MICA: Identification of compounds capable of de-repressing zeta-globin in order to treat patients with severe alpha-thalassaemia

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Haemoglobin (Hb) is the major component of the protein found in red blood cells, it gives blood its red colour and is responsible for carrying oxygen around the body. Haemoglobin is made up of four chains: 2 alpha chains and 2 beta chains. Mutations in the genetic code (the DNA) responsible for producing these chains can lead to decreased production of the alpha chains, a condition called alpha-thalassaemia (mutation of the beta-chains, causes beta-thalassemia). There are four alpha-globin genes in humans, each of which normally contributes to alpha-globin production. If one or two genes are affected by mutations, then this produces a mild anaemia without any symptoms. However, if three alpha-globin genes are affected, this can lead to a severe anaemia needing regular transfusions. If all four alpha-globin genes are affected, this means that no functional haemoglobin can be produced, and such patients die in the womb approximately 4-6 months after conception (a condition called Barts Hydrops fetalis). Mild alpha-thalassaemia provides some protection against the infectious disease malaria. In certain parts of the world, alpha-thalassaemia is therefore very common: the carrier frequency is 4-8% in Southern China and Hong Kong and at a similar level in the Thai, Filipino and Vietnamese populations, however, it is most common in Northern Thailand where up to 14% of the population are carriers. Severe alpha-thalassemia is therefore a major global health problem with at least 26,000 at-risk pregnancies annually and because of migration this is now a global health problem. At the moment, treatments for alpha-thalassaemia are limited to blood transfusion and occasionally, bone marrow transplantation. Bone marrow transplantation can be very dangerous, with up to 1/5 patients dying because of the procedure itself. Regular blood transfusions also cause serious medical problems long-term. In addition, it is normally recommended that Bart's Hydrops fetalis babies are aborted because they are so unwell prior to being born. We therefore urgently need new treatments for severe forms of alpha-thalssaemia. When babies develop, they initially produce a different globin chain, similar to alpha-globin for the first 8 weeks after conception; this is called zeta-globin. We know this is capable of substituting for alpha-globin in adults. Unfortunately however, it is normally switched off after eight weeks. If we could find a way of turning it back on in adult red blood cells, this would treat patients with severe forms of alpha-thalssaemia and could allow them to live a normal life.In this project, we aim to identify chemical compounds which could be used as medicines to switch zeta-globin back on, thereby treating patients with severe alpha-thalassaemia. To help undertake this, we have made a mouse, where zeta-globin is "tagged" by a fluorescent protein. This means that we have a sensitive and specific way of identifying blood cells where zeta-globin is turned on, as when zeta-globin is on, the red blood cell glows. This allows us to add lots of different compounds to red blood cells from the mouse, and see quickly and easily which ones cause the red blood cells to glow. Once we have identified potential compounds, we will make sure they also turn zeta-globin back on in human cells and try and understand how they are turning zeta-globin back on by doing additional experiments. We will perform the initial screen of compounds by collaborating with a pharmaceutical company called AstraZeneca, as they have particular expertise in developing medicines. Longer-term, we would aim to test the compounds, initially in mouse models of alpha-thalassaemia, then in human cellular systems and if that is successful, in people.