Mutations in Krüppel-like factor 1 cause transfusion-dependent hemolytic anemia and persistence of embryonic globin gene expression
In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented with severe, transfusion-dependent hemolytic anemia. In most cases, the red cells were hypochromic and microcytic, consistent with abnormalitie...
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Published in | Blood Vol. 123; no. 10; pp. 1586 - 1595 |
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Main Authors | , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
06.03.2014
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Abstract | In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented with severe, transfusion-dependent hemolytic anemia. In most cases, the red cells were hypochromic and microcytic, consistent with abnormalities in hemoglobin synthesis. In addition, in many cases, the red cells resembled those seen in patients with membrane defects or enzymopathies, known as chronic nonspherocytic hemolytic anemia (CNSHA). Analysis of RNA and protein in primary erythroid cells from these individuals provided evidence of abnormal globin synthesis, with persistent expression of fetal hemoglobin and, most remarkably, expression of large quantities of embryonic globins in postnatal life. The red cell membranes were abnormal, most notably expressing reduced amounts of CD44 and, consequently, manifesting the rare In(Lu) blood group. Finally, all tested patients showed abnormally low levels of the red cell enzyme pyruvate kinase, a known cause of CNSHA. These patients define a new type of severe, transfusion-dependent CNSHA caused by mutations in a trans-acting factor (Krüppel-like factor 1) and reveal an important pathway regulating embryonic globin gene expression in adult humans.
•KLF1 mutations cause severe congenital hemolytic anemia associated with a deficiency of red cell pyruvate kinase.•A severe KLF1 deficiency causes hereditary persistence of embryonic globin synthesis. |
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AbstractList | In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented with severe, transfusion-dependent hemolytic anemia. In most cases, the red cells were hypochromic and microcytic, consistent with abnormalities in hemoglobin synthesis. In addition, in many cases, the red cells resembled those seen in patients with membrane defects or enzymopathies, known as chronic nonspherocytic hemolytic anemia (CNSHA). Analysis of RNA and protein in primary erythroid cells from these individuals provided evidence of abnormal globin synthesis, with persistent expression of fetal hemoglobin and, most remarkably, expression of large quantities of embryonic globins in postnatal life. The red cell membranes were abnormal, most notably expressing reduced amounts of CD44 and, consequently, manifesting the rare In(Lu) blood group. Finally, all tested patients showed abnormally low levels of the red cell enzyme pyruvate kinase, a known cause of CNSHA. These patients define a new type of severe, transfusion-dependent CNSHA caused by mutations in a trans-acting factor (Krüppel-like factor 1) and reveal an important pathway regulating embryonic globin gene expression in adult humans. Key Points KLF1 mutations cause severe congenital hemolytic anemia associated with a deficiency of red cell pyruvate kinase. A severe KLF1 deficiency causes hereditary persistence of embryonic globin synthesis. In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented with severe, transfusion-dependent hemolytic anemia. In most cases, the red cells were hypochromic and microcytic, consistent with abnormalities in hemoglobin synthesis. In addition, in many cases, the red cells resembled those seen in patients with membrane defects or enzymopathies, known as chronic nonspherocytic hemolytic anemia (CNSHA). Analysis of RNA and protein in primary erythroid cells from these individuals provided evidence of abnormal globin synthesis, with persistent expression of fetal hemoglobin and, most remarkably, expression of large quantities of embryonic globins in postnatal life. The red cell membranes were abnormal, most notably expressing reduced amounts of CD44 and, consequently, manifesting the rare In(Lu) blood group. Finally, all tested patients showed abnormally low levels of the red cell enzyme pyruvate kinase, a known cause of CNSHA. These patients define a new type of severe, transfusion-dependent CNSHA caused by mutations in a trans-acting factor (Krüppel-like factor 1) and reveal an important pathway regulating embryonic globin gene expression in adult humans. •KLF1 mutations cause severe congenital hemolytic anemia associated with a deficiency of red cell pyruvate kinase.•A severe KLF1 deficiency causes hereditary persistence of embryonic globin synthesis. |
Author | Chalaow, Nipon Bejrachandra, Sasithorn Juntharaniyom, Monthana Babbs, Christian Higgs, Douglas R. Fisher, Chris Viprakasit, Vip Saipin, Jariya Tanphaichitr, Voravarn S. Riolueang, Suchada Kanno, Hitoshi Songdej, Duantida Sanpakit, Kleebsabai Philipsen, Sjaak Tachavanich, Kalaya Lower, Karen Ekwattanakit, Supachai Gibbons, Richard J. |
Author_xml | – sequence: 1 givenname: Vip surname: Viprakasit fullname: Viprakasit, Vip email: vip.vip@mahidol.ac.th organization: Department of Pediatrics & Thalassemia Centre, Mahidol University, Bangkok, Thailand – sequence: 2 givenname: Supachai surname: Ekwattanakit fullname: Ekwattanakit, Supachai organization: Department of Medicine, Mahidol University, Bangkok, Thailand – sequence: 3 givenname: Suchada surname: Riolueang fullname: Riolueang, Suchada organization: MSc-PhD in Immunology Program, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand – sequence: 4 givenname: Nipon surname: Chalaow fullname: Chalaow, Nipon organization: MSc-PhD in Immunology Program, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand – sequence: 5 givenname: Chris surname: Fisher fullname: Fisher, Chris organization: Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Headington, Oxford, United Kingdom – sequence: 6 givenname: Karen surname: Lower fullname: Lower, Karen organization: Department of Hematology and Genetic Pathology, School of Medicine, Flinders University, Adelaide, Australia – sequence: 7 givenname: Hitoshi surname: Kanno fullname: Kanno, Hitoshi organization: Department of Blood Transfusion Medicine and Cell Processing, Women's Medical College, Tokyo, Japan – sequence: 8 givenname: Kalaya surname: Tachavanich fullname: Tachavanich, Kalaya organization: Department of Pediatrics & Thalassemia Centre, Mahidol University, Bangkok, Thailand – sequence: 9 givenname: Sasithorn surname: Bejrachandra fullname: Bejrachandra, Sasithorn organization: Department of Transfusion Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand – sequence: 10 givenname: Jariya surname: Saipin fullname: Saipin, Jariya organization: Department of Transfusion Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand – sequence: 11 givenname: Monthana surname: Juntharaniyom fullname: Juntharaniyom, Monthana organization: Department of Pediatrics, Khon Kaen Regional Hospital, Ministry of Public Health, Khon Kaen, Thailand – sequence: 12 givenname: Kleebsabai surname: Sanpakit fullname: Sanpakit, Kleebsabai organization: Department of Pediatrics & Thalassemia Centre, Mahidol University, Bangkok, Thailand – sequence: 13 givenname: Voravarn S. surname: Tanphaichitr fullname: Tanphaichitr, Voravarn S. organization: Department of Pediatrics & Thalassemia Centre, Mahidol University, Bangkok, Thailand – sequence: 14 givenname: Duantida surname: Songdej fullname: Songdej, Duantida organization: Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Headington, Oxford, United Kingdom – sequence: 15 givenname: Christian surname: Babbs fullname: Babbs, Christian organization: Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Headington, Oxford, United Kingdom – sequence: 16 givenname: Richard J. surname: Gibbons fullname: Gibbons, Richard J. organization: Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Headington, Oxford, United Kingdom – sequence: 17 givenname: Sjaak surname: Philipsen fullname: Philipsen, Sjaak organization: Erasmus University Medical Center-Cell Biology, Rotterdam, The Netherlands – sequence: 18 givenname: Douglas R. surname: Higgs fullname: Higgs, Douglas R. organization: Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Headington, Oxford, United Kingdom |
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Snippet | In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented... Key Points KLF1 mutations cause severe congenital hemolytic anemia associated with a deficiency of red cell pyruvate kinase. A severe KLF1 deficiency causes... |
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SubjectTerms | Adolescent Adult alpha-Globins - metabolism Amino Acid Sequence Anemia, Hemolytic - blood Anemia, Hemolytic - etiology Anemia, Hemolytic - genetics beta-Globins - metabolism Child Child, Preschool Conserved Sequence Erythrocyte Indices Erythrocytes - metabolism Female Fetal Hemoglobin - chemistry Fetal Hemoglobin - genetics Gene Expression Regulation Gene Order Humans Infant Kruppel-Like Transcription Factors - genetics Male Molecular Sequence Data Mutation Protein Binding Protein Interaction Domains and Motifs Sequence Alignment Transfusion Reaction Young Adult |
Title | Mutations in Krüppel-like factor 1 cause transfusion-dependent hemolytic anemia and persistence of embryonic globin gene expression |
URI | https://dx.doi.org/10.1182/blood-2013-09-526087 https://www.ncbi.nlm.nih.gov/pubmed/24443441 https://search.proquest.com/docview/1514428530 |
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