Excessive intramedullary apoptosis is central in the pathogenesis of myelodysplastic syndromes (MDS). Growth-inhibiting cytokines, the Fas/FasLigand pathway, and autoreactive cytotoxic T-lymphocytes have been identified to be important proapoptotic factors in MDS. In normal hematopoiesis, a4b1 and a5b1 integrin-mediated interactions between progenitors and fibronectin are critical for progenitor cell survival. In this study, we have used flow cytometry to quantify the expression levels of members of the b1 integrin family on CD34 þ marrow progenitors in 27 untreated patients with MDS, three with s-AML, and 25 control subjects. In MDS, we observed that nonapoptotic progenitors significantly downregulate cell surface expression levels of a4 and b1 integrin chains compared with healthy controls. Downregulation of a4, b1, and also a5 was present in MDS patients with Z25% apoptotic progenitors, irrespective of their French, American, British subcategory. Reduced cell surface expression levels of a4, a5, and b1 did also correlate with decreased in vitro adhesiveness to fibronectin fragments. Therefore, our observations suggest that downregulation of a4b1 and a5b1 integrins on CD34 þ progenitors could be a newly identified proapoptotic mechanism in MDS.