Treatment of moderate to severe orbitopathy: Current modalities and perspectives

Depression- and anxiety-associated disrupted brain structural networks revealed by probabilistic tractography in thyroid associated ophthalmopathy

BACKGROUND

Patients with thyroid-associated opthalmopathy (TAO) have widespread white matter (WM) abnormalities in the emotional and cognitive functional regions. However, the topological representation of these WM abnormalities and the network-level structural aberrations underlying TAO and concomitant affective disorders are still unclear.

METHODS

We used probabilistic diffusion tractography and graph theory to investigate brain network topology in 37 active, 35 inactive TAO patients and 23 healthy controls. Then, we evaluated the partial correlations between network topological metrics and clinical parameters.

RESULTS

For global topology, only active TAO patients exhibited significantly decreased global (Eglob) and local (Eloc) efficiency compared with controls, while no significant difference was observed between active and inactive TAO patients. For regional topology, we found a significantly decreased nodal efficiency in the left orbital superior frontal gyrus (ORBsup), medial orbital superior frontal gyrus (ORBsupmed), hippocampus and amygdala in active TAO patients compared with inactive ones. Intriguingly, Eglob, Eloc, and nodal efficiency of left ORBsup, ORBsupmed, olfactory cortex, gyrus rectus, hippocampus, right parahippocampal gyrus and amygdala had significantly positive correlations with anxiety/depression scores, bilateral exophthalmos and intraocular pressure in active TAO patients, while no significant correlation was observed in inactive TAO patients.

LIMITATIONS

No longitudinal follow-up.

CONCLUSIONS

WM networks of TAO are characterized by decreased local specialization and global integration in the active phase, and decreased nodal efficiency highly related to anxiety and depression in the emotional and cognitive regions. Our findings provide new insight regarding the neurobiological mechanisms of TAO and contribute to the treatment of concomitant affective disorders.

Machine learning-based prediction of diagnostic markers for Graves' orbitopathy

PURPOSE

The pathogenesis of Graves' orbitopathy/thyroid-associated orbitopathy (TAO) is still unclear, and abnormal DNA methylation in TAO has been reported. Thus, selecting and exploring TAO biomarkers associated with DNA methylation may provide a reference for new therapeutic targets.

METHODS

The TAO-associated expression data and methylation data were downloaded from The Gene Expression Omnibus database. Firstly, weighted gene co-expression network analysis was used to obtain the TAO-related genes, which were intersected with differentially methylated genes (DMGs), and differentially expressed genes between TAO samples and normal samples to obtain TAO-associated DMGs (TA-DMGs). Thereafter, the functions of the TA-DMGs were analyzed, and diagnostic markers were screened by least absolute shrinkage and selection operator (Lasso) regression analysis and support vector machine (SVM) analysis. The expression levels and diagnostic values of the diagnostic markers were also analyzed. Furthermore, single gene pathway enrichment analysis was performed for each diagnostic marker separately using gene set enrichment analysis (GSEA) software. Next, we also performed immune infiltration analysis for each sample in the GSE58331 dataset using the single-sample GSEA algorithm, and the correlation between diagnostic markers and differential immune cells was explored. Lastly, the expressions of diagnostic markers were explored by quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

A total of 125 TA-DMGs were obtained. The enrichment analysis results indicated that these TA-DMGs were mainly involved in immune-related pathways, such as Th1 and Th2 cell differentiation and the regulation of innate immune response. Moreover, two diagnostic markers, including S100A11 and NKD2, were obtained by Lasso regression analysis and SVM analysis. Single gene pathway enrichment analysis showed that S100A11 was involved in protein polyufmylation, pancreatic-mediated proteolysis, and NKD2 was involved in innate immune response in mucosa, Wnt signaling pathway, etc. Meanwhile, immune cell infiltration analysis screened 12 immune cells, including CD56 dim natural killer cells and Neutrophil cells that significantly differed between TAO and normal samples, with the strongest positive correlation between NKD2 and CD56 dim natural killer cells. Finally, the qRT-PCR illustrated the expressions of NKD2 and S100A11 between normal and TAO.

CONCLUSION

NKD2 and S100A11 were screened as biomarkers of TAO and might be regulated by DNA methylation in TAO, providing a new reference for the diagnosis and treatment of TAO patients.

Morphological brain changes between active and inactive phases of thyroid associated ophthalmopathy: a voxel-based morphometry study

AIM

To explore the morphological brain changes among active thyroid-associated ophthalmopathy (TAO) patients, inactive TAO patients and healthy controls and to investigate the neuropathological relationship of TAO using magnetic resonance imaging (MRI) data.

METHODS

In this observational case-control study, we included 35 inactive TAO patients, 37 active TAO patients and 23 healthy controls. Voxel-based morphometry (VBM) analysis was conducted to evaluate the gray matter volume (GMV) changes among groups, and the correlations between GMV alterations and clinical parameters in active and inactive TAO groups were investigated.

RESULTS

Active TAO patients showed significantly increased GMV in the right inferior frontal gyrus, left superior frontal gyrus (SFG), orbital superior frontal gyrus, orbital middle frontal gyrus, precuneus and postcentral gyrus compared with controls and significantly increased GMV in the right middle temporal gyrus, left SFG and precuneus compared with the inactive TAO group. No significant differences were observed between the inactive TAO group and healthy controls. Notably, the receiver operating characteristic (ROC) curve analysis demonstrated altered GMV among groups and significantly (p<0.001) differentiated active TAO from inactive TAO and healthy controls. In addition, the mean GMV in precuneus and postcentral gyrus were significantly associated with clinical parameters in active TAO.

CONCLUSION

Our findings suggested the localized GMV alterations among groups were associated with the pathophysiology of TAO and served as a potential discriminative pattern to detect clinical phases of TAO at the individual level. The altered brain morphometry may suggest a corresponding process of self-repair and remodeling of the brain structure as the disease progresses in TAO.

Efficacy and safety of mycophenolate mofetil in the treatment of moderate to severe Graves' orbitopathy: a meta-analysis

The role of mycophenolate mofetil (MMF) in the treatment of Graves’ orbitopathy (GO) has attracted much attention. This study is to evaluate the benefit and safety of MMF in moderate-to-severe GO. A meta-analysis of clinical control trials comparing MMF (with or without glucocorticoid (GC)) for the treatment of GO with GC was conducted. We searched the databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI), for articles published up to 15 June 2022. The primary outcome is referred to the improvement in overall response, and secondary outcomes included the change in clinical activity score (CAS) and adverse events (AEs). Of the 289 articles initially searched, 6 studies were finally eligible for inclusion. The results showed that MMF (with or without GC) was superior to GC in the treatment of GO (OR 3.34, 95% CI 2.17–5.14; p < 0.00001). Subgroup analyses also showed that MMF monotherapy was more effective than GC (OR 4.46, 95% CI 2.52–7.87; p < 0.00001). Compared to methylprednisolone (MP) monotherapy, a combination of MP and MMF was more effective. CAS decreased even more significantly (WMD 0.29, 95% CI 0.10–0.48; p = 0.002) and fewer AEs occurred (OR 0.2, 95% CI 0.06–0.72; p = 0.01) in patients receiving MMF. The pooled data suggested that MMF treatment in GO might be promising. Compared with GC therapy, MMF is safer and more effective. However, more large-sample and high-quality studies targeting MMF use in GO patients and long-term surveillance of prognosis are urgently needed.