The kinetic inhibition of the gelation of hemoglobin S is compared to the change in hemoglobin S solubility, when the so-ubility is altered by carbn monoxide, pH, or urea. By means of a new technique, the delay time and the extent of gelation are measured on the same sample. The delay time, td, is found to be proportional to a hig power (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) of the hemoglobin S solubility. Together with the previously reported concentration dependence, this result demonstrates that the rate is proportional to a high power of the supersaturation, S, defined as the ratio of the total hemoglobin S concentration to the equilibrium solubility. The results obey the supersaturation equation td-' = ySFI, where 'y is an empirical constant (about 10-7 sec') and n is about 35. The supersaturation equation can successfully account for observations on the kinetics of cell sickling and is therefore used to estimate the increase in the delay time for sickling necessary to produce significant clinical benefit to patients with sickle cell disease. In previous papers we reported initial results on the kinetic and thermodynamic behavior of deoxyhemoglobin S gelation (1,2). When gelation was induced by temperature jumps, there was a delay period during which no observable polymerization took place (1, 3, 4). The delay time (td) was found to depend inversely on an extraordinarily high power (about 30) of the deoxyhemoglobin S concentration (ct) (1), and to be extremely sensitive to changes in temperature (1, 3). We also found that over a limited temperature range the delay time was proportional to a very high power of the equilibrium solubility (1, 2), where the solubility (c,) was taken as the concentration of deoxyhemoglobin S in the supernatant after sedimentation of the polymers by high-speed ultracentrifugation. The concentration and temperature dependence of the delay time could then be summarized to first order by a single empirical equation: 1/td = TS; S -Ce/c. [l] where y is an experimental constant. By analogy to crystallization or condensation processes, the ratio of the total initial concentration, ct, to the solubility, c5, was called the supersaturation ratio, S. The form of this "supersaturation equation" could be justified theoretically on the basis of our proposed nucleation-controlled polymerization mechanism (1).Using the supersaturation equation, we carried out a series of calculations on the influence of physiological variables on the delay time of intracellular gelation in vvo. The results of these calculations led to the kinetic hypothesis that the rate of intracellular gelation relative to the capillary transit time of the red cell is a major determinant of clinical severity in sickle cell disease (1,5). A crucial assumption in these calculations was that the supersaturation equation would hold approximately, no matter how the solubility was changed. Experimental data, however, on the influence of physiological variables, such as oxygen concentration and pH, on the delay t...