Key result
Genetic alterations of the TPO/MPL/JAK2 axis, including gain-of-function and loss-of-function mutations, disrupt megakaryopoiesis and lead to either thrombocytosis or thrombocytopenia.
This review highlights how hereditary and acquired mutations in the TPO/MPL/JAK2 signaling axis disrupt megakaryopoiesis, leading to either thrombocytosis or thrombocytopenia.
May inform genetic evaluation of unexplained platelet disorders; leaves open mutation-specific therapies pending prospective studies.
Megakaryopoiesis is an original and complex cell process which leads to the formation of platelets. The homeostatic production of platelets is mainly regulated and controlled by thrombopoietin (TPO) and the TPO receptor (MPL)/JAK2 axis. Therefore, any hereditary or acquired abnormality affecting this signaling axis can result in thrombocytosis or thrombocytopenia. Thrombocytosis can be due to genetic alterations that affect either the intrinsic MPL signaling through gain-of-function (GOF) activity (MPL, JAK2, CALR) and loss-of-function (LOF) activity of negative regulators (CBL, LNK) or the extrinsic MPL signaling by THPO GOF mutations leading to increased TPO synthesis. Alternatively, thrombocytosis may paradoxically result from mutations of MPL leading to an abnormal MPL trafficking, inducing increased TPO levels by alteration of its clearance. In contrast, thrombocytopenia can also result from LOF THPO or MPL mutations, which cause a complete defect in MPL trafficking to the cell membrane, impaired MPL signaling or stability, defects in the TPO/MPL interaction, or an absence of TPO production.
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Plo et al. (2017) conducted a review in Thrombocytosis and thrombocytopenia. Genetic alterations of the TPO/MPL/JAK2 axis was evaluated. Genetic alterations of the TPO/MPL/JAK2 axis, including gain-of-function and loss-of-function mutations, disrupt megakaryopoiesis and lead to either thrombocytosis or thrombocytopenia.
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