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Blood, 1 January 2001, Vol. 97, No. 1, pp. 147-153
HEMATOPOIESIS
Impaired survival of bone marrow hematopoietic progenitor cells
in cyclic neutropenia
Andrew A. G. Aprikyan,
W.
Conrad Liles,
Elin Rodger,
Mechthild Jonas,
Emil Y. Chi, and
David C. Dale
From the Departments of Medicine and Pathology,
University of Washington School of Medicine, Seattle, WA.
Cyclic neutropenia (CN) is a congenital hematopoietic disorder
characterized by remarkably regular oscillations of blood neutrophils from near normal to extremely low levels at 21-day intervals. Recurring
episodes of severe neutropenia lead to repetitive and sometimes
life-threatening infections. To investigate the cellular mechanism of
CN, the ultrastructure and the proliferative and survival
characteristics of bone marrow-derived CD34+ early
progenitors, CD33+/CD34 myeloid progenitors,
and CD15+ neutrophil precursors from CN patients and
healthy volunteers were studied. The ultrastructural studies showed
profound apoptotic features in bone marrow progenitor cells in CN.
Colony-forming assays demonstrated a 75% decrease in the number of
early myeloid-committed colonies compared with controls. Long-term
culture-initiating cell assays demonstrated a 6-fold increase in
production of primitive progenitor cells in CN. To determine whether
accelerated apoptosis might account for the underproduction of myeloid
progenitors, the hematopoietic subpopulations were labeled with
fluorescein isothiocyanate-annexin V and analyzed by flow cytometry.
Short-term culture of CN cells resulted in apoptosis of approximately
65% of CD34+ cells, 80% of
CD33+/CD34 cells, and more than 70% of
CD15+ cells, as compared with 20%, 7%, and 15% apoptosis
in respective control subpopulations. Evidence of accelerated apoptosis
of bone marrow progenitor cells was observed in all 8 patients
participating in the study, regardless of the stage in the CN cycle in
which bone marrow aspirations were obtained. Granulocyte
colony-stimulating factor therapy of CN patients significantly improved
survival of bone marrow progenitor cells. These data indicate that
ineffective production of neutrophils is due to accelerated apoptosis
of bone marrow myeloid progenitor cells in CN.

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