Positive and negative regulation of megakaryocytopoiesis

The recently cloned physiological regulator of megakaryocytopoiesis, known as Mpl ligand, thrombopoietin (TPO), megakaryocyte growth and development factor (MGDF) or megapoietin, is undergoing preclinical and clinical trials. This factor is an extremely potent thrombocytopoietic agent in vivo in normal animals, and accelerates platelet recovery in some but not all models of myelosuppression. Together with its apparent lack of adverse effects, the preclinical data suggest that TPO might permit the use of higher doses of chemotherapy in dose-intensive regimens and be useful in patients with ineffective platelet production or production abnormalities. The direct effects of TPO on primitive and various myeloid committed haematopoietic progenitor cells predict that TPO may be used in combination with other cytokines in a variety of clinical disorders. Along with the progress made in the understanding of the positive regulation of megakaryocytopoiesis, accumulating data demonstrate that platelet production is also controlled by negative regulators with potential clinical applications. Some of these regulators are effective in the treatment of essential thrombocythaemia and myeloproliferative disorders, while others seem capable of protecting progenitor cells from the cytotoxicity of chemotherapeutic drugs.