IntroductionHereditary spherocytosis (HS) is the most common inherited hemolytic anemia in people of Northern European descent, occurring with a frequency of approximately 1 in 2000. 1 HS is caused by defects in the red blood cell (RBC) membrane skeleton, a multiprotein structure located just beneath the lipid bilayer that imparts mechanical strength and elasticity to the RBC membrane. The major component of the membrane skeleton, spectrin, is present as tetramers of ā£-and ā¤-subunits cross-linked into a 2-dimensional array by short actin filaments. [1][2][3] There are 2 major interactions between membrane skeleton components and integral membrane proteins that attach the spectrin array to the plasma membrane: (1) band 3-spectrin-ankyrin-protein 4.2 and (2) protein 4.1-p55-glycophorin C linkages. [4][5][6][7][8] The band 3-spectrin-ankyrin-protein 4.2 interactions are critical in the pathogenesis of HS. Defects in all of these proteins cause HS in humans and in mice. 1,9,10 Recent estimates are that approximately 50% of the mutations causing HS in European populations are in ankyrin, 20% in band 3, 20% in ā¤-spectrin, 5% in protein 4.2, and less than 5% in ā£-spectrin. 1 Depending on the exact genetic defect, the hematologic phenotype varies from asymptomatic to life-threatening hemolysis requiring transfusion therapy and/or splenectomy. Secondary complications of HS include jaundice, gallstones, aplastic crises, and, more rarely, extramedullary hematopoietic masses and leg ulcers. 1 In the ankyrin-deficient nb mouse, progressive ataxia due to Purkinje cell degeneration occurs. 11 In other mouse models of HS, thrombosis and infarction are significant complicating factors. 12 Many specific molecular defects that cause HS in humans have been described. 1 Notably, as in other heritable syndromes, the clinical presentation varies significantly even among individuals with identical gene defects, illustrating the profound effects of genetic background on disease severity. 10 Identifying genetic modifiers by linkage analysis in humans is often difficult, if not impossible, due to environmental influences, genetic diversity, and small population (linkage group) size. Inbred mice, however, provide powerful tools for complex trait analysis. Moreover, as concordance between quantitative trait loci (QTL) in the mouse and human has been demonstrated for several diseases, complex trait analysis in the mouse has significant biomedical relevance. 13,14 Here, we describe a new spontaneous HS mutation in the mouse, wan, which arose on the C3H/HeJ (C3H) inbred strain, and identify QTL that modify the severity of the HS phenotype. Homozygous wan mice are severely anemic. A premature stop codon in the gene encoding erythroid band 3, Slc4a1 (solute carrier family 4 [anion exchanger], member 1; formerly Ae1, anion exchanger 1), results in complete deficiency of band 3 in homozygotes. In hybrid wan/wan newborns derived from F2 intercrosses between C3H wan/Ļ© and Mus musculus castaneus (CAST/Ei), marked Reprints: Luanne L. Peters, The Jacks...