Germline JAK2 E846D Substitution as the Cause of Erythrocytosis?

Abstract

The discovery in 2005 of the JAK2 V617F gain-of-function mutation in myeloproliferative neoplasms and more particularly in polycythemia vera has deeply changed the diagnostic and therapeutic approaches to polycythemia. More recently, the use of NGS in routine practice has revealed a large number of variants, although it is not always possible to classify them as pathogenic. This is notably the case for the JAK2 E846D variant for which for which questions remain unanswered. In a large French national cohort of 650 patients with well-characterized erythrocytosis, an isolated germline heterozygous JAK2 E846D substitution was observed in only two cases. For one of the patients, a family study could be performed, without segregation of the variant with the erythrocytosis phenotype. On the other hand, based on the large UK Biobank resource cohort including more than half a million UK participants, the JAK2 E846D variant was found in 760 individuals, associated with a moderate increase in hemoglobin and hematocrit values, but with no significant difference to the mean values of the rest of the studied population. Altogether, our data as well as UK Biobank cohort analyses suggest that the occurrence of an absolute polycythemia cannot be attributed to the sole demonstration of an isolated JAK2 E846D variant. However, it must be accompanied by other stimuli or favoring factors in order to generate absolute erythrocytosis.

Keywords: JAK2 mutation; erythrocytosis; familial erythrocytosis; germline mutation.

Figure 1

Diagnostic approach to erythrocytosis cases in Dijon’s hospital.

Figure 2

Presentation of patient one’s family. (A) Pedigree of patient one. (B) Electropherogram of the wild type son (S1), and mutated son (S2), mutated daughter (D1).

Figure 3

Illustration of the impact of the JAK2 E846D variant on hematological features in men and women in the UK biobank database. (A) The colored bars represent non carriers of the JAK2 E846D variant (pink bars) and the carriers of the mutation (green, and blue bars). (B) Impact of the JAK2 E846D variant on hemoglobin, red blood cell count, and reticulocyte count.