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Blood, 15 December 2006, Vol. 108, No. 13, pp. 4232-4236.
Prepublished online as a Blood First Edition Paper on August 29, 2006; DOI 10.1182/blood-2006-05-025148.


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Submitted May 23, 2006
Accepted August 8, 2006

Molecular basis of clonal expansion of hematopoiesis in two patients with paroxysmal nocturnal hemoglobinuria (PNH)

Norimitsu Inoue, Tomohisa Izui-Sarumaru, Yoshiko Murakami, Yuichi Endo, Jun-Ichi Nishimura, Ken Kurokawa, Maki Kuwayama, Hiroaki Shime, Takashi Machii, Yuzuru Kanakura, Gabrielle Meyers, Carl Wittwer, Zhong Chen, William Babcock, Debra Frei-Lahr, Charles J. Parker, and Taroh Kinoshita*

Department of Molecular Genetics, Osaka Medical Center for Cancer, Osaka, Japan
Department of Immunoregulation, Research Institute for Microbial Diseases, Osaka University, Japan
Research Institute for Microbial Diseases, Osaka University, Japan
Research Institute for Microbial Diseases, Osaka University
Department of Medicine, Duke University Medical Center, Durham, NC, USA
Genome Information Research Center, Osaka University, Osaka, Japan
Osaka University/Osaka University School of Medicine, Osaka, Japan
Department of Hematology and Oncology, Osaka University School of Medicine, Osaka, Japan
University of Utah School of Medicine/George E. Whalen VA Medical Center, Salt Lake City, Utah, USA
Department of Pathalogy, University of Utah School of Medicine, Salt Lake City, Utah, USA
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
Department of Medicine, Division of Hematology/Oncology, Baptist Medical Center, Columbia, SC, USA
Department of Medicine, Division of Hematology, Medical University of South Carolina, SC, USA
Osaka University, Osaka, Japan/Japan Science and Technology Agency, Saitama, Japan

* Corresponding author; email: tkinoshi{at}biken.osaka-u.ac.jp.

Somatic mutation of PIGA in hematopoietic stem cells causes deficiency of glycosyl phosphatidylinositol-anchored proteins in paroxysmal nocturnal hemoglobinuria (PNH) that underlies the intravascular hemolysis but does not account for expansion of the PNH clone. Immune mechanisms may mediate clonal selection but appear insufficient to account for the clonal dominance necessary for PNH to become clinically apparent. Herein we report two PNH patients whose PIGA-mutant cells had a concurrent, acquired rearrangement of chromosome 12. In both cases, der(12) had a break within the 3' untranslated region of HMGA2, the architectural transcription factor gene deregulated in many benign mesenchymal tumors, that caused ectopic expression of HMGA2 in the bone marrow. These observations suggest that aberrant HMGA2 expression, in concert with mutant PIGA, accounts for clonal hematopoiesis in these two patients and suggest the concept of PNH as a benign tumor of the bone marrow.


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