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Hemoglobin Abraham Lincoln, Β32 (B14) Leucine → Proline an UNSTABLE VARIANT PRODUCING SEVERE HEMOLYTIC DISEASE

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Hemoglobin Abraham Lincoln, Β32 (B14) Leucine → Proline an UNSTABLE VARIANT PRODUCING SEVERE HEMOLYTIC DISEASE Hemoglobin Abraham Lincoln, β32 (B14) Leucine → Proline AN UNSTABLE VARIANT PRODUCING SEVERE HEMOLYTIC DISEASE George R. Honig, … , David J. Gnarra, Helen S. Maurer J Clin Invest. 1973;52(7):1746-1755. https://doi.org/10.1172/JCI107356. Research Article An unstable hemoglobin variant was identified in a Negro woman with hemolytic anemia since infancy. A splenectomy had been performed when the patient was a child. The anemia was accompanied by erythrocyte inclusion bodies and excretion of darkly pigmented urine. Neither parent of the proposita demonstrated any hematologic abnormality, and it appeared that this hemoglobin variant arose as a new mutation. Erythrocyte survival in the patient was greatly reduced: the erythrocyte t½ using radiochromium as a tag was 2.4 days, and a reticulocyte survival study performed after labeling the cells with L-[14C]leucine indicated a t½ of 7.2 days. When stroma-free hemolysates were heated at 50°C, 16-20% of the hemoglobin precipitated. The thermolability was prevented by the addition of hemin, carbon monoxide, or dithionite, suggesting an abnormality of heme binding. An increased rate of methemoglobin formation was also observed after incubation of erythrocytes at 37°C. The abnormal hemoglobin could not be separated from hemoglobin A by electrophoresis or chromatography, but it was possible to isolate the variant β-chain by precipitation with p- hydroxymercuribenzoate. Purification of the β-chain by column chromatography followed by peptide mapping and amino acid analysis demonstrated a substitution of proline for β32 leucine. It appears likely that a major effect of this substitution is a disruption of the normal orientation of the adjacent leucine residue at β31 to impair […] Find the latest version: https://jci.me/107356/pdf Hemoglobin Abraham Lincoln, i32 (B14) Leucine Proline AN UNSTABLE VARIANT PRODUCING SEVERE HEMOLYTIC DISEASE GEORGE R. HONIG, DAVID GREEN, MIR SHAMSUDDIN, LOYDA N. VIDA, R. GEORGE MASON, DAVID J. GNARRA, and HEEN S. MAURER From the Department of Pediatrics, and the Sickle Cell Center, The Abraham Lincoln School of Medicine, University of Illinois, Chicago, Illinois 60612, and the Hematology Section, Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611 A B S T R A C T An unstable hemoglobin variant was adjacent leucine residue at P31 to impair heme stabili- identified in a Negro woman with hemolytic anemia since zation. infancy. A splenectomy had been performed when the patient was a child. The anemia was accompanied by erythrocyte inclusion bodies and excretion of darkly pig- INTRODUCTION mented urine. Neither parent of the proposita demon- Structural abnormalities of the hemoglobin molecule are strated any hematologic abnormality, and it appeared known to bring about a variety of adverse clinical con- that this hemoglobin variant arose as a new mutation. sequences in the affected individual (1). A group of Erythrocyte survival in the patient was greatly reduced: these abnormalities is characterized by instability of the erythrocyte ti using radiochromium as a tag was 2.4 the hemoglobin molecule and produces the clinical pic- days, and a reticulocyte survival study performed after ture of congenital Heinz body anemia. This syndrome has labeling the cells with L- [4C] leucine indicated a ti of 7.2 its onset in infancy and consists of hemolytic anemia, days. When stroma-free hemolysates were heated at with inclusion bodies demonstrable in the erythrocytes 500C, 16-20% of the hemoglobin precipitated. The ther- after incubation and supravital staining or in the un- molability was prevented by the addition of hemin, incubated cells of splenectomized individuals, and ex- carbon monoxide, or dithionite, suggesting an abnor- cretion of abnormal heme degradation products in the mality of heme binding. An increased rate of methemo- urine (2). In this report we present the findings in a globin formation was also observed after incubation of woman with a severe form of this syndrome, in whom a erythrocytes at 370C. The abnormal hemoglobin could new hemoglobin P-chain variant was identified. not be separated from hemoglobin A by electrophoresis or chromatography, but it was possible to isolate the METHODS variant /-chain by precipitation with p-hydroxymercuri- Hemnatological studies. Hematologic measurements were benzoate. Purification of the p-chain by column chroma- performed by standard methods (3). Autohemolysis and tography followed by and amino acid osmotic fragility tests were carried out with sterile de- peptide mapping fibrinated blood as described by Dacie (4). Erythrocyte analysis demonstrated a substitution of proline for P32 glutathione was determined by the method of Beutler, leucine. It appears likely that a major effect of this sub- Duron, and Kelly (5). The ascorbate cyanide screening stitution is a disruption of the normal orientation of the test was performed as described by Jacob and Jandl (6). The glucose-6-phosphate dehydrogenase assay employed the Dr. Honig is the recipient of a Research Career Develop- method of Zinkham (7). ment Award (K04 AM 41188) from the National Institute Erythrocyte survival measurements using radiochromium of Arthritis, Metabolism, and Digestive Diseases, U. S. were performed as previously described (8). For deter- Public Health Service. mination of the reticulocyte survival time ['4C] L-leucine Received for publication 24 January 1973 and in revised was used as a radioactive label as described by Alter, Kan. form 1 March 1973. and Nathan (9). 1746 The Journal of Clinical Investigation Volume 52 July 1973 1746-1755 Oxygen affinity measurements were made using samples TABLE I of fresh whole blood to which heparin was added as an anti- Representative Hematologic Values of the Proposita coagulant. The procedure described by Edwards and Martin (10) was used in these determinations. Erythrocyte 2,3- Hemoglobin concentration 8.5 gm/100 ml diphosphoglycerate (2,3-DPG) 1 was measured as previ- 24 ously described (11). Hematocrit %c/ Hemoglobin studies. Blood samples were collected in Erythrocyte count 1.67 X 106/1mm3 heparin and transported in melting ice. The cells were Mean corpuscular volume (MCV) 122 i11n3 washed three times in cold isotonic saline and lysed with Mean corpuscular hemoglobin 40 pg 3-5 vol of cold water. The cell stroma were removed by Mean corpuscular hemoglobin centrifugation. concentration 35% Hemoglobin electrophoresis was carried out in starch gel Leukocyte count 13,000/mm3 at pH 8.6 (12) and agar gel at pH 6.2 (13). Alkali-re- Nucleated erythrocytes 4/100 leukocytes sistant hemoglobin was quantitated as described by Betke, count determinations Reticulocyte 25%-, Marti, and Schlicht (14). Hemoglobin A2 Serum bilirubin concentration 2.3 mg/100 ml were performed by DEAE-Sephadex chromatography (15). dehydrogenase 840 IU MIethemoglobin was determined by the method of Evelyn Serum lactate with Serum iron concentration 127 ,Ag/l0 ml and Malloy (16). These determinations were made ml fresh defibrinated blood or defibrinated blood samples incu- Total serum iron-binding capacity 317 ;g/l00 hated aseptically at 370C for 24 or 48 h. Platelet count 350,000/mm3 For determination of the percentage of thermolabile hemoglobin, stroma-free erythrocyte lysates were incubated described for varying time periods at 500C under conditions 2 and 5 vr of age because of se- by Grimes, Meisler, and Dacie (17). The samples were several times between cooled, and the precipitates were collected by centrifuga- vere anemia, and received transfusions on a number of tion and washed free of soluble hemoglobin with 0.1 M occasions. A splenectomy was done when she was 5 yr phosphate buffer, pH 7.4. The precipitates were suspended old but apparently had little effect on the course of her col- in a solution of 1% HCl in acetone to remove heme, anemia. She has had a variable degree of jaundice and lected by centrifugation, and dissolved in water. Protein determinations of these solutions and of material similarly anemia accompanied intermittently by dark urine. These 1repared from an aliquot of the original lysate were per- manifestations have w-orsened strikingly with infections, formed by the method of Lowry, Rosebrough, Farr, and sometimes requiring supportive transfusions. She is not Randall (18). known to have been exposed to oxidant drugs or chemi- Structuhral analysis. Trypsin digestion and peptide map- ping procedures were adapted from methods described by cals but has reported an increase of jaundice and pig- Clegg, Naughton, and \Weatherall (19). High voltage elec- menturia after intake of alcohol. A cholecvstectomv was trophoresis of the tryptic digests was carried out at pH performed when she was 23 vr of age because of chole- 4.7 (pyridine: acetic acid: water, 5:5: 390) on 3-cm strips cystitis and gall stone formation. She has no children. of \Vhatman 3 MM paper. The strips were dried and sewn has been known to to sheets of paper, and descending chromatography was Neither parent of the proposita performed with butanol: acetic acid: water: pyridine (15: have anemia or jaundice. Blood samples from the parents 3:12:10). Peptides were identified by staining with nin- showed normal hematologic findings, and neither showed hydrin or stains specific for individual amino acids. evidence of anemia, eryrthrocyte inclusion body formation, Peptides were eluted from the papers with distilled water fraction. Blood group and were hydrolyzed in 6 N HCl uinder reduced pressure or a heat-unstable hemoglobin at 110'C for 40 h. Phenol was added before the hydrolysis analysis (A,B,D,C,E,c,e,CW, VKkFvF K.J 1,N, to reduce tyrosine oxidation. Amino acid analyses were per- P,Lua, and Lub) of the patient and her parents gave no formed with a Spinco model 120C amino acid analyzer indication of nonpaternity. The parents have no other (Beckman Instruments, Inc., Spinco Division, Palo Alto, children Calif.). .M1aterials. ["4C]L-leucine was obtained as a sterile aque- Hentatological studies. Representative hematologic ous solution from New England Nuclear, Boston, Mass.
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