A new recombinant, human anti-sickling -globin polypeptide designated  AS3 (Gly 16 3 Asp/Glu 22 3 Ala/Thr 87 3 Gln) was designed to increase affinity for ␣-globin. The amino acid substitutions at 22 and 87 are located at axial and lateral contacts of the sickle hemoglobin (HbS) polymers and strongly inhibit deoxyHbS polymerization. The 16 substitution confers the recombinant -globin subunit ( AS3 ) with a competitive advantage over  S for interaction with the ␣-globin polypeptide. Transgenic mouse lines that synthesize high levels of HbAS3 (␣ 2  AS3 2 ) were established, and recombinant HbAS3 was purified from hemolysates and then characterized. HbAS3 binds oxygen cooperatively and has an oxygen affinity that is comparable with fetal hemoglobin. Delay time experiments demonstrate that HbAS3 is a potent inhibitor of HbS polymerization. Subunit competition studies confirm that  AS3 has a distinct advantage over  S for dimerization with ␣-globin. When equal amounts of  S -and  AS3 -globin monomers compete for limiting ␣-globin chains up to 82% of the tetramers formed is HbAS3. Knock-out transgenic mice that express exclusively human HbAS3 were produced. When these mice were bred with knock-out transgenic sickle mice the  AS3 polypeptides corrected all hematological parameters and organ pathology associated with the disease. Expression of  AS3 -globin should effectively lower the concentration of HbS in erythrocytes of patients with sickle cell disease, especially in the 30% percent of these individuals who coinherit ␣-thalassemia. Therefore, constructs expressing the  AS3 -globin gene may be suitable for future clinical trials for sickle cell disease.Sickle cell disease (SCD) 1 results from an A to T transversion at the sixth codon of the human -globin gene on chromosome 11 (1, 2). The mutation of a single DNA base leads to the substitution of a valine for a glutamic acid in the -globin polypeptide of sickle hemoglobin (HbS). The positioning of a hydrophobic residue at this position permits an interaction with a hydrophobic pocket on another hemoglobin tetramer (see Fig. 1). This interaction allows deoxy-HbS to polymerize in an entropy-driven process (3-5). The polymerization of deoxyHbS leads to erythrocyte deformation from a biconcave morphology into the sickle shapes for which SCD is named.Polymerization of deoxy-HbS is effectively inhibited by fetal hemoglobin (HbF), and individuals who are homozygous for the sickle mutation but also express high levels of HbF are typically asymptomatic (6 -8). The level of HbF necessary to significantly reduce the symptoms of SCD ranges from about 20 to 25%; however, data showing an enhanced red cell survival with as little as 9% HbF have been reported (9). The efficacy of HbF in inhibiting HbS polymerization suggests that transduction of fetal globin genes into hematopoietic stem cells might be an effective strategy for sickle cell disease gene therapy. However, high levels of ␥-globin gene expression are difficult to achieve in adult erythroid cells even...