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Li X, Li M, Tian J, Shi ZW, Wang LZ, Song K. Secondary Polycythemia May Be an Early Clinical Manifestation of Multiple Myeloma: A Case Report. J Blood Med 2024; 15:325-330. [PMID: 39086399 PMCID: PMC11289518 DOI: 10.2147/jbm.s465827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
Multiple myeloma (MM) is a malignancy of plasma cells that can cause anemia due to renal failure and bone marrow failure. Secondary polycythemia (SE) is a clinically rare disease that involves the overproduction of red blood cells. To our knowledge, the association of multiple myeloma and polycythemia has been reported, but the association of SE and multiple myeloma is rare and has been infrequently reported in literature. In contrast to anemia, the presence of polycythemia in multiple myeloma patients is a rare finding. A patient of IgA-λ multiple myeloma with secondary erythrocytosis recently admitted to our department is now reported as follows and relevant literature is reviewed to improve clinicians' awareness of such rare comorbidities.
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Affiliation(s)
- XiaoLan Li
- Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
| | - Min Li
- Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
| | - Juan Tian
- Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
| | - Zi-Wei Shi
- Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
| | - Ling-Zhi Wang
- Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
| | - Kui Song
- Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan, People’s Republic of China
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Moore JA, Hubbi ME, Wang C, Wang Y, Luo W, Hofmann S, Rambally S. Isolated Erythrocytosis Associated With 3 Novel Missense Mutations in the EGLN1 Gene. J Investig Med High Impact Case Rep 2021; 8:2324709620947256. [PMID: 32755251 PMCID: PMC7543148 DOI: 10.1177/2324709620947256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hypoxia-inducible factor-1 (HIF-1) is a key regulator of erythropoiesis. In this article, we report 3 novel mutations, P378S, A385T, and G206C, on the EGLN1 gene encoding the negative HIF-1α regulator prolyl hydroxylase domain-2 (PHD2) in 3 patients with isolated erythrocytosis. These mutations impair PHD2 protein stability and partially reduce PHD2 activity, leading to increased HIF-1α protein levels in cultured cells.
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Affiliation(s)
- Joseph A Moore
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maimon E Hubbi
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chenliang Wang
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yingfei Wang
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Weibo Luo
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandra Hofmann
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Siayareh Rambally
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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McMullin MF. Genetic Background of Congenital Erythrocytosis. Genes (Basel) 2021; 12:genes12081151. [PMID: 34440325 PMCID: PMC8392557 DOI: 10.3390/genes12081151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023] Open
Abstract
True erythrocytosis is present when the red cell mass is greater than 125% of predicted sex and body mass, which is reflected by elevated hemoglobin and hematocrit. Erythrocytosis can be primary or secondary and congenital or acquired. Congenital defects are often found in those diagnosed at a young age and with a family history of erythrocytosis. Primary congenital defects mainly include mutations in the Erythropoietin receptor gene but SH2B3 has also been implicated. Secondary congenital erythrocytosis can arise through a variety of genetic mechanisms, including mutations in the genes in the oxygen sensing pathway, with high oxygen affinity hemoglobin variants and mutations in other genes such as BPMG, where ultimately the production of erythropoietin is increased, resulting in erythrocytosis. Recently, mutations in PIEZ01 have been associated with erythrocytosis. In many cases, a genetic variant cannot be identified, leaving a group of patients with the label idiopathic erythrocytosis who should be the subject of future investigations. The clinical course in congenital erythrocytosis is hard to evaluate as these are rare cases. However, some of these patients may well present at a young age and with sometimes catastrophic thromboembolic events. There is little evidence to guide the management of congenital erythrocytosis but the use of venesection and low dose aspirin should be considered.
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Roles of HIF and 2-Oxoglutarate-Dependent Dioxygenases in Controlling Gene Expression in Hypoxia. Cancers (Basel) 2021; 13:cancers13020350. [PMID: 33477877 PMCID: PMC7832865 DOI: 10.3390/cancers13020350] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Hypoxia—reduction in oxygen availability—plays key roles in both physiological and pathological processes. Given the importance of oxygen for cell and organism viability, mechanisms to sense and respond to hypoxia are in place. A variety of enzymes utilise molecular oxygen, but of particular importance to oxygen sensing are the 2-oxoglutarate (2-OG) dependent dioxygenases (2-OGDs). Of these, Prolyl-hydroxylases have long been recognised to control the levels and function of Hypoxia Inducible Factor (HIF), a master transcriptional regulator in hypoxia, via their hydroxylase activity. However, recent studies are revealing that such dioxygenases are involved in almost all aspects of gene regulation, including chromatin organisation, transcription and translation. Abstract Hypoxia—reduction in oxygen availability—plays key roles in both physiological and pathological processes. Given the importance of oxygen for cell and organism viability, mechanisms to sense and respond to hypoxia are in place. A variety of enzymes utilise molecular oxygen, but of particular importance to oxygen sensing are the 2-oxoglutarate (2-OG) dependent dioxygenases (2-OGDs). Of these, Prolyl-hydroxylases have long been recognised to control the levels and function of Hypoxia Inducible Factor (HIF), a master transcriptional regulator in hypoxia, via their hydroxylase activity. However, recent studies are revealing that dioxygenases are involved in almost all aspects of gene regulation, including chromatin organisation, transcription and translation. We highlight the relevance of HIF and 2-OGDs in the control of gene expression in response to hypoxia and their relevance to human biology and health.
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Baik AH, Jain IH. Turning the Oxygen Dial: Balancing the Highs and Lows. Trends Cell Biol 2020; 30:516-536. [PMID: 32386878 PMCID: PMC7391449 DOI: 10.1016/j.tcb.2020.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Oxygen is both vital and toxic to life. Molecular oxygen is the most used substrate in the human body and is required for several hundred diverse biochemical reactions. The discovery of the PHD-HIF-pVHL system revolutionized our fundamental understanding of oxygen sensing and cellular adaptations to hypoxia. It deepened our knowledge of the biochemical underpinnings of numerous diseases, ranging from anemia to cancer. Cellular dysfunction and tissue pathology can result from a mismatch of oxygen supply and demand. Recent work has shown that mitochondrial disease models display tissue hyperoxia and that disease pathology can be reversed by normalization of excess oxygen, suggesting that certain disease states can potentially be treated by modulating oxygen levels. In this review, we describe cellular and organismal mechanisms of oxygen sensing and adaptation. We provide a revitalized framework for understanding pathologies of too little or too much oxygen.
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Affiliation(s)
- Alan H Baik
- Department of Physiology, University of California, San Francisco, CA 94158, USA; Department of Medicine, Division of Cardiology, University of California, San Francisco, CA 94143, USA.
| | - Isha H Jain
- Department of Physiology, University of California, San Francisco, CA 94158, USA.
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Bonnin A, Gardie B, Girodon F, Airaud F, Garrec C, Bézieau S, Vignon G, Mottaz P, Labrousse J, Lellouche F. [A new case of rare erythrocytosis due to EGLN1 mutation with review of the literature]. Rev Med Interne 2020; 41:196-199. [PMID: 31980185 DOI: 10.1016/j.revmed.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The origin of polycythemia is often simple to detect. Sometimes it is necessary to look for hereditary forms, the decisive parameters being the dosage of erythropoietin and the measurement of the oxygen dissociation curve (P50). These rare diseases are related to high oxygen-affinity haemoglobins, abnormalities of the erythropoietin receptor or dysfunction of the HIF (hypoxia-inducible factor) pathway. CASE REPORT We report the case of a 56-year-old patient with unexplained polycythemia associated with normal serum erythropoietin and normal P50, in whom the never previously described mutation c.400C>T(p.Gln134*) on exon 1 in the EGLN1 gene (encoding PHD2) was found. CONCLUSION In the face of an unexplained polycythemia a good cooperation between clinicians and biologists is necessary to be able to characterize rare hereditary pathologies.
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Affiliation(s)
- A Bonnin
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France
| | - B Gardie
- École pratique des hautes études (EPHE), PSL research university, les Patios Saint-Jacques, 4-14, rue Ferrus, 75014 Paris, France; Inserm, centre national de la recherche scientifique (CNRS), institut du thorax, université de Nantes, 8, quai Moncousu, 44007 Nantes, France; Laboratory of excellence GR-Ex, Paris, France
| | - F Girodon
- Laboratory of excellence GR-Ex, Paris, France; Service d'hématologie biologique, pôle biologie, CHU de Dijon, hôpital du Bocage, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm U1231, université de Bourgogne, 21000 Dijon, France
| | - F Airaud
- Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - C Garrec
- Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - S Bézieau
- Inserm, centre national de la recherche scientifique (CNRS), institut du thorax, université de Nantes, 8, quai Moncousu, 44007 Nantes, France; Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - G Vignon
- Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France
| | - P Mottaz
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France
| | - J Labrousse
- Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France
| | - F Lellouche
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France; Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France.
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Barradas J, Rodrigues CD, Ferreira G, Rocha P, Constanço C, Andrade MR, Bento C, Silva HM. Congenital erythrocytosis - discover of a new mutation in the EGLN1 gene. Clin Case Rep 2018; 6:1109-1111. [PMID: 29881576 PMCID: PMC5986049 DOI: 10.1002/ccr3.1499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/03/2018] [Accepted: 02/23/2018] [Indexed: 01/03/2023] Open
Abstract
Congenital erythrocytosis is a hereditary disorder due to an increase in red cell mass that can be caused by mutations in proteins involved in HIF-α pathway, as PHD2. Hereby, we describe a new familial mutation in PHD2 gene. Considering an increased thrombotic potential, patients began antiplatelet aggregation therapy and phlebotomies.
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Affiliation(s)
- João Barradas
- Centro Hospitalar de Tondela‐ViseuEPE – Serviço de Hematologia ClínicaCoimbraPortugal
| | | | - Gisela Ferreira
- Centro Hospitalar do Baixo VougaEPE – Serviço de Hematologia ClínicaViseuPortugal
| | - Paula Rocha
- Centro Hospitalar de Tondela‐ViseuEPE – Serviço de Hematologia ClínicaCoimbraPortugal
| | - Conceição Constanço
- Centro Hospitalar de Tondela‐ViseuEPE – Serviço de Hematologia ClínicaCoimbraPortugal
| | - Maria Reis Andrade
- Centro Hospitalar de Tondela‐ViseuEPE – Serviço de Hematologia ClínicaCoimbraPortugal
| | - Celeste Bento
- Centro Hospitalar e Universitário de CoimbraEPE – Serviço de Hematologia ClínicaCoimbraPortugal
| | - Helena Matos Silva
- Centro Hospitalar de Tondela‐ViseuEPE – Serviço de Hematologia ClínicaCoimbraPortugal
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Desnoyers A, Pavic M, Houle PM, Castilloux JF, Beauregard P, Delisle L, Le Blanc R, Dufresne J, Boisjoly JA, Ethier V. Retrospective Study of High Hemoglobin Levels in 56 Young Adults. J Hematol 2018; 7:43-50. [PMID: 32300411 PMCID: PMC7155863 DOI: 10.14740/jh375w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/19/2018] [Indexed: 12/24/2022] Open
Abstract
Background Erythrocytosis is a frequent request for consultation in the hematologic field. The diagnostic approach is well established in the general population but in a young adult, finding the etiology of erythrocytosis can be a real diagnostic challenge. Methods This is an observational retrospective unicentric study made at the Sherbrooke University Hospital Center, over a period of 20 years (1995 - 2015). Every patient aged between 16 and 35 years old with a significant elevation of hemoglobin or hematocrit was included (hemoglobin > 185 g/L and/or hematocrit > 0.52 in men; hemoglobin > 165 g/L and/or hematocrit > 0.48 in women). Results Totally, 426 patients met the inclusion criteria (over a total of 113,453 complete blood counts) but only 56 entered the study for investigations. The majority of patients were of male gender, 43% of the patients were obese, 59% were smokers and 38% used excess alcohol or recreational drugs. Twenty-five patients had the diagnosis of absolute erythrocytosis. Seven patients had the diagnosis of relative erythrocytosis and no cause could be identified in 24 patients. No primary erythrocytosis was found in this cohort. Among the 25 patients with secondary erythrocytosis, hypoxia was the most frequent etiology identified. Less than half of the patients in the cohort had long term follow-up. Search for JAK2 mutation and serum EPO dosage were performed in 17.9% and 23.2% of cases respectively. Seven patients were treated with aspirin and five patients had phlebotomies. Conclusions This retrospective study reveals an actual clinical management that is often discordant with the current recommendations and a frequent lack of follow-up after initial investigations. Harmonization of management of erythrocytosis appears to be highly desirable.
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Affiliation(s)
| | - Michel Pavic
- Sherbrooke University Hospital Center, Sherbrooke, QC, Canada
| | | | | | | | - Line Delisle
- Sherbrooke University Hospital Center, Sherbrooke, QC, Canada
| | | | - Jean Dufresne
- Sherbrooke University Hospital Center, Sherbrooke, QC, Canada
| | | | - Vincent Ethier
- Sherbrooke University Hospital Center, Sherbrooke, QC, Canada
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