Primary myelofibrosis (PMF) is the most serious myeloproliferative disorder, characterized by clonal myeloproliferation associated with cytokine-mediated bone marrow stromal reaction including fibrosis and osteosclerosis. Current drug therapy remains mainly palliative. Because the NF-B pathway is implicated in the abnormal release of cytokines in PMF, the proteasome inhibitor bortezomib might be a potential therapy. To test its effect, we used the lethal murine model of myelofibrosis induced by thrombopoietin (TPO) overexpression. In this TPO high model, the development of the disease is related to a deregulated MPL signaling, as recently described in PMF patients. We first demonstrated that bortezomib was able to inhibit TPO-induced NF-B activation in vitro in murine megakaryocytes. It also inhibited NF-B activation in vivo in TPO high mice leading to decreased IL-1␣ plasma levels. After 4 weeks of treatment, bortezomib decreased TGF-1 levels in marrow fluids and impaired marrow and spleen fibrosis development. After 12 weeks of treatment, bortezomib also impaired osteosclerosis development through osteoprotegerin inhibition. Moreover, this drug reduced myeloproliferation induced by high TPO level. Finally, bortezomib dramatically improved TPO high mouse survival (89% vs 8% at week 52). We conclude that bortezomib appears as a promising therapy for future treatment of PMF patients.
IntroductionPrimary myelofibrosis (PMF) is a myeloproliferative disorder 1 known as a clonal stem-cell disorder, whereas the associated stromal reaction in the bone marrow environment, leading to fibrosis (excessive deposits of extracellular matrix proteins) and osteosclerosis (new bone formation), is considered to be reactive and cytokine mediated. 2,3 Because the description of mice overexpressing thrombopoietin (TPO), known as TPO high mice, 4 featuring numerous aspects of the human disease including dysmegakaryopoiesis, the implication of the TPO/MPL pathway in PMF has been demonstrated. Recently, two activating mutations of the TPO receptor MPL, MPL W515L and MPL W515K , have been detected in 5% of PMF patients and have been shown to induce fibrosis in mice. 5,6 Activated MPL is known to stimulate the members of the Janus family of protein tyrosine kinases, JAKs. Indeed, the activating JAK2 V617F mutation, directly linked to deregulated MPL signaling, is present in 50% of PMF patients 7-10 and also induces fibrosis in mice. 11,12 However, how these unique JAK2 or MPL mutations may lead to bone marrow fibrosis development is not yet understood. Notably, both mutations can be found in essential thrombocythemia, 6-10 a myeloproliferative disorder without fibrosis. Thus, PMF is related to TPO/MPL pathway alterations and the TPO high model, mimicking deregulated MPL signaling, appears to be the most relevant to test drugs in vivo.Several lines of evidence obtained from both studies of patients with PMF and of murine models ending with myelofibrosis are in favor of a crucial role (i) of the pleiotropic cytokine transforming growth f...