The -hemoglobinopathies sickle cell disease and -thalassemia are among the most common human genetic disorders worldwide. Hemoglobin A2 (HbA2, ␣ 2 ␦ 2 ) and fetal hemoglobin (HbF, ␣ 2 ␥ 2 ) both inhibit the polymerization of hemoglobin S, which results in erythrocyte sickling. Expression of erythroid Kruppel-like factor (EKLF) and GATA1 is critical for transitioning hemoglobin from HbF to hemoglobin A (HbA, ␣ 2  2 ) and HbA2. The lower levels of ␦-globin expression compared with -globin expression seen in adulthood are likely due to the absence of an EKLF-binding motif in the ␦-globin proximal promoter. In an effort to up-regulate ␦-globin to increase HbA2 expression, we created a series of EKLF-GATA1 fusion constructs composed of the transactivation domain of EKLF and the DNA-binding domain of GATA1, and then tested their effects on hemoglobin expression. EKLF-GATA1 fusion proteins activated ␦-, ␥-, and -globin promoters in K562 cells, and significantly up-regulated ␦-and ␥-globin RNA transcript and protein expression in K562 and/or CD34 ؉ cells. The binding of EKLF-GATA1 fusion proteins at the GATA1 consensus site in the ␦-globin promoter was confirmed by chromatin immunoprecipitation assay. Our studies demonstrate that EKLF-GATA1 fusion proteins can enhance ␦-globin expression through interaction with the ␦-globin promoter, and may represent a new genetic therapeutic approach to -hemoglobinopathies. (Blood. 2011; 117(11):3045-3052)
IntroductionSickle cell disease (SCD) and -thalassemia are among the most common genetic diseases worldwide, affecting global health and mortality. 1 Therefore, these -hemoglobinopathies represent a major public health challenge. In SCD, a point mutation in the -globin chain leads to abnormal production of sickle hemoglobin (HbS, ␣ 2  S2 ), which polymerizes and precipitates in red blood cells when deoxygenated, decreasing cell flexibility and damaging the cell membrane. These stiff sickle cells lead to hemolytic anemia and vaso-occlusion, causing severe clinical complications. 2,3 Genetic alterations in -thalassemia cause defective production of the -globin chain and result in an imbalanced accumulation of the ␣-globin chain. 4 These 2 disorders both produce a variable degree of hemolytic anemia and transfusion-related complications.Activation of ␥-globin to increase fetal hemoglobin (HbF, ␣ 2 ␥ 2 ) is currently a strategy used in the management of -hemoglobin disorders. Hydroxyurea has been successfully used in the treatment of SCD and -thalassemia by augmenting the production of HbF, which interferes with HbS polymerization, preventing red blood cells from sickling in SCD 5 and reducing the ␣-globin chain imbalance in -thalassemia. 6 Whereas both hemoglobin A2 (HbA2, ␣ 2 ␦ 2, 2%-2.5% of total Hb) and HbF (Յ 2% of total Hb) are minor components in adult blood, they have been proven to be equally effective in inhibiting intracellular deoxy-HbS polymerization. 7 However, unlike HbF, which is restricted to a small population of erythrocytes (5%-10%), 8 the distributio...