Erythropoiesis in myelodysplastic syndrome: expression of receptors for erythropoietin and kit ligand.

Ineffective erythropoiesis due to an impaired response to erythropoietin (EPO) is a prominent abnormality in myelodysplastic syndromes (MDS). The growth factor kit ligand (KL) may restore the in vitro erythroid colony-forming response to EPO in a subset of patients. The inability of MDS erythroid progenitors to react properly to EPO and/or KL has not been resolved. We have investigated erythropoietin receptor (EPO-R) and KL receptor (c-kit) expression in 15 cases of MDS by FACS analysis. The percentage of bone marrow cells expressing the EPO-R from patients with MDS were comparable to normal marrow. No apparent correlation was found between the number of MDS cells coexpressing the EPO-R and CD34 and impaired erythroid response. C-kit was expressed in most MDS patients, including those not responding to KL in EPO-induced cultures. In nine MDS cases the different splice variants of the EPO-R were analyzed. MDS cells, like normal marrow, expressed the full length EPO-R. These results show that impaired erythroid response in MDS cannot be explained by a quantitative lack of receptors for EPO or KL and that most likely suppression of erythroid response is caused by defective receptor signalling following ligand binding, representing a functional defect within the receptor itself or at a level downstream of the receptor.