Much of our understanding of human physiology, and of many aspects of pathology, has its antecedents in laboratory and clinical studies of hemoglobin. Over the last century, knowledge of the genetics, functions, and diseases of the hemoglobin proteins has been refined to the molecular level by analyses of their crystallographic structures and by cloning and sequencing of their genes and surrounding DNA. In the last few decades, research has opened up new paradigms for hemoglobin related to processes such as its role in the transport of nitric oxide and the complex developmental control of the ␣-like and -like globin gene clusters. It is noteworthy that this recent work has had implications for understanding and treating the prevalent diseases of hemoglobin, especially the use of hydroxyurea to elevate fetal hemoglobin in sickle cell disease. It is likely that current research will also have significant clinical implications, as well as lessons for other aspects of molecular medicine, the origin of which can be largely traced to this research tradition. (Blood. 2008;112: 3927-3938)
IntroductionDuring the past 60 years, the study of human hemoglobin, probably more than any other molecule, has allowed the birth and maturation of molecular medicine. Laboratory research, using physical, chemical, physiological, and genetic methods, has greatly contributed to, but also built upon, clinical research devoted to studying patients with a large variety of hemoglobin disorders. During this period, the pioneering work of Linus Pauling, Max Perutz, Vernon Ingram, Karl Singer, Herman Lehmann, William Castle, Ruth and Reinhold Benesch, Titus Huisman, Ernst Jaffé, Ernest Beutler, and many others still active has been instrumental in these studies. Our understanding of the molecular basis of hemoglobin developmental and genetic control, structure-function relations, and its diseases and their treatment is probably unparalleled in medicine. Indeed, this field, especially during the first 25 years of the existence of the American Society of Hematology, provided the model for developments in many other areas of research in hematology and other subspecialities. This review attempts to highlight some recent developments in hemoglobin research most relevant to the hematologist in the context of the current understanding of the functions of these proteins and their genes. I am occasionally asked, "What's new in hemoglobin?" I believe that this review will show that we are still learning much that is very relevant to our understanding of human physiology and disease.
Hemoglobin structureThe human hemoglobin molecules are a set of very closely related proteins formed by symmetric pairing of a dimer of polypeptide chains, the ␣-and -globins, into a tetrameric structural and functional unit. The ␣ 2  2 molecule forms the major adult hemoglobin. Their main function in mammals is to transport oxygen (O 2 ) from the lungs to tissues, but they also specifically interact with the 3 other gases, carbon dioxide (CO 2 ), carbon monoxide (CO), an...