Megakaryocytes and platelets express the Gs-coupled VPAC1 receptor, for which the pituitary adenylyl cyclase-activating peptide (PACAP) and the vasointestinal peptide (VIP) are agonists. We here demonstrate a regulatory role for VPAC1 signaling during megakaryopoiesis. A total of 2 patients with trisomy 18p with PACAP overexpression and transgenic mice overexpressing PACAP in megakaryocytes have thrombopathy, a mild thrombocytopenia, and a reduced number of mature megakaryocytes in their bone marrow. In vitro differentiation of hematopoietic stem cells from the patient and transgenic mice shows a reduced number of megakaryocyte colonies compared with controls. The addition of PACAP, VIP, or the adenylyl cyclase activator forskolin to CD34 ؉ cells inhibits megakaryocyte differentiation. In contrast, neutralizing monoclonal anti-PACAP (PP1A4) or anti-VPAC1 (23A11) antibodies inhibit cAMP formation and stimulate megakaryopoiesis in a thrombopoietin-independent manner. Moreover, wild-type mice obtain an increased platelet count after subcutaneous injection of PP1A4 or 23A11. These antibodies also elevate platelet numbers in animal models of myelosuppressive therapy and in GATA1-deficient mice with congenital thrombocytopenia. Furthermore, 23A11 stimulates the in vitro megakaryocyte differentiation of both normal and GATA1-deficient human CD34 ؉ cells. Together, our data strongly suggest that VPAC1 signaling tempers normal megakaryopoiesis, and that inhibition of this pathway stimulates megakaryocyte differentiation, enhancing platelet recovery after myelosuppressive therapy and in GATA1 deficiency.
IntroductionVasointestinal peptide (VIP) and pituitary adenylyl cyclaseactivating peptide (PACAP) belong to the glucagon hormone superfamily, which in humans includes secretin, growth hormonereleasing hormone (GHRH), glucagon, glucagon-like peptides 1 and 2 (GLP-1 and GLP-2), peptide histidine methionine (PHM), and glucose-dependent insulinotropic polypeptide (GIP). 1 These peptides have been grouped into a superfamily because the precursor molecules share a strikingly similar structural organization and similar amino acid sequences; in general, the hormones are related in terms of distribution and function. PACAP and VIP effects have been described in the digestive tract, cardiovascular system, airways, reproductive system, immune system, endocrine glands, and brain. 1,2 These pleiotropic neuropeptides share 2 common G protein-coupled receptors, VPAC1 (VIPR1) and VPAC2 (VIPR2), while PACAP has an additional specific receptor, PAC1 (ADCYAP1R1). 1,3 The human PACAP gene (ADCYAP1) is located on chromosome 18p32, 4 and is mainly expressed in testis and brain, but this peptide crosses the blood-brain barrier. 5 We previously found an important role for PACAP and its receptor VPAC1 in platelet function. 6 Studies in 2 related patients with a partial trisomy 18p and monosomy 20p revealed 3 copies of the PACAP gene and elevated PACAP concentrations in plasma. The patients suffer from mental retardation, have a bleeding tendency...