BCL11A, encoding a zinc-finger protein, is a transcriptional repressor predominantly expressed in the brain and hematopoietic tissue. It is crucial in brain and hematopoietic system development, especially in the fetal-to-adult hemoglobin switching process. Genetic variations, microRNAs, and transcription factors regulate its expression [3].

Erythroid-specific loss of BCL11A in engineered sickle cell disease (SCD) mice rescues the phenotype, suggesting that down-regulating BCL11A could benefit patients with SCD and β-thalassemia [1]. Clinical trials targeting the GATA-binding site in the BCL11A erythroid-specific enhancer using CRISPR/Cas9 gene editing have led to approval for ex vivo treatment of SCD and β-thalassemia [1]. Also, in a study, post-transcriptional genetic silencing of BCL11A in patients with sickle cell disease via infusion of autologous CD34+ cells transduced with a lentiviral vector encoding shRNA targeting BCL11A mRNA led to robust and stable HbF induction and reduced clinical manifestations [2].

In conclusion, BCL11A is essential for the fetal-to-adult hemoglobin switch. Studies using gene-edited mouse models and human clinical trials have shown that modulating BCL11A expression can be a promising therapeutic strategy for β-hemoglobinopathies like SCD and β-thalassemia.