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      Ineffective Erythropoiesis in β -Thalassemia

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          Abstract

          In humans, β -thalassemia dyserythropoiesis is characterized by expansion of early erythroid precursors and erythroid progenitors and then ineffective erythropoiesis. This ineffective erythropoiesis is defined as a suboptimal production of mature erythrocytes originating from a proliferating pool of immature erythroblasts. It is characterized by (1) accelerated erythroid differentiation, (2) maturation blockade at the polychromatophilic stage, and (3) death of erythroid precursors. Despite extensive knowledge of molecular defects causing β -thalassemia, less is known about the mechanisms responsible for ineffective erythropoiesis. In this paper, we will focus on the underlying mechanisms leading to premature death of thalassemic erythroid precursors in the bone marrow.

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          Most cited references139

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          Beta-thalassemia.

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            Iron-chelating therapy and the treatment of thalassemia.

            Iron-chelating therapy with deferoxamine in patients with thalassemia major has dramatically altered the prognosis of this previously fatal disease. The successes achieved with deferoxamine, as well as the limitations of this treatment, have stimulated the design of alternative strategies of iron-chelating therapy, including orally active iron chelators. The development of the most promising of these, deferiprone, has progressed rapidly over the last 5 years; data from several trials have provided direct and supportive evidence for its short-term efficacy. At the same time, the toxicity of this agent mandates a careful evaluation of the balance between risk and benefit of deferiprone in patients with thalassemia, in most of whom long-term deferoxamine is safe and efficacious therapy.
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              Erythroblastic islands: niches for erythropoiesis.

              Erythroblastic islands, the specialized niches in which erythroid precursors proliferate, differentiate, and enucleate, were first described 50 years ago by analysis of transmission electron micrographs of bone marrow. These hematopoietic subcompartments are composed of erythroblasts surrounding a central macrophage. A hiatus of several decades followed, during which the importance of erythroblastic islands remained unrecognized as erythroid progenitors were shown to possess an autonomous differentiation program with a capacity to complete terminal differentiation in vitro in the presence of erythropoietin but without macrophages. However, as the extent of proliferation, differentiation, and enucleation efficiency documented in vivo could not be recapitulated in vitro, a resurgence of interest in erythroid niches has emerged. We now have an increased molecular understanding of processes operating within erythroid niches, including cell-cell and cell-extracellular matrix adhesion, positive and negative regulatory feedback, and central macrophage function. These features of erythroblast islands represent important contributors to normal erythroid development, as well as altered erythropoiesis found in such diverse diseases as anemia of inflammation and chronic disease, myelodysplasia, thalassemia, and malarial anemia. Coupling of historical, current, and future insights will be essential to understand the tightly regulated production of red cells both in steady state and stress erythropoiesis.
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                Author and article information

                Journal
                ScientificWorldJournal
                ScientificWorldJournal
                TSWJ
                The Scientific World Journal
                Hindawi Publishing Corporation
                1537-744X
                2013
                28 March 2013
                : 2013
                : 394295
                Affiliations
                1Centre National de la Recherche Scientifique-Unité Mixte de Recherche 8147, Université Paris V, René Descartes, Hôpital Necker, Paris, France
                2Département de Biothérapie, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique—Hôpitaux de Paris, Hôpital Necker, Paris, France
                3Fondation Imagine, Institut des Maladies Génétiques, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique—Hôpitaux de Paris, Hôpital Necker, Paris, France
                4Laboratoire d'Excellence des Globules Rouges (GR-ex), Paris, France
                5Fondation Imagine, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
                6Service de Médecine Interne, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique—Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
                7INSERM U 699, Hôpital Bichat, Université Paris Diderot, Paris, France
                8Service d'Hématologie, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique—Hôpitaux de Paris Hôpital Necker, Paris, France
                Author notes

                Academic Editors: Y. Al-Tonbary, M. A. Badr, A. El-Beshlawy, and F. Tricta

                Article
                10.1155/2013/394295
                3628659
                23606813
                2d3e2ee2-7c2c-4a83-ae67-91eb0dd7e5ab
                Copyright © 2013 Jean-Antoine Ribeil et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 December 2012
                : 3 February 2013
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