Reduced number of peripheral blood granulocytic progenitor cells in patients with Down's syndrome

Leukemia in Down syndrome: a review

The incidence of leukemia is higher in children with Down syndrome (DS) than in normals. In approximately 50% of cases the type of leukemia is acute megakaryoblastic leukemia (AMKL) and it occurs during the first 4 years of life. The leukemic cell also has features of erythroid progenitors and therefore appears to be a precursor cell with biphenotypic properties. In addition, newborns with DS frequently develop transient leukemia (TL), which is characterized by the presence of megakaryoblasts in the blood which disappear during the first 1-3 months of life. The incidence of this disorder is unknown although preliminary studies suggest that megakaryoblasts may be found frequently in the blood of DS newborns. TL does not occur in normal newborn infants. Although TL disappears spontaneously, many of these children will develop AMKL at 1-4 years of age. Recent surveys suggest that 20-30% of newborns with TL will develop AMKL. Preliminary evidence suggests that TL is a clonal proliferation, can be fatal, and may occur in a specific subgroup of DS children. The observations in this report are drawn from our own experience, reports in the literature, and data accumulated in the Canadian Down Syndrome Leukemia Registry.

New evaluations of circulating granulocyte and macrophage stem cells in healthy adults using conditioned media and recombinant human growth factors

Peripheral human blood contains granulo-monocyte (CFU-GM) and eosinophil (CFU-Eo) progenitors. In vitro, the number of colony forming units is thought to range from 0.1-14 per 2 x 10(5) plated cells. We show that the number of CFU-GM, Eo depends on culture methods. By modifying the usual assay method (using human umbilical cord plasma and the association of 2 stimulating conditioned media: activated lymphocyte conditioned medium and bone marrow fibroblast conditioned medium), we found different circulating CFU-GM, Eo numbers. The mean number of circulating CFU-GM, Eo in 107 healthy adults was 22.4 per 2 x 10(5) plated cells (range: 1-84). There was a slight difference between males (mean number: 23.6) and females (mean number: 20.4). The mean number of CFU-GM, Eo harvested on Percoll gradient was 123/ml of peripheral blood (range: 7-513). These results are far over those commonly reported in literature. This suggests that these latter results were probably underestimated. The use of recombinant human interleukin 3 and recombinant human GM (granulocyte-monocyte) colony-stimulating factors shows that CFU-GM, Eo numbers are found to be comparatively increased compared to that obtained with our modified method (using rhIL-3 alone), or that the size of those colonies is notably increased (using rhIL-3 + rhGM-CSF).

Down's syndrome and leukemia: epidemiology, genetics, cytogenetics and mechanisms of leukemogenesis

The association of Down's syndrome and leukemia has been documented for over 50 years. Multiple studies have established the incidence of leukemia in Down's syndrome patients to be 10- to 20-fold higher than that in the general population. The age of onset for leukemia in these children is bimodal, peaking first in the newborn period and again at 3-6 years. This increased risk extends into adulthood. All cytogenetic types of Down's syndrome apparently predispose to leukemia. The proportion of acute lymphoblastic leukemia and acute nonlymphoblastic leukemia in patients with Down's syndrome is similar to non-Down's syndrome leukemia patients matched for age. There are case reports in which leukemia, Down's syndrome, and other chromosomal aberrations cluster within a family. In these kindreds, there may be a familial tendency toward nondisjunction. Congenital leukemia also occurs with increased frequency in Down's syndrome patients, and is characterized by a preponderance of acute nonlymphoblastic leukemia (similar to non-Down's syndrome patients). Transient leukemoid reactions have been observed in Down's syndrome patients, as well as in phenotypically normal children with constitutional trisomy 21 mosaicism. The transient leukemoid reactions are characterized by a high spontaneous remission rate. However, in some Downs syndrome patients with apparent transient leukemoid reaction, leukemia relapse following periods of spontaneous remission have been reported. Cytogenetic studies of leukemic cells in Down's syndrome patients show a tendency toward hyperdiploidy. Besides trisomy 21, there is no other specific cytogenetic abnormality that is characteristic of the leukemia cells in Down's syndrome patients. The possible mechanisms for leukemogenesis in Down's syndrome patients may involve factors at the levels of the organism, the organ/system, the cell, the chromosomes or the DNA.

Stem cell deficiencies and thymic abnormalities in fetal mouse trisomy 16

Mouse fetuses with trisomy 16 have severe abnormalities of several hematopoietic stem cell and precursor populations. The thymus is extremely hypoplastic, with a greater than or equal to 80% reduction in the number of thymocytes. This cellular deficiency appears to be the result of a deficiency in the number of precursor cells in the early thymus, since the rate of proliferation of thymocytes in explanted day-14 thymuses was normal. However, the functional maturation of thymocytes was delayed in vitro in day-17 organ explants, although the maximal response to the mitogenic and interleukin 2-stimulating effects of concanavalin A are quantitatively normal. B cells and pre-B cells in the fetal liver were moderately decreased, but the ability of fetal liver cells to be transformed by Abelson murine leukemia virus was nearly totally lost. There were also significant relative and absolute decreases in the number of spleen, culture, and erythroid colony-forming units (CFU-S, CFU-C, CFU-E) and of erythroid burst-forming units (BFU-E) in the trisomic liver, and the trisomic animals were anemic with small spleens and livers. However, unlike other genetically caused anemias, there was no reduction in the number of germ cells. The hematopoietic abnormalities in the trisomy 16 mouse, involving the lymphoid, myeloid, and erythroid cell lineages, are much more generalized than the abnormalities in any of the other described genetically caused immunodeficiencies or anemias in the mouse. They are also more severe than those in human trisomy 21 (Down syndrome), for which mouse trisomy 16 is a genetic model, but there does exist an interesting parallel between the thymic abnormalities in the two species.

Colony assays of hematopoietic progenitor cells and correlations to clinical situations

The production of blood cells is a dynamic process that is noticeably aberrant during disease. The availability of colony assays in vitro that allow detection of hematopoietic stem and progenitor cells for the neutrophil, monocyte-macrophage, erythroid and/or megakaryocyte lineages has been of importance for the present understanding of the mechanisms controlling the proliferation, self-renewal capacity, and differentiation of morphologically nonrecognizable immature cells which give rise to the mature progeny circulating in the blood. It is through the use of these assays that the existence of potentially relevant stimulatory and inhibitory feedback interactions has been demonstrated. Abnormalities in these interactions, which may be of significance during leukemia and related disorders, have been uncovered. This communication will discuss regulatory interactions detected via the colony assays, their potential relevance physiologically and pathologically, and the use of these assays for diagnosis, prognosis, and for monitoring the clinical status of patients.

Leukemia and other cancers, anomalies and infections as causes of death in Down's syndrome in the United States during 1976

All 995 persons with Down's syndrome who died in the United States during 1976 and whose death certificates listed Down's syndrome as the underlying or a contributing cause of death were identified. This allowed the underlying causes of death of 793 affected persons to be analysed and compared to deaths in the whole US population for that year. Mortality ratios provided evidence that the excess risk of leukemia mortality continues into adulthood and that deaths from other hematopoietic malignancies also occur excessively among Down's syndrome adults. Congenital anomalies of all kinds in infancy and congenital defects of the heart in infancy and later were also excessive. Respiratory tract infections and pneumonia showed persistently high ratios. Diabetes was raised only at ages 24 to 34 years. Ischemic heart disease, non-hematopoietic cancers, accidents, suicides and violence were under-represented among the causes of death. Methodological limitations of proportional mortality analysis are discussed.

Failure of chronic-granulocytic-leukaemia leucocytes to release an inhibition of granulopoiesis

Phagocytosing, but not resting, neutrophils normally release an inhibitor of in-vitro granulopoiesis which suppresses the production or release of colony-stimulating factor by monocytes and macrophages. Neutrophils from 12 patients with chronic granulocytic leukaemia (CGL) were found to contain the inhibitor, but in 11 of the 12 patients there was failure to release significant amounts during phagocytosis. It is suggested that such a defect in the feedback control of granulopoiesis could lead to the progressive inappropriate accumulation of morphologically normal granulocytes, as seen in CGL.

The effects of surgical trauma on human granulopoiesis

Marked changes in the concentration and proliferative state of circulating granulocytic progenitor cells (colony forming units in culture; CFUc) were observed in female patients following surgical trauma. Within one day of an abdominal hysterectomy there was an abrupt fall in the number of blood CFUc to between 10% and 20% of normal and an increase in the proportion synthesizing DNA which coincided with the maximum neutrophilia. Subsequently, as the neutrophil count declined, the CFUc concentration increased to supranormal values and the proliferative response persisted, both parameters returning to normal 2 weeks after surgery. These results suggest that, following surgical trauma, the increased demand for neutrophils is rapidly met by increased CFUc proliferation.

The proliferative state of granulocytic progenitor cells in human blood and marrow

A double layer agar technique was used to investigate the proliferative state of granulocytic progenitor cells (Colony Forming Units in Culture; CFUc) in human peripheral blood and bone marrow. The sensitivity of the progenitor cells to the S-phase specific agent, hydroxyurea, was used as an index of the proportion of cells engaged in DNA synthesis. In the presence of low concentrations of colony stimulating factor (CSF) the CFUc were found to be virtually insensitive to the drug. However, when cultured in the presence of increasing concentrations of CSF the proportion of CFUc apparently killed by hydroxyurea increased to a maximum of 23% for those cells in the blood and 39% for those in the marrow. The results indicate that CFUc which are slowly proliferating are sensitive to low concentrations of CSF. In contrast, those CFUc which are proliferating more rapidly require high concentrations of CSF before they will form colonies in culture. A model has been devised which suggests that as CFUc mature, their cell cycle time shortens and their sensitivity to CSF decreases.