High IGFBP-3 levels in marrow plasma in early-stage MDS: effects on apoptosis and hemopoiesis


The pathophysiology of the myelodysplastic syndromes (MDS) is incompletely understood. Tumor necrosis factor (TNF)α levels are elevated, particularly in early-stage MDS, and apoptosis in marrow cells is upregulated. Observations in other models have shown a role for insulin-like growth factor binding protein 3 (IGFBP-3) in TNFα-mediated apoptosis. We observed increased levels of IGFBP-3 in the marrow plasma of patients with MDS (P=0.005) and hypothesized that altered IGFBP-3 levels contribute to the dysregulation of hemopoiesis in MDS by affecting proliferation and apoptosis. Western analysis of marrow plasma from MDS patients revealed an increase in the ratio of intact vs fragmented IGFBP-3 in early-stage MDS (relative to controls) that decreased with MDS disease progression, suggesting increased proteolysis with more advanced disease. Thus, these results provide evidence for dysregulation of IGFBP-3 in patients with MDS. While the data are complex, they are consistent with a modulatory effect of IGFBP-3 on hemopoiesis in MDS. Conceivably, understanding these mechanisms may allow for the development of novel therapeutic strategies.


Myelodysplastic syndromes (MDS) comprise a spectrum of hemopoietic stem cell disorders that occur predominantly in older individuals (median age at diagnosis 70 years). Patients generally present with cytopenias in peripheral blood, while the marrow is usually normo- or hypercellular. A high myeloblast count in the marrow, multiple cytopenias, and certain clonal chromosome abnormalities (chromosome 7 deletion; complex abnormalities) are associated with a poor prognosis.1, 2

The pathophysiology of MDS is incompletely understood. The discrepancy in cellularity between marrow and peripheral blood is thought to be due to excessive proliferation concurrently with upregulation of programmed cell death (apoptosis). Tumor necrosis factor (TNF)α, Fas-L, and TNF-related apoptosis-inducing ligand (TRAIL) are dysregulated in patients with MDS.3 These cytokines and their receptors influence expression of various components of the insulin-like growth factor (IGF) system, including IGF-binding protein-3 (IGFBP-3), which has been shown to be required for TNFα-induced apoptosis in some models.4 The IGF system is a key modulator in cell proliferation, cell regulation, and cell survival in various tissues.5, 6, 7 Its role in hemopoiesis is less well defined.

IGFBP-3 is the predominant IGFBP present in blood that regulates IGF availability to cells and tissues. However, IGFBP-3 has multiple functions that are tissue/cell specific and are modulated by concurrent exposure to other cytokines. IGFBP-3 enhances proliferation and protects cells from apoptotic stimuli, and also has potent antiproliferative properties, for example, against the potentially transforming effects of growth hormone and IGF-I.8 IGFBP-3 alone has little effect on growth inhibition, but it can dramatically enhance cell death responses to apoptosis-inducing agents.9, 10 Cleavage by serine proteases, including plasmin, may further shift the functional properties of IGFBP-3 from proproliferative to proapoptotic.11, 12, 13, 14 IGFBP-3 may also be able to induce apoptosis via an IGF-independent pathway.4, 15, 16, 17 We observed in ancillary studies that IGFBP-3 levels in the marrow plasma of patients with MDS tended to be higher than in age-matched controls. As TNFα levels are also elevated in MDS, and TNFα has been shown to upregulate IGFBP-3, we hypothesized that altered IGFBP-3 levels contribute to the dysregulation of hemopoiesis in patients with MDS. Furthermore, IGFBP levels have been linked to aging, and MDS is primarily a disease of older patients. Elevated levels of IGFBP-3 have been observed in cultures of fibroblasts with increasing donor age, in vitro senescence, and increasing confluency of cell cultures.18, 19, 20, 21 Several studies show tissue specificity of IGFBP expression and evidence of increased proteolytic degradation in senescent cells.22, 23 Such degradation may decrease the ability of these proteins to present IGFs to cell surface receptors19, 24, 25 and as a result may alter proliferative signals. The function of IGFBP-3 is thought to be modulated by numerous factors, in particular, the milieu in which it is acting.26, 27 These considerations are relevant in the context of MDS, where multiple growth and inhibitory molecules are dysregulated, where clonal and normal hemopoietic precursors coexist for extended periods of time, and where interactions of hemopoietic precursors with cellular and humoral components of the marrow microenvironment are involved in the disease pathophysiology (reviewed in Steensma and Tefferi28 and Vergilio and Bagg29).

The objective of this study was to determine IGFBP-3 levels in patients with MDS, and to define a potential role of this molecule in the pathophysiology of MDS. An understanding of the role of IGFBP-3 in MDS might provide further insights into the disease pathophysiology and may allow for the development of novel therapeutic strategies.

Materials and methods


Rational for using leukemic cell lines to elucidate IGFBP-3 function

We faced several difficulties in designing functional experiments with MDS cells. First, because of the characteristics of MDS, that is, increased apoptosis of normal cells, no stable MDS-derived cell lines were available. Secondly, primary cells from MDS patients are already ‘sensitized’ to apoptosis (a hallmark of the disease), and therefore, high background levels of apoptosis tended to obscure actual induced changes. Therefore, KG1a and ML-1 myeloid leukemic cell lines in addition to primary MDS marrow cells were used.

Primary marrow cells and plasma

Marrow cells and plasma were obtained from normal volunteers and from patients with MDS who had given informed consent according to the requirements of the Institutional Review Board of the Fred Hutchinson Cancer Research Center, as described.30

IGFBP-3 protein levels were determined in 19 normal bone marrows (NBM, age 27–78 years), and marrow from 49 patients with MDS (age 28–80 years). The samples from MDS patients included 23 patients with refractory anemia (RA, six with chromosome 7 deletions (RA-7)), nine with RA with excess blasts (RAEB), six with RAEB in transformation (RAEBT), and 11 with MDS, which had transformed to acute myeloid leukemia (AML). As the IGFBP-3 gene is located on chromosome 7, we included six RA-7 patients in our studies in an attempt to determine if the loss of one of the chromosomes altered plasma levels of IGFBP-3.

Cell processing

ML-1 and KG1a cells, and primary marrow mononuclear cells, separated by Ficoll–Hypaque density centrifugation, were cultured in 1640 RPMI (GIBCO BRL, Grand Island, NY, USA) supplemented with 10% fetal bovine serum (FBS), L-glutamine, and 1 mM sodium pyruvate. For analysis of secreted IGFBP-3, cells were cultured in serum-free medium (SFM) consisting of RPMI supplemented with 1 mM sodium pyruvate, L-glutamine, and 0.05% bovine serum albumin (BSA, tissue culture tested; Sigma, St Louis, MO, USA). Cells were incubated at 37°C in a water vapor-saturated 5% CO2/air atmosphere.


Glycosylated human recombinant (hr) IGFBP-3 (gly-IGFBP3) was purchased from GroPep Limited (Adelaide SA, Australia). Nonglycosylated hrIGFBP-3 (ng-IGFBP3) was purchased from Diagnostic System Laboratories (Webster, TX, USA). After considerable review of published data, we chose a concentration of 400 ng/ml of IGFBP-3 (gly or ng) for these present experiments, as this is the highest physiological level of free, unbound IGFBP-3 observed in vivo (total IGFBP-3 protein levels can vary from 100 to 8000 ng/ml depending on the tissue source). The following apoptosis-inducing ligands were used: hrTNFα (Peprotech, Rocky Hill, NJ, USA) and hrTRAIL/APO-2L, provided by Dr A Ashkenazi, Genentech (South San Francisco, CA, USA). Affinity-purified anti-IGFBP-3 antibody was purchased from Diagnostic Systems Laboratories Inc. (DSL Inc., Webster, TX, USA).

ELISA analysis of IGFBP-3 in marrow plasma

Total IGFBP-3 protein levels were determined with IGFBP-3 ELISA kits (DSL Inc.) according to the manufacturer's instructions. This kit does not detect cleaved IGFBP-3.

In vitro hematopoiesis

CD34+ cells were purified from aspirated bone marrow samples taken from healthy volunteers and patients with MDS using magnetic cell sorting beads conjugated with anti-human CD34+ antibody (Miltenyi Biotech, CA, USA) and passaged through a one-directional magnetic bead sorter (Miltenyi Biotec AutoMACS). CD34+ cells were assayed for in vitro colony formation as described.3 Gly-IGFBP3 or ng-IGFBP3 was added at 400 ng/ml of medium to cells for 72–96 h at 37°C in 5% CO2/air, cells were then washed twice with 1 × PBS, resuspended in Iscove's medium with 2% FBS, and plated in MethoCult GF+ (Stemcell Technologies, Vancouver, BC, Cananda), as described.3 Untreated cells served as a reference for each sample, and results with treated cells were compared to the reference samples whose values were set to 100%. Plates were incubated at 37°C in 5% CO2/air for 18 days. On day 18, burst-forming units-erythroid (BFU-E) and colony-forming units-granulocyte/macrophage (CFU-GM) were counted. Colonies contained a minimum of 50 cells.

Immunoblot analysis of IGFBP-3 in marrow plasma

Marrow plasma was concentrated onto 0.45 μm nitrocellulose membrane (Bio-Rad, Hercules, CA, USA), and eluted into 1 × sample buffer (0.5 M Tris, 10% glycerol, 8 M urea, and 2% SDS) by incubation at 96°C for 6 min. Each sample was separated on a 4–20% gradient Tris-HCl SDS-PAGE precast gel (Bio-Rad) and transferred onto Immuno-Blot PVDF membrane (Bio-Rad). Membranes were incubated in 10% H2O2/0.05% Tween-20/1 × PBS (TPBS) for 10 min, blocked in 5% milk for 1 h at room temperature, and incubated overnight at 4°C with 1:1000 affinity-purified goat anti-human IGFBP-3 antibody (DSL Inc.) in 5% nonfat dry milk (Biorad)/1% BSA (Gemini Bioproducts, CA, USA) in TPBS. Proteins were detected with SuperSignal Chemiluminescent Substrate (Pierce, Rockford, IL, USA) and CL-Xposure film (Pierce).

Determination of secreted IGFBP-3 from cell lines treated with TNFα

Myeloid leukemic cell lines ML-1, KG1a, K562, and U937 were plated at 1 × 106 cells/ml in SFM containing graded doses of TNFα. HS-5 stroma cells,31 grown to 90–100% confluency, washed twice with 1 × PBS, and serum-containing medium was replaced with SFM containing various concentrations of TNFα. After 24 h, conditioned medium from each sample was collected and immediately concentrated onto 0.45 μm nitrocellulose membrane.32 Secreted proteins were separated and analyzed for IGFBP-3 protein levels as described above.

Immunoblot analysis of whole-cell lysates

ML-1 cells were lysed in RIPA buffer containing protease inhibitors (Mini Complete Protease Inhibitor Tablets, Roche, Indianapolis, IN, USA) and PMSF (Sigma). Protein samples were analyzed by immunodetection as described above. The following antibodies and blocking agents were used for immunodetection: phospho-Akt (Cell Signaling Technology (CST), Beverly, MA, USA), 1:1000 in 5% BSA; BAD (BD Transduction Laboratories, Lexington, KY, USA), 1:500 in 2.5% milk; phospho-BAD (Ab-1, Ser 112) and phospho-BAD (Ab-2, Ser 136) (Oncogene Research Products, San Diego, CA, USA), 1:500 in 3% BSA; BclXL (CST), 1:1000 in 5% milk; caspase-8 (C15, Alexis, San Diego, CA, USA), 1:5000 in 5% milk; caspase-9 (CST), 1:2000 in 5% milk; cytochrome c (BD Pharmingen, San Diego, CA, USA), 1:5000 in 5% milk; FLIP (NF6, gift from P Krammer, Deutsches Krebsforschungszentrum, Heidelberg), and 1:500 in TPBS. Immunoblots were blocked with 5% milk (except when using anti-FLIP antibody which was blocked in 2% milk). Horseradish peroxidase-labeled antibodies were purchased from Pierce and used at 1:20 000 dilution in 2 or 5% milk.

Flow cytometric analysis of apoptotic cells

Cells were harvested and prepared for FACS analysis of apoptosis as described previously.33 For determination of apoptosis in CD14+ or CD34+ subpopulations among nonfractionated marrow cells, the cell suspension was incubated with R-phycoerythrin (PE)-labeled anti-CD14 antibody (Caltag) or PE-labeled anti-CD34 antibody (Caltag), respectively, for 20 min at 4°C in the dark and washed in cold Flow Buffer.33 Data were analyzed using Cell Quest software.

Statistical analysis

For all experimental data, mean and standard errors were calculated. ELISA data were analyzed using the Student's t-test. Apoptosis and proliferation data were analyzed using the Wilcoxon's test.


IGFBP-3 protein levels are increased in marrow plasma in early-stage MDS

Plasma from bone marrow aspirates from 19 normal donors and 49 patients with MDS were analyzed for total IGFBP-3 protein by ELISA. IGFBP-3 levels were highest in patients with RA, that is, the least advanced MDS patients who also showed elevated levels of TNFα and the highest rates of apoptosis.3 IGFBP-3 levels were significantly higher than among age-matched healthy volunteers (Figure 1a, P<0.005).

Figure 1

Total IGFBP-3 protein levels are increased relative to age-matched controls in marrow plasma in early-stage MDS. Data were acquired using marrow plasma from 19 normal donors and 23 patients with RA (17 RA normal cytogenetics/six RA-7 deletion). (a) IGFBP-3 levels are significantly higher in marrow plasma from patients with MDS compared to normal donor plasma (P<0.005). (b) IGFBP-3 plasma levels are highest in early-stage MDS and decrease with more advanced disease.

Increased cleavage of IGFBP-3 in marrow plasma from patients with MDS

Total levels of IGFBP-3 in marrow plasma declined toward control values with progressive stages of MDS (Figure 1b). However, as indicated in Figure 2, cleaved IGFBP-3 levels increased with more advanced MDS. Therefore, the ratio of intact IGFBP-3 to cleaved IGFBP-3 was high with early-stage MDS and declined progressively as MDS progressed.

Figure 2

Intact vs fragmented IGFBP-3 protein ratios in marrow plasma are higher in early-stage MDS (RA/RA-7) and decrease during MDS disease progression. Marrow plasma was collected from normal donors and MDS patients and analyzed by Western immunoblotting. Signal intensity for gly-IGFBP-3 (41 and 44 kDa) and proteolyzed gly-IGFBP-3 (31 kDa) was analyzed using 1.62 NIH Image. The bars represent the ratio of intact and fragmented IGFBP-3, using data points from 19 normal bone marrow donors (NBM), 23 patients with RA/RA-7, 15 patients with RAEB/RAEBT, and 11 patients with MDS that had evolved to AML.

IGFBP-3 protein secretion is regulated by TNF-α

The higher levels of IGFBP-3 protein detected in marrow plasma from patients with RA suggested a possible correlation with increased TNFα levels. To further test this possibility, ML-1 myeloid leukemic cells were treated with hrTNFα, and secreted IGFBP-3 protein was measured (Figure 3). In a TNFα dose-dependent manner, IGFBP-3 protein was upregulated. In contrast, in human stroma-derived HS-5 cells, which provide effective supportive layers for in vitro hematopoiesis, TNFα induced a downregulation of IGFBP-3.31 Thus, as suggested by observations in other models, TNFα modulated levels of IGFBP-3 in a dose- and tissue-specific pattern.

Figure 3

TNFα upregulates secretion of IGFBP-3 in myeloid ML-1 cells and downregulates IGFBP-3 secretion from HS-5 stroma cells in a dose-dependent manner. ML-1 cells were plated in SFM in the presence of hrTNFα and harvested after 24 h. HS-5 cells were plated in complete medium (10% FBS) and grown to 95–100% confluence. Medium was replaced with SFM and supernatant was harvested at 24 and 48 h (48 h shown). Secreted proteins from the conditioned medium were separated by SDS-PAGE and IGFBP-3 immunodetected by Western analysis.

Effect of IGFBP-3 on in vitro hemopoiesis

In vitro hemopoiesis assays were carried out with purified CD34+ cells from bone marrow aspirates from normal donors and MDS patients. CD34+ cells were cultured in the presence of gly- or ng-hrIGFBP-3. Gly- and ng- IGFBP3 had no consistent effect on CFU-GM or BFU-E in CD34+ from normal samples. However, while gly-IGFBP3 either demonstrated no effect or slightly enhanced BFU-E, ng-IGFBP3-treated cells showed a marked decreased in BFU-E numbers compared to the untreated and gly-IGFBP-3-treated CD34+ cell samples from MDS patients. This is of interest as it is the erythrocyte lineage that is most frequently affected in patients with MDS.

IGFBP-3 interferes with apoptosis induced by TNFα and TRAIL

Two myeloid leukemic cell lines, ML-1 and KG1a, were tested for apoptotic responses to TNFα in the presence and absence of exogenous gly-IGFBP3. KG1a cells proved almost completely resistant to apoptosis, while ML-1 cells were apoptosis sensitive (data not shown). Therefore, subsequent experiments were carried out with ML-1 cells. To determine whether IGFBP-3 was involved in pathways other than TNFα-mediated apoptosis, we tested in parallel the effects of IGFBP-3 on TRAIL-mediated apoptosis.

ML-1 cells treated with TNFα or TRAIL in the presence of gly-IGFBP-3 showed decreases in apoptosis (relative to results without added IGFBP-3) of 20% or greater for both ligands (Figure 4a). Concurrent analysis of the effects of TNFα and TRAIL on selected components of apoptotic or proliferative signaling pathways in ML-1 cells showed striking alterations (Figure 4b). TNFα resulted in decreased levels of Akt and phosphorylated BAD, both of which were partially restored in the presence of IGFBP-3. TRAIL alone resulted in a loss of Akt, phosphorylated BAD and BclXL signals and partial cleavage of FLIPLong. In the presence of IGFBP-3, phosphorylated BAD (S136) and BclXL were partially restored, and FLIPLong cleavage was reduced. These findings are consistent with the observed decrease in apoptosis in the presence of IGFBP-3. However, the pattern of response involving pro- and antiapoptotic factors, as well as signals involved in cell proliferation, suggests a complex mechanism of IGFBP-3 action. As most reports on IGFBP-3-induced apoptosis describe the use of ng-IGFBP-3,34, 35 we compared the effects of gly- and ng-IGFBP-3 on ML-1 cells in the presence of TNFα or TRAIL. As shown in Figure 4c, both isoforms of IGFBP-3 inhibited apoptosis in response to proapoptotic signals. IGFBP-3 alone, regardless of glycosylation status, did not induce apoptosis, nor enhance proliferation. These studies suggest that IGFBP-3 functions as a regulator of cell response to external stimuli.

Figure 4

Effect of IGFBP-3 on the induction of pro- and antiapoptotic molecules in ML-1 cells by TNFα and TRAIL. (a) Percent of apoptotic cells generated in the presence of gly-IGFBP-3: apoptosis was determined using annexin V–FITC/PI staining and FACS. Results with treated cells were normalized to the untreated controls (set at a value of 1) before values were compared between independent experiments. Percent of apoptotic cells measured in untreated cells ranged between 2.53 and 6.05%. Each bar represents the mean multiple of the normalized control sample±s.e. determined from five independent experiments carried out in triplicate (P=0.05). (b) Protein expression using Western immunoblotting: blot is representative of three independent cell culture experiments (see text for details). (c) Percent of apoptotic cells generated in the presence of gly- vs ng-IGFBP-3: apoptosis was determined using annexin V–FITC/PI staining and FACS. Each bar represents the mean±s.e. determined from five independent experiments carried out in triplicate (P=0.05).


The objective of this study was to begin to elucidate a potential role of IGFBP-3 in the pathophysiology of MDS. IGFBP-3 protein levels were increased in early-stage MDS patient bone marrow plasma and an increase in cleaved IGFBP-3 was observed with progression of MDS to AML. These results are consistent with previous studies, which showed that myeloid leukemic cells express high levels of proteases capable of cleaving IGFBP-3.36 Thus, as MDS progresses to AML, more leukemic cells would be present to cleave IGFBP-3 and potentially alter the biologic function of IGFBP-3.

TNFα, which is increased in bone marrow plasma from early-stage MDS patients, upregulated secretion of gly-IGFBP-3 in myeloid leukemic cell cultures, further supporting a relationship between the dysregulation of IGFBP-3 and MDS. Interestingly, TNFα stimulated secretion of gly-IGFBP-3 in HS-5 cells, the stromal marrow cells that provide optimal growth conditions for the culturing of primary marrow cells harvested from MDS patients. The upregulation of gly-IGFBP-3 in response to TNFα suggests that HS-5 cells may secrete IGFBP-3 as a protective response to apoptotic effects of TNFα. The subsequent experiments described here show, indeed, that IGFBP-3 protected myeloid cells against apoptosis induced by TNFα, Fas ligand, and TRAIL.

Several reports show ng-IGFBP-3 to have a two- to three-fold higher cell binding affinity than gly-IGFBP-337, 38 and suggest that glycosylation status may play a role in the distribution of IGFBP-3 in the circulation and for its functional activities. Gly-IGFBP-3 may promote cell proliferation by the availability of IGFBP-3 to present IGFs to IGF receptors, while ng-IGFBP-3 may be taken out of circulation through cell surface binding or contribute to the growth inhibition via IGF-independent receptor activation of a growth inhibitory pathway. The IGF system is involved in erythropoiesis.39, 40 However, there is minimal data describing the function of IGFBP-3 in or on myeloid hemopoietic cells.36, 41 Preliminary in vitro hemopoiesis experiments demonstrated that ng-IGFBP-3 inhibited colony formation of BFU-E, while glyc-IGFBP-3 either showed no effect or minimally enhanced BFU-E colony numbers (data not shown). This is of interest as it is the erythrocyte lineage that is most frequently affected in MDS patients with cytopenia. These preliminary data are the first to show a link between glycosylation status and IGFBP-3 activity as no published reports indicate that glycosylation status affects IGFBP-3 function.

To determine the potential mechanism(s) by which the glycosylation status of IGFBP-3 was affecting in vitro hemopoiesis, we treated myeloid leukemic cells (KG1a and ML-1 cell lines) with the proapoptotic ligands TNFα and TRAIL in the absence and presence of IGFBP-3. In contrast to our original prediction that IGFBP-3, described as an inducer of apoptosis in other models,25, 42 would contribute to higher levels of apoptosis in MDS patients, our studies revealed a cytoprotective effect of IGFBP-3 against TNFα- and TRAIL-induced apoptosis. As we have shown that IGFBP-3 is upregulated in early-stage MDS, a preliminary step in the pathophysiology of MDS may be the generation of clonal populations with enhanced responsiveness to the cytoprotective effects of IGFBP-3. Thus, clonal cells could achieve a growth advantage over the surrounding normal cells when environmental concentrations of the apoptosis-inducing ligands TNFα, FasL, and TRAIL are increased, as observed in early-stage MDS marrow plasma.

In summary, we present data on abnormal expression and a possible role of IGFBP-3 in the regulation of apoptosis and proliferation of hemopoietic cells in patients with MDS. As TNFα is known to be upregulated in MDS and the present results show a regulatory effect of TNFα on IGFBP-3 expression, it is conceivable that IGFBP-3 levels change in response to TNFα and, thus, may be involved in the pathophysiology of MDS. If confirmed in additional studies and over a wider range of IGFBP-3 concentrations (and glycosylation patterns), insights from this work may point toward new therapeutic strategies to treat hemopoietic failure and possibly interfere with disease evolution in patients with MDS.


  1. 1

    Hellstrom-Lindberg E, Negrin R, Stein R, Krantz S, Lindberg G, Vardiman J et al. Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposal for a predictive model. Br J Haematol 1997; 99: 344–351.

    CAS  Article  Google Scholar 

  2. 2

    Hirai H . Molecular mechanisms of myelodysplastic syndrome. Jpn J Clin Oncol 2003; 33: 153–160.

    Article  Google Scholar 

  3. 3

    Gersuk GM, Beckham C, Loken MR, Kiener P, Anderson JE, Farrand A et al. A role for tumour necrosis factor-alpha, Fas and Fas-ligand in marrow failure associated with myelodysplastic syndrome. Br J Haematol 1998; 103: 176–188.

    CAS  Article  Google Scholar 

  4. 4

    Rajah R, Lee KW, Cohen P . Insulin-like growth factor binding protein-3 mediates tumor necrosis factor-alpha-induced apoptosis: role of Bcl-2 phosphorylation. Cell Growth Differ 2002; 13: 163–171.

    CAS  PubMed  Google Scholar 

  5. 5

    Lackey BR, Gray SL, Henricks DM . The insulin-like growth factor (IGF) system and gonadotropin regulation: actions and interactions. Cytokine Growth Factor Rev 1999; 10: 201–217.

    CAS  Article  Google Scholar 

  6. 6

    Samani AA, Brodt P . The receptor for the type I insulin-like growth factor and its ligands regulate multiple cellular functions that impact on metastasis. Surg Oncol Clin N Am 2001; 10: 289–312, viii.

    CAS  Article  Google Scholar 

  7. 7

    Butt AJ, Firth SM, Baxter RC . The IGF axis and programmed cell death. Immunol Cell Biol 1999; 77: 256–262, (review).

    CAS  Article  Google Scholar 

  8. 8

    Nickerson T, Huynh H, Pollak M . Insulin-like growth factor binding protein-3 induces apoptosis in MCF7 breast cancer cells. Biochem Biophys Res Commun 1997; 237: 690–693, (Erratum in: Biochem Biophys Res Commun 1997; 240:246).

    CAS  Article  Google Scholar 

  9. 9

    Fowler CA, Perks CM, Newcomb PV, Savage PB, Farndon JR, Holly JM . Insulin-like growth factor binding protein-3 (IGFBP-3) potentiates paclitaxel-induced apoptosis in human breast cancer cells. Int J Cancer 2000; 88: 448–453.

    CAS  Article  Google Scholar 

  10. 10

    Perks CM, McCaig C, Holly JM . Differential insulin-like growth factor (IGF)-independent interactions of IGF binding protein-3 and IGF binding protein-5 on apoptosis in human breast cancer cells. Involvement of the mitochondria. J Cell Biochem 2000; 80: 248–258.

    CAS  Article  Google Scholar 

  11. 11

    Yu H, Rohan T . Role of the insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst 2000; 92: 1472–1489.

    CAS  Article  Google Scholar 

  12. 12

    Maile LA, Gill ZP, Perks CM, Holly JM . The role of cell surface attachment and proteolysis in the insulin-like growth factor (IGF)-independent effects of IGF-binding protein-3 on apoptosis in breast epithelial cells. Endocrinology 1999; 140: 4040–4045.

    CAS  Article  Google Scholar 

  13. 13

    Angelloz-Nicoud P, Lalou C, Binoux M . Prostate carcinoma (PC-3) cell proliferation is stimulated by the 22–25-kDa proteolytic fragment (1–160) and inhibited by the 16-kDa fragment (1–95) of recombinant human insulin-like growth factor binding protein-3. Growth Horm IGF Res 1998; 8: 71–75.

    CAS  Article  Google Scholar 

  14. 14

    Loechel F, Fox JW, Murphy G, Albrechtsen R, Wewer UM . ADAM 12-S cleaves IGFBP-3 and IGFBP-5 and is inhibited by TIMP-3. Biochem Biophys Res Commun 2000; 278: 511–515, (Erratum in: Biochem Biophys Res Commun 2001; 280: 421.

    CAS  Article  Google Scholar 

  15. 15

    Schedlich LJ, Nilsen T, John AP, Jans DA, Baxter RC . Phosphorylation of insulin-like growth factor binding protein-3 by deoxyribonucleic acid-dependent protein kinase reduces ligand binding and enhances nuclear accumulation. Endocrinology 2003; 144: 1984–1993.

    CAS  Article  Google Scholar 

  16. 16

    Longobardi L, Torello M, Buckway C, O'Rear L, Horton WA, Hwa V et al. A novel insulin-like growth factor (IGF)-independent role for IGF binding protein-3 in mesenchymal chondroprogenitor cell apoptosis. Endocrinology 2003; 144: 1695–1702.

    CAS  Article  Google Scholar 

  17. 17

    McCaig C, Perks CM, Holly JM . Intrinsic actions of IGFBP-3 and IGFBP-5 on Hs578T breast cancer epithelial cells: inhibition or accentuation of attachment and survival is dependent upon the presence of fibronectin. J Cell Sci 2002; 115 (Part 22): 4293–4303.

    CAS  Article  Google Scholar 

  18. 18

    Grigoriev VG, Moerman EJ, Goldstein S . Overexpression of insulin-like growth factor binding protein-3 by senescent human fibroblasts: attenuation of the mitogenic response to IGF-I. Exp Cell Res 1995; 219: 315–321.

    CAS  Article  Google Scholar 

  19. 19

    Grigoriev VG, Moerman EJ, Goldstein S . Senescence and cell density of human diploid fibroblasts influence metabolism of insulin-like growth factor binding proteins. J Cell Physiol 1994; 160: 203–211.

    CAS  Article  Google Scholar 

  20. 20

    Goldstein S, Moerman EJ, Baxter RC . Accumulation of insulin-like growth factor binding protein-3 in conditioned medium of human fibroblasts increases with chronologic age of donor and senescence in vitro. J Cell Physiol 1993; 156: 294–302.

    CAS  Article  Google Scholar 

  21. 21

    Goldstein S, Moerman EJ, Jones RA, Baxter RC . Insulin-like growth factor binding protein 3 accumulates to high levels in culture medium of senescent and quiescent human fibroblasts. Proc Natl Acad Sci USA 1991; 88: 9680–9684.

    CAS  Article  Google Scholar 

  22. 22

    Matsunaga H, Handa JT, Gelfman CM, Hjelmeland LM . The mRNA phenotype of a human RPE cell line at replicative senescence. Mol Vis 1999; 5: 39.

    CAS  PubMed  Google Scholar 

  23. 23

    Arnold PM, Ma JY, Citron BA, Festoff BW . Insulin-like growth factor binding proteins in cerebrospinal fluid during human development and aging. Biochem Biophys Res Commun 1999; 264: 652–656.

    CAS  Article  Google Scholar 

  24. 24

    Perks CM, Holly JMP . Insulin-like growth factor binding proteins (IGFBPs) in breast cancer. J Mamm Gland Biol Neoplasia 2000; 5: 75–84.

    CAS  Article  Google Scholar 

  25. 25

    Ferry Jr RJ, Katz LE, Grimberg A, Cohen P, Weinzimer SA . Cellular actions of insulin-like growth factor binding proteins. Horm Metab Res 1999; 31: 192–202.

    CAS  Article  Google Scholar 

  26. 26

    Baxter RC . Signalling pathways involved in antiproliferative effects of IGFBP-3: a review. Mol Pathol 2001; 54: 145–148.

    CAS  Article  Google Scholar 

  27. 27

    Baxter RC . Insulin-like growth factor (IGF)-binding proteins: interactions with IGFs and intrinsic bioactivities. Am J Physiol Endocrinol Metab 2000; 278: E967–E976.

    CAS  Article  Google Scholar 

  28. 28

    Steensma DP, Tefferi A . The myelodysplatic syndrome(s): a perspective and review highlighting current controversies. Leukemia Res 2003; 27: 95–120.

    Article  Google Scholar 

  29. 29

    Vergilio JA, Bagg A . Myelodysplastic syndromes. Contemporary biologic concepts and emerging diagnostic approaches. Am J Con Pathol 2003; 119 (Suppl): S58–S77.

    Google Scholar 

  30. 30

    Deeg HJ, Beckham C, Loken MR, Bryant E, Lesnikova M, Shulman HM et al. Negative regulators of hemopoiesis and stroma function in patients with myelodysplastic syndrome. Leukemia Lymphoma 2000; 37: 405–414.

    CAS  Article  Google Scholar 

  31. 31

    Roecklein BA, Torok-Storb B . Functionally distinct human marrow stromal cell lines immortalized by transduction with the human papilloma virus E6/E7 genes. Blood 1995; 85: 997–1005.

    CAS  PubMed  Google Scholar 

  32. 32

    Wilson HM, Birnbaum RS, Poot M, Quinn LS, Swisshelm K . Insulin-like growth factor binding protein-related protein 1 inhibits proliferation of MCF-7 breast cancer cells via a senescence-like mechanism. Cell Growth Differ 2002; 13: 205–213.

    CAS  PubMed  Google Scholar 

  33. 33

    Platzbecker U, Ward JL, Deeg HJ . Chelerythrin activates caspase-8, downregulates FLIP long and short, and overcomes resistance to tumour necrosis factor-related apoptosis-inducing ligand in KG1a cells. Br J Haematol 2003; 122: 489–497.

    CAS  Article  Google Scholar 

  34. 34

    Gill ZP, Perks CM, Newcomb PV, Holly JM . Insulin-like growth factor-binding protein (IGFBP-3) predisposes breast cancer cells to programmed cell death in a non-IGF-dependent manner. J Biol Chem 1997; 272: 25602–25607.

    CAS  Article  Google Scholar 

  35. 35

    Bagnall W, Sharpe PM, Newham P, Tart J, Mott RA, Torr VR et al. Expression and purification of biologically active IGF-binding proteins using the LCR/Mel expression system. Protein Expr Purif 2003; 27: 1–11.

    CAS  Article  Google Scholar 

  36. 36

    Nusrat AR, Chapman Jr HA . An autocrine role for urokinase in phorbol ester-mediated differentiation of myeloid cell lines. J Clin Invest 1991; 87: 1091–1097.

    CAS  Article  Google Scholar 

  37. 37

    Firth SM, McDougall F, McLachlan AJ, Baxter RC . Impaired blockade of insulin-like growth factor I (IGF-I)-induced hypoglycemia by IGF binding protein-3 analog with reduced ternary complex-forming ability. Endocrinology 2002; 143: 1669–1676.

    CAS  Article  Google Scholar 

  38. 38

    Firth SM, Baxter RC . Characterisation of recombinant glycosylation variants of insulin-like growth factor binding protein-3. J Endocrinol 1999; 160: 379–387.

    CAS  Article  Google Scholar 

  39. 39

    Sivan B, Lilos P, Laron Z . Effects of insulin-like growth factor-I deficiency and replacement therapy on the hematopoietic system in patients with Laron syndrome (primary growth hormone insensitivity). J Pediatr Endocrinol Metab 2003; 16: 509–520.

    CAS  Article  Google Scholar 

  40. 40

    Miyagawa S, Kobayashi M, Konishi N, Sato T, Ueda K . Insulin and insulin-like growth factor I support the proliferation of erythroid progenitor cells in bone marrow through the sharing of receptors. Br J Haematol 2000; 109: 555–562.

    CAS  Article  Google Scholar 

  41. 41

    Ikezoe T, Tanosaki S, Krug U, Liu B, Cohen P, Taguchi H et al. Insulin-like growth factor binding protein-3 antagonizes the effects of retinoids in myeloid leukemia cells. Blood 2004; 104: 237–242.

    CAS  Article  Google Scholar 

  42. 42

    Schedlich LJ, Graham LD . Role of insulin-like growth factor binding protein-3 in breast cancer cell growth. Microsc Res Technol 2002; 59: 12–22.

    CAS  Article  Google Scholar 

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We thank Dr Deborah Banker for providing the ML-1 and KG1a cell lines and Dr Beverly Torok-Storb for providing the HS-5 stroma cell line. We also thank Dr Yansong Gu, Dr Uwe Platzbecker, Dr Jeffrey Schwartz, Dr Martin Benesch, and Cassandra Beckham for helpful discussions. We thank Kathleen Haugk for immunoblot analysis of phosphorylated IGF receptor in ML-1 cells. This work was supported by PHS Grant CA87948 and HL36444 Grant.

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Correspondence to H-M P Wilson.

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Wilson, H., Lesnikov, V., Plymate, S. et al. High IGFBP-3 levels in marrow plasma in early-stage MDS: effects on apoptosis and hemopoiesis. Leukemia 19, 580–585 (2005).

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  • myelodysplastic syndrome (MDS)
  • insulin-like growth factor binding protein-3 (IGFBP-3)
  • apoptosis
  • proliferation
  • dysregulation

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