Nagata Kenji, Shimoda Kazuya
Department of Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University, Kiyotake, Miyazaki 889-1692, Japan.
Rinsho Byori. 2009 Apr;57(4):357-64.
Polycythemia vera (PV), essential thrombocythemia(ET), and primary myelofibrosis (PMF) share common clinical features, being clonal disorders of multipotent progenitors. In 2005, a somatic activating mutation in JAK2 (V617F) was identified in most patients with PV and in about half of patients with ET or PMF. The JAK2 mutation causes the constitutive activation of the JAK-STAT signaling pathway, and leads to autonomous cell growth in a cytokine-independent manner. A higher expression of JAK2 V617F would favor erythrocytosis, and a lower one would favor thrombocytosis. This may suggest that the expression levels of JAK2 V617F directly determine which cell lineages increase, possibly leading to the diversity of myeloproliferative diseases. Although only V617F JAK2 may cause myeloproliferative disease (MPD), clonogenic assay, analysis of familial MPD patients, and examination of JAK2 mutation in acute leukemia patients transformed from MPD show that there are additional somatic mutations which contribute to the pathogenesis of V617F JAK2 positive PV, ET, and PMF.
真性红细胞增多症(PV)、原发性血小板增多症(ET)和原发性骨髓纤维化(PMF)具有共同的临床特征,均为多能祖细胞的克隆性疾病。2005年,在大多数PV患者以及约一半的ET或PMF患者中发现了JAK2(V617F)的体细胞激活突变。JAK2突变导致JAK-STAT信号通路的组成性激活,并以细胞因子非依赖的方式导致细胞自主生长。JAK2 V617F表达水平较高有利于红细胞增多,而较低水平则有利于血小板增多。这可能表明JAK2 V617F的表达水平直接决定哪些细胞谱系增加,可能导致骨髓增殖性疾病的多样性。虽然只有V617F JAK2可能导致骨髓增殖性疾病(MPD),但克隆形成试验、家族性MPD患者分析以及MPD转化的急性白血病患者的JAK2突变检测表明,还有其他体细胞突变参与了V617F JAK2阳性PV、ET和PMF的发病机制。