Establishment of a cell model of X-linked sideroblastic anemia using genome editing

•An in vitro cell model for X-linked sideroblastic anemia (XLSA) was established.•Ring sideroblasts were observed reproducibly in ALAS2 knockdown (HA2low) cells.•Erythroid differentiation induced ring sideroblast formation in HA2low cells.•Mitochondrial iron deposition in HA2low1 cells was confirmed...

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Published in:Experimental hematology Vol. 65; pp. 57 - 68.e2
Main Authors: Kaneko, Kiriko, Kubota, Yoshiko, Nomura, Kazumi, Hayashimoto, Haruka, Chida, Taisei, Yoshino, Naoto, Wayama, Marina, Ogasawara, Katsutoshi, Nakamura, Yukio, Tooyama, Ikuo, Furuyama, Kazumichi
Format: Journal Article
Language:English
Published: Netherlands Elsevier Inc 01-09-2018
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Summary:•An in vitro cell model for X-linked sideroblastic anemia (XLSA) was established.•Ring sideroblasts were observed reproducibly in ALAS2 knockdown (HA2low) cells.•Erythroid differentiation induced ring sideroblast formation in HA2low cells.•Mitochondrial iron deposition in HA2low1 cells was confirmed by elemental analysis. ALAS2 gene mutations cause X-linked sideroblastic anemia. The presence of ring sideroblasts in a patient's bone marrow is the hallmark of sideroblastic anemia, but the precise mechanisms underlying sideroblast formation are largely unknown. Using a genome-editing system, a mutation was introduced in the erythroid-specific enhancer of the ALAS2 gene in HUDEP2 cells, which were derived from human umbilical stem cells and can produce erythrocytes. The established cell line, termed HA2low, expressed less ALAS2 mRNA than did wild-type cells, even after erythroid differentiation. Although the mRNA expression of α-globin, β-globin, and the mitochondrial iron importer mitoferrin-1 was induced similarly in wild-type and HA2low cells, hemoglobinization of differentiated cells was limited in HA2low cells compared with wild-type cells. Importantly, Prussian blue staining revealed that approximately one-third of differentiated HA2low cells exhibited intracellular iron deposition and these cells looked like ring sideroblasts. Electron microscopy confirmed that the mitochondria in HA2low cells contained high-density deposits that might contain iron. Ring sideroblastic cells appeared among HA2low cells only after differentiation, whereas the induced expression of mitochondrial ferritin was observed in both cell types during differentiation. These results suggest that the induction of mitochondrial ferritin expression might be essential for, but not the primary cause of, ring sideroblast formation. Our results also suggest that the insufficient supply of protoporphyrin IX due to ALAS2 deficiency in combination with increased iron import into mitochondria during erythroid differentiation results in the formation of ring sideroblasts. Furthermore, HA2low cells are a useful tool for characterizing ring sideroblasts in vitro.
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content type line 23
ISSN:0301-472X
1873-2399
DOI:10.1016/j.exphem.2018.06.002