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2017 ; 129
(12
): 1607-1616
Nephropedia Template TP
Blood
2017[Mar]; 129
(12
): 1607-1616
PMID28159736
show ga
Myeloproliferative neoplasms (MPNs) arise in the hematopoietic stem cell (HSC)
compartment as a result of the acquisition of somatic mutations in a single HSC
that provides a selective advantage to mutant HSC over normal HSC and promotes
myeloid differentiation to engender a myeloproliferative phenotype. This
population of somatically mutated HSC, which initiates and sustains MPNs, is
termed MPN stem cells. In >95% of cases, mutations that drive the development of
an MPN phenotype occur in a mutually exclusive manner in 1 of 3 genes: JAK2,
CALR, or MPL The thrombopoietin receptor, MPL, is the key cytokine receptor in
MPN development, and these mutations all activate MPL-JAK-STAT signaling in MPN
stem cells. Despite common biological features, MPNs display diverse disease
phenotypes as a result of both constitutional and acquired factors that influence
MPN stem cells, and likely also as a result of heterogeneity in the HSC in which
MPN-initiating mutations arise. As the MPN clone expands, it exerts
cell-extrinsic effects on components of the bone marrow niche that can favor the
survival and expansion of MPN stem cells over normal HSC, further sustaining and
driving malignant hematopoiesis. Although developed as targeted therapies for
MPNs, current JAK2 inhibitors do not preferentially target MPN stem cells, and as
a result, rarely induce molecular remissions in MPN patients. As the
understanding of the molecular mechanisms underlying the clonal dominance of MPN
stem cells advances, this will help facilitate the development of therapies that
preferentially target MPN stem cells over normal HSC.