Blood cancers like leukemia often begin with silent changes deep inside the bone marrow, long before a person ever feels sick. The bone marrow is the soft, sponge‑like tissue inside our bones that produces millions of new blood cells every second.
It is home to special blood‑forming stem cells that create all the red blood cells, white blood cells, and platelets we need to stay alive.
But as people grow older, these stem cells can develop genetic mutations. Most of the time, these changes cause no symptoms, but in some cases, they can raise the risk of serious diseases later in life.
A team of scientists from the University Medical Center Mainz has now discovered how chronic inflammation can quietly change the bone marrow environment in people with these age‑related stem cell mutations, helping push them toward developing blood cancer.
Their work shows that inflammation is not just a side effect of disease—it may actually help start it.
To understand why this matters, it helps to imagine the bone marrow as a busy factory. Blood‑forming stem cells are the workers, while stromal cells—connective tissue cells—act like support staff, making sure the workers have what they need.
The immune system is also involved, sending signals that affect how fast or slow this factory runs. All these systems must work together smoothly for healthy blood production.
The researchers studied the bone marrow “microenvironment,” a term that refers to everything surrounding the stem cells, including stromal cells, immune cells, and the signals they exchange.
This environment is crucial because it can encourage either healthy growth or the expansion of abnormal cells. Until now, scientists knew little about how this environment changes at the earliest stages of blood diseases.
The team focused on people with two age‑related conditions: clonal hematopoiesis of indeterminate potential (CHIP) and myelodysplastic syndromes (MDS). CHIP is surprisingly common in older adults. About 10% to 20% of people over 60 have it, and nearly 30% of people over 80 are affected.
CHIP itself does not cause symptoms, but it increases the risk of blood cancer tenfold and doubles the risk of heart disease. MDS, on the other hand, is a disorder in which the bone marrow does not produce healthy blood cells.
It mainly affects older adults as well, and up to 30% of MDS cases eventually turn into acute myeloid leukemia (AML), a dangerous and fast‑growing cancer.
When the researchers examined the bone marrow of people with CHIP and MDS, they found something striking. A new type of inflammatory stromal cell had taken over the bone marrow. These inflammatory stromal cells pushed out the healthy connective tissue cells and began releasing large amounts of inflammatory signals.
These signals attracted special immune cells called interferon‑responsive T cells. Instead of protecting the body, these T cells made the inflammation even worse. As a result, normal blood formation became disrupted, and the environment began favoring the growth of mutated, disease‑linked stem cells.
What makes this discovery important is that these harmful changes occurred long before the patients developed any symptoms. This means the earliest stages of blood cancer may begin years before doctors can detect the disease using current tools.
If scientists can identify these inflammatory cell types—through their unique molecular signatures—they may be able to spot people at high risk much earlier.
The researchers believe this work could eventually lead to therapies aimed at calming inflammation in the bone marrow before cancer develops.
Instead of waiting for leukemia or MDS to appear, doctors might one day intervene early by targeting the microenvironment itself. This approach could prevent disease progression or even stop cancer from forming.
The study also adds to our understanding of “inflammaging,” a term used to describe the slow, chronic inflammation that increases as people age. This mild but persistent inflammation is linked to many age‑related diseases, including cancer, heart disease, and metabolic disorders.
By showing how inflammaging affects bone marrow, the research offers new clues about why older adults are more vulnerable to blood cancers.
In summary, the study reveals that early, hidden inflammation in the bone marrow can set the stage for blood cancer long before symptoms appear. The findings highlight the importance of the bone marrow microenvironment in disease development and open the door to new ways of detecting and preventing cancer earlier than ever before.
Although more research is needed, these insights give scientists a promising direction for future therapies and may one day help protect millions of aging adults from serious blood disorders.
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The study is published in Nature Communication.
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