Sato Naru, Goyama Susumu, Kitamura Toshio
Division of Molecular Oncology, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan.
Molecular Pharmacology of Malignant Diseases, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
Int J Hematol. 2025 Aug 7. doi: 10.1007/s12185-025-04038-5.
Clonal hematopoiesis (CH) is defined as the age-associated expansion of hematopoietic stem and progenitor cells harboring somatic mutations, most frequently in epigenetic regulators such as DNMT3A, TET2, and ASXL1. Although CH was initially recognized as a precursor to hematological malignancies, accumulating evidence has led to its broad recognition as a relevant factor in various age-related nonmalignant diseases, particularly those with inflammatory components, such as cardiovascular disease, autoimmune disorders, and solid tumors. Notably, the increased overall mortality associated with CH is primarily driven by cardiovascular complications rather than hematological malignancies. Among CH-associated genes, ASXL1 mutations are distinguished by their strong associations with adverse clinical outcomes and pro-inflammatory signatures. However, compared to TET2 and DNMT3A, the molecular and pathological implications of ASXL1-mutated CH remain underexplored. Recent studies have expanded the disease spectrum of ASXL1 mutations beyond hematological malignancies, implicating them in clonal expansion and systemic inflammation. This review aims to summarize the current epidemiological and experimental insights into ASXL1-mutated CH, focusing on its potential contributions to inflammation-associated diseases. By integrating clinical observations and emerging mechanistic data, we highlight the urgent need for deeper investigation into ASXL1-driven CH and its systemic consequences beyond hematological transformation.
克隆性造血(CH)被定义为携带体细胞突变的造血干细胞和祖细胞随年龄增长而发生的扩增,这些突变最常发生在表观遗传调节因子中,如DNMT3A、TET2和ASXL1。尽管CH最初被认为是血液系统恶性肿瘤的前体,但越来越多的证据表明,它已被广泛认可为各种与年龄相关的非恶性疾病的相关因素,特别是那些具有炎症成分的疾病,如心血管疾病、自身免疫性疾病和实体瘤。值得注意的是,与CH相关的总体死亡率增加主要是由心血管并发症而非血液系统恶性肿瘤驱动的。在与CH相关的基因中,ASXL1突变因其与不良临床结局和促炎特征的强烈关联而与众不同。然而,与TET2和DNMT3A相比,ASXL1突变型CH的分子和病理意义仍未得到充分探索。最近的研究已经将ASXL1突变的疾病谱扩展到血液系统恶性肿瘤之外,表明它们与克隆性扩增和全身炎症有关。本综述旨在总结目前对ASXL1突变型CH的流行病学和实验性见解,重点关注其对炎症相关疾病的潜在贡献。通过整合临床观察和新出现的机制数据,我们强调迫切需要更深入地研究ASXL1驱动的CH及其在血液学转化之外的全身后果。
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