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Erythropoiesis is a dynamic process regulated at multiple levels to balance proliferation, differentiation and survival of erythroid progenitors. Ineffective erythropoiesis is a key feature of various diseases, including β-thalassemia. The pathogenic mechanisms leading to ineffective erythropoiesis are complex and still not fully understood. Altered survival and decreased differentiation of erythroid progenitors are both critical processes contributing to reduced production of mature red blood cells. Recent studies have identified novel important players and provided major advances in the development of targeted therapeutic approaches. In this review, β-thalassemia is used as a paradigmatic example to describe our current knowledge on the mechanisms leading to ineffective erythropoiesis and novel treatments that may have the potential to improve the clinical phenotype of associated diseases in the future. [ABSTRACT FROM AUTHOR]

Iron is essential for the growth and proliferation of cells, as well as for many biological processes that are important for the maintenance and survival of the human body. However, excess iron is associated with the development of cancer and other pathological conditions, due in part to the pro-oxidative nature of iron and its damaging effects on DNA. Current studies suggest that iron depletion may be beneficial for patients that have diseases associated with iron overload or other iron metabolism disorders that may increase the risk for cancer. On the other hand, studies suggest that cancer cells are more vulnerable to the effects of iron depletion and oxidative stress in comparison to normal cells. Therefore, cancer patients might benefit from treatments that alter both iron metabolism and oxidative stress. This review highlights the pro-oxidant effects of iron, the relationship between iron and cancer development, the vulnerabilities of the iron-dependent cancer phenotype, and how these characteristics may be exploited to prevent or treat cancer. [ABSTRACT FROM AUTHOR]

Abstract: β-Thalassemia and Polycythemia vera are genetic disorders which affect the synthesis of red blood cells, also referred to as erythropoiesis. Although essentially different in clinical presentation – patients with β-thalassemia have an impairment in β-globin synthesis leading to defective erythrocytes and anemia, while patients with Polycythemia vera present with high hemoglobin levels because of excessive red blood cell synthesis – both pathologies may characterized by lasting high erythropoietic activity, i.e. chronic stress erythropoiesis. In both diseases, therapeutic strategies targeting chronic stress erythropoiesis may improve the address phenotype and prevent secondary pathology, such as iron overload. The current review will address the basic concepts of these strategies to reduce chronic stress erythropoiesis, which may have significant clinical implications in the near future. [Copyright &y& Elsevier]

Hemoglobinopathies are genetic inherited conditions that originate from the lack or malfunction of the hemoglobin (Hb) protein. Sickle cell disease (SCD) and thalassemia are the most common forms of these conditions. The severe anemia combined with complications that arise in the most affected patients raises the necessity for a cure to restore hemoglobin function. The current routine therapies for these conditions, namely transfusion and iron chelation, have significantly improved the quality of life in patients over the years, but still fail to address the underlying cause of the diseases. A curative option, allogeneic bone marrow transplantation is available, but limited by the availability of suitable donors and graft-vs-host disease. Gene therapy offers an alternative approach to cure patients with hemoglobinopathies and aims at the direct recovery of the hemoglobin function via globin gene transfer. In the last 2 decades, gene transfer tools based on lentiviral vector development have been significantly improved and proven curative in several animal models for SCD and thalassemia. As a result, clinical trials are in progress and 1 patient has been successfully treated with this approach. However, there are still frontiers to explore that might improve this approach: the stoichiometry between the transgenic hemoglobin and endogenous hemoglobin with respect to the different globin genetic mutations; donor cell sourcing, such as the use of induced pluripotent stem cells (iPSCs); and the use of safer gene insertion methods to prevent oncogenesis. With this review we will provide insights about (1) the different lentiviral gene therapy approaches in mouse models and human cells; (2) current and planned clinical trials; (3) hurdles to overcome for clinical trials, such as myeloablation toxicity, insertional oncogenesis, and high vector expression; and (4) future perspectives for gene therapy, including safe harbors and iPSCs technology. [ABSTRACT FROM AUTHOR]

Abstract: Ineffective erythropoiesis is the hallmark of beta-thalassemia that triggers a cascade of compensatory mechanisms resulting in clinical sequelae such as erythroid marrow expansion, extramedullary hematopoiesis, splenomegaly, and increased gastrointestinal iron absorption. Recent studies have begun to shed light on the complex molecular mechanisms underlying ineffective erythropoiesis and the associated compensatory pathways; this new understanding may lead to the development of novel therapies. Increased or excessive activation of the Jak2/STAT5 pathway promotes unnecessary disproportionate proliferation of erythroid progenitors, while other factors suppress serum hepcidin levels leading to dysregulation of iron metabolism. Preclinical studies suggest that Jak inhibitors, hepcidin agonists, and exogenous transferrin may help to restore normal erythropoiesis and iron metabolism and reduce splenomegaly; however, further research is needed. [Copyright &y& Elsevier]

An abstract of the article "Optimization of Globin Lentiviral Vector Design for the Treatment of ͒-Thalassemia," by Leszek Lisowski, Stefano Rivella and Michel Sadelain is presented.

• β-THAL is one of the most prevalent blood disorders in some regions of the world. • However, given its prevalence, in the EU and the US it is classified as a rare disease. • A wide array of therapeutic approaches has been developed over the past decades. • β-THAL is a learning case on the potential global impact of Orphan Legislations. • Gene therapy for β-THAL is promising, but scenarios for global access are missing. In many countries, β-thalassemia (β-THAL) is not uncommon; however, it qualifies as a rare disease in the US and in European Union (EU), where thalassemia drugs are eligible for Orphan Drug Designation (ODD). In this paper, we evaluate all 28 ODDs for β-THAL granted since 2001 in the US and the EU: of these, ten have since been discontinued, twelve are pending, and six have become licensed drugs available for clinical use. The prime mover for these advances has been the increasing depth of understanding of the pathophysiology of β-THAL; at the same time, and even though only one-fifth of β-THAL ODDs have become licensed drugs, the ODD legislation has clearly contributed substantially to the development of improved treatments for β-THAL. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is caused by genetic defects in the β-globin chain. SCD is a frequently inherited blood disorder, and sickle cell anemia is a common type of hemoglobinopathy. During anemia, the hypoxic response via the transcription factor hypoxia-inducible factor (HIF)-2α is highly activated in the intestine and is essential in iron absorption. Intestinal disruption of HIF-2α protects against tissue iron accumulation in iron overload anemias. However, the role of intestinal HIF-2α in regulating anemia in SCD is currently not known. Here we show that in mouse models of SCD, disruption of intestinal HIF-2α significantly decreased tissue iron accumulation. This was attributed to a decrease in intestinal iron absorptive genes, which were highly induced in a mouse model of SCD. Interestingly, disruption of intestinal HIF-2α led to a robust improvement in anemia with an increase in RBC, hemoglobin, and hematocrit. This was attributed to improvement in RBC survival, hemolysis, and insufficient erythropoiesis, which is evident from a significant decrease in serum bilirubin, reticulocyte counts, and serum erythropoietin following intestinal HIF-2α disruption. These data suggest that targeting intestinal HIF-2α has a significant therapeutic potential in SCD pathophysiology. [ABSTRACT FROM AUTHOR]

Alternative splicing has emerged as a vital way to expand the functional repertoire of a set number of mammalian genes. For example, such changes can dramatically alter the function and cellular localization of transcription factors. With this in mind, we addressed whether EKLF/KLF1 mRNA, coding for a transcription factor that plays a critical role in erythropoietic gene regulation, is alternatively spliced. We find that EKLF mRNA undergoes exon skipping only in primary tissues and that this splice variant (SV) remains at a very low level in both embryonic and adult erythroid cells, as well as during terminal differentiation. The resultant protein is truncated and partially encodes a non–erythroid Krüppel-like factor amino acid sequence. Its overexpression can alter full-length erythroid Krüppel-like factor function at selected promoters. We discuss these results in the context of stress and with respect to recent global studies on the role of alternative splicing during terminal erythroid differentiation. [ABSTRACT FROM AUTHOR]

Background: FGF-23, a bone-derived hormone, regulates phosphate and vitamin D in the kidney. Results: Genetic and pharmacological manipulations of FGF-23 alter erythropoiesis and HSC frequency both in young adult age and embryonically. Conclusion: Fgf-23 regulates erythropoiesis through Epo and independent of vitamin D. Significance: These findings provide a new target for treating blood disorders associated with bone and renal defects. Abnormal blood cell production is associated with chronic kidney disease (CKD) and cardiovascular disease (CVD). Bonederived FGF-23 (fibroblast growth factor-23) regulates phosphate homeostasis and bone mineralization. Genetic deletion of Fgf-23 in mice (Fgf-23-/-) results in hypervitaminosis D, abnormal mineral metabolism, and reduced lymphatic organ size. Elevated FGF-23 levels are linked to CKD and greater risk of CVD, left ventricular hypertrophy, and mortality in dialysis patients. However, whether FGF-23 is involved in the regulation of erythropoiesis is unknown. Here we report that loss of FGF-23 results in increased hematopoietic stem cell frequency associated with increased erythropoiesis in peripheral blood and bone marrow in young adult mice. In particular, these hematopoietic changes are also detected in fetal livers, suggesting that they are not the result of altered bone marrow niche alone. Most importantly, administration of FGF-23 in wild-type mice results in a rapid decrease in erythropoiesis. Finally, we show that the effect of FGF-23 on erythropoiesis is independent of the high vitamin D levels in these mice. Our studies suggest a novel role for FGF-23 in erythrocyte production and differentiation and suggest that elevated FGF-23 levels contribute to the pathogenesis of anemia in patients with CKD and CVD. [ABSTRACT FROM AUTHOR]

Abstract: HFE gene mutations are associated with over 80% of cases of hereditary hemochromatosis (HH), an iron-overload disease in which the liver is the most frequently affected organ. Research on HFE has traditionally focused on its interaction with the transferrin receptor. More recent studies have suggested a more complex function for this nonclassical MHC-I protein. The aim of this study was to examine how HFE and its two most common mutations affect the expression of selected genes in a hepatocyte-like cell line. Gene expression was analyzed in HepG2 cells overexpressing wild-type and mutant HFE. The effect of HFE in iron import and oxidative stress levels was assessed. Unfolded protein response (UPR)-activated gene expression was analyzed in peripheral blood mononuclear cells from characterized HH patients. C282Y HFE down-regulated hepcidin and enhanced calreticulin mRNA expression. Calreticulin levels correlated with intracellular iron increase and were associated with protection from oxidative stress. In C282Y+/+ patients calreticulin levels correlated with the expression of the UPR marker BiP and showed a negative association with the number of hereditary hemochromatosis clinical manifestations. The data show that expression of C282Y HFE triggers a stress-protective response in HepG2 cells and suggest a role for calreticulin as a modifier of the clinical expression of HH. [Copyright &y& Elsevier]

The ability to genetically modify embryonic stem cells (ESC) expands the potential of ESC to correct hereditary disorders and deliver gene products for specific therapies. Integrating gene transfer vectors, such as lentivirus vectors, have been used to deliver genes to ESC, but the transduction efficiencies are far from 100% and selection of transduced cells using drug resistance is often unpredictable and toxic. A surface marker delivered by a lentivirus vector that could be employed in a magnetic-bead purification strategy would be a powerful tool in selecting transduced from untransduced ESC. To address these issues, we hypothesized that: (1) lentivirus transfer of the truncated human low-affinity nerve growth factor (LNGFR), a non-toxic, non-tumorigenic and non- functional protein expressed on the surface of transduced cells, could be used to isolate transduced ESC; (2) LNGFR expression would not alter the characteristics of the undifferentiated ESC; and (3) LNGFR expression would not interfere with the response of ESC to differentiation signals. To assess LNGFR as a purification strategy for ESC, we utilized a lentivirus vector with a human phosphoglycerate kinase 1 (PGK) promoter to drive expression of LNGFR. Murine ESC (C57BL/6 strain) were transduced with this vector and cultured on a murine embryonic fibroblast (MEF) feeder layer. Flow cytometry analysis (FACS) 48 hr after transduction revealed LNGFR expression in 44% of the ESC and 2 % in the corresponding mouse IgG1-PE control. On day 4, LNGFR+ ESC were purified with magnetic beads using an anti-LNGFR antibody. After single purification with magnetic beads, 95% of the transduced cells were LNGFR+. Several different assessments demonstrated that LNGFR expression did not alter the characteristics of the purified undifferentiated ESC. First, LNGFR+ cells plated onto a MEF feeder layer remained undifferentiated for 2 wk and the expression pattern of SSEA1 (FACS analysis), a marker for undifferentiated ESC, was identical in mock and LNGFR+ ESC (p=0.7). Second, embryoid body formation was identical in LNGFR+ and mock transduced ESC. Third, after subcutaneous administration of purified LNGFR+ or mock transduced ESC, teratomas, tumors arising from undifferentiated ESC, developed within 2 wk. Finally, to determine whether LNGFR expression would interfere with the response of ESC to differentiation signals, differentiation to endoderm was induced by Activin A. After 5 days, FACS analysis for CXCR4, a marker for definitive endoderm, showed similar levels of expression in LNGFR+ ESC and the control group (20.4% vs 21.2%), suggesting that LNGFR expression does not interfere with differentiation to endoderm. Together, these observations demonstrate that lentivirus- mediated transfer of LNGFR is a useful tool in purifying transduced ESC without deleterious or toxic effects on maintenance or differentiation.Molecular Therapy (2006) 13, S130–S130; doi: 10.1016/j.ymthe.2006.08.399 [ABSTRACT FROM AUTHOR]