Abstract

Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases characterized by ineffective hematopoiesis. The risk of MDS is associated with aging and the accumulation of somatic mutations in hematopoietic stem cells and progenitors (HSPC). While advances in DNA sequencing in the past decade unveiled clonal selection driven by mutations in MDS, it is unclear at which stage the HSPCs are trapped or what prevents mature cells output. Single-cell-sequencing techniques in recent years have revolutionized our understanding of normal hematopoiesis by identifying the transitional cell states between classical hematopoietic hierarchy stages, and most importantly the biological activities behind cell differentiation and lineage commitment. Emerging studies have adapted these powerful tools to investigate normal hematopoiesis as well as the clonal heterogeneity in myeloid malignancies and provide a progressive description of disease pathogenesis. This review summarizes the potential of growing single-cell-sequencing techniques, the evolving efforts to elucidate hematopoiesis in physiological conditions and MDS at single-cell resolution, and discuss how they may fill the gaps in our current understanding of MDS biology.

Highlights

  • Hematopoietic stem cells give rise to a variety of mature cells in a programmed way as determined by their epigenetic, transcriptomic, and spatial information [1, 2]

  • hypomethylating agents (HMA)-induced resolution of anemia is associated with reduction of blast and an overall number of cytogenetically abnormal cells in bone marrow as well as repopulation of cytogenetically normal LT-hematopoietic stem cells (HSCs), yet the cytogenetically abnormal LT-HSCs persist and contribute to transformation to acute myeloid leukemia (AML) [44, 80]. These findings suggest that HMA treatment cannot eradicate Myelodysplastic syndromes (MDS) hematopoietic stem and progenitor cells (HSPCs)

  • It is important to remember MDS unlike AML, represents a progression of clonal hematopoiesis where dominant cytogenetically abnormal HSPCs have not yet gained the pass to uncontrolled proliferation, the imbalanced output contributes to abnormal cells spanning multiple differentiation stages that result in the clinical phenotypes

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Summary

Introduction

Hematopoietic stem cells give rise to a variety of mature cells in a programmed way as determined by their epigenetic, transcriptomic, and spatial information [1, 2]. It is likely that the integration of single-cell multiomics data will be required to clearly identify both normal HSPC subsets, and by comparison those affected by MDS.

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