Eatures of MDS patients are listed in Table 1.Preparation of Peripheral Blood Mononuclear Cells, Blood and Bone Marrow PlasmaPeripheral whole blood was collected from 37 patients (E-MDS, n = 17; L-MDS, n = 20) while bone marrow were drawn from 25 cases. Plasma was obtained by centrifugation of heparinized peripheral blood and stored at 280uC for cytokine analysis. Peripheral blood mononuclear cells (PBMCs) were isolated from EDTA anticoagulated blood by gradient centrifugation (400 g, 20 minutes) using Ficoll-Paque (Pharmacia Diagnostics) and stored at 280uC for RNA isolation.Flow Cytometric AnalysisIntracellular cytokines were studied by flow cytometry to reflex the cytokine-producing cells. Briefly, heparinized peripheral whole blood (400 ml) with an equal volume of Roswell Park Memorial Table 1. Demographic and clinical characteristics of MDS patients.Characteristics No. of patients Age(y) Sex(male/female) IPSS risk group, n( )value 54 52.6615.4 39/Materials and Methods Ethics StatementOur research has been approved by the Institutional Review Boards of Qilu Hospital of Shandong University. A written informed consent document has been obtained from each participant. The informed consent stated that the excess of peripheral blood for Flow Cytometry – Clinical Diagnostics or unused portion of bone marrow for Fluorescence in situ hybridization (FISH) – Clinical Diagnostics was the sample source of our research. The peripheral blood drawn from healthy subjects and bone marrow drawn from hematologically normal individuals undergoing orthopedic femoral surgery for this research was voluntary.E-MDS: Low+Intermediate-1 L-MDS: Intermediate-2+ High WHO MDS category, n( ) Unknown RCUD RARS RCMD RAEB-1 RAEB-2 MDS/MPD CMML-1 CMML-2 BM blasts, n( )29 (53.7 ) 25 (46.3 )15(27.7 ) 13(24.1 ) 1(0.2 ) 2(3.7 ) 6(11.1 ) 13(24.1 ) 2(3.7 ) 1(0.2 ) 1(0.2 )Patients and ControlsA total of 54 patients (15 females and 39 males; mean age 52.6615.4 years) with MDS according to the World Health Organization (WHO) classification [18] were recruited in this study. All patients were treatment-naive or had no medical interventions for at least 3 months when sampling. Twenty agematched healthy PB donors (6 females and 14 males; mean age 51.0615.9 years) were also included in the study. Ten hematologically normal age-matched individuals (3 females, 7 males; mean age 53.1611.8 years) were used as BM GLPG0634 controls. Enrollment took place between March 2011 and May 2012 in the Department of Hematology of Qilu Hospital, Shandong University, China.,5 5 IPSS karyotype, n( ) Favorable Intermediate Unfavorable30(55.6 ) 24(44.4 )33(61.1 ) 12(22.2 ) 9(16.7 )Abbreviations: BM, bone marrow; n, number; RCUD, refractory GMX1778 site cytopenia with unilineage dysplasia; RARS, refractory anemia with ring sideroblasts; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess blasts; CMML, chronic myelo-monocytic leukemia. doi:10.1371/journal.pone.0051339.tTh22 and Th17 Cells in Different 1379592 Stages of MDSInstitute 1640 medium was incubated for 4h at 37uC, 5 CO2 in the presence of 25 ng/ml of phorbol myristate acetate (PMA), 1 mg/ml of ionomycin, and 1.7 mg/ml Golgiplug (monensin; all from Alexis Biochemicals, San Diego, CA, USA). PMA and ionomycin are pharmacological T-cell-activating agents that mimic signals generated by the T-cell receptor (TCR) complex and have the advantage of stimulating T cells of any antigen specificity. Monensin was used to block the intracellular.Eatures of MDS patients are listed in Table 1.Preparation of Peripheral Blood Mononuclear Cells, Blood and Bone Marrow PlasmaPeripheral whole blood was collected from 37 patients (E-MDS, n = 17; L-MDS, n = 20) while bone marrow were drawn from 25 cases. Plasma was obtained by centrifugation of heparinized peripheral blood and stored at 280uC for cytokine analysis. Peripheral blood mononuclear cells (PBMCs) were isolated from EDTA anticoagulated blood by gradient centrifugation (400 g, 20 minutes) using Ficoll-Paque (Pharmacia Diagnostics) and stored at 280uC for RNA isolation.Flow Cytometric AnalysisIntracellular cytokines were studied by flow cytometry to reflex the cytokine-producing cells. Briefly, heparinized peripheral whole blood (400 ml) with an equal volume of Roswell Park Memorial Table 1. Demographic and clinical characteristics of MDS patients.Characteristics No. of patients Age(y) Sex(male/female) IPSS risk group, n( )value 54 52.6615.4 39/Materials and Methods Ethics StatementOur research has been approved by the Institutional Review Boards of Qilu Hospital of Shandong University. A written informed consent document has been obtained from each participant. The informed consent stated that the excess of peripheral blood for Flow Cytometry – Clinical Diagnostics or unused portion of bone marrow for Fluorescence in situ hybridization (FISH) – Clinical Diagnostics was the sample source of our research. The peripheral blood drawn from healthy subjects and bone marrow drawn from hematologically normal individuals undergoing orthopedic femoral surgery for this research was voluntary.E-MDS: Low+Intermediate-1 L-MDS: Intermediate-2+ High WHO MDS category, n( ) Unknown RCUD RARS RCMD RAEB-1 RAEB-2 MDS/MPD CMML-1 CMML-2 BM blasts, n( )29 (53.7 ) 25 (46.3 )15(27.7 ) 13(24.1 ) 1(0.2 ) 2(3.7 ) 6(11.1 ) 13(24.1 ) 2(3.7 ) 1(0.2 ) 1(0.2 )Patients and ControlsA total of 54 patients (15 females and 39 males; mean age 52.6615.4 years) with MDS according to the World Health Organization (WHO) classification [18] were recruited in this study. All patients were treatment-naive or had no medical interventions for at least 3 months when sampling. Twenty agematched healthy PB donors (6 females and 14 males; mean age 51.0615.9 years) were also included in the study. Ten hematologically normal age-matched individuals (3 females, 7 males; mean age 53.1611.8 years) were used as BM controls. Enrollment took place between March 2011 and May 2012 in the Department of Hematology of Qilu Hospital, Shandong University, China.,5 5 IPSS karyotype, n( ) Favorable Intermediate Unfavorable30(55.6 ) 24(44.4 )33(61.1 ) 12(22.2 ) 9(16.7 )Abbreviations: BM, bone marrow; n, number; RCUD, refractory cytopenia with unilineage dysplasia; RARS, refractory anemia with ring sideroblasts; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess blasts; CMML, chronic myelo-monocytic leukemia. doi:10.1371/journal.pone.0051339.tTh22 and Th17 Cells in Different 1379592 Stages of MDSInstitute 1640 medium was incubated for 4h at 37uC, 5 CO2 in the presence of 25 ng/ml of phorbol myristate acetate (PMA), 1 mg/ml of ionomycin, and 1.7 mg/ml Golgiplug (monensin; all from Alexis Biochemicals, San Diego, CA, USA). PMA and ionomycin are pharmacological T-cell-activating agents that mimic signals generated by the T-cell receptor (TCR) complex and have the advantage of stimulating T cells of any antigen specificity. Monensin was used to block the intracellular.