Stromal Cell Mediated Inhibition of Erythropoiesis Can Be Attenuated by Sotatercept (ACE-011), an Activin Receptor Type II Ligand Trap
Experimental hematology | 25 Dec 2012
C Iancu-Rubin, G Mosoyan, J Wang, T Kraus, V Sung and R Hoffman
Red cell production is primarily determined by the action of erythropoietin. Additional erythropoiesis-regulatory factors include molecules and cellular interactions occurring within the bone marrow (BM) microenvironment. Sotatercept (ACE-011) is an activin receptor ligand trap which binds several members of the TGF-β superfamily. Treatment with ACE-011 reverses bone loss and reduces the degree of osteoporosis. Surprisingly, this was accompanied by elevated hemoglobin and hematocrit levels. The mechanisms underlying the beneficial effects of ACE-011 on red cell production remain unknown. This study explores the means by which ACE-011 promotes erythropoiesis. We showed that ACE-011 does not directly affect erythroid differentiation of human CD34(+) cells in vitro. We next tested whether ACE-011 acts indirectly by affecting BM accessory cells. Conditioned media (CM) produced by BM stromal cells (SC) inhibited erythroid differentiation of CD34(+) cells while maintained their ability to proliferate. However, CM from SC treated with ACE-011 partially restored erythropoiesis coinciding with changes in the molecular and secretory profile of SC, including the expression and secretion of erythropoiesis-modulatory factors. We conclude that inhibitory factors produced by BM-SC in vitro might control erythropoiesis in vivo and that agents that reverse these microenvironmental signals may provide an approach to attenuate anemia in clinical conditions.
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