心力衰竭相关贫血:骨髓功能障碍与对促红细胞生成素的反应。
Heart failure-associated anemia: bone marrow dysfunction and response to erythropoietin.
机构信息
Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
出版信息
J Mol Med (Berl). 2011 Apr;89(4):377-87. doi: 10.1007/s00109-010-0710-6. Epub 2010 Dec 30.
Heart failure (HF)-associated anemia is common and has a poor outcome. Because bone marrow (BM) dysfunction may contribute to HF-associated anemia, we first investigated mechanisms of BM dysfunction in an established model of HF, the transgenic REN2 rat, which is characterized by severe hypertrophy and ventricular dilatation and SD rats as controls. Secondly, we investigated whether stimulation of hematopoiesis with erythropoietin (EPO) could restore anemia and BM dysfunction. After sacrifice, erythropoietic precursors (BFU-E) were isolated from the BM and cultured for 10 days. BFU-E were quantified and transcript abundance of genes involved in erythropoiesis were assayed. Number of BFU-E were severely decreased in BM of REN2 rats compared to SD rats (50 ± 6.2 vs. 6.4 ± 1.7, p < 0.01). EPO treatment increased hematocrit in the SD-EPO group (after 6 weeks, 49 ± 1 vs. 58 ± 1%, p < 0.01); however, in the mildly anemic REN2 rats, there was no effect (43 ± 1 vs. 44 ± 1%). This was paralleled by a 67% decrease in BFU-E in BM of REN2 rats compared to SD (p < 0.01). EPO significantly improved BFU-E in both SD and REN2 but could not restore this to control levels in the REN2 rats. Expression of several genes involved in differentiation (LMO2), mobilization (SDF-1), and iron incorporation (transferrin receptor) of the BM were differentially expressed in REN2 rats compared to SD rats, and EPO did not normalize this. Altogether, these results suggest that BM dysfunction is an important contributor to HF-associated anemia and that EPO is not an effective agent to treat HF-associated anemia.
心力衰竭(HF)相关的贫血很常见,且预后不良。由于骨髓(BM)功能障碍可能导致 HF 相关的贫血,我们首先在 HF 的一个既定模型,即转基因 REN2 大鼠中,研究了 BM 功能障碍的机制,该大鼠的特征是严重肥大和心室扩张,并以 SD 大鼠作为对照。其次,我们研究了促红细胞生成素(EPO)刺激造血是否可以恢复贫血和 BM 功能障碍。处死大鼠后,从 BM 中分离出红系祖细胞(BFU-E)并培养 10 天。BFU-E 的数量进行定量,并测定参与红细胞生成的基因的转录丰度。与 SD 大鼠相比,REN2 大鼠 BM 中的 BFU-E 数量明显减少(50±6.2 对 6.4±1.7,p<0.01)。EPO 治疗增加了 SD-EPO 组的血细胞比容(6 周后,49±1%对 58±1%,p<0.01);然而,在轻度贫血的 REN2 大鼠中,没有效果(43±1%对 44±1%)。这与 REN2 大鼠 BM 中的 BFU-E 比 SD 大鼠减少 67%相对应(p<0.01)。EPO 显著改善了 SD 和 REN2 大鼠的 BFU-E,但不能使 REN2 大鼠的 BFU-E 恢复到对照水平。与 SD 大鼠相比,REN2 大鼠的 BM 中几个参与分化(LMO2)、动员(SDF-1)和铁摄取(转铁蛋白受体)的基因的表达不同,EPO 不能使这种表达正常化。总之,这些结果表明 BM 功能障碍是 HF 相关贫血的一个重要原因,EPO 不是治疗 HF 相关贫血的有效药物。