Investigating the platelet-sparing mechanism of paclitaxel/carboplatin combination chemotherapy.

Paclitaxel and carboplatin chemotherapy is reported to be a platelet-sparing drug combination. This study investigated potential mechanisms for this observation by studying the effects of paclitaxel and carboplatin on (1) normal donor and chemotherapy patient-derived erythroid (burst-forming units-erythroid [BFU-E]), myeloid (colony-forming units-granulocyte/macrophage [CFU-GM]), and megakaryocyte (CFU-Meg) progenitor cell growth; (2) P-glycoprotein (P-gp) protein and glutathione S-transferase (GST) messenger RNA (mRNA) expression; (3) serum thrombopoietin (Tpo), stem cell factor (SCF), interleukin-6 (IL-6), IL-11, IL-1beta, IL-8, and tumor necrosis factor-alpha levels in patients treated with paclitaxel and carboplatin; and (4) stromal cell production of Tpo and SCF after paclitaxel and carboplatin exposure. CFU-Meg were more resistant to paclitaxel alone, or in combination with carboplatin, than CFU-GM and BFU-E. Although all progenitors expressed P-gp protein and GST mRNA, verapamil treatment significantly, and selectively, increased the toxicity of paclitaxel and carboplatin to CFU-Meg, suggesting an important role for P-gp in megakaryocyte drug resistance. Compared to normal controls, serum Tpo levels in patients receiving paclitaxel and carboplatin were significantly elevated 5 hours after infusion and remained elevated at day 7 (287% +/- 63% increase, P <.001). Marrow stroma was shown to be the likely source of this Tpo. It is concluded here that P-gp-mediated efflux of paclitaxel, and perhaps GST-mediated detoxification of carboplatin, results in relative sparing of CFU-Meg, which may then respond to locally high levels of stromal cell-derived Tpo. The confluence of these events might lead to the platelet-sparing phenomenon observed in patients treated with paclitaxel and carboplatin chemotherapy.

A novel serum free system for cloning human megakaryocytic progenitors (CFU-Meg). The role of thrombopoietin and other cytokines on bone marrow and cord blood CFU-Meg growth under serum free conditions.

Human megakaryocytic progenitors (CFU-Megs) are usually cloned in plasma clot cultures. Since the medium employed to prepare plasma clot contains animal or human serum, there exists a potential risk that CFU-Megs growing in vitro could be exposed to the serum derived megakaryopoietic inhibitors. To address this issue, we aimed to establish a relatively simple "serum free" cloning model for these progenitors. Accordingly, we found that if human bone marrow or cord blood CD34+ cells are plated in the methylcellulose medium containing serum substitute, and are stimulated with recombinant thrombopoietin (TpO), they exclusively form CFU-Meg colonies. Subsequently these colonies can be easily scored with an inverted microscope based only on their morphological criteria. We found that the cloning efficiency of CFU-Megs was higher in our serum free cloning system than in the traditional plasma clot cultures. Since the model proposed in this paper is relatively simple, and moreover does not require time consuming immunostaining to identify CFU-Meg colonies, it should be widely recommended for studying in vitro human megakaryopoiesis. We also found, that under serum free conditions TpO is crucial for CFU-Meg formation. In absence of TpO, neither gp 130 activating cytokines (IL-6, IL-11, LIF, CNTF) nor the other hematopoietic growth factors or cytokines (KL, IL-3, GM-CSF, EpO) were able, when added alone, to stimulate the growth of human CFU-Meg colonies. Finally, we report also that cord blood CD34+ cells are enriched in megakaryocytic progenitors, and moreover, CFU-Megs from cord blood possess a higher proliferative capacity than CFU-Megs isolated from normal adult bone marrow.

An improved serum free system for cloning human "pure" erythroid colonies. The role of different growth factors and cytokines on BFU-E formation by the bone marrow and cord blood CD34+ cells.

We have developed an efficient serum free culture model for cloning human erythroid progenitors. Accordingly, human bone marrow or cord blood CD34+ cells if plated in our serum free medium and stimulated with a mixture of EpO + KL, grow erythroid colonies exclusively. Cells isolated from these cultures express glycophorin-A (GPA-A), are CD33-, IIb/IIIa-, and finally all become hemoglobinized. By employing this system we also found out that cord blood CD34+ mononuclear cells (MNC) contain more BFU-E than adult marrow CD34+ MNC, moreover, the erythroid colonies formed by cord blood progenitors are significantly larger then the ones formed by the marrow cells. We have also compared the influence of different cytokines and growth factors, which were reported in the literature to costimulate BFU-E growth on cloning efficiency of human BFU-E cultured in our serum free medium. We found that from 20 different growth factors and cytokines tested, EpO dependent bone marrow BFU-E growth is costimulated only by KL, and to lesser degree also by IL-3, GM-CSF, TpO and IL-9. In contrast to marrow cells we observed that cord blood BFU-E in addition to KL, IL-3, GM-CSF, TpO, LIF and IL-9 were also costimulated by NGF-beta, FGF-1, FGF-2 and STK-IL. We found simultaneously that TPO which possess only negligible costimulatory effect on erythroid colony formation by bone marrow CD34+ cells, significantly costimulated the formation of erythroid colonies grown by cord blood CD34+ cells. Therefore, the cord blood CD34+ cells are largely committed to erythroid differentiation, and, moreover, they respond to a wider spectrum of the growth factors than their bone marrow counterparts.

The role of insulin (INS) and insulin-like growth factor-I (IGF-I) in regulating human erythropoiesis. Studies in vitro under serum-free conditions--comparison to other cytokines and growth factors.

The role of insulin (INS), and insulin-like growth factor-I (IGF-I) in the regulation of human erythropoiesis is not completely understood. To address this issue we employed several complementary strategies including: serum free cloning of CD34+ cells, RT-PCR, FACS analysis, and mRNA perturbation with oligodeoxynucleotides (ODN). In a serum-free culture model, both INS and IGF-I enhanced survival of CD34+ cells, but neither of these growth factors stimulated their proliferation. The influence of INS and IGF-I on erythroid colony development was dependent on a combination of growth factors used for stimulating BFU-E growth. When BFU-E growth was optimally stimulated with erythropoietin (EpO) + kit ligand (KL) the large erythroid colonies developed normally even in the absence of INS or IGF-I. However, the addition of both of these growth factors slightly enhanced colony size. On the other hand, if erythroid colonies were stimulated suboptimally with EpO + IL-3 only, INS or IGF-I increased the number of small erythroid bursts by approximately 30%. Both INS and IGF-I activated signal transduction in maturing human erythropoietic cells as determined by phosphorylation of the insulin receptor substrate-2 (IRS-2) protein. We also found by RT-PCR that mRNA coding for INS-R is expressed in FACS sorted CD34+, c-kit-R+ marrow cells, and in cells isolated from BFU-E and CFU-GM colonies. Expression of INS-R protein on these cells was subsequently confirmed by cytofluorometry. In contrast, the receptor for insulin-like growth factor-I (IGF-IR) was not detected on CD34+ cells, and was first easily detectable on more differentiated cells derived from day 6 BFU-E and CFU-GM colonies. We conclude that INS and IGF-I may be survival factors for human CD34+ cells, but are not required during early erythropoiesis. In contrast, both growth factors may play some role at the final stages of erythroid maturation.