Ethanol inhibition of haemoglobin synthesis: in vitro evidence for a haem correctable defect in normal subjects and in alcoholics

Current View on the Mechanisms of Alcohol-Mediated Toxicity

Alcohol is a psychoactive substance that is widely used and, unfortunately, often abused. In addition to acute effects such as intoxication, it may cause many chronic pathological conditions. Some of the effects are very well described and explained, but there are still gaps in the explanation of empirically co-founded dysfunction in many alcohol-related conditions. This work focuses on reviewing actual knowledge about the toxic effects of ethanol and its degradation products.

Effects of acetaldehyde on human red cell metabolism: evidence for the formation of enzyme inhibitors

Since red cells transport and metabolize acetaldehyde in vivo, the effects of acetaldehyde on human red cell enzyme activities were studied. Incubation of intact red cells or undiluted red cell lysates at 37 degrees C for 4 h with 1-10 mmol/l acetaldehyde decreased only GOT, GPT and aldolase activities among the 26 enzymes tested. No inhibition occurred at 4 degrees C or when acetaldehyde was incubated with dilute hemolysates. Incubation of lysates with other reducing substrates or with acetate inhibited aldolase but not GOT or GPT. Preincubation of lysates with cyanate or fluoride markedly decreased acetaldehyde-mediated transaminase inhibition but not aldolase inhibition. Addition of pyridoxal phosphate, the vitamin B6 transaminase coenzyme, to GOT and GPT assay mixes did not reverse acetaldehyde-mediated transaminase inhibition. These findings suggest that acetaldehyde-mediated aldolase inhibition results from oxidation of acetaldehyde while transaminase inhibition results from nonoxidative acetaldehyde metabolism. When 100-200 mumol/l acetaldehyde is added to lysates at 2-h intervals and when lysates are incubated with ethanol, alcohol dehydrogenase and an NAD-regenerating system, enzyme inhibition occurs at acetaldehyde levels approaching those seen in vivo. Thus, the role of acetaldehyde-mediated enzyme inhibition in the toxicity of alcohol abuse warrants further study.

The effect of ethanol on polypeptide chain initiation in reticulocyte lysates. Inhibition of recycling of initiation factor eIF-2

Using the reticulocyte cell-free system, we have investigated the mechanism by which ethanol inhibits the initiation of protein synthesis. Ethanol inhibited the formation of 40S-initiation complexes, and this effect correlated well with the inhibition by ethanol of overall peptide-chain initiation. Ethanol was a more potent inhibitor of translation at 37 degrees than at 30 degrees. The inhibition of peptide-chain initiation and 40S-initiation complex formation in reticulocyte lysates under other conditions is associated with increased phosphorylation of the alpha-subunit of protein synthesis initiation factor-2 (eIF-2 alpha) and the inhibition of recycling of this factor. Recycling of eIF-2 is mediated by another protein factor GEF (= guanine nucleotide-exchange factor). The addition of ethanol to reticulocyte lysates led to increased phosphorylation of eIF-2 alpha and to a decrease in the rate of exchange of guanine nucleotides bound to eIF-2. This second finding indicated that recycling of eIF-2 was impaired probably due to decreased availability of GEF. Using purified components it was found that ethanol inhibited the ability of GEF to stimulate eIF-2 and that this inhibition showed a similar temperature dependence to the effect of ethanol on overall protein synthesis. Taken together, these results suggest that ethanol leads to inhibition of peptide-chain initiation both through increased phosphorylation of eIF-2 alpha and by directly inhibiting the productive interaction of eIF-2 and GEF.

Effect of lead and ethanol upon gamma-globin synthesis in sickle reticulocytes

There is evidence from both in vivo and in vitro studies that the synthesis of hemoglobin can be modified by posttranslational alterations in the assembly of the tetrameric molecule. Globin biosynthesis in reticulocytes of patients with sickle cell disease was studied to ascertain the effects of lead and ethanol on gamma-globin chain synthesis and hemoglobin assembly. In incubations containing lead (400 micrograms/dl) or ethanol (1.0 M) there were 86.7 +/- 139.7% and 542.7 +/- 397.0% increases in the relative synthesis of the gamma-globin chain. This was associated with a relative reduction in alpha-chain synthesis, as estimated by changes in the alpha/gamma + beta S synthesis ratio, as well as a marked reduction in total globin synthesis.

[Alcohol induced changes in hemopoiesis (author's transl)]

In a prospective trial with 120 chronic alcoholics (July, 1978 to January, 1980) on admission the following haematological values significantly different from those of the normal population were found: elevated erythrocyte mean corpuscular volume (64%), increased mean corpuscular hemoglobin (32%), thrombocytopenia (48%), increased percentage of bone marrow sideroblasts (35%), decreased percentage of sideroblasts (37%), megaloblastic bone marrow changes (55%) including nuclear abnormalities (32%), and vacuolization in red cell (20%) and white cell (16%) precursors. These changes were independent of liver cirrhosis with hypersplenism (increased mean corpuscular volume in 52% of the patients who did not have liver cirrhosis, increased mean corpuscular volume in 76% of the patients who were cirrhotic but not suffering from major bleeding). Platelets returned to normal values within 6 days of discontinuation of alcohol ingestion. In respect to iron metabolism we found the following changes: decreased serum iron concentration (32%), increased iron concentration (42%), increased total iron binding capacity (54%), increased ferritin (41%), decreased transferrin (20%). In contrast to data from the Anglo-American literature, serum folate concentrations were mostly normal in our patients (87%). This may be due to different eating and drinking habits. The percentage of bone marrow sideroblasts was also lower in our patients than those described in the literature mentioned above. The changes in maturation are likely to be caused partially by a toxic effect of alcohol on nuclear metabolism of bone marrow cells.

Vitamin B6 metabolism in anaemic and alcoholic man

Physiological and pathological factors affecting intracellular red cell vitamin B6 metabolism in normal, anaemic and alcoholic man were studied using a new assay for pyridoxine kinase (PnK) together with saturated and total aspartate aminotransferase (EGOT) activities as indirect indices of intracellular pyridoxal 5-phosphate (PLP) availability. In studies of anaemic states, subjects with iron deficiency anaemia demonstrated elevated levels of both PnK and saturated EGOT, while seven out of 17 subjects with inflammatory anaemia had subnormal PnK but variable saturated EGOT activities. Despite a high incidence of complicating inflammatory disease, alcoholic subjects with or without ring sideroblastic anaemia had elevated levels of both PnK and saturated EGOT. As judged from the saturated EGOT and the ratio unsaturated EGOT/saturated EGOT, intracellular PLP availability was always appropriate to the higher levels of PnK activity.

Ethanol inhibition of rabbit reticulocyte haem synthesis at the level of delta-aminolaevulinic acid synthetase

Ethanol inhibition of rabbit reticulocyte synthesis occurs as a result of a decrease in haem synthesis. The present study therefore was undertaken in order to localize the inhibitory site of ethanol on the haem biosynthetic pathway. Ethanol (0.05--0.15 M) inhibition of reticulocyte protein synthesis was prevented by simultaneous incubation with 0.025--1 mM delta-aminolaevulinic acid (ALA). Ethanol inhibited both 14C-glycine and 14C-ALA incorporation into haem. However, the extent of haem formation with 14C-ALA as substrate in the presence of ethanol was still equal to that when 14C-glycine was used. These data suggest that ethanol inhibits the haem synthetic pathway at several loci, but that the decrease in haem synthesis, responsible for the decrease in protein synthesis, is due to the inhibition at the rate-limiting enzyme, delta-aminolaevulinic acid synthetase (ALA-S). To confirm this, ALA-S activity was then directly measured in intact reticulocytes, and it was shown that ethanol indeed inhibited its activity. The inhibition of ALA-S was prevented by 10(-4) M dibutyryl cyclic AMP (db cAMP) or theophylline, agents which elevate intracellular cAMP and which have previously been shown to prevent and reverse ethanol inhibition of haem and protein synthesis. Thus, it appears that cAMP protects against ethanol toxicity by preventing inhibition of ALA-S.

Benzene inhibition of in vitro rabbit reticulocyte haem synthesis at delta aminolaevulinic acid synthetase: reversal of benzene toxicity by pyridoxine

Benzene (0.113 M) inhibited haem and protein synthesis in rabbit reticulocytes. This inhibition of haem synthesis was found when L-2-[14C]-glycine was used as the radioactive precursor. However, when 4-[14C]delta-aminolaevulinic acid (ALA) was used, there was no significant inhibition. Since ALA measures the haem synthetic pathway beyond the enzyme delta-aminolaevulinic acid synthetase (ALA synthetase), these results suggest that benzene inhibits haem synthesis at or before ALA synthetase. This was confirmed by demonstrating that 1 mM ALA both protected against and reversed the benzene inhibition of reticulocyte protein synthesis. In addition, 1 mM pyridoxine both protected against and reversed the benzene inhibition of reticulocyte protein synthesis. In addition, ImM pyridoxine both protected against and reversed the benzene inhibition of reticulocyte haem and protein synthesis. These results indicate that benzene (or a metabolite) either competes with pyridoxal phosphate at ALA synthetase or competes with pyridoxine for pyridoxal phosphokinase. These results are discussed in terms of their implications for the possible roles of ALA synthetase and the haemin-controlled repressor in benzene-induced aplastic anaemia.

Alpha-thalassemia

The current concepts of alpha-thalassemia including incidence, genetics, clinical spectrum and diagnosis are reviewed. Speculation concerning clinical application of the molecular biology of alpha-thalassemia is also presented.