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Dussiot M, Maciel TT, Fricot A, Chartier C, Negre O, Veiga J, Grapton D, Paubelle E, Payen E, Beuzard Y, Leboulch P, Ribeil JA, Arlet JB, Coté F, Courtois G, Ginzburg YZ, Daniel TO, Chopra R, Sung V, Hermine O, Moura IC. An activin receptor IIA ligand trap corrects ineffective erythropoiesis in β-thalassemia. Nat Med 2014; 20:398-407. [PMID: 24658077 PMCID: PMC7730561 DOI: 10.1038/nm.3468] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/10/2014] [Indexed: 02/06/2023]
Abstract
The pathophysiology of ineffective erythropoiesis in β-thalassemia is poorly understood. We report that RAP-011, an activin receptor IIA (ActRIIA) ligand trap, improved ineffective erythropoiesis, corrected anemia and limited iron overload in a mouse model of β-thalassemia intermedia. Expression of growth differentiation factor 11 (GDF11), an ActRIIA ligand, was increased in splenic erythroblasts from thalassemic mice and in erythroblasts and sera from subjects with β-thalassemia. Inactivation of GDF11 decreased oxidative stress and the amount of α-globin membrane precipitates, resulting in increased terminal erythroid differentiation. Abnormal GDF11 expression was dependent on reactive oxygen species, suggesting the existence of an autocrine amplification loop in β-thalassemia. GDF11 inactivation also corrected the abnormal ratio of immature/mature erythroblasts by inducing apoptosis of immature erythroblasts through the Fas-Fas ligand pathway. Taken together, these observations suggest that ActRIIA ligand traps may have therapeutic relevance in β-thalassemia by suppressing the deleterious effects of GDF11, a cytokine which blocks terminal erythroid maturation through an autocrine amplification loop involving oxidative stress and α-globin precipitation.
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Affiliation(s)
- Michael Dussiot
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France. [6]
| | - Thiago T Maciel
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France. [6]
| | - Aurélie Fricot
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France
| | - Céline Chartier
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France
| | - Olivier Negre
- 1] Commissariat à l'Energie Atomique (CEA)-Institut des Maladies Emergentes et des Thérapies Innovantes (iMETI), Fontenay-aux-Roses, France. [2] UMR 962 (Inserm-CEA-University of Paris-Sud), Fontenay-aux-Roses, France
| | - Joel Veiga
- Laboratory of Excellence GR-Ex, Paris, France
| | - Damien Grapton
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France
| | - Etienne Paubelle
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France
| | - Emmanuel Payen
- 1] Commissariat à l'Energie Atomique (CEA)-Institut des Maladies Emergentes et des Thérapies Innovantes (iMETI), Fontenay-aux-Roses, France. [2] UMR 962 (Inserm-CEA-University of Paris-Sud), Fontenay-aux-Roses, France
| | - Yves Beuzard
- 1] Commissariat à l'Energie Atomique (CEA)-Institut des Maladies Emergentes et des Thérapies Innovantes (iMETI), Fontenay-aux-Roses, France. [2] UMR 962 (Inserm-CEA-University of Paris-Sud), Fontenay-aux-Roses, France
| | - Philippe Leboulch
- 1] Commissariat à l'Energie Atomique (CEA)-Institut des Maladies Emergentes et des Thérapies Innovantes (iMETI), Fontenay-aux-Roses, France. [2] UMR 962 (Inserm-CEA-University of Paris-Sud), Fontenay-aux-Roses, France
| | - Jean-Antoine Ribeil
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] Département de Biothérapie, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-Benoit Arlet
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France
| | - Francine Coté
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France
| | - Geneviève Courtois
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France
| | - Yelena Z Ginzburg
- Erythropoiesis Laboratory, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | | | | | | | - Olivier Hermine
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Ivan C Moura
- 1] INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France. [2] Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France. [3] CNRS ERL 8254, Paris, France. [4] Laboratory of Excellence GR-Ex, Paris, France. [5] INSERM U1149, Center for Research on Inflammation, Paris, France
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Negative autoregulation by Fas stabilizes adult erythropoiesis and accelerates its stress response. PLoS One 2011; 6:e21192. [PMID: 21760888 PMCID: PMC3132744 DOI: 10.1371/journal.pone.0021192] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/22/2011] [Indexed: 01/19/2023] Open
Abstract
Erythropoiesis maintains a stable hematocrit and tissue oxygenation in the basal state, while mounting a stress response that accelerates red cell production in anemia, blood loss or high altitude. Thus, tissue hypoxia increases secretion of the hormone erythropoietin (Epo), stimulating an increase in erythroid progenitors and erythropoietic rate. Several cell divisions must elapse, however, before Epo-responsive progenitors mature into red cells. This inherent delay is expected to reduce the stability of erythropoiesis and to slow its response to stress. Here we identify a mechanism that helps to offset these effects. We recently showed that splenic early erythroblasts, 'EryA', negatively regulate their own survival by co-expressing the death receptor Fas, and its ligand, FasL. Here we studied mice mutant for either Fas or FasL, bred onto an immune-deficient background, in order to avoid an autoimmune syndrome associated with Fas deficiency. Mutant mice had a higher hematocrit, lower serum Epo, and an increased number of splenic erythroid progenitors, suggesting that Fas negatively regulates erythropoiesis at the level of the whole animal. In addition, Fas-mediated autoregulation stabilizes the size of the splenic early erythroblast pool, since mutant mice had a significantly more variable EryA pool than matched control mice. Unexpectedly, in spite of the loss of a negative regulator, the expansion of EryA and ProE progenitors in response to high Epo in vivo, as well as the increase in erythropoietic rate in mice injected with Epo or placed in a hypoxic environment, lagged significantly in the mutant mice. This suggests that Fas-mediated autoregulation accelerates the erythropoietic response to stress. Therefore, Fas-mediated negative autoregulation within splenic erythropoietic tissue optimizes key dynamic features in the operation of the erythropoietic network as a whole, helping to maintain erythroid homeostasis in the basal state, while accelerating the stress response.
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Bleesing JJ, Straus SE, Fleisher TA. Autoimmune lymphoproliferative syndrome. A human disorder of abnormal lymphocyte survival. Pediatr Clin North Am 2000; 47:1291-310. [PMID: 11130997 DOI: 10.1016/s0031-3955(05)70272-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The importance of Fas in the homeostatic balance between lymphocyte survival and death is underscored by the three main consequences of defective Fas-mediated apoptosis, as experienced by patients with ALPS: (1) abnormal accumulation of lymphocytes results in lymphadenopathy, hepatosplenomegaly, and hypersplenism; (2) failure of removal of potentially autoreactive lymphocytes, a process normally used to eliminate lymphocytes that have escaped negative selection in the thymus and bone marrow (see article by Fleisher and Blessing, p. 1197), is associated with the appearance of autoimmune manifestations; and (3) inappropriate survival of lymphocytes may lead to the development of malignancies. As with other "experiments of nature," the many aspects of ALPS have provided valuable new insights into the immune system and the importance of a proper balance between life and death of lymphocytes. ALPS is an example of how a mouse disease model was applied directly to the identification of the molecular basis and the understanding of a remarkable disease in humans. It is also an example of clinical observations being linked to basic scientific data to unlock the underlying defect(s) causing a disease. Despite the difficulty in fully understanding the complex nature of the clinical course, the immunologic abnormalities, and the genetic aspects of ALPS, the accumulated experience in diagnosis, treatment, and follow-up of patients and relatives has generated a "road map" that can be used as a guide for their care. As examples, the appreciation that manifestations of lymphoproliferation usually subside over time has allowed a "wait-and-see" approach in many patients who might previously have been treated aggressively. The appreciation that these patients are at increased risk for malignancies has mandated the adoption of careful and lifelong follow-up. Future efforts directed at careful clinical follow-up and scientific investigation are required to learn more about the incidence and natural history of ALPS, therapeutic interventions directed at altering the consequences of TNFRSF6 mutations, and the identification of other genetic and environmental factors that may have a role in the pathogenesis of ALPS.
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Affiliation(s)
- J J Bleesing
- Department of Laboratory Medicine, Warren G. Magnuson Clinical Center, Bethesda, Maryland, USA
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