Inherited bone marrow failure syndromes (BMFS) are rare, distressing, inherited blood disorders of children. Although the genetic origin of these pathologies involves genes with different functions, all are associated with progressive haematopoietic impairment and an excessive risk of malignancies. Defects in energy metabolism induce oxidative stress, impaired energy production and an unbalanced ratio between ATP and AMP. This assumes an important role in self-renewal and differentiation in haematopoietic stem cells (HSC) and can play an important role in bone marrow failure. Defects in energetic/respiratory metabolism, in particular in FA and SDS cells, have been described recently and seem to be a pertinent argument in the discussion of the haematopoietic defect in BMFS, as an alternative to the hypotheses already established on this subject, which may shed new light on the evolution of these diseases.
KEYWORDSBone marrow failures, oxidative stress, energy metabolism, cancer prone diseases, hematopoietic stem cellsThe bone marrow failure syndromes (BMFS) include a group of disorders than can be either inherited or acquired, and share phenotypic hallmarks of age-related diseases. The aging process in particular affects haematopoietic stem cells, inducing reduced regenerative potential with a possible increase in genetically unstable cells and malignancy. Although the genetic origin of these pathologies involves genes with different functions 1,2 (e.g., DNA repair, ribosome biogenesis, and telomere maintenance) there is a common final pathway, yet still largely elusive, by which HSC are unable to support the production of blood cells.
3Telomere maintenance, DNA repair and oxidative stress are biochemically interrelated processes responsible for cellular aging. Even though the aging mechanism has not yet been clarified and several theories are proposed, 4 mitochondrial metabolism, reactive oxygen species (ROS) and cellular antioxidant systems maintain a central role in the aging process. 5,6 In fact, oxidative stress and ROS increment are a common factor in BMFS.
7Fanconi's Anaemia (FA), Shwachman-Diamond Syndrome (SDS), Dyskeratosis Congenital (DC) and the Diamond-Blackfan Syndrome (DBA) are the most frequent inherited BMFS disorders. FA cells show chromosomal instability, hypersensitivity to crosslinking agents and defects of DNA repair mechanisms. These characteristics seem strikingly linked to defects in the oxidative stress response. In fact, chromosomal aberrations in FA lymphocytes are positively related to oxygen tension and spontaneous chromosomal instability is reduced by superoxide dismutase and catalase activity. Recently, it has been shown that antioxidant (AO) molecules improve haematopoiesis and reduce spontaneous and induced chromosomal instability in FA. Moreover, oxidative stress is a critical factor in the pathogenesis of bone marrow failure and leukemia progression in FA cells. 8,9 SDS cells have a defect in ribosome biogenesis, chemotaxis, mitotic spindle formation and cellular stress...