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Patients with hypercortisolemic Cushing disease possess a distinct class of hematopoietic progenitor cells leading to erythrocytosis. | LitMetric

AI Article Synopsis

  • Human cell studies suggest glucocorticoid receptor (GR) activation promotes stress erythropoiesis, but its in vivo effects are unclear, especially in Cushing disease patients with high cortisol.
  • Patients with active Cushing disease show erythrocytosis along with increased GR-induced CD163+ monocytes and specific CD34+ cells, which can produce immature erythroid cells regardless of dexamethasone presence.
  • Even after remission, Cushing disease patients retain some changes, like high CD163+ monocytes and previously altered CD34+ cell activity, indicating that chronic glucocorticoid exposure leads to lasting effects on erythropoiesis.

Article Abstract

Although human cell cultures stimulated with dexamethasone suggest that the glucocorticoid receptor (GR) activates stress erythropoiesis, the effects of GR activation on erythropoiesis in vivo remain poorly understood. We characterized the phenotype of a large cohort of patients with Cushing disease, a rare condition associated with elevated cortisol levels. Results from hypercortisolemic patients with active Cushing disease were compared with those obtained from eucortisolemic patients after remission and from volunteers without the disease. Patients with active Cushing disease exhibited erythrocytosis associated with normal hemoglobin F levels. In addition, their blood contained elevated numbers of GR-induced CD163+ monocytes and a unique class of CD34+ cells expressing CD110, CD36, CD133 and the GR-target gene CXCR4. When cultured, these CD34+ cells generated similarly large numbers of immature erythroid cells in the presence and absence of dexamethasone, with raised expression of the GR-target gene GILZ. Of interest, blood from patients with Cushing disease in remission maintained high numbers of CD163+ monocytes and, although their CD34+ cells had a normal phenotype, these cells were unresponsive to added dexamethasone. Collectively, these results indicate that chronic exposure to excess glucocorticoids in vivo leads to erythrocytosis by generating erythroid progenitor cells with a constitutively active GR. Although remission rescues the erythrocytosis and the phenotype of the circulating CD34+ cells, a memory of other prior changes is maintained in remission.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071118PMC
http://dx.doi.org/10.3324/haematol.2021.280542DOI Listing

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