title: Metabolic persistence of fetal hemoglobin.
abstract: Hereditary persistence of fetal hemoglobin (HPFH) has typically been ascribed to mutations in the beta-globin gene cluster. Pharmacologic agents, including the short-chain fatty acid butyrate, have been shown to upregulate fetal and embryonic globin gene expression. In this report we investigate the possibility that metabolic derangements characterized by an inability to metabolize another short-chain fatty acid, propionate, could be associated with a persistence of fetal hemoglobin unrelated to alterations in the beta-globin cluster. Embryonic globin gene upregulation in a murine adult erythroid cell culture was shown by RNase protection after induction with three short-chain fatty acids (C2-C5). Chart reviews and measurement of fetal hemoglobin in five patients with abnormalities in propionate (C3) metabolism were undertaken; SSCP/dideoxy fingerprint analysis of the gamma-globin gene promoters was done in three of these five patients. Twelve patients with other metabolic derangements served as controls. Only the four patients with clinically severe abnormalities in propionate metabolism (ages 2 to 11), but without anemia, showed a sustained elevation in fetal hemoglobin (3% to 10%). The level of elevation of fetal hemoglobin in these patients, who lack erythropoietic stress, suggests that propionic acid and/or its metabolites are potent stimulators of fetal hemoglobin expression. Study of this group of patients should allow unique insights into the long-term effects of sustained exposure to elevations of short-chain fatty acid levels.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, 55455, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Little
authors.forename: N J
authors.initials: NJ
authors.lastname: Dempsey
authors.forename: M
authors.initials: M
authors.lastname: Tuchman
authors.forename: G D
authors.initials: GD
authors.lastname: Ginder
mesh_terms: D042964:Acyl-CoA Dehydrogenase; D000328:Adult; D000592:Amino Acid Metabolism, Inborn Errors / Q000097:blood* / Q000235:genetics; D000818:Animals; D001483:Base Sequence; D002262:Carboxy-Lyases / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D016172:DNA Fingerprinting; D004252:DNA Mutational Analysis; D044943:Fatty Acid Desaturases / Q000172:deficiency; D005227:Fatty Acids / Q000378:metabolism* / Q000494:pharmacology; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis* / Q000096:biosynthesis / Q000235:genetics; D005786:Gene Expression Regulation; D005914:Globins / Q000235:genetics; D006453:Hemoglobinopathies / Q000097:blood / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D004915:Leukemia, Erythroblastic, Acute / Q000473:pathology; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood; D043586:Methylmalonyl-CoA Decarboxylase; D008765:Methylmalonyl-CoA Mutase / Q000172:deficiency; D051379:Mice; D008969:Molecular Sequence Data; D018807:Polymorphism, Single-Stranded Conformational; D011401:Promoter Regions, Genetic; D011422:Propionates / Q000097:blood; D014407:Tumor Cells, Cultured / Q000187:drug effects / Q000378:metabolism
chemical_list: D005227:Fatty Acids; D011422:Propionates; D008764:Methylmalonic Acid; D005914:Globins; D005319:Fetal Hemoglobin; D044943:Fatty Acid Desaturases; D042964:Acyl-CoA Dehydrogenase; D002262:Carboxy-Lyases; D008765:Methylmalonyl-CoA Mutase; D043586:Methylmalonyl-CoA Decarboxylase; C029658:propionic acid