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Pyruvate kinase deficiency modifies sickle hemoglobin carrier and sickle cell disease phenotypes in mice
Xunde Wang, Meghann Smith, Sayuri Kamimura, Quan Li, Niharika Shah, Martha Quezado, Luis E.F. Almeida, Sebastian Vogel, Mickias B. Tegegn, Kevin Y. Sun, Rafael Villasmil, Chengyu Liu, William A. Eaton, Swee Lay Thein, Zenaide M.N. Quezado
Xunde Wang, Meghann Smith, Sayuri Kamimura, Quan Li, Niharika Shah, Martha Quezado, Luis E.F. Almeida, Sebastian Vogel, Mickias B. Tegegn, Kevin Y. Sun, Rafael Villasmil, Chengyu Liu, William A. Eaton, Swee Lay Thein, Zenaide M.N. Quezado
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Research Article Genetics Hematology

Pyruvate kinase deficiency modifies sickle hemoglobin carrier and sickle cell disease phenotypes in mice

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Abstract

Growing evidence indicates that PKLR, the gene for pyruvate kinase (PK), is a genetic modifier of the sickle cell phenotype. Coinheritance of specific PKLR variants is associated with increased pain-related hospitalization and can trigger sickle cell disease (SCD) phenotypes in asymptomatic carriers. PK deficiency disrupts RBC glycolysis, leading to ATP deficits and accumulation of 2,3-diphosphoglycerate, which exacerbates sickling in SCD. Using CRISPR-Cas9, we generated null mutations in Pklr [Pklr(13ntdel/13ntdel) or Pklr(246ntdel/246ntdel)] specific for the RBC isoform (PKR) in Townes mice that were homozygous (SS) or heterozygous (AS) for the human sickle globin gene, or homozygous for human hemoglobin A (AA, controls), to investigate the effect of PKR deficiency on the sickle phenotype in mice. PKR-deficient AA and AS mice developed severe anemia, reticulocytosis, and substantial spleen and liver iron deposits. Unlike what is observed in humans, PKR deficiency in AS and SS mice surprisingly decreased sickling, but it was also associated with increased extramedullary hematopoiesis and mitochondrial retention in mature RBCs. These results demonstrate the differential effect of Pklr mutations on the phenotype of both AS and SS mouse models, offering insights into the complex role of PKR deficiency in SCD pathology.

Authors

Xunde Wang, Meghann Smith, Sayuri Kamimura, Quan Li, Niharika Shah, Martha Quezado, Luis E.F. Almeida, Sebastian Vogel, Mickias B. Tegegn, Kevin Y. Sun, Rafael Villasmil, Chengyu Liu, William A. Eaton, Swee Lay Thein, Zenaide M.N. Quezado

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Figure 1

Coinheritance of Pklr-null mutations [Pklr(13ntdel/13ntdel) or Pklr(246ntdel/246ntdel)] specific for the RBC pyruvate kinase isoform (PKR) differentially alters ATP and 2,3-diphosphoglycerate (2,3-DPG) levels in AA, AS, and SS mice.

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Coinheritance of Pklr-null mutations [Pklr(13ntdel/13ntdel) or Pklr(246n...
Data are shown as scatter dot plots illustrating individual mouse measurements, with overlaid bars representing the least-squares mean ± 95% CI. Data were analyzed using a 2-way ANOVA, and P values were adjusted for multiple comparisons using the Tukey method. All experimental groups included balanced number of age- and sex-matched mice. SSPklr(WT/WT) mice had higher ATP (A), lower 2,3-DPG (D), and higher ATP/2,3-DPG ratio (G) compared with AAPklr(WT/WT) and ASPklr(WT/WT) animals (all P ≤ 0.0015). (A–C) The effect of Pklr mutations on ATP levels varied according to sickle genotype (P = 0.005 for genotype-by-Pklr mutation interactions). PKR-deficient AA and AS mice [Pklr(13ntdel/13ntdel) or Pklr(246ntdel/246ntdel)] had higher ATP levels compared with AAPklr(WT/WT) and ASPklr(WT/WT) respectively (all P ≤ 0.0112, A–C). Conversely, PKR-deficient SS mice had similar blood ATP levels compared with SSPklr(WT/WT) (P ≥ 0.7318, A–C). Pklr mutations also altered 2,3-DPG levels differentially depending on the sickle genotype (P < 0.0001 for genotype-by-Pklr mutation interactions). PKR-deficient [Pklr(13ntdel/13ntdel) or Pklr(246ntdel/246ntdel)] AA and AS mice had similar 2,3-DPG levels compared with AAPklr(WT/WT) and ASPklr(WT/WT), respectively (all, P ≥ 0.6275, D–F). Conversely, PKR-deficient SS [SSPklr(13ntdel/13ntdel) and SSPklr(246ntdel/246ntdel)] mice had higher 2,3-DPG levels compared with SSPklr(WT/WT) (P = 0.0145 and P = 0.0048, respectively; D–F). (G–I) As a result, PKR-deficient AA and AS mice [Pklr(13ntdel/13ntdel) or Pklr(246ntdel/246ntdel)] had higher ATP/2,3-DPG ratios compared with AAPklr(WT/WT) and ASPklr(WT/WT) (P = 0.0171 and P = 0.0007 for AA and P = 0.0134 and P = 0.0023 for AS, respectively; G–I). In contrast, PKR-deficient SS mice had lower ATP/2,3-DPG ratio compared with SSPklr(WT/WT) (P = 0.0020 and P = 0.0123, respectively; G–I).

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