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 Blood, 15 March 2008, Vol. 111, No. 6, pp. 3236-3244.
Prepublished online as a Blood First Edition Paper on December 20, 2007; DOI 10.1182/blood-2007-10-117812.

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RED CELLS

Somatic inactivation of the PHD2 prolyl hydroxylase causes polycythemia and congestive heart failure

Yoji Andrew Minamishima1, Javid Moslehi1,2, Nabeel Bardeesy3, Darragh Cullen2, Roderick T. Bronson4, and William G. Kaelin, Jr1,5

1 Department of Medical Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; 2 Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 3 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; 4 Rodent Histopathology Core, Department of Pathology, Harvard Medical School, Boston, MA; and 5 Howard Hughes Medical Institute, Chevy Chase, MD

Pharmacologic activation of the heterodimeric HIF transcription factor appears promising as a strategy to treat diseases, such as anemia, myocardial infarction, and stroke, in which tissue hypoxia is a prominent feature. HIF accumulation is normally linked to oxygen availability because an oxygen-dependent posttranslational modification (prolyl hydroxylation) marks the HIF{alpha} subunit for polyubiquitination and destruction. Three enzymes (PHD1, PHD2, and PHD3) capable of catalyzing this reaction have been identified, although PHD2 (also called Egln1) appears to be the primary HIF prolyl hydroxylase in cell culture experiments. We found that conditional inactivation of PHD2 in mice is sufficient to activate a subset of HIF target genes, including erythropoietin, leading to striking increases in red blood cell production. Mice lacking PHD2 exhibit premature mortality associated with marked venous congestion and dilated cardiomyopathy. The latter is likely the result of hyperviscosity syndrome and volume overload, although a direct effect of chronic, high-level HIF stimulation on cardiac myocytes cannot be excluded.


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