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Andrade NLM, Rezende RC, Crisostomo LG, Dantas NCB, Cellin LP, de Souza V, Quedas EPS, Lerario AM, Vasques GA, Jorge AAL. Clinical Characteristics of Children with THRA Mutations: Variable Phenotype and Good Response to Recombinant Human Growth Hormone Therapy. Horm Res Paediatr 2024:1-8. [PMID: 38744258 DOI: 10.1159/000539348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Mutations in the thyroid hormone receptor alpha (THRA) gene are a rare cause of thyroid hormone resistance, which leads to a pleomorphic phenotypic spectrum. Hormonal profiles are variable and subtle, making laboratory diagnoses challenging. Genetic evaluation can be a helpful tool in diagnosing these cases. CASE PRESENTATION Three patients (P1, P2, and P3) from unrelated families presented to their endocrinologists with short stature and abnormalities in thyroid function results. P1 showed hypoactivity and mild thyroid-stimulating hormone (TSH) elevation. P2 presented with a mild developmental delay and a hormonal profile initially interpreted as central hypothyroidism. Patient P3 had severe symptoms, including hypotonia, developmental delay, normal TSH, hypercholesterolemia, severe hypertriglyceridemia, high amylase levels, and mild pericardial effusion. All the patients had low free thyroxine (FT4) levels, mild constipation, and short stature. The patients underwent exome sequencing analysis that identified three different heterozygous variants in the THRA gene (P1 and P2 had missense variants, and P3 had a stop codon variant). All patients were treated with levothyroxine replacement, improving their clinical symptoms, such as constipation, and neurological symptoms. P1 and P2 were also treated with the recombinant human growth hormone (rhGH). The improvements in growth velocity and height standard deviation scores (SDS) were remarkable. Notably, P1 had a total height gain of 2.5 SDS, reaching an adult height within the normal range. CONCLUSION THRA gene defects can lead to growth disorders with different phenotypes. Children with THRA mutations can benefit from adequate treatment with levothyroxine and may respond well to rhGH treatment.
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Affiliation(s)
- Nathalia L M Andrade
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Raissa C Rezende
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Lindiane G Crisostomo
- Departamento de Pediatria, Faculdade de Medicina do Centro Universitário São Camilo, São Paulo, Brazil
| | - Naiara C B Dantas
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Laurana P Cellin
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Vinicius de Souza
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Elisangela P S Quedas
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Antonio M Lerario
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gabriela A Vasques
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Alexander A L Jorge
- Unidade de Endocrinologia Genética (LIM 25), Hospital Das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM42), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
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Kağızmanlı GA, Kırbıyık Ö, Abacı A, Böber E, Yiş U, Demir K. Anaemia-based screening for resistance to thyroid hormone alpha in children. Clin Endocrinol (Oxf) 2024; 100:304-311. [PMID: 38148509 DOI: 10.1111/cen.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The hypothyroid phenotype associated with resistance to thyroid hormone alpha (RTH-α) is associated with a diverse clinical picture. On the other hand, thyroid-stimulating hormone (TSH) levels are normal. Free triiodothyronine (fT3) and free thyroxine (fT4) levels can also be normal; however, normo- or macrocytic anaemia is usually present in reported cases. Diagnosis is challenging and there is limited data regarding screening methods. OBJECTIVE The study aimed to assess the efficiency of a screening strategy for RTH-α. SUBJECTS AND METHODS Out of a total of 6540 children evaluated at the outpatient clinics of paediatric neurology over 2 years and who underwent complete blood count and thyroid function tests, 432 were found to have anaemia. Within this group, we identified 42 children without an underlying specific neurological aetiology who exhibited normo- or macrocytic anaemia, normal TSH levels, fT3 levels in the upper half of the normal range or high, and fT4 levels in the lower half of the normal range or low. We excluded one patient who had already been diagnosed with RTH-α and nine patients could not be reached. Subsequently, clinical evaluation, biochemical assessment, and THRA sequencing analysis were conducted on 32 children. The findings were compared with those of the known RTH-α patients in our unit. RESULTS The median age of the patients was 5.7 (5.1-7.4) years, and 22 of them were males (69%). The main reasons for assessment in paediatric neurology clinics were autism spectrum disorder (n = 12, 38%), epilepsy (n = 11, 34%), and delay in developmental stages (n = 8, 25%). Constipation was present in five of the cases (16%), while the closure of the anterior fontanelle and tooth eruption were delayed in two cases (6%) and one case (3%), respectively. The median length/height and weight standard deviation (SD) scores were 0.3 [(-0.8)-(1.1)] and -0.1 [(-0.8)-(0.3)], respectively. The median fT3, fT4, and TSH levels were 4.6 (4.2-5.0) pg/mL, 0.9 (0.8-1.0) ng/dL, and 2.2 (1.8-3.1) uIU/mL, respectively. Thirteen of the patients (41%) had high fT3 levels, while none of them had low fT4 levels. The normo- or macrocytic anaemia rate was 47% (normocytic/macrocytic, n = 8/7) at the time of reassessment. Serum creatine kinase (CK) was elevated in five patients (16%; one had anaemia). None of the subjects had a pathological variant in THRA. Known RTH-α patients had significantly lower median height SD score, higher rates of delayed tooth eruption and closure of the anterior fontanelle, lower haemoglobin levels, and higher mean corpuscular volume (MCV) and CK levels as compared to those found without RTH-α. CONCLUSIONS This approach found one known patient with RTH-α but did not reveal any new cases. Notably, normo- or macrocytic anaemia did not persist in nearly half of the screened patients. A screening strategy that takes clinical findings and prominent laboratory features suggestive of RTH-α into account could lower unnecessary genetic analysis of THRA in patients presenting with neurological problems.
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Affiliation(s)
- Gözde Akın Kağızmanlı
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgür Kırbıyık
- Tepecik Training and Research Hospital, Genetic Diagnosis Center, University of Health Sciences, İzmir, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ece Böber
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uluç Yiş
- Department of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Korcan Demir
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Richard S, Ren J, Flamant F. Thyroid hormone action during GABAergic neuron maturation: The quest for mechanisms. Front Endocrinol (Lausanne) 2023; 14:1256877. [PMID: 37854197 PMCID: PMC10579935 DOI: 10.3389/fendo.2023.1256877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Thyroid hormone (TH) signaling plays a major role in mammalian brain development. Data obtained in the past years in animal models have pinpointed GABAergic neurons as a major target of TH signaling during development, which opens up new perspectives to further investigate the mechanisms by which TH affects brain development. The aim of the present review is to gather the available information about the involvement of TH in the maturation of GABAergic neurons. After giving an overview of the kinds of neurological disorders that may arise from disruption of TH signaling during brain development in humans, we will take a historical perspective to show how rodent models of hypothyroidism have gradually pointed to GABAergic neurons as a main target of TH signaling during brain development. The third part of this review underscores the challenges that are encountered when conducting gene expression studies to investigate the molecular mechanisms that are at play downstream of TH receptors during brain development. Unravelling the mechanisms of action of TH in the developing brain should help make progress in the prevention and treatment of several neurological disorders, including autism and epilepsy.
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Affiliation(s)
| | | | - Frédéric Flamant
- Institut de Génomique Fonctionnelle de Lyon, UMR5242, Ecole Normale Supérieure de Lyon, Centre National de la Recherche Scientifique, Université Claude Bernard-Lyon 1, USC1370 Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Lyon, France
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4
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Dahll LK, Westbye AB, Vinorum K, Sejersted Y, Barøy T, Thorsby PM, Hammerstad SS. Clinical and Biochemical Characteristics of Untreated Adult Patients With Resistance to Thyroid Hormone Alpha. J Endocr Soc 2023; 7:bvad089. [PMID: 37469961 PMCID: PMC10353041 DOI: 10.1210/jendso/bvad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Indexed: 07/21/2023] Open
Abstract
Background Thyroid hormone resistance due to pathogenic variants in thyroid hormone receptor alpha (THRA) is rare and descriptions of patients are sparse. The disorder is probably underdiagnosed as patients may have normal thyroid function tests. Treatment with thyroxine in childhood improves clinical symptoms. However, it is not clear if treatment has beneficial effects if started in adulthood. Cases We investigated 4 previously untreated Caucasian adult first-degree-related patients with the THRA c.788C > T, p.(Ala263Val) variant identified by a gene panel for intellectual disability in the index patient. Clinical data and previous investigations were obtained from medical reports. Results During childhood and adolescence, short stature, short limbs, metacarpals, and phalanges, and delayed bone age maturation were observed. Delayed motor and language development and decreased intellectual and learning abilities were described. Abdominal adiposity, round face, and increased head circumference were common features. All individuals complained of tiredness, constipation, and low mood. While thyrotropin (TSH) and free thyroxine (FT4) were within the reference range, free triiodothyronine (FT3) was high. FT4/FT3 ratio and reverse T3 were low. Other main features were low hemoglobin and high LDL/HDL ratio. Conclusion Investigation of 4 first-degree-related adult patients with untreated resistance to thyroid hormone alpha (RTHα) revealed more pronounced phenotype features and hypothyroid symptoms than previously described in patients treated with levothyroxine from childhood or adolescence. The delay in diagnosis is probably due to normal thyroid function tests. We suggest that THRA analysis should be performed in patients with specific clinical features, as treatment in early childhood may improve outcomes.
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Affiliation(s)
- Louise Koren Dahll
- Correspondence: Louise K. Dahll, MD, The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Postboks 4950, Aker sykehus, Nydalen, Oslo 0424, Norway.
| | - Alexander Bauer Westbye
- Hormone Laboratory, Department of Medical Biochemistry and Biochemical Endocrinology and Metabolism Work Group, Oslo University Hospital, Oslo 0424, Norway
| | - Kristin Vinorum
- Department of Medical Genetics, Oslo University Hospital, Oslo 0424, Norway
| | - Yngve Sejersted
- Department of Medical Genetics, Oslo University Hospital, Oslo 0424, Norway
| | - Tuva Barøy
- Department of Medical Genetics, Oslo University Hospital, Oslo 0424, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry and Biochemical Endocrinology and Metabolism Work Group, Oslo University Hospital, Oslo 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo 0316, Norway
| | - Sara Salehi Hammerstad
- Institute of Clinical Medicine, University of Oslo, Oslo 0316, Norway
- Department of Endocrinology, Oslo University Hospital, Oslo 0424, Norway
- Department of Pediatric Medicine, Oslo University Hospital, Oslo 0424, Norway
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5
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Erbaş IM, Çakır MD, Yener AS, Demir K. Long-term follow-up results and treatment outcomes of children and adults with resistance to thyroid hormone alpha. J Endocrinol Invest 2023:10.1007/s40618-023-02043-1. [PMID: 36821077 DOI: 10.1007/s40618-023-02043-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Resistance to thyroid hormone alpha (RTHα) is a rare entity and has no specific treatment. To date, mostly levothyroxine has been used, but there is a lack of knowledge about the long-term outcomes of this treatment. We aimed to evaluate the long-term follow-up results and treatment outcomes of children and their parents diagnosed with RTHα. METHODS Four children [the median (minimum-maximum) age at diagnosis, 4.5 (1.4-9.5) years] and three adults [age at diagnosis, 31.7 (28.0-35.3) years] from two families were included in the study, who had RTHα and followed up between 2014 and 2021. RESULTS The median duration of treatment was 6.7 (5.9-8.0) years, and the levothyroxine dose at the final visit was 1.4 (1.2-2.2) and 1.9 (1.2-2.4) mcg/kg/day for adults and pediatric patients, respectively. Treatment ameliorated constipation in all patients with this complaint (n = 5). Normal mental functions were achieved and IQ scores improved in most children except one (age at diagnosis, 9.5 years). At the final visit, creatine kinase levels relative to the reference upper limit were significantly lower compared to the pre-treatment ratios [0.9 (0.2-1.3) vs. 1.3 (0.5-1.6), p = 0.028]. Anemia was present in five patients at diagnosis, which resolved in one adult patient but occurred in one child despite treatment (p = 0.999). A minimal pericardial effusion persisted in one pediatric patient. CONCLUSIONS We demonstrated that constipation was ameliorated, neuromotor development of some children was improved, and creatine kinase levels were diminished with levothyroxine treatment in patients with RTHα, while some features including anemia did not resolve.
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Affiliation(s)
- I M Erbaş
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - M D Çakır
- Division of Pediatric Endocrinology, Eskişehir State Hospital, Eskişehir, Turkey
| | - A S Yener
- Division of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - K Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
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Wang M, Roggero VR, Allison LA. Mediator subunit MED1 differentially modulates mutant thyroid hormone receptor intracellular dynamics in Resistance to Thyroid Hormone syndrome. Mol Cell Endocrinol 2023; 559:111781. [PMID: 36191835 PMCID: PMC9985138 DOI: 10.1016/j.mce.2022.111781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
Thyroid hormone receptor (TR) controls the expression of thyroid hormone (T3)-responsive genes, while undergoing rapid nucleocytoplasmic shuttling. In Resistance to Thyroid Hormone syndrome (RTH), mutant TR fails to activate T3-dependent transcription. Previously, we showed that Mediator subunit 1 (MED1) plays a role in TR nuclear retention. Here, we investigated MED1's effect on RTH mutants using nucleocytoplasmic scoring and fluorescence recovery after photobleaching in transfected cells. MED1 overexpression and knockout did not change the nucleocytoplasmic distribution or intranuclear mobility of C392X and P398R TRα1 at physiological T3 levels. At elevated T3 levels, however, overexpression increased P398R's nuclear retention and MED1 knockout decreased P398R's and A263V's intranuclear mobility, while not impacting C392X. Although A263V TRα1-transfected cells had a high percentage of aggregates, MED1 rescued A263V's impaired intranuclear mobility, suggesting that MED1 ameliorates nonfunctional aggregates. Results correlate with clinical severity, suggesting that altered interaction between MED1 and TRα1 mutants contributes to RTH pathology.
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Affiliation(s)
- Moyao Wang
- Department of Biology, William & Mary, 540 Landrum Drive, Integrated Science Center 3030, Williamsburg, VA, 23185, USA
| | - Vincent R Roggero
- Department of Biology, William & Mary, 540 Landrum Drive, Integrated Science Center 3030, Williamsburg, VA, 23185, USA
| | - Lizabeth A Allison
- Department of Biology, William & Mary, 540 Landrum Drive, Integrated Science Center 3030, Williamsburg, VA, 23185, USA.
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Yao B, Yang C, Pan C, Li Y. Thyroid hormone resistance: Mechanisms and therapeutic development. Mol Cell Endocrinol 2022; 553:111679. [PMID: 35738449 DOI: 10.1016/j.mce.2022.111679] [Citation(s) in RCA: 6] [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: 12/09/2020] [Revised: 05/03/2021] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
As an essential primary hormone, thyroid hormone (TH) is indispensable for human growth, development and metabolism. Impairment of TH function in several aspects, including TH synthesis, activation, transportation and receptor-dependent transactivation, can eventually lead to thyroid hormone resistance syndrome (RTH). RTH is a rare syndrome that manifests as a reduced target cell response to TH signaling. The majority of RTH cases are related to thyroid hormone receptor β (TRβ) mutations, and only a few RTH cases are associated with thyroid hormone receptor α (TRα) mutations or other causes. Patients with RTH suffer from goiter, mental retardation, short stature and bradycardia or tachycardia. To date, approximately 170 mutated TRβ variants and more than 20 mutated TRα variants at the amino acid level have been reported in RTH patients. In addition to these mutated proteins, some TR isoforms can also reduce TH function by competing with primary TRs for TRE and RXR binding. Fortunately, different treatments for RTH have been explored with structure-activity relationship (SAR) studies and drug design, and among these treatments. With thyromimetic potency but biochemical properties that differ from those of primary TH (T3 and T4), these TH analogs can bypass specific defective transporters or reactive mutant TRs. However, these compounds must be carefully applied to avoid over activating TRα, which is associated with more severe heart impairment. The structural mechanisms of mutation-induced RTH in the TR ligand-binding domain are summarized in this review. Furthermore, strategies to overcome this resistance for therapeutic development are also discussed.
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Affiliation(s)
- Benqiang Yao
- The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Fujian, 361005, China
| | - Chunyan Yang
- The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Fujian, 361005, China.
| | - Chengxi Pan
- The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Fujian, 361005, China
| | - Yong Li
- The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Fujian, 361005, China.
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Affortit C, Blanc F, Nasr J, Ceccato JC, Markossian S, Guyot R, Puel JL, Flamant F, Wang J. A disease-associated mutation in thyroid hormone receptor α1 causes hearing loss and sensory hair cell patterning defects in mice. Sci Signal 2022; 15:eabj4583. [PMID: 35700264 DOI: 10.1126/scisignal.abj4583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Resistance to thyroid hormone due to mutations in THRA, which encodes the thyroid hormone receptor α (TRα1), shows variable clinical presentation. Mutations affecting TRβ1 and TRβ2 cause deafness in mice and have been associated with deafness in humans. To test whether TRα1 also affects hearing function, we used mice heterozygous for a frameshift mutation in Thra that is similar to human THRA mutations (ThraS1/+ mice) and reduces tissue sensitivity to thyroid hormone. Compared to wild-type littermates, ThraS1/+ mice showed moderate high-frequency sensorineural hearing loss as juveniles and increased age-related hearing loss. Ultrastructural examination revealed aberrant orientation of ~20% of sensory outer hair cells (OHCs), as well as increased numbers of mitochondria with fragmented morphology and autophagic vacuoles in both OHCs and auditory nerve fibers. Molecular dissection of the OHC lateral wall components revealed that the potassium ion channel Kcnq4 was aberrantly targeted to the cytoplasm of mutant OHCs. In addition, mutant cochleae showed increased oxidative stress, autophagy, and mitophagy associated with greater age-related cochlear cell damage, demonstrating that TRα1 is required for proper development of OHCs and for maintenance of OHC function. These findings suggest that patients with THRA mutations may present underdiagnosed, mild hearing loss and may be more susceptible to age-related hearing loss.
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Affiliation(s)
- Corentin Affortit
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France
| | - Fabian Blanc
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France.,Department of ENT and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Jamal Nasr
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France
| | - Jean-Charles Ceccato
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France
| | - Suzy Markossian
- Institut de Génomique Fonctionnelle de Lyon (IGFL), INRAE USC1370, CNRS (UMR5242), ENS, Lyon, France
| | - Romain Guyot
- Institut de Génomique Fonctionnelle de Lyon (IGFL), INRAE USC1370, CNRS (UMR5242), ENS, Lyon, France
| | - Jean-Luc Puel
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France
| | - Frédéric Flamant
- Institut de Génomique Fonctionnelle de Lyon (IGFL), INRAE USC1370, CNRS (UMR5242), ENS, Lyon, France
| | - Jing Wang
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, Montpellier, France.,Department of ENT and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
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Paisdzior S, Schuelke M, Krude H. What is the Role of Thyroid Hormone Receptor Alpha 2 (TRα2) in Human Physiology? Exp Clin Endocrinol Diabetes 2022; 130:296-302. [PMID: 35255520 DOI: 10.1055/a-1716-7980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Thyroid hormone receptors are nuclear receptors that function as transcription factors and are regulated by thyroid hormones. To date, a number of variants and isoforms are known. This review focuses on the thyroid hormone receptor α (TRα), in particular TRα2, an isoform that arises from alternative splicing of the THRA mRNA transcript. Unlike the TRα1 isoform, which can bind T3, the TRα2 isoform lacks a ligand-binding domain but still binds to DNA thereby antagonizing the transcriptional activity of TRα1. Although a regulatory role has been proposed, the physiological function of this TRα2 antagonism is still unclear due to limited in vitro and mouse model data. Recently, the first patients with resistance to thyroid hormone due to mutations in THRA, the TRα encoding gene, affecting the antagonistic function of TRα2 were described, suggesting a significant role of this particular isoform in human physiology.
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Affiliation(s)
- Sarah Paisdzior
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Schuelke
- NeuroCure Cluster of Excellence; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuropediatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Abstract
Thyroid diseases in children and adolescents include acquired or congenital conditions, including genetic disorders either isolated or part of a syndrome. Briefly, we will review the physiology and pathophysiology of the thyroid gland and its disorders. The aim of this chapter is to describe genetic abnormalities of the thyroid gland.
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11
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Tagami T. An overview of thyroid function tests in subjects with resistance to thyroid hormone and related disorders. Endocr J 2021; 68:509-517. [PMID: 33827995 DOI: 10.1507/endocrj.ej21-0059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Confirmation of sustained syndrome of inappropriate secretion of thyrotropin (SITSH) is a milestone in diagnosis of β type of resistance to thyroid hormone (RTHβ). The differential diagnoses of RTHβ include TSH-producing pituitary adenoma (TSHoma) and familial dysalbuminemic hyperthyroxinemia (FDH), which also present SITSH. Recently, patients with RTHα caused by a mutation in thyroid hormone receptor α were reported and they did not present SITSH but a decline in the serum T4/T3 ratio. This review was aimed to overview thyroid function tests in RTH and related disorders. First, the characteristics of the thyroid function in RTHβ, TSHoma, and FDH obtained from a Japanese database are summarized. Second, the degrees of SITSH in patients with truncations and frameshifts were compared with those in patients with single amino acid deletions and single amino acid substitutions obtained from the literature. Third, the degrees of SITSH in homozygous patients were compared with those in heterozygous patients with cognate mutations. Finally, the FT3/FT4 ratios in RTHα are summarized. In principle, the TSH values in FDH were within the normal range and apparent FT4 values in FDH were much higher than in RTHβ and TSHoma. The FT3/FT4 values in RTHβ were significantly lower than in TSHoma. The degrees of SITSH in patients with truncations and frameshifts were more severe than those in patients with single amino acid deletions and single amino acid substitutions, and those in homozygous patients were more severe than those in heterozygous patients with cognate mutations. The FT3/FT4 ratios in RTHα were higher than 1.0.
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Affiliation(s)
- Tetsuya Tagami
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- Clinical Research Institute for Endocrine and Metabolic Diseases, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
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Paisdzior S, Knierim E, Kleinau G, Biebermann H, Krude H, Straussberg R, Schuelke M. A New Mechanism in THRA Resistance: The First Disease-Associated Variant Leading to an Increased Inhibitory Function of THRA2. Int J Mol Sci 2021; 22:ijms22105338. [PMID: 34069457 PMCID: PMC8159125 DOI: 10.3390/ijms22105338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/15/2021] [Indexed: 12/25/2022] Open
Abstract
The nuclear thyroid hormone receptors (THRs) are key mediators of thyroid hormone function on the cellular level via modulation of gene expression. Two different genes encode THRs (THRA and THRB), and are pleiotropically involved in development, metabolism, and growth. The THRA1 and THRA2 isoforms, which result from alternative splicing of THRA, differ in their C-terminal ligand-binding domain (LBD). Most published disease-associated THRA variants are located in the LBD of THRA1 and impede triiodothyronine (T3) binding. This keeps the nuclear receptor in an inactive state and inhibits target gene expression. Here, we investigated a new dominant THRA variant (chr17:g.38,241,010A > G, GRCh37.13 | c.518A > G, NM_199334 | p.(E173G), NP_955366), which is located between the DNA- and ligand-binding domains and affects both splicing isoforms. Patients presented partially with hypothyroid (intellectual disability, motor developmental delay, brain atrophy, and constipation) and partially with hyperthyroid symptoms (tachycardia and behavioral abnormalities) to varying degrees. Functional characterization of THRA1p.(E173G) by reporter gene assays revealed increased transcriptional activity in contrast to THRA1(WT), unexpectedly revealing the first gain-of-function mutation found in THRA1. The THRA2 isoform does not bind T3 and antagonizes THRA1 action. Introduction of p.(E173G) into THRA2 increased its inhibitory effect on THRA1, which helps to explain the hypothyroid symptoms seen in our patients. We used protein structure models to investigate possible underlying pathomechanisms of this variant with a gain-of-antagonistic function and suggest that the p.(E173G) variant may have an influence on the dimerization domain of the nuclear receptor.
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Affiliation(s)
- Sarah Paisdzior
- Institute of Experimental Pediatric Endocrinology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany; (S.P.); (H.B.); (H.K.)
| | - Ellen Knierim
- NeuroCure Cluster of Excellence; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-10117 Berlin, Germany;
- Department of Neuropediatrics, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany
| | - Gunnar Kleinau
- Institute of Medical Physics and Biophysics, Group Protein X-ray Crystallography and Signal Transduction, D-10117 Berlin, Germany;
| | - Heike Biebermann
- Institute of Experimental Pediatric Endocrinology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany; (S.P.); (H.B.); (H.K.)
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany; (S.P.); (H.B.); (H.K.)
| | - Rachel Straussberg
- Schneider Children’s Medical Center, Petach Tikva, Israel, Department of Child Neurology, Neurogenetic Service, affiliated to Sackler School of Medicine, Tel Aviv University, Ramat Aviv IL-69978, Israel
- Correspondence: (R.S.); (M.S.); Tel.: +972-3-9253870 (R.S.); +49-30-450566112 (M.S.); FAX: +972-3-9253871 (R.S.); +49-30-45066920 (M.S.)
| | - Markus Schuelke
- NeuroCure Cluster of Excellence; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-10117 Berlin, Germany;
- Department of Neuropediatrics, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany
- Correspondence: (R.S.); (M.S.); Tel.: +972-3-9253870 (R.S.); +49-30-450566112 (M.S.); FAX: +972-3-9253871 (R.S.); +49-30-45066920 (M.S.)
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13
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Liang Y, Zhao D, Wang R, Dang P, Xi Y, Zhang D, Wang W, Shan Z, Teng X, Teng W. Generation and Characterization of a New Resistance to Thyroid Hormone Mouse Model with Thyroid Hormone Receptor Alpha Gene Mutation. Thyroid 2021; 31:678-691. [PMID: 32924834 DOI: 10.1089/thy.2019.0733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: In humans, resistance to thyroid hormone (RTH) caused by mutations in the thyroid hormone receptor alpha (THRA) gene, RTHα, manifests as tissue-specific hypothyroidism and circulating thyroid hormone levels exhibit hypothyroid-like clinical features. Before the identification of patients with RTHα, several Thrα1 knock-in mouse models were generated to clarify the function of TRα1. However, the phenotypes of these mice were not consistent with the clinical presentation of RTHα in humans. For the present study, we generated an RTHα mouse model that carries the Thra1E403X mutation found in human RTHα patients. Here, we report the gross phenotypes of this mouse RTHα model. Methods: Traditional homologous recombination gene targeting techniques were used to introduce a mutation (Thra1E403X) in the mouse Thra gene. The phenotypes of the resulting mice were studied and compared with clinical features observed for RTHα with THRAE403X. Results: Thrα1E403X/E403X homozygous mice exhibited severe neurological phenotypes, such as spasticity and motor ataxia, which were similar to those observed in endemic cretinism. Thrα1E403X/+ heterozygous mice reproduced most clinical manifestations of patient with RTHα, such as a normal survival rate and male fertility, as well as delayed postnatal growth and development, neurological and motor coordination deficits, and anemia. The mice had typical thyroid function with a modest increase in serum triiodothyronine (T3) levels, a low thyroxine (T4)/T3 ratio, and low reverse T3 (rT3) levels. Conclusions: The Thrα1E403X/+ mice faithfully recapitulate the clinical features of human RTHα and thus can provide a useful tool to dissect the role of TRα1 in development and to determine the pathological mechanisms of RTHα.
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Affiliation(s)
- Yue Liang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Defa Zhao
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Ranran Wang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Pingping Dang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Yue Xi
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Dan Zhang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Wei Wang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
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Abstract
Resistance to thyroid hormone alpha occurs due to pathogenic, heterozygous variants in THRA. The entity was first described in 2012 and to date only a small number of patients with varying severity have been reported. In this review, we summarize and interpret the heterogeneous clinical and laboratory features of all published cases, including ours. Many symptoms and findings are similar to those seen in primary hypothyroidism. However, thyroid-stimulating hormone levels are normal. Free triiodothyronine (T3) levels are in the upper half of normal range or frankly high and free thyroxine (T4) levels are low or in the lower half of normal range. Alterations in free T3 and free T4 may not be remarkable, particularly in adults, possibly contributing to underdiagnosis. In such patients, low reverse T3 levels, normo- or macrocytic anemia or, particularly in children, mildly elevated creatine kinase levels would warrant THRA sequencing. Treatment with L-thyroxine results in improvement of some clinical findings.
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Affiliation(s)
- İbrahim Mert Erbaş
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 412 60 77 E-mail:
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15
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Al Shidhani A, Ullah I, AlSaffar H, Al Kindi A, Al Nabhani H, Al Yaarubi S. Thyroid Hormone Resistance due to a Novel De Novo Mutation in Thyroid Hormone Receptor Alpha: First Case Report from the Middle East and North Africa. Oman Med J 2021; 36:e226. [PMID: 33628462 PMCID: PMC7897355 DOI: 10.5001/omj.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Abstract
The physiological actions of thyroid hormone (TH) are mediated through TH alpha and TH beta receptors. Resistance to TH (RTH) is characterized by a lack of peripheral tissues’ response to the active form of TH. TH receptor beta has been extensively studied. Mutations in this receptor were considered the main reason for TH resistance for some time up until the discovery of mutations in TH receptor alpha (TRα) that has attained more focus and interest in recent years. A 13-year-old child with classic hypothyroidism features (coarse facies, growth and developmental delay, skeletal dysplasia, generalized muscular hypertrophy, and severe constipation) associated with near-normal thyroid hormone levels, which did not support the diagnosis of hypothyroidism biochemically. Therefore, progressing with whole-exome sequencing had revealed a de novo heterozygous mutation in a gene encoding TRα that establishes a diagnosis of RTHα. This case report demonstrates a rare form of TH resistance due to mutation of TRα. It also emphasizes that THs act through distinctive receptor subtypes in different target tissues. Moreover, this report aims to raise awareness about this genetic mutation, which is thought to be more common than expected. However, due to its subtle features and insidious presentation, many cases remain undiagnosed; hence, the disorder’s exact incidence is unknown.
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Affiliation(s)
- Azza Al Shidhani
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Irfan Ullah
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hussain AlSaffar
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adila Al Kindi
- Genetic Department, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Saif Al Yaarubi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
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16
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Han CR, Wang H, Hoffmann V, Zerfas P, Kruhlak M, Cheng SY. Thyroid Hormone Receptor α Mutations Cause Heart Defects in Zebrafish. Thyroid 2021; 31:315-326. [PMID: 32762296 PMCID: PMC7891307 DOI: 10.1089/thy.2020.0332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Mutations of thyroid hormone receptor α1 (TRα1) cause resistance to thyroid hormone (RTHα). Patients exhibit growth retardation, delayed bone development, anemia, and bradycardia. By using mouse models of RTHα, much has been learned about the molecular actions of TRα1 mutants that underlie these abnormalities in adults. Using zebrafish models of RTHα that we have recently created, we aimed to understand how TRα1 mutants affect the heart function during this period. Methods: In contrast to human and mice, the thra gene is duplicated, thraa and thrab, in zebrafish. Using CRISPR/Cas9-mediated targeted mutagenesis, we created C-terminal mutations in each of two duplicated thra genes in zebrafish (thraa 8-bp insertion or thrab 1-bp insertion mutations). We recently showed that these mutant fish faithfully recapitulated growth retardation as found in patients and thra mutant mice. In the present study, we used histological analysis, gene expression profiles, confocal fluorescence, and transmission electron microscopy (TEM) to comprehensively analyze the phenotypic characteristics of mutant fish heart during development. Results: We found both a dilated atrium and an abnormally shaped ventricle in adult mutant fish. The retention of red blood cells in the two abnormal heart chambers, and the decreased circulating blood speed and reduced expression of contractile genes indicated weakened contractility in the heart of mutant fish. These abnormalities were detected in mutant fish as early as 35 days postfertilization (juveniles). Furthermore, the expression of genes associated with the sarcomere assembly was suppressed in the heart of mutant fish, resulting in abnormalities of sarcomere organization as revealed by TEM, suggesting that the abnormal sarcomere organization could underlie the bradycardia exhibited in mutant fish. Conclusions: Using a zebrafish model of RTHα, the present study demonstrated for the first time that TRα1 mutants could act to cause abnormal heart structure, weaken contractility, and disrupt sarcomere organization that affect heart functions. These findings provide new insights into the bradycardia found in RTHα patients.
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Affiliation(s)
- Cho Rong Han
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hui Wang
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Victoria Hoffmann
- Diagnostic and Research Services Branch, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Patricia Zerfas
- Diagnostic and Research Services Branch, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Kruhlak
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sheue-Yann Cheng
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Address correspondence to: Sheue-Yann Cheng, PhD, Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Room 5128, Bethesda, MD 20892-4264, USA
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17
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van der Spek AH, Fliers E, Boelen A. Thyroid Hormone and Deiodination in Innate Immune Cells. Endocrinology 2021; 162:6016930. [PMID: 33275661 DOI: 10.1210/endocr/bqaa200] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Thyroid hormone has recently been recognized as an important determinant of innate immune cell function. Highly specialized cells of the innate immune system, including neutrophils, monocytes/macrophages, and dendritic cells, are capable of identifying pathogens and initiating an inflammatory response. They can either phagocytose and kill microbes, or recruit other innate or adaptive immune cells to the site of inflammation. Innate immune cells derive from the hematopoietic lineage and are generated in the bone marrow, from where they can be recruited into the blood and tissues in the case of infection. The link between the immune and endocrine systems is increasingly well established, and recent studies have shown that innate immune cells can be seen as important thyroid hormone target cells. Tight regulation of cellular thyroid hormone availability and action is performed by thyroid hormone transporters, receptors, and the deiodinase enzymes. Innate immune cells express all these molecular elements of intracellular thyroid hormone metabolism. Interestingly, there is recent evidence for a causal relationship between cellular thyroid hormone status and innate immune cell function. This review describes the effects of modulation of intracellular thyroid hormone metabolism on innate immune cell function, specifically neutrophils, macrophages, and dendritic cells, with a special focus on the deiodinase enzymes. Although there are insufficient data at this stage for conclusions on the clinical relevance of these findings, thyroid hormone metabolism may partially determine the innate immune response and, by inference, the clinical susceptibility to infections.
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Affiliation(s)
- Anne H van der Spek
- Amsterdam UMC, University of Amsterdam, Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology & Metabolism, AZ Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology & Metabolism, AZ Amsterdam, the Netherlands
| | - Eric Fliers
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology & Metabolism, AZ Amsterdam, the Netherlands
| | - Anita Boelen
- Amsterdam UMC, University of Amsterdam, Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology Endocrinology & Metabolism, AZ Amsterdam, the Netherlands
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18
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Lauffer P, van Trotsenburg ASP, Zwaveling-Soonawala N. Low free thyroxine and normal thyroid-stimulating hormone in infants and children: possible causes and diagnostic work-up. Eur J Pediatr 2021; 180:2333-2338. [PMID: 33585976 PMCID: PMC8195777 DOI: 10.1007/s00431-021-03976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
Screening for hypo- or hyperthyroidism in adults is generally done by measuring the serum thyrotropin (thyroid-stimulating hormone, TSH) concentration. This is an efficient approach in case of suspected acquired thyroid disease. However, in infants and children, congenital hypothalamus-pituitary-thyroid (HPT) axis disorders also need to be considered, including primary and central congenital hypothyroidism, and even rarer thyroid hormone receptor and transporter defects. In primary congenital hypothyroidism, TSH will be elevated, but in the other congenital HPT axis disorders, TSH is usually within the normal range. Free thyroxine (FT4) assessment is essential for the diagnosis in these conditions.Conclusion: Here we discuss a number of rare congenital HPT axis disorders in which TSH is normal, but FT4 is low, and provide a clinical algorithm to distinguish between these disorders. What is Known: • A single thyroid-stimulating hormone (TSH) measurement is an appropriate screening method for primary hypothyroidism. • For central hypothyroidism and rare thyroid hormone receptor and transporter defects a free thyroxine (FT4) measurement is essential for the diagnosis because TSH is usually normal. What is New: • Here we present a new problem-oriented clinical algorithm including a diagnostic flow-chart for low FT4 and normal TSH in infants and children.
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Affiliation(s)
- Peter Lauffer
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - A. S. Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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19
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Rubingh J, van der Spek A, Fliers E, Boelen A. The Role of Thyroid Hormone in the Innate and Adaptive Immune Response during Infection. Compr Physiol 2020; 10:1277-1287. [PMID: 32969509 DOI: 10.1002/cphy.c200003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past decades, there has been growing evidence for a functional interaction between the thyroid hormone and the immune system. This article provides an overview of the mechanisms by which thyroid hormones affect the innate and adaptive immune response during infection. The influence of thyroid hormone on the most important players of the innate [neutrophils, macrophages, natural killer (NK) cells, and dendritic cells (DCs)] and adaptive immune system (B- and T-lymphocytes) is reviewed here based on both clinical and preclinical studies. The effects of modulation of the immune system by drugs, such as monoclonal antibodies, tyrosine kinase inhibitors, and interferons on thyroid function, are beyond the scope of this article. Thyroid hormones regulate the activity of neutrophils which is reflected by higher numbers of neutrophils outside the bloodstream and enhanced activity of the respiratory burst following stimulation with thyroid hormone. Hyperthyroidism affects neutrophil function to a larger extent than hypothyroidism. In addition to neutrophil function, macrophage function is strongly affected by thyroid hormones, with triiodothyronine having a pro-inflammatory effect in these cells. NK cell proliferation and cytotoxic activity are also dependent on thyroid hormone levels. Finally, thyroid hormones enhance DC proliferation and maturation. In the adaptive immune system, a hyperthyroid state leads to increased activation of lymphocytes. This effect of thyroid hormone is mediated by various factors including NF-κB and protein kinase C signaling pathways and the β-adrenergic receptor. In general, a hyperthyroid state leads to a more activated immune system whereas hypothyroidism leads to a less activated immune system. © 2020 American Physiological Society. Compr Physiol 10:1277-1287, 2020.
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Affiliation(s)
- Julia Rubingh
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne van der Spek
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Leitch VD, Bassett JHD, Williams GR. Role of thyroid hormones in craniofacial development. Nat Rev Endocrinol 2020; 16:147-164. [PMID: 31974498 DOI: 10.1038/s41574-019-0304-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
Abstract
The development of the craniofacial skeleton relies on complex temporospatial organization of diverse cell types by key signalling molecules. Even minor disruptions to these processes can result in deleterious consequences for the structure and function of the skull. Thyroid hormone deficiency causes delayed craniofacial and tooth development, dysplastic facial features and delayed development of the ossicles in the middle ear. Thyroid hormone excess, by contrast, accelerates development of the skull and, in severe cases, might lead to craniosynostosis with neurological sequelae and facial hypoplasia. The pathogenesis of these important abnormalities remains poorly understood and underinvestigated. The orchestration of craniofacial development and regulation of suture and synchondrosis growth is dependent on several critical signalling pathways. The underlying mechanisms by which these key pathways regulate craniofacial growth and maturation are largely unclear, but studies of single-gene disorders resulting in craniofacial malformations have identified a number of critical signalling molecules and receptors. The craniofacial consequences resulting from gain-of-function and loss-of-function mutations affecting insulin-like growth factor 1, fibroblast growth factor receptor and WNT signalling are similar to the effects of altered thyroid status and mutations affecting thyroid hormone action, suggesting that these critical pathways interact in the regulation of craniofacial development.
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Affiliation(s)
- Victoria D Leitch
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Royal Melbourne Institute of Technology (RMIT) Centre for Additive Manufacturing, RMIT University, Melbourne, VIC, Australia
| | - J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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21
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Wejaphikul K, van Gucht ALM, Groeneweg S, Visser WE, Visser TJ, Peeters RP, Meima ME. The In Vitro Functional Impairment of Thyroid Hormone Receptor Alpha 1 Isoform Mutants Is Mainly Dictated by Reduced Ligand Sensitivity. Thyroid 2019; 29:1834-1842. [PMID: 31530256 DOI: 10.1089/thy.2019.0019] [Citation(s) in RCA: 2] [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] [Indexed: 01/09/2023]
Abstract
Background: Thyroid hormone (TH) acts on TH receptors (TRs) and regulates gene transcription by binding of TRs to TH response elements (TREs) in target gene promoters. The transcriptional activity of TRs is modulated by interactions with TR-coregulatory proteins. Mutations in TRα cause resistance to thyroid hormone alpha (RTHα). In this study, we analyzed if, beyond reduced triiodothyronine (T3) affinity, altered interactions with cofactors or different TREs could account for the differential impaired transcriptional activity of different mutants. Methods: We evaluated four mutants derived from patients (D211G, M256T, A263S, and R384H) and three artificial mutants at equivalent positions in patients with RTHβ (T223A, L287V, and P398H). The in vitro transcriptional activity was evaluated on TRE-luciferase reporters (DR4, IR0, and ER6). The affinity for T3 and interaction with coregulatory proteins (nuclear receptor corepressor 1 [NCoR1] and steroid receptor coactivator 1 [SRC1]) were also determined. Results: We found that the affinity for T3 was significantly reduced for all mutants, except for TRα1-T223A. The reduction in the T3 sensitivity of the transcriptional activity on three TREs, the dissociation of the corepressor NCoR1, and the association of the coactivator SRC1 recruitment for each mutant correlated with the reduced affinity for T3. We did not observe mutation-specific alterations in interactions with cofactors or TREs. Conclusions: In summary, the degree of impaired transcriptional activity of mutants is mainly determined by their reduced affinity for T3.
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Affiliation(s)
- Karn Wejaphikul
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anja L M van Gucht
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Groeneweg
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Marcel E Meima
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
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22
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Boumaza H, Markossian S, Busi B, Rautureau GJP, Gauthier K, Elena-Herrmann B, Flamant F. Metabolomic Profiling of Body Fluids in Mouse Models Demonstrates that Nuclear Magnetic Resonance Is a Putative Diagnostic Tool for the Presence of Thyroid Hormone Receptor α1 Mutations. Thyroid 2019; 29:1327-1335. [PMID: 31298651 DOI: 10.1089/thy.2018.0730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Resistance to thyroid hormone alpha (RTHα) is a rare genetic disease due to mutations in the THRA gene, which encodes thyroid hormone receptor alpha 1 (TRα1). Since its first description in 2012, 46 cases of RTHα have been reported worldwide, corresponding to 26 different mutations of TRα1. RTHα patients share some common symptoms with hypothyroid patients, without significant reduction in thyroid hormone level. The high variability of clinical features and the absence of reliable biochemical markers make the diagnosis of this disease difficult. Some of these mutations have been recently modeled in mice. Methods: In our study, we used four different mouse models heterozygous for frameshift mutations in the Thra gene. Two of them are very close to human mutations, while the two others have not yet been found in patients. We characterized the metabolic phenotypes of urine and plasma samples collected from these four animal models using an untargeted nuclear magnetic resonance (NMR)-based metabolomic approach. Results: Multivariate statistical analysis of the metabolomic profiles shows that biofluids of mice that carry human-like mutations can be discriminated from controls. Metabolic signatures associated with Thra mutations in urine and plasma are stable over time and clearly differ from the metabolic fingerprint of hypothyroidism in the mouse. Conclusion: Our results provide a proof-of-principle that easily accessible NMR-based metabolic fingerprints of biofluids could be used to diagnose RTHα in humans.
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Affiliation(s)
- Houda Boumaza
- Institut des Sciences Analytiques, UMR 5280, CNRS, ENS de Lyon, Université Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- Institut de Génomique Fonctionnelle de Lyon, INRA USC 1370, Université de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Suzy Markossian
- Institut de Génomique Fonctionnelle de Lyon, INRA USC 1370, Université de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Baptiste Busi
- Institut des Sciences Analytiques, UMR 5280, CNRS, ENS de Lyon, Université Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Gilles J P Rautureau
- Institut des Sciences Analytiques, UMR 5280, CNRS, ENS de Lyon, Université Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Karine Gauthier
- Institut de Génomique Fonctionnelle de Lyon, INRA USC 1370, Université de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Bénédicte Elena-Herrmann
- Institut des Sciences Analytiques, UMR 5280, CNRS, ENS de Lyon, Université Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- Institute for Advanced Biosciences, CNRS UMR 5309, INSERM U1209, Université Grenoble Alpes, Grenoble, France
| | - Frédéric Flamant
- Institut de Génomique Fonctionnelle de Lyon, INRA USC 1370, Université de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon, France
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Wejaphikul K, Groeneweg S, Hilhorst-Hofstee Y, Chatterjee VK, Peeters RP, Meima ME, Visser WE. Insight Into Molecular Determinants of T3 vs T4 Recognition From Mutations in Thyroid Hormone Receptor α and β. J Clin Endocrinol Metab 2019; 104:3491-3500. [PMID: 30817817 PMCID: PMC6599431 DOI: 10.1210/jc.2018-02794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/25/2019] [Indexed: 12/27/2022]
Abstract
CONTEXT The two major forms of circulating thyroid hormones (THs) are T3 and T4. T3 is regarded as the biologically active hormone because it binds to TH receptors (TRs) with greater affinity than T4. However, it is currently unclear what structural mechanisms underlie this difference in affinity. OBJECTIVE Prompted by the identification of a novel M256T mutation in a resistance to TH (RTH)α patient, we investigated Met256 in TRα1 and the corresponding residue (Met310) in TRβ1, residues previously predicted by crystallographic studies in discrimination of T3 vs T4. METHODS Clinical characterization of the RTHα patient and molecular studies (in silico protein modeling, radioligand binding, transactivation, and receptor-cofactor studies) were performed. RESULTS Structural modeling of the TRα1-M256T mutant showed that distortion of the hydrophobic niche to accommodate the outer ring of ligand was more pronounced for T3 than T4, suggesting that this substitution has little impact on the affinity for T4. In agreement with the model, TRα1-M256T selectively reduced the affinity for T3. Also, unlike other naturally occurring TRα mutations, TRα1-M256T had a differential impact on T3- vs T4-dependent transcriptional activation. TRα1-M256A and TRβ1-M310T mutants exhibited similar discordance for T3 vs T4. CONCLUSIONS Met256-TRα1/Met310-TRβ1 strongly potentiates the affinity of TRs for T3, thereby largely determining that T3 is the bioactive hormone rather than T4. These observations provide insight into the molecular basis for underlying the different affinity of TRs for T3 vs T4, delineating a fundamental principle of TH signaling.
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Affiliation(s)
- Karn Wejaphikul
- Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, Rotterdam, Netherlands
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Stefan Groeneweg
- Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, Rotterdam, Netherlands
| | | | - V Krishna Chatterjee
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, Rotterdam, Netherlands
| | - Marcel E Meima
- Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, Rotterdam, Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, Rotterdam, Netherlands
- Correspondence and Reprint Requests: W. Edward Visser, MD, PhD, Department of Internal Medicine, Erasmus Medical Center, Academic Center for Thyroid Diseases, 3015 CN Rotterdam, Netherlands. E-mail:
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Korkmaz O, Ozen S, Ozdemir TR, Goksen D, Darcan S. A novel thyroid hormone receptor alpha gene mutation, clinic characteristics, and follow-up findings in a patient with thyroid hormone resistance. Hormones (Athens) 2019; 18:223-227. [PMID: 30747412 DOI: 10.1007/s42000-019-00094-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Thyroid hormone receptor alpha (THRA) gene mutation is a thyroid hormone resistance syndrome characterized by near-normal thyroid function tests and tissue-specific hypothyroidism. In this case study, we report a novel de novo p.G291S heterozygous mutation in the THRA gene was detected at mutation analysis. A 4-year-old male patient was admitted due to short stature, motor-mental retardation, and constipation. At physical examination, coarse facial appearance, eyelid edema, pallor, and umbilical hernia were observed. Primary thyroid hormone resistance should be considered in patients with phenotypically hypothyroid features. Laboratory analysis found moderate elevation in free triiodothyronine (T3) levels, normochromic normocytic anemia, and elevated creatine kinase levels. In conclusion, THRA gene mutation should be considered in patients with clinical hypothyroid findings and increased/moderately elevated free T3, decreased/ normal free thyroxine, normal thyroid-stimulating hormone levels, and increased muscle enzymes.
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Affiliation(s)
- Ozlem Korkmaz
- Ege University Faculty of Medicine Department of Pediatric Endocrinology and Diabetes, Ege University, 35100 Bornova, Izmir, Turkey.
| | - Samim Ozen
- Ege University Faculty of Medicine Department of Pediatric Endocrinology and Diabetes, Ege University, 35100 Bornova, Izmir, Turkey
| | - Taha Resid Ozdemir
- Tepecik Training and Research Hospital, Department of Genetics, Health Sciences University, Izmir, Turkey
| | - Damla Goksen
- Ege University Faculty of Medicine Department of Pediatric Endocrinology and Diabetes, Ege University, 35100 Bornova, Izmir, Turkey
| | - Sukran Darcan
- Ege University Faculty of Medicine Department of Pediatric Endocrinology and Diabetes, Ege University, 35100 Bornova, Izmir, Turkey
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25
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Freudenthal B, Shetty S, Butterfield NC, Logan JG, Han CR, Zhu X, Astapova I, Hollenberg AN, Cheng SY, Bassett JD, Williams GR. Genetic and Pharmacological Targeting of Transcriptional Repression in Resistance to Thyroid Hormone Alpha. Thyroid 2019; 29:726-734. [PMID: 30760120 PMCID: PMC6533791 DOI: 10.1089/thy.2018.0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Thyroid hormones act in bone and cartilage via thyroid hormone receptor alpha (TRα). In the absence of triiodothyronine (T3), TRα interacts with co-repressors, including nuclear receptor co-repressor-1 (NCoR1), which recruit histone deacetylases (HDACs) and mediate transcriptional repression. Dominant-negative mutations of TRα cause resistance to thyroid hormone alpha (RTHα; OMIM 614450), characterized by excessive repression of T3 target genes leading to delayed skeletal development, growth retardation, and bone dysplasia. Treatment with thyroxine has been of limited benefit, even in mildly affected individuals, and there is a need for new therapeutic strategies. It was hypothesized that (i) the skeletal manifestations of RTHα are mediated by the persistent TRα/NCoR1/HDAC repressor complex containing mutant TRα, and (ii) treatment with the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) would ameliorate these manifestations. Methods: The skeletal phenotypes of (i) Thra1PV/+ mice, a well characterized model of RTHα; (ii) Ncor1ΔID/ΔID mice, which express an NCoR1 mutant that fails to interact with TRα; and (iii) Thra1PV/+Ncor1ΔID/ΔID double-mutant adult mice were determined. Wild-type, Thra1PV/+, Ncor1ΔID/ΔID, and Thra1PV/+Ncor1ΔID/ΔID double-mutant mice were also treated with SAHA to determine whether HDAC inhibition results in amelioration of skeletal abnormalities. Results:Thra1PV/+ mice had a severe skeletal dysplasia, characterized by short stature, abnormal bone morphology, and increased bone mineral content. Despite normal bone length, Ncor1ΔID/ΔID mice displayed increased cortical bone mass, mineralization, and strength. Thra1PV/+Ncor1ΔID/ΔID double-mutant mice displayed only a small improvement of skeletal abnormalities compared to Thra1PV/+ mice. Treatment with SAHA to inhibit histone deacetylation had no beneficial or detrimental effects on bone structure, mineralization, or strength in wild-type or mutant mice. Conclusions: These studies indicate treatment with SAHA is unlikely to improve the skeletal manifestations of RTHα. Nevertheless, the findings (i) confirm that TRα1 has a critical role in the regulation of skeletal development and adult bone mass, (ii) suggest a physiological role for alternative co-repressors that interact with TR in skeletal cells, and (iii) demonstrate a novel role for NCoR1 in the regulation of adult bone mass and strength.
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Affiliation(s)
- Bernard Freudenthal
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Samiksha Shetty
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Natalie C. Butterfield
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - John G. Logan
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Cho Rong Han
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xuguang Zhu
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Inna Astapova
- Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Anthony N. Hollenberg
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine and New York Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Sheue-Yann Cheng
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - J.H. Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
- Address correspondence to: J.H. Duncan Bassett, BMBCh, PhD, Molecular Endocrinology Laboratory, Commonwealth Building, Hammersmith Campus, Imperial College London, Du Cane Road, London, W12 0NN, United Kingdom
| | - Graham R. Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
- Graham R. Williams, MBBS, PhD, Molecular Endocrinology Laboratory, Commonwealth Building, Hammersmith Campus, Imperial College London, Du Cane Road, London, W12 0NN, United Kingdom
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26
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Sun H, Wu H, Xie R, Wang F, Chen T, Chen X, Wang X, Flamant F, Chen L. New Case of Thyroid Hormone Resistance α Caused by a Mutation of THRA /TR α1. J Endocr Soc 2019; 3:665-669. [PMID: 30842990 PMCID: PMC6397419 DOI: 10.1210/js.2019-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/30/2019] [Indexed: 01/30/2023] Open
Abstract
We found a sporadic case of mental retardation associated with short stature and constipation. We investigated the possible genetic origin of the syndrome. Clinical and biochemical investigations were conducted. Exome sequencing was used to search for pathogenic variations. A de novo mutation (c.1183G>T, p.E395X) was found in one allele of the THRA gene. The mutation creates a stop codon, which eliminates the C-terminal helix of the TRα1 receptor for thyroid hormone. The patient has typical symptoms for the resistance to thyroid hormone α (RTHα) genetic disease, but has a normal head circumference. There are now 21 known mutations in THRA. All mutations that alter the C-terminal helix of TRα1 lead to severe forms of RTHα.
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Affiliation(s)
- Hui Sun
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Haiying Wu
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Rongrong Xie
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Fengyun Wang
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Ting Chen
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Xiuli Chen
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Xiaoyan Wang
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
| | - Frédéric Flamant
- Institut de Génomique Fonctionnelle de Lyon, INRA USC 1370, Université de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon cedex 07, France
| | - Linqi Chen
- Department of Endocrinology, Metabolism, and Genetic Diseases, Children's Hospital of Soochow University, Jiangsu, China
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27
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Persani L, Campi I. Syndromes of Resistance to Thyroid Hormone Action. EXPERIENTIA SUPPLEMENTUM (2012) 2019; 111:55-84. [PMID: 31588528 DOI: 10.1007/978-3-030-25905-1_5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Thyroid hormone (TH) action is crucial for the development of several tissues.A number of syndromes are associated with reduced responsiveness to thyroid hormones, expanding the original definition of thyroid hormone resistance, firstly described by Refetoff and collaborators in 1967, which is characterized by elevated circulating levels of T4 and T3 with measurable serum TSH concentrations, as a consequence of mutations of thyroid hormone receptor beta (TRβ), recently named as RTHβ. More recently, another form of insensitivity to TH has been identified due to mutations in the thyroid hormone receptor alpha (TRα), named RTHα. In this chapter we will focus the discussion on the phenotype of RTHβ and RTHα. These diseases share the same pathogenic mechanism caused by dominant negative mutations in TH receptor genes that reduce T3 binding or affect the recruitment of cofactors. As a consequence, thyroid hormone actions are impaired at the tissue level. The phenotypic manifestations of RTHβ and RTHα are to some extent correlated with the degree of disruption and the tissue distribution of the TRs being characterized by variable coexistence of hypothyroid or thyrotoxic manifestations in RTHβ or by a congenital hypothyroid features in RTHα despite normal TSH and borderline low free T4.
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Affiliation(s)
- Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Department of Endocrine and Metabolic Diseases, Lab of Endocrine and Metabolic Research, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Irene Campi
- Department of Endocrine and Metabolic Diseases, Lab of Endocrine and Metabolic Research, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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28
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Barakat-Walter I, Kraftsik R. Stimulating effect of thyroid hormones in peripheral nerve regeneration: research history and future direction toward clinical therapy. Neural Regen Res 2018; 13:599-608. [PMID: 29722302 PMCID: PMC5950660 DOI: 10.4103/1673-5374.230274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Injury to peripheral nerves is often observed in the clinic and severe injuries may cause loss of motor and sensory functions. Despite extensive investigation, testing various surgical repair techniques and neurotrophic molecules, at present, a satisfactory method to ensuring successful recovery does not exist. For successful molecular therapy in nerve regeneration, it is essential to improve the intrinsic ability of neurons to survive and to increase the speed of axonal outgrowth. Also to induce Schwann cell phenotypical changes to prepare the local environment favorable for axonal regeneration and myelination. Therefore, any molecule that regulates gene expression of both neurons and Schwann cells could play a crucial role in peripheral nerve regeneration. Clinical and experimental studies have reported that thyroid hormones are essential for the normal development and function of the nervous system, so they could be candidates for nervous system regeneration. This review provides an overview of studies devoted to testing the effect of thyroid hormones on peripheral nerve regeneration. Also it emphasizes the importance of combining biodegradable tubes with local administration of triiodothyronine for future clinical therapy of human severe injured nerves. We highlight that the local and single administration of triiodothyronine within biodegradable nerve guide improves significantly the regeneration of severed peripheral nerves, and accelerates functional recovering. This technique provides a serious step towards future clinical application of triiodothyronine in human severe injured nerves. The possible regulatory mechanism by which triiodothyronine stimulates peripheral nerve regeneration is a rapid action on both axotomized neurons and Schwann cells.
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Affiliation(s)
- I Barakat-Walter
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R Kraftsik
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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29
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Abstract
Thyroid hormones are essential for skeletal development and are important regulators of bone maintenance in adults. Childhood hypothyroidism causes delayed skeletal development, retarded linear growth and impaired bone mineral accrual. Epiphyseal dysgenesis is evidenced by classic features of stippled epiphyses on X-ray. In severe cases, post-natal growth arrest results in a complex skeletal dysplasia. Thyroid hormone replacement stimulates catch-up growth and bone maturation, but recovery may be incomplete dependent on the duration and severity of hypothyroidism prior to treatment. A severe phenotype characteristic of hypothyroidism occurs in children with resistance to thyroid hormone due to mutations affecting THRA encoding thyroid hormone receptor α (TRα). Discovery of this rare condition recapitulated animal studies demonstrating that TRα mediates thyroid hormone action in the skeleton. In adults, thyrotoxicosis is well known to cause severe osteoporosis and fracture, but cases are rare because of prompt diagnosis and treatment. Recent data, however, indicate that subclinical hyperthyroidism is associated with low bone mineral density (BMD) and an increased risk of fracture. Population studies have also shown that variation in thyroid status within the reference range in post-menopausal women is associated with altered BMD and fracture risk. Thus, thyroid status at the upper end of the euthyroid reference range is associated with low BMD and increased risk of osteoporotic fragility fracture. Overall, extensive data demonstrate that euthyroid status is required for normal post-natal growth and bone mineral accrual, and is fundamental for maintenance of adult bone structure and strength.
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Affiliation(s)
- G. R. Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, 10N5 Commonwealth Building, London, W12 0NN UK
| | - J. H. D. Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, 10N6 Commonwealth Building, London, W12 0NN UK
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30
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Markossian S, Guyot R, Richard S, Teixeira M, Aguilera N, Bouchet M, Plateroti M, Guan W, Gauthier K, Aubert D, Flamant F. CRISPR/Cas9 Editing of the Mouse Thra Gene Produces Models with Variable Resistance to Thyroid Hormone. Thyroid 2018; 28:139-150. [PMID: 29205102 DOI: 10.1089/thy.2017.0389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Resistance to thyroid hormone due to THRA mutations (RTHα) is a recently discovered genetic disease, displaying important variability in its clinical presentation. The mutations alter the function of TRα1, one of the two nuclear receptors for thyroid hormone. METHODS The aim of this study was to understand the relationship between specific THRA mutations and phenotype. CRISPR/Cas9 genome editing was used to generate five new mouse models of RTHα, with frameshift or missense mutations. RESULTS Like human patients, mutant mice displayed a hypothyroid-like phenotype, with altered development. Phenotype severity varied between the different mouse models, mainly depending on the ability of the mutant receptor to interact with transcription corepressor in the presence of thyroid hormone. CONCLUSION The present mutant mice represent highly relevant models for the human genetic disease which will be useful for future investigations.
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Affiliation(s)
- Suzy Markossian
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Romain Guyot
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Sabine Richard
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Marie Teixeira
- 2 Plateau de Biologie Expérimentale de la Souris SFR Biosciences, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Nadine Aguilera
- 2 Plateau de Biologie Expérimentale de la Souris SFR Biosciences, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Mathilde Bouchet
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | | | - Wenyue Guan
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Karine Gauthier
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Denise Aubert
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
| | - Frédéric Flamant
- 1 Institut de Génomique Fonctionnelle de Lyon, Université de Lyon CNRS UMR 5242, INRA USC 1370, Ecole Normale Supérieure de Lyon , Lyon, France
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31
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van der Spek AH, Surovtseva OV, Aan S, Tool ATJ, van de Geer A, Demir K, van Gucht ALM, van Trotsenburg ASP, van den Berg TK, Fliers E, Boelen A. Increased circulating interleukin-8 in patients with resistance to thyroid hormone receptor α. Endocr Connect 2017; 6:731-740. [PMID: 29101248 PMCID: PMC5670275 DOI: 10.1530/ec-17-0213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 12/20/2022]
Abstract
Innate immune cells have recently been identified as novel thyroid hormone (TH) target cells in which intracellular TH levels appear to play an important functional role. The possible involvement of TH receptor alpha (TRα), which is the predominant TR in these cells, has not been studied to date. Studies in TRα0/0 mice suggest a role for this receptor in innate immune function. The aim of this study was to determine whether TRα affects the human innate immune response. We assessed circulating interleukin-8 concentrations in a cohort of 8 patients with resistance to TH due to a mutation of TRα (RTHα) and compared these results to healthy controls. In addition, we measured neutrophil and macrophage function in one of these RTHα patients (mutation D211G). Circulating interleukin-8 levels were elevated in 7 out of 8 RTHα patients compared to controls. These patients harbor different mutations, suggesting that this is a general feature of the syndrome of RTHα. Neutrophil spontaneous apoptosis, bacterial killing, NAPDH oxidase activity and chemotaxis were unaltered in cells derived from the RTHαD211G patient. RTHα macrophage phagocytosis and cytokine induction after LPS treatment were similar to results from control cells. The D211G mutation did not result in clinically relevant impairment of neutrophil or pro-inflammatory macrophage function. As elevated circulating IL-8 is also observed in hyperthyroidism, this observation could be due to the high-normal to high levels of circulating T3 found in patients with RTHα.
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Affiliation(s)
- Anne H van der Spek
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
| | - Olga V Surovtseva
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
| | - Saskia Aan
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
| | - Anton T J Tool
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Center, Amsterdam, The Netherlands
| | - Annemarie van de Geer
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Center, Amsterdam, The Netherlands
| | - Korcan Demir
- Division of Pediatric EndocrinologyDokuz Eylül University, Izmir, Turkey
| | - Anja L M van Gucht
- Department of EndocrinologyErasmus Medical Center, Rotterdam, The Netherlands
| | | | - Timo K van den Berg
- Sanquin Research and Landsteiner LaboratoryAcademic Medical Center, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
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Kersseboom S, van Gucht ALM, van Mullem A, Brigante G, Farina S, Carlsson B, Donkers JM, van de Graaf SFJ, Peeters RP, Visser TJ. Role of the Bile Acid Transporter SLC10A1 in Liver Targeting of the Lipid-Lowering Thyroid Hormone Analog Eprotirome. Endocrinology 2017; 158:3307-3318. [PMID: 28938430 DOI: 10.1210/en.2017-00433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022]
Abstract
The thyroid hormone (TH) analog eprotirome (KB2115) was developed to lower cholesterol through selective activation of the TH receptor (TR) β1 in the liver. Interestingly, eprotirome shows low uptake in nonhepatic tissues, explaining its lipid-lowering action without adverse extrahepatic thyromimetic effects. Clinical trials have shown marked decreases in serum cholesterol levels. We explored the transport of eprotirome across the plasma membrane by members of three TH transporter families: monocarboxylate transporters MCT8 and MCT10; Na-independent organic anion transporters 1A2, 1B1, 1B3, 1C1, 2A1, and 2B1; and Na-dependent organic anion transporters SLC10A1 to SLC10A7. Cellular transport was studied in transfected COS1 cells using [14C]eprotirome and [125I]TH analogs. Of the 15 transporters tested initially, the liver-specific bile acid transporter SLC10A1 showed the highest eprotirome uptake (greater than a sevenfold induction after 60 minutes) as well as TRβ1-mediated transcriptional activity. Uptake of eprotirome by SLC10A1 was Na+ dependent and saturable with a Michaelis constant of 8 μM. Eprotirome transport was inhibited by known substrates for SLC10A1 (e.g., cholate and taurocholate), and by TH analogs such as triiodothyropropionic acid and triiodothyroacetic acid. However, no significant SLC10A1-mediated transport was observed of these [125I]TH analogs. We also studied the plasma disappearance and biliary excretion of [14C]eprotirome injected in control and Slc10a1 knockout mice. Although eprotirome is also transported by mouse Slc10a1, the pharmacokinetics of eprotirome were not affected by Slc10a1 deficiency. In conclusion, we have demonstrated that the liver-specific bile acid transporter SLC10A1 effectively transports eprotirome. However, Slc10a1 does not appear to be critical for the liver targeting of this TH analog in mice. Therefore, the importance of SLC10A1 for liver uptake of eprotirome in humans remains to be elucidated.
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Affiliation(s)
- Simone Kersseboom
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Anja L M van Gucht
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Alies van Mullem
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Giulia Brigante
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Stefania Farina
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Bo Carlsson
- Karo Bio AB, Novum Research Park, Huddinge S-141 57, Sweden
| | - Joanne M Donkers
- Tytgat Institute for Liver and Intestinal Research and Department of Gastroenterology and Hepatology, Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Stan F J van de Graaf
- Tytgat Institute for Liver and Intestinal Research and Department of Gastroenterology and Hepatology, Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Theo J Visser
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
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van Gucht ALM, Meima ME, Moran C, Agostini M, Tylki-Szymanska A, Krajewska M, Walasek, Chrzanowska K, Efthymiadou A, Chrysis D, Demir K, Visser WE, Visser TJ, Chatterjee K, van Dijk TB, Peeters RP. Anemia in Patients With Resistance to Thyroid Hormone α: A Role for Thyroid Hormone Receptor α in Human Erythropoiesis. J Clin Endocrinol Metab 2017; 102:3517-3525. [PMID: 28911146 PMCID: PMC5587074 DOI: 10.1210/jc.2017-00840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022]
Abstract
CONTEXT Patients with resistance to thyroid hormone (TH) α (RTHα) are characterized by growth retardation, macrocephaly, constipation, and abnormal thyroid function tests. In addition, almost all RTHα patients have mild anemia, the pathogenesis of which is unknown. Animal studies suggest an important role for TH and TH receptor (TR)α in erythropoiesis. OBJECTIVE To investigate whether a defect in TRα affects the maturation of red blood cells in RTHα patients. DESIGN, SETTING, AND PATIENTS Cultures of primary human erythroid progenitor cells (HEPs), from peripheral blood of RTHα patients (n = 11) harboring different inactivating mutations in TRα (P398R, F397fs406X, C392X, R384H, A382fs388X, A263V, A263S), were compared with healthy controls (n = 11). During differentiation, erythroid cells become smaller, accumulate hemoglobin, and express different cell surface markers. We assessed cell number and cell size, and used cell staining and fluorescence-activated cell sorter analysis to monitor maturation at different time points. RESULTS After ∼14 days of ex vivo expansion, both control and patient-derived progenitors differentiated spontaneously. However, RTHα-derived cells differentiated more slowly. During spontaneous differentiation, RTHα-derived HEPs were larger, more positive for c-Kit (a proliferation marker), and less positive for glycophorin A (a differentiation marker). The degree of abnormal spontaneous maturation of RTHα-derived progenitors did not correlate with severity of underlying TRα defect. Both control and RTHα-derived progenitors responded similarly when differentiation was induced. T3 exposure accelerated differentiation of both control- and RTHα patient-derived HEPs. CONCLUSIONS Inactivating mutations in human TRα affect the balance between proliferation and differentiation of progenitor cells during erythropoiesis, which may contribute to the mild anemia seen in most RTHα patients.
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Affiliation(s)
- Anja L. M. van Gucht
- Department of Internal Medicine, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
| | - Marcel E. Meima
- Department of Internal Medicine, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
| | - Carla Moran
- Wellcome–Medical Research Council Institute of Metabolic Science, University of Cambridge, CB2 0QQ Cambridge, United Kingdom
| | - Maura Agostini
- Wellcome–Medical Research Council Institute of Metabolic Science, University of Cambridge, CB2 0QQ Cambridge, United Kingdom
| | | | | | - Walasek
- The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | | | - Alexandra Efthymiadou
- Department of Pediatrics, Division of Endocrinology, University of Patras Medical School, 25002 Patras, Greece
| | - Dionisios Chrysis
- Department of Pediatrics, Division of Endocrinology, University of Patras Medical School, 25002 Patras, Greece
| | - Korcan Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, 35100 Izmir, Turkey
| | - W. Edward Visser
- Department of Internal Medicine, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
| | - Theo J. Visser
- Department of Internal Medicine, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
| | - Krishna Chatterjee
- Wellcome–Medical Research Council Institute of Metabolic Science, University of Cambridge, CB2 0QQ Cambridge, United Kingdom
| | - Thamar B. van Dijk
- Department of Cell Biology, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands
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Moran C, Agostini M, McGowan A, Schoenmakers E, Fairall L, Lyons G, Rajanayagam O, Watson L, Offiah A, Barton J, Price S, Schwabe J, Chatterjee K. Contrasting Phenotypes in Resistance to Thyroid Hormone Alpha Correlate with Divergent Properties of Thyroid Hormone Receptor α1 Mutant Proteins. Thyroid 2017; 27:973-982. [PMID: 28471274 PMCID: PMC5561448 DOI: 10.1089/thy.2017.0157] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Resistance to thyroid hormone alpha (RTHα), a disorder characterized by tissue-selective hypothyroidism and near-normal thyroid function tests due to thyroid receptor alpha gene mutations, is rare but probably under-recognized. This study sought to correlate the clinical characteristics and response to thyroxine (T4) therapy in two adolescent RTHα patients with the properties of the THRA mutation, affecting both TRα1 and TRα2 proteins, they harbored. METHODS Clinical, auxological, biochemical, and physiological parameters were assessed in each patient at baseline and after T4 therapy. RESULTS Heterozygous THRA mutations occurring de novo were identified in a 17-year-old male (patient P1; c.788C>T, p.A263V mutation) investigated for mild pubertal delay and in a 15-year-old male (patient P2; c.821T>C, p.L274P mutation) with short stature (0.4th centile), skeletal dysplasia, dysmorphic facies, and global developmental delay. Both individuals exhibited macrocephaly, delayed dentition, and constipation, together with a subnormal T4/triiodothyronine (T3) ratio, low reverse T3 levels, and mild anemia. When studied in vitro, A263V mutant TRα1 was transcriptionally impaired and inhibited the function of its wild-type counterpart at low (0.01-10 nM) T3 levels, with higher T3 concentrations (100 nM-1 μM) reversing dysfunction and such dominant negative inhibition. In contrast, L274P mutant TRα1 was transcriptionally inert, exerting significant dominant negative activity, only overcome with 10 μM of T3. Mirroring this, normal expression of KLF9, a TH-responsive target gene, was achieved in A263V mutation-containing peripheral blood mononuclear cells following 1 μM of T3 exposure, but with markedly reduced expression levels in L274P mutation-containing peripheral blood mononuclear cells, even with 10 μM of T3. Following T4 therapy, growth, body composition, dyspraxia, and constipation improved in P1, whereas growth retardation and constipation in P2 were unchanged. Neither A263V nor L274P mutations exhibited gain or loss of function in the TRα2 background, and no additional phenotype attributable to this was discerned. CONCLUSIONS This study correlates a milder clinical phenotype and favorable response to T4 therapy in a RTHα patient (P1) with heterozygosity for mutant TRα1 exhibiting partial, T3-reversible, loss of function. In contrast, a more severe clinical phenotype refractory to hormone therapy was evident in another case (P2) associated with severe, virtually irreversible, dysfunction of mutant TRα1.
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Affiliation(s)
- Carla Moran
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Maura Agostini
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Anne McGowan
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Erik Schoenmakers
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Louise Fairall
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom
| | - Greta Lyons
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Odelia Rajanayagam
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Laura Watson
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Amaka Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, United Kingdom
| | - John Barton
- Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Susan Price
- Department of Clinical Genetics, Northampton General Hospital, Northampton, United Kingdom
| | - John Schwabe
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom
| | - Krishna Chatterjee
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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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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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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Bernal J. Thyroid hormone regulated genes in cerebral cortex development. J Endocrinol 2017; 232:R83-R97. [PMID: 27852726 DOI: 10.1530/joe-16-0424] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/16/2016] [Indexed: 12/19/2022]
Abstract
The physiological and developmental effects of thyroid hormones are mainly due to the control of gene expression after interaction of T3 with the nuclear receptors. To understand the role of thyroid hormones on cerebral cortex development, knowledge of the genes regulated by T3 during specific stages of development is required. In our laboratory, we previously identified genes regulated by T3 in primary cerebrocortical cells in culture. By comparing these data with transcriptomics of purified cell types from the developing cortex, the cellular targets of T3 can be identified. In addition, many of the genes regulated transcriptionally by T3 have defined roles in cortex development, from which the role of T3 can be derived. This review analyzes the specific roles of T3-regulated genes in the different stages of cortex development within the physiological frame of the developmental changes of thyroid hormones and receptor concentrations in the human cerebral cortex during fetal development. These data indicate an increase in the sensitivity to T3 during the second trimester of fetal development. The main cellular targets of T3 appear to be the Cajal-Retzius and the subplate neurons. On the other hand, T3 regulates transcriptionally genes encoding extracellular matrix proteins, involved in cell migration and the control of diverse signaling pathways.
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Affiliation(s)
- Juan Bernal
- Instituto de Investigaciones BiomédicasConsejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid, and Center for Biomedical Research on Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain
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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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