Abstract
β-hemoglobinopathies such as sickle cell disease (SCD) and β-thalassemia result from mutations in the adult HBB (β-globin) gene. Reactivating the developmentally silenced fetal HBG1 and HBG2 (γ-globin) genes is a therapeutic goal for treating SCD and β-thalassemia1. Some forms of hereditary persistence of fetal hemoglobin (HPFH), a rare benign condition in which individuals express the γ-globin gene throughout adulthood, are caused by point mutations in the γ-globin gene promoter at regions residing ~115 and 200 bp upstream of the transcription start site. We found that the major fetal globin gene repressors BCL11A and ZBTB7A (also known as LRF) directly bound to the sites at –115 and –200 bp, respectively. Furthermore, introduction of naturally occurring HPFH-associated mutations into erythroid cells by CRISPR–Cas9 disrupted repressor binding and raised γ-globin gene expression. These findings clarify how these HPFH-associated mutations operate and demonstrate that BCL11A and ZBTB7A are major direct repressors of the fetal globin gene.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Improving adenine and dual base editors through introduction of TadA-8e and Rad51DBD
Nature Communications Open Access 03 March 2023
-
Therapeutic adenine base editing of human hematopoietic stem cells
Nature Communications Open Access 13 January 2023
-
Base-editing-mediated dissection of a γ-globin cis-regulatory element for the therapeutic reactivation of fetal hemoglobin expression
Nature Communications Open Access 04 November 2022
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Rent or buy this article
Get just this article for as long as you need it
$39.95
Prices may be subject to local taxes which are calculated during checkout





References
Bauer, D. E. & Orkin, S. H. Update on fetal hemoglobin gene regulation in hemoglobinopathies. Curr. Opin. Pediatr. 23, 1–8 (2011).
Wilber, A., Nienhuis, A. W. & Persons, D. A. Transcriptional regulation of fetal to adult hemoglobin switching: new therapeutic opportunities. Blood 117, 3945–3953 (2011).
Fessas, P. & Stamatoyannopoulos, G. Hereditary persistence of fetal hemoglobin in Greece. A study and a comparison. Blood 24, 223–240 (1964).
Collins, F. S. et al. A point mutation in the Aγ-globin gene promoter in Greek hereditary persistence of fetal haemoglobin. Nature 313, 325–326 (1985).
Oner, R., Kutlar, F., Gu, L. H. & Huisman, T. H. The Georgia type of nondeletional hereditary persistence of fetal hemoglobin has a C→T mutation at nucleotide–114 of the Aγ-globin gene. Blood 77, 1124–1125 (1991).
Fucharoen, S., Shimizu, K. & Fukumaki, Y. A novel C–T transition within the distal CCAAT motif of the Gγ-globin gene in the Japanese HPFH: implication of factor binding in elevated fetal globin expression. Nucleic Acids Res. 18, 5245–5253 (1990).
Gilman, J. G. et al. Distal CCAAT box deletion in the Aγ globin gene of two black adolescents with elevated fetal Aγ globin. Nucleic Acids Res. 16, 10635–10642 (1988).
Zertal-Zidani, S. et al. A novel C→A transversion within the distal CCAAT motif of the Gγ-globin gene in the Algerian Gγβ+-hereditary persistence of fetal hemoglobin. Hemoglobin 23, 159–169 (1999).
Costa, F. F. et al. The Brazilian type of nondeletional Aγ-fetal hemoglobin has a C→G substitution at nucleotide –195 of the Aγ-globin gene. Blood 76, 1896–1897 (1990).
Giglioni, B. et al. A molecular study of a family with Greek hereditary persistence of fetal hemoglobin and β-thalassemia. EMBO J. 3, 2641–2645 (1984).
Tasiopoulou, M. et al. Gγ-196 C→T, Aγ-201 C→T: two novel mutations in the promoter region of the γ-globin genes associated with nondeletional hereditary persistence of fetal hemoglobin in Greece. Blood Cells Mol. Dis. 40, 320–322 (2008).
Amato, A. et al. Interpreting elevated fetal hemoglobin in pathology and health at the basic laboratory level: new and known γ-gene mutations associated with hereditary persistence of fetal hemoglobin. Int. J. Lab. Hematol. 36, 13–19 (2014).
Collins, F. S., Stoeckert, C. J. Jr., Serjeant, G. R., Forget, B. G. & Weissman, S. M. Gγβ+ hereditary persistence of fetal hemoglobin: cosmid cloning and identification of a specific mutation 5′ to the Gγ gene. Proc. Natl. Acad. Sci. USA 81, 4894–4898 (1984).
Hattori, Y., Kutlar, F., Kutlar, A., McKie, V. C. & Huisman, T. H. Haplotypes of βS chromosomes among patients with sickle cell anemia from Georgia. Hemoglobin 10, 623–642 (1986).
Motum, P. I., Deng, Z. M., Huong, L. & Trent, R. J. The Australian type of nondeletional Gγ-HPFH has a C→G substitution at nucleotide –114 of the Gγ gene. Br. J. Haematol. 86, 219–221 (1994).
Gilman, J. G., Mishima, N., Wen, X. J., Kutlar, F. & Huisman, T. H. Upstream promoter mutation associated with a modest elevation of fetal hemoglobin expression in human adults. Blood 72, 78–81 (1988).
Uda, M. et al. Genome-wide association study shows BCL11A associated with persistent fetal hemoglobin and amelioration of the phenotype of β-thalassemia. Proc. Natl. Acad. Sci. USA 105, 1620–1625 (2008).
Menzel, S. et al. A QTL influencing F cell production maps to a gene encoding a zinc-finger protein on chromosome 2p15. Nat. Genet. 39, 1197–1199 (2007).
Bauer, D. E. et al. An erythroid enhancer of BCL11A subject to genetic variation determines fetal hemoglobin level. Science 342, 253–257 (2013).
Sankaran, V. G. et al. Developmental and species-divergent globin switching are driven by BCL11A. Nature 460, 1093–1097 (2009).
Xu, J. et al. Correction of sickle cell disease in adult mice by interference with fetal hemoglobin silencing. Science 334, 993–996 (2011).
Lee, S.-U. et al. LRF-mediated Dll4 repression in erythroblasts is necessary for hematopoietic stem cell maintenance. Blood 121, 918–929 (2013).
Masuda, T. et al. Transcription factors LRF and BCL11A independently repress expression of fetal hemoglobin. Science 351, 285–289 (2016).
Kurita, R. et al. Establishment of immortalized human erythroid progenitor cell lines able to produce enucleated red blood cells. PLoS One 8, e59890 (2013).
Wienert, B. et al. KLF1 drives the expression of fetal hemoglobin in British HPFH. Blood 130, 803–807 (2017).
Littlewood, T. D., Hancock, D. C., Danielian, P. S., Parker, M. G. & Evan, G. I. A modified oestrogen receptor ligand-binding domain as an improved switch for the regulation of heterologous proteins. Nucleic Acids Res. 23, 1686–1690 (1995).
Coghill, E. et al. Erythroid Kruppel-like factor (EKLF) coordinates erythroid cell proliferation and hemoglobinization in cell lines derived from EKLF null mice. Blood 97, 1861–1868 (2001).
Xu, J. et al. Transcriptional silencing of γ-globin by BCL11A involves long-range interactions and cooperation with SOX6. Genes Dev. 24, 783–798 (2010).
Huang, P. et al. Comparative analysis of three-dimensional chromosomal architecture identifies a novel fetal hemoglobin regulatory element. Genes Dev. 31, 1704–1713 (2017).
Wienert, B. et al. Editing the genome to introduce a beneficial naturally occurring mutation associated with increased fetal globin. Nat. Commun. 6, 7085 (2015).
Sankaran, V. G. et al. Human fetal hemoglobin expression is regulated by the developmental stage–specific repressor BCL11A. Science 322, 1839–1842 (2008).
Varala, K., Li, Y., Marshall-Colón, A., Para, A. & Coruzzi, G. M. “Hit-and-Run” leaves its mark: catalyst transcription factors and chromatin modification. BioEssays 37, 851–856 (2015).
Charoensawan, V., Martinho, C. & Wigge, P. A. “Hit-and-run”: transcription factors get caught in the act. BioEssays 37, 748–754 (2015).
Pessler, F. & Hernandez, N. Flexible DNA binding of the BTB/POZ-domain protein FBI-1. J. Biol. Chem. 278, 29327–29335 (2003).
Wang, J. et al. Sequence features and chromatin structure around the genomic regions bound by 119 human transcription factors. Genome Res. 22, 1798–1812 (2012).
Jawaid, K., Wahlberg, K., Thein, S. L. & Best, S. Binding patterns of BCL11A in the globin and GATA1 loci and characterization of the BCL11A fetal hemoglobin locus. Blood Cells Mol. Dis. 45, 140–146 (2010).
Canver, M. C. & Orkin, S. H. Customizing the genome as therapy for the β-hemoglobinopathies. Blood 127, 2536–2545 (2016).
Traxler, E. A. et al. A genome-editing strategy to treat β-hemoglobinopathies that recapitulates a mutation associated with a benign genetic condition. Nat. Med. 22, 987–990 (2016).
Andrews, N. C. & Faller, D. V. A rapid micropreparation technique for extraction of DNA-binding proteins from limiting numbers of mammalian cells. Nucleic Acids Res. 19, 2499 (1991).
Crossley, M. et al. Isolation and characterization of the cDNA encoding BKLF/TEF-2, a major CACCC-box-binding protein in erythroid cells and selected other cells. Mol. Cell. Biol. 16, 1695–1705 (1996).
Schmidt, D. et al. ChIP–seq: using high-throughput sequencing to discover protein–DNA interactions. Methods 48, 240–248 (2009).
Bolger, A. M., Lohse, M. & Usadel, B. Trimmomatic: a flexible trimmer for Illumina sequence data. Bioinformatics 30, 2114–2120 (2014).
Langmead, B. & Salzberg, S. L. Fast gapped-read alignment with Bowtie 2. Nat. Methods 9, 357–359 (2012).
Quinlan, A. R. & Hall, I. M. BEDTools: a flexible suite of utilities for comparing genomic features. Bioinformatics 26, 841–842 (2010).
Kharchenko, P. V., Tolstorukov, M. Y. & Park, P. J. Design and analysis of ChIP–seq experiments for DNA-binding proteins. Nat. Biotechnol. 26, 1351–1359 (2008).
Landt, S. G. et al. ChIP–seq guidelines and practices of the ENCODE and modENCODE consortia. Genome Res. 22, 1813–1831 (2012).
Machanick, P. & Bailey, T. L. MEME-ChIP: motif analysis of large DNA datasets. Bioinformatics 27, 1696–1697 (2011).
Heinz, S. et al. Simple combinations of lineage-determining transcription factors prime cis-regulatory elements required for macrophage and B cell identities. Mol. Cell 38, 576–589 (2010).
Huang, W., Sherman, B. T. & Lempicki, R. A. Systematic and integrative analysis of large gene lists using DAVID bioinformatics resources. Nat. Protoc. 4, 44–57 (2009).
Huang, W., Sherman, B. T. & Lempicki, R. A. Bioinformatics enrichment tools: paths toward the comprehensive functional analysis of large gene lists. Nucleic Acids Res. 37, 1–13 (2009).
Eden, E., Navon, R., Steinfeld, I., Lipson, D. & Yakhini, Z. GOrilla: a tool for discovery and visualization of enriched GO terms in ranked gene lists. BMC Bioinformatics 10, 48 (2009).
Eden, E., Lipson, D., Yogev, S. & Yakhini, Z. Discovering motifs in ranked lists of DNA sequences. PLoS Comput. Biol. 3, e39 (2007).
Supek, F., Bošnjak, M., Škunca, N. & Šmuc, T. REVIGO summarizes and visualizes long lists of gene ontology terms. PLoS One 6, e21800 (2011).
Acknowledgements
The px458 plasmid was a gift from F. Zhang (Massachusetts Institute of Technology and Harvard University) (Addgene 48138). We thank M. Porteus (Stanford University) for providing plasmids for genome editing. We acknowledge H. Lebhar and the UNSW Recombinant Products Facility (UNSW Sydney) for HPLC assistance, and C. Brownlee and E. Johansson Beves from BRIL (UNSW Sydney) for assistance with flow cytometry. This work was supported by funding from the Australian National Health and Medical Research Council to M.C. (APP1098391). B.W. was supported by a University International Postgraduate Award. G.E.M., M.S. and L.J.N. were supported by Australian Postgraduate Awards. L.Y. was supported by a China Scholarship Council scholarship granted by the Chinese government.
Author information
Authors and Affiliations
Contributions
M.C., K.G.R.Q., A.P.W.F., G.E.M. and B.W. designed the study and experiments. G.E.M. and B.W. performed and analyzed most experiments and data. L.Y. generated HUDEP-2 BCL11A-ER-V5 cells and related ChIP–seq data. M.S. and J.B. performed ChIP–seq data analysis. R.K. and Y.N. provided HUDEP-2 cells. A.P.W.F. performed ChIP–seq experiments in K562 cells. L.J.N. and A.P.W.F. performed preliminary experiments. A.P.W.F. and R.C.M.P. provided intellectual insight and feedback on the data and manuscript. G.E.M., B.W., K.G.R.Q. and M.C. wrote the manuscript. A.P.W.F., K.G.R.Q. and M.C. supervised the study. All of the authors read and approved the contents of the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Integrated supplementary information
Supplementary Figure 1 Pedigrees for HPFH families.
A compiled summary of previously published data is presented here describing the various HPFH mutations identified in each family, HbF levels and the genotypes of patients with HPFH mutations, β-thalassaemia (+/– β-thal) or sickle cell trait (+/– HbS). a–e, Pedigrees of families with HPFH mutations in the site at –115 bp in the γ-globin promoter. f–j, Pedigrees of families with HPFH mutations in the site at –200 bp in the γ-globin promoter.
Supplementary Figure 2 Probes with HPFH mutations at –115 and –200 bp do not compete as well as wild-type probes for BCL11A and ZBTB7A binding.
a, BCL11A cold competition assays show that the c.–117G>A and c.–114C>T HPFH mutant probes do not compete as well for BCL11A binding as the WT probe, confirming specificity of binding. Increasing concentrations of cold probe were added in excess as indicated (10× and 50×). Lanes 1–3 show FLAG-tagged BCL11A ZF binding to the WT probe and a super-shift with anti-FLAG antibody as a control. Probes span –128 to –100 of the γ-globin promoter b–d, ZBTB7A cold competition EMSAs using HPFH mutant probes. Lane 1 contains ZBTB7A ZF bound to the hot WT probe. Increasing concentrations of cold probe were added in excess as indicated (10×, 100× and 1,000×). Probes span –209 to –187 of the γ-globin promoter. These data represent n = 1 biologically independent experiment. e,f, Densitometry analysis of the cold competition assays in a–d. Binding of BCL11A and ZBTB7A to the WT probe was used as a standard to normalize binding for the densitometry.
Supplementary Figure 3 Engineering the inducible BCL11A system with an ER and V5 tag for ChIP–seq.
a, CRISPR–Cas-9 system used to tag the endogenous BCL11A gene. The sgRNA target site is indicated. The donor plasmid contains 400 bp of homology on either side of the ER-V5 construct. b, PCR screening BCL11A-ER-V5 clones in HUDEP-2 cells. Shown are three clonal populations with the desired modification (n = 3). c, Western blot of nuclear extracts from HUDEP-2 BCL11A-ER-V5 cells in the uninduced and induced (tamoxifen for 24 h) state. Shown are three BCL11A-ER-V5 clonal populations in the uninduced and induced (tamoxifen) state (n = 3). d, HUDEP-2 ChIP–qPCR, using an antibody specific to the V5 tag, demonstrating BCL11A-ER-V5 binding to the γ-globin promoter (n = 3). Shown is the mean ± s.e.m. e, Genomic distribution of BCL11A-ER-V5 ChIP–seq peaks in HUDEP-2 cells. TTS, transcription termination site. f, Distribution of BCL11A-ER-V5 ChIP–seq peaks relative to the transcription start site (TSS). g, Motifs identified within BCL11A binding sites from BCL11A ChIP–seq in HUDEP-2 cells. Shown are the top five motifs as identified using MEME-ChIP45, which incorporates multiple motif discovery programs such as MEME and DREME. The specific program used to identify the motif, the statistical significance (E value) and motif distribution within the peak list are shown. Similar known motifs are also shown. These data were generated from n = 2 biologically independent replicates. h, ChIP–qPCR of BCL11A, using an antibody specific to BCL11A, in HUDEP-2(ΔGγ) WT (n = 3), with the EGR1 gene as a positive control and the 1-kb region upstream of KLF4 as a negative control. Means ± s.e.m. are shown.
Supplementary Figure 4 Gene ontology analysis from BCL11A ChIP–seq in HUDEP-2 cells.
a,b, Gene ontology for the top 3,000 BCL11A ChIP–seq peaks analyzed with DAVID Bioinformatics Resources 6.7 and GOrilla, respectively. c,d, Gene ontology for the top 3,000 BCL11A ChIP–seq peaks located in promoters (–1,000 to +100 bp from the TSS) that do not contain the TGNCCA motif, analyzed by DAVID Bioinformatics Resources 6.7 and GOrilla, respectively. e,f, Gene ontology for the top 3,000 BCL11A ChIP–seq peaks located in promoters (–1,000 to +100 bp from the TSS) that do contain the TGNCCA motif, analyzed by DAVID Bioinformatics Resources 6.7 and GOrilla, respectively. Shown are the top 20 most significant GO terms for each analysis. The DAVID Bioinformatics Resources 6.7 and GOrilla analyses were performed on the peaks generated from n = 2 biologically independent replicates.
Supplementary Figure 5 BCL11A binds to both the proximal and distal TGACC sites in the γ-globin promoter.
a, There are two TGACC motifs within the proximal promoter of the γ-globin gene, located at approximately –115 and –90 bp with respect to the TSS. b, The BCL11A ZF can bind to both the proximal and distal TGACC sites in the γ-globin promoter via EMSA in vitro. These data represent n = 1 independent experiment.
Supplementary Figure 6 ZBTB7A ChIP–seq in K562 cells.
a, ZBTB7A binding across the γ-globin genes in four biologically independent replicates (n = 4) of ZBTB7A ChIP–seq in K562 cells. b, Shown are the top five motifs as identified using MEME-ChIP. The analysis was performed on the peaks generated from n = 4 biologically independent replicates. c, TALENs cut at the ATG of both endogenous γ-globin genes. TdTomato is integrated by homologous recombination from a donor vector with 1-kb arms of homology. The donor plasmid contains either the WT or –195C>G γ- promoter.
Supplementary Figure 7 ZBTB7A ChIP–seq in HUDEP-2 cells.
a, ZBTB7A ChIP–seq tracks across the β-globin locus in HUDEP-2(ΔGγ) WT and –195C>G cells. LCR, locus control region. These data represent n = 1 independent experiment. b, ZBTB7A binding at control promoter regions of GATA1 and KLF1 in HUDEP-2(ΔGγ) cells. These data represent n = 1 independent experiment. c,d, ZBTB7A binding motifs from ChIP–seq in HUDEP-2 cells. Shown are the top five motifs as identified using MEME-ChIP, known similar motifs and their distribution within the peak in HUDEP-2(ΔGγ) WT (c) and –195C>G (d) cells. The analysis was performed on the peaks generated from n = 1 independent experiment.
Supplementary Figure 8 Comparison between ZBTB7A ChIP–seq in K562 and HUDEP-2(ΔGγ) cells.
a, In vivo consensus motif of ZBTB7A in K562 and HUDEP-2(ΔGγ) cells. b, Distribution of ZBTB7A peaks within the genome of K562 and HUDEP-2(ΔGγ) cells. c, Location of ZBTB7A ChIP–seq peaks relative to the TSS.
Supplementary Figure 9 BCL11A and ZBTB7A bind the proximal promoter of the γ-globin gene independently.
a, BCL11A ChIP–qPCR in HUDEP-2(ΔGγ) cells with WT, –114C>A and –195C>G HPFH alleles (n = 3). Means ± s.e.m. b, ZBTB7A ChIP–qPCR in HUDEP-2(ΔGγ) cells with a WT, –114C>A or –195C>G HPFH mutation (n = 3). Means ± s.e.m.
Supplementary information
Supplementary Text and Figures
Supplementary Figures 1–9 and Supplementary Tables 1–9
Rights and permissions
About this article
Cite this article
Martyn, G.E., Wienert, B., Yang, L. et al. Natural regulatory mutations elevate the fetal globin gene via disruption of BCL11A or ZBTB7A binding. Nat Genet 50, 498–503 (2018). https://doi.org/10.1038/s41588-018-0085-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41588-018-0085-0
This article is cited by
-
Therapeutic adenine base editing of human hematopoietic stem cells
Nature Communications (2023)
-
Improving adenine and dual base editors through introduction of TadA-8e and Rad51DBD
Nature Communications (2023)
-
Design Principles of a Novel Construct for HBB Gene-Editing and Investigation of Its Gene-Targeting Efficiency in HEK293 Cells
Molecular Biotechnology (2023)
-
HIC2 controls developmental hemoglobin switching by repressing BCL11A transcription
Nature Genetics (2022)
-
Analysis of rare thalassemia genetic variants based on third-generation sequencing
Scientific Reports (2022)