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Singh R, Sharma P, Wadhwan V. Neutrophils defending the defenders. J Oral Maxillofac Pathol 2021; 25:177-182. [PMID: 34349432 PMCID: PMC8272482 DOI: 10.4103/jomfp.jomfp_495_20] [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: 12/04/2020] [Revised: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
Neutrophils are the most abundant granulocytes which are involved in defense mechanism. As innate immune cells, they are first-line defenders and can perform different functions in the human body to maintain equilibrium. Neutrophils are the main leukocyte and their role in healthy oral cavity is to face pathological changes within oral environment. With regard to these, it has been observed that neutrophils are highly heterogeneous in their behavior. The aim of this review is to give an overview of the role of neutrophils in context of various physiological and pathological conditions.
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Affiliation(s)
- Roli Singh
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Preeti Sharma
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Vijay Wadhwan
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
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2
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Mackey MC. Periodic hematological disorders: Quintessential examples of dynamical diseases. CHAOS (WOODBURY, N.Y.) 2020; 30:063123. [PMID: 32611100 DOI: 10.1063/5.0006517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
This paper summarizes the evidence supporting the classification of cyclic neutropenia as a dynamical disease and periodic chronic myelogenous leukemia is also considered. The unsatisfactory state of knowledge concerning the genesis of cyclic thrombocytopenia and periodic autoimmune hemolytic anemia is detailed.
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Affiliation(s)
- Michael C Mackey
- Department of Physiology, Department of Physics, and Department of Mathematics McGill University, Montreal, Quebec H4X 2C1, Canada
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3
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Knauer F, Stiehl T, Marciniak-Czochra A. Oscillations in a white blood cell production model with multiple differentiation stages. J Math Biol 2019; 80:575-600. [DOI: 10.1007/s00285-019-01432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/02/2019] [Indexed: 12/15/2022]
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Abstract
Neutropenia, usually defined as a blood neutrophil count <1·5 × 109 /l, is a common medical problem for children and adults. There are many causes for neutropenia, and at each stage in life the clinical pattern of causes and consequences differs significantly. I recommend utilizing the age of the child and clinical observations for the preliminary diagnosis and primary management. In premature infants, neutropenia is quite common and contributes to the risk of sepsis with necrotizing enterocolitis. At birth and for the first few months of life, neutropenia is often attributable to isoimmune or alloimmune mechanisms and predisposes to the risk of severe bacterial infections. Thereafter when a child is discovered to have neutropenia, often associated with relatively minor symptoms, it is usually attributed to autoimmune disorder or viral infection. The congenital neutropenia syndromes are usually recognized when there are recurrent infections, the neutropenia is severe and there are congenital anomalies suggesting a genetic disorder. This review focuses on the key clinical finding and laboratory tests for diagnosis with commentaries on treatment, particularly the use of granulocyte colony-stimulating factor to treat childhood neutropenia.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
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5
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Rubinow SI, Lebowitz JL. A mathematical model of neutrophil production and control in normal man. J Math Biol 2017; 1:187-225. [PMID: 28303306 DOI: 10.1007/bf01273744] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/1973] [Revised: 05/23/1974] [Indexed: 11/27/2022]
Abstract
A comprehensive mathematical model of neutrophil production in normal man is presented. The model incorporates three control elements which regulate homeostatically the rates of release of marrow cells to proliferation, maturation, and to the blood. The steady state properties of the model are demonstrated analytically. The basic equations of the model, which are nonlinear, have been integrated numerically. The solutions so obtained display graphically the dynamical response of the system to various perturbations, which simulate experimental investigations that have been made in the past of granulocytopoiesis. By an appropriate choice of values of the parameters characterizing the system, it is shown how most of the principal kinetic properties of the neutrophil production and control system are represented in a quantitative manner.
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Affiliation(s)
- S I Rubinow
- Biomathematics Division, Graduate School of Medical Sciences Cornell University, 10021, New York, NY, USA
| | - J L Lebowitz
- Biomathematics Division, Graduate School of Medical Sciences Cornell University, 10021, New York, NY, USA
- Physics Department, Belfer Graduate School of Sciences, Yeshiva University, 10019, New York, NY, USA
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6
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Dale DC, Mackey MC. Understanding, treating and avoiding hematological disease: better medicine through mathematics? Bull Math Biol 2014; 77:739-57. [PMID: 25213154 DOI: 10.1007/s11538-014-9995-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
Abstract
This paper traces the experimental, clinical and mathematical modeling efforts to understand a periodic hematological disease-cyclical neutropenia. It is primarily a highly personal account by two scientists from quite different backgrounds of their interactions over almost 40 years and their attempts to understand this intriguing disease. It's also a story of their efforts to offer effective treatments for the patients who suffer from cyclic neutropenia and other conditions causing neutropenia and infections.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA,
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7
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Abstract
Neutropenia, defined as an absolute neutrophil count (ANC) <1.5 × 10(9)/L, encompasses a wide range of diagnoses, from normal variants to life-threatening acquired and congenital disorders. This review addresses the diagnosis and management of isolated neutropenia, not multiple cytopenias due to splenomegaly, bone marrow replacement, or myelosuppression by chemotherapy or radiation. Laboratory evaluation generally includes repeat complete blood cell counts (CBCs) with differentials and bone marrow examination with cytogenetics. Neutrophil antibody testing may be useful but only in the context of clinical and bone marrow findings. The discovery of genes responsible for congenital neutropenias now permits genetic diagnosis in many cases. Management of severe chronic neutropenia includes commonsense precautions to avoid infection, aggressive treatment of bacterial or fungal infections, and administration of granulocyte colony-stimulating factor (G-CSF). Patients with severe chronic neutropenia, particularly those who respond poorly to G-CSF, have a risk of eventually developing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) and require monitoring for this complication, which also can occur without G-CSF therapy. Patients with cyclic, idiopathic, and autoimmune neutropenia have virtually no risk of evolving to MDS or AML. Hematopoietic stem cell transplantation is a curative therapy for congenital neutropenia with MDS/AML or with cytogenetic abnormalities indicating impending conversion.
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Affiliation(s)
- Peter E Newburger
- Departments of Pediatrics and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA.
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8
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A Model of Oscillatory Blood Cell Counts in Chronic Myelogenous Leukaemia. Bull Math Biol 2011; 73:2983-3007. [DOI: 10.1007/s11538-011-9656-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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9
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Multistability in an age-structured model of hematopoiesis: Cyclical neutropenia. J Theor Biol 2011; 270:143-53. [DOI: 10.1016/j.jtbi.2010.11.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 09/21/2010] [Accepted: 11/13/2010] [Indexed: 11/19/2022]
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Abstract
Patients with severe chronic neutropenia have blood neutrophil level <0.5 × 10(9)/L, predisposing them to increased susceptibility to life-threatening bacterial infections. This chapter focuses on cyclic and congenital neutropenia, two very interesting and rare hematological conditions causing severe chronic neutropenia. Both disorders respond well to treatment with the myeloid growth factor, granulocyte colony-stimulating factor (G-CSF). This chapter describes the basic features of these diseases and addresses several current clinical issues regarding their diagnosis and management. Cyclic neutropenia is a rare, inherited autosomal dominant disorder due to mutations in the gene for neutrophil elastase (ELA-2 or ELANE). Usually these patients have regular oscillation of blood neutrophil counts with periods of severe neutropenia occurring every 21 days. During these periods, they have painful mouth ulcers, fevers, and bacterial infections. The most severe consequences are gangrene, bacteremia, and septic shock. Cyclic neutropenia patients respond well to treatment with granulocyte colony-stimulating factor (G-CSF) given by subcutaneous injections on a daily or alternate-day basis. Severe congenital neutropenia is also a rare hematological disease, but it is probably more common than cyclic neutropenia. Blood neutrophils are extremely low on a continuing basis; the levels may be <0.2 × 10(9)/L, and the risk of severe bacterial infections is even greater than in cyclic neutropenia. The majority of cases are due to autosomal dominant inheritance of mutations in the ELA-2 or ELANE gene. Less commonly, mutations in HAX-1, G6PC3, and other genes cause this disorder. Treatment with G-CSF is usually effective, but the dose of G-CSF required to normalize blood neutrophils varies greatly. Ten to thirty percent of severe congenital neutropenia patients evolve to develop acute myeloid leukemia, necessitating careful clinical monitoring.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA 98195, USA.
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12
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Rahman FZ, Marks DJB, Hayee BH, Smith AM, Bloom SL, Segal AW. Phagocyte dysfunction and inflammatory bowel disease. Inflamm Bowel Dis 2008; 14:1443-52. [PMID: 18421761 DOI: 10.1002/ibd.20449] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Inflammatory bowel diseases are common chronic inflammatory disorders. The majority are idiopathic and can be broadly divided into Crohn's disease and ulcerative colitis. Their cause is unknown, but most hypotheses focus on a primary role for T-cell dysfunction. Conversely, there is a collection of congenital disorders of phagocyte function that result not only in immunodeficiency but also in noninfectious inflammatory bowel disease. In all cases, the latter is strikingly reminiscent of the clinical and pathological features of Crohn's disease. This coincides with recent work demonstrating that despite previous emphasis on adaptive immune dysfunction, patients with Crohn's disease actually possess an unusually weak acute innate inflammatory response. This review consolidates the literature on inflammatory bowel disease in congenital immunodeficiencies and considers the role of phagocyte dysfunction in Crohn's disease. Concepts about pathogenesis and treatment that can be carried across these disorders are also discussed.
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Affiliation(s)
- Farooq Z Rahman
- Department of Medicine, University College London, London, United Kingdom
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13
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Hoffman HJ, Guerry D, Dale DC. Analysis of cyclic neutropenia using digital band‐pass filtering techniques. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/09291017409359403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Dynamic hematological disease: a review. J Math Biol 2008; 58:285-322. [DOI: 10.1007/s00285-008-0165-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 01/22/2008] [Indexed: 10/22/2022]
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Colijn C, Foley C, Mackey MC. G-CSF treatment of canine cyclical neutropenia: A comprehensive mathematical model. Exp Hematol 2007; 35:898-907. [PMID: 17533044 DOI: 10.1016/j.exphem.2007.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 02/20/2007] [Accepted: 02/27/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the effects of different G-CSF temporal treatment schemes using a comprehensive mathematical model of the mammalian hematopoietic system that couples the pharmacokinetics of granulocyte colony-stimulating factor (G-CSF) to the hematopoietic stem cell, neutrophil, platelet, and erythrocyte dynamics. MATERIALS AND METHODS Data from cyclical neutropenic (CN) grey collies are used to build an extended model that reproduces the dynamics of circulating blood cells found in laboratory data from the dogs with and without daily G-CSF therapy. The effects of varying the treatment initiation time, and whether injections are given daily, every other day, or every three days, are examined. RESULTS The mathematical model is able to reproduce the large variation in data that occurs from one dog to another. Different drug delivery times, with no other changes in the model parameters, can have significant long-term effects on neutrophil numbers. The frequency of drug delivery also has long-term effects on the oscillations. CONCLUSION Using a realistic representation of the effects of G-CSF on the tissue-level hematopoietic system, the model matches a wide range of laboratory data. This implies that it would be possible to generate individualized predictions for specific dogs if data were available in real time. The proposed interventions are practical and may reduce the amount of G-CSF required while potentially maintaining or even improving the treatment effects.
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Affiliation(s)
- Caroline Colijn
- Department of Mathematics, Center for Nonlinear Dynamics in Physiology and Medicine, McGill University, Montreal, QC, Canada
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Goldschneider I. Cyclical mobilization and gated importation of thymocyte progenitors in the adult mouse: evidence for a thymus-bone marrow feedback loop. Immunol Rev 2006; 209:58-75. [PMID: 16448534 DOI: 10.1111/j.0105-2896.2006.00354.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It has recently been observed, as in the fetal thymus, that the importation of hematogenous thymocyte progenitors by the adult thymus is a gated phenomenon, whereby saturating numbers of progenitors periodically enter the thymus and occupy a finite number of intrathymic niches. In addition, the mobilization of thymocyte progenitors from the bone marrow appears to be a cyclical process that coincides temporally with the periods of thymic receptivity (open gate). It is proposed that these events are coordinated by a thymus-bone marrow feedback loop in which a wave of developing triple negative (CD3- CD4- CD8-) thymocytes interacts with stromal cells in the stratified regions of the thymus cortex to sequentially induce the release of diffusible cytokines that regulate the production, mobilization, and recruitment of thymocyte progenitors. The likely components of this feedback loop are described here, as are the properties of the intrathymic vascular gates and niches for thymocyte progenitors. The cyclical production and release of thymocyte progenitors from the bone marrow is placed in the context of a general phenomenon of oscillatory feedback regulation involving all lymphohemopoietic cell lineages. Lastly, the question of whether the gated (as opposed to the continuous) entry of thymocyte progenitors is essential for normal thymocytopoiesis in adult life is discussed.
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Affiliation(s)
- Irving Goldschneider
- Department of Immunology, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Foley C, Bernard S, Mackey MC. Cost-effective G-CSF therapy strategies for cyclical neutropenia: Mathematical modelling based hypotheses. J Theor Biol 2006; 238:754-63. [PMID: 16115650 DOI: 10.1016/j.jtbi.2005.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 06/21/2005] [Accepted: 06/23/2005] [Indexed: 11/18/2022]
Abstract
Using computer simulations of a mathematical model for the regulation of stem cell and neutrophil production in dogs, we have studied the efficacy of four different treatment protocols for cyclical neutropenia involving granulocyte colony stimulating factor (G-CSF). The first treatment scheme is based on the bifurcation analysis of the mathematical model and proposes a daily, phase-dependent, protocol. The second involves alternate day administration of G-CSF. The third triggers G-CSF administration whenever neutrophil levels fall below a predetermined level, and the fourth one follows a random administration protocol. The computer simulations predict that clinically desirable results can be achieved with the three last methods, using far less G-CSF than would be needed with the standard daily treatment. If the results of this modelling are borne out clinically, they will entail a considerable financial savings for patients.
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Affiliation(s)
- Catherine Foley
- Department of Mathematics and Centre for Nonlinear Dynamics, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, Canada, H3G 1Y6.
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18
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Colijn C, Mackey MC. A mathematical model of hematopoiesis: II. Cyclical neutropenia. J Theor Biol 2005; 237:133-46. [PMID: 15975606 DOI: 10.1016/j.jtbi.2005.03.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 03/22/2005] [Accepted: 03/30/2005] [Indexed: 11/30/2022]
Abstract
Cyclical neutropenia is a dynamical disease of the hematopoietic system marked by an oscillation in circulating leukocyte (e.g. neutrophil) numbers to near zero levels and then back to normal. This oscillation is also mirrored in the platelets and reticulocytes which oscillate with the same period. Cyclical neutropenia has an animal counterpart in the grey collie. Using the mathematical model of the hematopoietic system of Colijn and Mackey [A mathematical model of hematopoiesis: I. Periodic chronic myelogenous leukemia. Companion paper to the present paper.] we have determined what parameters are necessary to mimic laboratory and clinical data on untreated grey collies and humans, and also what changes in these parameters are necessary to fit data during treatment with granulocyte colony stimulating factor (G-CSF). Compared to the normal steady-state values, we found that the major parameter changes that mimic untreated cyclical neutropenia correspond to a decreased amplification (increased apoptosis) within the proliferating neutrophil precursor compartment, and a decrease in the maximal rate of re-entry into the proliferative phase of the stem cell compartment. For the data obtained during G-CSF treatment, good fits were obtained only when parameters were altered that would imply that G-CSF led to higher amplification (lower rate of apoptosis) in the proliferating neutrophil precursors, and a elevated rate of differentiation into the neutrophil line.
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Affiliation(s)
- Caroline Colijn
- Department of Mathematics and Centre for Nonlinear Dynamics, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, Canada H3G 1Y6
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Dror Y, Sung L. Update on childhood neutropenia: molecular and clinical advances. Hematol Oncol Clin North Am 2004; 18:1439-58, x. [PMID: 15511624 DOI: 10.1016/j.hoc.2004.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital and inherited disorders are important differential diagnoses of neutropenia, particularly in neonates and children, although acquired causes are more common. This article focuses on recent advances in understanding the cellular and molecular defects in inherited neutropenias as well as issues that are related to clinical presentation, diagnosis, and complications.
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Affiliation(s)
- Yigal Dror
- Division of Hematology/Oncology, The Hospital for Sick Children and The University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Abstract
We study the dynamics of a model of white-blood-cell (WBC) production. The model consists of two compartmental differential equations with two discrete delays. We show that from normal to pathological parameter values, the system undergoes supercritical Hopf bifurcations and saddle-node bifurcations of limit cycles. We characterize the steady states of the system and perform a bifurcation analysis. Our results indicate that an increase in apoptosis rate of either hematopoietic stem cells or WBC precursors induces a Hopf bifurcation and an oscillatory regime takes place. These oscillations are seen in some hematological diseases.
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Affiliation(s)
- Samuel Bernard
- Département de mathématiques et de statistique & Centre de recherches mathématiques, université de Montréal, Montréal, Québec H3C 3J7, Canada.
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Bernard S, Bélair J, Mackey MC. Oscillations in cyclical neutropenia: new evidence based on mathematical modeling. J Theor Biol 2003; 223:283-98. [PMID: 12850449 DOI: 10.1016/s0022-5193(03)00090-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a dynamical model of the production and regulation of circulating blood neutrophil number. This model is derived from physiologically relevant features of the hematopoietic system, and is analysed using both analytic and numerical methods. Supercritical Hopf bifurcations and saddle-node bifurcations of limit cycles are shown to exist. We make the estimation of kinetic parameters for dogs and then apply the model to cyclical neutropenia (CN) in the grey collie, a rare disorder in which oscillations in all blood cell counts are found. We conclude that the major cause of the oscillations in CN is an increased rate of apoptosis of neutrophil precursors which leads to a destabilization of the hematopoietic stem cell compartment.
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Affiliation(s)
- Samuel Bernard
- Département de Mathématiques et de Statistique and Centre de recherches mathématiques, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, Qué., Canada H3C 3J7.
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Deas DE, Mackey SA, McDonnell HT. Systemic disease and periodontitis: manifestations of neutrophil dysfunction. Periodontol 2000 2003; 32:82-104. [PMID: 12756035 DOI: 10.1046/j.0906-6713.2003.03207.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- David E Deas
- Director of Clinical Periodontics US Air Force Periodontics Residency Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA
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Bernard S, Pujo-Menjouet L, Mackey MC. Analysis of cell kinetics using a cell division marker: mathematical modeling of experimental data. Biophys J 2003; 84:3414-24. [PMID: 12719268 PMCID: PMC1302899 DOI: 10.1016/s0006-3495(03)70063-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2002] [Accepted: 01/14/2003] [Indexed: 11/16/2022] Open
Abstract
We consider an age-maturity structured model arising from a blood cell proliferation problem. This model is "hybrid", i.e., continuous in time and age but the maturity variable is discrete. This is due to the fact that we include the cell division marker carboxyfluorescein diacetate succinimidyl ester. We use our mathematical analysis in conjunction with experimental data taken from the division analysis of primitive murine bone marrow cells to characterize the maturation/proliferation process. Cell cycle parameters such as proliferative rate beta, cell cycle duration tau, apoptosis rate gamma, and loss rate micro can be evaluated from CarboxyFluorescein diacetate Succinimidyl Ester + cell tracking experiments. Our results indicate that after three days in vitro, primitive murine bone marrow cells have parameters beta = 2.2 day(-1), tau = 0.3 day, gamma = 0.3 day(-1), and micro = 0.05 day(-1).
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Affiliation(s)
- Samuel Bernard
- Département de Mathématiques et de Statistique and Centre de Recherches Mathématiques, Université de Montréal, Montréal, Québec H3C 3J7, Canada
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Aprikyan AAG, Liles WC, Boxer LA, Dale DC. Mutant elastase in pathogenesis of cyclic and severe congenital neutropenia. J Pediatr Hematol Oncol 2002; 24:784-6. [PMID: 12468929 DOI: 10.1097/00043426-200212000-00025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe neutropenia is characterized by maturation arrest of myeloid cells at the promyelocyte stage of hematopoiesis. We reported that accelerated apoptosis of bone marrow myeloid progenitor cells was observed in both cyclic (CN) and severe congenital neutropenia (SCN). Short and long-term cultures of bone marrow CD34+ cells revealed reduced production of multipotent progenitors in SCN. In contrast, production of these cells was slightly elevated in CN compared with CD34+ cells from healthy volunteers. Production of myeloid-committed progenitor cells was significantly reduced in both CN and SCN. FACS analysis of CD34+ cells revealed G /G cell cycle arrest in SCN but not in CN.(0) (1) All CN patients and more than 90% of SCN patients have mutation in the neutrophil elastase (NE) gene. Molecular modeling of NE tertiary structure indicates that mutations observed in SCN are primarily located around the glycosylation sites, whereas CN mutations affect predominantly the active site. Transient expression of CN- or SCN-specific mutant NE cDNA results in impaired survival of human myeloid progenitor cells compared with control cells transfected with intact NE cDNA. We hypothesize that abnormal processing and subcellular localization of mutant NE might predetermine the etiology of cyclic or severe congenital neutropenia.
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Affiliation(s)
- Andrew A G Aprikyan
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6422, USA.
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Abstract
Cyclic neutropenia is a rare hematologic disorder, characterized by repetitive episodes of fever, mouth ulcers, and infections attributable to recurrent severe neutropenia. Fluctuations in blood cells are due to oscillatory production of cells by the bone marrow. Recent genetic, molecular, and cellular studies have shown that autosomal-dominant cyclic neutropenia and sporadic cases of this disease are due to a mutation in the gene for neutrophil elastase (ELA2), located at 19p13.3. This enzyme is synthesized in neutrophil precursors early in the process of primary granule formation. It is currently presumed that the mutant neutrophil elastase functions aberrantly within the cells to accelerate apoptosis of the precursors, resulting in effective and oscillatory production. Cyclic neutropenia is effectively treated with granulocyte colony-stimulating factor (G-CSF), usually at doses of 1 to 5 microg/kg/d (median dose, 2.5 microg/kg/d). Long-term, daily, or alternate-day administration reduces fever, mouth ulcers, and other inflammatory events associated with this disorder. Leukemic transformation is not a recognized risk for cyclic neutropenia, with or without treatment with G-CSF.
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Affiliation(s)
- David C Dale
- Department of Medicine, and the Severe Chronic Neutropenia International Registry, University of Washington, Seattle, WA 98195-6422, USA
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26
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Taves DR. Optimum inorganic ion concentrations for hematopoiesis cultures. Med Hypotheses 2002; 58:225-8. [PMID: 12018974 DOI: 10.1054/mehy.2001.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Current limitations in the ability to culture hematopoietic cells may be due to the use of ion concentrations that reflect those in the general circulation rather than those expected at hematopoietic sites. Expected changes in calcium, phosphate and hydroxyl ion are calculated indirectly using published data. Results indicate doubling of normal concentrations for the first week, followed by 2 weeks of smaller elevations as the osteon undergoes resorption and replacement. The period of 3 weeks fits the expected time of the three stages of differentiation and proliferation of erythrocytes to the maturation phase. Mimicking the high concentrations of these ions in vitro may require the development of dynamic flow cultures because of problems with precipitation of calcium phosphate crystals. After 3 weeks 10% less than normal concentrations is expected as the bone mineral is replaced over a period of months, allowing a static system for maturation.
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Aprikyan AA, Dale DC. Mutations in the neutrophil elastase gene in cyclic and congenital neutropenia. Curr Opin Immunol 2001; 13:535-8. [PMID: 11543999 DOI: 10.1016/s0952-7915(00)00254-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe neutropenia disorders are characterized by extremely low levels of peripheral blood neutrophils, a maturation block of bone marrow progenitor cells and recurring severe bacterial and fungal infections. Recent reports indicated that severe neutropenia is a consequence of an impaired survival and abnormal cell cycle progression of myeloid progenitor cells in both cyclic and severe congenital neutropenia. Mutations in the neutrophil elastase gene were identified in all patients with cyclic neutropenia and most of the patients with severe congenital neutropenia. We hypothesize that expression of mutant neutrophil elastase protein results in deregulation of intracellular activity and premature cell death of myeloid-committed progenitor cells in these disorders, resulting in the lack of peripheral blood neutrophils. The potential molecular mechanisms of mutant-protein-mediated neutropenia is discussed.
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Affiliation(s)
- A A Aprikyan
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356422, Seattle, WA 98195-6522, USA.
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28
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Lubitz PA, Dower N, Krol AL. Cyclic neutropenia: an unusual disorder of granulopoiesis effectively treated with recombinant granulocyte colony-stimulating factor. Pediatr Dermatol 2001; 18:426-32. [PMID: 11737691 DOI: 10.1046/j.1525-1470.2001.01974.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cyclic neutropenia (CN) is a rare hematologic disorder characterized by regular cycling of the absolute neutrophil count and a symptom complex presenting during the neutropenic nadirs. Despite the profound cyclic neutropenia, most patients have a benign course of recurrent fever, malaise, oral ulceration, and minor skin and upper respiratory tract infections. Recurrent infections, inflammation, and ulcers can lead to significant chronic morbidity. Severe dental disease is common, pregnancy complications are increased, and overwhelming infections, bowel necrosis, and mortality, although rare, are potential sequelae. We report a 10-year-old boy with a classical presentation of CN that had remained undiagnosed for 10 years. The difficulty in diagnosing this unusual disorder is highlighted. Treatment with daily recombinant granulocyte colony-stimulating factor (rG-CSF) resulted in a complete clearing of symptoms and a significant increase in quality of life. The excellent clinical response of CN to rG-CSF, in the absence of major adverse effects, is strongly demonstrated by this case and supports rG-CSF as a first-line therapy for CN. The physiologic and adverse effects of rG-CSF use in CN and other neutropenic disorders, including potential leukemic induction, are reviewed. The need for long-term follow-up to investigate the effects of chronic hematopoietic stimulation by rG-CSF is emphasized.
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Affiliation(s)
- P A Lubitz
- Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, Alberta, Canada
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29
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Giani U, Filosa A. Cyclic red blood cell destruction in thalassemia. Chronobiol Int 2001; 18:729-36. [PMID: 11587093 DOI: 10.1081/cbi-100106084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective analysis of time series of hemoglobin (Hb) destruction of 24 children (11 males and 13 females) with thalassemia from the age of 6 to 12 years showed that the Hb destruction rate typically oscillated with an average period of 50 days. A possible relation between the periodism and the severity of the disease is also suggested.
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Affiliation(s)
- U Giani
- Department of Preventive Medical Sciences, Faculty of Medicine, University of Naples, Italy.
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Dale DC, Liles WC, Garwicz D, Aprikyan AG. Clinical implications of mutations of neutrophil elastase in congenital and cyclic neutropenia. J Pediatr Hematol Oncol 2001; 23:208-10. [PMID: 11846296 DOI: 10.1097/00043426-200105000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D C Dale
- Department of Medicine, University of Washington, Seattle, USA
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31
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Abstract
Neutrophil disorders are an uncommon yet important cause of morbidity and mortality in infants and children. This article is an overview of these conditions, with emphasis on clinical recognition, rational investigation, and treatment. A comprehensive list of references is provided for further reading.
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Affiliation(s)
- R Lakshman
- Sheffield Institute for Vaccine Studies, Division of Child Health, University of Sheffield Children's Hospital, Sheffield S10 2TH, UK.
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32
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Aprikyan AA, Liles WC, Rodger E, Jonas M, Chi EY, Dale DC. Impaired survival of bone marrow hematopoietic progenitor cells in cyclic neutropenia. Blood 2001; 97:147-53. [PMID: 11133754 DOI: 10.1182/blood.v97.1.147] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cyclic neutropenia (CN) is a congenital hematopoietic disorder characterized by remarkably regular oscillations of blood neutrophils from near normal to extremely low levels at 21-day intervals. Recurring episodes of severe neutropenia lead to repetitive and sometimes life-threatening infections. To investigate the cellular mechanism of CN, the ultrastructure and the proliferative and survival characteristics of bone marrow-derived CD34(+) early progenitors, CD33(+)/CD34(-) myeloid progenitors, and CD15(+) neutrophil precursors from CN patients and healthy volunteers were studied. The ultrastructural studies showed profound apoptotic features in bone marrow progenitor cells in CN. Colony-forming assays demonstrated a 75% decrease in the number of early myeloid-committed colonies compared with controls. Long-term culture-initiating cell assays demonstrated a 6-fold increase in production of primitive progenitor cells in CN. To determine whether accelerated apoptosis might account for the underproduction of myeloid progenitors, the hematopoietic subpopulations were labeled with fluorescein isothiocyanate-annexin V and analyzed by flow cytometry. Short-term culture of CN cells resulted in apoptosis of approximately 65% of CD34(+) cells, 80% of CD33(+)/CD34(-) cells, and more than 70% of CD15(+) cells, as compared with 20%, 7%, and 15% apoptosis in respective control subpopulations. Evidence of accelerated apoptosis of bone marrow progenitor cells was observed in all 8 patients participating in the study, regardless of the stage in the CN cycle in which bone marrow aspirations were obtained. Granulocyte colony-stimulating factor therapy of CN patients significantly improved survival of bone marrow progenitor cells. These data indicate that ineffective production of neutrophils is due to accelerated apoptosis of bone marrow myeloid progenitor cells in CN.
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Affiliation(s)
- A A Aprikyan
- Departments of Medicine and Pathology, University of Washington School of Medicine, Seattle, WA 98195-6422, USA
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33
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Abstract
Using Lomb periodogram analysis we have quantified variations in the peripheral neutrophil and platelet counts of the cyclical neutropenia animal model-the grey collie. We found that the amplitudes of the oscillations in these two cell lineages vary concomitantly. Further, the power spectrum and the shape of the oscillations in the absolute neutrophil counts vary together with the amplitude of the oscillations. As the amplitude of the oscillations increases, the height of the second subharmonic increases, giving rise to a distorted oscillation with two peaks per cycle. The particular dynamics of the absolute neutrophil counts can be reproduced by a combination of a delayed peripheral feedback, representing the peripheral control of granulopoiesis through granulocyte colony stimulating factor, together with a sinusoidal input representing an oscillatory input from the pluripotential stem cells to the granulocytic lineage. The same pluripotential stem cell input is probably responsible for the sinusoidal oscillations observed in the other cell lineages.
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Affiliation(s)
- C Haurie
- Department of Physiology, Centre for Nonlinear Dynamics, McGill University, Montreal, Canada
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34
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Haurie C, Dale DC, Mackey MC. Occurrence of periodic oscillations in the differential blood counts of congenital, idiopathic, and cyclical neutropenic patients before and during treatment with G-CSF. Exp Hematol 1999; 27:401-9. [PMID: 10089901 DOI: 10.1016/s0301-472x(98)00061-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using techniques developed in astrophysics to deal with unequally sampled data sets, we have analyzed serial differential cell counts from 45 congenital, idiopathic, and cyclic neutropenic patients before and during treatment with recombinant human G-CSF (rhG-CSF). Our results show that the occurrence of significant cycling in the absolute neutrophil count (ANC) of neutropenics not classified as cyclical is much more prevalent than had been previously thought, and that not all the patients classified as cyclic show significant ANC periodicity. In these patients, cycling in more than one cell line may be involved. The range of periods encountered in these patients is much broader (between 11 and 52 days) than is usually associated with classical cyclical neutropenia, and there is no obvious connection between the range of periods and the patient's diagnostic category. Administration of rhG-CSF is able to induce significant cycling in neutropenic patients that were not cycling prior to treatment. In patients who had significant cycling before treatment, rhG-CSF may either decrease the period to between 11 and 14 days, or may obliterate any statistical evidence of cycling.
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Affiliation(s)
- C Haurie
- Department of Physiology, McGill University, Montreal, Quebec, Canada
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35
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Cyclical Neutropenia and Other Periodic Hematological Disorders: A Review of Mechanisms and Mathematical Models. Blood 1998. [DOI: 10.1182/blood.v92.8.2629] [Citation(s) in RCA: 167] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Although all blood cells are derived from hematopoietic stem cells, the regulation of this production system is only partially understood. Negative feedback control mediated by erythropoietin and thrombopoietin regulates erythrocyte and platelet production, respectively, but the regulation of leukocyte levels is less well understood. The local regulatory mechanisms within the hematopoietic stem cells are also not well characterized at this point. Because of their dynamic character, cyclical neutropenia and other periodic hematological disorders offer a rare opportunity to more fully understand the nature of these regulatory processes. We review the salient clinical and laboratory features of cyclical neutropenia (and the less common disorders periodic chronic myelogenous leukemia, periodic auto-immune hemolytic anemia, polycythemia vera, aplastic anemia, and cyclical thrombocytopenia) and the insight into these diseases afforded by mathematical modeling. We argue that the available evidence indicates that the locus of the defect in most of these dynamic diseases is at the stem cell level (auto-immune hemolytic anemia and cyclical thrombocytopenia seem to be the exceptions). Abnormal responses to growth factors or accelerated cell loss through apoptosis may play an important role in the genesis of these disorders.
© 1998 by The American Society of Hematology.
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36
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Abstract
Although all blood cells are derived from hematopoietic stem cells, the regulation of this production system is only partially understood. Negative feedback control mediated by erythropoietin and thrombopoietin regulates erythrocyte and platelet production, respectively, but the regulation of leukocyte levels is less well understood. The local regulatory mechanisms within the hematopoietic stem cells are also not well characterized at this point. Because of their dynamic character, cyclical neutropenia and other periodic hematological disorders offer a rare opportunity to more fully understand the nature of these regulatory processes. We review the salient clinical and laboratory features of cyclical neutropenia (and the less common disorders periodic chronic myelogenous leukemia, periodic auto-immune hemolytic anemia, polycythemia vera, aplastic anemia, and cyclical thrombocytopenia) and the insight into these diseases afforded by mathematical modeling. We argue that the available evidence indicates that the locus of the defect in most of these dynamic diseases is at the stem cell level (auto-immune hemolytic anemia and cyclical thrombocytopenia seem to be the exceptions). Abnormal responses to growth factors or accelerated cell loss through apoptosis may play an important role in the genesis of these disorders.
© 1998 by The American Society of Hematology.
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37
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an der Heiden U. [Mathematical principles of medicine]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:557-64. [PMID: 9792025 DOI: 10.1007/bf03042668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Schmitz S, Franke H, Wichmann HE, Diehl V. The effect of continuous G-CSF application in human cyclic neutropenia: a model analysis. Br J Haematol 1995; 90:41-7. [PMID: 7540416 DOI: 10.1111/j.1365-2141.1995.tb03378.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human cyclic neutropenia (CN) is a rare haematological disorder characterized by oscillations of blood neutrophils at subnormal levels with a stable period of approximately 21 d. During the phase of severe neutropenia (neutrophils < 250 cells/microliters), which last 4-10 d, the patients are endangered by serious infections. Several authors report that continuous G-CSF application can elevate the blood neutrophils to such a level that the risk of infections is significantly reduced. Although the characteristic cycles are not eliminated by G-CSF, the period of the oscillations is shortened to 12-14 d. Based on a previously proposed computer-simulation model of human CN, the effects of continuous G-CSF application on CN are studied. It is shown how the known different cell-kinetic effects of G-CSF on granulopoiesis explain the clinical data in CN. The reduced length of the cycles emerges as a result of the transit time reduction of the post-mitotic granulopoietic cells by G-CSF. The measured increase of the neutrophil maxima is reproduced by the additional mitoses of the immature granulopoietic bone marrow cells induced by G-CSF. The slight elevation of the neutrophil nadirs can be attributed to a weak effect of G-CSF on the assumed underlying defect in CN (an abnormally small variance of the granulopoietic bone-marrow transit time).
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Affiliation(s)
- S Schmitz
- Clinic I for Internal Medicine, University of Cologne, Germany
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39
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Schmitz S, Franke H, Loeffler M, Wichmann HE, Diehl V. Reduced variance of bone-marrow transit time of granulopoiesis—a possible pathomechanism of human cyclic neutropenia. Cell Prolif 1994. [DOI: 10.1111/j.1365-2184.1994.tb01380.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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40
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Yamalik N, Yavuzyilmaz E, Cağlayan F, Tezcan I, Berkel I, Ersoy F, Sanal O. Periodical gingival bleeding as a presenting symptom of periodontitis due to underlying cyclic neutropenia. Case report. Aust Dent J 1993; 38:272-6. [PMID: 8216033 DOI: 10.1111/j.1834-7819.1993.tb05495.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 13-year-old boy presenting with spontaneous and periodical gingival bleeding accompanied by fever was thoroughly examined in order to determine the underlying aetiology of the gingival bleeding. Following repeated blood tests, the patient was diagnosed as having cyclic neutropenia. Thus, it was suggested, gingival bleeding, especially when spontaneous and periodical, should be carefully investigated to eliminate the possibility of cyclic neutropenia.
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Affiliation(s)
- N Yamalik
- Department of Periodontology, Faculty of Dentistry, University of Hacettepe, Turkey
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41
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Dale DC, Bolyard AA, Hammond WP. Cyclic neutropenia: natural history and effects of long-term treatment with recombinant human granulocyte colony-stimulating factor. Cancer Invest 1993; 11:219-23. [PMID: 7681723 DOI: 10.3109/07357909309024842] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- D C Dale
- Department of Medicine, University of Washington, Seattle
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42
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43
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Bandason C, Lee RJ. Fatal human cyclical neutropenia with unresolving tonsillitis and bilateral cervical abscesses. J Laryngol Otol 1991; 105:487-8. [PMID: 2072024 DOI: 10.1017/s002221510011638x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Human Cyclical Neutropenia is a rare haematological disorder, characterized by periodic oscillations in peripheral neutrophil levels from normal to neutropenic, during which patients experience ulcerative stomatitis, fever, malaise and occasional cutaneous and subcutaneous infections. We present our experience with a fatal case of Human Cyclical Neutropenia together with a brief review of the literature and diagnostic criteria. The paper aims to heighten the clinical awareness of the otolaryngologist to the condition. Close co-operation with the haematologist is essential both for diagnosis and management.
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44
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Junker AK, Poon MC, Hoar DI, Rogers PC. Severe combined immune deficiency presenting with cyclic hematopoiesis. J Clin Immunol 1991; 11:369-77. [PMID: 1761643 PMCID: PMC7101542 DOI: 10.1007/bf00918803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
At age 2 months a male infant presented with a cyclic clinical syndrome every 14-21 days that included pharyngeal aphthous ulcers, high fever, lymphadenopathy, pallor, and malaise. Serial blood studies indicated cycling of all blood cell elements, compatible with a diagnosis of cyclic hematopoiesis (CH). He also manifested a progressively severe immune deficiency, not described before in human CH. When first studied at age 5 months, he was hypogammaglobulinaemic with normal B lymphocyte numbers. By 6.5 months, he was agammaglobulinaemic. At age 8 months, he developed severe pneumocystis carinii pneumonia, and studies showed a state of severe combined immune deficiency. The patient received a bone marrow transplant from his HLA-identical sister with no preconditioning therapy. Subsequently, normal immune function developed and the cyclic hematopoiesis resolved. The majority of lymphocytes is of donor origin. Persistence of erythrocytes and neutrophils of recipient origin suggests that the hematopoietic stem cells were not abnormal. We speculate that this patient had a primary deficiency of a differentiation factor affecting maturation of lymphoid and myeloid progenitor cells.
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Affiliation(s)
- A K Junker
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
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45
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Affiliation(s)
- R D Christensen
- Division of Human Development and Aging, University of Utah School of Medicine, Salt Lake City 84132
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46
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Abstract
Six patients with cyclic neutropenia were treated with recombinant human granulocyte colony-stimulating factor (G-CSF) for 3 to 15 months. All had a history of recurrent aphthous stomatitis, pharyngitis, lymphadenopathy, fever, and numerous infections during periods of neutropenia. Serial blood-cell counts, findings on bone marrow examination, and signs and symptoms were evaluated before and during the daily administration of G-CSF (3 to 10 micrograms per kilogram of body weight per day), either intravenously or subcutaneously. The kinetics of labeled autologous blood neutrophils and the migration of neutrophils to skin chambers were also measured. Recombinant human G-CSF increased the mean (+/- SEM) neutrophil counts from 717 +/- 171 per microliter to 9814 +/- 2198 per microliter (P = 0.009). In five of the six patients, the cycling of blood-cell counts continued, but the length of the period decreased from 21 to 14 days. The number of days of severe neutropenia was reduced (P = 0.002). Neutrophil turnover increased almost four-fold (P = 0.005), whereas neutrophil migration to a skin chamber was normal. G-CSF therapy reduced the frequency of oropharyngeal inflammation, fever, and infections in these patients. During the first 40 months of treatment, no typical mouth ulcers or bacterial infections occurred; recurrent gingivitis improved. We conclude that G-CSF is effective for the treatment of cyclic neutropenia in humans.
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Affiliation(s)
- W P Hammond
- Department of Medicine, University of Washington School of Medicine, Seattle
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47
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Wright DG, LaRussa VF, Salvado AJ, Knight RD. Abnormal responses of myeloid progenitor cells to granulocyte-macrophage colony-stimulating factor in human cyclic neutropenia. J Clin Invest 1989; 83:1414-8. [PMID: 2649515 PMCID: PMC303837 DOI: 10.1172/jci114031] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Granulocyte-macrophage progenitors (CFU-GM) from four patients with childhood onset cyclic neutropenia demonstrated abnormal in vitro proliferative responses to purified, recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) when examined in detailed dose-response studies. Marrow aspirate specimens were obtained for these studies from cyclic neutropenia patients (both during neutropenic nadirs and during recovery phases of cycles), from leukemia patients in remission who had received myelosuppressive chemotherapy, and from healthy normal volunteers. Nucleated marrow cells were then isolated by density-gradient centrifugation and cryopreserved to permit studies of CFU-GM from patients and controls to be carried out at the same time and in replicate. Maximum clonal growth of CFU-GM from normal subjects and from individuals recovering from drug-induced myelosuppression was elicited by 20-100 pmol/liter rhGM-CSF, and the CSF concentrations that induced half-maximal responses (ED50) were between 1.0 and 3.0 pmol/liter. In contrast, maximum growth of CFU-GM from the cyclic neutropenia patients required greater than or equal to 1.0 nmol/liter rhGM-CSF and ED50's were greater than 30.0 pmol/liter. These abnormalities in the GM-CSF responsive growth of myeloid progenitors were independent of cycle time and were most apparent with the predominantly neutrophilic 7-d CFU-GM. Moreover, differences in the growth of 14-d CFU-GM could be attributed mostly if not entirely to differences in the generation of neutrophilic colonies. These findings indicate that childhood onset cyclic neutropenia is associated with an underlying disturbance in the GM-CSF responsive growth of myeloid progenitors committed to neutrophilic differentiation.
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Affiliation(s)
- D G Wright
- Department of Hematology, Walter Reed Army Institute of Research, Washington, DC 20307-5100
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48
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49
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Abstract
Cyclic neutropenia is a benign, hematologic disorder characterized by recurrent episodes of severe neutropenia at 21 day intervals. There are associated cyclical variations in other blood cells. Patients with this disease have malaise, stomatitis, cervical lymphadenopathy and fever during the recurrent neutropenic periods. The exact cause of cyclic neutropenia is unknown. About one third of human cases appear to be inherited in an autosomal dominant pattern. In the other cases, the disease appears to arise spontaneously with symptoms usually beginning in infancy or early childhood. In adult patients, the disease may be acquired and occur in association with a clonal proliferation of large granular lymphocytes. Clinical studies in man and investigations in grey collie dogs, which have a very similar disease, strongly suggest that cyclic neutropenia is due to an abnormality in the regulation of early hematopoietic precursor cells. Therapy for cyclic neutropenia involves local and symptomatic therapy for the recurrent mouth ulcers and pharyngitis, and antibiotics for episodes of sinusitis, pneumonia, peritonitis, or bacteremia. Therapy with glucocorticosteroids, androgens, and plasmapheresis has been efficacious in a few adult patients, but no therapy has been proven to alter the cycling of blood counts in children. Despite their repetitive illnesses, patients with cyclic neutropenia grow and develop normally. With the help of attentive physicians and dentists, their quality of life and life expectancy are good. Current research on hematopoietic growth factors offers promise of new approaches to therapy.
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Affiliation(s)
- D C Dale
- Department of Medicine, University of Washington School of Medicine, Seattle 98195
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50
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Tyazhelova VG. Oscillations in blood cells as a consequence of suppressed bone marrow cell production. CELL AND TISSUE KINETICS 1987; 20:539-49. [PMID: 3502924 DOI: 10.1111/j.1365-2184.1987.tb01363.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A hypothesis is proposed that the oscillations in blood cell numbers are the result of suppressed productivity of the bone marrow and its ability to satisfy both the demands of the erythroid and myeloid cell lines. The hypothesis is used as the basis for a mathematical model which describes the oscillations in all subpopulations of these cell lines. The relationship between the period and amplitude of the oscillations and the extent of suppression of the bone marrow productivity have been explored.
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