A study has identified a previously unknown but crucial component of platelet production that could help prevent Velcade-induced thrombocytopenia in myeloma patients. The researchers found that proteasome inhibition blocked proplatelet formation in megakaryocytes via upregulation and hyperactivation of the small GTPase, RhoA. Inhibition of the RhoA pathway with fasudil, a drug used to treat cerebral vasospasm, restored platelet production in mice made thrombocytopenic by Velcade treatment. Fasudil could, therefore, potentially prevent thrombocytopenia in myeloma patients undergoing Velcade treatment but clinical trials are needed to confirm these findings.

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