The bone marrow microenvironment plays a critical role in the pathogenesis of MDS.

Characterization of molecular pathways that contribute to MDS could lead to identification of novel approaches to treat MDS.

Inflammatory signals in the bone marrow determine hematopoietic stem cell fate and are aberrantly regulated in MDS hematopoietic stem cells.

Hypoxia is important for normal hematopoietic stem cell development and potentially plays a role in MDS.

Dysregulation of inflammatory signaling, including upregulation of TNFalpha, is associated with the development of acquired and inherited bone marrow failure syndromes. Dysregulation of inflammatory signaling contributes to the pathogenesis of MDS through both direct mechanisms on HSCs and by altering the bone marrow microenvironment.