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Tamura S, Kawamoto K, Miyoshi H, Suzuki T, Katagiri T, Kasami T, Nemoto H, Miyakoshi S, Kobayashi H, Shibasaki Y, Masuko M, Takeuchi K, Ohshima K, Sone H, Takizawa J. Cladribine treatment for Erdheim-Chester disease involving the central nervous system and concomitant polycythemia vera: A case report. J Clin Exp Hematop 2018; 58:161-165. [PMID: 30305475 PMCID: PMC6407475 DOI: 10.3960/jslrt.18015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Erdheim–Chester disease (ECD), a rare form of non-Langerhans cell histiocytosis, is
characterized by the infiltration of foamy CD68+ and CD1a-
histiocytes into multiple organ systems. Central nervous system (CNS) involvement has
recently been reported to be a poor prognostic factor when treating ECD with interferon
alpha. We report the case of a 66-year-old Japanese patient with ECD involving the CNS who
harbored the BRAF V600E mutation and also concomitantly developed
polycythemia vera with the JAK2 V617F mutation. We confirmed
2-chlorodeoxyadenosine (cladribine) therapy to be effective for the patient in this
case.
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Gerlach MM, Arranto C, Dirnhofer S, Tzankov A. Localized pain-causing JAK2-V617F-positive myeloproliferation with normal peripheral blood values. Ann Hematol 2018; 97:2265-2266. [PMID: 29766235 DOI: 10.1007/s00277-018-3363-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Magdalena M Gerlach
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031, Basel, Switzerland.
| | - Christian Arranto
- Department for Hematology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031, Basel, Switzerland
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Abstract
Since its approval in 2011, the Janus kinase 1/2 (JAK1/2) inhibitor ruxolitinib has evolved to become the centerpiece of therapy for myelofibrosis (MF), and its use in patients with hydroxyurea resistant or intolerant polycythemia vera (PV) is steadily increasing. Several other JAK2 inhibitors have entered clinical testing, but none have been approved and many have been discontinued. Importantly, the activity of these agents is not restricted to patients with JAK2 V617F or exon 12 mutations. Although JAK2 inhibitors provide substantial clinical benefit, their disease-modifying activity is limited, and rational combinations with other targeted agents are needed, particularly in MF, in which survival is short. Many such combinations are being explored, as are other novel agents, some of which could successfully be combined with JAK2 inhibitors in the future. In addition, new JAK2 inhibitors with the potential for less myelosuppression continue to be investigated. Given the proven safety and efficacy of ruxolitinib, it is likely that ruxolitinib-based combinations will be a major way forward in drug development for MF. If approved, less myelosuppressive JAK2 inhibitors such as pacritinib or NS-018 could prove to be very useful additions to the therapeutic armamentarium in MF. In PV, inhibitors of histone deacetylases and human double minute 2 have activity, but their role, if any, in the future treatment algorithm is uncertain, given the availability of ruxolitinib and renewed interest in interferons. Ruxolitinib is in late-phase clinical trials in essential thrombocythemia, in which it could fill an important void for patients with troublesome symptoms.
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Affiliation(s)
- Prithviraj Bose
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
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Vannucchi AM, Verstovsek S, Guglielmelli P, Griesshammer M, Burn TC, Naim A, Paranagama D, Marker M, Gadbaw B, Kiladjian JJ. Ruxolitinib reduces JAK2 p.V617F allele burden in patients with polycythemia vera enrolled in the RESPONSE study. Ann Hematol 2017; 96:1113-1120. [PMID: 28456851 PMCID: PMC5486779 DOI: 10.1007/s00277-017-2994-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Abstract
In patients with polycythemia vera (PV), an elevated JAK2 p.V617F allele burden is associated with indicators of more severe disease (e.g., leukocytosis, splenomegaly, and increased thrombosis risk); however, correlations between allele burden reductions and clinical benefit in patients with PV have not been extensively evaluated in a randomized trial. This exploratory analysis from the multicenter, open-label, phase 3 Randomized Study of Efficacy and Safety in Polycythemia Vera With JAK Inhibitor INCB018424 Versus Best Supportive Care trial evaluated the long-term effect of ruxolitinib treatment on JAK2 p.V617F allele burden in patients with PV. Evaluable JAK2 p.V617F-positive patients randomized to ruxolitinib (n = 107) or best available therapy (BAT) who crossed over to ruxolitinib at week 32 (n = 97) had consistent JAK2 p.V617F allele burden reductions throughout the study. At all time points measured (up to weeks 208 [ruxolitinib-randomized] and 176 [ruxolitinib crossover]), mean changes from baseline over time in JAK2 p.V617F allele burden ranged from −12.2 to −40.0% (ruxolitinib-randomized) and −6.3 to −17.8% (ruxolitinib crossover). Complete or partial molecular response was observed in 3 patients (ruxolitinib-randomized, n = 2; ruxolitinib crossover, n = 1) and 54 patients (ruxolitinib-randomized, n = 33; ruxolitinib crossover, n = 20; BAT, n = 1), respectively. Among patients treated with interferon as BAT (n = 13), the mean maximal reduction in allele burden from baseline was 25.6% after crossover to ruxolitinib versus 6.6% before crossover. Collectively, the data from this exploratory analysis suggest that ruxolitinib treatment for up to 4 years provides progressive reductions in JAK2 p.V617F allele burden in patients with PV who are resistant to or intolerant of hydroxyurea. The relationship between allele burden changes and clinical outcomes in patients with PV remains unclear.
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Affiliation(s)
- Alessandro Maria Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms (CRIMM), AOU Careggi, Largo Brambilla 3 - Padiglione 27B, 50134 Florence, Italy
- Laboratorio Congiunto and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Srdan Verstovsek
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 418, Houston, TX 77030 USA
| | - Paola Guglielmelli
- Center for Research and Innovation of Myeloproliferative Neoplasms (CRIMM), AOU Careggi, Largo Brambilla 3 - Padiglione 27B, 50134 Florence, Italy
- Laboratorio Congiunto and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center, Hans-Nolte-Straße 1, 32429 Minden, Germany
- UKRUB, University of Bochum, Bochum, Germany
| | - Timothy C. Burn
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Ahmad Naim
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Dilan Paranagama
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Mahtab Marker
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Brian Gadbaw
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Jean-Jacques Kiladjian
- Centre d’Investigations Cliniques (INSERM CIC 1427), Hôpital Saint-Louis, Université Paris Diderot, Paris, France
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Helbig G, Wichary R, Torba K, Kyrcz-Krzemień S. Resolution of thrombocytopenia, but not polycythemia after ruxolitinib for polycythemia vera with detectable mutation in the exon 12 of the JAK2 gene. Med Oncol 2017; 34:31. [PMID: 28120162 PMCID: PMC5263189 DOI: 10.1007/s12032-017-0891-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/16/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland.
| | - Ryszard Wichary
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
| | - Karolina Torba
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
| | - Sławomira Kyrcz-Krzemień
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
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ruxolitinib (JAKAVI°) and polycythaemia vera Inconclusive evaluation. Prescrire Int 2016; 25:229-31. [PMID: 30645821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients with polycythaemia vera, a myeloproliferative syndrome, are at increased risk of thrombotic events. Marrow fibrosis and transformation to acute leukaemia can also occur after several years. Treatment is based on phlebotomy and aspirin at low (antiplatelet) doses, sometimes combined with hydroxycarbamide, a cytotoxic drug. Various other drugs are available if hydroxycarbamide fails or is poorly tolerated, but there is no consensus treatment. Ruxolitinib inhibits Janus tyrosine kinases, which are involved, among other roles, in haematopoiesis. Ruxolitinib has been authorised in the European Union for patients with polycythaemia vera in whom hydroxycarbamide has failed or is poorly tolerated. Clinical evaluation of ruxolitinib in this setting is based on a randomised, unblinded trial versus treatment chosen by the investigators, in 222 patients treated for 32 weeks. Hydroxycarbamide was chosen in 59% of cases, even though the patients had unacceptable adverse effects or an inadequate response to the drug. The efficacy of the investigators' other treatment choices was uncertain. Phlebotomy was less frequent in the ruxofitinib group than in the control group. The adverse effects of ruxotitinib in this situation are poorly documented, due to inadequate long-term assessment. In the short term, ruxolitinib causes anaemia and thrombocytopenia, as well as bleeding, potentially severe infections, headache, sensory disturbances, and weight gain. It is also likely to share the serious adverse effects of other immunosuppressants. Ruxolitinib is mainly metabolised by cytochrome P450 isoenzymes CYP3A4 and CYP2C9, creating a risk of multiple drug interactions. Ruxolitinib showed embryofetal toxicity in animal studies. Virtually no data are available in pregnant women. In practice, available data on the harm-benefit balance of ruxolitinib fail to show that this drug represents a tangible advance for patients with polycythaemia vera, as compared with other drugs used when hydroxycarbamide is unsuitable.
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Nazha A, Khoury JD, Verstovsek S, Daver N. Second line therapies in polycythemia vera: What is the optimal strategy after hydroxyurea failure? Crit Rev Oncol Hematol 2016; 105:112-7. [PMID: 27401783 DOI: 10.1016/j.critrevonc.2016.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/11/2016] [Revised: 06/06/2016] [Accepted: 06/16/2016] [Indexed: 01/08/2023] Open
Abstract
Cytoreductive therapies have traditionally been the standard treatment for older patients with polycythemia vera (PV) or those with a history of prior thrombosis. Hydroxyurea (HU) is the most frequently used cytoreductive agent in PV. However, approximately 24% of patients treated with HU will eventually develop resistance or intolerance and patients who fail HU have an increased risk of death, transformation to myelofibrosis or acute myeloid leukemia. Interferon-alpha has been used in younger PV patients and is capable of inducing a complete hematologic response and significant reductions, or even eradication, of JAK2 V617F mutation allele burdens in a small but notable subset of PV patients. The potential toxicities of interferon-alpha must be weighed against the disease control benefit in a case-by-case fashion. Recently JAK2 inhibitor, ruxolitinib, demonstrated significant improvement in controlling the hematocrit and splenomegaly versus best available therapy in patients with PV who failed or are intolerant to HU and currently is FDA-approved in this setting. In this review, we will discuss novel emerging therapies for PV with a special focus on the currently available and upcoming treatment options for patients who fail HU.
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Affiliation(s)
- Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland, OH, USA.
| | - Joseph D Khoury
- Departments of Hematopathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Abstract
Pharmacological inhibition of the kinase activity of JAK proteins can interfere with the signaling of immunomodulatory cytokines and block the constitutive activation of the JAK-STAT pathway that characterizes certain malignancies, including chronic myeloproliferative neoplasms. JAK inhibitors may, therefore, be useful to treat malignancies as well as inflammatory or immune disorders. Currently, the most significant advances have been made in the treatment of myelofibrosis, where these drugs may lead to a remarkable improvement in the control of hyperproliferative manifestations. However, available data suggest that this treatment is not curative of myelofibrosis. In general, JAK2 inhibition induces cytopaenias, with this being considered a class side-effect. By contrast, the extrahaematologic toxicity profile varies significantly among the different JAK inhibitors. At present, there are several clinical trials evaluating the combination of ruxolitinib with other drugs, in order to improve its therapeutic activity as well as reducing haematologic toxicity.
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Affiliation(s)
| | - Montse Gómez
- Servicio de Hematología, Hospital Clínico Universitario, Valencia, España
| | - Ariadna Pérez
- Servicio de Hematología, Hospital Clínico Universitario, Valencia, España
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9
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Abstract
Patients with polycythemia vera (PV), a myeloproliferative neoplasm characterized by an elevated red blood cell mass, are at high risk of vascular and thrombotic complications and have reduced quality of life due to a substantial symptom burden that includes pruritus, fatigue, constitutional symptoms, microvascular disturbances, and bleeding. Conventional therapeutic options aim at reducing vascular and thrombotic risk, with low-dose aspirin and phlebotomy as first-line recommendations for patients at low risk of thrombotic events and cytoreductive therapy (usually hydroxyurea or interferon alpha) recommended for high-risk patients. However, long-term effective and well-tolerated treatments are still lacking. The discovery of mutations in Janus kinase 2 (JAK2) as the underlying molecular basis of PV has led to the development of several targeted therapies, including JAK inhibitors, and results from the first phase 3 clinical trial with a JAK inhibitor in PV are now available. Here, we review the current treatment landscape in PV, as well as therapies currently in development.
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Barrio S, Gallardo M, Arenas A, Ayala R, Rapado I, Rueda D, Jiménez-Ubieto A, Albizua E, Burgaleta C, Gilsanz F, Martinez-Lopez J. Inhibition of related JAK/STAT pathways with molecular targeted drugs shows strong synergy with ruxolitinib in chronic myeloproliferative neoplasm. Br J Haematol 2013; 161:667-676. [PMID: 23560534 DOI: 10.1111/bjh.12308] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 12/03/2012] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
Abstract
This study aimed to assess the antitumour effects, molecular mechanisms of action, and potential synergy of ruxolitinib with sorafenib, KNK437, dasatinib, and perifosine, in Philadelphia-negative chronic myeloproliferative neoplasms (MPN). Cytotoxic and cytostatic effects of the different compounds were determined in the JAK2 V617F-positive cell lines, HEL and Ba/F3 (JAK2V617F EPOR) , and in primary mononuclear and bone marrow CD34-positive cells from 19 MPN patients. Ruxolitinib [50% inhibitory concentration (IC50 )(PV) = 15 nmol/l], as well as sorafenib (IC50 PV=8μmol/l), KNK437 (IC50 PV=100μmol/l ), and perifosine (IC50 PV=15μmol/l ), were able to inhibit proliferation in cell line models and in primary cells from MPN patients. Dasatinib, KNK437, and sorafenib showed a strong synergistic effect in combination with ruxolitinib [combination index (CI)(PV) < 0·3]. Western blot confirmed that ruxolitinib blocked ERK, and consequently STAT5 activation, sorafenib inhibited ERK, P38 and STAT5, dasatinib blocked SRC and STAT5, and KNK437 decreased the stability of the JAK2 protein, reducing its expression. Inhibiting JAK2-related proliferative pathways has the potential to inhibit cell proliferation in MPNs. Furthermore, the combination of ruxolitinib with inhibitors that target these pathways has a strong synergistic effect, which may be due to decreased activation of the common effector, STAT5.
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Affiliation(s)
- Santiago Barrio
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Gallardo
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Alicia Arenas
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rosa Ayala
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inmaculada Rapado
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Rueda
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Jiménez-Ubieto
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enriqueta Albizua
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Haematology Service, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Florinda Gilsanz
- Haematology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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Landolfi R, Di Gennaro L, Nicolazzi MA, Giarretta I, Marfisi R, Marchioli R. Polycythemia vera: gender-related phenotypic differences. Intern Emerg Med 2012; 7:509-15. [PMID: 21660494 DOI: 10.1007/s11739-011-0634-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/20/2011] [Indexed: 01/14/2023]
Abstract
In polycythemia vera, gender has recently been shown to influence the JAK2(V617F) allele burden, but its effect on the disease phenotype is unknown. This issue was investigated using the database of the European Collaboration on Low-dose Aspirin in Polycythemia Vera (ECLAP) Study. The ECLAP Study recruited 1,638 polycythemic subjects and followed for 2.7 ± 1.3 years. At study entry, men, compared to women, had a higher prevalence of myocardial infarction (11.3 vs. 5.8%; P < 0.0001) and peripheral arterial disease (6.1 vs. 2.9%; P < 0.05) while a history of venous thrombosis was more common in women (11.4 vs. 7.9%, P = 0.016). Among 234 venous thrombosis, there were 39 splanchnic vein thromboses (33 extra-hepatic portal vein thromboses and 6 Budd-Chiari syndromes). Most of these events occurred as an early disease presentation in young female subjects. Women, compared to men, had higher platelet counts (average value 430 ± 213 vs. 375 ± 201 × 10(9)/L; P < 0.0001) and lower hematocrits (0.46 ± 0.06 vs. 0.48 ± 0.06 l/l; P < 0.0001). Cholesterol plasma level, available in 995 subjects (61%), was lower in male patients (180.8 ± 43.1 vs. 196 ± 46.6 mg/dl; P < 0.0001). During follow-up there were 205 major thromboses confirming an high incidence of myocardial infarction in men although not statistically significant (1.2 vs. 0.6 cases per 100 person-years; P > 0.05). These data show several gender-related differences both in the thrombotic diathesis and in the prevalence of vascular risk factors of PV patients.
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Affiliation(s)
- Raffaele Landolfi
- Institute of Internal Medicine and Geriatrics, Haemostasis Research Center, Catholic University School of Medicine, Rome, Italy.
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Scott LM, Rebel VI. JAK2 and genomic instability in the myeloproliferative neoplasms: a case of the chicken or the egg? Am J Hematol 2012; 87:1028-36. [PMID: 22641564 DOI: 10.1002/ajh.23243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 12/24/2022]
Abstract
The myeloproliferative neoplasms (MPNs) are a particularly useful model for studying mutation accumulation in neoplastic cells, and the mechanisms underlying their acquisition. This review summarizes our current understanding of the molecular defects present in patients with an MPN, and the effects of mutations targeting Janus kinase 2 (JAK2)-mediated intracellular signaling on DNA damage and on the elimination of mutation-bearing cells by programmed cell death. Moreover, we discuss findings that suggest that the acquisition of disease-initiating mutations in hematopoietic stem cells of some MPN patients may be the consequence of an inherent genomic instability that was not previously appreciated.
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MESH Headings
- Animals
- Apoptosis/genetics
- DNA Damage
- Genomic Instability
- Hematopoietic Stem Cells/enzymology
- Hematopoietic Stem Cells/pathology
- Humans
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Myeloproliferative Disorders/enzymology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/pathology
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Polycythemia Vera/pathology
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Primary Myelofibrosis/pathology
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
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Affiliation(s)
- Linda M Scott
- Greehey Children's Cancer Research Institute, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USA.
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Portell CA, Sekeres MA, Rogers HJ, Tiu RV. De novo polycythaemia vera arising 5 years following acute myeloid leukemia remission: suggestion of a chemotherapy resistant JAK2 clone. Br J Haematol 2011; 157:266-7. [PMID: 22150289 DOI: 10.1111/j.1365-2141.2011.08972.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu Z, Yuan H, Zhang X, Liu W, Xu J, Zhang W, Guan M. Development and inter-laboratory validation of unlabeled probe melting curve analysis for detection of JAK2 V617F mutation in polycythemia vera. PLoS One 2011; 6:e26534. [PMID: 22028900 PMCID: PMC3197667 DOI: 10.1371/journal.pone.0026534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/28/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND JAK2 V617F, a somatic point mutation that leads to constitutive JAK2 phosphorylation and kinase activation, has been incorporated into the WHO classification and diagnostic criteria of myeloid neoplasms. Although various approaches such as restriction fragment length polymorphism, amplification refractory mutation system and real-time PCR have been developed for its detection, a generic rapid closed-tube method, which can be utilized on routine genetic testing instruments with stability and cost-efficiency, has not been described. METHODOLOGY/PRINCIPAL FINDINGS Asymmetric PCR for detection of JAK2 V617F with a 3'-blocked unlabeled probe, saturate dye and subsequent melting curve analysis was performed on a Rotor-Gene® Q real-time cycler to establish the methodology. We compared this method to the existing amplification refractory mutation systems and direct sequencing. Hereafter, the broad applicability of this unlabeled probe melting method was also validated on three diverse real-time systems (Roche LightCycler® 480, Applied Biosystems ABI® 7500 and Eppendorf Mastercycler® ep realplex) in two different laboratories. The unlabeled probe melting analysis could genotype JAK2 V617F mutation explicitly with a 3% mutation load detecting sensitivity. At level of 5% mutation load, the intra- and inter-assay CVs of probe-DNA heteroduplex (mutation/wild type) covered 3.14%/3.55% and 1.72%/1.29% respectively. The method could equally discriminate mutant from wild type samples on the other three real-time instruments. CONCLUSIONS With a high detecting sensitivity, unlabeled probe melting curve analysis is more applicable to disclose JAK2 V617F mutation than conventional methodologies. Verified with the favorable inter- and intra-assay reproducibility, unlabeled probe melting analysis provided a generic mutation detecting alternative for real-time instruments.
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Affiliation(s)
- Zhiyuan Wu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Hong Yuan
- Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xinju Zhang
- Central Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Weiwei Liu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wei Zhang
- Shenzhen Key Laboratory for Translational Medicine of Dermatology, Shenzhen-PKU-HKUST Medical Center, Shenzhen, People's Republic of China
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Central Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- * E-mail:
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Rao N, Butcher CM, Lewis ID, Ross DM, Melo JV, Scott HS, Bardy PG, D'Andrea RJ. Clonal and lineage analysis of somatic DNMT3A and JAK2 mutations in a chronic phase polycythemia vera patient. Br J Haematol 2011; 156:268-70. [PMID: 21859430 DOI: 10.1111/j.1365-2141.2011.08837.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Zalcberg IR, Ayres-Silva J, de Azevedo AM, Solza C, Daumas A, Bonamino M. Hydroxyurea dose impacts hematologic parameters in polycythemia vera and essential thrombocythemia but does not appreciably affect JAK2-V617F allele burden. Haematologica 2011; 96:e18-20. [PMID: 21357711 DOI: 10.3324/haematol.2010.037846] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Wang K, Swierczek S, Hickman K, Hakonarson H, Prchal JT. Convergent mechanisms of somatic mutations in polycythemia vera. Discov Med 2011; 12:25-32. [PMID: 21794206 PMCID: PMC4347892] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Polycythemia vera (PV) is an acquired blood disorder, with variable increase of clonal myeloid cells (erythrocytes, granulocytes and platelets) and mostly normal polyclonal T lymphocytes. Most patients have a somatic V617F gain-of-function mutation in JAK2 associated with acquired uniparental disomy (UPD) on chromosome 9p. Yet, the JAK2 V617F mutation is not a PV-initiating event and the family clustering of PV suggests a contribution of inherited genetic events. Using whole-genome SNP arrays, we assayed 34 T-cells and 66 granulocytes (including 32 pairs from the same patients), and identified multiple SNPs around JAK2 that are associated with PV susceptibility (rs11999802, P=1.8E-8, OR=4.4). We also developed a quantitative measure of the fraction of somatic single nucleotide variants (SNVs) based on allele-specific PCR, and a quantitative measure of somatic UPD based on "fractional copy-neutral loss-of-heterozygosity (LOH)" on SNP arrays. Somatic genomic changes in granulocytes revealed strong genetic heterogeneity, including 9p UPD and chromosomal gain. The magnitude of somatic 9p UPD was strongly associated with V617F dosage (r2=0.74, P=4.8E-12), suggesting that UPD preferentially increases the V617F subclone. In granulocytes with heterozygous rs11999802 genotypes, UPD increased the relative fraction of germline risk alleles (P=0.03). Thus, germline risk variants at JAK2 predispose to somatic point mutations within JAK2, whose allelic dosage can be further increased by a serial subclonal expansion of allele-specific UPD or copy number alteration, contributing to PV pathogenesis. We argue that PV represents a unique disease model to study the interplay between germline risk variants and convergent mechanisms of somatic mutations.
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Affiliation(s)
- Kai Wang
- Center for Applied Genomics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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18
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Cişleanu D, Onisâi M, Vlădăreanu AM, Găman M, Neagul AM, Bumbea H, Iova A, Baluţa C, Cazaceanu O, Begu M, Ilea A. Double transformation of a hematopoietic malignancy and severe associated thrombopathy. Case presentation and review of the literature. Rom J Intern Med 2011; 49:137-144. [PMID: 22303605] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the case of a patient with a double transformation during the evolution of chronic hematopoietic malignancy - JAK2 positive chronic myeloproliferative neoplasm; the first transformation had occurred previous to the presentation in our Department, but the second transformation was observed in evolution and it was into a rapidly evolving disease, followed by survival of less than one month. We underline the very poor prognosis -- overall survival of 2.5 years from initial presentation -- a much reduced survival for a chronic myeloproliferative neoplasm, probably due also to multiple associated pathology. Also, the other interesting element of the case is related to the dysfunctional platelets -- hemorrhagic complication at increased platelet count, respectively thrombosis at platelet count under 20000/mmc.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Biomarkers/blood
- Cell Transformation, Neoplastic
- Chronic Disease
- Fatal Outcome
- Humans
- Janus Kinase 2/genetics
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Male
- Mutation
- Platelet Count
- Polycythemia Vera/diagnosis
- Polycythemia Vera/drug therapy
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Primary Myelofibrosis/diagnosis
- Primary Myelofibrosis/drug therapy
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Prognosis
- Pulmonary Embolism/diagnosis
- Risk Factors
- Splenomegaly
- Thrombocytosis/diagnosis
- Venous Thromboembolism/diagnosis
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Affiliation(s)
- Diana Cişleanu
- Hematology Department, Emergency University Hospital Bucharest, Romania
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19
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Antonioli E, Carobbio A, Pieri L, Pancrazzi A, Guglielmelli P, Delaini F, Ponziani V, Bartalucci N, Tozzi L, Bosi A, Rambaldi A, Barbui T, Vannucchi AM. Hydroxyurea does not appreciably reduce JAK2 V617F allele burden in patients with polycythemia vera or essential thrombocythemia. Haematologica 2010; 95:1435-8. [PMID: 20418246 DOI: 10.3324/haematol.2009.021444] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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20
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Tefferi A, Levitt R, Lasho TL, Knudson RA, Ketterling RP. Postimatinib therapy emergence of a new JAK2V617F clone and subsequent development of overt polycythemia vera in a patient with chronic myelogenous leukaemia. Eur J Haematol 2010; 85:86-7. [PMID: 20408872 DOI: 10.1111/j.1600-0609.2010.01458.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
MESH Headings
- Aged
- Amino Acid Substitution
- Antineoplastic Agents/adverse effects
- Benzamides
- Genes, abl
- Humans
- Imatinib Mesylate
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Mutation, Missense
- Piperazines/adverse effects
- Polycythemia Vera/enzymology
- Polycythemia Vera/etiology
- Polycythemia Vera/genetics
- Pyrimidines/adverse effects
- Time Factors
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Abstract
Protein kinases, which serve critical functions in signaling pathways in all cells, are popular therapeutic targets. At present, eight kinase inhibitors have been approved in the United States, each of which shows nanomolar potency. Although the initial goal was to generate inhibitors with a high degree of selectivity, recent experience has revealed that many of these approved compounds target more than one kinase. Surprisingly, this promiscuity is less problematic than one would have imagined; indeed, it opens new therapeutic opportunities. In this Perspective, we discuss the present status of Janus kinase inhibitors-a new class of immunosuppressive drugs-and the advantages and disadvantages of selectively inhibiting this class of kinase.
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Affiliation(s)
- Kamran Ghoreschi
- Molecular Immunology and Inflammation Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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25
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Bernardi M, Ruggeri M, Albiero E, Madeo D, Rodeghiero F. Isolated erythrocytosis in V617F negative patients with JAK2 exon 12 mutations: report of a new mutation. Am J Hematol 2009; 84:258-60. [PMID: 19229983 DOI: 10.1002/ajh.21357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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26
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Guglielmelli P, Barosi G, Pieri L, Antonioli E, Bosi A, Vannucchi AM. JAK2V617F mutational status and allele burden have little influence on clinical phenotype and prognosis in patients with post-polycythemia vera and post-essential thrombocythemia myelofibrosis. Haematologica 2008; 94:144-6. [PMID: 19042918 DOI: 10.3324/haematol.13721] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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27
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Sirhan S, Lasho TL, Hanson CA, Mesa RA, Pardanani A, Tefferi A. The presence of JAK2V617F in primary myelofibrosis or its allele burden in polycythemia vera predicts chemosensitivity to hydroxyurea. Am J Hematol 2008; 83:363-5. [PMID: 18266209 DOI: 10.1002/ajh.21149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
JAK2V617F-positive patients with essential thrombocythemia, as opposed to their mutation-negative counterparts, require lower doses of hydroxyurea (HU) for control of their platelet count. In the current study, we looked for predictors of HU response in 69 patients with primary myelofibrosis (PMF) and 56 with polycythemia vera (PV). JAK2V617F analysis was performed on bone marrow-derived DNA obtained at or near the time of diagnosis. HU response in PMF was associated with a shorter disease duration (P = 0.008), absence of previous therapy (P = 0.01), older age at diagnosis (P = 0.009), and presence of JAK2V617F (P = 0.02). On multivariable analysis, only the latter retained its significance (48% vs. 8% response in mutation positive vs. negative cases). In PV, JAK2V617F allele burden correlated directly with HU response (P = 0.05) and inversely with daily HU dose in responding patients (P = 0.02). The current study suggests that JAK2V617F presence identifies PMF patients who are likely to respond to HU therapy, and information on its allele burden helps in assigning the optimal starting dose in individual patients with PV.
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Affiliation(s)
- Shireen Sirhan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA
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28
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Geron I, Abrahamsson AE, Barroga CF, Kavalerchik E, Gotlib J, Hood JD, Durocher J, Mak CC, Noronha G, Soll RM, Tefferi A, Kaushansky K, Jamieson CHM. Selective inhibition of JAK2-driven erythroid differentiation of polycythemia vera progenitors. Cancer Cell 2008; 13:321-30. [PMID: 18394555 DOI: 10.1016/j.ccr.2008.02.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 12/26/2007] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
Abstract
Polycythemia Vera (PV) is a myeloproliferative disorder (MPD) that is commonly characterized by mutant JAK2 (JAK2V617F) signaling, erythrocyte overproduction, and a propensity for thrombosis, progression to myelofibrosis, or acute leukemia. In this study, JAK2V617F expression by human hematopoietic progenitors promoted erythroid colony formation and erythroid engraftment in a bioluminescent xenogeneic immunocompromised mouse transplantation model. A selective JAK2 inhibitor, TG101348 (300 nM), significantly inhibited JAK2V617F+ progenitor-derived colony formation as well as engraftment (120 mg/kg) in xenogeneic transplantation studies. TG101348 treatment decreased GATA-1 expression, which is associated with erythroid-skewing of JAK2V617F+ progenitor differentiation, and inhibited STAT5 as well as GATA S310 phosphorylation. Thus, TG101348 may be an effective inhibitor of JAK2V617F+ MPDs in clinical trials.
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Affiliation(s)
- Ifat Geron
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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29
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Wernig G, Kharas MG, Okabe R, Moore SA, Leeman DS, Cullen DE, Gozo M, McDowell EP, Levine RL, Doukas J, Mak CC, Noronha G, Martin M, Ko YD, Lee BH, Soll RM, Tefferi A, Hood JD, Gilliland DG. Efficacy of TG101348, a selective JAK2 inhibitor, in treatment of a murine model of JAK2V617F-induced polycythemia vera. Cancer Cell 2008; 13:311-20. [PMID: 18394554 DOI: 10.1016/j.ccr.2008.02.009] [Citation(s) in RCA: 301] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/29/2007] [Accepted: 02/07/2008] [Indexed: 01/04/2023]
Abstract
We report that TG101348, a selective small-molecule inhibitor of JAK2 with an in vitro IC50 of approximately 3 nM, shows therapeutic efficacy in a murine model of myeloproliferative disease induced by the JAK2V617F mutation. In treated animals, there was a statistically significant reduction in hematocrit and leukocyte count, a dose-dependent reduction/elimination of extramedullary hematopoiesis, and, at least in some instances, evidence for attenuation of myelofibrosis. There were no apparent toxicities and no effect on T cell number. In vivo responses were correlated with surrogate endpoints, including reduction/elimination of JAK2V617F disease burden assessed by quantitative genomic PCR, suppression of endogenous erythroid colony formation, and in vivo inhibition of JAK-STAT signal transduction as assessed by flow cytometric measurement of phosphorylated Stat5.
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Affiliation(s)
- Gerlinde Wernig
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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30
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James C. The JAK2V617F mutation in polycythemia vera and other myeloproliferative disorders: one mutation for three diseases? Hematology Am Soc Hematol Educ Program 2008; 2008:69-75. [PMID: 19074061 DOI: 10.1182/asheducation-2008.1.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The discovery of the JAK2V617F mutation has made the diagnosis of polycythemia vera (PV) much easier, but the pathogenesis of PV is still incompletely understood. In particular, it is not yet elucidated how a single mutation can be found in multiple myeloproliferative disorders (MPD) and myelodysplastic syndromes with ring sideroblasts and whether the sole JAK2V617F is sufficient to induce a MPD in humans. Several hypotheses are under investigation such as differences in the targeted hematopoietic stem cells (HSC), host modifier polymorphisms, intensity of JAK2V617F signaling, presence of other somatic mutations, or the presence of a pre-JAK2 event that may vary according to the MPD phenotype. Multiple studies have provided some evidence for and against each hypothesis, but it now seems possible to reconcile these hypotheses into a model that will need to be tested using newly developed tools. Recent investigations have also led to new treatment modalities that could benefit patients with PV.
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MESH Headings
- Amino Acid Substitution
- Animals
- Cell Division
- Humans
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Mice, Transgenic
- Models, Genetic
- Mutation
- Myeloproliferative Disorders/enzymology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/pathology
- Phenotype
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Primary Myelofibrosis/pathology
- Thrombocytosis/enzymology
- Thrombocytosis/genetics
- Thrombocytosis/pathology
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Affiliation(s)
- Chloé James
- INSERM U876, Université Bordeaux 2, Bordeaux, France.
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31
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Toyama K, Karasawa M, Yamane A, Irisawa H, Yokohama A, Saitoh T, Handa H, Matsushima T, Sawamura M, Miyawaki S, Murakami H, Nojima Y, Tsukamoto N. JAK2-V617F mutation analysis of granulocytes and platelets from patients with chronic myeloproliferative disorders: advantage of studying platelets. Br J Haematol 2007; 139:64-9. [PMID: 17854308 DOI: 10.1111/j.1365-2141.2007.06755.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There have been conflicting reports over the JAK2-V617F mutation status of platelets in chronic myeloproliferative diseases (CMPDs). The aim of this study was to analyse JAK2-V617F status, not only in granulocytes but also in platelets. The JAK2-V617F mutation was analysed in both granulocytes and platelets in 115 patients with CMPDs using direct sequencing. JAK2-V617F was detected in granulocytes from 71 of those patients, all 71 of whom also had platelet JAK2-V617F expression. The remaining 44 patients showed negative JAK2-V617F expression on granulocytes, but positive JAK2-V617F expression was detected on the platelets from nine of the 33 essential thrombocythaemia (ET) patients, one of the eight polycythaemia vera patients, and two of the three primary myelofibrosis patients. When ET patients were divided into three groups according to granulocyte and platelet JAK2-V617F status (both-positive, platelets-only positive and both-negative), the both-positive and platelets-only positive groups shared the clinical features of higher white blood cell count and frequent thrombosis. These results suggest that analysis of platelets is a more sensitive approach for detecting JAK2-V617F in CMPD patients than analysis of granulocytes. They also suggest that previous reports of the incidence of JAK2-V617F in CMPD patients, obtained using only analysis of granulocytes, could be underestimations.
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Affiliation(s)
- Kohtaro Toyama
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan
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Gaikwad A, Prchal JT. Study of two tyrosine kinase inhibitors on growth and signal transduction in polycythemia vera. Exp Hematol 2007; 35:1647-56. [PMID: 17976517 PMCID: PMC2206678 DOI: 10.1016/j.exphem.2007.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/20/2007] [Accepted: 08/07/2007] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An activating somatic mutation of Janus kinase 2 V617F (JAK2V617F) is present in most polycythemia vera (PV) patients. We studied efficacy of two potent tyrosine kinase inhibitors (TKI), AEE788 and AMN107, in vitro on cells bearing this mutation. MATERIALS AND METHODS We employed reporter cells expressing wild-type JAK2 and mutant JAK2V617F, human erythroleukemic cells (HEL) carrying JAK2V617F)to study the efficacy of these TKIs by cell proliferation assay, Annexin-V/propidium iodide staining, and on relevant cell-signaling and apoptotic events. These data were compared to ex vivo expanded native human erythroid PV progenitor cells grown in liquid cultures. RESULTS AEE788 showed a time- and dose-dependent growth inhibitory effect that was greater in FDCP cells expressing JAK2V617F and HEL cells than in cells expressing wild-type JAK2. AEE788 caused dephosphorylation of Akt(S243) and signal transducer and activator of transcription 5(Y694) proteins, increase in Annexin-V binding and caspase-3 cleavage, suggesting induction of apoptosis. We also observed AEE788-mediated decrease in heat shock protein 70 and 90 antiapoptotic proteins. Similarly, native PV erythroid progenitors showed more sensitivity to AEE788 than normal erythroid progenitors. AEE788 also exerted dose-dependent inhibition of PV-specific erythroid colonies. Nilotinib (AMN107) however, lacked specificity and required high (>8 microM) concentrations to inhibit growth of JAK2V617F-carrying cells. CONCLUSION Our data suggest that AEE788 exerts its apoptotic activity via downregulation of proliferative and antiapoptotic regulatory proteins. To our knowledge, this is the first report demonstrating the effect of AEE788 on PV erythroid progenitors. Differential effects on PV and normal progenitor cells suggest AEE788 has potential in the treatment of PV and other JAK2V617F positive hematologic malignancies.
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Affiliation(s)
- Amos Gaikwad
- Department of Pediatric-Hematology-Oncology, Texas Children’s Cancer Center, Baylor College of Medicine
| | - Josef T Prchal
- School of Medicine, Hematology Division, University of Utah
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Colaizzo D, Amitrano L, Tiscia GL, Grandone E, Guardascione MA, Margaglione M. A new JAK2 gene mutation in patients with polycythemia vera and splanchnic vein thrombosis. Blood 2007; 110:2768-9. [PMID: 17881638 DOI: 10.1182/blood-2007-05-092502] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hsieh PP, Olsen RJ, O'Malley DP, Konoplev SN, Hussong JW, Dunphy CH, Perkins SL, Cheng L, Lin P, Chang CC. The role of Janus Kinase 2 V617F mutation in extramedullary hematopoiesis of the spleen in neoplastic myeloid disorders. Mod Pathol 2007; 20:929-35. [PMID: 17643100 DOI: 10.1038/modpathol.3800826] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extramedullary hematopoiesis (EMH) in the spleen is a characteristic feature of the chronic myeloproliferative disorders (CMPDs) and various other neoplastic or reactive myeloid conditions. However, the origin of these hematopoietic precursor cells and the molecular mechanisms underlying their development in the spleen is uncertain. The V617F mutation in the Janus Kinase 2 gene (JAK2(V617F)) was recently shown to be frequently and preferentially present in the peripheral blood and bone marrow cells of CMPD patients, and the resulting dysregulation of its downstream targets is important to CMPD pathogenesis. To determine the occurrence and potential role of JAK2(V617F) in splenic EMH cells, we studied splenectomy specimens from 47 patients with significant EMH. JAK2(V617F) was detected by real-time PCR melting curve analysis in 22 specimens, including 11/17 chronic idiopathic myelofibrosis, 7/7 polycythemia vera, 1/1 essential thrombocythemia, 1/3 CMPD unclassifiable, 1/5 chronic myelomonocytic leukemia, 0/5 chronic myelogenous leukemia, 1/3 myelodysplastic syndrome and 0/6 acute myeloblastic leukemia cases, whereas only the JAK2 wild-type allele was detected in the other 25. Nineteen of 20 cases with adequate bone marrow samples available for molecular examination demonstrated concordant JAK2 genotypes. Laser-capture microdissection was then used to enrich the EMH and non-EMH splenic cell fractions, confirming that the mutant alleles specifically originated from the EMH cells. Furthermore, megakaryocytes in the JAK2(V617F)-positive splenectomy specimens expressed higher levels of Bcl-xL, an antiapoptotic protein and downstream target of the JAK2/STAT5 pathway. Thus, JAK2(V617F) is frequently present in splenic EMH cells associated with CMPD, but it is rarely identified in splenic EMH cells associated with other myeloid disorders. Our results indicate that the precursor cells leading to extramedullary hematopoietic expansion in CMPD most likely originate from the transformed bone marrow clone. Also, dysregulation of downstream pathways such as Bcl-xL may be important to CMPD disease pathogenesis in the spleen.
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MESH Headings
- Bone Marrow Cells/chemistry
- Bone Marrow Cells/enzymology
- Chronic Disease
- Hematopoiesis, Extramedullary/genetics
- Humans
- Immunohistochemistry
- Janus Kinase 2/genetics
- Janus Kinase 2/metabolism
- Lasers
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/blood
- Leukemia, Myelomonocytic, Chronic/enzymology
- Leukemia, Myelomonocytic, Chronic/genetics
- Megakaryocytes/chemistry
- Megakaryocytes/enzymology
- Microdissection/methods
- Mutation
- Myelodysplastic Syndromes/blood
- Myelodysplastic Syndromes/enzymology
- Myelodysplastic Syndromes/genetics
- Myeloproliferative Disorders/blood
- Myeloproliferative Disorders/enzymology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/metabolism
- Polycythemia Vera/blood
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Polymerase Chain Reaction
- Primary Myelofibrosis/blood
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Retrospective Studies
- Spleen/chemistry
- Spleen/enzymology
- Thrombocythemia, Essential/blood
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
- United States
- bcl-X Protein/analysis
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Affiliation(s)
- Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine, The Methodist Hospital and the Methodist Hospital Research Institute, Houston, TX 77030, USA
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Ashur-Fabian O, Amariglio N, Cohen Y, Nagler A, Rechavi G, Salomon O. The disappearance of two alleles of JAK2 V617F from peripheral blood of a polycythaemia vera patient correlates with transformation into myelofibrosis. Br J Haematol 2007; 138:822-3. [PMID: 17760813 DOI: 10.1111/j.1365-2141.2007.06743.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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Hussein K, Bock O, Ballmaier M, Göhring G, Steinemann D, Lehmann U, Kemper J, Buhr T, Kreipe H. Familial polycythemia vera with non-germ line JAK2V617F mutation sparing the abnormal and clonal granulopoiesis. Leukemia 2007; 21:2566-8. [PMID: 17625610 DOI: 10.1038/sj.leu.2404846] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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37
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Zhang SJ, Li JY, Li WD, Song JH, Xu W, Qiu HX. The investigation of JAK2 mutation in Chinese myeloproliferative diseases-identification of a novel C616Y point mutation in a PV patient. Int J Lab Hematol 2007; 29:71-2. [PMID: 17224012 DOI: 10.1111/j.1365-2257.2006.00864.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Girodon F, Lippert E, Mossuz P, Dobo I, Boiret-Dupré N, Lesesve JF, Hermouet S, Praloran V. JAK2V617F detection and dosage of serum erythropoietin: first steps of the diagnostic work-up for patients consulting for elevated hematocrit. Haematologica 2007; 92:431-2. [PMID: 17339201 DOI: 10.3324/haematol.10660] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The predictive values of common biological criteria for the diagnosis of polycythemia vera were studied in a cohort of patients with high hematocrit. We found JAK2V617F and erythropoietin assays were the most relevant first tests. Classification of patients according to their JAK2V617F status and erythropoietin levels facilitated the choice of further diagnostic investigations.
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Ditschkowski M, Elmaagacli AH, Trenschel R, Steckel NK, Koldehoff M, Beelen DW. No influence of V617F mutation in JAK2 on outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for myelofibrosis. Biol Blood Marrow Transplant 2007; 12:1350-1. [PMID: 17162218 DOI: 10.1016/j.bbmt.2006.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 07/20/2006] [Indexed: 10/23/2022]
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40
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Mazzotta S, Guerranti R, Gozzetti A, Bucalossi A, Bocchia M, Sammassimo S, Petralia S, Ogueli GI, Lauria F. Increased serum lactate dehydrogenase isoenzymes in Ph-negative chronic myeloproliferative diseases: a metabolic adaptation? ACTA ACUST UNITED AC 2007; 11:239-44. [PMID: 17178662 DOI: 10.1080/10245330600774835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We evaluated the significance of lactate dehydrogenase (LDH) isoenzymes in chronic myeloproliferative disorders (CMDs) by studying LDH isoenzymes in the serum of patients with secondary polycythemia (SP), polycythemia vera (PV), essential thrombocythemia (ET) and idiopathic myelofibrosis (IMF) in different disease status. LDH activity and isoenzymes were evaluated retrospectively in serum samples from four groups of patients and compared with a control group. LDH activity and isoenzyme distributions of patients with SP and PV did not reveal significant variations with respect to controls. In the ET and IMF group LDH isoenzyme revealed significant variations: IMF showed significant increase of LDH2 and significant reduction of LDH5 isoenzyme, whereas ET showed significant decrease in LDH1 and increase of LDH3. These data suggest that LDH isoenzyme patterns may be a useful marker of CMDs, but this enzymatic pattern could be expression of a metabolic adaptation.
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Affiliation(s)
- Serena Mazzotta
- Department of Hematology and Transplants, University of Siena, Siena, Italy.
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41
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Abstract
JAK2(V617F), a mutant of tyrosine kinase JAK2, is found in most patients with polycythemia vera (PV) and a substantial proportion of patients with idiopathic myelofibrosis or essential thrombocythemia. The JAK2 mutant displays a much increased kinase activity and generates a PV-like phenotype in mouse bone marrow transplant models. This study shows that the anti-cancer drug erlotinib (Tarceva) is a potent inhibitor of JAK2(V617F) activity. In vitro colony culture assays revealed that erlotinib at micro-molar concentrations effectively suppresses the growth and expansion of PV hematopoietic progenitor cells while having little effect on normal cells. Furthermore, JAK2(V617F)-positive cells from PV patients show greater susceptibility to the inhibitor than their negative counterparts. Similar inhibitory effects were found with the JAK2(V617F)-positive human erythroleukemia HEL cell line. These data suggest that erlotinib may be used for treatment of JAK2(V617F)-positive PV and other myeloproliferative disorders.
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Affiliation(s)
- Zhe Li
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
- Edmond H. Fischer Signal Transduction Laboratory, College of Life Sciences, Jilin University, Changchun, China
| | - Mingjiang Xu
- Section of Hematology/Oncology, University of Illinois at Chicago Cancer Center, University of Illinois College of Medicine, Chicago, IL, USA
| | - Shu Xing
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
- Edmond H. Fischer Signal Transduction Laboratory, College of Life Sciences, Jilin University, Changchun, China
| | - Wanting Tina Ho
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Takefumi Ishii
- Section of Hematology/Oncology, University of Illinois at Chicago Cancer Center, University of Illinois College of Medicine, Chicago, IL, USA
| | - Qingshan Li
- Edmond H. Fischer Signal Transduction Laboratory, College of Life Sciences, Jilin University, Changchun, China
| | - Xueqi Fu
- Edmond H. Fischer Signal Transduction Laboratory, College of Life Sciences, Jilin University, Changchun, China
| | - Zhizhuang Joe Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
- Edmond H. Fischer Signal Transduction Laboratory, College of Life Sciences, Jilin University, Changchun, China
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42
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Poodt J, Fijnheer R, Walsh IBB, Hermans MHA. A sensitive and reliable semi-quantitative real-time PCR assay to detect JAK2 V617F in blood. Hematol Oncol 2007; 24:227-33. [PMID: 17006961 DOI: 10.1002/hon.800] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diagnosis of the myeloproliferative disorders, polycythemia vera (PV), essential thrombocythemia (ET) and idiopathic myelofibrosis (IMF) is difficult due to lack of diagnostic markers. Recently, the acquisition of a mutation in the Janus kinase 2 (JAK2) gene by hemopoietic cells has been described as a genetic defect underlying myeloproliferative disorders. The mutation leads to constitutive activation of JAK2, a tyrosine kinase involved in cytokine receptor signalling. Because of the clinical importance of this mutation (JAK2 V617F) in diagnosing myeloproliferative disorders and its relevance for disease progression, we developed a semi-quantitative real-time PCR test to detect JAK2 V617F. With this assay, quantities down to 0.8% JAK2 V617F amongst wild-type DNA could reliably be detected. For quantification purposes, low intra- and inter-assay variabilities ensure good reproducibility of the assay. Thus the JAK2 V617F qPCR assay described here is quick, robust, simple and more sensitive than direct sequencing, RFLP, ARMS assay and other methods published so far to detect JAK2 V617F. We therefore believe that the assay will contribute to early diagnosis of myeloproliferative disorders and to disease management, especially when JAK2-specific inhibitors have become available for therapeutic use.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers/blood
- DNA Mutational Analysis
- Female
- Humans
- Janus Kinase 2/blood
- Janus Kinase 2/genetics
- Male
- Middle Aged
- Monitoring, Physiologic
- Mutation, Missense
- Polycythemia Vera/blood
- Polycythemia Vera/diagnosis
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Polycythemia Vera/therapy
- Polymorphism, Restriction Fragment Length
- Primary Myelofibrosis/blood
- Primary Myelofibrosis/diagnosis
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Primary Myelofibrosis/therapy
- RNA, Messenger/blood
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Thrombocythemia, Essential/blood
- Thrombocythemia, Essential/diagnosis
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
- Thrombocythemia, Essential/therapy
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Affiliation(s)
- J Poodt
- Multidisciplinary Laboratory for Molecular Diagnostics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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43
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Larsen TS, Hasselbalch HC, Pallisgaard N, Kerndrup GB. A der(18)t(9;18)(p13;p11) and a der(9;18)(p10;q10) in polycythemia vera associated with a hyperproliferative phenotype in transformation to postpolycythemic myelofibrosis. ACTA ACUST UNITED AC 2007; 172:107-12. [PMID: 17213018 DOI: 10.1016/j.cancergencyto.2006.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 07/31/2006] [Revised: 09/08/2006] [Accepted: 09/19/2006] [Indexed: 10/23/2022]
Abstract
Chromosomal aberrations in polycythemia vera (PV) are heterogenous and nonrandom. A prognostic predictive value of these aberrations has not been established. The V617F mutation in the JAK2 gene on chromosome 9p24.1 was identified recently in peripheral blood leukocytes in the majority of patients with PV and in approximately half of patients with essential thrombocythemia and idiopathic myelofibrosis. Within the JAK2 V617F-positive PV patients, however, clinical presentation and degree of myeloproliferation varies to a great extent. Here we report four cases of chronic myeloproliferative disorders [two with PV, one with PV in transformation to idiopathic myelofibrosis (IMF) and one IMF patient], with the distinct karyotypic abberations der(18) t(9;18) (p13;p11) and der(9;18)(p10;q10). Two patients had hyperproliferative PV and two had "transitional PV" and IMF, respectively. All four patients harbored the JAK2 V617F mutation. Our data, together with previously published data, clearly indicate an association of these chromosomal abnormalities with a highly proliferative PV phenotype with a propensity to transform into postpolycythemic myelofibrosis. Cytogenetic analysis seems to identify a subgroup of patients with a distinct prognostic profile, and should be performed in conjunction with a JAK2 mutation analysis in patients suspected of a chronic myeloproliferative disease.
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MESH Headings
- Aged
- Cell Proliferation
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Chromosomes, Human, Pair 18/enzymology
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 9/enzymology
- Chromosomes, Human, Pair 9/genetics
- Female
- Humans
- Janus Kinase 2/genetics
- Male
- Middle Aged
- Phenotype
- Phenylalanine/genetics
- Polycythemia Vera/complications
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Polycythemia Vera/pathology
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/etiology
- Primary Myelofibrosis/genetics
- Primary Myelofibrosis/pathology
- Translocation, Genetic
- Valine/genetics
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Affiliation(s)
- Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Sdr. Boulevard, 5000 Odense C, Denmark.
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Rossi D, Cortini F, Deambrogi C, Barbieri C, Cerri M, Franceschetti S, Conconi A, Capello D, Gaidano G. Usefulness of JAK2V617F mutation in distinguishing idiopathic erythrocytosis from polycythemia vera. Leuk Res 2007; 31:97-101. [PMID: 16620973 DOI: 10.1016/j.leukres.2006.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 02/25/2006] [Revised: 02/25/2006] [Accepted: 02/27/2006] [Indexed: 11/25/2022]
Abstract
Idiopathic erythrocytosis (IE) is a primary erythrocytosis not fulfilling the criteria for polycythemia vera (PV) diagnosis. In order to verify the relationship between IE and PV, we screened JAK2V617F mutation in a consecutive series of 11 IE and, for comparison, in 15 PV. JAK2V617F mutation was screened by both cDNA sequencing and mutation specific PCR in both peripheral blood and bone marrow samples. All 11 IE tested negative for JAK2V617F mutation, which, conversely, occurred in 11/15 (73.3%) PV. Our results demonstrate that JAK2V617F is absent in IE and may represent a useful molecular marker for distinguishing IE from PV.
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Affiliation(s)
- Davide Rossi
- Division of Haematology, Department of Clinical and Experimental Medicine & IRCAD, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
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45
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Butcher CM, Hutton JF, Hahn U, To LB, Bardy P, Lewis I, D'Andrea RJ. Cellular origin and lineage specificity of the JAK2V617F allele in polycythemia vera. Blood 2007; 109:386-7. [PMID: 17190855 DOI: 10.1182/blood-2006-07-036426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Zaleskas VM, Krause DS, Lazarides K, Patel N, Hu Y, Li S, Van Etten RA. Molecular pathogenesis and therapy of polycythemia induced in mice by JAK2 V617F. PLoS One 2006; 1:e18. [PMID: 17183644 PMCID: PMC1762384 DOI: 10.1371/journal.pone.0000018] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 09/18/2006] [Indexed: 01/17/2023] Open
Abstract
Background A somatic activating mutation (V617F) in the JAK2 tyrosine kinase was recently discovered in the majority of patients with polycythemia vera (PV), and some with essential thrombocythemia (ET) and chronic idiopathic myelofibrosis. However, the role of mutant JAK2 in disease pathogenesis is unclear. Methods and Findings We expressed murine JAK2 WT or V617F via retroviral bone marrow transduction/transplantation in the hematopoietic system of two different inbred mouse strains, Balb/c and C57Bl/6 (B6). In both strains, JAK2 V617F, but not JAK2 WT, induced non-fatal polycythemia characterized by increased hematocrit and hemoglobin, reticulocytosis, splenomegaly, low plasma erythropoietin (Epo), and Epo-independent erythroid colonies. JAK2 V617F also induced leukocytosis and neutrophilia that was much more prominent in Balb/c mice than in B6. Platelet counts were not affected in either strain despite expression of JAK2 V617F in megakaryocytes and markedly prolonged tail bleeding times. The polycythemia tended to resolve after several months, coincident with increased spleen and marrow fibrosis, but was resurrected by transplantation to secondary recipients. Using donor mice with mutations in Lyn, Hck, and Fgr, we demonstrated that the polycythemia was independent of Src kinases. Polycythemia and reticulocytosis responded to treatment with imatinib or a JAK2 inhibitor, but were unresponsive to the Src inhibitor dasatinib. Conclusions These findings demonstrate that JAK2 V617F induces Epo-independent expansion of the erythroid lineage in vivo. The fact that the central erythroid features of PV are recapitulated by expression of JAK2 V617F argues that it is the primary and direct cause of human PV. The lack of thrombocytosis suggests that additional events may be required for JAK2 V617F to cause ET, but qualitative platelet abnormalities induced by JAK2 V617F may contribute to the hemostatic complications of PV. Despite the role of Src kinases in Epo signaling, our studies predict that Src inhibitors will be ineffective for therapy of PV. However, we provide proof-of-principle that a JAK2 inhibitor should have therapeutic effects on the polycythemia, and perhaps myelofibrosis and hemostatic abnormalities, suffered by MPD patients carrying the JAK2 V617F mutation.
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Affiliation(s)
- Virginia M. Zaleskas
- Molecular Oncology Research Institute, Tufts‐New England Medical CenterBoston, Massachusetts, United States of America
| | - Daniela S. Krause
- Molecular Oncology Research Institute, Tufts‐New England Medical CenterBoston, Massachusetts, United States of America
| | - Katherine Lazarides
- Molecular Oncology Research Institute, Tufts‐New England Medical CenterBoston, Massachusetts, United States of America
| | - Nihal Patel
- Molecular Oncology Research Institute, Tufts‐New England Medical CenterBoston, Massachusetts, United States of America
| | - Yiguo Hu
- The Jackson LaboratoryBar Harbor, Maine, United States of America
| | - Shaoguang Li
- The Jackson LaboratoryBar Harbor, Maine, United States of America
| | - Richard A. Van Etten
- Molecular Oncology Research Institute, Tufts‐New England Medical CenterBoston, Massachusetts, United States of America
- * To whom correspondence should be addressed. E-mail:
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47
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Abstract
The molecular basis of polycythemia vera is discussed in the context of the JAK2 V617F mutation, in our view the most important advance in understanding the pathogenesis of polycythemia vera. This chapter discusses the nature of the JAK2 V617F mutation including the studies demonstrating its role in erythropoietin independence and hypersensitivity and endogenous erythroid colony formation. The evolving evidence that JAK2 V617F is not specific for polycythemia vera pathogenesis and the development of disease phenotype is presented as well as alternative candidates for pathogenic mutations such as the protein tyrosine phosphatases and SOCS-3. Finally, the clinical correlations and implications of the JAK2 V617F mutation are discussed.
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Affiliation(s)
- George Chen
- University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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48
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Larsen TS, Pallisgaard N, Christensen JH, Gram-Hansen P, Kerndrup GB, Møller MB, Hasselbalch HC. [New molecular markers within the chronic myeloproliferative disorders. II: the JAK2 mutation]. Ugeskr Laeger 2006; 168:3299-303. [PMID: 17032592] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Philadelphia-negative chronic myeloproliferative disorders feature autonomous myeloid hyperproliferation and hypersensitivity to a number of growth factors, which most recently have been shown to be explained by a guanine-to-thymidine mutation in the Janus tyrosine kinase (JAK2) gene, implicating that phenylalanine is substituted with valine in position 617 (V617F mutation). JAK2 is of particular importance to haematopoiesis, since JAK2 proteins are activated mainly by the haematopoietic growth factors. The JAK2 mutation is present in most patients with polycythaemia vera and about 50% of patients with essential thrombocytosis and idiopathic myelofibrosis. The identification of the JAK2 mutation is a major molecular breakthrough in the understanding of the pathobiology of these disorders, and it is a new molecular marker to be used in the future classification of the diseases as well as a simple and rapid diagnostic test. The mutated JAK2 tyrosine kinase is an obvious potential target for a small-molecule inhibitor of tyrosine kinase activity.
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49
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Delhommeau F, Dupont S, Tonetti C, Massé A, Godin I, Le Couedic JP, Debili N, Saulnier P, Casadevall N, Vainchenker W, Giraudier S. Evidence that the JAK2 G1849T (V617F) mutation occurs in a lymphomyeloid progenitor in polycythemia vera and idiopathic myelofibrosis. Blood 2006; 109:71-7. [PMID: 16954506 DOI: 10.1182/blood-2006-03-007146] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The JAK2 V617F mutation has recently been described as an essential oncogenic event associated with polycythemia vera (PV), idiopathic myelofibrosis (IMF), and essential thrombocythemia. This mutation has been detected in all myeloid lineages but has not yet been detected in lymphoid cells. This raises the question whether this molecular event occurs in a true lymphomyeloid progenitor cell. In this work, we studied the presence of the mutation in peripheral blood cells and sorted B, T, and natural killer (NK) cells from PV and IMF. We detected the JAK2 V617F mutation in B and NK cells in approximately half the patients with IMF and a minority of those with PV. Moreover, in a few cases patients with IMF had mutated peripheral T cells. The mutation (homozygous or heterozygous) could be subsequently detected in B/NK/myeloid progenitors from PV and IMF, with a much higher frequency in clones derived from IMF. Using the fetal thymus organ culture (FTOC) assay, the mutation was also detected in all T-cell fractions derived from IMF and PV CD34+ cells. These results demonstrate that myeloproliferative disorders take their origin in a true myeloid/lymphoid progenitor cell but that their phenotype is related to a downstream selective proliferative advantage of the myeloid lineages.
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Affiliation(s)
- François Delhommeau
- INSERM U790, Université Paris Sud; Institut Gustave Roussy, Pavillon de recherche 1, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
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50
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Samuelsson J, Mutschler M, Birgegård G, Gram-Hansen P, Björkholm M, Pahl HL. Limited effects on JAK2 mutational status after pegylated interferon alpha-2b therapy in polycythemia vera and essential thrombocythemia. Haematologica 2006; 91:1281-2. [PMID: 16956836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Twenty-five patients with myeloproliferative diseases were treated with pegylated interferon alpha-2b. Prior to therapy, 15/25 patients had a JAK2(V617F) mutation. Eight JAK2-positive patients were on therapy in hematological complete remission at 24 months. Five of eight patients demonstrated a 1.2-3.6 fold reduction in the percentage of JAK2(V617F) cells.
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