In 2005, several groups reported a unique, acquired, somatic activating mutation of JAK2 (V617F) in 95% of patients with polycythemia vera (PV) and in about half of those with essential thombocythemia (ET) or primary myelofibrosis (MF). [6][7][8][9] The discovery of JAK2 V617F led to screening for JAK mutations in other hematologic neoplasms. Thanks to improvements of sequencing techniques and the conduction of massive sequencing projects, the catalogue of genetic alterations in hematologic malignancies is constantly being updated as ever more new mutational targets are discovered. This review provides an overview of the different molecular mechanisms underlying constitutive activation of the JAK-STAT pathway and their respective frequencies among hematologic neoplasms. The use of JAK inhibitors in the clinic and in ongoing trials, resistance phenomena as well as future challenges are discussed. The review begins by documenting insights into the structural organization of JAK kinases, their mode of activation as well as the role of the different family members in hematopoiesis.
Janus kinasesJAK1, JAK2 and TYK2 tyrosine kinases are ubiquitously expressed and non-covalently bound to a distinct, mostly non-overlapping repertory of receptor chains. By contrast, JAK3 expression is restricted to the hematopoietic lineage and it associates exclusively with the common gammachain (γc). Based on their primary sequences, JAK kinases were initially divided into seven highly conserved JAK homology regions (JH1-7, starting from the C-terminal end) but were subsequently organized into four functional domains.
10The N-terminal moiety of JAK kinases constitutes the receptor-binding module with a FERM (band 4.1, ezrin, radixin, moesin) domain (JH4-7) and an atypical SH2 domain (JH3).11 It has been experimentally established that both domains do not exist as individual functional entities but structurally cooperate for non-covalent anchoring to two membrane-proximal regions of defined receptors. 12,13 This was corroborated by a recent crystal structure study showing that the N-terminal part of TYK2 forms a con-JAK kinase targeting in hematologic malignancies haematologica | 2015; 100 (10) 1241 Figure 1. Hematopoiesis. Hematopoiesis originates from a hematopoietic stem cell, which can undergo either self-renewal or hierarchical differentiation into lineage-committed progenitors with decreasing potential that ultimately will give rise to all mature blood cells. Cytokines and their receptor-associated JAK necessary for the progenitors to pass through the different maturation steps are indicated. HSC: hematopoietic stem cell; CMP: common myeloid progenitor; CLP: common lymphoid progenitor; GM: granulocyte macrophage progenitor; BCP: B cell progenitor; TNK: T and natural killer cell progenitor; EP: erythroid progenitor; Mk: megakaryocyte; GP: granulocyte progenitor; MP: macrophage progenitor; TPO: thrombopoietin; SCF: stem cell factor; IL: interleukin; GM-CSF: granulocyte/monocyte colony-stimulating factor; G-CSF: granulocyte c...