Clinical expression of alpha spectrin mutants in hereditary elliptocytosis

The group of disorders manifesting as hereditary elliptocytosis/pyropoikilocytosis (HE/HPP) represent a unique group of experiments of nature that result from molecular defects of alpha spectrin. At the level of protein structure, these alpha spectrins can be identified by analysis of peptides generated by limited tryptic digestion. Such an approach reveals that the peptide containing alpha spectrin self-association site (the alpha I domain, molecular mass of 80 daltons) is cleaved to peptides of smaller size, presumably due to changes in the primary structure that lead to increased susceptibility of existing cleavage sites or the opening of new sites. Based on the mass of these peptides, we designate these alpha spectrin (Sp) mutants, Sp alpha 1/74, Sp alpha 1/65, and Sp alpha 1/46. At the level of protein function, these mutant alpha spectrins are characterized by a defective self-association of spectrin heterodimers to tetramers, the major structural subunits of the skeleton. One of the most interesting features of this group of disorders is a variable severity of their clinical expression. Molecular determinants of disease severity include the percentage of unassembled, that is, dimeric spectrin in the membrane and the total spectrin content in the cells. Consequently, the most severely affected patients, manifesting as HPP, contain a high fraction of unassembled, dimeric spectrin in the membrane (55 +/- 7%) and are, in addition, partially deficient in spectrin. In contrast, HE individuals and asymptomatic carriers have a moderate (33 +/- 11) or mild (24 +/- 9) increase in spectrin dimers (normals 5 +/- 4%) and they contain normal amounts of spectrin in their membranes.(ABSTRACT TRUNCATED AT 250 WORDS)