F icolins are members of the defense collagen family that comprises oligomeric proteins with globular recognition domains able to sense danger signals, such as pathogen-or apoptotic cell-associated molecular patterns, and collagen-like stalks providing the link with immune effectors (1, 2). Ficolins are assembled from homotrimeric subunits comprising a collagen-like triple helix and a lectin-like domain composed of three fibrinogenlike (FBG) 3 domains. Two cysteines at the N-terminal end of the polypeptide chains form interchain disulfide bonds that mediate assembly into higher oligomerization structures (3, 4). In humans, L-and H-ficolins have been characterized in serum whereas Mficolin is mainly expressed by the monocytic cell lineage (5-7). In addition to humans, ficolins have been identified in different mammalian species including rodents and pigs (8, 9), which have two related ficolin genes called A and B and ␣ and , respectively, orthologous to the human L-and M-ficolin genes, respectively (10). To date, H-ficolin has only been identified in humans and it has been reported recently that the mouse and rat homologues of the H-ficolin gene are pseudogenes, which accounts for the absence of the corresponding protein in rodents (10). Like mannan-binding lectin (MBL), ficolins are able to activate the lectin complement pathway in response to recognition of neutral carbohydrates and N-acetyl groups on pathogens and damaged cells. This results from the ability of MBL and ficolins to associate with and trigger activation of MBL-associated serine protease (MASP)-2. Activated MASP-2 cleaves the complement proteins C2 and C4, thereby triggering the complement cascade (11-13). Three other MBL/ficolins-associated proteins have been described, the MASP-1 and MASP-3 proteases (14, 15) and a truncated form of MASP-2 called MAp19 (19-kDa MBL-associated protein) or sMAp (16,17). MASP-3 has no known physiological substrates whereas MASP-1 cleaves with a low efficiency a few protein substrates, among which are fibrinogen and coagulation factor XIII (18). It has been proposed recently that MASP-1 might contribute to the activation of the lectin pathway, but this issue is still controversial (19,20). Complement activation results in opsonization of microbes and apoptotic cells with C3-derived fragments, thus promoting their clearance through interaction with C3 receptors on The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.1 This work was supported by the Commissariat à l'Energie Atomique, the Centre National de la Recherche Scientifique, the Université Joseph Fourier (Grenoble, France).
Most patients with idiopathic membranous nephropathy (IMN) have IgG4 autoantibodies against phospholipase A2 receptor (PLA2R). C3 and C5b-9 are found in immune deposits of IMN kidney biopsy specimens, but the pathway of complement activation in IMN remains elusive. We report the case of a patient who developed IMN with intense staining for PLA2R, IgG4, C3, C5b-9, factor B, and properdin and very weak staining for C1q, C4d, and IgG1. Measurement of mannan binding lectin (MBL) antigenic level and activity revealed MBL deficiency. Genotyping revealed a heterozygous (A/C) polymorphism in codon 57 of MBL2 exon 1 associated with homozygous and heterozygous variations in the promoter region at -550 (L/L) and -221 (X/Y), respectively, suggesting that the patient harbored the LXA/LYC haplotypes linked to MBL deficiency. Genetic sequencing in 77 consecutive patients with IMN identified four patients with MBL2 promoter and coding region variations associated with MBL deficiency and the same complement pattern in immune deposits as the index patient. In contrast, patients with wild-type MBL2 had immune deposits with intense Cd4 staining. Thus, IMN can develop in patients with complete MBL deficiency, with complement activated mainly by the alternative pathway, whereas the lectin pathway is also activated in those with wild-type MBL2.
Diagnosis of type III HAE should be based on clinical (typical attacks, often hormonally influenced), laboratory (normal C1Inh antigenic protein) and genetic (F12 gene mutation) evidence.
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