Androgens, Telomerase, and Aplastic Anemia

In patients with aplastic anemia, reduced counts of red blood cells, leukocytes, and platelets sometimes improve with androgen therapy. Androgens raise red cell mass by stimulating renal erythropoietin production, but the mechanism responsible for increased leukocyte and platelet production is not understood. Telomerase gene (TERT) mutations have been detected in some patients with acquired aplastic anemia, and TERT and other telomerase gene mutations cause dyskeratosis congenita, a disorder characterized by bone marrow failure and aplastic anemia. Citing evidence that androgens control telomerase activity in certain cell types, investigators from the National Institutes of Health postulated that androgens might stimulate hematopoietic cell…