Figure 1.

The regulation of thrombopoietin levels. A steady-state amount of hepatic thrombopoietin (TPO) is regulated by platelet c-Mpl receptor–mediated uptake and destruction of the hormone. Hepatic production of the hormone is depicted. Upon binding to platelet c-Mpl receptors, the hormone is removed from the circulation and destroyed, which reduces blood levels. In the presence of inflammation, IL-6 is released from macrophages and, through TNF-α stimulation, from fibroblasts and circulates to the liver to enhance thrombopoietin production. Thrombocytopenia also leads to enhanced marrow stromal cell production of thrombopoietin, although the molecular mediator(s) of this effect is not yet completely understood.