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Protective role of estrogen against excessive erythrocytosis in Monge’s disease

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dc.contributor.author Azad, Priti
dc.contributor.author Patel, Gargi
dc.contributor.author Bermutez, Daniella
dc.contributor.author Villafuerte, Francisco C.
dc.contributor.author Haddad, Gabriel
dc.date.accessioned 2020-07-14T00:00:56Z
dc.date.available 2020-07-14T00:00:56Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8228
dc.description.abstract Rationale Chronic mountain sickness (CMS), or Monge's disease, is an advancing and debilitating syndrome caused by chronic (years) exposure to high altitude hypoxia, as experienced by people living in the Andean region. Excessive erythrocytosis (EE) is one of the critical traits of CMS and this excessive pathobiologic response has deleterious effects since a high hematocrit would increase blood viscosity and reduce blood flow to hypoxia-sensitive organs (brain and heart), often resulting in myocardial infarction or stroke in young adults. Within the population of Cerro de Pasco in the Andes, CMS prevalence is vastly different between males and females, being rare in females. Of interest is that there is a sharp increase in CMS incidence in females after menopause. This suggests the role of gender and sex hormones in altering disease manifestation. Methods In order to understand the molecular basis for polycythemia of high altitude, we have generated a disease in-the dish-model by re-programming fibroblasts and native CD34+ve cells from CMS and non-CMS subjects and converting them to RBC. Using this in-vitro platform, we are now studying the interactions between genetic factors and sex hormones (Testosterone, Estrogen and Progesterone) and their effect on RBC production in the CMS and non-CMS subjects at high altitude. Results While we found that testosterone increased RBC production somewhat, estrogen in physiologic concentrations (10nM), in sharp contrast, reduced the CD235a (Glycophorin A-marker of mature RBC) remarkably (from 65.4% in the untreated CMS sample to 11% in the treated CMS) and eliminated the CMS EE phenotype. There was also stage-specificity since we found that the impact was most severe when estrogen was present at the EB stage. This strongly suggests that estrogen has a protective role against the polycythemia phenotype. To probe further, we studied the effect of estrogen (10nM) on GATA1, a critical link with erythropoiesis. There was a sharp 5 fold decrease in GATA1 (p<0.01) and its target genes such as Alas2 (14 fold, p<0.001) in erythroid cells. This decreased expression resulted in marked reduction (>50%) in RBC production, demonstrating that estrogen constrains RBC production in females. Conclusion Our results demonstrate that estrogen inhibits GATA1 expression and prevents excessive erythropoiesis and Monge?s disease in females at high altitude. We believe that these studies not only shed light on role of sex hormones on hypoxia-induced excessive erythropoiesis but have a broader application in their regulation of erythropoiesis and related blood disorders. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries FASEB Journal
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Estrogen en_US
dc.subject Erythrocytosis en_US
dc.subject Monge’s Disease en_US
dc.title Protective role of estrogen against excessive erythrocytosis in Monge’s disease en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1096/fasebj.2020.34.s1.09512
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.03
dc.relation.issn 1530-6860

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