Complement Factor H-related 5 Research Articles

Characterization and Association of CFHR5 Gene Polymorphism with Fatty Acid Composition and Cholesterol in Sheep

The Complement Factor H Related 5 (CFHR5) gene is speculated to have an important role in regulating fatty acid composition in sheep. The aim of this study was to investigate the polymorphism of the CFHR5 gene and its association with fatty acid composition and cholesterol of sheep in Indonesia. A total of 172 rams from 83 priangan sheep (PS), 20 sapudi sheep (SS), 19 Garut sheep (GS), 20 jonggol sheep (JS), 10 Garut composite sheep (GCS), 10 compass agrinac sheep (CAS), and 10 Barbados cross sheep (BCS) were used for this study. Identification of CFHR5 gene polymorphism were performed by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) using AciI restriction enzyme. The results showed that the CFHR5 gene in all sheep populations were polymorphic producing three genotypes, e.g. CC, CT and TT, respectively. The polymorphism had a significant effect (p<0.05) on fatty acid composition (miristoleic [C14:1], ginkgolic [C17:1], tridecanoic [C13:0], and heptadecanoic [C17:0] acids) and cholesterol. The breed and polymorphism had a significant effect (p<0.05) on fatty acid composition (JS with tridecanoic acid [C13:0] and BCS with miristoleic acid [C14:1]). The CC genotype is the preferred genotype and as it exhibits reduced levels of saturated fatty acids and cholesterol. The BCS sheep is the preferred genotype and as it exhibits high PUFA/SFA ratio. The CFHR5 gene (SNP c.1011C>T) has the potential to be used as a genetic marker for the selection of low saturated fatty acid composition and cholesterol in sheep

Effect of forsythoside A on the transcriptional profile of bovine mammary epithelial cells challenged with lipoteichoic acid.

Mastitis is a common disease of the dairy cattle, which affects the development of the dairy industry and leads to huge economic losses. Forsythoside A (FTA) has anti-inflammatory, antioxidant, antiviral and anti-apoptotic effects. However, the therapeutic effect and molecular mechanism of FTA on dairy cow mastitis remain unclear. In this study, bovine mammary epithelial cells (BMECs) were stimulated with lipoteichoic acid (LTA), a key virulence factor of Staphylococcus aureus (S. aureus), to construct in vitro models, and then treated with FTA. Subsequently, the differentially expressed genes (DEGs) in different groups were determined by RNA sequencing (RNA-Seq) analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to analyse the possible function of the DEGs, real-time quantitative PCR (RT-qPCR) was used to verify whether the expression levels of these DEGs were consistent with RNA-Seq results. The results showed that cell division cycle 20B (CDC20B), endothelial cell surface expressed chemotaxis and apoptosis regulator (ECSCR), complement factor H-related 5 (CFHR5) and phospholipase A2 group IVA (PLA2G4A) were down-regulated after FTA treatment. In contrast, Kruppel-like factor 15 (KLF15) and Metallothionein 1E (MT1E) were up-regulated. These DEGs are involved in processes such as apoptosis, inflammation and development of cancer. This study provides valuable insights into the transcriptome changes in BMECs after FTA treatment. Further analysis may help identify the underlying molecular mechanisms.

Immunologic markers and risk of hepatocellular carcinoma in hepatitis B virus- and hepatitis C virus-infected individuals.

Clinical and experimental studies suggest immunologic proteins contribute to hepatocellular carcinoma (HCC) development. To evaluate circulating immunologic markers and HCC risk. From a Taiwanese cohort of chronically hepatitis B virus (HBV)-infected individuals followed over time (REVEAL-HBV), we sampled 175 who developed HCC, 117 cirrhosis only, and 165 non-cirrhotic controls. From a similar Taiwanese cohort of chronically hepatitis C virus (HCV)-infected individuals (REVEAL-HCV), we included 94 individuals who developed HCC, 68 cirrhosis only and 100 non-cirrhotic controls. We compared pre-diagnostic plasma levels of 102 markers in HCC cases to non-cirrhotic and cirrhotic controls using polytomous logistic regression. A priori markers included insulin-like growth factor binding protein-3 (IGFBP-3), intercellular adhesion molecule 1 (ICAM-1) and interleukin 6 (IL-6). P-values for other markers were corrected for multiple testing (false discovery rate=10%). In both REVEAL-HBV and REVEAL-HCV, increasing levels of ICAM-1 were associated with increased risk of HCC compared to non-cirrhotic controls (P-trend 0.02 and 0.001, respectively). In both REVEAL-HBV and REVEAL-HCV, two novel markers [C-X-C motif chemokine 11 (CXCL11) and hepatocyte growth factor (HGF)] were positively associated [strongest odds ratioquartile 4 versus 1 (OR) 4.55 for HGF in HCV], while two [complement factor H related 5 (CFHR5) and stem cell factor (SCF)] were negatively associated (strongest ORQ4vQ1 0.14 for SCF in HCV) with development of HCC compared to non-cirrhotic controls. We confirmed the association for ICAM-1 and identified 4 additional proteins associated with HBV- and HCV-related HCC. These findings highlight the importance of immunologic processes in HBV- and HCV-related HCC.

Proteomic analysis reveals distinctive protein expression patterns of thrombus in clear cell renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) is a type of malignant tumor of the urinary system. The renal vein or vena cava thrombus can be found in a subset of ccRCC patients in whom it leads to worse prognosis. However, the protein expression profile and molecular features of ccRCC thrombus remain largely unclear. Here, a comparative proteomic analysis was performed using the 2D-LC-MS strategy for the thrombus-tumor-normal tissue triples of 15 ccRCC patients. Statistical analysis, GO enrichment analysis, protein-protein interaction network construction, and mRNA-based survival analysis were used to interpret the proteomic data. Three dysregulated proteins, GGT5 (gamma-glutamyl transferase 5), KRT7 (keratin 7) and CFHR1 (complement factor H related 1), were analyzed using western blot (WB) and immunohistochemistry (IHC) to validate the reliability of the proteomic analysis. The result of this analysis revealed 251 dysregulated proteins, which could be divided into 11 clusters depending on the changing trends, among the thrombus, tumor, and normal tissues. Several pathways and regulation networks were found to be associated with the thrombus, and some dysregulated proteins showed potential values for prognosis prediction. WB and IHC results were in accordance with the proteomic results, further validating the reliability of this study. In conclusion, our findings provide an overview of the thrombus at the molecular level as well as valuable information for further pathological studies or research on biomarkers and therapeutic targets.

Electrochemical ELISA-based platform for bladder cancer protein biomarker detection in urine

A novel fluidic-based electrochemical ELISA platform is descried for estimation of the bladder cancer protein markers nuclear mitotic apparatus protein 1 (NUMA1) and complement factor H-related 1 (CFHR1). The platform uses an off-site chamber for a sandwich immunoassay and performs the electrochemistry on-chip in a separate chamber. The off-site matrices were connected to the sensor chip in a manner that the sensors were exposed only to the final electroactive product for signal detection, thus avoiding interference from other molecules present in the sample. Two off-site matrices using 3D polymethyl methacrylate (PMMA) sheets and 2D polycarbonate (PC) membranes modified with the desired antibodies were investigated. Antibodies for NUMA1 and CFHR1 were utilized for the immunoassay and hair comb structured gold electrodes were used for sensing. Results in 10% synthetic urine reveal that the system can detect NUMA1 and CFHR1 in the 1–100 ng/ml range with high sensitivities of 260 nA/(ng/ml) and 310 nA/(ng/ml), for NUMA1 and CFHR1, respectively; negligible interference from the diluted urine and other molecules has been observed. A fully automated fluidic prototype has also been developed to demonstrate that automation of the process and multiplexing of detection can be achieved in a small footprint benchtop device. The use of off-site matrix-based platforms paves the way towards a new generation of electrochemical immunosensors for biomarker estimation with negligible non-specific interactions and false signals in complex samples.

Three Cases of Patients with Complement Regulatory Factor Genetic Mutations and Acquired Thrombotic Thrombocytopenic Purpura (TTP)

Acquired TTP is a thrombotic microangiopathy (TMA) associated with deficiency of the vonWillebrandfactor cleaving protein ADAMTS13. Atypical hemolytic uremic syndrome (aHUS) is a TMA with a genetic predisposition todysregulationin the alternative complement pathway. Causes ofaHUSinclude mutations in CD46, complement factor I (CFI), complement factor B, complement component 3 (C3), complement factor H-related 5 (CFHR5), andthrombomodulin(THBD) or secondary to Complement factor H (CFH) autoantibodies.Treatment of these two TMAs differs. Whereas therapeutic plasma exchange (TPE), steroids, rituximab, cyclophosphamide and/or vincristine are used in TTP,aHUSrequires controlling unrestrained complement activation with eculizumab, an antibody preventing cleavage of C5.Testing for genetic predisposition to complementdysregulationis not commonly considered in TTP. To our knowledge, only one case report has described such a genetic association (Ref: PMID# 22409250). Here we describe 3 new cases with concurrent TTP,aHUSand genetic changes in complement genes.Case 1: 24y.o. African American (AA) man with XXY syndrome presented with bloody diarrhea, diffuse abdominal pain and renal dysfunction and a presumptive diagnosis ofaHUS. He was treated with eculizumab prior to transfer to our institution. On arrival to us, ADAMTS13 was low and inhibitor elevated. He initially responded to TPE but renal failure progressed andaHUS gene testing was ordered revealing a CFHR1-CFHR3 homologous deletion. Eculizumab was restarted but increased ADAMTS13 inhibitor required continued TPE, rituximab and vincristine; eculizumab was held until ADAMTS13 inhibitor was no longer detectable. At 8 months he continues on eculizumab with undetectable ADAMTS13 inhibitor and normal renal function, platelets and LDH (Figure).Case 2: 35y.o. AA woman presented with complaints of slurred speech, left-sided numbness, and thrombocytopenia, but normal renal function. Testing revealed ADAMTS13 <5%, presence of inhibitor (2.2 BU; normal <0.4 BU) and normal complement levels. TPE and steroids were initiated, with rituximab and vincristine added due to inhibitor boosting after initial response. Despite continued treatment, clinical/laboratory parameters did not improve, C3 and C4 levels declined, andaHUS genetic mutation analysis was ordered. This revealed heterozygous missense variants in exon 11 (c.1246A>C, plle416Leu) and exon 7 (c.1135G>C,p.Val379Leu). Once platelets recovered, we treated her with one dose of eculizumab; however, subsequently her plateletsdropped as she had not yet cleared the inhibitor. We then resumed plasma exchange and added eculizumab to her treatment at a later point (figure). Her laboratory parameters have normalized and she is on eculizumab maintenance.Case 3: 67y.o. AA woman presented with thrombocytopenia, microangiopathic hemolytic anemia, and left arm weakness. Renal function was mildly affected, with GFR ~ 30 mL/min/1.73m2. ADAMTS13 was <5% and inhibitor titer was 1.1 BU. TPE and steroids were initiated on admission, followed by rituximab, but due to lack of response after 14 days, she was given eculizumab. She had an immediate rise in platelet count after one dose and a sustained rise after the second dose. Her CBC and hemolysis parameters normalized after 4 doses. She continued treatment with eculizumab for a total of 6 months after which she opted to stop the drug. Within a month of discontinuing treatment, she developed a deep venous thrombosis and received anticoagulation for 6 months. She is now 2 years out of stopping eculizumab and has a normal CBC and LDH. Subsequent gene testing revealed the same CFHR1-CFHR3 homologous deletion identified in case 1. (Figure)Conclusion:We found treatment of TTP first allowed control of complementdysregulation, while treatment ofaHUSfirst did not allow control of TTP. This suggests that low ADAMTS13 levels may be the initiating factor in uncontrolled complement activation inaHUS. These cases suggest the need to test forgermlinemutations leading to abnormal complement activation in patients with refractory TTP, as they may have a dual diagnosis of both TTP andaHUSas our patients did. We therefore suggest treating the underlying TTP first, monitoring the ADAMTS13 activity and inhibitor levels to assess the clearance of the inhibitor, and initiating treatment with eculizumab once the inhibitor has cleared. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Fine Mapping Implicates a Deletion of CFHR1 and CFHR3 in Protection from IgA Nephropathy in Han Chinese.

An intronic variant at the complement factor H (CFH) gene on chromosome 1q32 (rs6677604) associates with risk of IgA nephropathy (IgAN), but the association signal has not been uniformly replicated in Han Chinese populations. We investigated whether the causal sequence variant resides in the CFH gene or the neighboring complement factor H-related 1 (CFHR1) gene and CFHR3, which harbor an 84-kb combined deletion (CFHR3,1Δ) in linkage disequilibrium with rs6677604. Imputation of 1000 Genomes Project data did not suggest new causal single-nucleotide variants within the CFH cluster. We next performed copy number analysis across the CFH locus in two independent Han Chinese case-control cohorts (combined n=3581). The CFHR3,1Δ and rs6677604-A alleles were rare (4.4% in patients and 7.1% in controls) and in strong linkage disequilibrium with each other (r2=0.95); of these alleles, CFHR3,1Δ associated more significantly with decreased risk of IgAN (odds ratio [OR], 0.56; 95% confidence interval [95% CI], 0.46 to 0.70; P=8.5 × 10-8 versus OR, 0.61; 95% CI, 0.50 to 0.75; P=1.6 × 10-6 for rs6677604-A). Moreover, CFHR3,1Δ explained all of the association signal at rs6677604 and remained significant after conditioning on rs6677604 genotype (P=0.01). Exploratory analyses of clinical and histopathologic parameters using the Oxford classification criteria revealed a suggestive association of CFHR3,1Δ with reduced tubulointerstitial injury (OR, 0.46; 95% CI, 0.25 to 0.79). These data indicate that dysregulated activity of the alternative complement pathway contributes to IgAN pathogenesis in both Asians and Europeans and implicate CFHR3,1Δ as the functional allele at this locus.

Identification of novel candidate circulating biomarkers for malignant soft tissue sarcomas: Correlation with metastatic progression.

Soft tissue sarcomas (STS) are a heterogeneous group of rare tumors for which identification and validation of biological markers may improve clinical management. The fraction of low-molecular-weight (LMW) circulating proteins and fragments of proteins is a rich source of new potential biomarkers. To identify circulating biomarkers useful for STS early diagnosis and prognosis, we analyzed 53 high-grade STS sera using hydrogel core-shell nanoparticles that selectively entrap LMW proteins by size exclusion and affinity chromatography, protect them from degradation and amplify their concentration for mass spectrometry detection. Twenty-two analytes mostly involved in inflammatory and immunological response, showed a progressive increase from benign to malignant STS with a relative difference in abundance, more than 50% when compared to healthy control. 16 of these were higher in metastatic compared to non-metastatic tumors. Cox's regression analysis revealed a statistical significant association between the abundance of lactotransferrin (LTF) and complement factor H-related 5 (CFHR5) and risk of metastasis. In particular, CFHR5 was associated with the risk of metastasis. The role of circulating proteins involved in metastatic progression will be crucial for a better understanding of STS biology and patient management.

A novel CFHR5 mutation associated with C3 glomerulonephritis in a Turkish girl

C3 glomerulopathy defines a subgroup of membranoproliferative glomerulonephritis (MPGN) characterized by complement 3 (C3)-positive, immunoglobulin-negative deposits in immunofluorescence microscopy. It comprises 3 clinical conditions: dense deposit disease, C3 glomerulonephritis, and complement factor H-related 5 (CFHR5) nephropathy. Mutations in genes encoding regulatory proteins of the alternative complement pathway have been described. A 16-year-old girl was admitted to the hospital due to periorbital edema. Nephrotic syndrome accompanied by low C3 level was diagnosed. Renal biopsy showed MPGN in light microscopy, only C3 deposits in immunofluorescence microscopy, and subendothelial electron dense deposits and capillary basement membrane thickening with double contour formation in electron microscopy. C3 nephritic factor and anti complement factor H antibody were negative. Complement factor H level was normal. Genetic screening showed a novel heterozygous p.Cys269Arg variation in the CFHR5 gene without any mutation in CFH and CFI genes. Eculizumab therapy was started but was unsuccessful at 10months of follow-up. We have identified a novel heterozygous variation in CFHR5-related nephropathy presenting with nephrotic syndrome and persistently low C3 level, thus expanding the genetic and phenotypic spectrum of the disease. Eculizumab seems to be ineffective in this subtype.

C3 glomerulopathy–associated CFHR1 mutation alters FHR oligomerization and complement regulation

C3 glomerulopathies (C3G) are a group of severe renal diseases with distinct patterns of glomerular inflammation and C3 deposition caused by complement dysregulation. Here we report the identification of a familial C3G-associated genomic mutation in the gene complement factor H–related 1 (CFHR1), which encodes FHR1. The mutation resulted in the duplication of the N-terminal short consensus repeats (SCRs) that are conserved in FHR2 and FHR5. We determined that native FHR1, FHR2, and FHR5 circulate in plasma as homo- and hetero-oligomeric complexes, the formation of which is likely mediated by the conserved N-terminal domain. In mutant FHR1, duplication of the N-terminal domain resulted in the formation of unusually large multimeric FHR complexes that exhibited increased avidity for the FHR1 ligands C3b, iC3b, and C3dg and enhanced competition with complement factor H (FH) in surface plasmon resonance (SPR) studies and hemolytic assays. These data revealed that FHR1, FHR2, and FHR5 organize a combinatorial repertoire of oligomeric complexes and demonstrated that changes in FHR oligomerization influence the regulation of complement activation. In summary, our identification and characterization of a unique CFHR1 mutation provides insights into the biology of the FHRs and contributes to our understanding of the pathogenic mechanisms underlying C3G.

C3 glomerulonephritis and CFHR5 nephropathy

Complement is an important aspect of defence against infection and its activation and regulation are finely balanced. Disordered complement regulation can lead to C3 glomerulonephritis (C3GN), which is characterized by complement (but not immunoglobulin) deposition in the glomerulus of the kidney. Although only recently recognized as a clinical entity, C3GN is important and elucidation of its molecular causes, by studies of single cases and families, has identified key proteins that protect the kidney from complement-mediated damage. The commonest cause of C3GN is complement factor H-related 5 (CFHR5) nephropathy, which is endemic in Greek Cypriots. Genetic evidence implicates some of the same complement regulators in the aetiology of common immune complex glomerular disorders such as IgA nephropathy and lupus nephritis. Importantly, therapeutic manipulation of the complement pathway is now feasible. An exciting challenge is to determine whether this can be applied to kidney diseases that are caused by complement dysregulation, and also whether they might be used to intervene in other kidney diseases.

Increasing evidence that genetic variation in Complement factor H related 5 (CFHR5) causes disease: A commentary on ‘Atypical haemolytic uremic syndrome and genetic aberrations in the complement factor-H-related 5 gene’

Increasing evidence that genetic variation in Complement factor H related 5 (CFHR5) causes disease: A commentary on ‘Atypical haemolytic uremic syndrome and genetic aberrations in the complement factor-H-related 5 gene’

Clinical validation of a genetic model to estimate the risk of developing choroidal neovascular age-related macular degeneration

Predictive tests for estimating the risk of developing late-stage neovascular age-related macular degeneration (AMD) are subject to unique challenges. AMD prevalence increases with age, clinical phenotypes are heterogeneous and control collections are prone to high false-negative rates, as many control subjects are likely to develop disease with advancing age. Risk prediction tests have been presented previously, using up to ten genetic markers and a range of self-reported non-genetic variables such as body mass index (BMI) and smoking history. In order to maximise the accuracy of prediction for mainstream genetic testing, we sought to derive a test comparable in performance to earlier testing models but based purely on genetic markers, which are static through life and not subject to misreporting. We report a multicentre assessment of a larger panel of single nucleotide polymorphisms (SNPs) than previously analysed, to improve further the classification performance of a predictive test to estimate the risk of developing choroidal neovascular (CNV) disease. We developed a predictive model based solely on genetic markers and avoided inclusion of self-reported variables (eg smoking history) or non-static factors (BMI, education status) that might otherwise introduce inaccuracies in calculating individual risk estimates. We describe the performance of a test panel comprising 13 SNPs genotyped across a consolidated collection of four patient cohorts obtained from academic centres deemed appropriate for pooling. We report on predictive effect sizes and their classification performance. By incorporating multiple cohorts of homogeneous ethnic origin, we obtained >80 per cent power to detect differences in genetic variants observed between cases and controls. We focused our study on CNV, a subtype of advanced AMD associated with a severe and potentially treatable form of the disease. Lastly, we followed a two-stage strategy involving both test model development and test model validation to present estimates of classification performance anticipated in the larger clinical setting. The model contained nine SNPs tagging variants in the regulators of complement activation (RCA) locus spanning the complement factor H (CFH), complement factor H-related 4 (CFHR4), complement factor H-related 5 (CFHR5) and coagulation factor XIII B subunit (F13B) genes; the four remaining SNPs targeted polymorphisms in the complement component 2 (C2), complement factor B (CFB), complement component 3 (C3) and age-related maculopathy susceptibility protein 2 (ARMS2) genes. The pooled sample size (1,132 CNV cases, 822 controls) allowed for both model development and model validation to confirm the accuracy of risk prediction. At the validation stage, our test model yielded 82 per cent sensitivity and 63 per cent specificity, comparable with metrics reported with earlier testing models that included environmental risk factors. Our test had an area under the curve of 0.80, reflecting a modest improvement compared with tests reported with fewer SNPs.

Mutations in alternative pathway complement proteins in American patients with atypical hemolytic uremic syndrome

Atypical hemolytic uremic syndrome (aHUS) is characterized by acute renal failure, thrombocytopenia and microangiopathic hemolytic anemia, and occurs with an estimated incidence in the USA of 2 per 1,000,000. Disease pathogenesis is related to dysregulation of the alternative pathway (AP) of the complement cascade at the level of the cell membrane secondary to mutations in a number of complement genes including complement factor H (CFH), complement factor H-related 5 (CFHR5), complement factor I (CFI), CD46 (MCP), complement factor B (CFB), complement component 3 (C3) and thrombomodulin (THBD). Since aHUS is rare, mutation rate data in large patient cohorts are scarce. Here we present the first cohort of American patients in whom mutation screening was completed on all genes currently implicated in aHUS. In addition to identifying a number of novel variants, we provide information on the relative frequency of mutations in these genes in an American aHUS population. Twelve percent (12%) of patients carrying disease-associated genetic variants segregated mutations in more than one gene mandating comprehensive genetic testing in the diagnosis and management of these patients.

The high frequency of complement factor H related CFHR1 gene deletion is restricted to specific subgroups of patients with atypical haemolytic uraemic syndrome

Background:Deletion of the complement factor H related 1 (CFHR1) gene is a consequence of non-allelic homologous recombination and has been reported to be more frequent in atypical haemolytic uraemic syndrome...

Deletion of Complement Factor H–Related Genes CFHR1 and CFHR3 Is Associated with Atypical Hemolytic Uremic Syndrome

Atypical hemolytic uremic syndrome (aHUS) is associated with defective complement regulation. Disease-associated mutations have been described in the genes encoding the complement regulators complement factor H, membrane cofactor protein, factor B, and factor I. In this study, we show in two independent cohorts of aHUS patients that deletion of two closely related genes, complement factor H–related 1 (CFHR1) and complement factor H–related 3 (CFHR3), increases the risk of aHUS. Amplification analysis and sequencing of genomic DNA of three affected individuals revealed a chromosomal deletion of ∼84 kb in the RCA gene cluster, resulting in loss of the genes coding for CFHR1 and CFHR3, but leaving the genomic structure of factor H intact. The CFHR1 and CFHR3 genes are flanked by long homologous repeats with long interspersed nuclear elements (retrotransposons) and we suggest that nonallelic homologous recombination between these repeats results in the loss of the two genes. Impaired protection of erythrocytes from complement activation is observed in the serum of aHUS patients deficient in CFHR1 and CFHR3, thus suggesting a regulatory role for CFHR1 and CFHR3 in complement activation. The identification of CFHR1/CFHR3 deficiency in aHUS patients may lead to the design of new diagnostic approaches, such as enhanced testing for these genes.

Genetic analysis of the complement factor H related 5 gene in haemolytic uraemic syndrome

Several mutations in the CFH gene have been described in non-Shiga-toxin-associated haemolytic uraemic syndrome (non-Stx-HUS), a rare syndrome characterized by haemolytic anaemia, thrombocytopenia and acute renal failure. Mutations in genes encoding other complement regulatory proteins, membrane cofactor protein (CD46) and complement factor I (CFI), were also involved in the pathogenesis of the disease. Anyway, mutations in the three genes account for no more than 50% of cases of non-Stx-HUS. Human complement factor H related 5 (CFHR5) is a recently characterised member of the human complement factor H (CFH) family that has been found as a component of immune deposits in human kidney with sclerotic lesions from different causes. CFHR5 possesses cofactor activity and has been proposed to play a role in complement regulation in the glomerulus. We screened CFHR5 gene for variations potentially involved in the aetiology of HUS. Forty-five patients with HUS and 80 controls were analysed. Altogether, 5 genetic variants in CFHR5 were found in overall 9/45 HUS patients and in 4/80 controls. Statistical analysis showed that allelic variants in CFHR5 were prefentially associated with HUS. Based on these data, we conclude that, though not causative, CFHR5 genetic alterations may play a secondary role in the pathogenesis of HUS.