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A Gain-of-Function Mutation in the HIF2A Gene in Familial Erythrocytosis
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Hypoxia-inducible factor (HIF) alpha, which has three isoforms, is central to the continuous balancing of the supply and demand of oxygen throughout the body. HIF-alpha is a transcription factor that modulates a wide range of processes, including erythropoiesis, angiogenesis, and cellular metabolism. We describe a family with erythrocytosis and a mutation in the HIF2A gene, which encodes the HIF-2alpha protein. Our functional studies indicate that this mutation leads to stabilization of the HIF-2alpha protein and suggest that wild-type HIF-2alpha regulates erythropoietin production in adults.
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“Most gain-of-function mutations in HIF-2α are in direct proximity to proline residue 531, which is one of the two main hydroxylation sites (the other major hydroxylation site is proline 405). 147–154”
From Regulation of erythropoiesis by hypoxia-inducible factors (2013) · cites this paper as [147]
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“In humans, important evidence for a role of HIF-2a in EPO regulation is provided by the identification of heterozygous GOF mutations in the HIF2A gene in patients with erythrocytosis (Percy et al. 2008a,b).”
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“In many instances, such as VHL syndrome, upregulated HIFs are tumor promoter genes, but in some contexts, HIFs can also have a role as tumor suppressors [20].”
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“This notion is further supported by a linkage of familial erythrocytosis with a gain-of-function mutation in HIF-2α [101].”
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“These include Chuvash polycythemia, which is caused by pVHL mutations,(21-23) and familial erythrocytosis with paraganglioma caused by inactivating mutations in PHD2(24-26) or gain-of-function HIF2a mutations that prevent its interaction with pVHL.(27) Similar phenotypes are also observed in mice where HIF2a is stabil…”
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“dividuals are homozygous for a hypomorphic allele of the von Hippel-Lindau (VHL) tumor suppressor, which impairs HIF degradation (2), and HIF2 gain-of-function mutations (30, 31).”
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“In vitro studies showed that this mutation would result in major change in function of the protein (Percy et al., 2008).”
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“…of recent data demonstrating genetic variation in EPAS-1 resulting in phenotypic differences (Yi et al. 2010; Beall et al. 2010; Bigham et al. 2009; Percy et al. 2008), it is possible that the gene encoding HIF-1 a gene was replicated at some point in evolution giving rise to EPAS-1 and HIF-2 a .”
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“The mutation is predicted to produce a G537W change in the amino acid sequence of HIF2a, which is very close to the primary site of hydroxylation (Pro-531).(69) The resulting impairment of the hydroxylation of HIF2a and its subsequent VHL binding leads to an aberrant stabilization of this transcription factor during n…”
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“Genetic defects have been identi-fied in VHL (hypomorphic allele), PHD2 (haploinsufficiency), and HIF-2 a (activating mutation), which are associated with excess EPO production in patients (9, 63, 135, 189, 190).”
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“The mouse data have recently been confirmed by the identification of HIF-2 P534L, M535V, M535I, G537W, G537R, and D539E mutations that cause human familial erythrocytosis (36, 37, 80, 102, 104, 107, 138).”
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Erythrocytosis and Pulmonary Hypertension in a Mouse Model of Human HIF2A Gain of Function Mutation
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“We recently identified a heterozygous gain of function missense mutation in the HIF2A gene associated with erythrocytosis (19).”
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“Genetic changes in key elements of hypoxia-sensing pathways, such as germline mutations in VHL or EGLN1, are essential for the establishment of polycythemia.(7,8) Percy et al(9) reported novel HIF2A mutations (M535V, G537R) associated with polycythemia as a result of constitutively activated hypoxic cell signaling.”
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“Spontaneously occurring mutations in humans confirm this to be the case, with genetic upregulation of the pathway resulting in polycythaemia, pulmonary arterial hypertension, abnormal ventilatory drive and impaired skeletal muscle oxidative phosphorylation (14-18).”
Formenti, F., Beer, P. A., Croft, Q. P. P., Dorrington, K. L., Gale, D. P., Lappin, T. R. J., Lucas, G. S., Maher, E. R., Maxwell, P. H., McMullin, M. F., et al. (2011) · The FASEB Journal · doi:10.1096/fj.10-177378 · Cited by 92
“They were identified from previous studies (25, 28) and recruited through their respective physicians.”
BackgroundMethodSelf-citationHypoxia-Inducible Factor and Its Role in the Management of Anemia in Chronic Kidney Disease
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“G537R – a well-described gain-of-function mutation found in erythrocytosis patients (30, 31) – was detected.”
BackgroundSelf-citationTherapeutic Manipulation of the HIF Hydroxylases
Nagel, S., Talbot, N. P., Mecinović, J., Smith, T. G., Buchan, A. M., & Schofield, C. J. (2009) · Antioxidants and Redox Signaling · doi:10.1089/ars.2009.2711 · Cited by 77
“Intravenous administration of DFO increases EPO production in healthy volunteers (11, 158, 183) and excessive erythropoiesis has been reported in families with HIFactivating mutations (3, 61, 108, 149, 150).”
Increased prevalence of EPAS1 variant in cattle with high-altitude pulmonary hypertension
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Genetic Variants in EPAS1 Contribute to Adaptation to High-Altitude Hypoxia in Sherpas
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Yan, L. Y., Colandrea, V. J., & Hale, J. J. (2010) · Expert Opinion on Therapeutic Patents · doi:10.1517/13543776.2010.510836 · Cited by 87
“Several patients with familial erythrocytosis were found to carry mutations in HIF2A gene [26-28].”
BackgroundDavis, L., Recktenwald, M., Hutt, E., Fuller, S., Briggs, M., Goel, A., & Daringer, N. (2022) · Cancers · doi:10.3390/cancers14051259 · Cited by 83
Hypoxia Pathway Proteins are Master Regulators of Erythropoiesis
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Uremic Toxins Affect Erythropoiesis during the Course of Chronic Kidney Disease: A Review
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Defective Tibetan PHD2 Binding to p23 Links High Altitude Adaption to Altered Oxygen Sensing
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“The first erythrocytosisassociated mutation in the pathway was identified in the VHL gene [20] followed by a mutation in the PHD2 gene [21] and subsequently by a mutation of the HIF2A (also known as EPAS1) gene in a family with hereditary erythrocytosis [22].”
BackgroundSelf-citationRussell, R. C., Sufan, R. I., Zhou, B. R., Heir, P., Bunda, S., Sybingco, S. S., Greer, S. N., Roche, O., Heathcote, S. A., Chow, V. W. K., et al. (2011) · Nature Medicine · doi:10.1038/nm.2370 · Cited by 79
Investigation and Management of Erythrocytosis
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Self-citationDiabetic nephropathy: a disorder of oxygen metabolism?
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Prediction of disease-related mutations affecting protein localization
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“Most mutations reduce protein activity, but increasing numbers of gain-of-function mutations [16,17] are also being identified.”
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“highlighted that also gain-of-function mutations of HIF2A gene cause hereditary erythrocytosis.(12,13) In this study we report a novel mutation of the HIF2A gene in 2 members of a familiy affected by idiopathic erythrocytosis.”
BackgroundInfluentialHIF prolyl hydroxylase inhibitors for anemia
Muchnik, E., & Kaplan, J. (2011) · Expert Opinion on Investigational Drugs · doi:10.1517/13543784.2011.566861 · Cited by 76
“Various analyses have indicated that HIF-2a is the prime factor in the regulation of renal erythropoietin (Epo) synthesis [17-24] and thus is the primary HIF molecule in the response to anemia.”
BackgroundInterplay of Hypoxia and A2B Adenosine Receptors in Tissue Protection
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“Finally, missense mutations that result in the substitution of evolutionarily conserved residues (M535V, M535I, G537W, and G537R) in HIF-2α that are located near a proline residue that is subject to hydroxylation (Pro-532), suggesting that the substitutions reduce the efficiency with which the hydroxylases modify the…”
BackgroundDiabetic nephropathy: are there new and potentially promising therapies targeting oxygen biology?
Miyata, T., Suzuki, N., & de Strihou, C. V. Y. (2013) · Kidney International · doi:10.1038/ki.2013.74 · Cited by 87
Hypoxic regulation of mRNA expression
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“76 77-80 Mutations in succinate dehyrogenase and fumarate hyroxylase, which lead to increases in intermediaries that act as B I O S C I N competitive inhibitors of prolyl hydroxylase, lead to increase HIF-1 activity and hereditary cancer syndromes 81 The fact that erythropoietin (a HIF target) and erythropoiesis are i…”
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“…as well as isolated individuals have been encountered in which erythrocytosis owing to elevated plasma Epo levels is explained by heterozygosity for an activating mutation in HIF-2a (Gale et al. 2008; Martini et al. 2008; Percy et al. 2008a,b, 2012; Furlow et al. 2009; van Wijk et al. 2010).”
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“2008, Gale et al. 2008, Percy et al. 2008a,b, Furlow et al. Figure 3 Functional imaging with [68Ga]-DOTATATE, [18F]-FDG, [18F]-FDOPA and [18F]-FDA PET/CT in patient No. 2.”
Erythropoietin in Brain Development and Beyond
Alnaeeli, M., Wang, L., Piknova, B., Rogers, H. M., Li, X., & Noguchi, C. T. (2012) · Anatomy Research International · doi:10.1155/2012/953264 · Cited by 64
“The corresponding receptors for the hematopoietic class 1 cytokines are single transmembrane polypeptides that associate as homodimers, as is the case with EpoR, heterodimers, or heterotrimers.”
BackgroundSelf-citationRenal anemia: from incurable to curable
Sato, Y., & Yanagita, M. (2013) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00233.2013 · Cited by 62
“A gain-of-function mutation in the HIF-2 gene has been also reported to be responsible for excessive erythrocytosis in humans (100).”
BackgroundTaïeb, D., Yang, C., Delenne, B., Zhuang, Z., Barlier, A., Sebag, F. A., & Pacák, K. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1217 · Cited by 59
“To date, the genes of the oxygen-sensing pathway in which polycythemia-associated mutations have been identified include VHL (von Hippel-Lindau; Chuvash polycythemia) (1), PHD2 (prolyl hydroxylase domain 2 containing protein) (2), and HIF2A (hypoxia-inducible factor 2 ) (3).”
BackgroundZheng, Q., Yang, H., Sun, L., Wei, R., Fu, X., Wang, Y., Huang, Y., Liu, Y., & Liu, W. J. (2020) · Pharmacological Research · doi:10.1016/j.phrs.2020.105020 · Cited by 77
Pietras, A., Johnsson, A. S., & Påhlman, S. (2010) · Current topics in microbiology and immunology · doi:10.1007/82_2010_72 · Cited by 62
Hypoxia. 5. Hypoxia and hematopoiesis
Yoon, D., Ponka, P., & Prchal, J. T. (2011) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00044.2011 · Cited by 63
“A family was described in which members with polycythemia were heterozygous carriers of a HIF-2 Gly537Trp mutation that served to stabilize the HIF-2 protein (3, 54).”
BackgroundSelection signatures for high‐altitude adaptation in ruminants
Friedrich, J., & Wiener, P. (2020) · Animal Genetics · doi:10.1111/age.12900 · Cited by 68
Genetics of pheochromocytoma and paraganglioma syndromes
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“Dominantly inherited gain-offunction mutations of HIF2A were previously found to be associated with an increase of erythropoietin and congenital polycythemia [30,31].”
BackgroundFurlow, P. W., Percy, M. J., Sutherland, S., Bierl, C., McMullin, M. F., Master, S. R., Lappin, T. R. J., & Lee, F. S. (2009) · Journal of Biological Chemistry · doi:10.1074/jbc.m808737200 · Cited by 58
Inherited predisposition to myeloproliferative neoplasms
Jones, A. V., & Cross, N. C. P. (2013) · Therapeutic Advances in Hematology · doi:10.1177/2040620713489144 · Cited by 58
Metadata
- Authors
- Percy, M. J., Furlow, P. W., Lucas, G. S., Li, X., Lappin, T. R. J., McMullin, M. F., & Lee, F. S.
- Affiliations
- Belfast City Hospital (GB)
- University of Pennsylvania (US)
- Manchester Royal Infirmary (GB)
- Queen's University (CA)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-01-10
- Volume
- 358
- Issue
- 2
- Pages
- 162-168
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC2295209
- OpenAlex
- W2086913408
- Cited by
- 314
- References
- 0
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 8 · 2023: 14 · 2022: 8 · 2021: 16 · 2020: 24 · 2019: 23 · 2018: 16 · 2017: 14 · 2016: 14 · 2015: 13 · 2014: 22 · 2013: 25 · 2012: 19
- FWCI
- 19.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Funders
- University of Pennsylvania
- U.S. Public Health Service (R01 C090261)
- National Cancer Institute (R01CA090261)
- Topics
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
- Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
- Keywords
- HIF-2α, familial erythrocytosis, gain-of-function mutations, hypoxia-inducible factor alpha, protein stabilization, erythropoietin regulation, erythropoiesis, hereditary erythrocytosis
- MeSH terms
- Endothelial PAS Domain-Containing Protein 1, Adult, DNA Mutational Analysis, Erythropoiesis, Erythropoietin, Female, Genotype, Hematocrit, Hemoglobins, Humans, Male, Pedigree, Polycythemia, Polymerase Chain Reaction, Point Mutation, Basic Helix-Loop-Helix Transcription Factors, Basic Helix-Loop-Helix Proteins
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