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Blood, 5 February 2009, Vol. 113, No. 6, pp. 1350-1357. Prepublished online as a Blood First Edition Paper on October 17, 2008; DOI 10.1182/blood-2008-07-171140.
RED CELLS, IRON, AND ERYTHROPOIESIS The monovalent cation leak in overhydrated stomatocytic red blood cells results from amino acid substitutions in the Rh-associated glycoprotein1 Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Bristol, United Kingdom; 2 Laboratoire de Biologie et Physiopathologie des Systèmes Intégrés, FRE3094 CNRS-Université de Nice, Nice, France; 3 Department of Biochemistry, University of Bristol, Bristol, United Kingdom; 4 Hématologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris; Faculté de Médecine Paris-Sud, Universite Paris-Sud, Inserm U779, Le Kremlin-Bicêtre, France; and 5 Department of Medicine, University College London, London, United Kingdom Overhydrated hereditary stomatocytosis (OHSt) is a rare dominantly inherited hemolytic anemia characterized by a profuse membrane leak to monovalent cations. Here, we show that OHSt red cell membranes contain slightly reduced amounts of Rh-associated glycoprotein (RhAG), a putative gas channel protein. DNA analysis revealed that the OHSt patients have 1 of 2 heterozygous mutations (t182g, t194c) in RHAG that lead to substitutions of 2 highly conserved amino acids (Ile61Arg, Phe65Ser). Unexpectedly, expression of wild-type RhAG in Xenopus laevis oocytes induced a monovalent cation leak; expression of the mutant RhAG proteins induced a leak about 6 times greater than that in wild type. RhAG belongs to the ammonium transporter family of proteins that form pore-like structures. We have modeled RhAG on the homologous Nitrosomonas europaea Rh50 protein and shown that these mutations are likely to lead to an opening of the pore. Although the function of RhAG remains controversial, this first report of functional RhAG mutations supports a role for RhAG as a cation pore.
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