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Blood, 1 June 2008, Vol. 111, No. 11, pp. 5400-5402.
Prepublished online as a Blood First Edition Paper on March 31, 2008; DOI 10.1182/blood-2008-02-137703.


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RED CELLS

Brief Report

Novel exon 12 mutations in the HIF2A gene associated with erythrocytosis

Melanie J. Percy1, Philip A. Beer2, Gavin Campbell3, Ad W. Dekker4, Anthony R. Green2, David Oscier5, M. Glenn Rainey6, Richard van Wijk7, Marion Wood3, Terence R. J. Lappin8, Mary Frances McMullin1,8, and Frank S. Lee9

1 Department of Haematology, Belfast City Hospital, Belfast, United Kingdom; 2 Department of Haematology, University of Cambridge, Cambridge, United Kingdom; 3 Essex Rivers Healthcare National Health Service (NHS) Trust, Colchester General Hospital, Colchester, United Kingdom; 4 Department of Clinical Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; 5 Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom; 6 Department of Haematology, Vale of Leven District General Hospital, Alexandria, United Kingdom; 7 Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; 8 Centre for Cancer Research and Cell Biology, Queen's University, Belfast, United Kingdom; and 9 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia

Erythrocytosis can arise from deregulation of the erythropoietin (Epo) axis resulting from defects in the oxygen-sensing pathway. Epo synthesis is controlled by the hypoxia inducible factor (HIF) complex, composed of an {alpha} and a β subunit. There are 2 main {alpha} subunits, HIF-1{alpha} and HIF-2{alpha}. Recently, a HIF-2{alpha} Gly537Trp mutation was identified in a family with erythrocytosis. This raises the possibility of HIF2A mutations being associated with other cases of erythrocytosis. We now report a subsequent analysis of HIF2A in a cohort of 75 erythrocytosis patients and identify 4 additional patients with novel heterozygous Met535Val and Gly537Arg mutations. All patients presented at a young age with elevated serum Epo. Mutations at Gly-537 account for 4 of 5 HIF2A mutations associated with erythrocytosis. These findings support the importance of HIF-2{alpha} in human Epo regulation and warrant investigation of HIF2A in patients with unexplained erythrocytosis.


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