Myeloproliferative neoplasms: A model of the journey from clonal hematopoiesis to cardiovascular disease and cancer.

In the last decade, the coming of next-generation sequencing and its application to large human populations is breaking the barrier between inflammation and cancer. Indeed, acquired mutations in key genes that regulate hematopoiesis and thus confer a selective advantage in the proliferation of hematopoietic progenitors have established the concept of clonal hematopoiesis of indeterminate potential or CHIP. A growing body of clinical and experimental evidence is highlighting the link between CHIP and adverse outcomes, in particular atherosclerotic cardiovascular disease and cancer. The apparent surprise about how these two different entities share common mechanisms can be explained by myeloproliferation and inflammation. These mechanisms are involved not only in the development of myeloid tumors but also in atherogenesis. Myeloproliferative neoplasms or MPN are a type of myeloid tumors where thrombotic risk is increased not only by higher blood counts but also by means of an accelerated atherosclerosis. Therefore, myeloproliferative neoplasms are a model of the link between clonal hematopoiesis and atherosclerotic cardiovascular disease. The concept of CHIP has important clinical applications. A deeper understanding of these mechanisms may pave the way for the future early diagnosis and potential pre-emptive treatments of these two major causes of death.