MDGA1

gene
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Also known as GPIMMAMDC3

Summary

MDGA1 (MAM domain containing glycosylphosphatidylinositol anchor 1, HGNC:19267) is a protein-coding gene on chromosome 6p21.2, encoding MAM domain-containing glycosylphosphatidylinositol anchor protein 1 (Q8NFP4). Required for radial migration of cortical neurons in the superficial layer of the neocortex.

This gene encodes a glycosylphosphatidylinositol (GPI)-anchored cell surface glycoprotein that is expressed predominantly in the developing nervous system. In addition to possessing several cell adhesion molecule-like domains, the mature protein has six Ig-like domains, a single fibronectin type III domain, a MAM domain and a C-terminal GPI-anchoring site. Studies in other mammals suggest this protein plays a role in cell adhesion, migration, and axon guidance and, in the developing brain, neuronal migration. In humans, this gene is associated with bipolar disorder and schizophrenia.

Source: NCBI Gene 266727 — RefSeq curated summary.

At a glance

  • GWAS associations: 15
  • Clinical variants (ClinVar): 148 total
  • MANE Select transcript: NM_153487

Identifiers

Gene identifiers

FieldValue
HGNC IDHGNC:19267
Approved symbolMDGA1
NameMAM domain containing glycosylphosphatidylinositol anchor 1
Location6p21.2
Locus typegene with protein product
StatusApproved
AliasesGPIM, MAMDC3
Ensembl geneENSG00000112139
Ensembl biotypeprotein_coding
OMIM609626
Entrez266727

Gene structure

Transcript identifiers

Ensembl transcripts: 14 — 8 protein_coding, 3 nonsense_mediated_decay, 2 retained_intron, 1 protein_coding_CDS_not_defined

ENST00000373401, ENST00000418178, ENST00000434837, ENST00000478143, ENST00000502298, ENST00000505425, ENST00000508399, ENST00000510077, ENST00000515437, ENST00000650466, ENST00000680397, ENST00000681439, ENST00000681472, ENST00000955606

RefSeq mRNA: 1 — MANE Select: NM_153487 NM_153487

CCDS: CCDS47417

Canonical transcript exons

ENST00000434837 — 17 exons

ExonStartEnd
ENSE000007501503763853737638667
ENSE000010276463764717337647324
ENSE000010858623764898237649266
ENSE000010858643765480037654932
ENSE000011923533764619837646375
ENSE000012711443769674537697883
ENSE000012711573765010937650405
ENSE000012711673765570037655896
ENSE000014604773764593337645956
ENSE000020679693763067937637459
ENSE000034905053766396737664106
ENSE000035382233764380937643943
ENSE000035444773765427437654543
ENSE000035776693765824537658419
ENSE000036311483764449737644649
ENSE000036562023765201137652340
ENSE000036776733763820537638313

Expression profiles

Bgee: expression breadth ubiquitous, 223 present calls, max score 98.18.

FANTOM5 (CAGE): breadth broad, TPM avg 2.1757 / max 280.1258, expressed in 673 samples.

FANTOM5 promoters (12 alternative TSS)

Promoter IDTPM avgSamples expressed
734481.1811323
734450.3057117
734460.192173
734490.189477
734500.116639
734400.060610
734470.044414
734380.041013
734440.02169
734420.01073

Top tissues by expression

245 total, by Bgee expression score (0-100, higher = more expressed):

TissueAnatomy IDExpression scoreQuality
cerebellar hemisphereUBERON:000224598.18gold quality
cardiac muscle of right atriumUBERON:000337998.18silver quality
cerebellar cortexUBERON:000212998.08gold quality
right hemisphere of cerebellumUBERON:001489097.73gold quality
left ventricle myocardiumUBERON:000656697.40silver quality
cerebellumUBERON:000203797.11gold quality
kidney epitheliumUBERON:000481995.45silver quality
nasal cavity epitheliumUBERON:000538492.89silver quality
upper arm skinUBERON:000426392.55silver quality
lower esophagus mucosaUBERON:003583490.09gold quality
myocardiumUBERON:000234989.28silver quality
lateral globus pallidusUBERON:000247688.60gold quality
vena cavaUBERON:000408788.57gold quality
epithelial cell of pancreasCL:000008388.42silver quality
lateral nuclear group of thalamusUBERON:000273686.43silver quality
substantia nigra pars compactaUBERON:000196585.84gold quality
substantia nigra pars reticulataUBERON:000196685.65silver quality
subthalamic nucleusUBERON:000190685.34silver quality
cardia of stomachUBERON:000116285.12silver quality
granulocyteCL:000009485.02gold quality
dorsal plus ventral thalamusUBERON:000189784.90silver quality
cerebellar vermisUBERON:000472084.71gold quality
ventral tegmental areaUBERON:000269184.69silver quality
vastus lateralisUBERON:000137984.59silver quality
left ovaryUBERON:000211984.14gold quality
stromal cell of endometriumCL:000225583.19gold quality
pancreatic ductal cellCL:000207983.18silver quality
skeletal muscle tissue of rectus abdominisUBERON:000451183.02silver quality
ponsUBERON:000098882.90gold quality
body of tongueUBERON:001187682.90silver quality

Single-cell (SCXA)

Detected in 1 experiment(s), a significant marker in 0.

ExperimentMarker?Max mean expression
E-ANND-3no4.64

Regulation

Is transcription factor: no

miRNA regulators (miRDB)

176 targeting MDGA1, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):

miRNAMax scoreAvg scoremiRNA target_count
HSA-MIR-8485100.0077.574731
HSA-MIR-6867-5P100.0082.213464
HSA-MIR-9-5P100.0072.282361
HSA-MIR-574-5P100.0066.01989
HSA-MIR-3689D100.0066.141181
HSA-MIR-6851-5P100.0065.631294
HSA-MIR-4692100.0067.322066
HSA-MIR-4283100.0066.422097
HSA-MIR-4533100.0069.482758
HSA-MIR-1277-5P100.0073.955056
HSA-MIR-7110-3P100.0073.182486
HSA-MIR-3120-5P100.0065.56965
HSA-MIR-118499.9968.191458
HSA-MIR-451499.9967.101870
HSA-MIR-520G-5P99.9966.76658
HSA-MIR-150-5P99.9966.691976
HSA-MIR-3605-5P99.9667.12932
HSA-MIR-4725-3P99.9669.532520
HSA-MIR-6780B-5P99.9669.602562
HSA-MIR-211099.9666.681930
HSA-MIR-185-3P99.9567.011743
HSA-MIR-218-5P99.9372.222103
HSA-MIR-6721-5P99.9368.922981
HSA-MIR-130599.9171.433443
HSA-MIR-449399.9066.48977
HSA-MIR-4731-5P99.8967.232537
HSA-MIR-427199.8868.322244
HSA-MIR-449299.8768.253611
HSA-MIR-477999.8666.501583
HSA-MIR-4728-5P99.8569.394718

Literature-anchored findings (GeneRIF, showing 5)

  • A novel human gene mapped to chromosome 6p21, encodes a putative glycosylphosphatidylinositol (GPI) anchored protein containing a MAM (meprin, A5 antigen, protein tyrosine phosphatase mu) domain. (GPIM) (PMID:12082541)
  • MDGA1, a novel glycosylphosphatidylinositol-anchored protein, is localized in lipid rafts. (PMID:15922729)
  • MDGA1 is a new schizophrenia susceptibility gene, and altered neuronal migration is involved in SZ pathology. (PMID:18384059)
  • The MDGA1 gene may confer risk to schizophrenia and bipolar disorder in Chinese Han population. (PMID:21146959)
  • MDGAs regulate the formation of neuroligin-neurexin trans-synaptic bridges by sterically blocking access of neurexins to neuroligins. (PMID:28641112)

Cross-species orthologs

3 orthologs

OrganismSymbolGene ID
danio_reriomdga1ENSDARG00000074376
mus_musculusMdga1ENSMUSG00000043557
rattus_norvegicusMdga1ENSRNOG00000000536

Paralogs (4): MDGA2 (ENSG00000139915), MAMDC2 (ENSG00000165072), MAMDC4 (ENSG00000177943), MALRD1 (ENSG00000204740)

Protein

Protein identifiers

MAM domain-containing glycosylphosphatidylinositol anchor protein 1Q8NFP4 (reviewed: Q8NFP4)

Alternative names: GPI and MAM protein, Glycosylphosphatidylinositol-MAM, MAM domain-containing protein 3

All UniProt accessions (9): Q8NFP4, A0A3B3IU48, A0A7P0T822, A0A7P0TB21, A0A7P0TB62, D6RFG6, D6RHU8, H0Y4Q2, H0YA23

UniProt curated annotations — full annotation on UniProt →

Function. Required for radial migration of cortical neurons in the superficial layer of the neocortex. Plays a role in the formation or maintenance of inhibitory synapses. May function by inhibiting the activity of NLGN2.

Subunit / interactions. Interacts heterophilically through its MAM domain with proteins in axon-rich regions and through its Ig-like domains with proteins in differentiating muscle. Interacts (through the Ig-like domains) with NLGN2.

Subcellular location. Cell membrane.

Tissue specificity. Has been found in brain, heart, skeletal muscle and kidney. Found to be overexpressed in tumor tissues.

Isoforms (2)

UniProt IDNamesCanonical?
Q8NFP4-11yes
Q8NFP4-22

RefSeq proteins (1): NP_705691* (*=MANE)

Domains & families (InterPro)

IDNameType
IPR000998MAM_domDomain
IPR003598Ig_sub2Domain
IPR003599Ig_subDomain
IPR003961FN3_domDomain
IPR007110Ig-like_domDomain
IPR013098Ig_I-setDomain
IPR013320ConA-like_dom_sfHomologous_superfamily
IPR013783Ig-like_foldHomologous_superfamily
IPR036116FN3_sfHomologous_superfamily
IPR036179Ig-like_dom_sfHomologous_superfamily
IPR050958Cell_Adh-Cytoskel_OrgnFamily

Pfam: PF00629, PF07679, PF13927

UniProt features (65 total): strand 26, glycosylation site 11, domain 8, disulfide bond 6, helix 4, sequence variant 2, signal peptide 1, chain 1, region of interest 1, compositionally biased region 1, lipid moiety-binding region 1, propeptide 1, splice variant 1, turn 1

Structure

Experimental structures (PDB)

3 structures.

PDBMethodResolution (Å)
5V5WX-RAY DIFFRACTION2.72
5XEQX-RAY DIFFRACTION3.14
5V5VX-RAY DIFFRACTION4.11

Predicted structure (AlphaFold)

ModelpLDDTFraction very-high
AF-Q8NFP4-F184.890.60

Functional residue map

Curated UniProt residues grouped by drug-discovery relevance — catalytic, ligand-binding, modification, and mutation-validated positions. Source: UniProtKB sequence features.

Post-translational modifications (1): 932

Disulfide bonds (6): 60–108, 157–214, 262–308, 357–415, 463–514, 560–615

Glycosylation sites (11): 42, 90, 235, 247, 257, 307, 331, 432, 655, 747, 826

Function

Pathways and Gene Ontology

Reactome pathways

3 pathways

IDPathway
R-HSA-163125Post-translational modification: synthesis of GPI-anchored proteins
R-HSA-392499Metabolism of proteins
R-HSA-597592Post-translational protein modification

MSigDB gene sets: 187 (showing top): GOBP_SPINAL_CORD_DEVELOPMENT, GCACCTT_MIR18A_MIR18B, GOBP_PHENOL_CONTAINING_COMPOUND_METABOLIC_PROCESS, E2F4DP1_01, GOBP_SYNAPSE_ASSEMBLY, GOCC_CELL_SURFACE, GOBP_NEUROGENESIS, GOBP_REGULATION_OF_CELL_JUNCTION_ASSEMBLY, GOBP_REGULATION_OF_CELLULAR_COMPONENT_BIOGENESIS, GOBP_CELL_DIFFERENTIATION_IN_SPINAL_CORD, GOBP_FOREBRAIN_DEVELOPMENT, NKX61_01, GOBP_FOREBRAIN_CELL_MIGRATION, GOBP_CELL_CELL_ADHESION, GOBP_STARTLE_RESPONSE

GO Biological Process (13): neuron migration (GO:0001764), nervous system development (GO:0007399), brain development (GO:0007420), spinal cord association neuron differentiation (GO:0021527), cerebral cortex radially oriented cell migration (GO:0021799), dopamine metabolic process (GO:0042417), serotonin metabolic process (GO:0042428), prepulse inhibition (GO:0060134), presynapse assembly (GO:0099054), regulation of synaptic membrane adhesion (GO:0099179), inhibitory synapse assembly (GO:1904862), regulation of presynapse assembly (GO:1905606), cell differentiation (GO:0030154)

GO Molecular Function (1): protein binding (GO:0005515)

GO Cellular Component (10): extracellular region (GO:0005576), obsolete extracellular space (GO:0005615), Golgi apparatus (GO:0005794), plasma membrane (GO:0005886), cell surface (GO:0009986), axon (GO:0030424), dendrite (GO:0030425), side of membrane (GO:0098552), GABA-ergic synapse (GO:0098982), membrane (GO:0016020)

Reactome top-level categories

Rollup of top-2 pathways:

CategoryPathways
Post-translational protein modification1
Metabolism of proteins1

GO top-level categories

Rollup of top GO terms by namespace:

CategoryTerms
cellular anatomical structure4
synapse assembly2
membrane2
neuron projection2
cell migration1
generation of neurons1
system development1
central nervous system development1
animal organ development1
head development1
cell differentiation in spinal cord1
dorsal spinal cord development1
central nervous system neuron differentiation1
cerebral cortex cell migration1
catecholamine metabolic process1
phenol-containing compound metabolic process1
indole-containing compound metabolic process1
startle response1
negative regulation of response to external stimulus1
cellular component assembly1
presynapse organization1
regulation of cell-cell adhesion1
regulation of synapse organization1
synaptic membrane adhesion1
regulation of synapse assembly1
presynapse assembly1
regulation of presynapse organization1
cellular developmental process1
binding1
cytoplasm1
endomembrane system1
intracellular membrane-bounded organelle1
cell periphery1
dendritic tree1
leaflet of membrane bilayer1
synapse1

Protein interactions and networks

STRING

1520 interactions, top by confidence (×1000):

Protein AProtein BPartner UniProtScore
MDGA1NLGN2Q8NFZ4848
MDGA1NTNG2Q96CW9594
MDGA1FN1P02751588
MDGA1NRXN1Q9ULB1566
MDGA1NRXN2Q9P2S2562
MDGA1RORBQ92753528
MDGA1KCNIP2Q9NS61491
MDGA1PTPRMP28827480
MDGA1TMEM19Q96HH6456
MDGA1NTN5Q8WTR8441
MDGA1NLGN3Q9NZ94431
MDGA1DLX1P56177429
MDGA1NLGN1Q8N2Q7427
MDGA1EFNA5P52803423
MDGA1TBR1Q16650423

IntAct

3 interactions, top by confidence:

ABTypeScore
MDGA1CDK5psi-mi:“MI:0915”(physical association)0.400
SYNGAP1POTEFpsi-mi:“MI:0914”(association)0.350

BioGRID (3): NLGN2 (Reconstituted Complex), CDK5 (Affinity Capture-MS), MDGA1 (Two-hybrid)

ESM2 similar proteins: A0A140LHF2, A2AJ76, A6H8M9, A8T688, D3YXG0, E7FF10, O60500, P0C0L4, P0C0L5, P21709, P35590, P43121, P50895, P55144, P55146, P59996, P85171, Q00657, Q05695, Q06805, Q06806, Q0PMG2, Q13308, Q3UH53, Q53RD9, Q60750, Q62786, Q7Z5N4, Q8BKG3, Q8HW98, Q8IZJ3, Q8N0Z9, Q8NBP7, Q8NDA2, Q8NFP4, Q8TDY8, Q923P0, Q96MS0, Q96NU0, Q96RW7

Diamond homologs: A2AJA7, O14786, P28824, P85171, P98072, P98073, P98157, Q0PMG2, Q0WYX8, Q63191, Q6UXC1, Q8NFP4, Q8QFX6, Q9QWJ9, A2AJX4, B3EWZ5, B3EWZ6, B3EX02, C0HL13, O75581, O88572, P35953, P60755, P60756, P97435, P98074, Q2PC93, Q5VYJ5, Q7Z553, Q9GMT4, O35375, P28825, P79795, P97333, Q16820, Q61847, Q64230, A2ARV4, O14522, O60462

SIGNOR signaling

0 interactions.

Disease & clinical

Clinical variants and AI predictions

ClinVar

148 variants total. Per-class counts are floors (≥ shown; pagination cap):

ClassificationCount (floor)
Pathogenic0
Likely pathogenic0
Uncertain significance128
Likely benign5
Benign4

Top pathogenic / likely-pathogenic (0)

SpliceAI

3779 predictions. Top by Δscore:

VariantEffectΔscore
6:37644495:AC:Adonor_gain1.0000
6:37644496:CC:Cdonor_gain1.0000
6:37644646:TTGT:Tacceptor_gain1.0000
6:37644647:TGT:Tacceptor_gain1.0000
6:37644653:CATTT:Cacceptor_gain1.0000
6:37644655:T:TCacceptor_gain1.0000
6:37644656:T:Cacceptor_gain1.0000
6:37644656:T:TCacceptor_gain1.0000
6:37644657:T:Cacceptor_gain1.0000
6:37644657:T:TCacceptor_gain1.0000
6:37644659:A:ACacceptor_gain1.0000
6:37644659:A:Cacceptor_gain1.0000
6:37644665:C:CTacceptor_gain1.0000
6:37646196:A:ACdonor_gain1.0000
6:37646197:C:CCdonor_gain1.0000
6:37646197:CG:Cdonor_gain1.0000
6:37646197:CGCT:Cdonor_gain1.0000
6:37646274:G:Cdonor_gain1.0000
6:37646373:CAA:Cacceptor_gain1.0000
6:37646376:C:CCacceptor_gain1.0000
6:37647168:CCCA:Cdonor_loss1.0000
6:37647169:CCA:Cdonor_loss1.0000
6:37647172:C:CTdonor_loss1.0000
6:37647273:C:CCacceptor_gain1.0000
6:37649791:T:TAdonor_gain1.0000
6:37650107:A:ACdonor_gain1.0000
6:37650108:C:CCdonor_gain1.0000
6:37650108:CA:Cdonor_gain1.0000
6:37650108:CACTG:Cdonor_gain1.0000
6:37650426:A:Tacceptor_gain1.0000

AlphaMissense

6193 scored. Top likely-pathogenic:

VariantProtein changeam_pathogenicity
6:37638579:C:AW875C1.000
6:37638579:C:GW875C1.000
6:37638661:A:GL848P1.000
6:37643879:A:CS822R1.000
6:37643879:A:TS822R1.000
6:37643881:T:GS822R1.000
6:37644579:C:AW773C1.000
6:37644579:C:GW773C1.000
6:37644581:A:GW773R1.000
6:37644581:A:TW773R1.000
6:37647235:A:GW662R1.000
6:37647235:A:TW662R1.000
6:37650184:A:CY512D1.000
6:37650293:C:AW475C1.000
6:37650293:C:GW475C1.000
6:37650295:A:GW475R1.000
6:37650295:A:TW475R1.000
6:37652086:A:CY413D1.000
6:37652210:C:AW371C1.000
6:37652210:C:GW371C1.000
6:37652212:A:GW371R1.000
6:37652212:A:TW371R1.000
6:37654433:A:GW275R1.000
6:37654433:A:TW275R1.000
6:37654870:G:CC214W1.000
6:37654872:A:GC214R1.000
6:37654916:A:GL199P1.000
6:37655772:C:AW169C1.000
6:37655772:C:GW169C1.000
6:37655773:C:GW169S1.000

dbSNP variants (sampled 300 via entrez): RS1000009917 (6:37686639 C>T), RS1000022709 (6:37652774 C>G), RS1000038336 (6:37679748 C>T), RS1000071712 (6:37685537 C>A), RS1000182780 (6:37638445 C>G,T), RS1000189680 (6:37686910 G>C), RS1000198263 (6:37670548 A>G), RS1000207858 (6:37675038 C>G), RS1000265858 (6:37675306 A>G), RS1000280273 (6:37657659 C>G,T), RS1000346277 (6:37697057 G>C,T), RS1000364687 (6:37645539 A>AG), RS1000437087 (6:37657917 C>A,T), RS1000471107 (6:37685580 C>T), RS1000486078 (6:37639841 A>G)

Disease associations

OMIM: gene MIM:609626 | disease phenotypes:

GenCC curated gene-disease

Mondo (2): acute megakaryoblastic leukemia (MONDO:0018872), mediastinal germ cell tumor (MONDO:0021067)

Orphanet (1): Acute megakaryoblastic leukemia (Orphanet:518)

HPO phenotypes

0 total (0 of 0 shown, HPO-id order):

GWAS associations

15 associations (top):

StudyTraitp-value
GCST002481_11Acne (severe)2.000000e-06
GCST003560_5Coronary artery aneurysm in Kawasaki disease4.000000e-07
GCST005042_8Restless legs syndrome3.000000e-26
GCST007387_49Insomnia symptoms (never/rarely vs. sometimes/usually)8.000000e-07
GCST007388_38Insomnia symptoms (never/rarely vs. usually)3.000000e-08
GCST007576_100Chronotype2.000000e-09
GCST008478_23Neurological blood protein biomarker levels6.000000e-19
GCST008478_24Neurological blood protein biomarker levels7.000000e-91
GCST008478_25Neurological blood protein biomarker levels9.000000e-14
GCST008478_26Neurological blood protein biomarker levels3.000000e-12
GCST008478_27Neurological blood protein biomarker levels5.000000e-11
GCST008478_50Neurological blood protein biomarker levels1.000000e-11
GCST008478_62Neurological blood protein biomarker levels1.000000e-69
GCST010133_10Lamb consumption2.000000e-08
GCST011494_28Daytime nap1.000000e-18

EFO canonical traits (4, from GWAS)

EFO IDTrait name
EFO:0007876insomnia measurement
EFO:0008328chronotype measurement
EFO:0008111diet measurement
EFO:0007828daytime rest measurement

MeSH disease descriptors (1)

DescriptorNameTree numbers
D007947Leukemia, Megakaryoblastic, AcuteC04.557.337.539.275.450; C15.378.508.539.275.450

Drugs & pharmacology

Drug and pharmacology data

Is drug target: no

PharmGKB: 1 entry (VIP=true, CPIC=false)

CTD chemical–gene interactions

37 total (human), top 30 by PubMed support.

ChemicalActions (top 5)PubMed papers
bisphenol Aaffects cotreatment, decreases methylation, increases expression2
sodium arsenitedecreases expression, increases expression2
Acetaminophendecreases expression, increases expression2
Benzo(a)pyreneaffects methylation, decreases methylation2
Valproic Acidaffects cotreatment, increases expression2
Aflatoxin B1decreases methylation2
aristolochic acid Iincreases expression1
afuresertibincreases expression1
Esketamineincreases expression1
sotorasibincreases expression, affects cotreatment1
beta-lapachoneincreases expression1
mono-(2-ethylhexyl)phthalatedecreases expression1
butyraldehydedecreases expression1
aflatoxin B2decreases methylation1
perfluorooctane sulfonic aciddecreases expression1
CGP 52608increases reaction, affects binding1
4-(5-benzo(1,3)dioxol-5-yl-4-pyridin-2-yl-1H-imidazol-2-yl)benzamideaffects cotreatment, increases expression1
abrinedecreases expression1
dorsomorphinincreases expression, affects cotreatment1
licochalcone Bincreases expression1
trametinibaffects cotreatment, increases expression1
NVP-BKM120affects cotreatment, increases expression1
Dasatinibincreases expression1
Sunitinibdecreases expression1
Fulvestrantaffects cotreatment, decreases methylation1
Dichlorodiphenyl Dichloroethylenedecreases expression1
Dexamethasoneaffects cotreatment, increases expression1
Diethylhexyl Phthalatedecreases expression1
Doxorubicinincreases expression1
Estradiolaffects cotreatment, increases expression1

Clinical trials (associated diseases)

4 trials via MONDO — disease-level, not drug-specific.

TrialPhaseStatusTitle
NCT04083170PHASE2TERMINATEDCord Blood Transplant With Dilanubicel for the Treatment of HIV Positive Hematologic Cancers
NCT00392353PHASE1/PHASE2ACTIVE_NOT_RECRUITINGVorinostat and Azacitidine in Treating Patients With Myelodysplastic Syndromes or Acute Myeloid Leukemia
NCT01823198PHASE1/PHASE2COMPLETEDDonor Natural Killer Cells and Donor Stem Cell Transplant in Treating Patients With High Risk Myeloid Malignancies
NCT02530619Not specifiedUNKNOWNAlisertib in Treating Patients With Myelofibrosis or Relapsed or Refractory Acute Megakaryoblastic Leukemia