Mathematical modelling of premature haematopoietic ageing in dyskeratosis congenita.

Idiopathic dyskeratosis congenita (DC) is a disorder characterized by mucocutaneous alterations, bone-marrow failure, immune deficiency, liver cirrhosis, and other morbidities, due to alterations in telomere maintenance, which, in most cases, lead to short telomeres and poor tissue regeneration and function. The main cause of mortality is bone-marrow failure. A non-local diffusion-advection model with zero-flux boundary conditions is used to simulate the generational and temporal evolution of a hematopoietic stem cell (HSC) population in order to investigate the progression of DC. Blood-cell production from progenitor cells that had exited the HSC compartment was quantified. The influence of variations in initial proliferation potential ([Formula: see text]) and telomerase activity (s) on the onset of pancytopenia was examined. Age-and weight-dependent blood cell demands are modeled for both sexes, establishing a physiological baseline against which DC-related deficiencies are compared. Simulations revealed that lower [Formula: see text] values and reduced telomerase activity accelerate stem cell exhaustion, resulting in early pancytopenia, sometimes before age of 2 years. In contrast, patients with moderately higher [Formula: see text] values developed pancytopenia later in life, with onset delayed until the third or fourth decade. Treatment simulations demonstrated that a two-year course of danazol, a synthetic androgen, can slow telomere attrition. These findings suggest that pharmacological intervention may delay hematopoietic failure and possibly improve the production of oocytes with better-preserved telomeres in female DC patients. Our model provides a valuable framework for assessing (or understanding, or both) disease progression and evaluating therapeutic strategies in telomeropathy-associated bone marrow failure.