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van Gucht ALM, Moran C, Meima ME, Visser WE, Chatterjee K, Visser TJ, Peeters RP. Resistance to Thyroid Hormone due to Heterozygous Mutations in Thyroid Hormone Receptor Alpha. Curr Top Dev Biol 2017; 125:337-355. [PMID: 28527577 DOI: 10.1016/bs.ctdb.2017.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Thyroid hormone (TH) acts via nuclear thyroid hormone receptors (TRs). TR isoforms (TRα1, TRα2, TRβ1, TRβ2) are encoded by distinct genes (THRA and THRB) and show differing tissue distributions. Patients with mutations in THRB, exhibiting resistance within the hypothalamic-pituitary-thyroid axis with elevated TH and nonsuppressed thyroid-stimulating hormone (TSH) levels, were first described decades ago. In 2012, the first patients with mutations in THRA were identified. Scope of this review: This review describes the clinical and biochemical characteristics of patients with resistance to thyroid hormone alpha (RTHα) due to heterozygous mutations in THRA. The genetic basis and molecular pathogenesis of the disorder together with effects of levothyroxine treatment are discussed. CONCLUSIONS The severity of the clinical phenotype of RTHα patients seems to be associated with the location and type of mutation in THRA. The most frequent abnormalities observed include anemia, constipation, and growth and developmental delay. In addition, serum (F)T3 levels can be high-normal to high, (F)T4 and rT3 levels normal to low, while TSH is normal or mildly raised. Despite heterogeneous consequences of mutations in THRA, RTHα should be suspected in subjects with even mild clinical features of hypothyroidism together with high/high-normal (F)T3, low/low-normal (F)T4, and normal TSH.
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Affiliation(s)
| | - Carla Moran
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Marcel E Meima
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - W Edward Visser
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Krishna Chatterjee
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Theo J Visser
- Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Robin P Peeters
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
Thyroid hormones (TH) are endocrine messengers essential for normal development and function of virtually every vertebrate. The hypothalamic-pituitary-thyroid axis is exquisitely modulated to maintain nearly constant TH (T4 and T3) levels in circulation. However peripheral tissues and the CNS control the intracellular availability of TH, suggesting that circulating concentrations of TH are not fully representative of what each cell type sees. Indeed, recent work in the field has identified that TH transporters, deiodinases and thyroid hormone receptor coregulators can strongly control tissue-specific sensitivity to a set amount of TH. Furthermore, the mechanism by which the thyroid hormone receptors regulate target gene expression can vary by gene, tissue and cellular context. This review will highlight novel insights into the machinery that controls the cellular response to TH, which include unique signaling cascades. These findings shed new light into the pathophysiology of human diseases caused by abnormal TH signaling.
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Affiliation(s)
- Arturo Mendoza
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anthony N Hollenberg
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Marelli F, Carra S, Rurale G, Cotelli F, Persani L. In vivo Functional Consequences of Human THRA Variants Expressed in the Zebrafish. Thyroid 2017; 27:279-291. [PMID: 27809680 DOI: 10.1089/thy.2016.0373] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Heterozygous mutations in the thyroid hormone receptor alpha (THRA) gene cause resistance to thyroid hormone alpha (RTHα), a disease characterized by variable manifestations reminiscent of untreated congenital hypothyroidism but a raised triiodothyronine/thyroxine ratio and normal thyrotropin levels. It was recently described that zebrafish embryos expressing a dominant negative (DN) form of thraa recapitulate the key features of RTHα, and that zebrafish and human receptors are functionally interchangeable. METHODS This study expressed several human thyroid hormone receptor alpha (hTRα) variants in zebrafish embryos and analyzed the resulting phenotypes. RESULTS All hTRα-injected embryos showed variable defects, including cerebral and cardiac edema likely caused by an aberrant looping during heart development, anemia, and an incomplete formation of the vascular network. Moreover, the hTRα-injected embryos presented severe defects of motorneurons and craniofacial development, thus affecting their autonomous feeding and swimming behaviors. Surprisingly, expression of all hTRα mutants had no detectable effect on thyrotropin beta and thyrotropin-releasing hormone transcripts, indicating that their DN action is limited on the thyroid hormone reception beta 2 targets at the hypothalamic/pituitary level in vivo. As previously described in vitro, treatment with high triiodothyronine doses can efficiently revert the observed defects only in embryos injected with missense hTRα variants. CONCLUSION Injection of human THRA variants in zebrafish embryos causes tissue-specific defects recapitulating most of the RTHα clinical and biochemical manifestations. The described manipulation of zebrafish embryos represents a novel in vivo model to screen the functional consequences of THRA variants and the rescue potential of new therapeutic compounds.
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Affiliation(s)
- Federica Marelli
- 1 Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Carra
- 2 Dipartimento di Bioscienze, Università degli Studi di Milano , Milan, Italy
| | - Giuditta Rurale
- 3 Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano , Milan, Italy
| | - Franco Cotelli
- 2 Dipartimento di Bioscienze, Università degli Studi di Milano , Milan, Italy
| | - Luca Persani
- 1 Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Istituto Auxologico Italiano , Milan, Italy
- 3 Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano , Milan, Italy
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Santiago LA, Faustino LC, Pereira GF, Imperio GE, Pazos-Moura CC, Wondisford FE, Bloise FF, Ortiga-Carvalho TM. Gene expression of T3-regulated genes in a mouse model of the human thyroid hormone resistance. Life Sci 2017; 170:93-99. [PMID: 27919825 DOI: 10.1016/j.lfs.2016.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/16/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022]
Abstract
AIMS To understand how thyroid hormone (TH) regulates tissue-specific gene expression in patients with the syndrome of resistance to TH (RTHβ), we used a mouse model that replicates the human RTHβ, specifically the ∆337T mutation in the thyroid hormone receptor β (THRβ). MAIN METHODS We investigated the expression of key TH target genes in the pituitary and liver of TRβ∆337T and wild type THRβ mice by qPCR before and after a T3 suppression test consisting of the administration of increasing concentrations of T3 to hypothyroid mice. KEY FINDINGS Pituitary Tshb and Cga expression decreased and Gh expression increased in TRβ∆337T mice after T3 suppression. The stimulation of positively regulated TH genes was heterogeneous in the liver. Levels of liver Me1 and Thsrp were elevated in TRβ∆337T mice after T3 administration. Slc16a2 and Gpd2 did not respond to T3 stimulation in the liver of TRβ∆337T mice whereas Dio1 response was lower than that observed in WT mice. Moreover, although Chdh and Upd1 genes were negatively regulated in the liver, the expression of these genes was elevated after T3 suppression. We did not observe significant changes in THRα expression in the liver and pituitary, while THRβ levels were diminished in the pituitary and increased in the liver. SIGNIFICANCE Using a model expressing a THRβ unable to bind T3, we showed the expression pattern of liver negative and positive regulated genes by T3.
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Affiliation(s)
- L A Santiago
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - L C Faustino
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - G F Pereira
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - G E Imperio
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - C C Pazos-Moura
- Laboratório de Endocrinologia Molecular, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - F E Wondisford
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - F F Bloise
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - T M Ortiga-Carvalho
- Laboratório de Endocrinologia Translacional, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Demir K, van Gucht ALM, Büyükinan M, Çatlı G, Ayhan Y, Baş VN, Dündar B, Özkan B, Meima ME, Visser WE, Peeters RP, Visser TJ. Diverse Genotypes and Phenotypes of Three Novel Thyroid Hormone Receptor-α Mutations. J Clin Endocrinol Metab 2016; 101:2945-54. [PMID: 27144938 DOI: 10.1210/jc.2016-1404] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Recently several patients with resistance to thyroid hormone (RTH)-α due to T3 receptor-α (TRα) mutations were identified. The phenotype of these patients consists of varying degrees of growth impairment, delayed bone, mental and motor development, constipation, macrocephaly, and near-normal thyroid function tests. OBJECTIVE The objective of the study was to describe the clinical phenotype of three new families with RTHα and thereby gain more detailed knowledge on this novel syndrome. DESIGN, SETTING, AND PARTICIPANTS RTHα was suspected in three index patients from different families. Detailed clinical and biochemical assessment and imaging and genetic analyses were performed in the patients and their relatives. In addition, functional consequences of TRα mutations were investigated in vitro. RESULTS We studied 22 individuals from three families and identified 10 patients with heterozygous TRα mutations: C380fs387X, R384H, and A263S, respectively. The frame-shift mutation completely inactivated TRα, whereas the missense mutations produced milder defects. These mutations were associated with decreasing severity of the clinical phenotype: the patient in family 1 showed severe defects in growth, mental, and motor development, whereas the seven patients in family 3 had only mild clinical features. The most frequent abnormalities were anemia, constipation, and a delay in at least one of the developmental milestones. Serum free T3 ranged from high-normal to high and serum free T4 and rT3 from normal to low. TSH levels were normal in all patients. CONCLUSIONS This large case series underlines the variation in the clinical phenotype of RTHα patients. RTHα should be suspected in subjects when even mild clinical and laboratory features of hypothyroidism are present along with high/high-normal free T3, low/normal free T4, and normal TSH.
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Affiliation(s)
- Korcan Demir
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Anja L M van Gucht
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Muammer Büyükinan
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Gönül Çatlı
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Yavuz Ayhan
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Veysel Nijat Baş
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Bumin Dündar
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Marcel E Meima
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - W Edward Visser
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Robin P Peeters
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
| | - Theo J Visser
- Division of Pediatric Endocrinology (K.D.), Faculty of Medicine, Dokuz Eylül University, 35340, Balcova, Izmir, Turkey; Division of Pediatric Endocrinology (B.Ö.), Dr Behçet Uz Children's Hospital, 35210 İzmir, Turkey; Department of Internal Medicine (A.L.M.v.G., M.E.M., W.E.V., R.P.P., T.J.V.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Division of Pediatric Endocrinology (M.B., G.Ç.), Tepecik Education and Research Hospital, 35170, İzmir, Turkey; Department of Psychiatry (Y.A.), Hacettepe University, 06532 Ankara, Turkey; Division of Pediatric Endocrinology (V.N.B.), Eskisehir State Hospital, 26060, Eskisehir, Turkey; and Division of Pediatric Endocrinology (G.Ç., B.D.), Katip Çelebi University, 35620 İzmir, Turkey
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Moran C, Chatterjee K. Resistance to Thyroid Hormone α-Emerging Definition of a Disorder of Thyroid Hormone Action. J Clin Endocrinol Metab 2016; 101:2636-9. [PMID: 27381958 DOI: 10.1210/jc.2016-2317] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Carla Moran
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research Council, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Krishna Chatterjee
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research Council, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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Ortiga-Carvalho TM, Chiamolera MI, Pazos-Moura CC, Wondisford FE. Hypothalamus-Pituitary-Thyroid Axis. Compr Physiol 2016; 6:1387-428. [PMID: 27347897 DOI: 10.1002/cphy.c150027] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The hypothalamus-pituitary-thyroid (HPT) axis determines the set point of thyroid hormone (TH) production. Hypothalamic thyrotropin-releasing hormone (TRH) stimulates the synthesis and secretion of pituitary thyrotropin (thyroid-stimulating hormone, TSH), which acts at the thyroid to stimulate all steps of TH biosynthesis and secretion. The THs thyroxine (T4) and triiodothyronine (T3) control the secretion of TRH and TSH by negative feedback to maintain physiological levels of the main hormones of the HPT axis. Reduction of circulating TH levels due to primary thyroid failure results in increased TRH and TSH production, whereas the opposite occurs when circulating THs are in excess. Other neural, humoral, and local factors modulate the HPT axis and, in specific situations, determine alterations in the physiological function of the axis. The roles of THs are vital to nervous system development, linear growth, energetic metabolism, and thermogenesis. THs also regulate the hepatic metabolism of nutrients, fluid balance and the cardiovascular system. In cells, TH actions are mediated mainly by nuclear TH receptors (210), which modify gene expression. T3 is the preferred ligand of THR, whereas T4, the serum concentration of which is 100-fold higher than that of T3, undergoes extra-thyroidal conversion to T3. This conversion is catalyzed by 5'-deiodinases (D1 and D2), which are TH-activating enzymes. T4 can also be inactivated by conversion to reverse T3, which has very low affinity for THR, by 5-deiodinase (D3). The regulation of deiodinases, particularly D2, and TH transporters at the cell membrane control T3 availability, which is fundamental for TH action. © 2016 American Physiological Society. Compr Physiol 6:1387-1428, 2016.
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Affiliation(s)
- Tania M Ortiga-Carvalho
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Maria I Chiamolera
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carmen C Pazos-Moura
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
| | - Fredic E Wondisford
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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58
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Amlashi FG, Tritos NA. Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine 2016; 52:427-40. [PMID: 26792794 DOI: 10.1007/s12020-016-0863-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/09/2016] [Indexed: 01/10/2023]
Abstract
Inappropriate secretion of TSH was first described in 1960 in a patient with evidence of hyperthyroidism and expanded sella on imaging. It was later found that a type of pituitary adenoma that secretes TSH (thyrotropinoma) was the underlying cause. The objective of the present review article is to summarize data on the epidemiology, pathogenesis, diagnosis, and management of thyrotropinomas. The prevalence of thyrotropinomas is lower than that of other pituitary adenomas. Early diagnosis is now possible thanks to the availability of magnetic resonance imaging and sensitive laboratory assays. As a corollary, many patients now present earlier in the course of their disease and have smaller tumors at the time of diagnosis. Treatment also has evolved over time. Transsphenoidal surgery is still considered definitive therapy. Meanwhile, radiation therapy, including radiosurgery, is effective in achieving tumor control in the majority of patients. In the past, radiation therapy was used as second line treatment in patients with residual or recurrent tumor after surgery. However, the availability of somatostatin analogs, which can lead to normalization of thyroid function as well as shrink these tumors, has led to an increase in the role of medical therapy in patients who are not in remission after pituitary surgery. In addition, dopamine agonists have shown some efficacy in the management of these tumors. Better understanding of the molecular pathogenesis of thyrotropinomas may lead to rationally designed therapies for patients with thyrotropinomas.
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Affiliation(s)
- Fatemeh G Amlashi
- Neuroendocrine Unit, Massachusetts General Hospital, Zero Emerson Place # 112, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Zero Emerson Place # 112, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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Tang Y, Yu M, Lian X. Resistance to thyroid hormone α, revelation of basic study to clinical consequences. J Pediatr Endocrinol Metab 2016; 29:511-22. [PMID: 26812777 DOI: 10.1515/jpem-2015-0286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022]
Abstract
In the past 3 years, 15 patients with resistance to thyroid hormone α (RTHα), nine THRA gene mutations have been reported, reforming classification of RTH. RTHα exhibits distinguished clinical manifestations from RTHβ, including growth retardation, skeletal dysplasia, impaired neurodevelopment, cardiovascular dysfunction, constipation and specific thyroid axis type. This review focuses on possible pathogenesis by revelatory basic science of RTHα animal models in vivo, and patients' mutant thyroid hormone receptor α (TRα) in vitro. Clinical manifestations and L-T4 effects are summarized, showing strong correlation to the severity of mutation mostly within the domain which dominated TR interaction with T3 and its corepressors/coactivators. In particular, we propose the diagnosis clues and promising treatment for clinicians.
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Astapova I. Role of co-regulators in metabolic and transcriptional actions of thyroid hormone. J Mol Endocrinol 2016; 56:73-97. [PMID: 26673411 DOI: 10.1530/jme-15-0246] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 12/18/2022]
Abstract
Thyroid hormone (TH) controls a wide range of physiological processes through TH receptor (TR) isoforms. Classically, TRs are proposed to function as tri-iodothyronine (T3)-dependent transcription factors: on positively regulated target genes, unliganded TRs mediate transcriptional repression through recruitment of co-repressor complexes, while T3 binding leads to dismissal of co-repressors and recruitment of co-activators to activate transcription. Co-repressors and co-activators were proposed to play opposite roles in the regulation of negative T3 target genes and hypothalamic-pituitary-thyroid axis, but exact mechanisms of the negative regulation by TH have remained elusive. Important insights into the roles of co-repressors and co-activators in different physiological processes have been obtained using animal models with disrupted co-regulator function. At the same time, recent studies interrogating genome-wide TR binding have generated compelling new data regarding effects of T3, local chromatin structure, and specific response element configuration on TR recruitment and function leading to the proposal of new models of transcriptional regulation by TRs. This review discusses data obtained in various mouse models with manipulated function of nuclear receptor co-repressor (NCoR or NCOR1) and silencing mediator of retinoic acid receptor and thyroid hormone receptor (SMRT or NCOR2), and family of steroid receptor co-activators (SRCs also known as NCOAs) in the context of TH action, as well as insights into the function of co-regulators that may emerge from the genome-wide TR recruitment analysis.
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Affiliation(s)
- Inna Astapova
- Division of Endocrinology, Diabetes and MetabolismBeth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Joustra SD, Heinen CA, Schoenmakers N, Bonomi M, Ballieux BEPB, Turgeon MO, Bernard DJ, Fliers E, van Trotsenburg ASP, Losekoot M, Persani L, Wit JM, Biermasz NR, Pereira AM, Oostdijk W. IGSF1 Deficiency: Lessons From an Extensive Case Series and Recommendations for Clinical Management. J Clin Endocrinol Metab 2016; 101:1627-36. [PMID: 26840047 PMCID: PMC4880178 DOI: 10.1210/jc.2015-3880] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Mutations in the immunoglobulin superfamily, member 1 (IGSF1) gene cause the X-linked IGSF1 deficiency syndrome consisting of central hypothyroidism, delayed pubertal testosterone rise, adult macroorchidism, variable prolactin deficiency, and occasionally transient partial GH deficiency. Since our first reports, we discovered 20 new families with 18 new pathogenic IGSF1 mutations. OBJECTIVE We aimed to share data on the largest cohort of patients with IGSF1 deficiency to date and formulate recommendations for clinical management. METHODS We collected clinical and biochemical characteristics of 69 male patients (35 children, 34 adults) and 56 female IGSF1 mutation carriers (three children, 53 adults) from 30 unrelated families according to a standardized clinical protocol. At evaluation, boys were treated with levothyroxine in 89%, adult males in 44%, and females in 5% of cases. RESULTS Additional symptoms in male patients included small thyroid gland volume (74%), high birth weight (25%), and large head circumference (20%). In general, the timing of pubertal testicular growth was normal or even premature, in contrast to a late rise in T levels. Late adrenarche was observed in patients with prolactin deficiency, and adult dehydroepiandrosterone concentrations were decreased in 40%. Hypocortisolism was observed in 6 of 28 evaluated newborns, although cortisol concentrations were normal later. Waist circumference of male patients was increased in 60%, but blood lipids were normal. Female carriers showed low free T4 (FT4) and low-normal FT4 in 18% and 60%, respectively, delayed age at menarche in 31%, mild prolactin deficiency in 22%, increased waist circumference in 57%, and a negative correlation between FT4 concentrations and metabolic parameters. CONCLUSION IGSF1 deficiency represents the most common genetic cause of central hypothyroidism and is associated with multiple other characteristics. Based on these results, we provide recommendations for mutational analysis, endocrine work-up, and long-term care.
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Affiliation(s)
- S D Joustra
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - C A Heinen
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - N Schoenmakers
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - M Bonomi
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - B E P B Ballieux
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - M-O Turgeon
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - D J Bernard
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - E Fliers
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - A S P van Trotsenburg
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - M Losekoot
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - L Persani
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - J M Wit
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - N R Biermasz
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - A M Pereira
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
| | - W Oostdijk
- Department of Pediatrics (S.D.J., J.M.W., W.O.), Department of Medicine (S.D.J., N.R.B., A.M.P.), Division of Endocrinology, Department of Clinical Chemistry and Laboratory Medicine (B.E.P.B.), and Department of Clinical Genetics (M.L.), Leiden University Medical Center, 2300 C Leiden, The Netherlands; Department of Pediatric Endocrinology (C.A.H., A.S.P.v.T.), Emma Children's Hospital, and Department of Endocrinology and Metabolism (C.A.H., E.F.), Academic Medical Center, University of Amsterdam, 1100 DE, The Netherlands; University of Cambridge Metabolic Research Laboratories (N.S.), Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge DB2 2OO, United Kingdom; Division of Endocrine and Metabolic Disorders (M.B.), Instituto di Ricovero e Cura a Carettere Scientifico, Instituto Auxologica Italiano, 20132 Milan, Italy; Department of Clinical Sciences and Community Health (M.B., L.P.), Università degli Studi di Milano, 20122 Milan, Italy; Department of Pharmacology and Therapeutics (M.-O.T., D.J.B.), McGill University, Montréal, Québec, Canada H9X 3V9
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Abstract
The skeleton is an exquisitely sensitive and archetypal T3-target tissue that demonstrates the critical role for thyroid hormones during development, linear growth, and adult bone turnover and maintenance. Thyrotoxicosis is an established cause of secondary osteoporosis, and abnormal thyroid hormone signaling has recently been identified as a novel risk factor for osteoarthritis. Skeletal phenotypes in genetically modified mice have faithfully reproduced genetic disorders in humans, revealing the complex physiological relationship between centrally regulated thyroid status and the peripheral actions of thyroid hormones. Studies in mutant mice also established the paradigm that T3 exerts anabolic actions during growth and catabolic effects on adult bone. Thus, the skeleton represents an ideal physiological system in which to characterize thyroid hormone transport, metabolism, and action during development and adulthood and in response to injury. Future analysis of T3 action in individual skeletal cell lineages will provide new insights into cell-specific molecular mechanisms and may ultimately identify novel therapeutic targets for chronic degenerative diseases such as osteoporosis and osteoarthritis. This review provides a comprehensive analysis of the current state of the art.
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Affiliation(s)
- J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
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Marelli F, Carra S, Agostini M, Cotelli F, Peeters R, Chatterjee K, Persani L. Patterns of thyroid hormone receptor expression in zebrafish and generation of a novel model of resistance to thyroid hormone action. Mol Cell Endocrinol 2016; 424:102-17. [PMID: 26802880 DOI: 10.1016/j.mce.2016.01.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 11/15/2022]
Abstract
Resistance to thyroid hormone can be due to heterozygous, dominant negative (DN) THRA (RTHα) or THRB (RTHβ) mutations, but the underlying mechanisms are incompletely understood. Here, we delineate the spatiotemporal expression of TH receptors (TRs) in zebrafish and generated morphants expressing equivalent amounts of wild-type and DN TRαs (thraa_MOs) and TRβs (thrb_MOs) in vivo. Both morphants show severe developmental abnormalities. The phenotype of thraa_MOs includes brain and cardiac defects, but normal thyroid volume and tshba expression. A combined modification of dio2 and dio3 expression can explain the high T3/T4 ratio seen in thraa_MOs, as in RTHα. Thrb_MOs show abnormal eyes and otoliths, with a typical RTHβ pattern of thyroid axis. The coexpression of wild-type, but not mutant, human TRs can rescue the phenotype in both morphants. High T3 doses can partially revert the dominant negative action of mutant TRs in morphant fish. Therefore, our morphants recapitulate the RTHα and RTHβ key manifestations representing new models in which the functional consequences of human TR mutations can be rapidly and faithfully evaluated.
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Affiliation(s)
- Federica Marelli
- Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Silvia Carra
- Dipartimento di Bioscienze, Università degli Studi di Milano, 20133 Milano, Italy
| | - Maura Agostini
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Franco Cotelli
- Dipartimento di Bioscienze, Università degli Studi di Milano, 20133 Milano, Italy
| | | | - Krishna Chatterjee
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Luca Persani
- Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Istituto Auxologico Italiano, 20149 Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy.
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64
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van Gucht ALM, Meima ME, Zwaveling-Soonawala N, Visser WE, Fliers E, Wennink JMB, Henny C, Visser TJ, Peeters RP, van Trotsenburg ASP. Resistance to Thyroid Hormone Alpha in an 18-Month-Old Girl: Clinical, Therapeutic, and Molecular Characteristics. Thyroid 2016; 26:338-46. [PMID: 26782358 DOI: 10.1089/thy.2015.0463] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recently, the first patients with resistance to thyroid hormone alpha (RTHα) due to inactivating mutations in the thyroid hormone receptor alpha (TRα) were identified. These patients are characterized by growth retardation, variable motor and cognitive defects, macrocephaly, and abnormal thyroid function tests. The objective was to characterize a young girl (18 months old) with a mutation in both TRα1 and TRα2, and to study the effects of early levothyroxine (LT4) treatment. METHODS The patient was assessed clinically and biochemically before and during 12 months of LT4 treatment. In addition, the consequences of the mutation for TRα1/2 receptor function were studied in vitro. RESULTS At 18 months of age, the patient presented with axial hypotonia, delayed motor development, severe growth retardation, and abnormally elevated triiodothyronine (T3)/thyroxine (T4) ratios. RTHα was suspected, and concomitantly a c.632A>G/p.D211G missense mutation was identified, affecting both the TRα1 and TRα2 proteins. This mutation was also found in the girl's father. LT4 treatment was started, resulting in a marked improvement of her hypotonia, motor skills, and growth. Functionally, the missense mutation led to decreased transcriptional activity of TRα1, which could be overcome by higher T3 levels in vitro. The mutant TRα1 showed a moderate dominant negative activity on wild type (WT) TRα1. In contrast, WT TRα2 and mutant TRα2 had negligible transcriptional activity and showed no dominant-negative effect over TRα1. CONCLUSIONS This report describes the phenotype of a young RTHα patient with a mild TRα mutation before and during early LT4 treatment. Treatment had beneficial effects on her muscle tone, motor development, and growth.
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Affiliation(s)
- Anja L M van Gucht
- 1 Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
- 2 Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Marcel E Meima
- 1 Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
- 2 Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- 3 Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
| | - W Edward Visser
- 1 Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
- 2 Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Eric Fliers
- 4 Department of Endocrinology and Metabolism, Amsterdam University Medical Center , Amsterdam, The Netherlands
| | - Johanna M B Wennink
- 5 Department of Pediatrics, St. Lucas Andreas Hospital , Amsterdam, The Netherlands
| | - Civile Henny
- 6 Practice of Pediatric Physiotherapy, Sport Medical Center , Amsterdam, The Netherlands
| | - Theo J Visser
- 1 Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
- 2 Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Robin P Peeters
- 1 Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
- 2 Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - A S Paul van Trotsenburg
- 3 Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
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Han R, Ye L, Jiang X, Zhou X, Billon C, Guan W, Gauthier K, Fang W, Wang W, Samarut J, Ning G. Characteristics of patients with late manifestation of resistance thyroid hormone syndrome: a single-center experience. Endocrine 2015; 50:689-97. [PMID: 26041374 DOI: 10.1007/s12020-015-0622-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
Resistance to thyroid hormone (RTH) is a rare genetic disease caused by reduced tissue sensitivity to thyroid hormone. The hallmark of RTH is elevated serum levels of thyroid hormone with unsuppressed thyrotropin (TSH). However, the most common form of RTH results from minor defects in the ligand-binding domain or hinge domain of the TRβ gene, resulting in impaired T3-induced transcriptional activity, often showing mild presentation. Early diagnosis can be challenging. The objective of the current study was to characterize this specific group of RTH patients. This was a retrospective study. Patients diagnosed as RTH with TRβ mutations were enrolled in a single institute between 2004 and 2014. A total of 14 patients were diagnosed as RTH with mutation in THβ gene. The median age at diagnosis was 22.5 (IQR: 13.25-32.75). Goiter was the most common clinical finding. TSH was significantly elevated after TRH injection (median peak was 21.83 μIU/l, IQR: 13.59-31.48), 9.2-fold compared to the basal level. We found 10 mutations in TRβ gene, all located in the last four exons, and including one novel mutation, H271D. In vitro study found that H271D mutation reduced TR affinity to T3. Four patients with intact thyroid were diagnosed after 16 years old, defined as late manifestation. Compared to those diagnosed before 10 years old, patients with late manifestation presented with normal growth and mental development. Interestingly, three of them carried R438H mutation. We identified a novel p.H271D mutation in TRβ associated with RTH. Endocrinologists should be alert that RTH is frequently found in euthyroid patients with mild symptoms and often leads to misleading diagnosis as well as inappropriate treatment.
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Affiliation(s)
- Rulai Han
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lei Ye
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
- Shanghai Key Laboratory for Endocrine Tumors and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China.
| | - Xiaohua Jiang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiaoyi Zhou
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Cyrielle Billon
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon, Université Lyon 1, CNRS, INRA, Ecole Normale Supérieure de Lyon, 46 allée d'Italie, 69364, Lyon Cedex 07, France
| | - Wenyue Guan
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon, Université Lyon 1, CNRS, INRA, Ecole Normale Supérieure de Lyon, 46 allée d'Italie, 69364, Lyon Cedex 07, France
| | - Karine Gauthier
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon, Université Lyon 1, CNRS, INRA, Ecole Normale Supérieure de Lyon, 46 allée d'Italie, 69364, Lyon Cedex 07, France
| | - Weiyuan Fang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Weiqing Wang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jacques Samarut
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon, Université Lyon 1, CNRS, INRA, Ecole Normale Supérieure de Lyon, 46 allée d'Italie, 69364, Lyon Cedex 07, France
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200025, People's Republic of China
- Laboratory for Endocrine & Metabolic Diseases of Institute of Health Science, Shanghai Jiaotong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 227 South Chong Qing Road, Shanghai, 200025, People's Republic of China
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66
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TRα receptor mutations extend the spectrum of syndromes of reduced sensitivity to thyroid hormone. Presse Med 2015; 44:1103-12. [PMID: 26585273 DOI: 10.1016/j.lpm.2015.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/31/2015] [Indexed: 11/23/2022] Open
Abstract
Since 2012, eight different abnormalities have been described in the THRA gene (encoding the TRα1 thyroid hormone receptor) of 14 patients from 9 families. These mutations induce a clinical phenotype (resistance to thyroid hormone type α) associating symptoms of untreated mild congenital hypothyroidism and a near-normal range of free and total thyroid hormones and TSH (the T4/T3 ratio is nevertheless usually low). The phenotype can diversely include short stature (due to growth retardation), dysmorphic syndrome (face and limb extremities), psychoneuromotor disorders, constipation and bradycardia. The identified genetic abnormalities are located within the ligand-binding domain and result in defective T3 binding, an abnormally strong interaction with corepressors and a dominant negative activity against still functional receptors. The identification of patients with consistent phenotypes and the underlying mutations are warranted to better delineate the spectrum of the syndromes of reduced sensitivity to thyroid hormone.
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Abstract
Thyroid hormones act via nuclear receptors (TRα1, TRβ1, TRβ2) with differing tissue distribution; the role of α2 protein, derived from the same gene locus as TRα1, is unclear. Resistance to thyroid hormone alpha (RTHα) is characterised by tissue-specific hypothyroidism associated with near-normal thyroid function tests. Clinical features include dysmorphic facies, skeletal dysplasia (macrocephaly, epiphyseal dysgenesis), growth retardation, constipation, dyspraxia and intellectual deficit. Biochemical abnormalities include low/low-normal T4 and high/high-normal T3 concentrations, a subnormal T4/T3 ratio, variably reduced reverse T3, raised muscle creatine kinase and mild anaemia. The disorder is mediated by heterozygous, loss-of-function, mutations involving either TRα1 alone or both TRα1 and α2, with no discernible phenotype attributable to defective α2. Whole exome sequencing and diagnostic biomarkers may enable greater ascertainment of RTHα, which is important as thyroxine therapy reverses some metabolic abnormalities and improves growth, constipation, dyspraxia and wellbeing. The genetic and phenotypic heterogeneity of RTHα and its optimal management remain to be elucidated.
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Affiliation(s)
- Carla Moran
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - Krishna Chatterjee
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
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Huang CCJ, Kraft C, Moy N, Ng L, Forrest D. A Novel Population of Inner Cortical Cells in the Adrenal Gland That Displays Sexually Dimorphic Expression of Thyroid Hormone Receptor-β1. Endocrinology 2015; 156:2338-48. [PMID: 25774556 PMCID: PMC4430604 DOI: 10.1210/en.2015-1118] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of the adrenal cortex involves the formation and then subsequent regression of immature or fetal inner cell layers as the mature steroidogenic outer layers expand. However, controls over this remodeling, especially in the immature inner layer, are incompletely understood. Here we identify an inner cortical cell population that expresses thyroid hormone receptor-β1 (TRβ1), one of two receptor isoforms encoded by the Thrb gene. Using mice with a Thrb(b1) reporter allele that expresses lacZ instead of TRβ1, β-galactosidase was detected in the inner cortex from early stages. Expression peaked at juvenile ages in an inner zone that included cells expressing 20-α-hydroxysteroid dehydrogenase, a marker of the transient, so-called X-zone in mice. The β-galactosidase-positive zone displayed sexually dimorphic regression in males after approximately 4 weeks of age but persisted in females into adulthood in either nulliparous or parous states. T3 treatment promoted hypertrophy of inner cortical cells, induced some markers of mature cortical cells, and, in males, delayed the regression of the TRβ1-positive zone, suggesting that TRβ1 could partly divert the differentiation fate and counteract male-specific regression of inner zone cells. TRβ1-deficient mice were resistant to these actions of T3, supporting a functional role for TRβ1 in the inner cortex.
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Affiliation(s)
- Chen-Che Jeff Huang
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892
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69
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Krude H, Kühnen P, Biebermann H. Treatment of congenital thyroid dysfunction: Achievements and challenges. Best Pract Res Clin Endocrinol Metab 2015; 29:399-413. [PMID: 26051299 DOI: 10.1016/j.beem.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The active thyroid hormone tri-iodothyronine (T3) is essential for a normal development of children. Especially within the first years of life, thyroid hormone is pivotal in enabling maturation of complex brain function and somatic growth. The most compelling example for a life without thyroid hormone are those historical cases of children who came to birth without a thyroid gland - as shown in autopsy-studies- and who suffered from untreated hypothyroidism, at that time initially called "sporadic congenital hypothyroidism" (CH). In the last decades huge achievements resulted in a normal development of these children based on newborn screening programs that enable an early onset of a high dose LT4-treatment. Further progress will be necessary to further tailor an individualized thyroid hormone substitution approach and to identify those more complex patients with congenital hypothyroidism and associated defects, who will not benefit from an even optimized LT4 therapy. Besides the primary production of thyroid hormone a variety of further mechanisms are necessary to mediate the function of T3 on normal development that are located downstream of thyroid hormone production. Abnormalities of these mechanisms include the MCT8-transport defect, deiodinase-insufficiency and thyroid hormone receptor alpha-and beta defects. These thyroid hormone resistant diseases can not be treated with classical LT4 substitution alone. The development of new treatment options for those rare cases of thyroid hormone resistance is one of the most challenging tasks in the field of congenital thyroid diseases today.
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Affiliation(s)
- Heiko Krude
- Institute for Experimental Paediatric Endocrinology, Charite, University-Medicine-Berlin, Augustenburgerplatz 1, D-13353 Berlin, Germany.
| | - Peter Kühnen
- Institute for Experimental Paediatric Endocrinology, Charite, University-Medicine-Berlin, Augustenburgerplatz 1, D-13353 Berlin, Germany
| | - Heike Biebermann
- Institute for Experimental Paediatric Endocrinology, Charite, University-Medicine-Berlin, Augustenburgerplatz 1, D-13353 Berlin, Germany
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70
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Cheng SY. My journey to unravel complex actions of thyroid hormone: was it fate or destiny? Endocr Relat Cancer 2015; 22:P1-P10. [PMID: 25662575 DOI: 10.1530/erc-15-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sheue-yann Cheng
- Laboratory of Molecular BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Room 5128, Bethesda, Maryland 20892-4264, USA
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71
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Medici M, Visser WE, Visser TJ, Peeters RP. Genetic determination of the hypothalamic-pituitary-thyroid axis: where do we stand? Endocr Rev 2015; 36:214-44. [PMID: 25751422 DOI: 10.1210/er.2014-1081] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For a long time it has been known that both hypo- and hyperthyroidism are associated with an increased risk of morbidity and mortality. In recent years, it has also become clear that minor variations in thyroid function, including subclinical dysfunction and variation in thyroid function within the reference range, can have important effects on clinical endpoints, such as bone mineral density, depression, metabolic syndrome, and cardiovascular mortality. Serum thyroid parameters show substantial interindividual variability, whereas the intraindividual variability lies within a narrow range. This suggests that every individual has a unique hypothalamus-pituitary-thyroid axis setpoint that is mainly determined by genetic factors, and this heritability has been estimated to be 40-60%. Various mutations in thyroid hormone pathway genes have been identified in persons with thyroid dysfunction or altered thyroid function tests. Because these causes are rare, many candidate gene and linkage studies have been performed over the years to identify more common variants (polymorphisms) associated with thyroid (dys)function, but only a limited number of consistent associations have been found. However, in the past 5 years, advances in genetic research have led to the identification of a large number of new candidate genes. In this review, we provide an overview of the current knowledge about the polygenic basis of thyroid (dys)function. This includes new candidate genes identified by genome-wide approaches, what insights these genes provide into the genetic basis of thyroid (dys)function, and which new techniques will help to further decipher the genetic basis of thyroid (dys)function in the near future.
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Affiliation(s)
- Marco Medici
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, 3015 GE Rotterdam, The Netherlands
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72
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Alkemade A. Thyroid hormone and the developing hypothalamus. Front Neuroanat 2015; 9:15. [PMID: 25750617 PMCID: PMC4335174 DOI: 10.3389/fnana.2015.00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/02/2015] [Indexed: 01/12/2023] Open
Abstract
Thyroid hormone (TH) plays an essential role in normal brain development and function. Both TH excess and insufficiency during development lead to structural brain abnormalities. Proper TH signaling is dependent on active transport of the prohormone thyroxine (T4) across the blood-brain-barrier and into brain cells. In the brain T4 undergoes local deiodination into the more active 3,3′,5-triiodothyronine (T3), which binds to nuclear TH receptors (TRs). TRs are already expressed during the first trimester of pregnancy, even before the fetal thyroid becomes functional. Throughout pregnancy, the fetus is largely dependent on the maternal TH supply. Recent studies in mice have shown that normal hypothalamic development requires intact TH signaling. In addition, the development of the human lateral hypothalamic zone coincides with a strong increase in T3 and TR mRNA concentrations in the brain. During this time the fetal hypothalamus already shows evidence for TH signaling. Expression of components crucial for central TH signaling show a specific developmental timing in the human hypothalamus. A coordinated expression of deiodinases in combination with TH transporters suggests that TH concentrations are regulated to prevent untimely maturation of brain cells. Even though the fetus depends on the maternal TH supply, there is evidence suggesting a role for the fetal hypothalamus in the regulation of TH serum concentrations. A decrease in expression of proteins involved in TH signaling towards the end of pregnancy may indicate a lower fetal TH demand. This may be relevant for the thyrotropin (TSH) surge that is usually observed after birth, and supports a role for the hypothalamus in the regulation of TH concentrations during the fetal period anticipating birth.
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Affiliation(s)
- Anneke Alkemade
- Amsterdam Brain and Cognition Center, University of Amsterdam Amsterdam, Netherlands
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73
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Tylki-Szymańska A, Acuna-Hidalgo R, Krajewska-Walasek M, Lecka-Ambroziak A, Steehouwer M, Gilissen C, Brunner HG, Jurecka A, Różdżyńska-Świątkowska A, Hoischen A, Chrzanowska KH. Thyroid hormone resistance syndrome due to mutations in the thyroid hormone receptor α gene (THRA). J Med Genet 2015; 52:312-6. [PMID: 25670821 DOI: 10.1136/jmedgenet-2014-102936] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/20/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Resistance to thyroid hormone is characterised by a lack of response of peripheral tissues to the active form of thyroid hormone (triiodothyronine, T3). In about 85% of cases, a mutation in THRB, the gene coding for thyroid receptor β (TRβ), is the cause of this disorder. Recently, individual reports described the first patients with thyroid hormone receptor α gene (THRA) defects. METHODS We used longitudinal clinical assessments over a period of 18 years at one hospital setting combined with biochemical and molecular studies to characterise a novel thyroid hormone resistance syndrome in a cohort of six patients from five families. FINDINGS Using whole exome sequencing and subsequent Sanger sequencing, we identified truncating and missense mutations in the THRA gene in five of six individuals and describe a distinct and consistent phenotype of mild hypothyroidism (growth retardation, relatively high birth length and weight, mild-to-moderate mental retardation, mild skeletal dysplasia and constipation), specific facial features (round, somewhat coarse and flat face) and macrocephaly. Laboratory investigations revealed anaemia and slightly elevated cholesterol, while the thyroid profile showed low free thyroxine (fT4) levels coupled with high free T3 (fT3), leading to an altered T4 : T3 ratio, along with normal thyroid-stimulating hormone levels. We observed a genotype-phenotype correlation, with milder outcomes for missense mutations and more severe phenotypical effects for truncating mutations. INTERPRETATION THRA mutations may be more common than expected. In patients with clinical symptoms of mild hypothyreosis without confirmation in endocrine studies, a molecular study of THRA defects is strongly recommended.
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Affiliation(s)
- Anna Tylki-Szymańska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Rocio Acuna-Hidalgo
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Nijmegen, The Netherlands
| | | | - Agnieszka Lecka-Ambroziak
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marloes Steehouwer
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Nijmegen, The Netherlands
| | - Christian Gilissen
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Nijmegen, The Netherlands
| | - Han G Brunner
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Nijmegen, The Netherlands
| | - Agnieszka Jurecka
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Alexander Hoischen
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Nijmegen, The Netherlands
| | - Krystyna H Chrzanowska
- Department of Clinical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
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74
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Whole-genome sequencing of quartet families with autism spectrum disorder. Nat Med 2015; 21:185-91. [PMID: 25621899 DOI: 10.1038/nm.3792] [Citation(s) in RCA: 354] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/22/2014] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorder (ASD) is genetically heterogeneous, with evidence for hundreds of susceptibility loci. Previous microarray and exome-sequencing studies have examined portions of the genome in simplex families (parents and one ASD-affected child) having presumed sporadic forms of the disorder. We used whole-genome sequencing (WGS) of 85 quartet families (parents and two ASD-affected siblings), consisting of 170 individuals with ASD, to generate a comprehensive data resource encompassing all classes of genetic variation (including noncoding variants) and accompanying phenotypes, in apparently familial forms of ASD. By examining de novo and rare inherited single-nucleotide and structural variations in genes previously reported to be associated with ASD or other neurodevelopmental disorders, we found that some (69.4%) of the affected siblings carried different ASD-relevant mutations. These siblings with discordant mutations tended to demonstrate more clinical variability than those who shared a risk variant. Our study emphasizes that substantial genetic heterogeneity exists in ASD, necessitating the use of WGS to delineate all genic and non-genic susceptibility variants in research and in clinical diagnostics.
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75
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Ortiga-Carvalho TM, Sidhaye AR, Wondisford FE. Thyroid hormone receptors and resistance to thyroid hormone disorders. Nat Rev Endocrinol 2014; 10:582-91. [PMID: 25135573 PMCID: PMC4578869 DOI: 10.1038/nrendo.2014.143] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Thyroid hormone action is predominantly mediated by thyroid hormone receptors (THRs), which are encoded by the thyroid hormone receptor α (THRA) and thyroid hormone receptor β (THRB) genes. Patients with mutations in THRB present with resistance to thyroid hormone β (RTHβ), which is a disorder characterized by elevated levels of thyroid hormone, normal or elevated levels of TSH and goitre. Mechanistic insights about the contributions of THRβ to various processes, including colour vision, development of the cochlea and the cerebellum, and normal functioning of the adult liver and heart, have been obtained by either introducing human THRB mutations into mice or by deletion of the mouse Thrb gene. The introduction of the same mutations that mimic human THRβ alterations into the mouse Thra and Thrb genes resulted in distinct phenotypes, which suggests that THRA and THRB might have non-overlapping functions in human physiology. These studies also suggested that THRA mutations might not be lethal. Seven patients with mutations in THRα have since been described. These patients have RTHα and presented with major abnormalities in growth and gastrointestinal function. The hypothalamic-pituitary-thyroid axis in these individuals is minimally affected, which suggests that the central T3 feedback loop is not impaired in patients with RTHα, in stark contrast to patients with RTHβ.
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Affiliation(s)
- Tânia M Ortiga-Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, S/N, Cidade Universitária, 21941-902, Rio de Janeiro, Brazil
| | - Aniket R Sidhaye
- Departments of Paediatrics and Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, CMSC 10-113, Baltimore, MD 21287, USA
| | - Fredric E Wondisford
- Departments of Paediatrics and Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, CMSC 10-113, Baltimore, MD 21287, USA
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76
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Osório J. Thyroid function: new mutation in human TRα proteins. Nat Rev Endocrinol 2014; 10:511. [PMID: 25022813 DOI: 10.1038/nrendo.2014.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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77
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Affiliation(s)
- Josef Köhrle
- Institut für Experimentelle Endokrinologie, CVK, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany.
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