Three gene networks discovered in autism, may present treatment targets

Hakon Hakonarson, MD, PhDA large new analysis of DNA from thousands of patients has uncovered several underlying gene networks with potentially important roles in autism. These networks may offer attractive targets for developing new autism drugs or repurposing existing drugs that act on components of the networks.

Furthermore, one of the autism-related gene pathways also affects some patients with attention-deficit hyperactivity disorder (ADHD) and schizophrenia — raising the possibility that a class of drugs may treat particular subsets of all three neurological disorders.

‘Neurodevelopmental disorders are extremely heterogeneous, both clinically and genetically,’ said study leader Hakon Hakonarson, MD, PhD, director of the Center for Applied Genomics at The Children’s Hospital of Philadelphia (CHOP). ‘However, the common biological patterns we are finding across disease categories strongly imply that focusing on underlying molecular defects may bring us closer to devising therapies.’

The study by Hakonarson and colleagues draws on gene data from CHOP’s genome center as well as from the Autism Genome Project and the AGRE Consortium, both part of the organisation Autism Speaks.

Autism spectrum disorders (ASDs), of which autism is the best known, are a large group of heritable childhood neuropsychiatric conditions characterised by impaired social interaction and communication, as well as by restricted behaviours. The authors note that recent investigations suggest that up to 400 distinct ASDs exist.

The current research is a genome-wide association study comparing more than 6,700 patients with ASDs to over 12,500 control subjects. It was one of the largest-ever studies of copy number variations (CNVs) in autism. CNVs are deletions or duplications of DNA sequences, as distinct from single-base changes in DNA.

The study team focused on CNVs within defective gene family interaction networks (GFINs) — groups of disrupted genes acting on biological pathways. In patients with autism, the team found three GFINs in which gene variants perturb how genes interact with proteins. Of special interest to the study group was the metabotropic glutamate receptor (mGluR) signalling pathway, defined by the GRM family of genes that affects the neurotransmitter glutamate, a major chemical messenger in the brain regulating functions such as memory, learning, cognition, attention and behaviour.

Hakonarson’s team and other investigators previously reported that 10 percent or more of ADHD patients have CNVs in genes along the glutamate receptor metabotropic (GRM) pathway, while other teams have implicated GRM gene defects in schizophrenia.

Based on these findings, Hakonarson is planning a clinical trial in selected ADHD patients of a drug that activates the GRM pathway. ‘If drugs affecting this pathway prove successful in this subset of patients with ADHD, we may then test these drugs in autism patients with similar gene variants,’ he said.

In ASDs and other complex neurodevelopmental disorders, common gene variants often have very small individual effects, while very rare gene variants exert stronger effects. Many of these genes with very rare defects belong to gene families that may offer druggable targets.

The three gene families found in the current study have notable functional roles. The CALM1 network includes the calmodulin family of proteins, which regulate cell signaling and neurotransmitter function. The MXD-MYC-MAX gene network is involved in cancer development, and may underlie links reported between autism and specific types of cancer. Finally, members of the GRM gene family affect nerve transmission, neuron formation, and interconnections in the brain — processes highly relevant to ASDs. Children’s Hospital of Philadelphia

Scientists take totally tubular journey through brain cells

In a new study, scientists at the National Institutes of Health took a molecular-level journey into microtubules, the hollow cylinders inside brain cells that act as skeletons and internal highways. They watched how a protein called tubulin acetyltransferase (TAT) labels the inside of microtubules. The results answer long-standing questions about how TAT tagging works and offer clues as to why it is important for brain health.
Microtubules are constantly tagged by proteins in the cell to designate them for specialized functions, in the same way that roads are labelled for fast or slow traffic or for maintenance. TAT coats specific locations inside the microtubules with a chemical called an acetyl group. How the various labels are added to the cellular microtubule network remains a mystery. Recent findings suggested that problems with tagging microtubules may lead to some forms of cancer and nervous system disorders, including Alzheimer’s disease, and have been linked to a rare blinding disorder and Joubert Syndrome, an uncommon brain development disorder.
‘This is the first time anyone has been able to peer inside microtubules and catch TAT in action,’ said Antonina Roll-Mecak, Ph.D., an investigator at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, and the leader of the study.
Microtubules are found in all of the body’s cells. They are assembled like building blocks, using a protein called tubulin. Microtubules are constructed first by aligning tubulin building blocks into long strings. Then the strings align themselves side by side to form a sheet. Eventually the sheet grows wide enough that it closes up into a cylinder. TAT then bonds an acetyl group to alpha tubulin, a subunit of the tubulin protein.
Some microtubules are short-lived and can rapidly change lengths by adding or removing tubulin pieces along one end, whereas others remain unchanged for longer times. Recognising the difference may help cells function properly. For example, cells may send cargo along stable microtubules and avoid ones that are being rebuilt. Cells appear to use a variety of chemical labels to describe the stability of microtubules.
‘Our study uncovers how TAT may help cells distinguish between stable microtubules and ones that are under construction,’ said Dr. Roll-Mecak. According to Dr. Roll-Mecak, high levels of microtubule tagging are unique to nerve cells and may be the reason that they have complex shapes allowing them to make elaborate connections in the brain.
For decades scientists knew that the insides of long-lived microtubules were often tagged with acetyl groups by TAT. Changes in acetylation may influence the health of nerve cells. Some studies have shown that blocking this form of microtubule tagging leads to nerve defects, brain abnormalities or degeneration of nerve fibres. Since the discovery of microtubule acetylation, scientists have been puzzled about how TAT accesses the inside of the microtubules and how the tagging reaction happens.
To watch TAT at work, Dr. Roll-Mecak and her colleagues took high resolution movies of individual TAT molecules interacting with microtubules in real time. They saw that TAT surfs through the inside of microtubules and although it can find acetylation sites quickly, the process of adding the tag occurs very slowly.
In general, tagging reactions work like keys fitting into locks: the better the key fits, the faster the lock can open. Similarly, the rate of the reactions is determined by how well TAT molecules fit around tagging sites.
Dr. Roll-Mecak’s team investigated this idea by using a technique called X-ray crystallography to look at how atoms on TAT molecules interact with acetylation sites on tubulin molecules. Their results suggested that TAT fit poorly around the sites.
‘It looks as though TAT can easily journey through microtubules spotting acetylation sites but may only label those that are stable for longer periods of time,’ said Dr. Roll-Mecak.
This may help cells identify the microtubules they need to rapidly change shapes or send cargo to other places. Further studies may help researchers understand how microtubule tagging influences nerve cells in health and disease. National Institute of Neurological Disorders and Stroke

Involving a genetic health care professional may improve quality, reduce unnecessary testing

A new Moffitt Cancer Center study shows that counselling from a genetic health care provider before genetic testing educates patients and may help reduce unnecessary procedures.

Up to 10 percent of cancers are inherited, meaning a person was born with an abnormal gene that increases their risk for cancer. ‘Pre-test genetic counselling in which a health care provider takes a thorough family history and discusses the potential risks and benefits of genetic testing is standard of care as recommended by the American Society of Clinical Oncology and National Society of Genetic Counselors,’ said Tuya Pal, M.D., a board-certified geneticist at Moffitt and senior author of the paper.

In the Moffitt study, researchers surveyed 473 patients who had genetic testing for BRCA1 and BRCA2 gene mutations, which are associated with an increased risk of breast and ovarian cancers. Among study participants who saw a board-certified geneticist or genetic counsellor, almost all recalled having a pre-test discussion, compared to only 59 percent of those who did not. These findings suggest large differences in quality of care across providers who order testing.

The researchers also suggest there may be cost-of-care implications when genetic health care providers are involved. ‘Our results suggest that genetic health care providers are less likely to order more expensive comprehensive genetic testing, when less expensive testing may be appropriate,’ said Deborah Cragun, Ph.D., lead study author and post-doctoral fellow at Moffitt. ‘Our study found that in cases where less expensive testing may be appropriate, genetic health care providers ordered comprehensive testing for 9.5 percent of participants, compared to 19.4 percent when tests were ordered by other health care providers. At the time of data collection, comprehensive genetic testing cost approximately $4,000, compared to $400 for the less expensive testing.’

The findings are important, noted researchers, because costs and quality of care are often the focus of policy-level decisions in health care. Moffitt Cancer Center

Found: ‘master’ protein in pulmonary fibrosis

This spring has brought rare but tangible moments of progress against the devastating lung disease idiopathic pulmonary fibrosis (IPF), which afflicts millions of people worldwide. Two drugs recently showed promise in clinical trials, and now a study offers both an unprecedentedly deep explanation of how the disease progresses and introduces another potential therapeutic avenue.
The new study features a central figure: an evolutionarily ancient protein called ‘chitinase 3-like-1’ (CHI3L1). The authors implicate it as the ‘master regulator’ of what appears to be a tragically errant repair response to the mysterious lung injuries that give rise to the disease. In describing how CHI3L1 works in IPF, the research also points to a strategy for treatment.
The report demonstrates that CHI3L1 is produced to help in response to the injury. It feeds back to protect injured cells from dying and simultaneously stimulates tissue repair to patch the damage that has occurred. But the study also shows how this dual role contributes to the ultimate problem. If IPF resulted from a single injury, like a paper cut, CHI3L1 would decrease the injury and cause local scarring while it restored tissue integrity. In that case, the amount of scarring would not be excessive and tissue function would not be significantly altered. But in IPF lungs, cells undergo ongoing injury, so CHI3L1 is chronically elevated and scar tissue accumulates. As CHI3L1 rescues cell after cell, the scarring builds up, eventually compromising the lung’s ability to breathe. In IPF, 70 percent of patients die within five years.
‘The CHI3L1 is doing exactly what it is supposed to do — it is designed to shut off cell death and decrease injury,’ said Dr. Jack A. Elias, a co-senior author of the study and dean of medicine and biological sciences at Brown University. He is joined on the paper by a host of his former colleagues and students at Yale University where the research occurred. ‘But at the same time it is decreasing cell death it is driving the fibrosis. You’ve got this ongoing injury so you’ve got these ongoing attempts to shut off injury which stimulate scarring.’
 
 
They compared tissues and serum from normal patients, outpatients with IPF, and patients with an acute exacerbation (AE) of IPF. In AE, widespread lung injury is superimposed on the pulmonary fibrosis, which frequently occurs before patients die. In lung biopsies and serum, they found that CHI3L1 levels are elevated in both tissue compartments in the outpatients with IPF and that the levels of CHI3L1 correlated with their disease progression. In the patients with AE, elevated levels of CHI3L1 were not noted, showing that the levels of CHI3L1 decrease right before the patients die.
‘This demonstrates that the CHI3L1 plays a key role in controlling lung injury in this setting,’ Elias said.
After documenting that elevated levels of CHI3L1 correlate with ongoing fibrosis and scarring and that a lack of the protein associates with widespread cell death, the team engaged in several manipulations of CHI3L1 in mice to see how levels and the clinical outcomes might be related. (In mice, CHI3L1 is also called BRP-39.)
Scientists can induce an IPF-like response in mice using a drug called bleomycin. In mice given bleomycin, the researchers found that the levels of CHI3L1 declined at first and then surged. At the times when the protein levels were low, cell damage occurred, and when the protein surged, the excessive scarring set in.
In previous research the team had engineered several lines of genetically modified mice. Some were transgenic and can produce CHI3l1 on chemically delivered command. Other mice were engineered to never produce BRP-39 — the mouse version of CHI3L1 — at all.
Using these mice, the researchers found that if they triggered CHI3L1 production early after administering bleomycin, the mice fared well, experiencing less injury, less damage and less scarring than controls. If they waited several days after bleomycin to trigger CHI3L1, the mice fared very poorly and scarring and mortality went up.
Mice who couldn’t produce CHI3L1/BRP-39, had acute lung cell damage, somewhat like AE patients who have a relative deficiency of CHI3L1. However, without CHI3L1 they did not generate much scarring.
All of these findings were supplemented with several other experiments that were designed to learn how CHI3L1 interacts with other cells involved in the tissue repair response in both human and mouse lungs. The experiments, including studies conducted in a bioengineered 3-D model of lung tissue seeded with relevant cells, showed that CHI3L1 regulates a pathway that recruits cells such as macrophages and fibroblasts that produce the scarring, or fibrosis.
In all, the results show that CHI3L1 plays a fundamental role in the course, if not the origin, of IPF. An ongoing buildup of it results in excessive scarring. Too little and cells die much more frequently.
‘To my knowledge this is the first comprehensive paper that’s been able to explain the many facets and presentations of IPF,’ Elias said. ‘It explains and links the injury and the repair responses that are critical in the disease. It also provides an explanation for the slowly progressing patients and the patients that experience acute exacerbations.’ Brown University

Are female hormones playing a key role in obesity epidemic?

An imbalance of female sex hormones among men in Western nations may be contributing to high levels of male obesity, according to new research from the University of Adelaide.
In a paper researchers from the University’s School of Medical Sciences suggest that obesity among Western men could be linked with exposure to substances containing the female sex hormone oestrogen – substances that are more often found in affluent societies, such as soy products and plastics.
The research was conducted by University of Adelaide medical student James Grantham and co-authored by Professor Maciej Henneberg, Wood Jones Professor of Anthropological and Comparative Anatomy.
Mr Grantham compared obesity rates among men and women from around the world with measures such as Gross Domestic Product to determine the impact of affluence on obesity. He found that while it was normal for women in the developing world to have significantly greater levels of obesity than men, the developed world offers quite a different picture.
‘Hormonally driven weight gain occurs more significantly in females than in males, and this is very clear when we look at the rates of obesity in the developing world,’ Mr Grantham says.
‘However, in the Western world, such as in the United States, Europe and Australia, the rates of obesity between men and women are much closer. In some Western nations, male obesity is greater than female obesity.
‘While poor diet is no doubt to blame, we believe there is more to it than simply a high caloric intake,’ Mr Grantham says.
Professor Henneberg says: ‘Exposure to oestrogen is known to cause weight gain, primarily through thyroid inhibition and modulation of the hypothalamus. Soy products contain xenoestrogens, and we are concerned that in societies with a high dietary saturation of soy, such as the United States, this could be working to ‘feminise’ the males. This would allow men in those communities to artificially imitate the female pattern of weight gain.
‘Another well-established source of xenoestrogen is polyvinyl chloride, known as PVC. This product is in prominent use in most wealthy countries, from plastic medical devices to piping for our water supplies.’
Professor Henneberg says micro-evolutionary changes may be occurring within Western societies that could also be leading to changes in testosterone and oestrogen in men. ‘This would certainly explain the various concerns about sperm count reductions among men in developed nations,’ he says.
Professor Henneberg and Mr Grantham say further research is needed to better understand whether or not environmental factors are leading to a ‘feminisation’ of men in the Western world. University of Adelaide

Discovery may lead to improvements in diagnosing, treating Alzheimer’s disease

A new drug target to fight Alzheimer’s disease has been discovered by a research team led by Gong Chen, a professor of biology and the Verne M. Willaman Chair in Life Sciences at Penn State. The discovery also has potential for development as a novel diagnostic tool for Alzheimer’s disease, which is the most common form of dementia and one for which no cure has yet been found.

Chen’s research was motivated by the recent failure in clinical trials of once-promising Alzheimer’s drugs being developed by large pharmaceutical companies. ‘Billions of dollars were invested in years of research leading up to the clinical trials of those Alzheimer’s drugs, but they failed the test after they unexpectedly worsened the patients’ symptoms,’ Chen said.

The research behind those drugs had targeted the long-recognised feature of Alzheimer’s patients’ brains: the sticky buildup of the amyloid protein known as plaques, which can cause neurons in the brain to die.

‘The research of our lab and others now has focused on finding new drug targets and on developing new approaches for diagnosing and treating Alzheimer’s disease,’ Chen explained.

‘We recently discovered an abnormally high concentration of one inhibitory neurotransmitter in the brains of deceased Alzheimer’s patients,’ Chen said.

He and his research team found the neurotransmitter, called GABA (gamma-aminobutyric acid), in deformed cells called ‘reactive astrocytes’ in a structure in the core of the brain called the dentate gyrus. This structure is the gateway to hippocampus, an area of the brain that is critical for learning and memory.

Chen’s team found that the GABA neurotransmitter was drastically increased in the deformed versions of the normally large, star-shaped ‘astrocyte’ cells which, in a healthy individual, surround and support individual neurons in the brain. ‘Our research shows that the excessively high concentration of the GABA neurotransmitter in these reactive astrocytes is a novel biomarker that we hope can be targeted in further research as a tool for the diagnosis and treatment of Alzheimer’s disease,’ Chen said.

Chen’s team developed new analysis methods to evaluate neurotransmitter concentrations in the brains of normal and genetically modified mouse models for Alzheimer’s disease (AD mice).

‘Our studies of AD mice showed that the high concentration of the GABA neurotransmitter in the reactive astrocytes of the dentate gyrus correlates with the animals’ poor performance on tests of learning and memory,’ Chen said.

His lab also found that the high concentration of the GABA neurotransmitter in the reactive astrocytes is released through an astrocyte-specific GABA transporter, a novel drug target found in this study, to enhance GABA inhibition in the dentate gyrus. With too much inhibitory GABA neurotransmitter, the neurons in the dentate gyrus are not fired up like they normally would be when a healthy person is learning something new or remembering something already learned.

Importantly, Chen said, ‘After we inhibited the astrocytic GABA transporter to reduce GABA inhibition in the brains of the AD mice, we found that they showed better memory capability than the control AD mice. We are very excited and encouraged by this result because it might explain why previous clinical trials failed by targeting amyloid plaques alone. One possible explanation is that while amyloid plaques may be reduced by targeting amyloid proteins, the other downstream alterations triggered by amyloid deposits, such as the excessive GABA inhibition discovered in our study, cannot be corrected by targeting amyloid proteins alone. Our studies suggest that reducing the excessive GABA inhibition to the neurons in the brain’s dentate gyrus may lead to a novel therapy for Alzheimer’s disease. An ultimate successful therapy may be a cocktail of compounds acting on several drug targets simultaneously.’ Penn State University

Biomarkers predict long-term outcomes in juvenile idiopathic arthritis

Different mechanisms of response could explain poor treatment response in rheumatoid factor positive patients
Data demonstrate the possibility of using biomarkers (developed from whole blood gene expression profiles) in children with juvenile idiopathic arthritis (JIA) to predict the status of their disease at 12 months. The long-term disease status at 12 months was accurately predicted only after treatment had been initiated, in newly diagnosed patients.
JIA is the most common childhood chronic rheumatic disease, affecting 16-150 children in every 100,000. As indicated by the name, the cause of JIA is largely unknown.3
‘By predicting disease progression in these young children we can better understand the course of the disease and how best to treat the individual,’ said lead author of the study Professor James Jarvis, from the Department of Paediatrics, University at Buffalo, Buffalo, New York.
Blood gene expression profiling has led to major advances in the field of rheumatology over the last decade but to date it has only been possible to predict therapeutic outcome at 6 months.
‘The challenge was to test the feasibility of using these prognostic biomarkers from whole blood gene expression profiles in children with newly diagnosed JIA to predict disease status at one year,’ explained Professor Jarvis. ‘Baseline expression profiles that could predict disease status at six months could not predict status at 12 months. However, using four month data (the earliest point at which samples were collected from children on treatment) we were able to determine strong predictive properties for disease status at 12 months. Thus, after children had initiated therapy longer term outcome was predictable,’ Professor Jarvis said.
In this study, researchers also discovered the appearance of different mechanisms of response in Rheumatoid Factor (RF) positive and RF negative patients after four months of therapy, a finding that could explain the relative refractoriness of RF positive patients to otherwise effective therapies.
Whole blood expression profiles were studied from children enrolled in the TREAT study, an NIH-funded clinical trial comparing methotrexate (MTX) with MTX + etanercept in children with newly-diagnosed JIA. Gene expression profiles were examined to determine those genes whose expression levels best predicted outcome (active vs. inactive disease) at 12 months.
Researchers have described seven types of JIA, which are distinguished by their signs and symptoms, the number of joints affected, the results of laboratory tests, and the family history. In general, symptoms include joint pain, swelling, tenderness and stiffness that last for more than six continuous weeks; the condition can also affect the eyes and lymph nodes. EurekAlert

Researchers find gene critical for development of brain motor centre

An Ottawa-led team of researchers describe the role of a specific gene, called Snf2h, in the development of the cerebellum. Snf2h is required for the proper development of a healthy cerebellum, a master control centre in the brain for balance, fine motor control and complex physical movements.

Athletes and artists perform their extraordinary feats relying on the cerebellum. As well, the cerebellum is critical for the everyday tasks and activities that we perform, such as walking, eating and driving a car. By removing Snf2h, researchers found that the cerebellum was smaller than normal, and balance and refined movements were compromised.

Led by Dr. David Picketts, a senior scientist at the Ottawa Hospital Research Institute and professor in the Faculty of Medicine at the University of Ottawa, the team describes the Snf2h gene, which is found in our brain’s neural stem cells and functions as a master regulator. When they removed this gene early on in a mouse’s development, its cerebellum only grew to one-third the normal size. It also had difficulty walking, balancing and coordinating its movements, something called cerebellar ataxia that is a component of many neurodegenerative diseases.

‘As these cerebellar stem cells divide, on their journey toward becoming specialized neurons, this master gene is responsible for deciding which genes are turned on and which genes are packed tightly away,’ said Dr. Picketts. ‘Without Snf2h there to keep things organized, genes that should be packed away are left turned on, while other genes are not properly activated. This disorganization within the cell’s nucleus results in a neuron that doesn’t perform very well—like a car running on five cylinders instead of six.’

The cerebellum contains roughly half the neurons found in the brain. It also develops in response to external stimuli. So, as we practice tasks, certain genes or groups of genes are turned on and off, which strengthens these circuits and helps to stabilize or perfect the task being undertaken. The researchers found that the Snf2h gene orchestrates this complex and ongoing process. These master genes, which adapt to external cues to adjust the genes they turn on and off, are known as epigenetic regulators.

‘These epigenetic regulators are known to affect memory, behaviour and learning,’ said Dr. Picketts. ‘Without Snf2h, not enough cerebellar neurons are produced, and the ones that are produced do not respond and adapt as well to external signals. They also show a progressively disorganized gene expression profile that results in cerebellar ataxia and the premature death of the animal.’

There are no studies showing a direct link between Snf2h mutations and diseases with cerebellar ataxia, but Dr. Picketts added that it ‘is certainly possible and an interesting avenue to explore.’

In 2012, Developmental Cell published a paper by Dr. Picketts’ team showing that mice lacking the sister gene Snf2l were completely normal, but had larger brains, more cells in all areas of the brain and more actively dividing brain stem cells. The balance between Snf2l and Snf2h gene activity is necessary for controlling brain size and for establishing the proper gene expression profiles that underlie the function of neurons in different regions, including the cerebellum. Ottawa Hospital Research Institute

Key to identifying, enriching mesenchymal stem cells

The Children’s Medical Center Research Institute at UT Southwestern (CRI) has identified a biomarker that enables researchers to accurately characterise the properties and function of mesenchymal stem cells (MSCs) in the body. MSCs are the focus of nearly 200 active clinical trials registered with the National Institutes of Health, targeting conditions such as bone fractures, cartilage injury, degenerative disc disease, and osteoarthritis.

The finding, published in the journal Cell Stem Cell on June 19, significantly advances the field of MSC biology, and if the same biomarker identified in CRI’s studies with mice works in humans, the outlook for clinical trials that use MSCs will be improved by the ability to better identify and characterize the relevant cells.

“There has been an increasing amount of clinical interest in MSCs, but advances have been slow because researchers to date have been unable to identify MSCs and study their normal physiological function in the body,” said Dr. Sean Morrison, Director of the Children’s Research Institute, Professor of Paediatrics at UT Southwestern Medical Center, and a Howard Hughes Medical Institute Investigator. “We found that a protein known as leptin receptor can serve as a biomarker to accurately identify MSCs in adult bone marrow in vivo, and that those MSCs are the primary source of new bone formation and bone repair after injury.”

In the course of their investigation, the CRI researchers found that leptin receptor-positive MSCs are also the main source of factors that promote the maintenance of blood-forming stem cells in the bone marrow.

“Unfortunately, many clinical trials that are testing potential therapies using MSCs have been hampered by the use of poorly characterized and impure collections of cultured cells,” said Dr. Morrison, senior author of the study and holder of the Mary McDermott Cook Chair in Pediatric Genetics at UT Southwestern. “If this finding is duplicated in our studies with human MSCs, then it will improve the characterization of MSCs that are used clinically and could increase the probability of success for well-designed clinical trials using MSCs.” Children’s Medical Center Research Institute at UT Southwestern 

Microenvironment of haematopoietic stem cells can be a target for myeloproliferative disorders

The discovery of a new therapeutic target for certain kinds of myeloproliferative disease is, without doubt, good news. This is precisely the discovery made by the Stem Cell Physiopathology group at the CNIC (the Spanish National Cardiovascular Research Center), led by Dr. Simón Méndez–Ferrer. The team has shown that the microenvironment that controls hematopoietic stem cells can be targeted for the treatment of a set of disorders called myeloproliferative neoplasias, the most prominent of which are chronic myelomonocytic leukemia (CMML), juvenile myelomonocytic leukemia (JMML), and atypical chronic myelogenous leukemia (CML).

The findings, published today in Nature, demonstrate that these myeloproliferative neoplasias only appear after damage to the microenvironment that sustains and controls the hematopoietic stem cells—the cells that produce the cells of the blood and the immune system. Protecting this microenvironment, or niche, has thus emerged as a new route for the treatment of these diseases, for which there is currently no fully effective treatment.

‘In normal conditions, the microenvironment is able to control the proliferation, differentiation and migration of the hematopoietic stem cell. A specific genetic mutation in these cells results in inflammatory injury to the microenvironment and this control breaks down. What our work shows is that this damage can be prevented or reversed by treatments that target the niche,’ explained Dr. Méndez-Ferrer.

Indeed, the same team of researchers has demonstrated the efficacy of a possible new treatment, which has been patented through the CNIC. The treatment involves an innovative use of clinically approved treatments for other diseases, so that, according to the authors, ‘it shouldn’t be associated with adverse side effects’. The new treatment route has been tested in animals and has received financial backing for a multicenter phase II clinical trial. ‘This study has a very strong translational and clinical potential’, emphasized study first author Dr. Lorena Arranz, who added that ‘current treatment for myeloproliferative neoplasias is largely symptomatic and directed at preventing thrombosis and fatal cardiovascular events’.

The only real cure available today is a bone marrow transplant, which is not advisable in patients over 50 years old. ‘This makes it important to identify new therapeutic targets for the development of effective treatments,’ the investigators conclude.
EurekAlert
www.eurekalert.org/pub_releases/2014-06/cndi-moh062014.php