{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:31:13Z","timestamp":1788571873310,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Fluorescently labeled aerolysin (FLAER) is widely used for the identification of paroxysmal nocturnal hemoglobinuria (PNH) clones in peripheral blood (PB) samples. However, there are only a few reports on the differential fluorescent intensity of FLAER in normal bone marrow (BM) cell subpopulations. The purpose of this study was to evaluate FLAER expression during normal and pathological hematopoiesis, to map the critical existence of non\u2010PNH FLAER\u2010dim cells.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 54 BM aspirates were prospectively analyzed with FLAER\u2010based flow cytometric (FC) protocols, during their routine work\u2010up. These were obtained from patients with the following diagnoses: PNH (3), infections\/reactive (5), myelodysplastic syndromes (MDS) (7), myelodysplastic\/myeloproliferative neoplasms (MDS\/MPN) (4), chronic myelogenous leukemia (CML) (3), acute myelogenous leukemia (AML) at diagnosis (20), AML in measurable residual disease (MRD) assessment (7), and B\u2010cell acute lymphoblastic leukemia (B\u2010ALL) in MRD assessment (5). The applied protocols consisted of FLAER, HLA\u2010DR, CD14, CD33, CD34, CD66b, CD38, CD117, CD64, CD45, and FLAER, CD66c, CD14, CD33, CD34, CD66b, CD123, CD16, CD64, and CD45, respectively. FLAER expression was assessed in CD34++\/CD38\u2010 and CD34+\/CD38+ stem cells, CD34\u2010\/CD117+\/HLA\u2010DR+\/CD33+ myeloid precursors, and CD64+\/CD14\u2010\/HLA\u2010DR+ monocyte precursors but also in mature myeloid cells.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients revealed an intermediate FLAER intensity in CD34++\/CD38\u2010 stem cells, with a discrete FLAER\u2010negative subpopulation observed only in maturing CD34+\/CD38+ stem cells of patients with PNH. The lowest FLAER intensity was noticed in CD34\u2010\/CD117+\/HLA\u2010DR+\/CD33+ myeloid precursors, not only in patients with PNH but also in PNH\u2010negative BM aspirates. An ascending FLAER intensity was further observed during monocytic and granulocytic maturation, with a discrete FLAER\u2010negative population in CD64+\/CD14\u2010\/HLA\u2010DR+ monocyte precursors and maturing neutrophils and monocytes of patients with PNH only. The maturation pattern of FLAER expression was further confirmed in a patient with acute promyelocytic leukemia treated with all\u2010trans retinoic acid (ATRA), where FLAER was concurrently upregulated with CD66b in a consecutive series of PB samples tested over a 20\u2010day\u2010period after diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The application of FLAER in PNH\u2010positive and PNH\u2010negative reactive or malignant BM aspirates identified normally expected non\u2010PNH FLAER\u2010dim CD34\u2010\/CD117+\/HLA\u2010DR+\/CD33+ myeloid precursors in all samples. A specific FLAER\u2010associated maturation pattern was observed, which is proposed for further study within MRD and diagnostic protocols.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14394","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T04:34:32Z","timestamp":1730349272000},"page":"228-235","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["<scp>FLAER<\/scp> Revealed Normally Expected Non\u2010<scp>PNH FLAER<\/scp>\u2010Dim Immature Myeloid Cells (<scp>CD117<\/scp>+\/<scp>CD34<\/scp>\u2010) In Bone Marrow Aspirates and Could Be Utilized as a Marker of Hierarchical Hematopoiesis"],"prefix":"10.1111","volume":"47","author":[{"given":"Christina","family":"Karela","sequence":"first","affiliation":[{"name":"Department of Immunology General Hospital of Athens \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9759-0048","authenticated-orcid":false,"given":"Nikolaos J.","family":"Tsagarakis","sequence":"additional","affiliation":[{"name":"Hematology Laboratory General Hospital of Athens \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8539-5202","authenticated-orcid":false,"given":"Georgios","family":"Oudatzis","sequence":"additional","affiliation":[{"name":"Department of Immunology General Hospital of Athens \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Xanthopoulos","sequence":"additional","affiliation":[{"name":"Hematology Clinic HYGEIA General Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maroula","family":"Milaiou","sequence":"additional","affiliation":[{"name":"Department of Immunology General Hospital of Athens \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Nikolaou","sequence":"additional","affiliation":[{"name":"Department of Immunology General Hospital of Athens \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassiliki","family":"Zina","sequence":"additional","affiliation":[{"name":"Hematology Clinic General Hospital of Athens \u201cG. 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