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Blood, 15 November 2000, Vol. 96, No. 10, pp. 3310-3321
PLENARY PAPER
Hypersensitivity of circulating progenitor cells to megakaryocyte
growth and development factor (PEG-rHu MGDF) in essential
thrombocythemia
Arthur A. Axelrad,
Denise Eskinazi,
Paulo N. Correa, and
Dominick Amato
From the Department of Anatomy and Cell Biology and
Medical Biophysics, University of Toronto; and the Department of
Medicine (Hematology/ Oncology), Mt Sinai Hospital, Toronto, Ontario,
Canada.
Hematopoietic progenitor cells in 2 myeloproliferative disorders,
juvenile chronic myelomonocytic leukemia and polycythemia vera, are
known to be hypersensitive to cytokines that control normal progenitor
cell proliferation, differentiation, and survival in their respective
granulocyte/macrophage and erythroid lineages. Because thrombopoietin
controls these functions in the normal megakaryocytic lineage, we asked
the question: Are megakaryocytic progenitor cells in the
myeloproliferative disorder essential thrombocythemia (ET)
hypersensitive to thrombopoietin? Peripheral blood mononuclear cells
from patients with ET, or secondary (reactive) thrombocytosis (2°T),
or healthy volunteers were grown in strictly serum-free agarose culture
containing interleukin 3 (IL-3) and all-trans-retinoic acid, with
various concentrations of PEG-rHu megakaryocyte growth and development
factor (MGDF). The concentration of cytokine at half-maximum colony
number served as a measure of progenitor cell sensitivity.
Hypersensitivity to PEG-rHu MGDF was found in circulating progenitors
from 18 of 20 (90%) informative patients with presumptive diagnosis
ET, 1 of 8 (12.5%) 2 °T patients, and none of the 22 healthy
volunteers. Median MGDF sensitivity ratio in ET patients was
approximately 53 times greater than in the controls. This
hypersensitivity, which was also directed to rHu thrombopoietin, was
highly specific with respect to cytokine, disease, and cell lineage. We
propose that, despite their single pluripotential cell origin, the
different clinicopathologic phenotypes in different chronic
myeloproliferative disorders are determined by lineage-restricted
hypersensitivities of hematopoietic progenitor cells to endogenous
cytokines. This work emphasizes the importance of stringent serum-free
conditions for revealing true sensitivities to cytokines. The findings
also offer a basis for evolving a positive test for ET, a diagnosis now
made essentially by exclusion.

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