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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Mol Immunol. Author manuscript; available in PMC 2010 April 1.
Published in final edited form as:
PMCID: PMC2716727

Great Genotypic and Phenotypic Diversities Associated with Copy-Number Variations of Complement C4 and RP-C4-CYP21-TNX (RCCX) Modules: a Comparison of Asian Indian and European American Populations


Inter-individual gene copy-number variations (CNVs) probably afford human populations the flexibility to respond to a variety of environmental challenges, but also lead to differential disease predispositions. We investigated gene CNVs for complement component C4 and steroid 21-hydroxylase from the RP-C4-CYP21-TNX (RCCX) modules located in the major histocompatibility complex among healthy Asian-Indian Americans (AIA) and compared them to European Americans. A combination of definitive techniques that yielded cross-confirmatory results was used. The medium gene copy-numbers for C4 and its isotypes, acidic C4A and basic C4B, were 4, 2 and 2, respectively, but their frequencies were only 53–56%. The distribution patterns for total C4 and C4A are skewed towards the high copy-number side. For example, the frequency of AIA-subjects with three copies of C4A (30.7%) was 3.92-fold of those with a single copy (7.83%). The monomodular-short haplotype with a single C4B gene and the absence of C4A, which is in linkage- disequilibrium with HLA DRB1*0301 in Europeans and a strong risk factor for autoimmune diseases, has a frequency of 0.012 in AIA but 0.106 among healthy European Americans (p=6.6×10−8). The copy-number and the size of C4 genes strongly determine the plasma C4 protein concentrations. Parallel variations in copy-numbers of CYP21A (CYP21A1P) and TNXA with total C4 were also observed. Notably, 13.1% of AIA-subjects had three copies of the functional CYP21B, which were likely generated by recombinations between monomodular and bimodular RCCX haplotypes. The high copy-numbers of C4 and the high frequency of RCCX recombinants offer important insights to the prevalence of autoimmune and genetic diseases.

Keywords: CNV, complement C4A and C4B, congenital adrenal hyperplasia, extracellular matrix protein tenascin-X, graft rejections and C4 polymorphisms, recombinations, steroid CYP21-hydroxylase, systemic lupus erythematosus

1. Introduction

Among healthy human subjects of each gender, the number of nuclear genes has been presumed to be constant. Such concept of constant gene copy-numbers is being gradually revised in the past twenty years, albeit unnoticeably. For examples, complement C4 and amylase manifest frequent and heritable gene copy-number variations among different healthy individuals (Bank et al., 1992;Blanchong et al., 2000;Carroll et al., 1984;Chung et al., 2002a;Dangel et al., 1994;Perry et al., 2007;Shen et al., 1994;Wu et al., 2007;Yang et al., 2003;Yang et al., 2007;Yang et al., 1999;Yu, 1991;Yu et al., 2003;Yu and Campbell, 1987). Recent advent of whole genome microarray studies and personal genomic DNA sequencing revealed numerous genomic loci with duplications of DNA segments > 1 kb in size; many of those segments contain protein-coding genes (Lupski, 2007;McCarroll, 2008;Redon et al., 2006;Sebat et al., 2004). However, the physiologic impact of common CNVs in health and in disease remain conjectural or largely unknown. Little knowledge is available about the details and consequences of each common CNV locus among human populations. To understand the effects of CNVs, it is essential to characterize the genetic compositions for each CNV locus and the patterns of variations among different subjects and populations, and to determine the associated qualitative and quantitative diversities of protein products created by CNV.

Complement C4 is an important component protein in the classical and mannose-binding lectin complement activation pathways, which are main effectors of the adaptive and innate immune responses against microbial infections, respectively (Walport, 2001;Yu et al., 2003). Deposition of activated C4 on immune complexes opsonizes them for immunoclearance through binding to complement receptor CR1 on the red blood cells and disposal through phagocytosis by Kupffer cells in the liver (Cornacoff et al., 1983;Yu et al., 2007), and facilitates B-cell activation in germinal centers of lymph nodes (Carroll, 2004). Polymorphic plasma protein variants with acidic C4A that migrated faster, and basic variants that migrated slower, were observed decades ago using non-denaturing, high voltage agarose gel electrophoresis (Awdeh et al., 1979;Mauff et al., 1983;Sim and Cross, 1986).

The discovery of gene copy-number variations for human complement component C4 took a relatively crooked route. The modes of inheritance were debated among the single co-dominant locus, polygenic loci, and two-locus C4A-C4B model (Awdeh and Alper, 1980;O’Neill et al., 1978;Roos et al., 1982;Teisberg et al., 1976). The two-locus model was favored as it was supported by most (but not all) experimental data. When genomic clones for human C4A and C4B genes in the MHC class III region were isolated, characterized and sequenced (Carroll et al., 1984;Yu et al., 1986;Yu, 1991), it was soon found that cytochrome P450 steroid 21-hydroxylase genes CYP21A (also known as CYP21A1P) and CYP21B (also known as CYP21A2) were present approximately 3.0 kb downstream of C4A and C4B, respectively (Carroll et al., 1985a;Rodrigues et al., 1987;White et al., 1984;Yu, 1991). Further work revealed that the serine/threonine kinase gene RP1 (also known as STK19) is located 613 bp upstream of the first C4 gene locus (Shen et al., 1994), and the gene for extracellular matrix protein tenascin TNXB, while organized in the opposite transcriptional orientation, overlaps to the 3′ region of CYP21B. A gene fragment of 911-bp known as RP2 that matches to the 3′ region of RP1, and another gene fragment of 4.5 kb in size known as TNXA that corresponds to intron 32 to exon 45 of TNXB, are found in every duplicated C4-CYP21 complex. Such discrete four-gene duplication unit is termed the RCCX (RP-C4-CYP21-TNX) module (Shen et al., 1994;Yang et al., 1999;Yu et al., 2003) (Figure 1).

Figure 1
An introduction to the copy-number and size variations of RCCX modules and complement C4. Panel A, A molecular haplotype map showing the copy-number variations of RP-C4-CYP21-TNX (RCCX) in the class III region of the major histocompatibility complex (MHC) ...

Cumulative studies in the past fifteen years revealed that one to four RCCX modules are present in the central region of the MHC. Therefore, the copy-number of C4 genes in a diploid genome varies from 2 to 8 (Chung et al., 2002b;Chung et al., 2002a;Wu et al., 2007;Yang et al., 2007). In each duplicated RCCX, the C4 gene is usually functional and is either a long or a short gene. The long gene is created by the integration of an ancient endogenous retrovirus HERV-K(C4) into intron 9 of the C4 gene (Chu et al., 1995;Dangel et al., 1994) (Figure 1, panel B). Each C4 gene can code for a polymorphic C4A or a polymorphic C4B protein. The CYP21 gene in the duplicated RCCX module is generally a mutant gene CYP21A (also known as CYP21A1P) that has acquired three deleterious mutations in exons 3, 7 and 8, plus multiple point mutations in the coding and non-coding regions (Higashi et al., 1986). In comparison with the intact gene TNXB, nine single nucleotide polymorphisms and a 120-bp deletion are present in the 4.5 kb TNXA gene segment that is present in each duplicated RCCX module. The location of the 120-bp deletion in TNXA corresponds to the sequence between intron 36 and exon 36 in TNXB (Gitelman et al., 1992;Yang et al., 1999).

In a study of healthy European Americans, the frequency of monomodular RCCX haplotypes with single and intact genes for RP1, C4, CYP21B and TNXB (mono-L and mono-S) is 0.149; bimodular RCCX with organization of RP1-C4-[CYP21A-TNXA-RP2-C4]-CYP21B-TNXB has a frequency of 0.769, while trimodular haplotype with RP1-C4-[CYP21A-TNXA-RP2-C4]2 -CYP21B-TNXB has a frequency of 0.088. The copy-number of C4 genes in a diploid among different human subjects varies between 2 to 6 in the European American population, with 60.7% of the healthy subjects having four copies of C4 genes, 26.1% having three copies, and 9.8% having five copies. A similar pattern of C4 gene copy-number variation was also observed in the Hungarian population (Yang et al., 2003).

We postulate that copy-number variation of C4 genes creates a diversity of intrinsic strengths in the immune effector system. Such inherent structural variations probably empower individuals in a population the capability to respond to a variety of environmental challenges effectively, although they could also predispose some subjects to autoimmune or genetic diseases. Therefore, it is of interest to note that among the patients with systemic lupus erythematosus (SLE) of European ancestry, the copy-number of total C4 or C4A genes are significantly reduced. Remarkably, 32.9% of the SLE patients have a homozygous or heterozygous deficiency of C4A (compared to 18.9% in matched healthy controls; p=0.00014) (Yang et al., 2007). The high prevalence C4A deficiency was caused by increased frequency of a monomodular RCCX haplotype with a single C4B gene (mono-S; SLE patient: 0.169, healthy controls: 0.106).

Concurrent with C4 gene CNV is the CNV for CYP21 gene that codes for the steroid 21-hydroxylase. The 21-hydroxylase is an essential enzyme for the biosynthesis of cortisols that is important for blood sugar homeostasis and responses to stress, and aldosterone that is essential for the regulation of electrolytes by the kidneys and the maintenance of blood pressure. A wide spectrum of defects ranging from partial impairment of enzymatic activities to complete deficiencies of the steroid 21-hydroxylase that contribute to the mild non-classical congenital adrenal hyperplasia (CAH) with hyperandrogenisation, the severe classical CAH with salt-losing disease that can be life-threatening, and/or the simple virilizing phenotypes (Goncalves et al., 2007). Complete deficiency of 21-hydroxylase can be caused by the absence of the CYP21B gene in monomodular RCCX haplotypes containing a single CYP21A pseudogene, or through genetic recombination or gene conversion-like events that resulted in the presence of two CYP21A pseudogenes in bimodular RCCX haplotypes, or the acquisition of deleterious mutations to CYP21B gene (Blanchong et al., 2000;Chung et al., 2002a;Yang et al., 1999). The incidence of classical CAH varies widely with 1 in13,000 –15,000 live births in the US, 1 in 2,575 in India (Rama Devi and Naushad, 2004) to 1 in 280 in Yupik Eskimos in Alaska (Pang et al., 1988;Wilson et al., 2007). Acquisitions of missense mutations or SNPs from CYP21A to CYP21B reduce the 21-hydroxylase enzymatic activities and probably contribute to non-classical CAH phenotypes, which has a prevalence of 1% in the population of New York City, and remarkably, 1 in 27 among Ashkenazi Jews (New, 2006).

We undertake a series of studies to determine the genotypic and phenotypic diversities created by common gene CNVs in different human populations in order understand the roles of CNVs in complex and genetic diseases. Here we report the great inter-individual polymorphisms of the RCCX modules and C4 gene copy-numbers in one of the largest human ethnic groups, the Asian-Indians.

2. Materials and Methods

Study Populations

The healthy Asian-Indian American (AIA) group comprised 168 subjects who originated from India, Pakistan, Bangladesh, and Sri Lanka. These subjects were mainly recruited during the Annual Indian Festivals in central Ohio, plus friends and colleagues of the Nationwide Children’s Hospital (NCH) in Columbus, Ohio. Informed consent from each participant was obtained according to approved protocol by the Institutional Human Subject Review Board, NCH. From each individual, 10 ml of peripheral blood was collected in EDTA (purple-top) tubes. The mean age (± SD) of the AIA group was 35.9±14.1 years. The comparison group consisted of 440 healthy European Americans from central Ohio with an average age 36.8±11.5 years. The studied subjects and their first-degree relatives did not have a history of autoimmune disease (Yang et al., 2007).

Genotyping of RCCX modules

EDTA-blood samples were processed according to standard protocols to harvest plasma and genomic DNA (Chung et al., 2005). The copy-number variations and genotypes of the RCCX modules were determined by two independent approaches. First, TaqI genomic Southern blot analyses were applied to determine the constituents and variations of RP-C4-CYP21-TNX (RCCX) modules. Three different hybridization probes were used. The first probe detected the presence and relative number of an RP1 gene linked to a long C4 gene (7.0 kb), an RP1 gene linked to a short C4 gene (6.4 kb), an RP2 gene fragment linked to a long C4 gene (6.0 kb), or an RP2 gene fragment linked to a short C4 gene (5.4 kb). The second probe elucidated the presence and relative number of cytochrome-P450 21-hydroxylase CYP21B (3.7 kb; also known as CYP21A2), and its non-functional mutant gene CYP21A that is characterized by three deleterious indels and point mutations (3.2 kb; also known as CYP21A1P). The third probe elucidated the presence and relative number of extracellular matrix protein tenascin TNXB (2.5 kb), and the truncated gene fragment TNXA that corresponds to the 3′ region of TNX (2.4 kb). TNXA is characterized by a 120-bp deletion that corresponds to the region between exon 36 and intron 36 of TNXB.

Second, large molecular weight genomic DNA from leukocytes in agarose plugs were prepared, digested with PmeI restriction enzyme, resolved by pulsed field gel electrophoresis under conditions that maximize resolution of DNA fragments between 20 and 350 kb in size, and processed after Southern blot analysis. The breakpoints RCCX modular duplications are present at the 3′ region of the RP1 gene, and at intron 32 of the TNXB gene. Two PmeI restriction sites are located outside the duplicated regions, by which one is present in complement factor B gene, and the other at the 5′ region of the TNXB gene. Therefore, the size of the PmeI fragment(s) represent the number of RCCX modules in haplotypes. A monomodular RCCX haplotype with a short C4 gene has a PmeI fragment of 107 kb in size, while that with a long C4 gene has a fragment size of 113 kb. An addition of one RCCX module increases the fragment size by 26.3 kb if it contains a short C4 gene, and by 32.7 kb if it contains a long C4 gene. Thus, bimodular haplotype with two long C4 genes (LL) has a PmeI fragment size of 148 kb, while that with one long and one short C4 gene (LS), 139 kb. A trimodular haplotype with three long C4 genes (LLL) has a PmeI fragment of 178 kb in size, and that with one long and two short C4 genes, 172 kb. Thus, PmeI-PFGE yields information on the total number of RCCX modules or copy-numbers of C4 genes, and elucidates the haplotypes of RCCX modules and C4 gene copy-numbers in a subject (Chung et al., 2002b;Chung et al., 2002a).

Third, human subjects with high copy-numbers or with ambiguous copy-numbers were further interrogated by TaqMan-based real-time PCR assays that elucidated the copy-number of RCCX modules, the copy-number of C4A genes, and the copy-number of C4B genes (Wu et al., 2007).

Genotyping of C4A and C4B

The C4 protein isotypes are defined by amino acid sequence PCPVLD 1101–1106 for C4A, and LSPVIH 1101–1106 for C4B (Yu et al., 1986). These changes are the results of five single nucleotide polymorphisms within a sequence of 20 nucleotides in exon 26. These polymorphic nucleotides for C4A can be recognized by restriction enzyme PshAI. Using PshAI-PvuII digested genomic DNA for Southern blot analyses using a C4d-specific probe, the C4A is represented by a 1.7 kb restriction fragment, and C4B by a 2.2 kb restriction fragment (Chung et al., 2002b).

Allotyping of C4A and C4B protein variants

EDTA-plasma samples were digested with neuraminidase and carboxyl peptidase B to remove heterogeneities in glycosylations (Awdeh and Alper, 1980), and incomplete processing of the carboxyl terminals for the alpha and beta chains in C4 proteins (Sim and Cross, 1986), respectively. The polymorphic variants of C4A and C4B proteins are resolved by high voltage agarose gel electrophoresis that is non-denaturing and separate protein allotypes through their gross difference in electric charges. The C4 proteins were immunofixed with goat anti-C4 sera and the agarose gel was washed to remove diffusible proteins, and stained with SimplyBlue Safestain (Invitrogen), as described previously (Awdeh and Alper, 1980;Chung et al., 2005;Sim and Cross, 1986). The relative band intensities for C4A and C4B allotypes were scanned by densitometry and quantified by ImageQuant software. C4A and C4B protein concentrations were calculated from total C4 concentrations determined by radial immunodiffusion.

Radial immunodiffusion of plasma C4

Total C4 plasma protein concentrations were determined by single radial immunodiffusion assays using kits from the Binding Site (U.K).

Determination of TNXA-XB recombinants by TaqI and PshAI RFLPs

Except for cases with DNA recombinations, all human subjects have one copy of TNXB on each copy chromosome 6, while that of TNXA varies from 0 to 1, 2 or 3, dependent on the number of RCCX duplication modules present in a haplotype. A recombination at the 3′ regions can transfer the intact 120-bp sequence from TNXB to TNXA. Using a specific 500-bp probe spanning exons 35–37, the presence of such 5′-TNXA-XB-3′ recombinant increases the relative band intensity of the 2.5 kb TaqI fragment. The presence of such recombinant can also be detected by a specific, 3.45 kb PshAI restriction fragment in genomic Southern blot analysis.

Statistical Analyses

Copy-number variants were compared using Chi-Square analysis, and multiple continuous variables using One-Way-Analysis-of-Variance (AN0VA). Numeric data from individual groups were also compared using Student’s t-test. Statistical programs and graphing software include Excel, JMP 7.0, and Graph Pad Prizm 5.0.

3. Results

Determination of RCCX modular variations, total C4, C4A and C4B gene copy-numbers

We determined the copy-number variations RCCX constituents RP1 and R2, long C4 and short C4, CYP21B and CYP21A, and TNXB and TNXA in the AIA-samples by TaqI RFLP. The relative copy-numbers of C4A and C4B genes were determined by PshAI-PvuII RFLP and their respective numbers calculated from total C4. High copy-numbers and ambiguous results were further clarified by three different real-time PCR amplicons, which independently determined the copy-numbers of RCCX modules, C4A and C4B genes. The protein polymorphisms of C4A and C4B allotypes were determined by immunofixation and their relative band intensities quantified by ImageQuant software. The plasma C4 protein concentrations from each blood sample were determined by radial immunodiffusion. The protein concentrations of C4A and C4B were calculated from total C4.

Figure 2 panel A illustrates the complex patterns of TaqI RFLP present in eleven Asian Indian subjects. AIA-48 was characterized by the presence of has three RCCX modules with LL and L haplotypes (LL/L), as the 7.0 kb RP1-C4L TaqI fragment was twice as intense as the 6.0 kb RP2-C4L TaqI fragment. Such interpretation is corroborated by the presence of two CYP21B and one CYP21A, as the 3.7 kb TaqI fragment for CYP21B was twice as intense as the 3.2 kb CYP21A fragment; and the presence of two TNXB and one TNXA, as the 2.5 kb TNXB fragment was twice as intense as the 2.4 kbTNXA fragment. PshAI-PvuII RFLP (pane B) showed that the 2.2 kb fragment specific for C4B in AIA-48 was twice as intense as the 1.7 kb fragment specific for C4A. C4 protein allotyping experiments (panel C) revealed that AIA-48 has C4A3 and C4B1, the band intensities for C4B1 was approximately twice as intense as that of C4A3. Radial immunodiffusion assay revealed that the plasma C4 protein concentration of AIA-48 was 20.2 mg/dL. ImageQuant of the C4A3 and C4B1 protein bands in allotyping gel showed a ratio of 0.391 to 0.609 and thus the C4A and C4B protein concentrations were calculated to be 7.9 and 12.3 mg/dL, respectively.

Figure 2
Determination of RCCX modular variations, C4A and C4B genotypes and phenotypes in Asian Indian Americans. Panel A. Genomic TaqI RFLP to demonstrate the variation patterns of RP, C4, CYP21 and TNX: RP1-C4L (7.0 kb), RP2-C4L (6.0 kb), RP2-C4S (5.4 kb), ...

Interpretations for the C4 genotypes and phenotypes for the eleven subjects shown in Figure 2 are detailed in Supplementary-Table 1. Remarkably, AIA-61 appeared to possess seven copies of C4 genes, by which 6 copies were C4A and one copy was C4B. The C4B protein of AIA-61 in the allotyping gel was almost invisible, suggesting a probable mutation of the C4B gene. AIA-58, AIA-62 and AIA-64 each had five copies of C4 genes but their C4A to C4B ratio were 3:2, 5:0 and 2:3, respectively. The absence of C4B gene and C4B protein in AIA-62 was conspicuous in the PshAI-PvuII RFLP (panel B), C4 allotyping (panel C), and real-time PCR (Supplementary-Table 1).

Six subjects had four copies of C4 genes, AIA-53, -56, -57, -65, -66, and -67, who had different combinations of RCCX modules and C4A and C4B gene copy-numbers per diploid genome (gene dosage) producing differential quantities of C4A and C4B proteins. AIA-53, -56 and -57 had RCCX modules LS/LS, LL/LS and LL/LL, respectively. Each of these three subjects had two C4A and two C4B, coding for C4A3 and C4B1. In AIA-57, the C4A and C4B genes all belonged to the long form and the protein band intensities for C4A3 and C4B1 in allotyping gel were almost identical. In AIA-53, there were two long genes and two short genes. The C4B protein band intensity was 32.5% higher than that of C4A, implying that human subjects with equal number of long genes and short genes, and equal number of C4A and C4B genes, produced larger quantities of C4B proteins than C4A proteins. In AIA-56, there were three long genes and one short gene, the C4B protein was 22.2% higher than that of C4A. This infers a dosage effect of short C4 genes on the relative higher expression of C4B than C4A.

In AIA-65, -66 and -67, the RCCX haplotypes were LL/LS, LL/LL and LL/LS respectively, and their corresponding C4A to C4B gene ratios were 3:1, 3:1 and 2:2. Polymorphic protein variant C4A2 was present in AIA-65 and AIA-66, and C4A6 was present in AIA-67 (and AIA-58), in addition to the common C4A3. This phenomenon revealed that among AIA-subjects with same C4 gene copy-number, the C4 genes could either long or short, each C4 gene could code for a C4A or a C4B protein, and the corresponding C4A or C4B protein could be polymorphic.

Demonstration of RCCX length Variants by PmeI-PFGE

To confirm the high copy gene numbers of C4 and elucidate their haplotypes, we performed PmeI-PFGE on the AIA-samples. Figure 3 illustrates results of such experiments in eight AIA-subjects, together with three controls which were previously demonstrated to be homozygous trimodular LLL/LLL (c008, lane 5), monomodular L/L (EW, lane 10) and monomodular S/S (c071, lane 11) (Chung et al., 2002a).

Figure 3
Pulsed-field gel electrophoresis (PFGE) of PmeI digested genomic DNA and Southern blot analysis to show length variants of RCCX modules. Intact genomic DNA in agarose blocks from peripheral blood lymphocytes were digested with PmeI restriction enzyme, ...

Homozygous trimodular LSL (or LLS, the order of the short gene in the second and third module not defined) was found in AIA-45 (lane 6), bimodular LL in AIA-05 (lane 8) and bimodular LS in AIA-39 (lane 9). The others contained heterozygous RCCX length variants as each was marked by the presence of two PmeI fragments corresponding to distinct RCCX haplotypes.

Results by TaqI RFLP revealed that AIA-61 had five long C4 genes and two short C4 genes. PmeI-PFGE showed that these seven genes were organized with quadrimodular L(LLS) in one haplotype and trimodular LSL in the other haplotype (lane 2). TaqI RFLPs showed that AIA-27 and AIA-19 each had 6 copies of C4 genes in a diploid genome, with four long genes and two short genes for AIA-27, and two long genes and four short genes for AIA-19. PmeI PFGE revealed that the C4 genes in AIA-27 were organized in qudrimodular L(LLS) and bimodular LS (lane 3), while those of AIA-19 were organized in quadrimodular LSSS and bimodular LS (lane 4).

TaqI RFLPs showed that AIA-62 and AIA-38 each had five C4 genes. Four long genes and one short gene were present in the former; two long and three short C4 genes in the latter. PmeI-PFGE showed that AIA-62 had trimodular LSL and bimodular LL (lane 1), and AIA-38 had trimodular LSS and bimodular LS (lane 7).

Copy-number variations of human complement C4 in AIA

CNV of C4 genes

The copy-number of C4 genes in a diploid genome ranged from 2 to 7 among the AIA-subjects. The distribution and frequencies of C4 GCN and RCCX haplotypes are presented in Table 1. The median C4 GCN was 4, whose frequency was 0.530. The overall distribution (Figure 4) biased toward higher copy-numbers with double the frequency of 5 genes (0.286) versus 3 genes (0.137). Additionally, there were a greater amount of individuals with 6 and 7 genes (0.042) versus 2 genes (0.006). The propensity toward higher copy-number of total C4 is reflected in the gene copy index (GCI) of 4.23 ± 0.77, which is greater than the median 4 in healthy Asian Indians.

Figure 4
Variations of complement C4 gene copy-numbers and RCCX modules in Asian-Indian Americans. L and S, monomodular haplotypes with long and short C4 genes, respectively; LL and LS, bimodular haplotypes with two long C4 genes, and with one long and one short ...
Table 1
Variations of C4 gene copy-numbers in diploid genomes and RCCX haplotypes in healthy Americans of Asian Indian and European ancestries.

CNVs of C4A and C4B

C4A and C4B gene copy-numbers were determined in 166 AIA-subjects. A total of 391 C4A genes (frequency: 0.556) and 312 C4B genes (frequency: 0.444) were found.

The distribution of C4A genes resembled to that of total C4, with higher copy-numbers appearing more frequently than lower copy-numbers. C4A displayed a large distribution ranging from 0 to 6 copies per diploid genome, with slightly greater than half of the population centered at the median of 2 genes (0.548). Less than one-tenth of the population (0.0783) contained one copy of C4A, with a single individual lacking C4A completely. The remaining individuals comprised 3 or more C4A genes. Of these, 3 copies appeared most frequently with a frequency of 0.307, and 4, 5 or 6 copies occupied a combined frequency of 0.06. The GCI of C4A is 2.36±0.79.

C4B GCN distribution contrasted that of C4A with a predilection toward lower copy-numbers. C4B copy-number ranged from 0–4 copies with the majority containing 2 copies (0.560). Approximately one-fourth of AIA carried a single copy of C4B (0.259). Three AIA-subjects (0.018) lacked C4B genes and proteins entirely. The lower frequency of individuals with either 3 or 4 copies of C4B (0.151 and 0.012, respectively) contributed to a GCI of C4B slightly less than the median (1.87 ± 0.72).

Copy-number variation of C4L and C4S

Long and short C4 genes were elucidated in 165 Asian Indian subjects. A total of 699 C4 genes were accounted for, of which 520 were long genes (frequency: 0.744) and 179 were short genes (frequency: 0.256). The GCN distribution of long C4 genes in AIA ranged from 0 to 6 total copies and followed a pattern similar to that for both C4 and C4A, skewed toward increased frequency of higher GCN. Nearly half the population (0.494) presented a median copy-number of 3 C4L. Higher GCN was evidenced by the 31.7% of AIA with more than 3 copies of long genes (4 copies, 0.274; 5 copies, 0.043). A smaller proportion carried 2 copies of C4L (0.177), and two individuals contained 0 or only 1 copy of long C4 gene (0.012). The gene copy index of long C4 is 3.152 ± 0.82.

AIA-subjects frequently carried 0, 1 or 2 copies of short C4 genes. The corresponding frequencies were 0.317, 0.354 and 0.268, respectively. The presence of both 3 and 4 copies of short C4 extended the GCI over the median to 1.085 ± 0.94 (3 copies, 0.049; 4 copies, 0.012).

RCCX modular variations

All AIA-subjects contained at least two RCCX modules in a diploid genome, with the presence of at least a single module and up to four modules on each Chromosome 6. Monomodular L had a frequency of 0.071, while monomodular S had a frequency of 0.012. Bimodular LL was the most frequent haplotype with a frequency of 0.432, which was followed by bimodular LS with a frequency of 0.301. Trimodular RCCX were present in 17.3% of the haplotypes (frequencies: LLL, 0.039; LSL, 0.054; LSS, 0.080). Quadrimodular RCCX haplotypes were present in four subjects (two LLLS and two LSSS) with a combined frequency of 0.012.

Phenotypes of complement component proteins C4A and C4B

Polymorphic variants

C4 protein allotypes were elucidated in 160 AIA-subjects based on results of immunofixation experiments of plasma C4, and verified by C4A and C4B genotyping through TaqI RFLP and PshAI-PvuII RFLP on each subject (Table 2). A total of 671 C4 protein phenotypes were identified, by which 372 were C4A and 299 were C4B.

Table 2
Quantitative variations of plasma C4, C4A and C4B with C4, C4A and C4B gene copy-numbers (GCN) and gene sizes.

Among C4A, C4A3 was the most common allotype, which had a frequency of 0.839. Minor common variants of C4A included C4A2 and C4A6, each of which had a frequency close to 0.06. Rare minor variants included C4A4 (frequency: 0.013) and C4A1 (frequency: 0.022). Mutant C4A genes without protein products were observed in two AIA-subjects.

Among C4B, C4B1 was the most common allotype that had a frequency of 0.866. C4B2 was the main C4B minor variant with a frequency of 0.094. Other detectable minor variants included C4B92, C4B5, C4B3 and C4B96. Mutant C4B gene with undetectable C4B protein product was suspected in one AIA-subject.

The most common combination of C4A and C4B proteins present in a subject is C4A3 and C4B1, irrespective of their corresponding gene dosages. Such combination has a frequency of 56.0% in AIA. Non C4A3-C4B1 combinations have a combined frequency of 44%.

Protein concentrations of total C4, C4A, and C4B

C4 plasma protein concentrations in healthy Asian Indians were determined by radial immunodiffusion experiments. Total C4 protein concentrations ranged from 11.6 to 72.4 mg/dL. Mean C4 protein levels measured 36.0 ± 10.4 mg/dL, with a similar median value of 35.4 mg/dL. The larger constituent of C4 protein, C4A, ranged from 0 (no C4A genes) to 40.1 mg/dL with a mean of 19.1 ± 6.1 mg/dL. A mean of 16.8 ± 7.7 mg/dL for C4B was determined. Mirroring C4A protein range, levels of C4B ranged from 0 to 39.3 mg/dL.

The effect of C4 gene copy-number on protein concentration was accessed by comparing the protein levels among the various copy-number groups or RCCX haplotype present (Table 2). Figure 5 demonstrates increased copy-number of total C4, C4A or C4B equated with increased corresponding protein levels. In Figure 5A, individuals with 2–3 copies of C4 produced a mean C4 protein level of 26.2 ± 7.0 mg/dL, which was less than those with 4 copies of C4 (34.0 ± 7.8 mg/dL). Likewise subjects with five C4 genes had mean plasma C4 protein concentration increased to 42.6 ± 10.1 mg/dL. Additional copies of C4 also demonstrated increased effect (6–7 copies: 49.0 ± 11.1). As shown by analyses of variance (ANOVA), the differences in mean plasma protein concentrations from among the gene copy-number groups are highly significant (p=6.6×10−14).

Figure 5
Correlations of plasma C4 protein concentrations with C4 gene copy-numbers and long and short C4 genes. Panels A, B and C, scatter plots plasma C4 protein with total C4 gene copy-numbers (A), C4A protein with C4A gene copy-numbers (B), and C4B proteins ...

As expected, the copy-number of C4A genes positively influenced the amount of C4A protein being produced (Figure 4B). A mean protein level of 13.4 ± 4.2 mg/dL was represented in individuals with a single copy of C4A, which was significantly reduced compared to individuals with 2 copies of C4A, producing an average of 17.2 ± 4.1 mg/dL. Those with 3 and then 4–6 copies of C4A genes also demonstrated significant increases (3: 23.2 ± 5.5 mg/dL, 4–6: 27.3 ± 6.3 mg/dL). ANOVA of plasma C4A protein concentrations with C4A gene copy-numbers yielded a p-value of 2.5×10−16.

Similarly, the copy-numbers of C4B genes strongly affect the concentrations of plasma C4B proteins. AIA-subjects with single copy of C4B genes had a mean C4B concentration of 9.7 ± 3.0 mg/dL. Those with two copies of C4B, 17.6 ±4.7 mg/dL; and ≥3 copies of C4B, 27.3±7.0 mg/dL. ANOVA of plasma C4B protein concentrations with C4B gene copy-numbers yielded a p-value of 1.4×10−30.

Effects of long and short C4 genes on total C4, C4A and C4B protein levels

To investigate the effect of long and short genes on the C4 protein expression levels among the AIA-subjects, we compared the total C4, C4A and C4B protein concentrations among subjects with equal gene copy-numbers of C4A and C4B. Fifty-five AIA-subjects were identified to have four copies of C4 genes and their C4A and C4B gene copy-numbers were both at 2. The long and short gene haplotypes were LL/LL, LL/LS and LS/LS. The group with 4 copies of C4L (LL/LL) presented with the lowest protein concentrations of total C4 (30.8 ± 7.2 mg/dL). When replacing one long gene with a short gene as in haplotypes LL/LS, the mean C4 protein levels increased to 34.6 ± 6.8 mg/dL. When 2 long genes were exchanged with 2 short genes, as in LS/LS, the mean C4 protein level raised to 41.3 ± 7.4 mg/dL, which was significantly different from that with LL/LL (t-test, p=0.0003) (Table 2).

We further asked whether the positive effects of short C4 genes on C4 protein expression levels affected C4A, C4B or both. Among the AIA-subjects with two copies of C4A and two copies of C4B, the presence of 0, 1 and 2 copies of short genes only had modest effects on the mean protein concentration of C4A, which increased from 15.9±3.5 mg/dL to 17.0±4.2 and 18.3±3.2 mg/dL in each group, respectively. By contrast, the copy-numbers of short genes had drastic effects on the protein concentrations of C4B. In the 2 C4A + 2 C4B group, the mean concentrations of C4B protein with 0, 1, and 2 copies of short genes were 15.5±3.7, 17.3±4.3 and 23.1±5.5 mg/dL, respectively. Highly significant difference in C4B protein levels were observed between the LL/LL and the LS/LS group (t-test, p=0.00006) (Table 2).

Gene copy-number variations of CYP21 and TNX in the RCCX modules

The increase of C4 gene copy-numbers concurs with neighboring genes CYP21, and gene fragments TNXA and RP2. In a bimodular RCCX, the duplicated CYP21 is frequently the pseudogene CYP21A (also known as CYP21A1P). However, subsequent recombinations between CYP21A from a bimodular haplotype and CYP21B from a monomodular haplotype could convert the CYP21A in a bimodular haplotype to CYP21B, yielding the presence two functional CYP21B in one recombinant, and the presence of a CYP21A mutant gene and no CYP21B in the reciprocal recombinant. In trimodular and quadrimodular RCCX, the duplicated CYP21 can be either CYP21A or CYP21B or both. Similarly, the TNXA gene segment that overlaps with CYP21A at the 3′ regions usually has a 120-bp deletion. Recombinations between TNXB and TNXA at the 3′ region can add the 120-bp sequence to the TNXA gene segment, creating an additional TNXB-like gene resembling XB-S. From the TaqI RFLP the presence of TNXA+120 was marked by higher intensities of the 2.5 kb TaqI restriction fragment, as shown in AIA-56 and AIA-57 (Figure 2, panel A). We have further developed a definitive method to detect the presence of the TNXA+120 recombinants by PshAI RFLP, by which a TNXA-TNXB recombinant is represented by the presence of a novel 3.5 kb PshAI restriction fragment.

The copy-number distributions of CYP21 and TNX are shown Figure 6 and Table 4. The distribution patterns of CYP21A and TNXA were highly analogous, and largely resembled that of total C4.

Figure 6
Copy-number variations of CYP21A (CYP21A1P), CYP21B (CYP21A2), TNXA with 2.4 kb TaqI fragment (T2.4), TNXB plus recombinant TNXA-XB with a 2.5 kb TaqI fragment (TNXA+120 or T2.5) among healthy AIA-subjects.
Table 4
Copy-number variations and recombinants of CYP21 and TNX in RCCX.

It was found that 22 out of 166 AIA-subjects had three copies of CYP21B (carrier frequency: 0.131). Remarkably, 15 of these 22 subjects were also characterized by the concurrent presence of the TNXA+120 (carrier frequency for 21B-21B plus TNXA+120: 0.09; Figure 7). An example of such haplotype is present in AIA-56 shown in Figure 2. Bimodular haplotypes with CYP21B-CYP21B without the involvement of TNXA+120 were found only in four AIA-subjects. Bimodular haplotypes with TNXA+120 haplotypes but no concurrent presence of CYP21B-CYP21B were observed in 8 subjects (carrier frequency: 0.048), by which one homozygous case was shown in AIA-57 (lane 4, panel A, Figure 2; lane 5, panel C, Figure 7).

Figure 7
High frequency of TNXA-XB recombinants among AIA subjects. Panel A, A comparison of DNA sequences between TNXB and TNXA at exon 36 region. An 120-bp deletion is present in TNXA that spans the exon 36-intron 36 junction. Panel B. A comparison of PshAI ...


We performed a study of the complement C4 and RCCX copy-number variations in one of the world’s largest ethnic groups, the Asian Indians. Ethnically, socially and culturally, India is renowned for her multiplicity and complexity, and harmonious coexistence of various entities. The current Indian gene pool include the Dravidians in the southern-most states and immigrants to the northern India such as the Aryans from Central Asia between 2000 and 1400 B.C., the Greeks in 400 B.C., Arabs in 800 A.D., the Turks, the Afghans and the Moghuls in 1500 A.D (Papiha, 1996). Here we show a parallel complexity and multiplicity on genotypic and phenotypic diversities of complement C4 and constituents of RCCX modules among the Asian Indian Americans (AIA).

Genotypic variations of total C4, C4A and C4B

One to four copies of C4 genes or RCCX modules per MHC haplotype are frequently present. Slightly over half (53.0%) of the AIA each has four copies of C4 genes per diploid genome, and the rest have C4 gene copy-numbers spreading between 2 and 7. The distribution curve of C4 gene copy-number is tilted towards the high gene copy-number side as the frequency of subjects with five copies (28.6%) was twice more than those with three copies (13.7%). The gene-copy index or the mean copy-number of total C4 among the Asian Indians is 4.23±0.77, and those for C4A and C4B are 2.36±0.79 and 1.87±0.72, respectively. The medium copy-number for C4A and C4B are both at 2. Similar to total C4, the distribution of C4A is heavily skewed towards the high copy-number side as subjects with three C4A genes (30.7%) out-number those with one C4A gene (7.8%). On the other hand, the distribution of C4B gene copy-number is slightly tilted towards the low copy-number side, as 25.9% of AIA had one C4B, compared to 15.1% having three C4B.

The copy-number and size variations of C4 genes create a repertoire of physical or length variants among the AIA-subjects. Ten different physical variants (monomodular L and S; bimodular LL and LS; trimodular LLL, LSL and LSS; quadrimodular LLLL, LSSS and LLLS) have been detected among the AIA-subjects by PmeI-PFGE and by TaqI RFLP with Southern blot analyses. Such RCCX length variants could generate misalignments between homologous chromosomes during meiosis, leading to unequal crossovers.

We had previously determined the copy-number variations of complement C4 and its associated RCCX modules in healthy subjects of European ancestry (Table 1) (Blanchong et al., 2000;Yang et al., 2003;Yang et al., 2007). In stark contrast to Asian-Indians, the distribution of C4 gene copy-number in European Americans is skewed towards the side with lower copy-numbers instead (panel A, Figure 8). The GCI of total C4 is below the medium, 3.85±0.69. The frequency of subjects with three C4 genes is 2.7 times greater than that with five C4 genes (three genes: 26.1%; five genes: 9.8%), a phenomenon that is opposite to that in AIA. Unlike the AIA-subjects that have C4A gene copy-numbers skewed towards the high end with increased frequencies of 3 to 6 copies, the distribution of C4A genes among European Americans is more balanced between the low and high copy-numbers, and follows to a sigmoidal curve more closely (panel C, Figure 8).

Figure 8
A comparison of C4 gene copy-numbers and RCCX modular variations between healthy Asian-Indian (AIA) and European American (EUA) subjects. Frequencies of AIA-subjects are shown in burgundy and EUA-subjects in gray. Note that AIA-subjects had high frequencies ...

Comparing the RCCX modular haplotypes between Americans of Asian-Indian and European ancestries, we observed lower frequencies of monomodular structures and higher frequencies of trimodular and quadrimodular structures in AIA. Of particular interest is the monomodular-short (mono-S) haplotype with a single C4B gene and the absence of C4A, which is central to the European ancestral-haplotype with HLA A1 B8 DR3 (AH8.1) and is strongly associated with increased risk of autoimmune diseases including SLE and type I diabetes mellitus (Awdeh et al., 1983;Carroll et al., 1985b;Dawkins et al., 1999;Horton et al., 2008;Stewart et al., 2004;Yang et al., 2007). Such mono-S haplotype has a frequency of 10.6% in healthy subjects (panel B, Figure 8), and 16.9% in SLE patients of European ancestry (Yang et al., 2007). Remarkably, only three subjects with mono-S haplotypes (two heterozygous and one homozygous; haplotype frequency: 1.2%) were detected among our AIA-cohort (χ2=29.2, p=6.6×10−8). The prevalence of SLE in India was reported to be relatively low, 3.2 per 100,000 (Malaviya et al., 1993), compared to an overall rate between 14.6 and 50.8 per 100,000 among US subjects (Rus et al., 2007). The relatively low frequency of mono-S, or the high gene copy-number of C4A, probably reduces the risk of SLE among Asian-Indian subjects.

Quantitative and qualitative diversities of C4 proteins and implications

The C4 gene copy-number variation leads to a large range of C4 plasma protein concentrations from 11.6 to 72.4 mg/dL among the healthy Asian-Indian subjects, and the presence of polymorphic variants of C4A and C4B proteins. The C4 gene copy-numbers and gene size are important determining factors plasma C4 protein concentrations. Linear correlations between total C4, C4A and C4B gene copy-numbers with their corresponding plasma protein concentration were observed. Also, the presence of short C4 genes significantly increased the plasma C4 protein concentrations, particularly C4B. In a logistic regression model of determinants for plasma C4 proteins, C4 gene copy-number has an F-ratio of 13.8 (p=2.9×10−6), and copy-number of short C4 genes has an F-ratio of 6.3 (p=0.0005). We reason that the quantitative and qualitative diversities of C4 would provide the flexibility among different subjects to react to environmental and microbial challenges. The relatively higher copy-number of C4 genes among the Asian-Indians would infer a powerful effector arm of the innate and adaptive immune system.

Phenotyping experiments of plasma C4 proteins showed that C4A3 allotypes and C4B1 allotypes were the most common variants in each class of C4 proteins. C4A3 has a frequency of 0.839 among C4A; and C4B1, 0.866 among C4B. AIA-subjects with C4A3 plus C4B1 and no other C4 protein variants carry a frequency of 56.0%. In other words, 44% of AIA-subjects had other C4 variants in addition to C4A3 and C4B1, or did not have both C4A3 and C4B1. This is relevant because blood transfusion patients can make alloantibodies against mismatched donor C4 protein variants, which contributed to the presence of Chido and Rodgers blood groups (Giles et al., 1988;Longster and Giles, 1976;Middleton and Crooksten, 1972;Robson et al., 1989;Yu et al., 1986;Yu et al., 1988). The recent application of immunosuppression drugs has significantly increased the success of organ transplantations. However, a proportion of transplants are rejected because of humoral alloreactivity against grafts such as kidneys. Many rejected kidney transplants are characterized by depositions of C4d on peritubular capillaries (Bohmig et al., 2008;Feucht, 2003;Feucht and Mihatsch, 2005;Ranjan et al., 2008). C4d is an activation and degradation product for complement C4. While plasma C4 are mainly synthesized by the livers, the kidneys, adrenal and the thyroid glands, heart, small intestine, ovary and thymus also synthesize considerable quantities of C4 (Berger et al., 2005;Seelen et al., 1993;Yu et al., 2003). There is a relatively high likelihood for a mismatch of C4A and/or C4B protein allotypes produced by the donor organ and the corresponding transplant recipient. Whether the polymorphic C4 protein variant(s) from the donor organ would elicit and/or aggravate alloimmune responses leading to a graft rejection by the recipient deserves detailed investigations.

Recombinations between RCCX length variants as a mechanism for genetic diseases

Our studies of RCCX modules also shed light on the genetics of cytochrome P450 21-hydroxylase CYP21 and extracellular matrix protein tenascin TNX. TaqI genomic RFLP revealed concurrent copy-number variations of pseudogene CYP21A and gene fragment TNXA with total C4. CYP21A and TNXA are present in MHC haplotypes with two or more RCCX modules. The copy-numbers of these two genetic elements both varied between 0 and 5 (Figure 6), and their distributions are highly analogous to that of total C4 (Figure 4). It is striking to note that 13.1% of the Asian- Indian study population (22 subjects) had 3 copies of the functional CYP21B gene. Besides three subjects who had trimodular RCCX structures with 21A-21B-21B configurations, the remaining 19 subjects were from bimodular RCCX haplotypes with 21B-21B configurations. Remarkably, 15 of these bimodular 21B-21B haplotypes also had an additional marker for the 120-bp addition to the TNXA gene segment. Such CYP21B-TNXA+120 structures were likely generated through recombinations or gene conversion-like events between TNXA from a bimodular RCCX haplotype and TNXB from a monomodular RCCX haplotype because of misalignments between these RCCX length variants during meiosis (Rupert et al., 1999;Yang et al., 1999;Yu et al., 2000). Acquisition by TNXA of the 120-bp sequence between exon 36 and intron 36 from TNXB without the apparent involvement of CYP21B was found in an additional 8 MHC haplotypes. At this stage, the physiologic impact of higher steroid 21-hydroxylase activity due to high copy-numbers of CYP21B has not been investigated, nor has the presence of a novel protein coded by TNXA+120, which resembles XB-S (Kato et al., 2008;Tee et al., 1995). The reciprocal products for the unequal recombinations would be haplotypes with CYP21A pseudogene only, and/or TNXB gene that is missing the 120-bp sequence between exon 36-intron 36. We and others showed the presence of such recombinants in patients with congenital adrenal hyperplasia (Blanchong et al., 2000;Yang et al., 1999) and patients with Ehlers Danlos Syndrome (Burch et al., 1997). The steroid 21-hydroxylase (CAH) is essential in the biosynthesis of the stress hormone hydrocortisone, and the salt-retaining hormone aldosterone. Deficiencies of 21-hydroxylase leads to CAH with a range of disease severity from salt-losing phenotype that is life-threatening, simple virilizing, ambiguous genitalia and male secondary sex characters among females (White and Speiser, 2000). It is of interest to point out that India has relatively high rate of CAH (Incidence: 1 in 2575 new-born). The high frequencies of the reciprocal recombination products, CYP21B-CYP21B and/or TNXA+120, plus the presence of many length variants with different long and short C4 genes coding for C4A or C4B among AIA, are indicative of high rates of unequal recombinations between RCCX haplotypes.

In summary, our results demonstrate great diversities associated with gene copy-number variations of complement C4, steroid 21-hydroxylase CYP21 and tenascin TNX. It also offers an explanation for the low prevalence of SLE but the high incidence of CAH among Asian Indians.

Table 3
Frequencies of C4A and C4B protein allotypes among Asian-Indian Americans

Supplementary Material


We wish to express our sincere gratitude to the blood donors. We are indebted to Dr. Yaoling Shu for assistance. This work was supported by grants 1R01 AR050078 and 1R01 AR054459 from the NIAMS, NIAID, NIDDK, and the Office of the Director, the National Institutes of Health, USA, and by Lupus Foundation of America.


Asian-Indian Americans
congenital adrenal hyperplasia
copy-number variation
monomodular RCCX with a single long C4 gene
LL and LS
bimodular RCCX haplotypes with two long, or with one long and one short, C4 genes, respectively
mono-S or S
monomodular RCCX with a single short C4 gene
systemic lupus erythematosus
TNXA-XB recombinant in which the TNXA incorporated the 120-bp sequences from TNXB


Gene symbols are italicized, protein symbols are in regular fonts.

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