Sickle cell anemia (SCA) and thalassemia are among the most common genetic diseases worldwide. Current approaches to the development of murine models of SCA involve the elimination of functional murine ␣-and -globin genes and substitution with human ␣ and  s transgenes. Recently, two groups have produced mice that exclusively express human HbS. The transgenic lines used in these studies were produced by coinjection of human ␣-, ␥-, and -globin constructs. Thus, all of the transgenes are integrated at a single chromosomal site. Studies in transgenic mice have demonstrated that the normal gene order and spatial organization of the members of the human -globin gene family are required for appropriate developmental and stage-restricted expression of the genes. As the cis-acting sequences that participate in activation and silencing of the ␥-and -globin genes are not fully defined, murine models that preserve the normal structure of the locus are likely to have significant advantages for validating future therapies for SCA. To produce a model of SCA that recapitulates not only the phenotype, but also the genotype of patients with SCA, we have generated mice that exclusively express HbS after transfer of a 240-kb  The biochemical basis for sickle cell anemia (SCA) was described more than 30 years ago (1, 2); however, advances in the treatment of SCA have in part been hampered by the lack of an animal model that accurately reproduces the pathophysiology and genetics of this disorder. The strategies for making a murine model of SCA have evolved as the limitations of each approach became apparent. Thus, initial efforts focused on the transfer of human  s -globin genes to generate transgenic lines. Heterotetramers of murine ␣-globin and human  s -globin do not polymerize efficiently; even with the addition of human ␣-globin transgenes only a small fraction of the cells sickled in vivo because of the disruption of HbS by murine ␣-and -globins (3-11). Under hypoxic conditions there is more extensive deoxygenation of murine hemoglobin than HbS, as mouse hemoglobin has a lower O 2 affinity than does HbS (12). To produce a hemoglobin that would polymerize more readily, two additional mutations were introduced into  s transgenes; a second mutation in codon 23 to reproduce the  s Antilles allele, and a third mutation to yield  s AntillesD Punjab or HbSAD (6,7,13). While the SAD mice exhibited a greater propensity for red cell sickling under hypoxic conditions, this model did not fully recapitulate the features of sickle cell disease. Hence, recent efforts have been directed toward reducing or eliminating endogenous mouse globin gene expression and the production of mice that exclusively express human HbS as adults.Two such models have been reported recently (15, 16). Expression of the adult murine ␣-and -globin genes was eliminated by targeted disruption of these loci in embryonic stem (ES) cells. Mice exclusively expressing human HbS were identified after successive cycles of crossbreeding knockout lines wi...