The origin of molecular disease: functional abnormalities and consequent clinical symptoms caused by single amino acid substitutions

The discovery of sickle cell hemoglobin in 1949 lead to the concept of "molecular disease". Since then, the total number of abnormal hemoglobins has been increasing, reaching 750 in April, 1998. Of these, 91% are variants with single amino acid substitutions. A "scratch" made in the protein moiety can cause alterations in physicochemical properties such as oxygen affinity, stability and autooxidation of 50% of all variants, further causing hematological or clinical disorders with significant frequencies. Generally, these alterations in properties and consequent hematological or clinical disorders are closely related to the mode and intramolecular location of the mutation. Conventional laboratory methods for mass screening of abnormal hemoglobins such as electrophoresis, isoelectric focusing and ion-exchange HPLC may overlook clinically important variants which possess amino acid substitutions without change in the charge. Oxygen affinity measurement may be a useful method to detect silent variants. Modern apparatuses can quickly and conveniently construct a continuous oxygen dissociation curve from one drop of whole blood. The dissociation curve becomes biphasic when the red cell contains abnormal hemoglobin with abnormal oxygen affinity. The continuous curve recording is advantageous because the proportion of the abnormal hemoglobin component can be estimated and the abnormal chain, either alpha or beta, can be predicted based on the inflection point of the biphasic curve.