobelnik, J., Rougier, M., Delyfer, M., Delcourt, C., & Gattoussi, S. (2024) · Acta Ophthalmologica · doi:10.1111/aos.16645 · Cited by 5
“The frequencies of the genotypes of CFH Y402H (Despriet et al., 2006; Klein et al., 2008; Xing et al., 2008) and ARMS2 (Thee et al., 2022) polymorphisms were also similar to those observed in previous studies in Caucasian subjects.”
ResultImportance of genetic polymorphisms in the response to age-related macular degeneration treatment
Veloso, C. E. D. R., de Almeida, L. N. F., Marco, L. A. D., Vianna, R. N. G., & Nehemy, M. B. (2012) · Revista Brasileira de Oftalmologia · doi:10.1590/s0034-72802012000300011 · Cited by 5
“histidine substitution at amino acid position 402 (Y402H) in the CFH protein.(7-33) The A69S polymorphism (rs”
BackgroundHo, L., van Leeuwen, R., Witteman, J. C. M., van Duijn, C. M., Albert Hofman, D., de Jong, P. T. V. M., Vingerling, J. R., & Klaver, C. C. W. (2011) · Archives of Ophthalmology · doi:10.1001/archophthalmol.2011.141-a · Cited by 6
“The risk allele Y402H appears to impair this regulatory function of CFH,(45-47) leading to complement overactivation, thereby increasing the risk of AMD.(15-19) The reason diet has an antagonistic effect in CFH Y402H carriers can be explained by several biological mechanisms: (1) Oxidative damage can activate the comp…”
Self-citationLi, J., Long, D., Wu, S., Wu, X., Wei, B., Chen, D., Shao, Y., Wang, H., Cui, L., Chen, X., et al. (2019) · Gene · doi:10.1016/j.gene.2019.144127 · Cited by 5
Mechanisms of Oxidative Stress in Retinal Injury
Brantley, M. A., & Sternberg, P. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4557-0737-9.00022-9 · Cited by 8
Pathobiology of the Outer Retina: Genetic and Nongenetic Causes of Disease
Haider, N. B., Cruz, N. M., Allocca, M., & Yuan, J. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-386456-7.04706-7 · Cited by 6
Retinal Effects of Resveratrol
Jarratt, R. A., Bartlett, H. E., Eperjesi, F., & Optometry, S. L. I. (2013) · touchREVIEWS in Ophthalmology · doi:10.17925/usor.2013.06.02.132 · Cited by 5
Zhang, H., Wang, J., Wang, Y., Li-guang, Z., & Lei, L. (2010) · Molecular Biology Reports · doi:10.1007/s11033-010-9956-x · Cited by 5
“This variant has been demonstrated to be associated with age-related macular degeneration [11], which shared many common pathophysiological mechanisms with coronary artery atherosclerosis [12, 13].”
BackgroundCruz-González, F., Lorenzo-Pérez, R., Cañete-Campos, C., Hernández-Galilea, E., & González‐Sarmiento, R. (2012) · Archivos de la Sociedad Española de Oftalmología · doi:10.1016/j.oftal.2012.04.019 · Cited by 4
Guideline for data analysis of genomewide association studies.
Heping Zhang, D., Liu, L., Wang, X., & Gruen, J. R. (2007) · PubMed · Cited by 5
Soheilian, R., Bonyadi, M. H. J., Moein, H.-R., Babanejad, M., Ramezani, A., Yaseri, M., & Soheilian, M. (2016) · International Ophthalmology · doi:10.1007/s10792-016-0373-6 · Cited by 4
“This finding was similar to some other published reports [15, 44].”
ResultGenetic Polymorphisms Affecting Ranibizumab Response in High Myopia Patients
Blánquez-Martínez, D., Díaz-Villamarín, X., Antúnez-Rodríguez, A., Pozo-Agundo, A., Muñoz‐Ávila, J. I., Martínez-González, L. J., & Dávila-Fajardo, C. L. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13111973 · Cited by 4
“Changes in the CFH gene may result in a malfunctioning CFH, rendering it unable to inhibit the complement cascade [53], especially its affinity to C-reactive protein (CRP), enhancing CRP levels in the choroid.”
BackgroundSuprachoroidal injection of ketorolac tromethamine does not cause retinal damage.
Liu, S., Liu, W., Ma, Y., Liu, K., & Wang, M. (2012) · Europe PMC (PubMed Central) · doi:10.3969/j.issn.1673-5374.2012.35.004 · Cited by 4
Cruz-González, F., Lorenzo-Pérez, R., Cañete-Campos, C., Hernández-Galilea, E., & González‐Sarmiento, R. (2013) · Archivos de la Sociedad Española de Oftalmología (English Edition) · doi:10.1016/j.oftale.2013.02.001 · Cited by 3
Cruz-González, F., Cabrillo-Estevez, L., Campos, C. C., Sanchez, A., Marcos, L. J., & González‐Sarmiento, R. (2016) · Archivos de la Sociedad Española de Oftalmología (English Edition) · doi:10.1016/j.oftale.2015.12.015 · Cited by 3
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Late-stage Age-Related Macular Degeneration
Pinna, A., Solinas, G., Giancipoli, E., Porcu, T., Zinellu, A., Ricci, G. D., Boscia, F., Lanzetta, P., Avitabile, T., Schwartz, A. G., et al. (2019) · International Journal of Medical Sciences · doi:10.7150/ijms.30155 · Cited by 3
Complement Factor H Variant Y402H is Not a Risk Factor for Preeclampsia in the Finnish Population
Kaare, M., Seitsonen, S., Järvelä, I. E., Meri, S., & Laivuori, H. M. (2008) · Hypertension in Pregnancy · doi:10.1080/10641950801955691 · Cited by 3
“These deposits in age-related macular degeneration have similarities with atherosclerotic plaques (17), including an inflammatory role in pathogenesis (18).”
BackgroundDégénérescence maculaire liée à l’âge et génétique : données actuelles
Fajnkuchen, F., & Cohen, S. Y. (2008) · Journal Français d Ophtalmologie · doi:10.1016/s0181-5512(08)75469-x · Cited by 3
Krishnaiah, S., Bapi, R. S., & Keeffe, J. E. (2015) · International Journal of Community Medicine and Public Health · doi:10.5455/2394-6040.ijcmph20150514 · Cited by 3
Age-related Macular Degeneration—Review and Current Concepts
Seth, R. K., Sigler, E. J., Adelman, R. A., & Resident, C. (2011) · touchREVIEWS in Ophthalmology · doi:10.17925/usor.2011.04.01.96 · Cited by 3
Complement Factor H Variant p.Y402H in Pseudoxanthoma Elasticum Patients
Götting, C., Hendig, D., Zarbock, R., Szliska, C., & Kleesiek, K. (2008) · Genetic Testing · doi:10.1089/gte.2008.0026 · Cited by 3
“The genotype frequencies of the CFH variant p.Y402H in our study were comparable to those found in other Caucasian groups (Zareparsi et al ., 2005; Despriet et al ., 2006; Sepp et al ., 2006).”
Finzi, A., Ottoboni, S., CELLINI, M., Corcioni, B., Gaudiano, C., & Fontana, L. (2024) · Clinical ophthalmology · doi:10.2147/opth.s479225 · Cited by 2
“50 51–53 Metabolic factors contributing to the development of AMD are closely associated with retinal aging processes and involve various mechanisms; these factors include the formation of drusen containing pro-inflammatory molecules, 54,55 thickening and stiffening of Bruch’s membrane due to lipid…”
BackgroundThe Role of Inflammation in Age-Related Macular Degeneration
Harris, J. M., & Wu, D. M. (2025) · International Ophthalmology Clinics · doi:10.1097/iio.0000000000000578 · Cited by 2
Altankhuyag, A., Ganbold, C., Byambadorj, B., Tumurbaatar, S., Sodnomtseren, P., Davaatseren, U., & Jav, S. (2024) · Molecular vision · doi:10.63500/mv_v30_320 · Cited by 2
Oxidative Stress and Systemic Changes in Age-Related Macular Degeneration
Brantley, M. A., Osborn, M. P., Cai, J., & Sternberg, P. (2012) · Humana Press eBooks · doi:10.1007/978-1-61779-606-7_18 · Cited by 2
Wiggs, J. L. (2007) · Archives of Ophthalmology · doi:10.1001/archopht.125.9.1264 · Cited by 2
Diet, dietary supplements and age-related macular degeneration (AMD)
Cicero, A. F. G., & Tartagni, E. (2014) · Nutrafoods · doi:10.1007/s13749-014-0017-2 · Cited by 2
Conceitos atuais e perspectivas na prevenção da degeneração macular relacionada à idade
Torres, R. J. D. A., Précoma, D. B., Maia, M., Kaiber, F., Prim, C. R., Luchini, A., Matos, R. S., & Farah, M. E. (2008) · Revista Brasileira de Oftalmologia · doi:10.1590/s0034-72802008000300008 · Cited by 2
Reflections on “Hot” Blind Spots: Lessons from Research on Aging Macula Disorder and Glaucoma
de Jong, P. T. V. M. (2011) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.11-8229 · Cited by 2
Younger Siblings, C-Reactive Protein, and Risk of Age-Related Macular Degeneration
Cohn, A., Busija, L., Robman, L. D., Dimitrov, P. N., Varsamidis, M., Lim, L. L., Baird, P. N., & Guymer, R. H. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kws332 · Cited by 2
The role of genetically determined factors in age-related macular degeneration pathogenesis
Belekhova, S. G., & Astakhov, Y. S. (2015) · Ophthalmology Reports · doi:10.17816/ov2015430-39 · Cited by 2
What is on the horizon for dry age-related macular degeneration drug treatment?
Rissotto, F., Sacconi, R., Apuzzo, A., Oldoni, G., Fusi, E., Servillo, A., Bandello, F. M., & Querques, G. (2023) · Expert Review of Ophthalmology · doi:10.1080/17469899.2023.2267179 · Cited by 2
Cruz-González, F., Cabrillo-Estevez, L., Campos, C. C., Sanchez, A., Marcos, L. J., & González‐Sarmiento, R. (2016) · Archivos de la Sociedad Española de Oftalmología · doi:10.1016/j.oftal.2015.12.016 · Cited by 2
Metadata
- Authors
- Despriet, D. D. G., Klaver, C. C. W., Witteman, J. C. M., Bergen, A. A. B., Kardys, I., de Maat, M. P. M., Boekhoorn, S. S., Vingerling, J. R., Hofman, A., Oostra, B. A., Uitterlinden, A. G., Stijnen, T., van Duijn, C. M., & de Jong, P. T. V. M.
- Affiliations
- Erasmus MC (NL)
- Netherlands Institute for Neuroscience (NL)
- Amsterdam Neuroscience (NL)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2006-07-19
- Volume
- 296
- Issue
- 3
- Pages
- 301
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2107143742
- Cited by
- 348
- References
- 44
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 2 · 2021: 8 · 2020: 10 · 2019: 11 · 2018: 8 · 2017: 8 · 2016: 7 · 2015: 21 · 2014: 17 · 2013: 28 · 2012: 24
- FWCI
- 36.22
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- KNAW research portal (Royal Academy of Art and Sciences (KNAW)) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- Erasmus Medisch Centrum
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Life Sciences › Immunology and Microbiology › Immunology › Complement system in diseases
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- age-related macular degeneration, complement factor H, CFH Y402H polymorphism, complement system, genetic susceptibility, smoking, C-reactive protein, serum inflammatory markers, erythrocyte sedimentation rate, inflammation, AMD progression, late AMD, genetic risk factors, Rotterdam Study, older adults, gene-environment interaction
- MeSH terms
- Aged, Aged, 80 and over, Blood Sedimentation, C-Reactive Protein, Complement Pathway, Alternative, Female, Haplotypes, Humans, Leukocyte Count, Macular Degeneration, Male, Middle Aged, Polymorphism, Genetic, Prospective Studies, Risk Factors, Smoking, Cohort Studies, Complement Factor H, Inflammation Mediators
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