SIRT1 Increases the Expression of Fetal Hemoglobin Genes in Human Adult and Cord Blood Erythroblasts

Introduction: High fetal hemoglobin (HbF, α₂γ₂) levels ameliorate the clinical manifestations of sickle cell disease and β thalassemia. The mechanisms that repress HbF expression and silence γ-globin genes (HBG) in adults are incompletely characterized and only a single HbF inducer, hydroxyurea, is approved for treatment, and only in patients with sickle cell disease. Many efforts have been made to develop new HbF inducers. HDAC1 and HDAC2, the class I histone deacetylases, suppress HbF gene transcription, and histone deacetylase inhibitors induce HbF expression. We therefore wanted to study whether SIRT1, a NAD-dependent class III histone deacetylase, also played a role in suppressing HBG expression. Unexpectedly, we found that SIRT1 was an inducer of HBG expression.

Methods: We evaluated the role of SIRT1 in fetal globin gene regulation by ectopic expression or knockdown of SIRT1 and treatment with small molecule SIRT1 activators SRT2104 and SRT1720, in primary erythroid progenitor cells isolated from both cord blood and adult peripheral blood, CD34⁺ HUDEP-1 and HUDEP-2 cell lines that express fetal and adult hemoglobins, and K562 cells, using qRT-PCR, flow cytometry, immunoblotting, chromatin immunoprecipitation, and chromatin conformation capture assays.

Results: We identified SIRT1 as a new inducer of γ-globin. Ectopic expression of SIRT1 in cord blood CD34⁺ cells increased HBG mRNA 4-fold and the g-globin protein level 2.5-fold compared with vector control (p<0.05). SIRT1 knockdown in cord blood CD34⁺ cells decreased HBG mRNA 8-fold and γ-globin protein level 5-fold compared with a scrambled shRNA control (p<0.05). Stable SIRT1 knockdown in K562 cells decreased HBG mRNA levels by 11-fold (p<0.01).

To evaluate the effect of small molecule SIRT1 agonists on HbF gene expression, we treated erythroid progenitor cells from cord blood or normal adult blood and HUDEP-1 and HUDEP-2 cells and analyzed HBG mRNA, HbF-cells and g-globin protein levels. In cord erythroid progenitor cells, SRT12104 at 100nM, 500nM, and 2uM concentrations induced a mean increase of 2.4-fold, 3.4-fold and 8.1-fold in HBG mRNA, respectively, compared with vehicle treated controls (p<0.01). SRT1720 at 500nM and 5uM concentrations induced a mean increase of 2.1-fold and 4.4-fold in HBG mRNA levels above the controls, respectively (p<0.05). In adult progenitor cells, SRT2104 at 500nM and 2uM induced a mean increase of 2.6-fold and 4.1-fold HBG mRNA respectively (p<0.05), and induced an increase of 2.7% and 6.5% HbF-cells respectively (p<0.01). g-Globin was increased 5-fold and 3-fold by exposure to SRT2104 at 2uM and SRT1720 at 2.5uM respectively. Incubation of HUDEP-1 cells with 500nM and 2uM SRT2104 induced HBG expression 3.3-fold (p<0.01) and 6.2-fold (p<0.05) respectively; SRT1720 at 2.5uM induced HBG expression 8.4-fold (p<0.01), compared with controls. F-cells were elevated by 15.0 % and 17.4 % with SRT2104 treatment at 500nM and 2uM respectively (p<0.05), compared with controls. HUDEP-2 cells treated with SRT2104 at 500 nM and 2 uM had 1.8-fold and 2.5-fold induction of HBG expression (p<0.05). Treatment with SRT1720 at 2.5uM induced HBG expression 4.2-fold (p<0.05) compared with controls. These findings show that SIRT1 is an HBG inducer and that SIRT1 activators can reactivate silenced HBG expression in adult progenitor cells.

SIRT1 binds in the β-globin gene cluster locus control region (LCR) and HBG promoters, and promotes the looping of the LCR to HBG promoter, and increases the binding of RNA polymerase II and H4K16Ac in the HBG promoter. SIRT1 suppressed the expression of the HBG suppressors BCL11A, KLF1, HDAC1 and HDAC2 . SIRT1 did not change the proliferation of human erythroid progenitor cells or the expression of differentiation marker CD235a.

Conclusions: SIRT1 is an activator of HBG transcription. Our data suggest that SIRT1 activates HBG expression through facilitating LCR looping to the HBG promoter, inhibiting the expression of transcriptional suppressors of HBG, and indirectly increasing histone acetylation in the HBG promoter. SIRT1 is a potential therapeutic target for γ-globin induction, and small molecule SIRT1 activators might serve as a lead compound for the development of new HbF inducers.