1
|
Costa MM, Stilhano RS, Oliveira CR, Barbosa CMV, Pereira GJS, Paredes-Gamero EJ, Nakaie CR, Smaili SS, Bincoletto C. Angiotensin II modulates the murine hematopoietic stem cell and progenitors cocultured with stromal S17 cells. Cell Biol Int 2021; 45:1459-1467. [PMID: 33675269 DOI: 10.1002/cbin.11584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/07/2021] [Accepted: 02/27/2021] [Indexed: 01/18/2023]
Abstract
Although the existence of the renin-angiotensin system (RAS) in the bone marrow is clear, the exact role of this system in hematopoiesis has not yet been fully characterized. Here the direct role of angiotensin II (AngII) in hematopoietic stem cells (HSCs), common myeloid progenitors (CMPs), granulocyte/monocyte progenitors (GMPs), and megakaryocytes/erythroid progenitors (MEPs), using a system of coculture with stromal S17 cells. Flow cytometry analysis showed that AngII increases the percentage of HSC and GMP, while reducing CMP with no effect on MEP. According to these data, AngII increased the total number of mature Gr-1+ /Mac-1+ cells without changes in Terr119+ cells. AngII does not induce cell death in the population of LSK cells. In these populations, treatment with AngII decreases the expression of Ki67+ protein with no changes in the Notch1 expression, suggesting a role for AngII on the quiescence of immature cells. In addition, exposure to AngII from murine bone marrow cells increased the number of CFU-GM and BFU-E in a clonogenic assay. In conclusion, our data showed that AngII is involved in the regulation of hematopoiesis with a special role in HSC, suggesting that AngII should be evaluated in coculture systems, especially in cases that require the expansion of these cells in vitro, still a significant challenge for therapeutic applications in humans.
Collapse
Affiliation(s)
- Maíra M Costa
- Departamento de Farmacologia, Escola Paulista de Medicina, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Roberta S Stilhano
- Departamento de Biofísica, Centro de Terapia Celular e Molecular, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos R Oliveira
- Departamento de Farmacologia, Escola Paulista de Medicina, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Chistiano M V Barbosa
- Departamento de Biofísica, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Gustavo J S Pereira
- Departamento de Farmacologia, Escola Paulista de Medicina, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Edgar J Paredes-Gamero
- Departamento de Bioquímica, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Clovis R Nakaie
- Departamento de Biofísica, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Departamento de Bioquímica, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Soraya S Smaili
- Departamento de Farmacologia, Escola Paulista de Medicina, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Claudia Bincoletto
- Departamento de Farmacologia, Escola Paulista de Medicina, Instituto Nacional de Farmacologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Santos EJF, Hortegal EV, Serra HO, Lages JS, Salgado-Filho N, Dos Santos AM. Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study. ACTA ACUST UNITED AC 2018; 51:e7288. [PMID: 29742267 PMCID: PMC5972010 DOI: 10.1590/1414-431x20187288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/07/2018] [Indexed: 12/17/2022]
Abstract
Anemia is an inevitable complication of hemodialysis, and the primary cause is
erythropoietin deficiency. After diagnosis, treatment begins with an
erythropoiesis-stimulating agent (ESA). However, some patients remain anemic
even after receiving this medication. This study aimed to investigate the
factors associated with resistance to recombinant human erythropoietin therapy
with epoetin alfa (αEPO). We performed a prospective, longitudinal study of
hemodialysis patients receiving treatment with αEPO at our reference hospital
from July 2015 to June 2016. Clinical data was collected, and the response to
αEPO treatment was evaluated using the erythropoietin resistance index (ERI).
The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per
week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted
with random effects to verify the relationships between clinical and laboratory
data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male,
51.5%; 86.8% with hypertension). The ERI showed a significant positive
association with serum ferritin and C-reactive protein, percentage interdialytic
weight gain, and continuous usage of angiotensin receptor blocker (ARB)
hypertension medication. The ERI was negatively associated with serum iron and
albumin, age, urea reduction ratio, and body mass index. Our findings indicate
that resistance to αEPO was related to a low serum iron reserve, an inflammatory
state, poor nutritional status, and continuous usage of ARBs.
Collapse
Affiliation(s)
- E J F Santos
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - E V Hortegal
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - H O Serra
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - J S Lages
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - N Salgado-Filho
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A M Dos Santos
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| |
Collapse
|
3
|
Stević N, University of Niš, Faculty of Medicine, Niš, Serbia, Stefanović N, Veličković - Radovanović R, Apostolović B, Paunović K, Cvetković M, Virijević D, Cvetković T. T HE INFLUENCE OF ACE INHIBITORS TREATMENT ON ANEMIA PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
4
|
Erythropoiesis and Blood Pressure Are Regulated via AT1 Receptor by Distinctive Pathways. PLoS One 2015; 10:e0129484. [PMID: 26107632 PMCID: PMC4479565 DOI: 10.1371/journal.pone.0129484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
The renin–angiotensin system (RAS) plays a central role in blood pressure regulation. Although clinical and experimental studies have suggested that inhibition of RAS is associated with progression of anemia, little evidence is available to support this claim. Here we report that knockout mice that lack angiotensin II, including angiotensinogen and renin knockout mice, exhibit anemia. The anemia of angiotensinogen knockout mice was rescued by angiotensin II infusion, and rescue was completely blocked by simultaneous administration of AT1 receptor blocker. To genetically determine the responsible receptor subtype, we examined AT1a, AT1b, and AT2 knockout mice, but did not observe anemia in any of them. To investigate whether pharmacological AT1 receptor inhibition recapitulates the anemic phenotype, we administered AT1 receptor antagonist in hypotensive AT1a receptor knockout mice to inhibit the remaining AT1b receptor. In these animals, hematocrit levels barely decreased, but blood pressure further decreased to the level observed in angiotensinogen knockout mice. We then generated AT1a and AT1b double-knockout mice to completely ablate the AT1 receptors; the mice finally exhibited the anemic phenotype. These results provide clear evidence that although erythropoiesis and blood pressure are negatively controlled through the AT1 receptor inhibition in vivo, the pathways involved are complex and distinct, because erythropoiesis is more resistant to AT1 receptor inhibition than blood pressure control.
Collapse
|
5
|
Kiss Z, Ambrus C, Kulcsár I, Szegedi J, Kiss I. Effect of angiotensin-converting enzyme gene insertion/deletion polymorphism and angiotensin-converting enzyme inhibition on erythropoiesis in patients on haemodialysis. J Renin Angiotensin Aldosterone Syst 2014; 16:1021-7. [PMID: 25002133 DOI: 10.1177/1470320314535276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEis) improve survival; however, their effect on erythropoiesis remains a matter of debate in this population. Since insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene largely influences serum ACE activity, its effect on erythropoiesis is also anticipated. METHOD In this multicentre, cross-sectional study of 660 patients on maintenance haemodialysis, we analysed the effect of ACEi use and ACE gene I/D polymorphism on haemoglobin levels and erythropoietin resistance. Patients were allocated in groups based on genotype and ACEi therapy. We identified 128 matched pairs with I/I and D/D genotypes. RESULT There was no difference in haemoglobin levels between genotype groups. Haemoglobin levels were lower in patients on ACEi therapy in the entire cohort (95.5±12.1 g/l vs 97.4±13.4 g/l, p=0.02) and patients with I/D (95.2±11 g/l vs 98.2±11.9 g/l, p=0.04) and D/D (93.3±13.2 g/l vs 97.4±14.2 g/l, p=0.02) genotypes. In patient pairs treated with ACEi therapy, subjects with D/D genotype had lower Haemoglobin level (93.0±12.8 g/l vs 98.2±11.9 g/l, p=0.006) and higher erythropoietin resistance index (ERI) (199.1 vs 175.0, p=0.046) than individuals with I/I genotype. CONCLUSION These results indicate that ACEi therapy may increase erythropoietin resistance and worsen erythropoiesis in haemodialysis patients with the D allele.
Collapse
Affiliation(s)
- Zoltán Kiss
- School for Ph.D. Candidates of Aesculap Academy, Hungary
| | - Csaba Ambrus
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary Department of Nephrology-Hypertension, St Imre University Teaching Hospital, Hungary
| | - Imre Kulcsár
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary
| | - János Szegedi
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary
| | - István Kiss
- School for Ph.D. Candidates of Aesculap Academy, Hungary Division Section of Geriatrics, 2nd Department of Internal Medicine, Semmelweis University, Hungary
| | | | | |
Collapse
|
6
|
Local bone marrow renin-angiotensin system in primitive, definitive and neoplastic haematopoiesis. Clin Sci (Lond) 2013; 124:307-23. [PMID: 23157407 DOI: 10.1042/cs20120300] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The locally active ligand peptides, mediators, receptors and signalling pathways of the haematopoietic BM (bone marrow) autocrine/paracrine RAS (renin-angiotensin system) affect the essential steps of definitive blood cell production. Haematopoiesis, erythropoiesis, myelopoiesis, formation of monocytic and lymphocytic lineages, thrombopoiesis and other stromal cellular elements are regulated by the local BM RAS. The local BM RAS is present and active even in primitive embryonic haematopoiesis. ACE (angiotensin-converting enzyme) is expressed on the surface of the first endothelial and haematopoietic cells, forming the marrow cavity in the embryo. ACE marks early haematopoietic precursor cells and long-term blood-forming CD34(+) BM cells. The local autocrine tissue BM RAS may also be active in neoplastic haematopoiesis. Critical RAS mediators such as renin, ACE, AngII (angiotensin II) and angiotensinogen have been identified in leukaemic blast cells. The local tissue RAS influences tumour growth and metastases in an autocrine and paracrine fashion via the modulation of numerous carcinogenic events, such as angiogenesis, apoptosis, cellular proliferation, immune responses, cell signalling and extracellular matrix formation. The aim of the present review is to outline the known functions of the local BM RAS within the context of primitive, definitive and neoplastic haematopoiesis. Targeting the actions of local RAS molecules could represent a valuable therapeutic option for the management of neoplastic disorders.
Collapse
|
7
|
Bleyer AJ, Zivná M, Hulková H, Hodanová K, Vyletal P, Sikora J, Zivný J, Sovová J, Hart TC, Adams JN, Elleder M, Kapp K, Haws R, Cornell LD, Kmoch S, Hart PS. Clinical and molecular characterization of a family with a dominant renin gene mutation and response to treatment with fludrocortisone. Clin Nephrol 2010; 74:411-22. [PMID: 21084044 PMCID: PMC4264543 DOI: 10.5414/cnp74411] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A family was identified with autosomal dominant inheritance of anemia, polyuria, hyperuricemia, and chronic kidney disease. Mutational analysis revealed a novel heterozygous mutation c.58T > C resulting in the amino acid substitution of cysteine for arginine in the preprorenin signal sequence (p.cys20Arg) occurring in all affected members. METHODS Effects of the identified mutation were characterized using in vitro and in vivo studies. Affected individuals were clinically characterized before and after administration of fludrocortisone. RESULTS The mutation affects endoplasmic reticulum co-translational translocation and posttranslational processing, resulting in massive accumulation of non-glycosylated preprorenin in the cytoplasm. This affects expression of intra-renal RAS components and leads to ultrastructural damage of the kidney. Affected individuals suffered from anemia, hyperuricemia, decreased urinary concentrating ability, and progressive chronic kidney disease. Treatment with fludrocortisone in an affected 10-year-old child resulted in an increase in blood pressure and estimated glomerular filtration rate. CONCLUSIONS A novel REN gene mutation resulted in an alteration in the amino acid sequence of the renin signal sequence and caused childhood anemia, polyuria, and kidney disease. Treatment with fludrocortisone improved renal function in an affected child. Nephrologists should consider REN mutational analysis in families with autosomal dominant inheritance of chronic kidney disease, especially if they suffer from anemia, hyperuricemia, and polyuria in childhood.
Collapse
Affiliation(s)
- A J Bleyer
- Section on Nephrology, Wake Forest University School of Medicine, Winston- Salem, NC 27157, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Stark S, Winkelmann B, Kluthe C, Roigas J, Querfeld U, Müller D. Polycythemia and increased erythropoietin in a patient with chronic kidney disease. ACTA ACUST UNITED AC 2007; 3:222-6. [PMID: 17389891 DOI: 10.1038/ncpneph0437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 01/16/2007] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 16-year-old white male with a history of obstructive uropathy presented to a pediatric outpatient clinic with a first syncope. At presentation, he had a hemoglobin level of 220 g/l, a serum erythropoietin level of 27.4 U/l and a serum creatinine level of 200.7 micromol/l (2.27 mg/dl). INVESTIGATIONS Physical examination, serum laboratory analysis, renal ultrasound, MRI, and 99mTc-MAG3 scintigraphy of the kidneys. DIAGNOSIS Chronic renal insufficiency caused by obstructive hydronephrosis and accompanied by increased erythropoietin levels of renal origin and polycythemia. MANAGEMENT Serial phlebotomies and laparoscopic removal of the right hydronephrotic kidney.
Collapse
Affiliation(s)
- Simone Stark
- Department of Neonatology, University Hospital Charité of Berlin, Germany
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
Pathogenetically fundamental observations have identified polycythemia vera (PV) as a clonal stem cell disease with bone marrow histological and other biological features that distinctly differentiate it from other causes of 'increased' hematocrit. However, relatively little attention has been given to the effective utilization of pathology and laboratory markers of clonal myeloproliferation as diagnostic tools in PV. In contrast, the diagnostic use of red cell mass (RCM) measurement in PV stemmed from the accidental endorsement, as 'diagnostic criteria', of 'study eligibility criteria' that were formulated for clinical trials. It has since become evident that RCM measurement is a tedious procedure that is fraught with multiple-level imprecision, as well as suboptimal diagnostic accuracy. Therefore, it is reasonable to consider dispensing with RCM measurement as a diagnostic test for PV and instead utilize a diagnostic algorithm that combines clinical information with easily accessible laboratory data, including serum erythropoietin level and bone marrow histology. Recent discoveries of myeloproliferative-disease-specific molecular markers, including the JAK2 V617F tyrosine kinase mutation that is found in the majority of patients with PV, provide further support for such a measure.
Collapse
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
10
|
Halperin ML, Cheema-Dhadli S, Lin SH, Kamel KS. Properties Permitting the Renal Cortex to Be the Oxygen Sensor for the Release of Erythropoietin: Clinical Implications. Clin J Am Soc Nephrol 2006; 1:1049-53. [PMID: 17699326 DOI: 10.2215/cjn.00100106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The PO2 at this site where erythropoietin release is regulated should vary only when the hemoglobin concentration changes in capillary blood. The kidney cortex is an ideal location for this O2 sensor for four reasons. First, it extracts a small proportion of the oxygen that is delivered in each liter of blood; this makes the PO2 signal easier to recognize. Second, there is a constant ratio of the work performed (consumption of O2) to the renal blood flow rate (delivery of O2). Third, the high renal blood flow rate improves diffusion of O2 from capillaries to this O2 receptor. Fourth, a high renal cortical PCO2 prevents an additional shift of the O2:hemoglobin dissociation curve by other factors from being a confounding variable. This suggests that the GFR and the renal blood flow rate should be examined in patients with unexplained anemia or erythrocytosis.
Collapse
Affiliation(s)
- Mitchell L Halperin
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
11
|
Abstract
Heart failure affects 5 million persons in the United States, with 400,000 new cases occurring every year. Paradoxically, although advances in coronary angioplasty and effective drugs have increased survival post infarction, the myocardial damage and subsequent neurohormonal activation-induced remodeling causes significant morbidity years later in the form of heart failure. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) together with beta blockers modify the neurohormonal activation associated with heart failure and are key treatments for improving cardiac function and survival. Anemia is a significant risk factor predicting morbidity and mortality in heart failure. This article describes the various etiologies of anemia in heart failure. Of particular importance is the fact that recent stem cell studies have shown that the drugs acting on the renin-angiotensin system inhibit erythropoiesis in vivo and may cause anemia in patients with both normal renal function and end-stage renal disease (ESRD). The role of angiotensin-II as an erythropoietic growth factor and ACE in facilitating erythropoiesis is described in this article. Anemia has been shown to be a modifiable risk factor and its treatment correlates with improvement in clinical outcomes. Thus, anemia, its etiology (especially the contribution of ACEIs and ARBs), physiologic and prognostic impact, and treatment in the setting of heart failure are critical areas for investigation.
Collapse
Affiliation(s)
| | | | - William E. Lawson
- Department of Cardiovascular Medicine at SUNY Stony Brook, Stony Brook, New York, USA
| |
Collapse
|
12
|
Kato H, Ishida J, Imagawa S, Saito T, Suzuki N, Matsuoka T, Sugaya T, Tanimoto K, Yokoo T, Ohneda O, Sugiyama F, Yagami KI, Fujita T, Yamamoto M, Nangaku M, Fukamizu A. Enhanced erythropoiesis mediated by activation of the renin‐angiotensin system via angiotensin II type 1a receptor. FASEB J 2005; 19:2023-5. [PMID: 16223784 DOI: 10.1096/fj.05-3820fje] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although clinical and experimental studies have long suggested a role for the renin-angiotensin system (RAS) in the regulation of erythropoiesis, the molecular basis of this role has not been well understood. We report here that transgenic mice carrying both the human renin and human angiotensinogen genes displayed persistent erythrocytosis as well as hypertension. To identify the receptor molecule responsible for this phenotype, we introduced both transgenes into the AT1a receptor null background and found that the hematocrit level in the compound mice was restored to the normal level. Angiotensin II has been shown to influence erythropoiesis by two means, up-regulation of erythropoietin levels and direct stimulation of erythroid progenitor cells. Thus, we conducted bone marrow transplantation experiments and clarified that AT1a receptors on bone marrow-derived cells were dispensable for RAS-dependent erythrocytosis. Plasma erythropoietin levels and kidney erythropoietin mRNA expression in the double transgenic mice were significantly increased compared with those of the wild-type control, while the elevated plasma erythropoietin levels were significantly attenuated in the compound mice. These results provide clear genetic evidence that activated RAS enhances erythropoiesis through the AT1a receptor of kidney cells and that this effect is mediated by the elevation of plasma erythropoietin levels in vivo.
Collapse
Affiliation(s)
- Hideki Kato
- Center for Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Essential thrombocythemia, polycythemia vera, and myelofibrosis with myeloid metaplasia constitute the "classic" bcr/abl-negative myeloproliferative disorders (MPDs). Each of these MPDs represents a stem cell-derived clonal myeloproliferation with the respective features of thrombocytosis, erythrocytosis, and bone marrow fibrosis. Unlike with cases of chronic myeloid leukemia, in which the bcr/abl mutation is invariably detected, current diagnosis of essential thrombocythemia, polycythemia vera, and myelofibrosis with myeloid metaplasia is based on a consensus-driven set of clinical and laboratory criteria that have undergone substantial modification in recent times. The recent discovery of a recurrent activating Janus tyrosine kinase (JAK2) mutation (JAK2VG17F) in all 3 classic MPDs offers another opportunity for refining current diagnoses and disease classifications. In this article, we outline contemporary diagnostic algorithms for each of these disorders and provide an evidence-based approach to management.
Collapse
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | | |
Collapse
|