Cytotoxic Mechanisms in Autoimmune Thyroid Disorders and Thyroid-associated Ophthalmopathy

Novel Therapies for Thyroid Autoimmune Diseases

C-X-C chemokine receptor (CXCR)3 and its interferon(IFN)γ-dependent chemokines (CXCL10, CXCL9, CXCL11) are implicated in the immune-pathogenesis of autoimmune thyroiditis (AT), Graves disease (GD) and Graves Ophthalmopathy (GO). In tissue, recruited Th1 lymphocytes produce IFNγ, enhancing the tissue secretion of IFNγ-inducible chemokines, initiating and perpetuating the autoimmune process. Patients with AT (with hypothyroidism), and with GO and GD, particularly in the active phase, have high IFNγ-inducible chemokines. Peroxisome proliferator-activated receptor (PPAR)γ or -α agonists and methimazole exert an immune-modulation on CXCR3 chemokines in AT, GD and GO. Other studies are ongoing to evaluate new molecules acting as antagonists of CXCR3, or blocking CXCL10, in Hashimoto thyroiditis (HT), GD and GO. Recently, novel molecules targeting the various agents involved in the pathogenesis of GO, such as rituximab, have been proposed as an alternative to corticosteroids. However, randomized and controlled studies are needed to generalize these interesting results.

Evidence that the immunosuppressive effects of antithyroid drugs are mediated through actions on the thyroid cell, modulating thyrocyte-immunocyte signaling: a review

The mechanism of action of the immunosuppressive effects of antithyroid drugs has remained a matter of controversy, despite our earlier contention that such effects in vivo were indirect, i.e., it was our view that the drugs were acting on the thyroid cells, reducing their hormone production and other activities, with a consequent reduction in thyrocyte-immunocyte signaling. The reduction in the activation of CD4+ cells, the increased number and activation of CD8+ (and CD8+CDIIb+) cells, and the reduction of soluble interleukin-2 receptors, thought once to be direct effects of the medication, are now shown to be due to amelioration of the hyperthyroidism. Thus the reduction in thyroid hormone production induced by the drugs is central to these actions. In addition, the iodination of thyroglobulin is inhibited by these agents, which may affect antigen presentation by the thyrocyte. Furthermore, there is now evidence that the thionamides interfere with thyrocyte expression of Class I antigen, interleukin-1, interleukin-6, prostaglandin E2, and heat shock protein. The expression of thyrocyte Class II antigen is probably not inhibited by these drugs, although one group has shown that lectin-stimulated thyrocyte Class II expression is diminished by this treatment; this group postulated that this effect might be mediated by reduced interferon-gamma production by T lymphocytes, but in vitro experiments do not corroborate this proposal. In any event, the actions as described, of the antithyroid drugs on the thyroid cells, would certainly suffice to explain the diminution of thyroid antibodies (including thyroid stimulating antibody), the reduced immunological response, and the increased remission rate in Graves' disease, without the need to invoke a direct immunosuppressive effect.

Cellular basis of T-cell autoreactivity in autoimmune diseases

There is no doubt that T cells play a key role in the pathogenesis of autoimmune diseases (AD) both as effector and regulatory cells. Despite spectacular progress in the understanding of natural tolerance to self, owing particularly to transgenic technology, important questions remain open regarding the pathogenesis of AD, the conditions favoring the transition from benign or 'physiological' autoimmunity to deleterious autoimmunity, and the precise effector mechanisms. This review on the cellular basis of T-cell-mediated AD begins with an enumeration of the main arguments in favor of direct T-cell involvement, special emphasis being given to two animal models which have been most extensively investigated: experimental allergic encephalomyelitis, and the nonobese diabetic mouse. The question as to whether pathogenic T cells use a restricted repertoire of V beta genes is examined in the context of these two models. From here we proceed to an evaluation of the mechanisms of onset of AD, discussing both extrinsic and intrinsic factors responsible for the breakdown in T-cell tolerance and reviewing the arguments in favor of suppressor T cells being actively involved in the prevention of autoimmunity. The last two sections are devoted to the effector mechanisms responsible for tissue injury in organ-specific AD and to T-cell-directed therapeutic interventions, respectively. We discuss the two main pathogenic hypotheses based on direct intervention of cytotoxic T cells or indirect involvement of inflammatory cytokines and macrophages, and evaluate the importance of ecotaxis in leading autoreactive T cells to the site of injury. We conclude on a brief and nonexhaustive list of strategies aimed at selectively neutralizing potentially harmful T cells.

The role of interferon-gamma in lymphocytic thyroiditis: its functional and pathological effect on human thyrocytes in culture

Interferon-gamma (IFN-gamma) has been recognized to possess diverse non-immunological effects on epithelial cells such as cellular growth and differentiation. We have previously demonstrated that IFN-gamma suppressed thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (TG) synthesis in human thyrocytes through inhibition of TG gene transcription. To define the pathological mechanism involved in the action of IFN-gamma, we studied the ultrastructural changes of human thyrocytes cultured in monolayer. Stimulation of the thyrocytes with TSH 10 mU/ml for 2 days resulted in marked increase in TG release into the medium. This was accompanied by elongation of microvilli, increase in follicles and acinar formation, increase in secretory granules and prominence of Golgi apparatus and rough-surfaced endoplasmic reticulum. Addition of IFN-gamma (500 U/ml) resulted in marked degeneration with shrinkage of the cell membrane, vacuolation of cytoplasm, swollen mitochondria and presence of lysosomal granules. Co-culturing the thyrocytes with the IFN-gamma and TSH resulted in suppression of the morphological responsiveness to TSH. There was also suppression of TSH-induced TG secretion. However, at 500 U/ml IFN-gamma did not cause lysis of the thyrocytes as estimated by the cellular DNA content. Furthermore, binucleated cells were frequently encountered in those wells that were treated with IFN-gamma for either 2 or 5 days. The findings suggest that IFN-gamma resulted in de-differentiation and degeneration of the thyrocytes, which subsequently regained the growth potential and showed attempts at regeneration. This may explain why most patients with lymphocytic thyroiditis recover from the acute injury and do not suffer from permanent hypothyroidism.

Thyrotoxicosis in childhood

Evidence supports the presence of a genetic predisposition to an abnormality in immune surveillance, with environmental factors precipitating the development of Graves' disease.

Expression of intercellular adhesion molecule-1 (ICAM-1) on human thyroid cells lines correlated with their binding of lymphoblasts

We have investigated the expression of intercellular adhesion molecule-1 (ICAM-1) by novel functional human thyroid cell lines (designated SGHTL). ICAM-1 is constitutively expressed and it is rapidly upregulated in response to each of the recombinant cytokines: gamma-interferon, interleukin-1 and tumour necrosis factor. This contrasts with the more slowly increased expression of major histocompatibility complex (MHC) class II antigens in response to gamma-interferon alone. We have also demonstrated binding of activated lymphocytes to SGHTL cells: this interaction is increased following treatment with these cytokines and is inhibited by monoclonal antibodies directed against ICAM-1 or lymphocyte function-associated antigen-1 (LFA-1) but not by antibodies against CD2 or MHC class II antigens. Hence, we conclude that the binding of lymphoblasts to human thyroid cells involves an LFA-1- and ICAM-1-dependent pathway as well as other basal and cytokine-inducible pathway(s). These do not appear to involve MHC class II antigens, CD2 or an LFA-1 ligand other than ICAM-1.

Human autoimmune thyroid disease A mechanistic update

Autoimmune thyroid disease refers to a group of common, often familial, disorders of thyroid function, which are associated with disturbances in both cellular and humoral immunity. Current research into autoimmune thyroid disease is characterizing specific target antigens and the cellular and molecular events that lead to tissue-specific immune dysfunction. The thyroid gland is an accessible and useful model for the study of human autoimmune disease. This review highlights some of the more active research areas.

Autoimmunity and hypothyroidism

Hypothyroidism can be induced by various diseases. An autoimmune cause accounts for approximately 90% of adult hypothyroidism, mostly due to Hashimoto's disease. The majority of Hashimoto patients are women aged between 20 and 60 years old and nearly 10% show overt hypothyroidism. With time euthyroid patients progress to hypothyroidism and thus the prevalence of hypothyroidism is higher in elderly patients. Especially at 3 to 8 months postpartum, the prevalence of hypothyroidism is very high, up to 2-4%, but more than 90% of these cases are transient. Autoimmune destructive mechanisms, such as antibody dependent cytotoxicity, K and NK cell cytotoxicity, T lymphocyte cytotoxicity and lymphokine cytotoxicity, have been studied in vitro, but the most important factor in vivo is still unknown. A recent finding is that thyroid stimulation blocking antibody (TSBAb) may induce primary atrophic hypothyroidism. This antibody not only blocks TSH-induced cAMP production but also blocks TSH-induced DNA synthesis and iodine uptake in cultured thyroid cells. The prevalence of TSBAb in patients with primary atrophic hypothyroidism varies in different studies, from 0 to 47%. Reports on the relationship between TSBAb and TSH-binding inhibitory immunoglobulin (TBII) detected by radioreceptor assay are conflicting. The prevalence of TSBAb in patients with goitrous hypothyroidism is also controversial, varying from 0 to 20%. Transient hypothyroidism is observed frequently in the postpartum period and in the post-thyrotoxic phase of pregnancy-unrelated silent thyroiditis. Maternal TSBAb causes transient neonatal hypothyroidism when the activity is more than 1500 i.u./litre. The blocking and stimulatory types of anti-TSH receptor antibodies may both react with the same epitope(s) of TSH-receptor related antigens but the exact mechanisms that lead to the different effects are unknown. In some patients, including those with Graves' disease, stimulating and blocking antibodies co-exist and thyroid function may change from hyperthyroidism to hypothyroidism, or vice-versa, depending on the balance of stimulatory and blocking activities. Hypothyroidism in Graves' disease after treatment is thought to be induced in two ways: autoimmune thyroid destruction and the predominant appearance of TSBAb. Dietary iodine restriction is helpful in allowing recovery from hypothyroidism in more than half of the patients with spontaneously occurring primary hypothyroidism in Japan. Submaximal doses of T3 may be useful in differentiating transient from persistent hypothyroidism, since spontaneous recovery is detected by an increase of serum T4.(ABSTRACT TRUNCATED AT 400 WORDS)