267 references, every PMID retrieved by direct query against the NCBI PubMed E-utilities API while this model was being built. Nothing here is recalled from memory. Sections follow the structure of the mechanistic map (
pkd_qsp_model.dot) and the mrgsolve model (pkd_mrgsolve_model.R).
The model has four fitted parameters and roughly two hundred that are either taken from literature or back-calculated from the normal erythrocyte operating point. The list below is not "key papers"; it is the set of papers a specific number in the model came from, with the number named. If one of these is wrong, a stated result moves.
| Quantity in the model | Value used | Source |
|---|---|---|
| Reduced glycolysis / 2,3-BPG kinetic structure and reference metabolite set | ATP 1.70, ADP 0.22, 2,3-BPG 4.80, 3-PG 0.060, PEP 0.017, FBP 0.012 mM; flux 1.60 mmol/L RBC/h | Mulquiney & Kuchel 1999, PMID 10477269 and PMID 10477270 |
| Mitapivat haemoglobin response rate and endpoint definition | 16/40 (40%) vs 0/40 placebo, ≥1.5 g/dL sustained at ≥2 of weeks 16/20/24 | ACTIVATE, Al-Samkari 2022, PMID 35417638 |
| Time-to-response, and the genotype restriction on response | median 10 d to first >1.0 g/dL (range 7–187); responses only with ≥1 missense variant, correlated with baseline PK-R protein | DRIVE-PK, Grace 2019, PMID 31483964 |
| Transfusion-burden endpoint | ≥33% reduction in 10/27 (37%) | ACTIVATE-T, Glenthøj 2022, PMID 35988546 |
| Splenectomy effect; complication frequencies | median Hb +1.6 g/dL; iron overload 48%, gallstones 45%, post-splenectomy thrombosis 11%, neonatal phototherapy 93%, exchange transfusion 46%; 48% of splenectomies without simultaneous cholecystectomy later need one | PK Deficiency Natural History Study, Grace 2018, PMID 29549173 |
| Iron axis response to mitapivat (direction and magnitude of every analyte) | hepcidin +4770 ng/L, erythroferrone −9835 ng/L, sTfR −56.0 nmol/L, EPO −32.9 IU/L at wk 24; liver iron −2.0 mg Fe/g dw at wk 96 | van Beers 2024, PMID 38330179 |
| Splenic sequestration as distinct from destruction | organ sequestration measured alongside red cell life-span | Nathan 1968, PMID 5634483 |
| Dose-dependent ↑ATP and ↓2,3-BPG in healthy volunteers — the observation the whole "two opposing trunks" structure rests on | glycolytic intermediates shifted consistently with pathway activation at all multiple-dose levels | Yang 2019, PMID 30091852 |
| Genotype–phenotype relation and molecular heterogeneity | missense vs non-missense classification driving the "activatable protein" parameter | Zanella 2007 PMID 17360088; Bianchi 2020 PMID 32043619, PMID 33054047 |
| UGT1A1 co-inheritance multiplying gallstone risk in chronic haemolysis | used to set the UGT activity multiplier (1.0 / 0.7 / 0.3) | del Giudice 1999, PMID 10498597 |
| Statistical structure of red cell survival (age-dependent vs random hazard) | motivates the 14-cohort age axis rather than a single pool | Korell 2011, PMID 20950630 |
| Gene-therapy correction thresholds (fraction of corrected output needed) | sets the GTFRAC values simulated | Garcia-Gomez 2016 PMID 27138040; Navarro 2021 PMID 34514027 |
The single most load-bearing parameter is NOT in this table, and that is worth
saying plainly: the 3-PG inhibition constant of the 2,3-BPG phosphatase
(KIPG3 = 30 µM). It is what makes 2,3-BPG rise 2-fold rather than 9% when
pyruvate kinase activity falls, and the entire oxygen-transport argument scales
with the size of that excursion. It is the least well pinned number in the model.
The break-even table in §3.2 of pkd_reference_output.txt exists so the
conclusion can be re-scored against a different 2,3-BPG estimate without
rebuilding anything.
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