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Blood, 15 February 2001, Vol. 97, No. 4, pp. 1099-1105

RED CELLS

Expression, purification, and characterization of human hemoglobins Gower-1 (zeta 2epsilon 2), Gower-2 (alpha 2epsilon 2), and Portland-2 (zeta 2beta 2) assembled in complex transgenic-knockout mice

Zhenning He and J. Eric Russell

From the Departments of Medicine and Pediatrics, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, PA.


    Abstract
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

Embryonic zeta - and epsilon -globin subunits assemble with each other and with adult alpha - and beta -globin subunits into hemoglobin heterotetramers in both primitive and definitive erythrocytes. The properties of these hemoglobins---Hbs Gower-1 (zeta 2epsilon 2), Gower-2 (alpha 2epsilon 2), and Portland-2 (zeta 2beta 2)---have been incompletely described as they are difficult to obtain in quantity from either primary human tissue or conventional expression systems. The generation of complex transgenic-knockout mice that express these hemoglobins at levels between 24% and 70% is described, as are efficient methods for their purification from mouse hemolysates. Key physiological characteristics---including P50, Hill coefficient, Bohr effect, and affinity for 2,3-BPG---were established for each of the 3 human hemoglobins. The stability of each hemoglobin in the face of mechanical, thermal, and chemical stresses was also determined. Analyses indicate that the zeta -for-alpha exchange distinguishing Hb Portland-2 and Hb A alters hemoglobin O2-transport capacity by increasing its P50 and decreasing its Bohr effect. By comparison, the epsilon -for-beta exchange distinguishing Hb Gower-2 and Hb A has little impact on these same functional parameters. Hb Gower-1, assembled entirely from embryonic subunits, displays an elevated P50 level, a reduced Bohr effect, and increased 2,3-BPG binding compared to Hb A. The data support the hypothesis that Hb Gower-2, assembled from reactivated epsilon  globin in individuals with defined hemoglobinopathies and thalassemias, would serve as a physiologically acceptable substitute for deficient or dysfunctional Hb A. In addition, the unexpected properties of Hb Gower-1 call into question a common hypothesis for its primary role in embryonic development. (Blood. 2001;97:1099-1105)

© 2001 by The American Society of Hematology.

    Introduction
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

Physiologically meaningful human hemoglobins assemble from 2 alpha -like and 2 beta -like globin subunits. The 3 genes that encode alpha -like globins (5'-zeta -alpha 2-alpha 1-3') and the 5 genes that encode beta -like globins (5'-epsilon -Ggamma -Agamma -delta -beta -3') are expressed in a developmental sequence that parallels their structural arrangement.1,2 Coordinated switching of the alpha -like and beta -like genes results in the high-level expression of Hb Gower-1 (zeta 2epsilon 2), Hb F (alpha 2gamma 2), and Hb A (alpha 2beta 2) during the embryonic, fetal, and adult developmental stages, respectively. Other structurally defined hemoglobins---Gower-2 (alpha 2epsilon 2), Portland-1 (zeta 2gamma 2), and Portland-2 (zeta 2beta 2)---are expressed at relatively low levels in primitive and definitive erythroid cells, primarily during embryonic and early fetal development.1-8 Their heterotetrameric structures predict that each of these semi-embryonic hemoglobins will display properties compatible with human physiology.

Unlike Hb A (alpha 2beta 2) and Hb F (alpha 2gamma 2), the properties of semi-embryonic Hbs Gower-2 (alpha 2epsilon 2) and Portland-2 (zeta 2beta 2), as well as fully embryonic Hb Gower-1 (zeta 2epsilon 2), remain largely undefined.3-8 Intact erythrocytes from 35-mm crown-rump embryos (approximately 7-week gestation), containing a complex mixture of embryonic, semi-embryonic, and fetal hemoglobins, have been shown to bind O2 strongly.9 However, it is difficult to purify individual hemoglobins from primitive erythroid cells because they are produced in low numbers during an early and relatively brief developmental window4,5 and because they contain a highly heterogeneous population of hemoglobin heterotetramers.4,5,9 Recently, a yeast expression system was developed to generate Gower hemoglobins for in vitro analysis.10 As with bacteria, yeast culture systems express relatively low levels of functional hemoglobin, which must be rigorously purified from incompletely processed globins and from inaccurately assembled heterotetramers.11-13 Nevertheless, yeast-expressed Gower hemoglobins appear to exhibit high O2 affinities when studied under defined conditions.10,14 A more comprehensive functional and structural characterization of Gower and other low-abundance hemoglobins would be facilitated by the generation of a system that expresses high levels of fully functional heterotetramers.

The successful high-level expression of fully processed and fully assembled human Hbs A, F, S, and C in complex transgenic-knockout mice15-17 suggested that a similar strategy might be used to generate large quantities of less common human hemoglobins for in vitro analysis. A key step in this process was the generation of adult mice expressing high levels of human (h) embryonic zeta - and epsilon -globins in their definitive erythrocytes.18 These mice were subsequently used to generate lines expressing hybrid mouse-human semi-embryonic hemoglobins at 100% levels.19 Comprehensive in vitro and in vivo evaluation demonstrated that hemoglobins assembled from malpha - and hepsilon -globin subunits (malpha 2hepsilon 2) displayed O2-binding properties similar to those of control Hb malpha 2hbeta 2. This result strengthened the hypothesis that physiologically important characteristics of fully human Hb Gower-2 (alpha 2epsilon 2) might be similar to those of Hb A (alpha 2beta 2).19 In contrast, substantial differences in the properties of Hbs hzeta 2mbeta 2 and halpha 2mbeta 2 suggested that the physiological characteristics of fully human Hb Portland-2 (zeta 2beta 2) and Hb A might differ in several important respects.19 In addition to providing an estimate of the biochemical and physiological properties of the semi-embryonic hemoglobins, these studies also indicated the potential value of human embryonic globin subunits as substitutes for adult globin subunits in individuals with defined thalassemias or hemoglobinopathies.

The current study extends our previous work by assessing key biochemical and physiological properties of fully human semi-embryonic and embryonic hemoglobins purified from complex transgenic-knockout mice. We describe a strategy for generating mice expressing high levels of human Hbs Gower-1 (zeta 2epsilon 2), Gower-2 (alpha 2epsilon 2), and Portland-2 (zeta 2beta 2), as well as specific methods for their rapid and efficient purification. The key biochemical characteristics of each hemoglobin are subsequently determined, including their O2 affinities, subunit cooperativities, and changes in O2 affinity in response to allosteric modifiers and variations in ambient pH. We also assess the stability of each of these hemoglobins in response to defined mechanical, chemical, and thermal stresses. Based on the data, we speculate on the evolutionary basis for hemoglobin switching and the potential value of these poorly understood hemoglobins to patients with congenital alpha - and beta -globin chain defects.


    Materials and methods
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

Transgenic and knockout mice

The generation and characterization of transgenic mice expressing high levels of human alpha , beta , zeta , and epsilon  globins have previously been described.18-21 Mice with heterozygous knockout of their endogenous alpha -globin genes (genotype malpha +/-) or beta -globin genes (genotype mbeta +/-) were generously provided by Y. W. Kan and Judy Chang (University of California, San Francisco)22 and O. Smithies (University of North Carolina, Chapel Hill),23 respectively. All mouse husbandry and experimentation was performed using protocols approved by the IACUC of the University of Pennsylvania.

Hemoglobin purification

Whole blood was collected from decapitated mice in 200 µL phosphate-buffered saline (PBS)-heparin (20 U/mL) or PBS-EDTA (27 mM), and the hemoglobins were promptly converted to the carbonmonoxy form by bubbling the sample with CO. Erythrocytes were subsequently washed twice with excess PBS-EDTA (2.7 mM), and the cell pellets were stored in aliquots at -80°C. Lysate was prepared in approximately 3-fold excess buffer A (see below) and clarified by ultracentrifugation at 20°C in a TLA-100 rotor at 40 000 rpm for 20 minutes (Beckman, Fullerton, CA). Hemolysates were fractionated over an SP/H 4.5 × 100 Poros column (PerSeptive Biosystems, Foster City, CA) using a BioCAD Sprint perfusion chromatography system (Framingham, MA). Hb Gower-1 was purified using buffer A (40 mM Bis-Tris, 5 mM EDTA, pH 6.5) and buffer B (buffer A + 200 mM NaCl) at 2 mL/min using a linear 10% to 60% buffer B gradient. Hb Portland-2 was similarly purified using a 10% to 40% buffer B gradient. To purify Hb Gower-2, buffers were adjusted to pH 6.8, and a nonlinear 30% to 50% buffer B gradient was used. Fractions collected in 96-well microtiter plates were analyzed at A540 on a SpectraMAX plate reader (Molecular Devices, Sunnyvale, CA), pooled, and concentrated at 4°C over a Centricon YM-10 filter (Millipore, Bedford, MA). Hb A, prepared from human hemolysate, was used as a control in all experiments.

Electrophoretic analysis

The identity and purity of each hemoglobin preparation was verified by denaturing Triton-acid-urea24,25 and nondenaturing cellulose acetate electrophoresis19 using methods recommended by the manufacturer (Helena Laboratories, Beaumont, TX).

Oxygen equilibrium curves

Purified CO-hemoglobins were resuspended to a final concentration of approximately 7.5 µM in P50 buffer (50 mM Bis-Tris, pH 7.4, 100 mM NaCl, 5 mM EDTA) and converted to the oxy form by photolysis under 100% O2 using an ice water-cooled rotary condenser.26 Conversion to the oxyhemoglobin form was judged complete by an A540:A576 ratio of less than 0.95. Oxygen equilibrium curves (OECs) were subsequently determined on a HEMOX analyzer (TCS, Southampton, PA) at 20°C. Studies of 2,3-bisphosphoglycerate binding (2,3-BPG; Sigma, St Louis, MO) were carried out in P50 buffer (pH 7.4), whereas Bohr effect studies were carried out in P50 buffer adjusted to defined pH values.

Stability determinations

Mechanical. Using a modified version of a previously described method,27 Hbs were diluted to approximately 13 µM with 10 mM potassium phosphate buffer (pH 8.0) and converted to the oxyhemoglobin form (see above). Aliquots (2 mL) were shaken for defined intervals at a setting of 2000 on a Maxi-Mix III type 65800 shaker (Thermolyne, Dubuque, IA), and denatured hemoglobins were precipitated by a 5-minute desktop spin. The soluble hemoglobin was determined by A542 spectrophotometry of the supernatant.

Chemical. Purified hemoglobins were diluted to approximately 0.1 mM in buffer (0.1 mM Tris, pH 7.4) and converted to the oxyhemoglobin form as described above. Aliquots diluted 10-fold in prewarmed Tris buffer containing 17% (vol/vol) isopropanol were incubated at 37°C for 5 minutes.28 Precipitated hemoglobins were clarified by desktop centrifugation, and the A542 of the supernatant was determined.

Thermal. Purified hemoglobins were diluted to approximately 50 µM in buffer (0.1 mM Tris, pH 7.4) and converted to the oxyhemoglobin form as described above. Test and control aliquots were incubated for 2 hours at 50°C and 4°C, respectively, and spun for 10 minutes on a desktop centrifuge.29 The supernatant was diluted 10-fold with developer solution [11.9 mM NaHCO3, 0.77 mM KCN, 0.61 mM K3Fe(CN)6], insoluble hemoglobins were precipitated by desktop centrifugation, and the A540 of the supernatant was determined.


    Results
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

Generation of adult mice expressing high levels of human embryonic and semi-embryonic hemoglobins

The construction of transgenes and the generation of mice expressing hzeta , halpha , hepsilon , and hbeta globins in definitive erythrocytes has previously been described.18-20 The high-level, developmental-stage inappropriate expression of transgenic hzeta and hepsilon globins was achieved by linking their encoding genes to transcriptional control elements from the halpha and hbeta globin genes, respectively (Figure 1A).18 Full-length genes encoding halpha and hbeta globins, containing their native transcriptional control elements, were anticipated to be expressed at high levels in adult erythrocytes and consequently were not modified.19,20 Each transgene was linked to a micro beta -locus control region to insure its high-level, integration position-independent expression.18-20,30 Single lines expressing high levels of each transgenic globin were identified by phenotypical screening of hemolysates using denaturing globin electrophoresis.24,25 These lines were used in the experiments described in the current work.


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Figure 1. Generation of transgenic mice expressing high levels of human embryonic and semi-embryonic hemoglobins. (A) Structures of human transgenes. Exons are depicted as open boxes, with the positions of the translational initiation and termination codons indicated by tick marks. Globin-gene origins of promoter and enhancer elements (cross-hatched) are also indicated. All transgenes were linked to an identical micro beta -LCR cassette (shaded).30 The common name for each transgene and the human globin it expresses are indicated to the left and right of the diagram, respectively. (B) Mating strategy for generating mice expressing human Hb Gower-1 (zeta 2epsilon 2). Partial globin genotypes of selected mice from 5 generations (F1-F5) are depicted. The strategy facilitates the generation of mice expressing high levels of human Hb zeta 2epsilon 2 from progenitors expressing hzeta or hepsilon globin or containing heterozygous deletion of their endogenous malpha or mbeta globin genes. A similar strategy was used to generate mice expressing high levels of human Hbs Gower-2 (alpha 2epsilon 2) and Portland-2 (zeta 2beta 2). m, mouse; h, human; +/+, homozygous; +/-, heterozygous; -/-, nullizygous.

A breeding strategy was designed to generate mice expressing high levels of human embryonic or semi-embryonic hemoglobins with minimal mouse globin background (Figure 1B). We had previously noted that the expression of each of the 4 human globin transgenes increased substantially in mice carrying one or more knockout mutations of the related endogenous adult globin gene homologue.18,19 The level of hzeta and halpha induction was sufficient to rescue the viability of mice with homozygous-lethal deletions of their endogenous malpha -globin genes,18,31,32 whereas the viability of mice with homozygous-lethal deletions of the mbeta -globin genes could be rescued by the expression of either transgenic hepsilon or hbeta globins.18,31,32 We reasoned that the assembly of hemoglobin heterotetramers from transgenic human alpha -like and beta -like globins would be similarly enhanced in mice carrying both malpha - and mbeta -globin knockout alleles.

Design of methods to purify human hemoglobins from transgenic hemolysates

A combination of genetic and biochemical strategies was used to facilitate the preparation of human Hbs from transgenic mice. We screened more than 125, 335, and 89 candidate pups expressing Hbs Gower-1, Gower-2, and Portland-2, respectively, without identifying any malpha -/-/mbeta -/- mice expressing 100% of the desired human hemoglobins (data not shown). On the other hand, a substantial proportion of these pups displayed either malpha +/-/mbeta -/- or malpha +/+/mbeta -/- genotypes (more than 25 pups expressing each hemoglobin; data not shown). Hbs Gower-1 (zeta 2epsilon 2), Gower-2 (alpha 2epsilon 2), and Portland-2 (zeta 2beta 2) were expressed in the these complex transgenic-knockout mice as 37%, 24%, and approximately 70% of total hemoglobin, respectively, corresponding to the expression of human hemoglobin in the range of approximately 20 to 80 mg/mouse (data not shown). These high levels of expression facilitated the task of hemoglobin purification, as did the fact that malpha +/-/mbeta -/- or malpha +/+/mbeta -/- mice each assembled only a single contaminant hemoglobin species (malpha 2hepsilon 2 or malpha 2hbeta 2).

A method was subsequently established for isolating each of the desired human hemoglobin heterotetramers using cation-exchange chromatography. Human Hbs Gower-1 (zeta 2epsilon 2), Gower-2 (alpha 2epsilon 2), and Portland-2 (zeta 2beta 2) were purified from contaminant hybrid Hbs malpha 2hepsilon 2, malpha 2hepsilon 2, and malpha 2hbeta 2, respectively, in single-step processes using NaCl gradients at defined pH levels (Figure 2, and data not shown). The identities and purities of the eluted human hemoglobins were subsequently verified by nondenaturing19 and denaturing24,25 electrophoretic methods (Figure 2 and data not shown). The large quantities of high-purity human embryonic and semi-embryonic hemoglobins efficiently prepared by this method were sufficient to permit their detailed physiological and biochemical evaluation and to provide substantial banked product for future functional and structural studies.


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Figure 2. Purification of human embryonic and semi-embryonic hemoglobins. (A) Human Hb Gower-1 (zeta 2epsilon 2). (Left) Hemolysate prepared from adult malpha +/-/mbeta -/-/hzeta /hepsilon complex transgenic-knockout mice was resolved over a Poros SP/H column using a linear 20 to 120 mM NaCl gradient (pH 6.5). The positions of human Hb zeta 2epsilon 2 (peak 1) and contaminant hybrid mouse-human Hb malpha 2hepsilon 2 (peak 2) are indicated (arbitrary A280 units). Eluate conductivity (in mS) is depicted by a gray line. (Right) Aliquots of unfractionated (U) lysate and eluate corresponding to peaks 1 and 2 were resolved by nondenaturing cellulose acetate electrophoresis. A control lane contains a mixture of human Hbs A, F, S, and C. The migration of constituent hemoglobins is indicated to the left, and gel polarity to the right. (B) Human Hb Gower-2 (alpha 2epsilon 2). Resolution of hemolysate from an adult malpha +/-/mbeta -/-/halpha /hepsilon complex transgenic-knockout mouse into human Hb alpha 2epsilon 2 (peak 2) and contaminant hybrid mouse/human Hb malpha 2hepsilon 2 (peak 1) using a nonlinear 60- to 100-mM NaCl gradient (pH 6.8). (C) Human Hb Portland-2 (zeta 2beta 2). Resolution of hemolysate from an adult malpha +/-/mbeta -/-/hzeta /hbeta complex transgenic-knockout mouse into human Hb zeta 2beta 2 (peak 1) and contaminant hybrid mouse/human Hb malpha 2hbeta 2 (peak 2) using a linear 20- to 80-mM NaCl gradient (pH 6.5).

Embryonic and semi-embryonic hemoglobins exhibit elevated O2 affinities

The O2-binding affinities of human Hbs zeta 2epsilon 2, alpha 2epsilon 2, and zeta 2beta 2 were determined on 3 or more occasions under standard conditions by HEMOX analysis (Figure 3A-C, Table 1).19 Each of the hemoglobins displayed a higher O2 affinity than control Hb A, whose P50 of 3.2 torr was highly reproducible. The P50 values of Hbs Gower-1 (zeta 2epsilon 2) and Portland-2 (zeta 2beta 2) (1.4 and 1.9 torr, respectively) were approximately one-half the P50 for control Hb A. In contrast, Hb Gower-2 (alpha 2epsilon 2) exhibited a P50 of 2.7 torr, only marginally different from that of Hb A. These results were substantiated in independent experiments, using different temperature and buffer conditions, in which the relative P50 values of the 4 human hemoglobins were preserved (data not shown).14 Hill coefficients derived from OEC analyses indicated substantially reduced subunit cooperativity for Hbs Gower-1 (zeta 2epsilon 2) and Portland-2 (zeta 2beta 2) (Hill n = 1.7 and 1.6, respectively) relative to control Hb A (Figure 3D-F; Table 1). In contrast, Hb Gower-2 (alpha 2epsilon 2) (n = 2.3) displayed subunit cooperativity much closer to our observed measure for Hb A (n = 2.9), which reproduced its accepted value (n = 2.8-3.0).1 These results indicate that the O2-binding properties of Hb alpha 2beta 2 heterotetramers are not materially affected by a beta -to-epsilon exchange (converting Hb A to Hb Gower-2), whereas an alpha -to-zeta exchange (converting Hb A to Hb Portland-2) has a more substantial impact on both O2 affinity and subunit cooperativity.


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Figure 3. Oxygen equilibrium curves and Hill coefficients for human embryonic and semi-embryonic hemoglobins. Oxygen equilibrium curves are displayed in panels A-C. (A) Human Hb Gower-1 (zeta 2epsilon 2). (B) Human Hb Gower-2 (alpha 2epsilon 2). (C) Human Hb Portland-2 (zeta 2beta 2). OECs were established for affinity-purified human hemoglobins under standard assay conditions ("Materials and methods"). Representative curves (black) are displayed with an OEC from control human Hb A for reference (gray). P50 values derived from analyses of these curves are included in Table 1. Hill coefficients are displayed in panels D-F. (D) Human Hb Gower-1 (zeta 2epsilon 2, black-lozenge ). (E) Human Hb Gower-2 (alpha 2epsilon 2, ). (F) Human Hb Portland-2 (zeta 2beta 2, ). Hill plots constructed from OECs of human hemoglobins in panels A to C are illustrated along with control human Hb A (O). Hill coefficients derived from these curves are included in Table 1.


                              
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Table 1. Properties of human hemoglobins

The P50 values of embryonic and semi-embryonic hemoglobins display disparate responses to changes in pH and [2,3-BPG]

The effect of pH on the O2-binding affinities of the 3 human embryonic and semi-embryonic hemoglobins was determined by measuring the P50 values for each in a series of buffers with defined pH levels ranging from 6.0 to 8.2 (Figure 4A; Table 1). The 2 human hemoglobins containing zeta -globin subunits displayed attenuated Bohr effects [Hbs zeta 2epsilon 2 (-0.10 Delta logP50/Delta PO2) and zeta 2beta 2 (-0.25 Delta logP50/Delta PO2)], whereas the Bohr effect of Hb Gower-1 (alpha 2epsilon 2) and control Hb A (alpha 2beta 2) were nearly identical (-0.51 vs -0.54 Delta logP50/Delta PO2, respectively). The apparent binding constant of 2,3-BPG for each hemoglobin was estimated by establishing the half-saturation point using buffers with defined concentrations of the allosteric modifier (Figure 4B; Table 1). 2,3-BPG appears to bind to Hb Portland-2 (zeta 2beta 2) and control Hb A with equal affinity (0.30 mM and 0.29 mM, respectively) while binding to Hbs Gower-1 (zeta 2epsilon 2) and Gower-2 (alpha 2epsilon 2) with substantially higher avidity (0.09 mM and 0.17 mM, respectively). These results indicate that the inclusion of embryonic globin subunits may have an impact on the biochemical function of intact heterotetramers, permitting speculation on the evolutionary pressures favoring the conservation of globin gene switching.


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Figure 4. Biochemical properties of human embryonic and semi-embryonic hemoglobins. (A) Effect of pH on O2 binding (Bohr effect). The P50 of each hemoglobin was determined in standard buffers adjusted to defined pH levels. Bohr effect values (included in Table 1) were calculated from best-fit curves of values from the alkaline range. zeta 2epsilon 2 (black-lozenge ), alpha 2epsilon 2 (), zeta 2beta 2 (), alpha 2beta 2 (open circle ). (B) Effect of allosteric modifiers on O2 binding. The P50 values of human hemoglobins were determined in standard buffers containing defined concentrations of 2,3-BPG. The affinity of each Hb for 2,3-BPG (indicated in Table 1) was derived from the half-saturation point of each curve. zeta 2epsilon 2 (black-lozenge ), alpha 2epsilon 2 (), zeta 2beta 2 (), alpha 2beta 2 (open circle ).

Human embryonic and semi-embryonic hemoglobins display different physical stabilities

Hbs Gower-1, Gower-2, and Portland-2 were assessed for their stability in the setting of defined mechanical,27 chemical,28 and thermal stresses.29 Hbs A and S were evaluated in parallel as stable and unstable hemoglobin controls, respectively (Figure 5). The stabilities of the various hemoglobins by each of the 3 methods were in general agreement: Hbs Gower-1 (zeta 2epsilon 2) and Portland-2 (zeta 2beta 2) were equally or less stable than Hb S, whereas the stability of Hb Gower-2 (alpha 2epsilon 2) was generally intermediate between the 2 control hemoglobins. Hence, the low stability of Hb Gower-1 appears to be well adapted to the short survival of primitive erythrocytes, whereas the higher stability of Hb Gower-2 may facilitate its expression in long-lived definitive erythrocytes.


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Figure 5. Stabilities of human hemoglobins to defined perturbations. (A) Mechanical stability. The stabilities of the human hemoglobins exposed to mechanical stress were determined as described in "Materials and methods." The percentage soluble hemoglobin is plotted as a function of time. Early time points are displayed on an expanded scale (inset). (B) Chemical stability. The stabilities of the human hemoglobins exposed to 17% isopropanol are illustrated. Bars represent the average of duplicate determinations using independently prepared isopropanol solutions. Symbols are the same as in panel A. (C) Thermal stability. The relative stabilities of the human hemoglobins incubated at 50°C were determined and plotted as a function of precipitated hemoglobin. Symbols are the same as in panel A.


    Discussion
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

In spite of their developmental sobriquets, there is considerable overlap in the temporal expression of embryonic zeta  and epsilon  globins and adult alpha  and beta  globins, respectively. Human alpha  and beta  globins are expressed at moderate levels in developing embryos and fetuses,33-36 whereas varying amounts of embryonic zeta  and epsilon  globins and their encoding mRNAs can be detected in fetal erythrocytes and in adult-stage reticulocytes, respectively.37,38 The developmental integrity of embryonic globin gene expression is further compromised in patients with certain congenital genetic disorders. Low-level zeta -globin expression persists in adults heterozygous for the alpha -thalassemia -SEA deletion,39 whereas fetuses and infants with defined trisomies may express easily detectable levels of epsilon  globin.40-43 The temporal overlap of embryonic and adult globin expression, particularly during intrauterine development, favors the assembly of Hbs Gower-2 and Portland-2. Remarkably few studies have directly addressed the biochemical and physiological properties of either of these hemoglobins or of the embryonic hemoglobin Gower-1, despite their assembly in normal primitive and definitive erythrocytes.

Although it is uncertain whether Hbs Gower-2 and Portland-2 play a defined role in human development or are simply incidental to developmental overlapping of globin gene expression, a full understanding of their properties, along with the properties of Hb Gower-1, would be valuable for several purposes. First, structure-function analyses of all 3 hemoglobins are likely to provide additional insight into the biochemistry of abundant, thoroughly studied hemoglobins such as Hbs A and F. Second, knowledge of its properties would provide a context for assessing the role of Hb Gower-1 in normal development and would help focus speculation on the evolutionary pressures favoring absolute phylogenic conservation of developmental globin gene switching. Third, a direct application of the analyses of Hbs Gower-2 and Portland-2 stems from the possibility that reactivation of the zeta  and epsilon  genes would produce globins that could substitute for deficient or abnormal alpha - or beta -globin chains, respectively, in individuals with defined thalassemias and hemoglobinopathies.18,19 The implications of the current work on each of these 3 issues are considered below.

Many well-established studies have identified functionally crucial amino acid residues in the alpha - and beta -globin chains. Our data generally confirm the role of these residues, but they also emphasize the importance of distant residues on specific hemoglobin functions through their likely influence on the high-order structure of the globin molecule. In general, Hb Gower-2 and Hb A function similarly, suggesting that many of the 36 amino acid differences between the beta - and epsilon -globin chains (of 146 total residues) cluster in functionally silent domains (Table 1). The 2 hemoglobins exhibit similar O2-binding characteristics and display Hill coefficients consistent with normal hemoglobin function (Figures 3B, E), reflecting the conservation of 13 of 17 and 15 of 16 residues comprising the alpha 1beta 1 and alpha 1beta 2 interfaces, respectively.44,45 Similarly, the robust Bohr effect common to Hb Gower-2 and Hb A (Figure 4A) might be anticipated from the conservation of 82Lys, 143His, and 146His in both the epsilon - and beta -globin chains.46-48 Unexpectedly, Hb Gower-2 and Hb A displayed markedly different affinities for 2,3-BPG (Figure 4B) despite their identity at all 4 residues believed to mediate this property (1Val, 2His, 82Lys, and 143His).46,49,50 Although the half-saturation method provides only an estimate of the strength of this interaction, it is likely that one or more differences in amino acid content elsewhere in the epsilon - and beta -globin chains alter the spatial arrangement, and hence the function, of the 4 conserved residues. A less likely explanation is that a fifth, unrecognized residue, differing between the beta - and epsilon -globin chains, directly participates in 2,3-BPG binding. Crystallographic evaluation of Hb Gower-2, available in quantity from the transgenic-knockout mice, would be useful in evaluating these 2 possibilities.

In comparison to the beta -like globin chains, the 57 (of 141) amino acid differences between the zeta - and alpha -globin chains appear to occupy functionally sensitive regions (Table 1). Hb Portland-2 and Hb A, differing only in the identity of their alpha -like chains, display substantially different P50 values and Hill coefficients (Figure 3C, F) despite sharing 14 of 16 and 14 of 15 residues at the alpha 1beta 1 and alpha 1beta 2 interfaces, respectively. Remarkably, 2 of the 3 interface substitutions are conservative, emphasizing the unpredictable functional effects of changes in high-order globin subunit structure resulting from spatially distant amino acid substitutions. Although both globins share a common 122His, the alpha 1Val-zeta 1Ser exchange would be expected to substantially blunt the Bohr effect exhibited by Hb Portland-2,46,51 a prediction that is experimentally observed (Figure 4A). A direct comparison of Hb Portland-2 function with its high-resolution structure, when available, may yield important new information relative to the function of human heterotetramers.

The observation that the properties of Hb Gower-1, comprising developmental stage-concordant zeta - and epsilon -globin subunits, are strikingly different from those of Hb A suggests a strong evolutionary basis for Hb switching (Figures 3A, 4A-B; Table 1). A widely held, yet largely unsubstantiated, explanation for this process suggests that embryonic and fetal hemoglobins have been evolutionarily selected to facilitate the trans-placental delivery of O2 during intrauterine development. This hypothesis has been challenged by studies that do not detect the predicted elevated rates of fetal wastage in pregnant women with high-affinity hemoglobins.52,53 By demonstrating that the O2-binding properties of Hb Gower-1 differ from those of Hb F, our data support the latter dissenting opinion. In contrast to Hb F, which exhibits a normal O2 affinity (in the absence of 2,3-BPG), a relatively high Bohr effect, and poor 2,3-BPG binding, we have found that Hb Gower-1 displays a high O2 affinity, a reduced Bohr effect, and relatively tight 2,3-BPG binding. Were their developmental roles strictly limited to O2-transport, the O2-binding properties of Hbs Gower-1 and F might be anticipated to be more similar. An alternative explanation for this difference is that the evolutionary basis for developmental hemoglobin switching reflects properties of Hb Gower-1 that are independent of its gaseous-exchange function. This possibility is underscored by recent reports indicating that in addition to its O2-transporting function, Hb A may serve an important role in the regulation of vascular tone and blood flow.54 It is clear that the functional properties of Hb Gower-1, reflecting poorly understood evolutionary demands and manifesting as phylogenic conservation of hemoglobin switching, merit additional study.

We have previously proposed that Hbs Portland-2 (zeta 2beta 2) and Gower-2 (alpha 2epsilon 2) might be suitable substitutes for Hb A in individuals with defined hemoglobinopathies and thalassemias.18,19 These 2 hemoglobins would assemble from existing adult globin chains in adults in whom the embryonic globin genes were reactivated. The functional identity between Hb Gower-2 (alpha 2epsilon 2) and Hb A (alpha 2beta 2) indicates that the former hemoglobin would act in a physiologically valuable manner in definitive erythrocytes. Evidence that the epsilon - and gamma -globin genes are independently regulated55-58 raises the possibility that different classes of agents, with different toxicities, might be used to separately reactivate expression from the 2 genes. This consideration is particularly important in patients with severe beta -thalassemia determinants in whom gamma -globin reactivation by current agents is toxicity-limited.59,60 The observation that Hb Gower-2 will serve a physiologically important role in individuals with any of several hemoglobinopathies and thalassemias should serve as an impetus to identify agents that might be useful in this regard.


    Acknowledgments

We thank S. Krishnaswami and K. Adachi for access to protein purification and analytical instruments and Y. Yang for technical assistance. J.E.R. is the recipient of a Junior Faculty Scholar Award from the American Society of Hematology.


    Footnotes

Submitted September 14, 2000; accepted October 16, 2000.

Supported by National Institutes of Health grant R01 HL61399 and past support from Cooley's Anemia Foundation.

The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 U.S.C. section 1734.

Reprints: J. Eric Russell, Abramson Research Bldg, Rm 316F, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104; e-mail: jeruss{at}mail.med.upenn.edu.


    References
Top
Abstract
Introduction
Materials and methods
Results
Discussion
References

1. Bunn HF, Forget BG. Hemoglobin: molecular, genetic, and clinical aspects. Philadelphia: WB Saunders; 1986.

2. Russell JE, Liebhaber SA. Molecular genetics of thalassemia. In: Verma RS, ed. Advances in Genome Biology. Vol 2. Greenwich: JAI Press; 1993:283-353.

3. Hecht F, Motulsky A, Lemire R, Shepard T. Predominance of human hemoglobin Gower-1 in early human embryonic development. Science. 1966;152:91-92[Abstract/Free Full Text].

4. Huehns ER, Flynn FV, Butler EA, Beaven GH. Two new haemoglobin variants in a very young embryo. Nature. 1961;189:496-497[CrossRef][Medline] [Order article via Infotrieve].

5. Huehns E, Dance N, Beaven G, Hecht F, Motulsky A. Human embryonic hemoglobins. Cold Spring Harb Symp Quant Biol. 1964;29:327-331.

6. Huehns E, Beaven G. Developmental changes in human hemoglobins. Clin Dev Med. 1971;37:175-203.

7. Gale R, Clegg J, Huehns E. Human embryonic hemoglobins Gower-1 and Gower-2. Nature. 1979;280:162-164[CrossRef][Medline] [Order article via Infotrieve].

8. Randhawa Z, Jones R, Lie-Injo L. Human hemoglobin Portland II (zeta 2beta 2). J Biol Chem. 1984;259:7325-7330[Abstract/Free Full Text].

9. Huehns ER, Farooqui AM. Oxygen dissociation properties of human embryonic red cells. Nature. 1975;234:335-337[CrossRef].

10. Mould RM, Hofmann OM, Brittain T. Production of human embryonic hemoglobin (Gower-II) in a yeast expression system. Biochem J. 1994;298:619-622.

11. Hoffman S, Looker D, Roehrich J, et al. Expression of fully functional tetrameric human hemoglobin in Escherichia coli. Proc Natl Acad Sci U S A. 1990;87:8521-8525[Abstract/Free Full Text].

12. Shen T-J, Ho N, Simplaceanu V, et al. Production of unmodified human adult hemoglobin in Escherichia coli. Proc Natl Acad Sci U S A. 1993;90:8108-8112[Abstract/Free Full Text].

13. Adachi K, Konitzer P, Lai CH, Kim J, Surrey S. Oxygen-binding properties and other physical properties of human hemoglobin made in yeast. Protein Eng. 1992;5:807-810[Abstract/Free Full Text].

14. Hofmann OM, Mould R, Brittain T. Allosteric modulation of oxygen binding to the three human embryonic hemoglobins. Biochem J. 1995;306:367-370.

15. Pastzy C, Brion CM, Manci E, et al. Transgenic knockout mice with exclusively human sickle hemoglobin and sickle cell disease. Science. 1997;278:876-879[Abstract/Free Full Text].

16. Ryan TM, Ciavatta DJ, Townes TM. Knockout-transgenic mouse model of sickle cell disease. Science. 1997;278:873-876[Abstract/Free Full Text].

17. Romero J, Suzuka S, Romero-Gonzalex G, Nagel R, Fabry M. Knockout mouse red cells expressing human HbC or HbS and gamma  have high K:Cl cotransport activity in contrast to HbA mouse red cells Program of the 24th Annual Meeting of the National Sickle Cell Disease Program, April 9-12; 2000; Philadelphia. Abstract 112.

18. Russell JE, Liebhaber SA. Reversal of lethal alpha  and beta  thalassemias in mice by expression of human embryonic globins. Blood. 1998;92:3057-3063[Abstract/Free Full Text].

19. He Z, Lian L, Asakura T, Russell JE. Functional effects of replacing human alpha  and beta  globins with their embryonic globin homologues in defined haemoglobin heterotetramers. Br J Haematol. 2000;109:882-890[CrossRef][Medline] [Order article via Infotrieve].

20. Liebhaber SA, Wang Z, Cash F, Monks B, Russell JE. Developmental silencing of the embryonic zeta -globin gene: concerted action of the promoter and the 3' flanking region combined with stage-specific silencing of the transcribed region. Mol Cell Biol. 1996;16:2637-2646[Abstract].

21. Morales J, Russell JE, Liebhaber SA. Destabilization of human alpha-globin mRNA by translation anti-termination is controlled during erythroid terminal differentiation and paralleled by phased shortening of the poly(A) tail. J Biol Chem. 1997;272:6607-6613[Abstract/Free Full Text].

22. Chang J, Lu RH, Xu SM, et al. Inactivation of mouse alpha -globin gene by homologous recombination: mouse model of hemoglobin H disease. Blood. 1996;88:1846-1851[Abstract/Free Full Text].

23. Detloff P, Lewis J, John S, et al. Deletion and replacement of the mouse adult beta -globin genes by a "plug and socket" repeated targeting strategy. Mol Cell Biol. 1994;14:6936-6943[Abstract/Free Full Text].

24. Alter BP. Gel electrophoretic separation of globin chains. Prog Clin Biol Res. 1981;60:157-175[Medline] [Order article via Infotrieve].

25. Rovera G, Magarian C, Borun TW. Resolution of hemoglobin subunits by electrophoresis in acid urea polyacrylamide gels containing Triton X-100. Anal Biochem. 1978;85:506-518[CrossRef][Medline] [Order article via Infotrieve].

26. Shen T, Ho N, Zou M, et al. Production of human normal adult and fetal hemoglobins in Escherichia coli. Protein Eng. 1997;10:1085-1097[Abstract/Free Full Text].

27. Asakura T, Ohnishi T, Friedman S, Schwartz E. Abnormal precipitation of oxyhemoglobin S by mechanical shaking. Proc Natl Acad Sci U S A. 1974;71:1594-1598[Abstract/Free Full Text].

28. Carrell R, Kay R. A simple method for the detection of unstable haemoglobins. Br J Haematol. 1972;23:615[Medline] [Order article via Infotrieve].

29. Schneiderman LJ, Junga IG, Fawley DE. Effect of phosphate and nonphosphate buffers on thermolability of unstable hemoglobins. Nature. 1970;225:1041-1042[CrossRef][Medline] [Order article via Infotrieve].

30. Talbot D, Collis P, Antoniou M, Vidal M, Grosveld F, Greaves DR. A dominant control region from human beta -globin locus conferring integration site-independent gene expression. Nature. 1989;33:352-355.

31. Pastzy C, Mohandis N, Stevens ME, et al. Lethal alpha -thalassemia created by gene targeting in mice and its genetic rescue. Nat Gene. 1995;11:33-39[CrossRef][Medline] [Order article via Infotrieve].

32. Ciavatta DJ, Ryan TM, Farmer SC, Townes TM. Mouse model of human beta(o) thalassemia: targeted deletion of the mouse beta maj- and beta min-globin genes in embryonic stem cells. Proc Natl Acad Sci U S A. 1995;92:9259-9263[Abstract/Free Full Text].

33. Albitar M, Cash F, Peschle C, Liebhaber S. Developmental switch in the relative expression of the alpha 1- and alpha 2-globin genes in humans and in transgenic mice. Blood. 1992;79:2471-2474[Abstract/Free Full Text].

34. Kazazian H, Woodhead A. Hemoglobin A synthesis in the developing fetus. N Engl J Med. 1973;289:58-62.

35. Wood W, Weatherall D. Hemoglobin synthesis during human foetal development. Nature. 1973;244:162-167[CrossRef][Medline] [Order article via Infotrieve].

36. Peschle C, Mavilio F, Care F, et al. Haemoglobin switching in human embryos: asynchrony of zeta-alpha and epsilon-gamma globin switches in primitive and definitive erythropoietic lineage. Nature. 1985;313:235-238[CrossRef][Medline] [Order article via Infotrieve].

37. Albitar M, Peschle C, Liebhaber S. Theta, zeta, and epsilon globin messenger RNAs are expressed in adults. Blood. 1989;74:629-637[Abstract/Free Full Text].

38. Luo H, Xl L, Frye C, et al. Embryonic hemoglobins are expressed in definitive cells. Blood. 1999;94:359-361[Abstract/Free Full Text].

39. Chui DHK, Wong SC, Chung S-W, Patterson M, Bhargava S, Poon M-C. Embryonic zeta-globin chains in adults: a marker for alpha-thalassemia-1 haplotype due to a >17.5 kb deletion. N Engl J Med. 1986;314:76-79[Abstract].

40. Blum N, DeGrouchy J, Alison F. Deux cas de trisomie 13 avec persistance d'hemoglobine embryonnaire Gower 2 [Two cases of trimomy 13 with persistence of the embryonal hemoglobin Gower 2]. Annales de Genetique. 1967;10:138-140[Medline] [Order article via Infotrieve].

41. Huehns E, Hecht F, Keil J, Motulsky A. Developmental hemoglobin anomalies in a chromosomal triplication: D1 trisomy syndrome. Proc Natl Acad Sci U S A. 1964;51:89-97[Free Full Text].

42. Jensen M, Murken J. Hemoglobin chain synthesis in two children with trisomy 13: evidence for temporary imbalance during switch from gamma to beta chain synthesis. Eur J Pediatr. 1976;122:151-157[CrossRef][Medline] [Order article via Infotrieve].

43. Bethlenfalvay N, Lourp J, Greer H. Translocation trisomy D syndrome 46, XX, D-, t(DqDq)+: report of a case with a note on the cold-instability of Hb Gower-2. Pediatrics. 1972;50:928-930[Abstract/Free Full Text].

44. Hill AV. The possible effects of the aggregation of the molecules of haemoglobin on its dissociation curve. J Physiol. 1910;40:iv.

45. Fermi G, Perutz M. Haemoglobin and myoglobin. In: Phillips DC,Richards FM, eds. Atlas of molecular structures in biology. Oxford: Clarendon Press; 1981.

46. Perutz MF, Kilmartin JV, Nishikura K, Fogg JH, Butler PJG, Rollema HS. Identification of residues contributing to the Bohr effect of human haemoglobin. J Mol Biol. 1980;138:649-668[Medline] [Order article via Infotrieve].

47. Kilmartin JV, Fogg JH, Perutz MF. Role of C-terminal histidine in the alkaline Bohr effect of human hemoglobin. Biochemistry. 1980;19:3189-3193[CrossRef][Medline] [Order article via Infotrieve].

48. Matsukawa S, Itatani Y, Mawatari K, Shimokawa Y, Yoneyama Y. Quantitative evaluation for the role of beta 146 His and beta 143 His residues in the Bohr effect of human hemoglobin in the presence of 0.1 M chloride ion. J Biol Chem. 1984;259:11479-11486[Abstract/Free Full Text].

49. Arnone A. X-ray diffraction study of binding of 2,3-diphosphoglycerate to human deoxyhaemoglobin. Nature. 1972;237:146-149[CrossRef][Medline] [Order article via Infotrieve].

50. Gupta RK, Benovic JL, Rose ZB. Location of the allosteric site for 2,3-bisphosphoglycerate on human oxy- and deoxyhemoglobin as observed by magnetic resonance spectroscopy. J Biol Chem. 1979;254:8250-8255[Free Full Text].

51. Nishikura K. Identification of histidine-122 alpha  in human haemoglobin as one of the unknown alkaline Bohr groups by hydrogen-tritium exchange. Biochem J. 1978;173:651-657[Medline] [Order article via Infotrieve].

52. Charache S, Jacobson R, Brimhall B, et al. Hb Potomac (101 Glu-Asp): speculations on placental oxygen transport in carriers of high-affinity hemoglobins. Blood. 1978;51:331-338[Abstract/Free Full Text].

53. Charache S, Catalano P, Burns S, et al. Pregnancy in carriers of high-affinity hemoglobins. Blood. 1985;65:713-718[Abstract/Free Full Text].

54. Jia L, Bonaventura C, Bonaventura J, Stamler JS. S-nitrosohaemoglobin: a dynamic activity of blood involved in vascular control. Nature. 1996;380:221-226[CrossRef][Medline] [Order article via Infotrieve].

55. Lamb P, Watt P, Proudfoot NJ. Negative regulation of the human embryonic globin genes zeta and epsilon. In: Stamatoyannopoulous G,Nienhuis AW, eds. Hemoglobin switching. New York: Alan R. Liss; 1988:269-277.

56. Raich N, Enver T, Nakamoto B, Josephson B, Papayannopoulou T, Stamatoyannopoulous G. Autonomous developmental control of human embryonic globin gene switching in transgenic mice. Science. 1990;23:1147-1149.

57. Trepicchio WL, Dyer MA, Baron MH. Developmental regulation of the human embryonic beta-like globin gene is mediated by synergistic interactions among multiple tissue- and stage-specific elements. Mol Cell Biol. 1993;13:7457-7468[Abstract/Free Full Text].

58. Vyas P, Sharpe JA, Watt P, Higgs DR, Wood WG. Regulation of human embryonic globin genes zeta 2 and epsilon in stably transformed mouse erythroleukemia cells. Blood. 1992;80:1832-1837[Abstract/Free Full Text].

59. Hajjar FM, Pearson HA. Pharmacologic treatment of thalassemia intermedia with hydroxyurea. J Pediatr. 1994;125:490-492[CrossRef][Medline] [Order article via Infotrieve].

60. Sher GD, Ginder GD, Little J, Yang S, Dover GJ, Olivieri NF. Extended therapy with intravenous arginine butyrate in patients with beta hemoglobinopathies. N Engl J Med. 1995;332:1606-1610[Abstract/Free Full Text].

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