A Common Alpha Globin Gene Deletion is Associated with Decreased Arterial Alpha Globin Gene Expression and Altered Vasoreactivity among Black Americans.

Alpha globin binds to endothelial nitric oxide (NO) synthase (eNOS) and limits the diffusion of NO from endothelial cells into vascular smooth muscle. Previously, we demonstrated that pharmacologic disruption of alpha globin-eNOS binding enhanced NOS-dependent vasodilation in human arteries. Here, we explore the hypothesis that individuals with alpha globin gene deletions will have reduced alpha globin gene expression in resistance arteries and altered arterial vasoreactivity. To test this hypothesis, we screened healthy Black Americans (clinical trial # 02692872) for a common 3.7 kb gene deletion in the alpha globin gene locus (HBA) that reduces the number of functional gene copies. We excluded people with risk factors for cardiovascular disease and created a nested case control study that included 15 people with four copies, 8 people with three copies, and 2 people with two copies of HBA. Each individual underwent an incisional subcutaneous adipose biopsy (clinical trial # 03937817), from which we isolated resistance arteries less than 200 μm in diameter. Resistance arteries were cannulated and perfused free of blood before undergoing multiphoton imaging, gene expression analysis, or pressure myography. Multiphoton imaging of adipose resistance arteries revealed alpha globin to co-localize with eNOS near the myoendothelial junction between endothelial and smooth muscle cells. Arteries from individuals with three functional copies of HBA had lower expression of HBA compared to arteries from individuals with four functional copies of HBA(1715 copies/ng cDNA vs 1176 copies/ng cDNA, p = 0.03). The concentration of phenylephrine required to constrict the human adipose arteries to 50% of baseline was 8 times greater for arteries from subjects with three copies of HBA compared to arteries from subjects with four copies of HBA (log [EC50]: -4.78 (95% CI: -4.29 to -5.22) vs -5.68 ± (95%CI: -5.33 to -5.98) p = 0.003). Arteries from individuals with three copies of HBA also had reduced maximal constriction to phenylephrine compared to subjects with four copies of HBA(p < 0.01). These results offer compelling new genetic evidence from humans supporting the role of alpha globin as a regulator of NO signaling in resistance arteries. We demonstrate that HBA deletions reduce arterial expression of HBA and change arterial vasoreactivity. This clinical investigation defines a novel vascular phenotype for individuals with alpha thalassemia and provides insight into a vascular mechanism by which alpha globin gene deletions protect against severe malaria, chronic kidney disease, and vascular complications of sickle cell disease.