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Sphingolipid dysregulation due to lack of functional KDSR impairs proplatelet formation causing thrombocytopenia

Turro, Ernest; Bariana, Tadbir K; Gomez, Keith; Labarque, Veerle; Heremans, Jessica; Whitehorn, Deborah; Thys, Chantal; NIHR BioResource; De Reys, Mara; Freson, Kathleen; Greene, Daniel; Frontini, Mattia; Jenkins, Benjamin; Ghevaert, Cedric; Grassi, Luigi; Ouwehand, Willem H; Seyres, Denis; Koulman, Albert; Burden, Frances; Van Geet, Chris; Papadia, Sofia; Shamardina, Olga


Ernest Turro

Tadbir K Bariana

Keith Gomez

Veerle Labarque

Jessica Heremans

Deborah Whitehorn

Chantal Thys

NIHR BioResource

Mara De Reys

Kathleen Freson

Daniel Greene

Mattia Frontini

Benjamin Jenkins

Cedric Ghevaert

Luigi Grassi

Willem H Ouwehand

Denis Seyres

Albert Koulman

Frances Burden

Chris Van Geet

Sofia Papadia

Olga Shamardina



Sphingolipids are fundamental to membrane trafficking, apoptosis and cell differentiation and proliferation. KDSR or 3-keto-dihydrosphingosine reductase is an essential enzyme for de novo sphingolipid synthesis, and pathogenic mutations in KDSR result in the severe skin disorder erythrokeratodermia variabilis et progressiva-4. Four of the eight reported cases also had thrombocytopenia but the underlying mechanism has remained unexplored. Here we expand upon the phenotypic spectrum of KDSR deficiency with studies in two siblings with novel compound heterozygous variants associated with thrombocytopenia, anemia and minimal skin involvement. We report a novel phenotype of progressive juvenile myelofibrosis in the propositus, with spontaneous recovery of anemia and thrombocytopenia in the first decade of life. Examination of bone marrow biopsies showed megakaryocyte hyperproliferation and dysplasia. Megakaryocytes obtained by culture of CD34+ stem cells confirmed hyperproliferation and showed reduced proplatelet formation. The effect of KDSR insufficiency on the sphingolipid profile was unknown, and was explored in vivo and in vitro by a broad metabolomics screen that indicated activation of an in vivo compensatory pathway that leads to normalisation of downstream metabolites such as ceramide. Differentiation of propositus-derived induced pluripotent stem cells to megakaryocytes followed by expression of functional KDSR showed correction of the aberrant cellular and biochemical phenotypes, corroborating the critical role of KDSR in proplatelet formation. Finally, Kdsr depletion in zebrafish recapitulated the thrombocytopenia and showed biochemical changes similar to those observed in the affected siblings. These studies support an important role for sphingolipids as regulators of cytoskeletal organisation during megakaryopoiesis and proplatelet formation.


Turro, E., Bariana, T. K., Gomez, K., Labarque, V., Heremans, J., Whitehorn, D., …Shamardina, O. (2018). Sphingolipid dysregulation due to lack of functional KDSR impairs proplatelet formation causing thrombocytopenia. Haematologica, 104(4), haematol.2018.204784.

Journal Article Type Article
Acceptance Date Nov 19, 2018
Online Publication Date Nov 22, 2018
Publication Date Nov 22, 2018
Deposit Date Apr 17, 2019
Publicly Available Date Oct 27, 2022
Journal Haematologica
Print ISSN 0390-6078
Electronic ISSN 1592-8721
Publisher Ferrata Storti Foundation
Peer Reviewed Peer Reviewed
Volume 104
Issue 4
Pages haematol.2018.204784
Public URL
Publisher URL


NIHR Sphingolipid Paper (2.3 Mb)

Copyright Statement
© 2018, Ferrata Storti Foundation

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