The in vitro effect of pegylated recombinant human megakaryocyte growth and development factor (PEGrHuMGDF) on megakaryopoiesis in patients with aplastic anaemia

development factor (rHuMGDF), a truncated form of the Mpl ligand, stimulates megakaryopoiesis both in vitro and in vivo. We describe the in vitro effect of pegylated recombinant human MGDF (PEGrHuMGDF) alone and in combination with other haemopoietic growth factors (G-CSF GM-CSF IL3, IL6, erythropoietin, SCF) on megakaryopoiesis in bone marrow from 11 normal subjects and 19 patients with aplastic anaemia (AA), We used semi-solid cultures to assess megakaryocyte colony growth (CFU-Mk) and 7d suspension cultures to assess production of platelet glycoprotein IIIa (CD61) positive cells, CFU-Mk growth from normal marrow increased 3-4-fold and CD6+ve cells in suspension culture increased 8-10-fold with the addition of 10 ng/ml PEGrHuMGDF In normal subjects growth factor combinations further increased responses in suspension culture, PEGrHuMGDF + SCP, PEGrHuMGDF + IL3 and PEGrKuMGDF + SCF + IL3 + Epo (P < 0.05). IL6, GM-CSF, G-CSF or Epo added with PEGrHuMGDF did not consistently give this increase. CFU-Mk growth from AA marrow remained very low in the presence of PEGrHuMGDF with or without the addition of other growth factors. CD61+ve cells in suspension culture were, however, increased in the presence of PEGrHuMGDF alone in 12/19 AA cases. Of the 12 patients responsive to PEGrHuMGDF, nine were tested with additional growth factors and further responses were seen in six, rn the AA cases PEGrHuMGDF+SCF and PEGrHuMGDF+SCF+IL3+Epo gave the highest responses. These data suggest that PEGrHuMGDF, alone or in combination with SCF and/or IL3, can enhance megakaryocyte proliferation in some patients with aplastic anaemia and may therefore have a role in the treatment of thrombocytopenia in these cases.