Key Points• Platelets from essential thrombocythemia patients have an intrinsic impairment in the P13kinase/Rap1/integrin ␣IIb3 signaling pathway.• This explains the clinical observation that in vitro platelet aggregation is impaired in patients with essential thrombocythemia.
IntroductionThe myeloproliferative disorders (MPDs) are a group of clonal hemopoietic disorders characterized by increased proliferation of one or more of the myeloid, erythroid, or megakaryocytic cell lineages. The MPDs include polycythemia vera (PV; excess production of red cells) and essential thrombocythemia (ET; excess production of platelets) and other disorders. 1 The clinical course of untreated MPDs is dominated by arterial and venous thrombosis, which are major causes of mortality and morbidity in patients with early stage disease. [2][3][4][5] Abnormal bleeding occurs in 5% to 10% of patients with ET during the disease course, particularly gastrointestinal, urogenital, and intracranial. 5,6 Several independent groups demonstrated in 2005 that the defect in the majority of patients with MPDs is a somatic V617F gain-of-function mutation in the gene encoding Janus kinase 2 (JAK2) in hematopoietic progenitor cells. 3 JAK2 V617F is present in peripheral blood cells, including platelets, 7,8 in virtually all patients with PV and approximately 60% of patients with ET. 8,9 In ET, JAK2 V617F increases the risk of thrombosis by approximately 2-fold 10,11 and the risk of thrombosis is even higher in ET patients with Ͼ 50% JAK2 V617F allele load. 12 The JAK2V617F mutation is also present in some patients presenting with thrombosis who do not meet the diagnostic criteria for MPDs. [13][14][15] Bleeding risk in ET appears not to be associated with the presence of JAK2 V617F. Flow cytometry studies demonstrated that JAK2V617F platelets express higher levels of platelet activation markers, such as P-selectin, compared with platelets from patients without the mutation, 16,17 suggesting that increased platelet activation may contribute to the thrombotic phenotype. A recent study also observed that platelet-mediated thrombin production is increased in ET patients. 18 In contrast, numerous studies performed over the past 35 years clearly showed that in vitro platelet function, in particular aggregation, is impaired in MPD patients, 19-22 a finding difficult to reconcile with the increased thrombotic risk. Although it is generally accepted that platelets contribute to the increased occurrence of thrombosis in patients with MPDs, very little is known how the JAK2V617F mutation changes intracellular platelet signaling pathways, subsequent platelet function and how this contributes to the MPD phenotype.In this study, we therefore aimed to identify the role of JAK2 in platelet function and how the JAK2V617F mutation affects platelet function in ET patients. We studied agonist-stimulated intracellular signaling pathways and related these findings to integrin ␣ IIb  3Submitted May 20, 2012; accepted November 26, 2012. Prepublished online as Blood First...