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      Associations of complement factor B and complement component 2 genotypes with subtypes of polypoidal choroidal vasculopathy

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          Abstract

          Background

          We previously reported on subtypes of polypoidal choroidal vasculopathy (PCV), and categorized PCV as polypoidal choroidal neovascularization (CNV) and typical PCV. The aim of this study was to clarify whether complement component 2 ( C2) and complement factor B ( CFB) genotypes are associated with subtypes of polypoidal choroidal vasculopathy, such as polypoidal CNV and typical PCV.

          Methods

          First, we categorized 677 patients into typical age-related macular degeneration (tAMD; 250 patients), PCV (376) and retinal angiomatous proliferation (RAP; 51). Second, we categorized 282 patients with PCV as having polypoidal CNV (84 patients) or typical PCV (198) based on indocyanine green angiographic findings. In total, 274 subjects without AMD, such as PCV and CNV, served as controls. A SNP (rs547154) in the C2 gene and three SNPs (rs541862, rs2072633, rs4151667) in the CFB gene were genotyped, and case–control studies were performed in subjects with these PCV subtypes.

          Results

          In tAMD, no SNPs were associated with allele distributions. In PCV, rs547154 and rs2072633 were associated with allele distributions. RAP was only associated with rs2072633. After logistic regression analysis with adjustment for confounding factors, tAMD, PCV and RAP were found to be associated with rs2072633.

          As to PCV subtypes, there were significant differences in the distributions of rs547154, rs541862 and rs2072633 in the case–control studies for polypoidal CNV, but not between the typical PCV and control groups. Logistic regression analysis with adjustment for confounding factors showed the distributions of rs547154, rs541862 and rs2072633 to differ significantly between the controls and polypoidal CNV cases and that these SNPs were protective. The A/A genotype of rs2072633 was significantly more common in the polypoidal CNV than in the typical PCV group (p = 0.03), even with adjustment for polyp number and greatest linear dimension.

          Conclusions

          PCV might be genetically divisible into polypoidal CNV and typical PCV. The C2 and CFB gene variants were shown to be associated with polypoidal CNV. Typical PCV was not associated with variants in these genes.

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          Most cited references23

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          Clinicopathologic findings in polypoidal choroidal vasculopathy.

          To elucidate the pathogenic mechanism of polypoidal choroidal vasculopathy (PCV) based on histopathologic findings. Specimens obtained by surgical excision of PCV from five eyes of five patients (mean age, 75.6 +/- 3.1 years) were studied histopathologically. Immunohistochemical studies were also performed to identify CD34, vascular endothelial growth factor (VEGF), CD68, alpha-smooth muscle actin (alpha-SMA) and hypoxia-inducible factor (HIF)-1alpha. Hyalinization of choroidal vessels and massive exudation of fibrin and blood plasma were observed in all the specimens of PCV lesions. Some blood vessels were located above the RPE in two of the five eyes. Immunohistochemically, CD68-positive cells were detected around the hyalinized vessels. There were no alpha-SMA-positive cells in the vessels of PCV. CD34 staining showed endothelial discontinuity. Vascular endothelial cells within the PCV specimens were negative for VEGF. HIF-1alpha positive inflammatory cells were located in the stroma of specimens. Hyalinization of choroidal vessels, like arteriosclerosis, is characteristic of PCV.
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            Risk alleles in CFH and ARMS2 are independently associated with systemic complement activation in age-related macular degeneration.

            Systemic complement activation is associated with age-related macular degeneration (AMD) and has mainly been attributed to a risk allele in the complement factor H (CFH) gene. Whether other important AMD genes also influence complement activation is unclear. In the present case-control study, complement activity and concentrations of complement components and their activation products are measured in AMD patients and in unaffected controls and correlated with genetic variants in the CFH, ARMS2, C3, CFI, and CFB genes. Case-control study. A cohort of 197 confirmed AMD patients and 150 unaffected age-matched controls were recruited prospectively for the study. Hemolytic complement assays (AP50, CP50, and LP50), complement components (C3, CFB, CFI, and CFH), and the activation products (C3d, C5a, and SC5b-9) were analyzed in serum or plasma. The DNA samples were genotyped for 5 single nucleotide polymorphisms (SNPs) previously associated with AMD in the CFH, ARMS2, C3, CFB, and CFI genes. Complement concentrations and their associations with SNPs in the CFH, ARMS2, C3, CFB, and CFI genes. The AMD patients had increased activation of the alternative complement pathway (P = 0.003) and elevated levels of complement activation components C3d (P<0.0001) and C5a (P<0.0001), CFB (P<0.0001), and an increased C3d/C3 ratio (P<0.0001) calculated as a measure of C3 activation. While the CFH risk genotype was significantly associated with the elevated C3d/C3 ratios obtained, in the absence of CFH risk alleles the ARMS2 risk genotype also showed significantly increased levels of complement activation (P = 0.013). Furthermore, the carriers of the CFB protective allele had lower CFB concentrations. The current study found evidence showing that in AMD risk alleles in CFH and ARMS2 are independently associated with complement activation. Especially the C3d/C3 ratio seems to be a strong marker for AMD. The findings suggest that CFH and ARMS2 share a common pathway in the pathogenesis of AMD. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy.

              To identify the precise choroidal abnormalities associated with idiopathic polypoidal choroidal vasculopathy (IPCV), patients with IPCV were examined with indocyanine green (ICG) videoangiography. Twelve patients with IPCV were examined using standard clinical, fluorescein, and ICG videoangiographic techniques. Indocyanine green videoangiography showed two basic choroidal vascular changes: a branching network of vessels in the inner choroid, and vascular dilations at the border of the network of vessels. The vascular dilations appeared to be associated with the exudative and hemorrhagic manifestations of IPCV. The choroidal vasculopathy seen in IPCV is distinct from the changes seen in other choroidal abnormalities. Recognition of these changes aids in diagnosis and patient management, since the clinical implications of IPCV differ from those of other similar entities.
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                Author and article information

                Contributors
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central
                1471-2415
                2014
                25 June 2014
                : 14
                : 83
                Affiliations
                [1 ]Department of Ophthalmology, Nihon University School of Medicine, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8309, Japan
                [2 ]Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
                Article
                1471-2415-14-83
                10.1186/1471-2415-14-83
                4076251
                24965207
                44d9f335-3af7-4845-a5dc-c7c033a40f35
                Copyright © 2014 Tanaka et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 March 2014
                : 9 June 2014
                Categories
                Research Article

                Ophthalmology & Optometry
                subtypes of pcv,c2,cfb,genetic variants
                Ophthalmology & Optometry
                subtypes of pcv, c2, cfb, genetic variants

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