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Champigneulle B, Caton F, Seyve L, Stauffer É, Pichon A, Brugniaux JV, Furian M, Hancco I, Deschamps B, Kaestner L, Robach P, Connes P, Bouzat P, Polack B, Marlu R, Verges S. Are coagulation profiles in Andean highlanders with excessive erythrocytosis favouring hypercoagulability? Exp Physiol 2024. [PMID: 38554124 DOI: 10.1113/ep091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024]
Abstract
Chronic mountain sickness is a maladaptive syndrome that affects individuals living permanently at high altitude and is characterized primarily by excessive erythrocytosis (EE). Recent results concerning the impact of EE in Andean highlanders on clotting and the possible promotion of hypercoagulability, which can lead to thrombosis, were contradictory. We assessed the coagulation profiles of Andeans highlanders with and without excessive erythrocytosis (EE+ and EE-). Blood samples were collected from 30 EE+ and 15 EE- in La Rinconada (Peru, 5100-5300 m a.s.l.), with special attention given to the sampling pre-analytical variables. Rotational thromboelastometry tests were performed at both native and normalized (40%) haematocrit using autologous platelet-poor plasma. Thrombin generation, dosages of clotting factors and inhibitors were measured in plasma samples. Data were compared between groups and with measurements performed at native haematocrit in 10 lowlanders (LL) at sea level. At native haematocrit, in all rotational thromboelastometry assays, EE+ exhibited hypocoagulable profiles (prolonged clotting time and weaker clot strength) compared with EE- and LL (all P < 0.01). At normalized haematocrit, clotting times were normalized in most individuals. Conversely, maximal clot firmness was normalized only in FIBTEM and not in EXTEM/INTEM assays, suggesting abnormal platelet activity. Thrombin generation, levels of plasma clotting factors and inhibitors, and standard coagulation assays were mostly normal in all groups. No highlanders reported a history of venous thromboembolism based on the dedicated survey. Collectively, these results indicate that EE+ do not present a hypercoagulable profile potentially favouring thrombosis.
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Affiliation(s)
- Benoit Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | | | - Landry Seyve
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
| | - Émeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
- Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Aurélien Pichon
- Université de Poitiers, Laboratoire Move UR 20296, STAPS, Poitiers, France
| | | | - Michael Furian
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Ivan Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | - Lars Kaestner
- Dynamics of Fluids, Experimental Physics, Saarland University, Homburg, Germany
- Theoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
| | - Paul Robach
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, Grenoble, France
| | - Benoit Polack
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Raphael Marlu
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Samuel Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
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2
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O'Neill C, O'Connell C. Idiopathic erythrocytosis: A diagnostic and management challenge with emerging areas for exploration. Br J Haematol 2024; 204:774-783. [PMID: 38262687 DOI: 10.1111/bjh.19287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
Despite published algorithms for approaching the work-up of erythrocytosis, a significant proportion of patients are left with uncertainty as to its aetiology and prognosis. The term 'idiopathic erythrocytosis' (IE) is applied when known primary and secondary aetiologies have been ruled out. However, the assignment of secondary aetiologies is not always straightforward or evidence based, which can lead to misdiagnosis and heterogeneity in cohort studies. Furthermore, new studies have identified germline or somatic mutations that may affect prognosis. Epidemiological and cohort data are inconsistent as to whether IE increases the risk for complications such as arterial and venous thromboembolism, clonal transformation or comorbid conditions. Randomized trials assessing the role of phlebotomy for long-term management of IE have not been performed, so treatment remains a vexing problem for clinicians. Standardization of terminology and testing strategies, including comprehensive genetic screening in clinical research, are key to refining our understanding of IE.
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Affiliation(s)
- Caitlin O'Neill
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Casey O'Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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3
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Delamare M, Le Roy A, Pacault M, Schmitt L, Garrec C, Maaziz N, Myllykoski M, Rimbert A, Karaghiannis V, Aral B, Catherwood M, Airaud F, Mansour-Hendili L, Hoogewijs D, Peroni E, Idriss S, Lesieur V, Caillaud A, Si-Tayeb K, Chariau C, Gaignerie A, Rab M, Haferlach T, Meggendorfer M, Bézieau S, Benetti A, Casadevall N, Hirsch P, Rose C, Wemeau M, Galacteros F, Cassinat B, Bellosillo B, Bento C, Van Wijk R, Petrides PE, Randi ML, McMullin MF, Koivunen P, Girodon F, Gardie B. Characterization of genetic variants in the EGLN1/PHD2 gene identified in a European collection of patients with erythrocytosis. Haematologica 2023; 108:3068-3085. [PMID: 37317877 PMCID: PMC10620589 DOI: 10.3324/haematol.2023.282913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
Hereditary erythrocytosis is a rare hematologic disorder characterized by an excess of red blood cell production. Here we describe a European collaborative study involving a collection of 2,160 patients with erythrocytosis sequenced in ten different laboratories. We focused our study on the EGLN1 gene and identified 39 germline missense variants including one gene deletion in 47 probands. EGLN1 encodes the PHD2 prolyl 4-hydroxylase, a major inhibitor of hypoxia-inducible factor. We performed a comprehensive study to evaluate the causal role of the identified PHD2 variants: (i) in silico studies of localization, conservation, and deleterious effects; (ii) analysis of hematologic parameters of carriers identified in the UK Biobank; (iii) functional studies of the protein activity and stability; and (iv) a comprehensive study of PHD2 splicing. Altogether, these studies allowed the classification of 16 pathogenic or likely pathogenic mutants in a total of 48 patients and relatives. The in silico studies extended to the variants described in the literature showed that a minority of PHD2 variants can be classified as pathogenic (36/96), without any differences from the variants of unknown significance regarding the severity of the developed disease (hematologic parameters and complications). Here, we demonstrated the great value of federating laboratories working on such rare disorders in order to implement the criteria required for genetic classification, a strategy that should be extended to all hereditary hematologic diseases.
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Affiliation(s)
- Marine Delamare
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Amandine Le Roy
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Mathilde Pacault
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Loïc Schmitt
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Céline Garrec
- Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Nada Maaziz
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | - Matti Myllykoski
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, 90014 Oulu, Finland. 90014 Oulu
| | - Antoine Rimbert
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Valéna Karaghiannis
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Bernard Aral
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | | | | | - Lamisse Mansour-Hendili
- Département de Biochimie-Biologie Moléculaire, Pharmacologie, Génétique Médicale AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil, IMRB Equipe Pirenne, Laboratoire d'excellence LABEX GRex, Créteil
| | - David Hoogewijs
- Section of Medicine, Department of Endocrinology, Metabolism and Cardiovascular System, University of Fribourg, CH-1700 Fribourg, Switzerland; National Center of Competence in Research "Kidney.CH"
| | - Edoardo Peroni
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy; Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro
| | - Salam Idriss
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Valentine Lesieur
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Amandine Caillaud
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Karim Si-Tayeb
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Caroline Chariau
- Nantes Université, CHU Nantes, CNRS, Inserm, BioCore, FR-44000, Nantes
| | - Anne Gaignerie
- Nantes Université, CHU Nantes, CNRS, Inserm, BioCore, FR-44000, Nantes
| | - Minke Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht
| | | | | | - Stéphane Bézieau
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Andrea Benetti
- Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128, Padua
| | - Nicole Casadevall
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, 75012, Paris
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, 75012, Paris
| | - Christian Rose
- Service d'onco-hématologie, Saint-Vincent de Paul Hospital, Boulevard de Belfort, Université Catholique de Lille, Univ. Nord de France, F-59000 Lille
| | - Mathieu Wemeau
- Hematology Department, Claude Huriez Hospital, Lille Hospital, 59000 Lille
| | - Frédéric Galacteros
- Département de Biochimie-Biologie Moléculaire, Pharmacologie, Génétique Médicale AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Red Cell Disease Referral Center-UMGGR, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Bruno Cassinat
- Université Paris Cité, APHP, Hôpital Saint-Louis, Laboratoire de Biologie Cellulaire, Paris
| | | | - Celeste Bento
- Hematology Department, Centro Hospitalar e Universitário de Coimbra; CIAS, University of Coimbra
| | - Richard Van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Petro E Petrides
- Hematology Oncology Center and Ludwig-Maximilians-University Munich Medical School, Munich
| | - Maria Luigia Randi
- Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128, Padua
| | - Mary Frances McMullin
- Belfast Health and Social Care Trust, Belfast N.Ireland; Queen's University, Belfast, N. Ireland
| | - Peppi Koivunen
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, 90014 Oulu, Finland. 90014 Oulu
| | - François Girodon
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France; Inserm U1231, Université de Bourgogne, Dijon, France; Laboratoire d'Excellence GR-Ex
| | - Betty Gardie
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Laboratoire d'Excellence GR-Ex
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4
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Shah BN, Zhang X, Sergueeva AI, Miasnikova GY, Ganz T, Prchal JT, Gordeuk VR. Increased transferrin protects from thrombosis in Chuvash erythrocytosis. Am J Hematol 2023; 98:1532-1539. [PMID: 37435906 PMCID: PMC10529798 DOI: 10.1002/ajh.27021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
Von Hippel-Lindau protein (VHL) is essential to hypoxic regulation of cellular processes. VHL promotes proteolytic clearance of hypoxia-inducible transcription factors (HIFs) that have been modified by oxygen-dependent HIF-prolyl hydroxylases. A homozygous loss-of-function VHLR200W mutation causes Chuvash erythrocytosis, a congenital disorder caused by augmented hypoxia-sensing. Homozygous VHLR200W results in accumulation of HIFs that increase transcription of the erythropoietin gene and raise hematocrit. Phlebotomies reduce hematocrit and hyperviscosity symptoms. However, the major cause of morbidity and mortality in Chuvash erythrocytosis is thrombosis. Phlebotomies cause iron deficiency, which may further elevate HIF activity and transferrin, the HIF-regulated plasma iron transporter recently implicated in thrombogenesis. We hypothesized that transferrin is elevated in Chuvash erythrocytosis, and that iron deficiency contributes to its elevation and to thrombosis. We studied 155 patients and 154 matched controls at steady state and followed them for development of thrombosis. Baseline transferrin was elevated, and ferritin reduced in patients. VHLR200W homozygosity and lower ferritin correlated with higher erythropoietin and transferrin. During 11 years of follow-up, risk of thrombosis increased 8.9-fold in patients versus controls. Erythropoietin elevation, but not hematocrit or ferritin, correlated with thrombosis risk. Unexpectedly, transferrin elevation associated with reduced rather than increased thrombosis risk. The A allele of the promoter EPO single nucleotide polymorphisms (SNP), rs1617640, associated with elevated erythropoietin and increased thrombosis risk, whereas the A allele of the intronic TF SNP, rs3811647, associated with higher transferrin and protection from thrombosis in patients. Our findings suggest an unexpected causal relationship between increased transferrin and protection from thrombosis in Chuvash erythrocytosis.
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Affiliation(s)
- Binal N Shah
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xu Zhang
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Adelina I Sergueeva
- Department of Pediatric Oncology and Hematology, N. Ulianov Chuvash State University, Cheboksary, Chuvashia, Russia
| | - Galina Y Miasnikova
- Department of Hematology and Chemotherapy, Chuvash Republic Clinical Hospital, Cheboksary, Chuvashia, Russia
| | - Tomas Ganz
- Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Josef T Prchal
- Department of Medicine, University of Utah, VAH, and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Victor R Gordeuk
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Prchal JT, Semenza GL. On either side of homeostasis: EPAS1 gain- and loss-offunction mutations. Haematologica 2023; 108:2564-2565. [PMID: 37288511 PMCID: PMC10542834 DOI: 10.3324/haematol.2023.283285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
| | - Gregg L Semenza
- Department of Genetic Medicine and Armstrong Oxygen Biology Research Center, Johns Hopkins University School of Medicine, Baltimore
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6
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Gangat N, Szuber N, Tefferi A. JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management. Am J Hematol 2023; 98:965-981. [PMID: 36966432 DOI: 10.1002/ajh.26920] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
DISEASE OVERVIEW JAK2 unmutated or non-polycythemia vera (PV) erythrocytosis encompasses a heterogenous spectrum of hereditary and acquired entities. DIAGNOSIS Foremost in the evaluation of erythrocytosis is the exclusion of PV through JAK2 (inclusive of exons 12-15) mutation screening. Initial assessment should also include gathering of previous records on hematocrit (Hct) and hemoglobin (Hgb) levels, in order to streamline the diagnostic process by first distinguishing longstanding from acquired erythrocytosis; subsequent subcategorization is facilitated by serum erythropoietin (Epo) measurement, germline mutation screening, and review of historical data, including comorbid conditions and medication list. Hereditary erythrocytosis constitutes the main culprit in the context of longstanding erythrocytosis, especially when associated with a positive family history. In this regard, a subnormal serum Epo level suggests EPO receptor mutation. Otherwise, considerations include those associated with decreased (high oxygen affinity Hgb variants, 2,3-bisphosphoglycerate deficiency, PIEZO1 mutations, methemoglobinemia) or normal oxygen tension at 50% Hgb saturation (P50). The latter include germline oxygen sensing pathway (HIF2A-PHD2-VHL) and other rare mutations. Acquired erythrocytosis commonly results from central (e.g., cardiopulmonary disease, high-altitude habitat) or peripheral (e.g., renal artery stenosis) hypoxia. Other noteworthy conditions associated with acquired erythrocytosis include Epo-producing tumors (e.g., renal cell carcinoma, cerebral hemangioblastoma) and drugs (e.g., testosterone, erythropoiesis stimulating agents, sodium-glucose cotransporter-2 inhibitors). Idiopathic erythrocytosis is an ill-defined terminology that presumes the existence of an increased Hgb/Hct level without an identifiable etiology. Such classification often lacks accounting for normal outliers and is marred by truncated diagnostic evaluation. MANAGEMENT Current consensus treatment guidelines are not supported by hard evidence and their value is further undermined by limited phenotypic characterization and unfounded concerns for thrombosis. We are of the opinion that cytoreductive therapy and indiscriminate use of phlebotomy should be avoided in the treatment of non-clonal erythrocytosis. However, it is reasonable to consider therapeutic phlebotomy if one were to demonstrate value in symptom control, with frequency determined by symptoms rather than Hct level. In addition, cardiovascular risk optimization and low dose aspirin is often advised. FUTURE DIRECTIONS Advances in molecular hematology might result in better characterization of "idiopathic erythrocytosis" and expansion of the repertoire for germline mutations in hereditary erythrocytosis. Prospective controlled studies are needed to clarify potential pathology from JAK2 unmutated erythrocytosis, as well as to document the therapeutic value of phlebotomy.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Natasha Szuber
- Department of Hematology, Université de Montréal, Montréal, Quebec, Canada
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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7
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Kragesteen BK, Giladi A, David E, Halevi S, Geirsdóttir L, Lempke OM, Li B, Bapst AM, Xie K, Katzenelenbogen Y, Dahl SL, Sheban F, Gurevich-Shapiro A, Zada M, Phan TS, Avellino R, Wang SY, Barboy O, Shlomi-Loubaton S, Winning S, Markwerth PP, Dekalo S, Keren-Shaul H, Kedmi M, Sikora M, Fandrey J, Korneliussen TS, Prchal JT, Rosenzweig B, Yutkin V, Racimo F, Willerslev E, Gur C, Wenger RH, Amit I. The transcriptional and regulatory identity of erythropoietin producing cells. Nat Med 2023; 29:1191-1200. [PMID: 37106166 DOI: 10.1038/s41591-023-02314-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
Erythropoietin (Epo) is the master regulator of erythropoiesis and oxygen homeostasis. Despite its physiological importance, the molecular and genomic contexts of the cells responsible for renal Epo production remain unclear, limiting more-effective therapies for anemia. Here, we performed single-cell RNA and transposase-accessible chromatin (ATAC) sequencing of an Epo reporter mouse to molecularly identify Epo-producing cells under hypoxic conditions. Our data indicate that a distinct population of kidney stroma, which we term Norn cells, is the major source of endocrine Epo production in mice. We use these datasets to identify the markers, signaling pathways and transcriptional circuits characteristic of Norn cells. Using single-cell RNA sequencing and RNA in situ hybridization in human kidney tissues, we further provide evidence that this cell population is conserved in humans. These preliminary findings open new avenues to functionally dissect EPO gene regulation in health and disease and may serve as groundwork to improve erythropoiesis-stimulating therapies.
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Affiliation(s)
- Bjørt K Kragesteen
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel.
| | - Amir Giladi
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Eyal David
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Shahar Halevi
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Laufey Geirsdóttir
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Olga M Lempke
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Baoguo Li
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Andreas M Bapst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Ken Xie
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Sophie L Dahl
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Fadi Sheban
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Anna Gurevich-Shapiro
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
- Division of Haematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Zada
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Truong San Phan
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Roberto Avellino
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Shuang-Yin Wang
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Oren Barboy
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Shir Shlomi-Loubaton
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Sandra Winning
- Institute of Physiology, University of Duisburg-Essen, Essen, Germany
| | | | - Snir Dekalo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Urology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hadas Keren-Shaul
- Department of Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Merav Kedmi
- Department of Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Martin Sikora
- GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Fandrey
- Institute of Physiology, University of Duisburg-Essen, Essen, Germany
| | | | - Josef T Prchal
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Fernando Racimo
- GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Eske Willerslev
- GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Chamutal Gur
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
- Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roland H Wenger
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- National Centre of Competence in Research 'Kidney.CH', University of Zurich, Zurich, Switzerland
| | - Ido Amit
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel.
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8
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Prchal JT, Reeves BN. EnvIRONment modifies polycythemia vera. Blood 2023; 141:2042-2044. [PMID: 37103951 DOI: 10.1182/blood.2023020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
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9
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Abstract
Red blood cells transport O2 from the lungs to body tissues. Hypoxia stimulates kidney cells to secrete erythropoietin (EPO), which increases red cell mass. Hypoxia-inducible factors (HIFs) mediate EPO gene transcriptional activation. HIF-α subunits are subject to O2-dependent prolyl hydroxylation and then bound by the von Hippel-Lindau protein (VHL), which triggers their ubiquitination and proteasomal degradation. Mutations in the genes encoding EPO, EPO receptor, HIF-2α, prolyl hydroxylase domain protein 2 (PHD2), or VHL cause familial erythrocytosis. In addition to O2, α-ketoglutarate is a substrate for PHD2, and analogs of α-ketoglutarate inhibit hydroxylase activity. In phase III clinical trials evaluating the treatment of anemia in chronic kidney disease, HIF prolyl hydroxylase inhibitors were as efficacious as darbepoetin alfa in stimulating erythropoiesis. However, safety concerns have arisen that are focused on thromboembolism, which is also a phenotypic manifestation of VHL or HIF-2α mutation, suggesting that these events are on-target effects of HIF prolyl hydroxylase inhibitors.
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Affiliation(s)
- Gregg L Semenza
- McKusick-Nathans Department of Genetic Medicine and Vascular Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
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10
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Abstract
Hypoxia-inducible factors (HIFs) are master regulators of oxygen homeostasis that match O2 supply and demand for each of the 50 trillion cells in the adult human body. Cancer cells co-opt this homeostatic system to drive cancer progression. HIFs activate the transcription of thousands of genes that mediate angiogenesis, cancer stem cell specification, cell motility, epithelial-mesenchymal transition, extracellular matrix remodeling, glucose and lipid metabolism, immune evasion, invasion, and metastasis. In this Review, the mechanisms and consequences of HIF activation in cancer cells are presented. The current status and future prospects of small-molecule HIF inhibitors for use as cancer therapeutics are discussed.
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Affiliation(s)
| | - Gregg L Semenza
- Department of Genetic Medicine.,Institute for Cell Engineering, and.,Stanley Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Sun P, Kumar N, Tin A, Zhao J, Brown MR, Lin Z, Yang ML, Zheng Q, Jia J, Bielak LF, Yu B, Boerwinkle E, Hunker KL, Coresh J, Chen YE, Huo Y, Kardia SL, Khoriaty R, Zhou X, Morrison AC, Zhang Y, Ganesh SK. Epidemiologic and Genetic Associations of Erythropoietin With Blood Pressure, Hypertension, and Coronary Artery Disease. Hypertension 2021; 78:1555-1566. [PMID: 34488438 PMCID: PMC8516734 DOI: 10.1161/hypertensionaha.121.17597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pengfei Sun
- Department of cardiology, Peking University First hospital, Beijing, 100034, China
| | - Nitin Kumar
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Adrienne Tin
- Johns Hopkins Bloomberg School of Public Health, MD, 21205, USA
- University of Mississippi Medical Center, MS, 38677, USA
| | - Jing Zhao
- Department of cardiology, Peking University First hospital, Beijing, 100034, China
| | - Michael R Brown
- Human Genetics Center, Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Zesen Lin
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Min-Lee Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Qiwen Zheng
- Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, 100101, China
| | - Jia Jia
- Department of cardiology, Peking University First hospital, Beijing, 100034, China
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Kristina L. Hunker
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, MD, 21205, USA
| | - Y. Eugene Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Yong Huo
- Department of cardiology, Peking University First hospital, Beijing, 100034, China
| | - Sharon L.R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rami Khoriaty
- Division of Hematology, Department of Internal Medicine and Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Xiang Zhou
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Alanna C. Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Yan Zhang
- Department of cardiology, Peking University First hospital, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, 100034, China
| | - Santhi K. Ganesh
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
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12
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Abstract
PURPOSE OF REVIEW This review summarizes high-impact research in myeloproliferative neoplasms (MPN) from the last 18 months, with a particular focus on basic science findings. RECENT FINDINGS A pseudo-hypoxia state with stabilization of hypoxia-inducible factor (HIFα exists that is central to cell growth, cell renewal, inflammation, and thrombotic potential in MPN hematopoietic cells. SUMMARY HIFα and inflammatory pathways are new therapeutic targets in MPN, with the potential to ameliorate thrombotic risk and perhaps eradicate mutant progenitor cells.
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Affiliation(s)
- Brandi N Reeves
- Hematology Division, Department of Medicine, Blood Research Center, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison R Moliterno
- Hematology Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Semenza GL. Breakthrough Science: Hypoxia-Inducible Factors, Oxygen Sensing, and Disorders of Hematopoiesis. Blood 2021:blood. [PMID: 34411243 DOI: 10.1182/blood.2021011043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022] Open
Abstract
Hypoxia-inducible factors (HIF) were discovered as activators of erythropoietin gene transcription in response to reduced O2 availability. O2-dependent hydroxylation of HIFs on proline and asparagine residues regulates protein stability and transcription activity, respectively. Mutations in genes encoding components of the oxygen sensing pathway cause familial erythrocytosis. Several small molecule inhibitors of HIF prolyl hydroxylases are currently in clinical trials as erythropoiesis stimulating agents. HIFs are overexpressed in bone marrow neoplasms, and the development of HIF inhibitors may improve outcome in these disorders.
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15
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Gangat N, Szuber N, Pardanani A, Tefferi A. JAK2 unmutated erythrocytosis: current diagnostic approach and therapeutic views. Leukemia 2021; 35:2166-2181. [PMID: 34021251 PMCID: PMC8324477 DOI: 10.1038/s41375-021-01290-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/08/2023]
Abstract
JAK2 unmutated or non-polycythemia vera (PV) erythrocytosis encompasses both hereditary and acquired conditions. A systematic diagnostic approach begins with documentation of historical hematocrit (Hct)/hemoglobin (Hgb) measurements and classification of the process as life-long/unknown duration or acquired. Further investigation in both categories is facilitated by determination of serum erythropoietin level (EPO). Workup for hereditary/congenital erythrocytosis requires documentation of family history and laboratory screening for high-oxygen affinity hemoglobin variants, 2, 3 biphosphoglycerate deficiency, and germline mutations that are known to alter cellular oxygen sensing (e.g., PHD2, HIF2A, VHL) or EPO signaling (e.g., EPOR mutations); the latter is uniquely associated with subnormal EPO. Acquired erythrocytosis is often elicited by central or peripheral hypoxia resulting from cardiopulmonary disease/high-altitude dwelling or renal artery stenosis, respectively; EPO in the former instance is often normal (compensated by negative feed-back). Other conditions associated with acquired erythrocytosis include EPO-producing tumors and the use of drugs that promote erythropoiesis (e.g., testosterone, erythropoiesis stimulating agents). "Idiopathic erythrocytosis" loosely refers to an otherwise not explained situation. Historically, management of non-PV erythrocytosis has been conflicted by unfounded concerns regarding thrombosis risk, stemming from limited phenotypic characterization, save for Chuvash polycythemia, well-known for its thrombotic tendency. In general, cytoreductive therapy should be avoided and phlebotomy is seldom warranted where frequency is determined by symptom control rather than Hct threshold. Although not supported by hard evidence, cardiovascular risk optimization and low-dose aspirin use are often advised. Application of modern genetic tests and development of controlled therapeutic intervention trials are needed to advance current clinical practice.
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Affiliation(s)
- Naseema Gangat
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Natasha Szuber
- grid.14848.310000 0001 2292 3357Department of Hematology, Université de Montréal, Montréal, QC Canada
| | - Animesh Pardanani
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Ayalew Tefferi
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
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16
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Oberholzer L, Lundby C, Stauffer E, Ulliel-roche M, Hancco I, Pichon A, Lundby AM, Villafuerte FC, Verges S, Robach P. Reevaluation of excessive erythrocytosis in diagnosing chronic mountain sickness in men from the world’s highest city. Blood 2020; 136:1884-8. [DOI: 10.1182/blood.2019004508] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/22/2020] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of chronic mountain sickness (CMS) is based on a score including 7 clinical features (breathlessness, sleep disturbance, cyanosis, venous dilatation, paresthesia, headache, and tinnitus) in the setting of extreme erythrocytosis. Examining individuals in La Rinconada, Peru, the highest city in the world, the authors demonstrated that CMS at extreme altitude is not linked to elevation of hemoglobin, since CMS+ and CMS− individuals had similar levels of erythrocytosis.
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