NEWS AND VIEWS calcium consumption does not seem to have without increasing the risk of coronary heart 7. Aoki, K. et al. Ann. Epidemiol. 15, 598–606 (2005). such an effect. How to optimize calcium sup- disease, which has been associated with cal- 8. Langhans, N. et al. Gastroenterology 112, 280–286 13 plements for human health deserves further cium supplementation . (1997). investigation. 9. Recker, R.R. N. Engl. J. Med. 313, 70–73 (1985). 10. Yang, Y.-X. et al. J. Am. Med. Assoc. , 2947– Maybe it’s time to determine whether low- 1. Zaidi, M. Nat. Med. 13, 791–801 (2007). 296 2. Del Fattore, A. et al. Bone 42, 19–29 (2008). 2953 (2006). fat milk–based drinks taken as an alternative 3. Sobacchi, C. et al. Hum. Mol. Genet. 10, 1767–1773 11. Collazo-Clavell, M.L., Jimenez, A., Hodgson, S.F. & to the soda so frequently consumed, especially (2001). Sarr, M.G. Endocr. Pract. 10, 195–198 (2004). 4. Amling, M. et al. Nat. Med. 15, 674–681 (2009). 12. Bo-Linn, G.W. et al. J. Clin. Invest. 73, 640–647 during the early adolescent years, can attain 5. Straub, D.A. Nutr. Clin. Pract. 22, 286–296 (2007). (1984). the noble goal of keeping bones healthy— 6. Teitelbaum, S.L. Science 289, 1504–1508 (2000). 13. Bolland, M.J. BMJ 336, 262–266 (2008). IFN-α wakes up sleeping hematopoietic stem cells Emmanuelle Passegué & Patricia Ernst The cytokine interferon-α stimulates the turnover and proliferation of hematopoietic cells in vivo (pages 696–700). The findings hint at a new strategy to treat hematopoietic cancers. At homeostasis, complex regulatory net- a ↑IFN-α ↓IFN-α works maintain the ongoing production of all blood cell types1. During this process, very few hematopoietic stem cells (HSCs) actively STAT1 STAT2 STAT1 STAT2 divide, and most of them remain quiescent in ISGF3 Proliferation IRF9 Proliferation the bone marrow. In response to injury to the IRF2 ISRE hematopoietic system, such as from irradiation ISRE or chemotherapy, HSCs can temporarily exit their quiescent state and generate a larger pool b of progenitor cells, thus increasing production Wild-type HSCs Wild-type HSCs + IFN-α IRF2-deficient HSCs of the needed mature blood cells. Some of the IFN-α ↑IFN-IFN-α IFN-IFN-α proteins that regulate the choice between qui- escence and proliferation in HSCs have already 1,2 been identified . ISGF3ISGF3 ↑ISGF3ISG ↑ISGFISGF33 Two recent studies, one in Nature3 and the IRF2 IRF2 other in this issue of Nature Medicine4, now expand upon this small list of players. The © All rights reserved. 2009 Inc. Nature America, studies show that the cytokine interferon-α DiffDifferentiatingere ng (IFN-α) stimulates the turnover and prolifera- cellc 3,4 tion of HSCs in vivo . IFN-α is an important Self- renewing immune modulator not previously known to cell influence HSC function. This feedback mech- anism between the immune system and the tip of the hematopoietic hierarchy may lead to a Caesar Kim new strategy for leukemia treatment. Figure 1 Role of low-level and induced IFNα signaling within HSCs. (a) Hypothetical target gene linking IFN-α signaling to HSC proliferation. Left, IFN-α–induced proliferation via the ISGF3 complex; Type I interferons (IFN-α and IFN-β) are right, endogenous (uninduced) IFN-α signaling, in which IRF2 acts on the same hypothetical gene produced by a variety of immune and nonim- to constitutively suppress expression. ISRE, IFN-stimulated response element. (b) Outcome of HSC mune cells in response to microbial infections proliferation in the presence of endogenous IFN-α signaling, induced IFN-α signaling (↑IFN-α) and or recognition of tumor cells5. Upon engaging in the IRF2 knockout. Arrows indicate decisions of the stem cell to divide to yield mostly progeny their receptors, type I interferons induce a set committing to differentiate (blue-green cells) versus dividing to self-renew and maintain the stem cell pool (purple cells). Emmanuelle Passegué is at the Eli and Edythe Broad Center of Regeneration Medicine and Stem of genes that inhibit viral replication and clear are still largely unknown, but IFN-α treatment Cell Research, Department of Medicine, Division of infected cells. Because of their ability to regu- of cancer cells generally results in growth arrest Hematology/Oncology, University of California–San late the immune system, recombinant type I by activating negative regulators of prolifera- Francisco, San Francisco, California, USA, and interferons have been used clinically to treat tion such as p53 (ref. 6). Patricia Ernst is at the Dartmouth Medical School, viral infections, solid tumors, myeloprolifera- Now Essers et al.3 and Sato et al.4 report a Department of Genetics and Norris Cotton Cancer tive disorders, hematopoietic neoplasms and new role for IFN signaling within the most Center, Hanover, New Hampshire, USA. autoimmune diseases such as multiple sclero- primitive cells of the hematopoietic system. e-mail: [email protected] or patricia. sis. For most of these diseases, the mechanisms The two groups came to similar conclusions [email protected] of action and the precise cellular targets of IFNs starting from very different observations. In 612 VOLUME 15 | NUMBER 6 | JUNE 2009 NATURE MEDICINE NEWS AND VIEWS the course of using a mouse model commonly IRF9-mediated transcription. Essers et al.3 therapy directed against BCR-ABL, the fusion employed in the study of HSC function, Essers found that Stat1 was required for the IFN-α– protein characteristic of CML—experienced et al.3 found that high levels of IFN-α induced mediated exit from dormancy, indicating that persistent remission, and perhaps cure, upon HSC proliferation. Sato et al.4 were studying this unusual effect on proliferation is medi- drug discontinuation9,10. In contrast, patients the immune modulatory effects of IFNs and ated by a canonical IFN signaling component. from the same study, and from other clinical other cytokines on immune effector cells when How IFN-α signals are interpreted differently cohorts, who achieved remission after imatinib they found that mice lacking a component of in HSCs compared to other cell types is yet to treatment but were not previously treated with the IFN signaling pathway had an unexpected be determined. IFN-α, often relapsed upon imatinib discon- imbalance of proliferation within the HSC A remaining mystery is why an important tinuation9–11. Persistent CML-initiating cells, pool. Both groups tracked their observations antiviral signal should influence HSC activity or CML stem cells, which are protected from to a direct effect of IFN-α on the proliferation and hematopoiesis. The induced prolifera- imatinib killing by their quiescent status, are state of HSCs3,4. tion of HSCs could be a means to replace the probably responsible for the regrowth of the Sato et al.4 studied mice that were genetically immune cells turned over in the process of viral disease12. deficient for a negative regulator of type I inter- clearance. However, both groups show that The emerging possibility to explain the feron signaling, interferon response factor-2 one outcome of the enhanced HSC prolifera- stable remission in the patients previously (IRF2)4,7. The investigators discovered that tion is ultimately the decreased production of treated with IFN-α could be that the exposure these mice had a greater proportion of HSCs mature cells3,4. So it is unlikely that this feed- to IFN-α induced the CML stem cells to exit that were proliferating, instead of quiescent back mechanism is in place simply to amplify quiescence and proliferate such that, upon as would be found in normal mice. Chronic cells at the top of the hematopoietic hierarchy. imatinib treatment, they became vulnerable proliferation can impair certain functions One aspect not investigated by either group is to imatinib rather than remaining protected. of HSCs, such as their ability to repopulate whether the proliferating HSCs are mobilized Although the results of the patient studies the bone marrow of irradiated mice2. Sato et or trafficked differently as compared to nonin- need to be confirmed in larger studies, they al.4 found that the IRF2-deficient HSCs were duced HSCs. Previous studies have illustrated raise the tantalizing possibility of an effective unable to restore hematopoiesis in irradiated that bacterial products mimicking infection targeting strategy for drug-resistant quiescent mice, indicating that this cell population was cause the preferential migration of HSCs into cancer stem cells in individuals suffering from no longer fully functional. However, if type I peripheral tissues, where they participate in CML and other hematologic malignancies11. IFN signaling was disabled in the HSCs, the immune regulation by differentiating into These new insights into the role of IFN signal- ability to repopulate the bone marrow could immune effector cells8. Therefore, the HSC ing in normal HSC quiescence may spark fur- be restored in IRF2-deficient HSCs. This obser- proliferation induced by IFNs may serve to ther interest in manipulating this pathway to vation suggests that IRF2 normally suppresses generate immune effector cells from circulating kick quiescent leukemia stem cells into a more IFN signaling in wild-type HSCs, maintaining HSCs for rapid deployment against infections vulnerable state. these cells mostly in a dormant state (Fig. 1). or tumor cells. Both groups found that high levels of IFN-α In contrast to the value of this feedback sys- 1. Wilson, A. et al. Ann. NY Acad. Sci. 1106, 64–75 directly induced wild-type HSCs to exit qui- tem to the hematopoietic system, the potential (2007). 3,4 2. Jude, C.D., Gaudet, J.J., Speck, N.A. & Ernst, P. Cell escence and transiently proliferate in vivo . clinical value of these findings is quite clear. Cycle 7, 586–591 (2008).