Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms
Thrombosis in myeloproliferative neoplasms is associated with increased NETosis that can be targeted with JAK inhibitors. A NET increase in thrombosis Excessive thrombosis is a major cause of complications in cancer, including myeloproliferative neoplasms. Neutrophil extracellular traps (NETs) are structures formed from DNA expelled by activated neutrophils in infection, autoimmune disease, or cancer, and these can be associated with thrombosis. Wolach et al. discovered that increased activity of a protein called JAK2 is associated with NET formation in myeloproliferative neoplasms and that inhibiting it with ruxolitinib, a drug that targets JAK2, decreases thrombosis in a mouse model. Moreover, in a data set from more than 10,000 people without myeloproliferative neoplasms, detection of a clonal population of blood cells with overactive JAK2 correlated with a risk of thrombotic events, suggesting a broader relevance for this finding beyond the setting of cancer. Thrombosis is a major cause of morbidity and mortality in Philadelphia chromosome negative myeloproliferative neoplasms (MPNs) clonal disorders of hematopoiesis characterized by activated Janus kinase (JAK) signal transducer and activator of transcription (STAT) signaling. Neutrophil extracellular trap (NET) formation, a component of innate immunity, has been linked to thrombosis. We demonstrate that neutrophils from patients with MPNs are primed for NET formation, an effect blunted by pharmacological inhibition of JAK signaling. Mice with conditional knock in of Jak2V617F, the most common molecular driver of MPN, have an increased propensity for NET formation and thrombosis. Inhibition of JAK STAT signaling with the clinically available JAK2 inhibitor ruxolitinib abrogated NET formation and reduced thrombosis in a deep vein stenosis murine model. We further show that expression of PAD4, a protein required for NET formation, is increased in JAK2V617F expressing neutrophils and that PAD4 is required for Jak2V617F driven NET formation and thrombosis in vivo. Finally, in a population study of more than 10,000 individuals without a known myeloid disorder, JAK2V617F positive clonal hematopoiesis was associated with an increased incidence of thrombosis. In aggregate, our results link JAK2V617F expression to NET formation and thrombosis and suggest that JAK2 inhibition may reduce thrombosis in MPNs through cell intrinsic effects on neutrophil function.
Science Translational Medicine