Blood samples were obtained from anonymous, healthy volunteers with informed, written consent in accordance with Dutch regulations, and this study was approved by the Sanquin Ethical Advisory Board in accordance with the Declaration of Helsinki. The previously described cohort was extended with new donors of which serum and EDTA plasma were collected and analyzed as reported (26). DNA was extracted from peripheral blood leukocytes to determine CNV by multiplex ligation-dependent probe amplification (MLPA; MRC Holland, Amsterdam, the Netherlands) (26). Pooled serum of >400 healthy donors was a gift from Sanquin Diagnostic Services (Sanquin, Amsterdam, the Netherlands) and used as a standard curve in all ELISAs except the FHR-2/2 homodimer ELISA, in which pooled serum of four donors with a homozygous CFHR3/CFHR1 deletion was used.

Rat anti-mouse kappa (RM-19) monoclonal antibody (mAb), high-performance ELISA buffer (HPE), and streptavidin conjugated to poly-horseradish-peroxidase (strep-poly-HRP) were purchased from Sanquin Reagents (Amsterdam, the Netherlands); streptavidin conjugated to horseradish-peroxidase (strep-HRP) was obtained from Pierce/Thermofisher Scientific (Waltham, MA, USA). Nanogam [intravenous immunoglobulins (IVIg)] was purchased from Sanquin Plasma Products (Amsterdam, the Netherlands). The monospecific anti-FHR-2 mAb was purchased from R&D Systems (clone MAB5484, Minneapolis, MN, USA); the polyclonal goat anti-human-FH from Quidel (San Diego, CA, USA), conjugated in-house with HRP. mAb anti-FH.02 was generated against FH, in-house as part of another study at our laboratory (directed against SCR20; manuscript in preparation). Proteins were labeled with EZ-link Sulfo-NHS-LC-Biotin, No-Weigh Format according to manufacturer’s instructions (Pierce/Thermofisher Scientific). Sulfo-SMCC and M2 anti-FLAG mAb (F1804) were obtained from Sigma (St. Louis, MO, USA).

Recombinant human FHR (rFHR) proteins, containing a C-terminal 6×-histidine (6×His) tag, were produced and purified as previously described (26). For FHR-1, the CFHR1*A allotype sequence was used (33). In short, proteins were expressed by transient transfection of pcDNA3.1 expression vectors in HEK293F cells, after which proteins were purified from the supernatant by Ni²⁺ affinity chromatography using HisTrap™ High Performance 1 mL columns (GE Healthcare Life Sciences, Freiburg, Germany). rFHRs were filtrated and concentrated using Amicon^® Ultra Centrifugal Filter Devices (Merck Millipore, Darmstadt, Germany).

Monomer exchange reactions were recorded in real-time with a previously developed FRET assay (34–36). rFHR-2 and rFHR-5 were labeled with DyLight 488 or 594 (Pierce/Thermofisher Scientific) with a labeling degree of 3 to 4 labels per monomer. Experiments were performed at 37°C in quartz cuvettes with an inner chamber of 0.25 mL. Reactions were carried out at 200 ng/mL in degassed PBS in presence of 1 mg/mL IVIg (Nanogam, Sanquin) to prevent adsorption of fluorescent protein to the cuvette wall. To assess monomer exchange between 488- and 594-labeled protein, equimolar amounts were mixed and monitored in time. Monomer exchange between fluorescently labeled and unlabeled protein was carried out by pre-mixing and equilibrating equimolar amounts of 488- and 594-labeled protein, after which a >5 times molar excess of unlabeled protein was added. Fluorophores were excited at 488 nm in a 60 s cycle using a Cary Eclipse fluorescence spectrophotometer (Varian, Mulgrave, VIC, Australia). The appearance of a FRET signal at 620 nm was used to monitor kinetics, while emission at 588 nm was used to account for baseline drifts during reactions (34, 35). Monomer exchange rates were analyzed by fitting a first-order exponential (Graphpad Prism, version 6.04; Graphpad Software, La Jolla, CA, USA).

Murine mAbs directed against FHR-1, FHR-2, and FHR-5 were generated as previously described (26). The mAbs were screened for cross-reactivity against all rFHRs and plasma-derived FH and were assessed by ELISA to determine their competition for similar binding epitopes. Four mAbs were monospecific for FHR-5, but none were monospecifically detecting FHR-1 or FHR-2. Three mAbs reacted with recombinant protein only: two directed against all FHRs, one directed against rFHR-5.

Factor H-related proteins were precipitated from 200 µL human serum using 50 µL of 1 mg/mL anti-FH-02, 100 µg/mL anti-FHR-2, or 100 µg/mL anti-FHR-5.1, as indicated, captured on 500 µL of 5 mg/mL CNBr-activated Sepharose (GE Healthcare), coupled with RM-19 (25 mg mAb per 1 g sepharose), all diluted in PBS supplemented with 0.1% (w/v) Tween-20, 0.1% (w/v) BSA, 10 mM EDTA and incubated rotating o/n at 4°C. Sepharose was washed five times in 1 mL PBS supplemented with 0.1% (w/v) Tween-20 (PT) and eluted with 50 µL 1× NuPAGE LDS Sample Buffer (Invitrogen) before heating at 70°C for 10 min. SDS-PAGE was performed on non-reducing Novex NuPAGE 4–12% Bis–Tris gels (Invitrogen), followed by Western blot onto nitrocellulose membranes (Novex iBlot Gel Transfer Kit, Invitrogen), before blocking with 1% (v/v) Western Blocking Reagent (WBR, Roche, Basel, Switzerland) in PBS for 30 min at RT or o/n at 4°C. Membranes were then incubated with 1 µg/mL biotinylated mAb anti-FHR-5.4 (to detect FHR-5) and anti-FHR-2.1 (to detect FHR-1 and FHR-2) for 1 h at RT. Membranes were washed three times in PT, followed by incubation for 1 h with 0.1% (v/v) strep-HRP and 0.5% (v/v) WBR in PBS, before washing three times in PT and two times in PBS. Membranes were developed with Pierce ECL 2 Western Blotting substrate kit (Pierce/Thermofisher Scientific) according to manufacturer’s instructions and visualized on a ChemiDoc MP System (Bio-Rad, Hercules, CA, USA). Images were analyzed using ImageLab (version 5.0; Bio-Rad).

Sucrose gradients were used to separate FHR proteins based on size and density. Pooled sera of CFHR1-sufficient and -deficient donors (150 µL, diluted 1:2 in PBS) were loaded on 5–32.9% (w/v) sucrose (Merck, 1.07654) gradients in PBS, which had been generated using a pump system. Gradients were centrifuged for 20 h at 36,000 rpm (160,000g) using a SW 41 rotor (Beckman Coulter, Woerden, the Netherlands) after which they were fractionated in 24 fractions of 500 µL. All fractions were analyzed for presence of IgM, IgG, and albumin, using in-house ELISAs. FHRs were immunoprecipitated using 400 µL of each fraction, 50 µL of 200 µg/mL anti-FHR-5.5, and 500 µL RM-19-coupled sepharose, as described above.

Anti-FHR-2 was conjugated with FLAG peptide (Dris El Atmioui, Netherlands Cancer Institute, Amsterdam, the Netherlands), via a sulfo-SMCC hetero-crosslinker. Sulfo-SMCC was diluted to 10 mg/mL in deionized water and added 1:50 to 1 mg/mL anti-FHR-2. After 30 min at RT and dialysis to PBS o/n at 4°C, FLAG peptide with an additional C-terminal cysteine (DYKDDDDKC) was added at 200 µg/mL to anti-FHR-2 and incubated for 30 min at RT, followed by dialysis to PBS.

All ELISAs were performed on Nunc Maxisorp 96-wells microtiter plates (Invitrogen), each step in a final volume of 100 µL at RT. Between incubation steps, plates were washed five times with PBS 0.02% (w/v) Tween-20, using a Biotek 405 LSRS (Biotek Instruments, Winooski, VT, USA). Assays were developed by addition of 100 µg/mL 3,5,3′,5′-Tetramethylbenzidine in 0.11 M sodium acetate containing 0.003% (v/v) H₂O₂, pH 5.5, and stopped by addition of 100 µL 2 M H₂SO₄. Absorbance was measured at 450 nm and corrected for absorbance at 540 nm using a Synergy 2 Multi-Mode plate reader (BioTek Instruments).

Sequencing was performed as previously described (37). Briefly, an Ampliseq custom panel (Thermo Fisher Scientific, Waltham, MA, USA) “Sanquin Complement Panel,” was used to sequence the coding regions of various complement factors, including the CFH-CFHR locus.

Serum-derived proteins were analyzed for their heparin-binding affinity using 1 mL HP Heparin columns (GE Healthcare) and an ÄKTA Avant HPLC system (GE Healthcare). Briefly, the columns were equilibrated with 10 mM NaPO₄, before loading 150 µL serum that was diluted in 3 mL of 10 mM NaPO₄, pH 7.4. Following washing, bound proteins were eluted using a linear salt gradient of 20 mL from 0 to 2 M NaCl. Fractions of 250 µL were collected in a deep 96-well plate, and analyzed by ELISA (26).

GraphPad Prism software versions 6.04 and 7.02 were used to analyze data and perform statistics (GraphPad Software, La Jolla, CA, USA). Significant differences were assessed by Mann–Whitney or Kruskal–Wallis tests. Correlations were assessed using a nonparametric Spearman’s correlation test.

To analyze the circulating molecular size of FHRs in vivo with minimal artifacts (e.g., without prior purification or enrichment steps), pooled sera from healthy individuals were fractionated on sucrose gradients. This allowed us to investigate the FHR composition as close as possible to the in vivo situation. IgM (900 kDa), IgG (150 kDa), and albumin (67 kDa) were utilized as protein size references. The presence of FHRs in the fractions was analyzed by immunoprecipitation (IP) and visualization on Western blot, using in-house generated monoclonal antibodies (Figure 1A).

When FHR-1 (37–42 kDa), FHR-2 (26–29 kDa), and FHR-5 (65 kDa) (Figure S1 in Supplementary Material) would circulate as dimers, the largest protein complex would be a FHR-5/5 homodimer (130 kDa), migrating similar to IgG. FHR-2/2 homodimers would form the smallest complex (52–58 kDa), migrating similar to albumin, closely followed by FHR-1/1 homodimers (74–84 kDa). Indeed, protein bands corresponding with FHR-5 were found in IgG-containing fractions, while FHR-1 and FHR-2 were found in albumin-containing fractions, demonstrating these proteins migrated predominantly as dimers and not as monomers. No high-intensity bands were found in fractions where higher-order oligomers or monomers would migrate, indicating that the majority (if not all) of FHR-1, FHR-2, and FHR-5 circulate in vivo as dimers. Although it was previously suggested that FHR-5 would form heterodimers with FHR-1 (11, 23), the highest intensity bands of FHR-5 did not shift in pooled CFHR3/CFHR1-deficient serum, suggesting that heterodimers containing FHR-1 and FHR-5 do not form.

As the resolution of the fractionation was too low to discriminate between homo- and heterodimers of FHR-1, FHR-2, and FHR-5, we aimed to verify FHR heterodimerization by IP from serum without prior purification steps. The highly specific anti-FHR-5.1 mAb only precipitated FHR-5 and did not co-precipitate FHR-1 or FHR-2 from healthy donor serum (Figure 1B). It is conceivable that FHR-2/FHR-5 might form in the absence of FHR-1, but also in donors carrying the CFHR3/CFHR1 deletion, no FHR-2 was co-precipitated with anti-FHR-5.1. In contrast, FHR-1 and FHR-2 precipitated both with the FHR-1-specific anti-FH.02 and the FHR-2-specific anti-FHR-2, demonstrating FHR-1/2 heterodimers are present in serum. In line with our observations with anti-FHR-5.1, we did not detect any band corresponding to FHR-5 in the IP of anti-FH.02 or anti-FHR-2. No FHR-1/2 heterodimers were found in serum of donors carrying the CFHR3/CFHR1 deletion.

In order to study the kinetics of the dimerization of FHR-1, FHR-2, and FHR-5, we analyzed the monomer exchange between rFHRs using FRET, analogous to previous studies on non-covalent subunit exchange (34, 36). We labeled rFHR-2 and rFHR-5 with either DyLight⁴⁸⁸ or DyLight⁵⁹⁴. When these fluorochromes are in close proximity, exciting DyLight⁴⁸⁸ allows for FRET toward DyLight⁵⁹⁴, emitting light at 620 nm (Figure 2A). This allows monitoring of the monomer exchange process upon mixing 488- and 594-labeled rFHR-2, which will result in increasing amounts of a product containing both fluorescent labels until equilibrium is reached. Indeed, upon mixing FHR-2⁴⁸⁸ with FHR-2⁵⁹⁴, we detected the emergence of a FRET signal (Figure 2B). A similar observation was made when rFHR-5⁴⁸⁸ and rFHR-5⁵⁹⁴ were mixed (Figure 2C). Both processes followed first-order kinetics with comparable observed rate constants (k = 5.6 × 10⁻⁴ s⁻¹ and 6.8 × 10⁻⁴ s⁻¹ for FHR-2/2 and FHR-5/5, respectively). In other words, the exchange process is relatively fast, with a dissociation half-life of less than 30 min.

To further study which of these rFHRs could homo- or heterodimerize, we mixed previously exchanged rFHR-2⁴⁸⁸ and rFHR-2⁵⁹⁴ with an excess of unlabeled rFHR-1, rFHR-2, or rFHR-5 (Figures 2D,E). When either unlabeled rFHR-1 or rFHR-2 was added, the observed rate constants (k = 5.3 × 10⁻⁴ s⁻¹, k = 4.0 × 10⁻⁴ s⁻¹, respectively) were equal to the observed rate constant when rFHR-2⁴⁸⁸ and rFHR-2⁵⁹⁴ exchanged monomers (Figure 2B). This confirms that the monomer exchange process occurs quickly and is not affected by the presence of fluorescent labels. Furthermore, it shows that rFHR-2 is able to form homodimers with itself as well as heterodimers with rFHR-1. As expected, when rFHR-5 was added, the signal remained unchanged, showing that rFHR-2 and rFHR-5 do not form heterodimers. Concordantly, we mixed rFHR-5⁴⁸⁸ and rFHR-5⁵⁹⁴ with an excess of unlabeled rFHR-1, rFHR-2, or rFHR-5 (Figure 2F). When unlabeled rFHR-5 was added, the FRET signal decreased (with a rate constant of k = 1.2 × 10⁻³ s⁻¹), confirming that the FRET signal increase seen previously (Figure 2C) was due to monomer exchange of rFHR-5. In line with our previous results with unlabeled FHR-5 not being able to decrease FHR-2 homodimerization (Figure 2E), addition of either unlabeled rFHR-1 or rFHR-2 did not decrease the FRET signal caused by FHR-5 homodimerization.

Together, these results, using both serum-derived and recombinant FHRs, show that FHR-1 and FHR-2 are equally able to form either homo- or heterodimers. In contrast to previous reports (11, 31), but in line with IP experiments shown here, we observed that rFHR-5 only forms homodimers. Our observations of both recombinant and serum-derived FHRs demonstrate that four dimers are present under physiological conditions: FHR-1/1, FHR-2/2, and FHR-5/5 homodimers, as well as heterodimers containing FHR-1 and FHR-2.

After determining their exact in vivo composition, we set out to determine the serum concentrations of FHR-1/1, FHR-2/2 and FHR-5/5 homodimers. As rFHR-1 and FHR-2 showed a rapid monomer exchange, we anticipated to find FHR-1/2 heterodimers as well.

Generation of monospecific mAbs toward serum-derived FHR-1 was unsuccessful, as all anti-FHR-1 mAbs obtained either cross-reacted with FH or one or more FHRs. Instead, to distinguish between FHR-1 and FH, we made use of antibodies that recognize epitopes in FHR-1 that, due to dimerization, would be present twice in FHR-1/1 homodimers, but only once in monomeric FH. We did not obtain mAbs directed against SCR4, which is identical to SCR19 of FH. Additionally, we did not use mAbs reactive toward SCR3 (95–100% identical to SCR18 of FH) to exclude the possibility that the measurements would be affected by the two different allotypes of FHR-1: FHR-1*A and FHR-1*B (33). Six mAbs were reactive toward SCR5 (97% identical to SCR20 of FH), but did not recognize the same epitope as indicated by competition ELISA. Five of these mAbs showed similar titrations of both normal human serum (NHS) and rFHR-1 (Figure S2 in Supplementary Material). No signal was observed when CFHR3/CFHR1-deficient serum was tested, confirming that FH was not detected and thus confirming the specificity of the FHR-1/1 homodimer assays. Those with parallel curves all showed a similar ratio between NHS and rFHR-1, suggesting that the measurement of FHR-1/1 homodimers was not affected by the specific epitope targeted. Taking into account sensitivity and specificity, we continued with anti-FH.02 (Figures S3 and S4A in Supplementary Material).

The FHR-1/1 homodimer assay, using anti-FH.02 as capturing and detecting mAb, showed identical curves when rFHR-1 was spiked in CFHR3/CFHR1-deficient serum when compared to NHS (Figure 3A). The protein concentration of rFHR-1 was determined with an extinction coefficient of 1.74 (280 nm, 0.1% (w/v) solution, incl. 6× His-tag) to calibrate NHS, which was determined to contain 11.5 µg/mL FHR-1/1 homodimers (146 nM, based on MW of 79 kDa). As this concentration of FHR-1 was lower than suggested by recent reports (29, 30), we checked the relative concentration of FHR-1 in comparison to FH on Western blot using our characterized mAbs, and found that FHR-1 circulates in serum at an average 1:10 ratio compared to FH, in line with our ELISA results (Figure S5 in Supplementary Material).

Factor H-related-1/2 heterodimers were measured using anti-FH.02 as capturing mAb, and the monospecific anti-FHR-2 as detecting mAb (Figure 3B; Figure S3 and S4B in Supplementary Material). Similar to the FHR-1/1 assay, specificity was confirmed using CFHR3/CFHR1-deficient serum.

A FHR-2/2 homodimer ELISA was developed using the monospecific anti-FHR-2 that served both as a capturing and detecting antibody (Figure S4C in Supplementary Material). The capturing anti-FHR-2 was conjugated with a FLAG-tag, to be bound by an anti-FLAG antibody, to improve the sensitivity of the assay. The CFHR3/CFHR1-deficient serum titration ran parallel to rFHR-2, while the presence of FHR-1 in CFHR3/CFHR1-sufficient serum interfered with the detection of FHR-2/2 homodimers; the more genes, the more interference, thus suggesting a link between genotype and levels (Figures 3C,D). The pooled CFHR3/CFHR1-deficient serum was determined to contain 3.1 µg/mL FHR-2/2 homodimers (56 nM, based on MW of 55 kDa), using rFHR-2 as a reference with an extinction coefficient of 1.62 (280 nm, 0.1% (w/v) solution, incl. 6× His-tag). Due to formation of FHR-1/2 heterodimers in most sera, it was anticipated that FHR-1/2 heterodimers were interfering with the detection of FHR-2/2 homodimers.

Assuming that (1) FHR-1 and FHR-2 randomly associate in serum, (2) all the molecules are dimeric, and (3) the monomer exchange is a quick process, we calculated the concentration of FHR-1/2 heterodimers in NHS to be 5.2 µg/mL (78 nM, based on MW of 67 kDa), using the spike of rFHR-1 in CFHR3/CFHR1-deficient serum as standard curve. Using distribution laws [e.g., in classic genetics, and as described previously for IgG4 half-molecules (38)], we then inferred levels of FHR-2/2 homodimers in NHS, determining the FHR-2/2 homodimer concentration in NHS at 0.5 µg/mL (11 nM).

We obtained two monospecific mAbs against FHR-5, and used these to measure FHR-5/5 homodimers in serum (Figures S3 and S4D in Supplementary Material). The specificity of the assay was confirmed by Western blotting, as no FHR-5-deficient serum was available (Figures 3E,F). The protein concentration of rFHR-5 was determined using an extinction coefficient of 1.49 (0.1% (w/v) solution, 280 nm, incl. 6×His-tag), setting NHS at 1.49 µg/mL (11 nM, based on MW of 130 kDa).

Being able to measure all dimer species in a highly sensitive and specific manner, we determined each of their heparin-binding capacities, as surrogate to polyanionic residues on host cell surfaces. Although binding capacities were known for rFHR-5 (39), and suggested for serum-derived FHR-1 and FHR-2 (11), none had determined the exact capacity of each dimer species separately, without prior purification steps. We loaded serum (NHS, pooled CFHR3/CFHR1-deficient serum) directly onto heparin columns. Heparin-bound proteins were eluted by a linear increasing salt gradient and the FHRs were detected in all eluted fractions with our newly developed ELISAs.

As suggested for rFHR-5, serum-derived FHR-5/5 homodimers eluted at a conductivity of ~19.0 mS/cm (Figure 4A). The elution of FHR-5/5 homodimers was not affected by presence of FHR-1, again confirming that FHR-5 does not form heterodimers with FHR-1 (Figure 4B). In accordance with Tortajada et al. (11), FHR-1/1 homodimers eluted at a conductivity of ~16.5 mS/cm, the same conductivity at which FH eluted from the heparin column. However, FHR-1 eluted at lower ionic strength when dimerized with FHR-2 (~11.5 mS/cm), while FHR-2/2 homodimers showed no adequate binding strength at all (8.8 mS/cm), and was unable to bind heparin at physiological salt conditions (~14.06 mS/cm). While these results confirm the expected differences in binding capacities of each FHR protein, we now show that also the composition of plasma-derived FHR-1-containing dimers affects their binding capacity.

Having shown that the composition of dimers determines ligand specificity, we determined the serum levels of each dimer species, making use of a healthy donor cohort, genotyped for CFHR1 CNV by MLPA (Table S1 in Supplementary Material) (26).

Serum levels of FHR-1 were strongly determined by the CNV in CFHR1 (Figure 5A). Individuals carrying two gene copies of CFHR1 had more FHR-1/1 homodimers (mean = 14.64 µg/mL, SD = 3.04 µg/mL) when compared to those with one copy of CFHR1 (mean = 4.88 µg/mL, SD = 1.33 µg/mL), while FHR-1/1 homodimers were undetectable in donors homozygous for the CFHR1 deletion. Although levels of FHR-1/1 homodimers correlated with levels of FHR-1/2 heterodimers [Figure 5B, r_s = 0.42, p = 0.01 (CNV^CFHR1 = 1); r_s = 0.39, p = 0.0004 (CNV^CFHR1 = 2)], FHR-1/2 heterodimer levels were not significantly affected by the CNV of CFHR1 [Figure 5C, mean = 5.01 µg/mL, SD = 1.49 µg/mL (CNV^CFHR1 = 1); mean = 5.84 µg/mL, SD = 2.41 µg/mL (CNV^CFHR1 = 2)]. Nonetheless, inferred data showed FHR-2/2 homodimer levels to be significantly affected by the CNV of CFHR1 [Figure 5D, p = 0.03; mean = 0.85 µg/mL, SD = 0.41 µg/mL (CNV^CFHR1 = 1); mean = 0.65 µg/mL, SD = 0.41 µg/mL (CNV^CFHR1 = 2)], and to be strongly correlated with FHR-1/2 heterodimer levels [Figure 5E, r_s = 0.96, p < 0.0001 (CNV^CFHR1 = 1), r_s = 0.94, p < 0.0001 (CNV^CFHR1 = 2)], demonstrating that FHR-1/2 levels are mostly determined by FHR-2 serum levels. As expected, FHR-5/5 homodimer levels were not affected by the presence of FHR-1 levels (Figure 5F, p = 0.3058, mean = 1.66 µg/mL, SD = 0.43 µg/mL).

Two donors that had two copies of both CFHR1 and CFHR2, according to the MLPA results, showed a signal in the FHR-1/1 homodimer assay, but not in the FHR-1/2 heterodimer assay. The absence of FHR-1/2 heterodimers was confirmed by IP, demonstrating that these two individuals have no FHR-2 in serum (Figure 6A) as FHR-2 bands were completely lacking. Using a next generation sequencing platform for targeted analysis of complement factors (Ion Torrent; Sanquin Complement Panel; de Boer et al., manuscript in preparation; Table S2 in Supplementary Material), sequencing revealed two heterozygous mutations in the CFHR2 gene of the two donors, c.215G >A (p.Cys72Tyr) and c.595G >T (p.Glu199Ter; CFHR2^mut/mut; Figure S6 in Supplementary Material). FHR-1 and FHR-5 showed normal elution patterns when serum of one CFHR2^mut/mut donor was loaded onto heparin columns (Figure 6B). Having sera available that lacked either FHR-1 or FHR-2, allowed us to test whether FHR-1/2 heterodimers would also form in vivo. We mixed both sera and measured the appearance of FHR-1/2 heterodimers (Figure 6C). Indeed, similar to the quantity found in NHS, FHR-1/2 heterodimers were formed, indicating that the ability of heterodimerization with FHR-1 was not affected in these CFHR2^mut/mut donors. Furthermore, these data confirm our FRET data, showing that FHR-1 and FHR-2 can indeed exchange rapidly in vivo.