Role of Defective High-Affinity Thiamine Transporter slc19a2 in Marrow from a Mouse Model of Thiamine-Responsive Anemia Syndrome: Evidence for Defective Deoxyribose and Heme Synthesis.
Authors: Sahai Inderneel , Montefusco M. Claudia , Fleming Judidth C. , Boros Laszlo , Tartaglini Elena , Chick Gretchen , Neufeld Ellis J. 
Published: April 2020

Abstract
The rare autosomal recessive human disorder, TRMA syndrome (thiamine-responsive anemia with diabetes and deafness, OMIM 249270), is caused by mutations in the high affinity vitamin B1 transporter, SLC19A2. In human TRMA, ringed sideroblasts and megaloblastic changes are found in the marrow, suggesting potential defects in heme synthesis or mitochondrial function, and DNA synthesis, respectively. The mechanism whereby defective marrow thiamine transport causes these findings in the marrow was examined in a mouse model for TRMA. We previously demonstrated in fibroblasts from humans with TRMA a defect in the rate and pathway used for de novo ribose synthesis using Stable Isotope Dynamic Metabolic Profiling (SIDMaP analysis - Boros et al, Blood102: 3556, 2003).
To examine whether this fibroblast defect accurately defined the marrow pathophysiology, we have now examined this pathway in detail in mice defective for the orthologous slc19a2 gene by targeted gene disruption (Fleming et al, Mol Genet Metab80:234, 2003). Slc19a2 mutant (−/−) or wildtype (+/+) mice were subjected to normal mouse chow (22 mg/kg thiamine), or thiamine deficient chow diet. Diets were confirmed thiamine deficient by chemical analysis. To examine heme biosynthesis, we used 55Fe-transferrin, ex vivo, to label marrow from +/+ or −/− mice maintained for 10 days in thiamine replete or deficient chow. Mutant mice had cell surface labeling indistinguishable from +/+ at 0°C (P&gt;0.3), reflecting available transferrin receptors. Total cellular 55Fe uptake at 37 C was equal to or slightly greater than that of +/+ marrow in thiamine depleted state. However, incorporation of 55Fe into heme lagged in −/− cells (7.3 +/− 0.4 pmol/106cells/7 min) compared to +/+ (8.6 +/− 0.5 pmol/106 cells, P =0.018 in triplicate experiments). To examine deoxyribose (dRibose) synthesis, mice were maintained on thiamine replete or depleted chow for 10 days, then [1,2 13C] glucose was administered intraperitoneally overnight and 3 hours before sacrifice and marrow harvest. DNA from whole marrow and from sorted basophilic erythroblasts (CD71+/Ter119+) was isolated, hydrolized, derivatized, and dRibose analyzed by GC-MS. The initial rate of incorporation of 13C into DNA dRibose, reflecting de novo synthetic rate, was reduced 34% in basophilic erythroblasts of −/− mice after thiamine depletion (n=3 in duplicate experiments, P&lt;0.001). dRibose enrichment at position C1 and C2 (m2) compared to C1 onl1 (m1) reflects synthesis via transketolase (thiamine dependent, non-oxidative, m2), vs G6PD (oxidative, non-thiamine dependent, m1). The m2/m1 ratio was 0.73 in +/+ cells, but only 0.36 in −/− erythroblasts, demonstrating defective non-oxidative branch of the pentose phosphate pathway. Thus, defective slc9a2 leads to two distinct erythropoietic defects. De novo DNA dRibose synthesis via transketolase is markedly impaired. Further, while iron uptake by marrow cells is maintained at normal levels, the heme biosynthetic rate is decreased in −/− mice in thiamine-depleted status. This is the first direct demonstration of a role for thiamine in normal erythrocyte heme and DNA metabolism. Together, these defects can account directly for the meglaoblastosis and sideroblasts of human SLC19A2 defects in TRMA.