RESUMEN
Myeloproliferative neoplasms (MPN), which include primary myelofibrosis (PMF) and essential thrombocytopenia (ET), are characterized by the clonal proliferation of mature blood cells as a result of the overactivation of the JAK/STAT pathway. Extramedullary hematopoiesis (EMH), a common complication of PMF, occurs due to the dysregulation of the bone marrow microenvironment. We report an interesting case of a 73-year-old female with a working diagnosis of ET who was found to have EMH in the liver on biopsy after she had newly onset elevated liver enzymes and her ET had progressed to secondary myelofibrosis. We conclude that in patients with MPN who have rising liver enzymes, EMH in the liver should be part of the differential diagnosis. In addition, we believe that EMH is a sign of progression from MPN to secondary myelofibrosis and that it is imperative for performing bone marrow aspiration and biopsy in order to reassess hematopoiesis and to look for bone marrow fibrosis as well as evidence of progression.
RESUMEN
The tumor microenvironment (TME) plays an essential role in the development, proliferation, and survival of leukemic blasts in acute myeloid leukemia (AML). Within the bone marrow and peripheral blood, various phenotypically and functionally altered cells in the TME provide critical signals to suppress the anti-tumor immune response, allowing tumor cells to evade elimination. Thus, unraveling the complex interplay between AML and its microenvironment may have important clinical implications and are essential to directing the development of novel targeted therapies. This review summarizes recent advancements in our understanding of the AML TME and its ramifications on current immunotherapeutic strategies. We further review the role of natural products in modulating the TME to enhance response to immunotherapy.
RESUMEN
Gastrointestinal perforations are a complication of 2-10% of duodenal ulcers. There are a variety of etiologies associated with duodenal ulcer formation and its complications. Corticosteroid use is associated with an increased risk of duodenal ulcer perforation, with the first documented case in 1950. Other important medications associated with perforation include NSAIDS and opioids. Beyond medication, one of the most common disease processes, chronic obstructive pulmonary disease (COPD), has been found to be associated with peptic ulcer disease. Up to 30% of COPD patients have been found to have peptic ulcers, and COPD frequency in peptic ulcer disease is 2-3 times the general population. We herein present a case of an acute duodenal ulcer perforation in a patient receiving corticosteroid treatment for an acute COPD exacerbation.
RESUMEN
The lipin protein family of phosphatidate phosphatases has an established role in triacylglycerol synthesis and storage. Physiological roles for lipin-1 and lipin-2 have been identified, but the role of lipin-3 has remained mysterious. Using lipin single- and double-knockout models we identified a cooperative relationship between lipin-3 and lipin-1 that influences adipogenesis in vitro and adiposity in vivo. Furthermore, natural genetic variations in Lpin1 and Lpin3 expression levels across 100 mouse strains correlate with adiposity. Analysis of PAP activity in additional metabolic tissues from lipin single- and double-knockout mice also revealed roles for lipin-1 and lipin-3 in spleen, kidney, and liver, for lipin-1 alone in heart and skeletal muscle, and for lipin-1 and lipin-2 in lung and brain. Our findings establish that lipin-1 and lipin-3 cooperate in vivo to determine adipose tissue PAP activity and adiposity, and may have implications in understanding the protection of lipin-1-deficient humans from overt lipodystrophy.
