Abnormal red cell membrane proteolytic activity in severe heterozygous beta-thalassemia

A 63-year-old man of italian origin with severe heterozygous beta-thalassemia whose clinical condition deteriorated after splenectomy is described. The alpha/beta synthesis ration in the peripheral blood was 3.02 +/- 0.56 and in the bone marrow 1.43. The free alpha-chain pool comprised 73% of the total radioactive alpha-globin in the peripheral blood and 68% in the bone marrow. RBC membranes isolated from erythrocytes incubated in the presence of 14C-leucine were practically devoid of nascent beta-chains with an alpha/beta ratio of 5.12 +/- 1.47, significantly higher than that present in the corresponding hemolysate. RBC membranes from this patient, compared to control membrane preparations, showed increased proteolytic activity directed against tetrameric hemoglobin and beta-hemoglobin chains, with concomitant decreased catabolism of alpha-hemoglobin chains. RBC membranes from individuals with mild beta-thalassemia trait and from transfused patients with homozygous beta-thalassemia degraded alpha-hemoglobin chains more efficiently than those from the patient described. The data suggest that decreased degradation of the alpha-chain by RBC membranes from this patient might lead to progressive accumulation of this polypeptide and expansion of the free alpha-chain pool, which, in turn, may be responsible for the severity of the clinical picture.