Proposal for using small molecule tumor necrosis factor-alpha lowering agents, possibly bupropion, in aplastic anemia.

Aplastic anemia (AA) is associated with non-trival mortality. Although diagnostic boarders with other myelodysplastic syndromes are unclear, AA is thought, at some point in the chain of events that destroy marrow hematopoiesis, to involve overproduction of tumor necrosis factor-alpha (TNF) and that TNF is the proximal death programming signal the stem cells receive. Thus agents that lower TNF may be of benefit in AA. In preliminary studies we have found that the commonly used antidepressant bupropion lowers TNF. Thus, bupropion is a potential initial small molecule TNF inhibitor to consider for AA.