IGF1 and myelodysplastic syndrome: For example, IGF-1 enforces SASP acquisition as high levels of IGF-binding proteins have been found in multiple types of senescent cells.178 Moreover, bone matrix and extracellular calcium released during bone resorption are potent activators of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3), which is overexpressed in MDS patients carrying various somatic mutations (e.g., ASXL1, SF3B1, SRSF2, and the del(5q) subtype) and is correlated with a poor prognosis179,180 (Fig. 5.4).