Radiation-induced pancytopenia proved to be a suitable model system in
mice and rhesus monkeys for studying thrombopoietin (TPO) target cell
range and efficacy. TPO was highly effective in rhesus monkeys exposed to
the mid-lethal dose of 5 Gy (300 kV x-rays) TBI, a model in which it
alleviated thrombocytopenia, promoted red cell reconstitution, accelerated
reconstitution of immature CD34+ bone marrow cells, and potentiated the
response to growth factors such as GM-CSF and G-CSF. In contrast to the
results in the 5 Gy TBI model, TPO was ineffective following
transplantation of limited numbers of autologous bone marrow or highly
purified stem cells in monkeys conditioned with 8 Gy TBI. In the 5 Gy
model, a single dose of TPO augmented by GM-CSF 24 h after TBI was
effective in preventing thrombocytopenia. The strong erythropoietic
stimulation may result in iron depletion, and TPO treatment should be
accompanied by monitoring of iron status. This preclinical evaluation thus
identified TPO as a potential major therapeutic agent for counteracting
radiation-induced pancytopenia and demonstrated pronounced stimulatory
effects on the reconstitution of immature CD34+ hemopoietic cells with
multilineage potential. The latter observation explains the potentiation
of the hematopoietic responses to G-CSF and GM-CSF when administered
concomitantly. It also predicts the effective use of TPO to accelerate
reconstitution of immature hematopoietic cells as well as possible
synergistic effects in vivo with various other growth factors acting on
immature stem cells and their direct lineage-committed progeny. The
finding that a single dose of TPO might be sufficient for a clinically
significant response emphasizes its potency and is of practical relevance.
The heterogeneity of the TPO response encountered in the various models
used for evaluation points to multiple mechanisms operating on the TPO
response and heterogeneity of its target cells. Mechanistic mouse studies
made apparent that the response of multilineage cells shortly after TBI to
a single administration of TPO is quantitatively more important for
optimal efficacy than the lineage-restricted response obtained at later
intervals after TBI and emphasized the importance of a relatively high
dose of TPO to overcome initial c-mpl-mediated clearance. Further
elucidation of mechanisms determining efficacy might very well result in a
further improvement, e.g., following transplantation of limited numbers of
stem cells. Adverse effects of TPO administration to myelosuppressed or
stem cell transplanted experimental animals were not observed