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Brancatella A, Torregrossa L, Viola N, Sgrò D, Casula M, Basolo F, Materazzi G, Marinò M, Marcocci C, Santini F, Latrofa F. In Graves' disease, thyroid autoantibodies and ultrasound features correlate with distinctive histological features. J Endocrinol Invest 2023:10.1007/s40618-023-02044-0. [PMID: 36840841 DOI: 10.1007/s40618-023-02044-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Laboratory, imaging, and pathological features of Graves' disease (GD), although well characterized, have been barely correlated each other. Aim of the study was to link laboratory and ultrasound characteristics of GD with its pathological features. METHODS We correlated laboratory and ultrasound data at the time of diagnosis in 28 consecutive GD patients who underwent thyroidectomy with their pathological features, i.e., lymphocytic infiltration and follicular hyperplasia (both classified as mild or severe). RESULTS Thyroid volume correlated positively with the levels of FT4 (P = 0.002, r2 = 0.42), FT3 (P = 0.011, r2 = 0.22), autoantibodies to thyroglobulin (TgAbs) (P = 0.016, r2 = 0.32), autoantibodies to thyroid peroxidase (TPOAbs) (P = 0.011, r2 = 0.34) and the extent of lymphocytic infiltration (P = 0.006 comparing mild to severe lymphocytic infiltration) but not with the levels of autoantibodies to the thyrotropin receptor (TRAbs) and to follicular hyperplasia. Compared to subjects with mild lymphocytic infiltration, those with severe lymphocytic infiltration showed higher levels of TgAbs (316 vs 0.0 IU/mL, P < 0.0001) and TPOAbs (295 IU/mL vs 14 IU/mL, P < 0.0001) and similar levels of TRAbs (7.5 vs 13 IU/mL, P = 0.68). Compared to patients with mild, those with severe follicular hyperplasia had similar levels of TgAbs (76 vs 30 IU/mL, P = 0.31) and TPOAbs (251 IU/mL vs 45 IU/mL, P = 0.26) but higher levels of TRAbs (39 vs 7.2 IU/mL, P < 0.001). CONCLUSION In GD, TgAbs and TPOAbs levels correlate with the extent of lymphocytic infiltration, TRAbs levels with the degree of follicular hyperplasia. Thyroid volume, the main factor influencing the severity of hyperthyroidism, is related to lymphocytic infiltration and not to follicular hyperplasia.
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Affiliation(s)
- A Brancatella
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - L Torregrossa
- Pathology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126, Pisa, Italy
| | - N Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - D Sgrò
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - M Casula
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - F Basolo
- Pathology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126, Pisa, Italy
| | - G Materazzi
- Surgery Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126, Pisa, Italy
| | - M Marinò
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - C Marcocci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - F Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - F Latrofa
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy.
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Luo Y, Zeng H, Ye Y, Yu G, Song C, Liu S, Chen X, Jiang Y, Duan H, Li Y, He S, Chen Z, Liu L, Liang Y, Lin X, Wan H, Shen J. Associations of metal profiles in blood with thyroiditis: a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:21072-21080. [PMID: 36264466 PMCID: PMC9938027 DOI: 10.1007/s11356-022-23625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Autoimmune thyroiditis (AIT) is increasingly common, and serological markers include thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb). To determine if selected metals influence thyroiditis antibody positivity, this cross-sectional study investigated associations between metals and thyroiditis antibody status. Healthy individuals (n = 1104) completed a questionnaire and underwent checkups of anthropometric parameters, thyroid function status, and levels of seven metals in blood (magnesium, iron, calcium, copper, zinc, manganese, and lead). Associated profiles of glyco- and lipid metabolism were also established. Logistic regression and restricted cubic spline (RCS) regression analysis were applied to adjudge associations between metals and TPOAb and TgAb status. It was found that, after adjusting for likely cofounding factors, participants with antibody positivity had significantly lower serum concentrations of magnesium and iron. When serum magnesium levels were analyzed in quartiles, the odds ratios of quartile 4 were 0.329-fold (95% confidence interval (CI): 0.167-0647) and 0.259-fold (95% CI 0.177-0.574) that of quartile 1 regarding TPOAb and TgAb positivity (P = 0.004, 0.003). After adjustment, the RCS analysis detected nonlinear associations between iron and TPOAb and TgAb positivity (P < 0.01, both). In stratified analyses, these associations regarding magnesium and iron remained for women of reproductive age, but not for postmenopausal women and men. We conclude that lower serum levels of magnesium and iron are associated with incremental positivity of thyroiditis antibodies and may be among the most important metals contributing to AIT in women of reproductive age.
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Affiliation(s)
- Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Huixian Zeng
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Yanshi Ye
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Cheng Song
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Siyang Liu
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Xingying Chen
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Yuqi Jiang
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Hualin Duan
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Yue Li
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Shengqing He
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Zhi Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Lingling Liu
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Yongqian Liang
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Xu Lin
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- Medical Research Center, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Heng Wan
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
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Atapattu N, Amoroso M, Powell M, de Silva DGH, de Silva KSH, Furmaniak J, Rees Smith B, Premawardhana LD. The prevalence of diabetes and thyroid related autoantibodies in Sri Lankan children with type 1 diabetes and their unaffected siblings - The utility of a new screening assay. Front Endocrinol (Lausanne) 2023; 14:1028285. [PMID: 36814577 PMCID: PMC9939822 DOI: 10.3389/fendo.2023.1028285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is limited information about diabetes and thyroid related autoantibodies in children with type 1 diabetes (T1D) or their siblings in Sri Lanka. OBJECTIVES To assess in T1D children and their unaffected siblings the prevalence of autoantibodies to (1) glutamic acid decarboxylase (GADA), insulinoma associated antigen-2 (IA-2A) and zinc transporter 8 (ZnT8A) using 3 Screen ICA™ (3-Screen) and individual ELISA assays; (2) insulin (IAA); and (3) thyroid peroxidase (TPOA), thyroglobulin (TgA) and the TSH receptor (TSHRA). METHODS We selected - (a) consecutive T1D children, and (b) their unaffected siblings of both sexes, from the T1D Registry at Lady Ridgeway Hospital, Colombo. RESULTS The median age (IQR) of 235 T1D children and 252 unaffected siblings was 11 (8.4, 13.2) and 9 (5.4, 14.9) years respectively, and the duration of T1D was 23 (7, 54) months. (1) T1D children (a) 79.1% were 3-Screen positive; (b) all 3-Screen positives were individual antibody positive (GADA in 74%; IA-2A 31.1%; ZnT8A 38.7%); (c) and were younger (p=0.01 vs 3-Screen negatives); (d) multiple autoantibodies were present in 45.1%; (e) IA-2A (p=0.002) and ZnT8A (p=0.006) prevalence decreased with T1D duration. (f) TPOA and TgA prevalence was higher in T1D children compared to unaffected siblings (28%, p=0.001 and 31%, p=0.004, respectively). (2) Unaffected siblings (a) 6.3% were 3-Screen positive (p=0.001 vs T1D), and 2.4% were positive for IAA; (b) four subjects had two diabetes related autoantibodies, one of whom developed dysglycaemia during follow-up. CONCLUSIONS The 3-Screen assay, used for the first time in Sri Lankan T1D children and their siblings as a screening tool, shows a high prevalence of T1D related Abs with a high correlation with individual assays, and is also a helpful tool in screening unaffected siblings for future T1D risk. The higher prevalence of thyroid autoantibodies in T1D children is consistent with polyglandular autoimmunity.
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Affiliation(s)
- Navoda Atapattu
- Endocrinology and Diabetes Unit, Lady Ridgeway Hospital, Colombo, Sri Lanka
- *Correspondence: Navoda Atapattu,
| | - Marie Amoroso
- FIRS Laboratories, RSR Ltd., Cardiff, United Kingdom
| | | | - D. G. Harendra de Silva
- Department of Paediatrics, Lady Ridgeway Hospital and Faculty of Medicine, Colombo, Sri Lanka
| | - K. Shamya H. de Silva
- Department of Paediatrics, Lady Ridgeway Hospital and Faculty of Medicine, Colombo, Sri Lanka
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Brancatella A, Lupi I, Montanelli L, Ricci D, Viola N, Sgrò D, Antonangeli L, Sardella C, Brogioni S, Piaggi P, Molinaro E, Bianchi F, Aragona M, Antonuzzo A, Sbrana A, Lucchesi M, Chella A, Falcone A, Del Prato S, Elisei R, Marcocci C, Caturegli P, Santini F, Latrofa F. Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade. J Endocr Soc 2021; 5:bvab093. [PMID: 34337277 PMCID: PMC8317632 DOI: 10.1210/jendso/bvab093] [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: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
Context Thyrotoxicosis is a common immune-related adverse event in patients treated with programmed cell death protein-1 (PD1) or programmed cell death protein ligand-1 (PD-L1) blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy, is lacking, as are data on response to treatment and follow-up. Objective The aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment. Methods We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis on PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mtechnecium scintiscan, and longitudinal thyroid function tests. Results Five patients had normal or increased scintigraphic uptake (Sci+), no serum antibodies against the thyrotropin receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci–) and experienced destructive thyrotoxicosis followed by hypothyroidism (N = 9) or euthyroidism (N = 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P = .04). Among Sci– individuals, a larger thyroid volume was associated with a longer time to remission (P < .05). Methimazole (MMI) was effective only in Sci+ individuals (P < .05). Conclusion Administration of PD1- or PD-L1–blocking antibodies may induce 2 different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2, characterized by destructive and transient thyrotoxicosis that evolves to hypothyroidism or euthyroidism. Thyroid scintigraphy and ultrasound help in differentiating and managing these 2 forms of iatrogenic thyrotoxicosis.
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Affiliation(s)
| | - Isabella Lupi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Lucia Montanelli
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Debora Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Nicola Viola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Daniele Sgrò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Lucia Antonangeli
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Chiara Sardella
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Sandra Brogioni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, Pisa 56126, Italy
| | - Eleonora Molinaro
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Francesca Bianchi
- Nuclear Medicine Unit, Azienda Ospedaliero-Unuversitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Michele Aragona
- Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Andrea Antonuzzo
- Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56126, Italy
| | - Andrea Sbrana
- Oncology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa 56126, Italy
| | - Maurizio Lucchesi
- Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Antonio Chella
- Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy
| | - Alfredo Falcone
- Oncology Unit, Azienda Ospedaliero-Univeritaria Pisana and Department of Translational Research and New Technologies in Medicine abd Surgery, University Hospital of Pisa, Pisa 56126, Italy
| | - Stefano Del Prato
- Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Rossella Elisei
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Claudio Marcocci
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Patrizio Caturegli
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Ferruccio Santini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
| | - Francesco Latrofa
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy
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Okamura K, Bandai S, Fujikawa M, Sato K, Kitazono T. Clinical experience of treating Graves' hyperthyroidism complicated with malignancy-The possible role of potassium iodide for avoiding the risk of thionamide-associated neutropenia. Endocr J 2020; 67:751-758. [PMID: 32238669 DOI: 10.1507/endocrj.ej20-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
The treatment of Graves' hyperthyroidism (GD) complicated with malignancy is challenging, as anti-thyroid thionamide drugs (ATDs) and anti-cancer chemotherapy are both associated with a risk of neutropenia. Treatment with conventional ATDs, radioactive iodine (RAI) or potassium iodide (KI) was attempted in 8 patients with malignancy (34-80 years of age; 2 males and 6 females) in whom GD had been fortuitously diagnosed during a detailed systematic examination. Three patients requiring surgery were initially treated conventionally with methylmercaptoimidazole (MMI), MMI and KI or RAI (group A; one patient each). The patients became euthyroid on days 17-31 and underwent surgery on days 25-47. RAI therapy was administered to one patient after surgery. The patients were then treated with KI during chemotherapy. Five other patients who did not require surgery were initially treated with 100 mg KI monotherapy (group B). The serum free T4 level declined immediately in all of these patients, and they became euthyroid on days 7-18, remaining almost entirely euthyroid for more than 120 days. Anti-cancer chemotherapy was successfully completed for three of the patients while taking KI, despite the patients experiencing repeated episodes of anti-cancer chemotherapy-induced neutropenia. Our present findings suggest that, in patients with GD and malignancy, MMI + KI or RAI may be required if immediate surgery is scheduled, but KI monotherapy may be worth trying, if anti-cancer chemotherapy is scheduled, thus avoiding the possibility of thionamide-induced neutropenia.
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Affiliation(s)
- Ken Okamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Sachiko Bandai
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Megumi Fujikawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kaori Sato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Martin TC, Šimurina M, Ząbczyńska M, Martinic Kavur M, Rydlewska M, Pezer M, Kozłowska K, Burri A, Vilaj M, Turek-Jabrocka R, Krnjajić-Tadijanović M, Trofimiuk-Müldner M, Ugrina I, Lityńska A, Hubalewska-Dydejczyk A, Trbojevic-Akmacic I, Lim EM, Walsh JP, Pocheć E, Spector TD, Wilson SG, Lauc G. Decreased Immunoglobulin G Core Fucosylation, A Player in Antibody-dependent Cell-mediated Cytotoxicity, is Associated with Autoimmune Thyroid Diseases. Mol Cell Proteomics 2020; 19:774-792. [PMID: 32024769 PMCID: PMC7196582 DOI: 10.1074/mcp.ra119.001860] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/17/2020] [Indexed: 11/06/2022] Open
Abstract
Autoimmune thyroid diseases (AITD) are the most common group of autoimmune diseases, associated with lymphocyte infiltration and the production of thyroid autoantibodies, like thyroid peroxidase antibodies (TPOAb), in the thyroid gland. Immunoglobulins and cell-surface receptors are glycoproteins with distinctive glycosylation patterns that play a structural role in maintaining and modulating their functions. We investigated associations of total circulating IgG and peripheral blood mononuclear cells glycosylation with AITD and the influence of genetic background in a case-control study with several independent cohorts and over 3,000 individuals in total. The study revealed an inverse association of IgG core fucosylation with TPOAb and AITD, as well as decreased peripheral blood mononuclear cells antennary α1,2 fucosylation in AITD, but no shared genetic variance between AITD and glycosylation. These data suggest that the decreased level of IgG core fucosylation is a risk factor for AITD that promotes antibody-dependent cell-mediated cytotoxicity previously associated with TPOAb levels.
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Affiliation(s)
- Tiphaine C Martin
- Department of Twin Research and Genetic Epidemiology, King's College, London, United Kingdom; School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Mirna Šimurina
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marta Ząbczyńska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | | | - Magdalena Rydlewska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Marija Pezer
- Genos, Glycoscience Research Laboratory, Zagreb, Croatia
| | - Kamila Kozłowska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Andrea Burri
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand; Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Marija Vilaj
- Genos, Glycoscience Research Laboratory, Zagreb, Croatia
| | - Renata Turek-Jabrocka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland; Department of Endocrinology, University Hospital in Krakow, Krakow, Poland
| | | | - Małgorzata Trofimiuk-Müldner
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland; Department of Endocrinology, University Hospital in Krakow, Krakow, Poland
| | - Ivo Ugrina
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia; Genos, Glycoscience Research Laboratory, Zagreb, Croatia
| | - Anna Lityńska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland; Department of Endocrinology, University Hospital in Krakow, Krakow, Poland
| | | | - Ee Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ewa Pocheć
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College, London, United Kingdom
| | - Scott G Wilson
- Department of Twin Research and Genetic Epidemiology, King's College, London, United Kingdom; School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia; Genos, Glycoscience Research Laboratory, Zagreb, Croatia.
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7
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Yuksekkaya R, Celikyay F, Gul SS, Yuksekkaya M, Kutluturk F, Ozmen C. Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves' Disease. Curr Med Imaging 2020; 16:1111-1124. [PMID: 32107993 DOI: 10.2174/1573405616666200124121546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Graves' Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive. OBJECTIVES To investigate the thyroid blood flow in patients with Graves' Disease by color Doppler Ultrasonography and a newly developed software Color Quantification. METHODS Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated. RESULTS The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all). CONCLUSION The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves' Disease.
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Affiliation(s)
- Ruken Yuksekkaya
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Celikyay
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Serdar S Gul
- Department of Nuclear Medicine, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mehmet Yuksekkaya
- Department of Biomedical Engineering, Faculty of Engineering, Baskent University, Ankara, Turkey
| | - Faruk Kutluturk
- Department of Endocrinology and Metabolism, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Cansel Ozmen
- Department of Biochemistry, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
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8
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Low CSF/serum ratio of free T4 is associated with decreased quality of life in mild hypothyroidism - A pilot study. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 19:100218. [PMID: 32154116 PMCID: PMC7052503 DOI: 10.1016/j.jcte.2020.100218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022]
Abstract
General health, according to the Likert scale, was considerable affected even in mild hypothyroidism. The level of T4 in the brain, expressed as the CSF/serum f-T4 ratio, was associated with decreased general health. Depressive symptoms, according to the MADRS scale, correlated with the CSF/serum f-T4 ratio. T4 might have a direct effect in the brain, and not only as a storage hormone for the more active T3. Further studies on pharmacokinetics of CSF-thyroxine might be of benefit especially in patients not feeling well.
Background & Objective Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). Methods Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the questionnaires were related to serum and CSF levels of free- T4 and T3 as well as the ratios between them in CSF and in serum. Results Self-reported health was considerably lower in hypothyroid subjects. MADRS was considerably higher than the normal range for healthy individuals. Low CSF/serum free-T4 ratio was correlated with an increased depressed state according to MADRS (p < 0.01), and in addition, CSF/serum free-T4 ratio correlated positively with the self-reported general health Likert scale (p < 0.05). Concentrations of TSH, or free-T3 in serum or CSF, were not associated with an increased depressed state or self-reported general health. Conclusions Low CSF/serum ratio of free-T4 was correlated with impaired general health and mood, in contrast to serum measurements not showing any correlations. These findings might partly explain why some patients with hypothyroidism suffer from mental symptoms, despite adequate serum levels of free-T4. However, the findings need to be confirmed in further and larger studies.
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Key Words
- AHDS, Allan-Herndon-Dudley syndrome
- BBB, blood brain barrier
- BSA, body surface area
- CON, healthy control group in our study
- CRP, C reactive protein
- CSF, cerebrospinal fluid
- DIO2, type II iodothyronine deiodinase-enzyme
- GHLS, General Health Likert Scale
- HYP, hypothyroid subjects in our study
- Hb, hemoglobulin
- M, mean value
- MADRS
- MADRS, Montgomery Asberg Depression Rating Scale
- MCT8, monocarboxylate transporter 8
- Md, median value
- Mild hypothyroidism
- NS, non-significant
- OATP1C1, organic anion transporter polypeptide 1C1
- PH, primary hypothyroidism in general
- Q1, first quartile
- Q3, third quartile
- QoL, quality of life
- Quality of life
- Subclinical hypothyroidism
- T3, triiodothyronine
- T4, thyroxine
- TPO, thyroid peroxidase antibody
- TSH, thyroid stimulating hormone
- Thyroxine
- Triiodothyronine
- f-T3 and f-T4, free unbound thyroid hormone
- s-, serum
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9
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Ząbczyńska M, Polak K, Kozłowska K, Sokołowski G, Pocheć E. The Contribution of IgG Glycosylation to Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC) and Complement-Dependent Cytotoxicity (CDC) in Hashimoto's Thyroiditis: An in Vitro Model of Thyroid Autoimmunity. Biomolecules 2020; 10:biom10020171. [PMID: 31979029 PMCID: PMC7072644 DOI: 10.3390/biom10020171] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
Antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) are involved in destruction of thyroid tissue in Hashimoto’s thyroiditis (HT). N-glycosylation of the Fc fragment affects the effector functions of IgG by enhancing or suppressing the cytotoxicity effect. The aim of the present study was to assess the impact of HT-specific IgG glycosylation in ADCC and CDC, using in vitro models. The normal thyroid Nthy-ori 3-1 cell line and thyroid carcinoma FTC-133 cells were used as the target cells. Peripheral blood mononuclear cells (PBMCs) from healthy donors and the HL-60 human promyelotic leukemia cell line served as the effector cells. IgG was isolated from sera of HT and healthy donors and then treated with α2-3,6,8-neuraminidase to cut off sialic acids (SA) from N-glycans. We observed more intensive cytotoxicity in the presence of IgG from HT patients than in the presence of IgG from healthy donors. Removal of SA from IgG N-glycans increased ADCC intensity and reduced CDC. We conclude that the enhanced thyrocyte lysis resulted from the higher anti-TPO content in the whole IgG pool of HT donors and from altered IgG glycosylation in HT autoimmunity.
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Affiliation(s)
- Marta Ząbczyńska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Gronostajowa 9, 30-387 Kraków, Poland; (M.Z.); (K.P.); (K.K.)
| | - Katarzyna Polak
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Gronostajowa 9, 30-387 Kraków, Poland; (M.Z.); (K.P.); (K.K.)
| | - Kamila Kozłowska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Gronostajowa 9, 30-387 Kraków, Poland; (M.Z.); (K.P.); (K.K.)
| | - Grzegorz Sokołowski
- Department of Endocrinology, University Hospital in Kraków, Kopernika 17, 31-501 Kraków, Poland;
| | - Ewa Pocheć
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Gronostajowa 9, 30-387 Kraków, Poland; (M.Z.); (K.P.); (K.K.)
- Correspondence: ; Tel.: +48-12-664-6467
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10
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Nalla P, Young S, Sanders J, Carter J, Adlan MA, Kabelis K, Chen S, Furmaniak J, Rees Smith B, Premawardhana LDKE. Thyrotrophin receptor antibody concentration and activity, several years after treatment for Graves' disease. Clin Endocrinol (Oxf) 2019; 90:369-374. [PMID: 30485487 DOI: 10.1111/cen.13908] [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] [Received: 10/02/2018] [Revised: 11/17/2018] [Accepted: 11/25/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE TSH receptor antibodies (TRAb) are responsible for autoimmune hyperthyroid disease (Graves' disease; GD) with TRAb levels tending to decrease following treatment. Measurement of TRAb activity during follow-up could prove valuable to better understand treatment effectiveness. STUDY DESIGN TRAb concentration and stimulating (TSAb) and blocking (TSBAb) activity of patient serum were assessed following different treatment modalities and follow-up length. METHODS Sixty-six subjects were recruited following treatment with carbimazole (n = 26), radioiodine (n = 27) or surgery (n = 13). TRAb, TPOAb, TgAb and GADAb were measured at a follow-up visit as well as bioassays of TSAb and TSBAb activity. RESULTS Forty-five per cent of all patients remained TRAb-positive for more than one year and 23% for more than 5 years after diagnosis, irrespective of treatment method. Overall, TRAb concentration fell from a median (IQR) of 6.25 (3.9-12.7) to 0.65 (0.38-3.2) U/L. Surgery conferred the largest fall in TRAb concentration from 11.4 (6.7-29) to 0.58 (0.4-1.4) U/L. Seventy per cent of TRAb-positive patients were positive for TSAb, and one patient (3%) was positive for TSBAb. TRAb and TSAb correlated well (r = 0.83). In addition, 38/66 patients were TgAb-positive, 47/66 were TPOAb-positive and 6/66 were GADAb-positive at follow-up. CONCLUSIONS TRAb levels generally decreased after treatment but persisted for over 5 years in some patients. TRAb activity was predominantly stimulatory, with only one patient demonstrating TSBAb. A large proportion of patients were TgAb/TPOAb-positive at follow-up. All treatment modalities reduced TRAb concentrations; however, surgery was most effective.
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Affiliation(s)
- Preethi Nalla
- Section of Endocrinology and Biochemistry, Aneurin Bevan University Health Board, Caerphilly, UK
| | | | | | - Joanne Carter
- Section of Endocrinology and Biochemistry, Aneurin Bevan University Health Board, Caerphilly, UK
| | - Mohamed A Adlan
- Section of Endocrinology and Biochemistry, Aneurin Bevan University Health Board, Caerphilly, UK
| | | | - Shu Chen
- FIRS Laboratories, RSR Ltd., Cardiff, UK
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11
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Barić A, Brčić L, Gračan S, Škrabić V, Brekalo M, Šimunac M, Lovrić VT, Anić I, Barbalić M, Zemunik T, Punda A, Boraska Perica V. Thyroglobulin Antibodies are Associated with Symptom Burden in Patients with Hashimoto's Thyroiditis: A Cross-Sectional Study. Immunol Invest 2018; 48:198-209. [PMID: 30332318 DOI: 10.1080/08820139.2018.1529040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is the most common form of autoimmune thyroid disorders characterized by lower production of thyroid hormones and positivity to autoantibodies to thyroglobulin (TgAb) and/or thyroid peroxidase (TPOAb). We performed a comprehensive phenotypic characterization of patients with HT, with specific focus on thyroid autoimmunity, to get better understanding of disease manifestation. METHODS We collected information on thyroid-specific phenotypes (TSH, T3, T4, fT4, TgAb, TPOAb, thyroid volume) and other clinical phenotypes (age, body surface area, number of hypothyroidism symptoms, blood pressure) from 290 patients with HT without levothyroxine (LT4) therapy with the aim to test for correlations between thyroid-specific and clinical phenotypes. RESULTS Our key and novel finding is the existence of significant positive correlation between TgAb levels and the number of symptoms (r = 0.25, p = 0.0001) in HT patients without LT4 therapy that remained significant after adjustment for TPOAb, T3, TSH levels and thyroid volume (β = 0.66, SE = 0.3, p = 0.0299). Increased TgAb levels are significantly associated with fragile hair (p = 0.0043), face edema (p = 0.0061), edema of the eyes (p = 0.0293) and harsh voice (p = 0.0349). CONCLUSIONS Elevated TgAb levels are associated with symptom burden in HT patients, suggesting a role of thyroid autoimmunity in clinical manifestations of HT. Based on these results, we recommend screening for TgAb antibodies in HT patients with symptom burden. We also suggest that further work on understandings of symptoms appearance due to their autoimmune or hypothyroid causation is needed.
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Affiliation(s)
- Ana Barić
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Luka Brčić
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Sanda Gračan
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Veselin Škrabić
- c Department of Pediatrics , University Hospital Split , Split , Croatia
| | - Marko Brekalo
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Marta Šimunac
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | | | - Iva Anić
- d School of Medicine , University of Split , Split , Croatia
| | - Maja Barbalić
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Tatijana Zemunik
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Ante Punda
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Vesna Boraska Perica
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
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12
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Kiseleva EP, Mikhailopulo KI, Zdorovenko EL, Knirel YA, Novik GI. Linear α-(1 → 6)-d-glucan from Bifidobacterium bifidum BIM В-733D is low molecular mass biopolymer with unique immunochemical properties. Carbohydr Res 2017; 466:39-50. [PMID: 29422338 DOI: 10.1016/j.carres.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/02/2017] [Accepted: 12/19/2017] [Indexed: 11/24/2022]
Abstract
Role of microorganisms in induction of/protection from autoimmune diseases is proven though molecular mechanisms and bacterial/viral/yeast biopolymers responsible for these effects are in the research stage. Autoantobodies (AAbs) to thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) as well as AAbs to transglutaminase 2 (anti-TG2) and antibodies to gliadins (anti-gliadins) are serological markers of autoimmune thyroid disease and celiac disease, respectively, and players in pathogenesis of these autoimmune diseases. In current study, biopolymer of Bifidobacterium bifidum BIM В-733D that interacts selectively with anti-gliadins (Bb-Ganti-gliadins) was isolated by affinity chromatography with anti-gliadins, purified by size exclusion chromatography on TSK 40 gel and identified by NMR as linear α-(1 → 6)-d-glucan with molecular mass about 5000 Da. It was proven that compounds Bb-Ganti-gliadins and Bb-Ganti-TPO/Bb-Ganti-Tg isolated early from the same strain [Kiseleva, E. P. et al., Benef Microbes.2013, 4, 375 -391] are the same substance designated GBb. Its unique immunochemical property is the ability to interact selectively with anti-TPO, anti-Tg, anti-TG2 and anti-gliadins in presence of no less than 10-fold excess of total immunoglobulins of class G (tIgG), as it was proven by ELISA. Synthesis of GBb-bovine serum albumin (GBb-BSA) conjugate is an example of increasing the reliability and reproducibility of ELISA results by mediated immobilization of a polysaccharide covalently attached to a well-adsorbed protein. Taking into account that there are population of bispecific anti-gliadins (anti-gliadins and anti-TG2 simultaneously) we regard our data as first argument in favor of hypothesis that GBb differentiates between human AAbs per se and other human Ig (e.g. antibodies to antigens of infectious agents) due to its binding with a yet unidentified site which is present in the molecules of all AAbs (independently on their specificity) and absent in other human Igs.
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Affiliation(s)
- Elena P Kiseleva
- Institute of Bioorganic Chemistry, National Academy of Sciences of Belarus, Minsk, Belarus.
| | | | - Evelina L Zdorovenko
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Yuriy A Knirel
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Galina I Novik
- Institute of Microbiology, National Academy of Sciences of Belarus, Minsk, Belarus
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13
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Nishihara E, Amino N, Kudo T, Ito M, Fukata S, Nishikawa M, Nakamura H, Miyauchi A. Comparison of thyroglobulin and thyroid peroxidase antibodies measured by five different kits in autoimmune thyroid diseases. Endocr J 2017; 64:955-961. [PMID: 28768936 DOI: 10.1507/endocrj.ej17-0164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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
It is generally believed that the detection of thyroid peroxidase antibodies (TPOAb) is superior to that of thyroglobulin antibodies (TgAb) for the diagnosis of Hashimoto's thyroiditis. However, limited data are available on the comparison of TgAb and TPOAb prevalence as a diagnostic measurement for Hashimoto's thyroiditis using sensitive immunoassays. We herein used five different current immunoassay kits (A-E) to compare the prevalence of TgAb and TPOAb in Hashimoto's thyroiditis (n = 70), Graves' disease (n = 70), painless thyroiditis (n = 50), and healthy control subjects (n = 100). In patients with Hashimoto's thyroiditis, positive TgAb was significantly more frequent than positive TPOAb in kits A-D (mean ± SD of the four kits: 98.6 ± 1.7 vs 81.4 ± 2.0%). In patients with Graves' disease, TgAb prevalence was almost equivalent to that of TPOAb in five kits. Patients with painless thyroiditis exhibited positive TgAb significantly more frequently than positive TPOAb in kits A-D (73.5 ± 4.1 vs 33.0 ± 3.4%). The prevalence of TgAb alone was significantly higher than that of TPOAb alone in both Hashimoto's thyroiditis and painless thyroiditis in kits A-D. In kit E, TgAb and TPOAb prevalence did not differ significantly for any disease, and TgAb distribution was different from other kits. In conclusion, the prevalence of TgAb was higher than that of TPOAb in patients with Hashimoto's thyroiditis and painless thyroiditis using commercially available kits. We suggest that TgAb immunoassay is the first choice of screening test for thyroid autoimmune abnormalities in Japan.
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Affiliation(s)
- Eijun Nishihara
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | - Nobuyuki Amino
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | - Takumi Kudo
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | - Mitsuru Ito
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | - Shuji Fukata
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | | | - Hirotoshi Nakamura
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
| | - Akira Miyauchi
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe 650-0011, Japan
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14
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Lin JD, Yang SF, Wang YH, Fang WF, Lin YC, Liou BC, Lin YF, Tang KT, Cheng CW. Associations of melatonin receptor gene polymorphisms with Graves' disease. PLoS One 2017; 12:e0185529. [PMID: 28961261 PMCID: PMC5621676 DOI: 10.1371/journal.pone.0185529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
Background Melatonin plays an important role in immunity and has been linked to autoimmune diseases. Possible associations of single-nucleotide polymorphisms (SNPs) of melatonin receptor type 1A (MTNR1A) and 1B (MTNR1B), with autoimmune thyroid disease in an ethnic Chinese (i.e., Taiwanese) population were examined. Materials and methods Totally, 83 Hashimoto’s thyroiditis patients, 319 Graves’ disease (GD), and 369 controls were recruited. Three SNPs (rs6553010, rs13140012, and rs2119882) of MTNR1A and three SNPs (rs1387153, rs10830963, and rs1562444) of MTNR1B were genotyped. Results There were a reduced frequency of the C allele of rs2119882 and a reduced percentage of the CC+CT genotype in the GD group compared to the control group (p = 0.039, odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.63~0.99, and p = 0.032, OR = 0.72, 95% CI = 0.53~0.97, respectively). There was a significant difference in the percentage of the AT haplotype of the combination of rs13140012 and rs2119882 between the GD and control groups (p = 0.010, OR = 1.34, 95% CI = 1.07~1.67). In addition, there were significant associations of anti-thyroid peroxidase antibody titers with rs13140012 and rs2119882, and the AATT genotype of the combination of rs13140012 and rs2119882 (p = 0.003, 0.003, and 0.004, respectively). There were no significant associations of SNPs and possible haplotypes of MTNR1B with susceptibility to GD. Conclusions Genetic variants of rs2119882 of MTNR1A and the AT haplotype of the combination of rs2119882 and rs13140012 were associated with GD susceptibility in an ethnic Chinese population. The results support the involvement of the melatonin pathway in the pathogenesis of GD.
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Affiliation(s)
- Jiunn-Diann Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Endocrinology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Fang Fang
- Department of Family Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ying-Chin Lin
- Department of Family Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Bing-Chun Liou
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kam-Tsun Tang
- Division of Endocrinology and Metabolism, Department of Internal Medicine Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Wen Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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15
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Kiseleva EP, Mikhailopulo KI, Novik GI, Szwajcer Dey E, Zdorovenko EL, Shashkov AS, Knirel YA. Isolation and structural identification of glycopolymers of Bifidobacterium bifidum BIM B-733D as putative players in pathogenesis of autoimmune thyroid diseases. Benef Microbes 2013; 4:375-391. [PMID: 24311320 DOI: 10.3920/bm2013.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2024]
Abstract
Bifidobacterium bifidum 791 (commercially available as B. bifidum BIM B-733D) cell-surface biopolymers (BPs) interact selectively with human serum thyroid peroxidase (TPO) and thyroglobulin (Tg) autoantibodies (anti TPO and anti Tg, respectively). BPanti-TPO and BPanti-Tg were isolated from the soluble fraction of B. bifidum BIM B-733D by affinity chromatography with anti-TPO or anti-Tg, respectively. Homogeneity of affinity eluates (AEanti-TPO and AEanti-Tg) was tested by size exclusion chromatography. For each AE, the elution profiles generated on the basis of absorbance at 280 nm do not conform to ELISA data for functional activity characteristic of BPs. Moreover, high functional activity was detected in chromatographic fractions that had significantly different molecular weights and no absorbance at 280 nm, which suggests a non-protein (carbohydrate) nature of BPanti-TPO and BPanti-Tg. The semi-preparative size exclusion chromatography of AEanti-TPO and AEanti-Tg with detection by refractometer gave 5,000-7,000 Da fractions containing substances that interact selectively with either anti TPO (BPanti-TPO) or anti-Tg (BPanti-Tg) according to ELISA data. Analysis by two-dimensional NMR spectroscopy including a 1H, 13C-heteronuclear single-quantum coherence experiment indicated that both substances are linear α-1,6-glucans. For the first time, an immunological similarity (molecular mimicry) of glycopolymers of B. bifidum BIM B-733D and human thyroid proteins, TPO and Tg, was shown. On the whole, our data point to a possible role of bifidobacteria in the pathogenesis of autoimmune thyroid diseases (ATD). The main requirements for triggering/acceleration or prevention/abrogation of ATD by bifidobacteria through molecular mimicry mechanism are hypothesised to be (1) genetic predisposition to ATD and (2) intestinal epithelium penetration by α-1,6-glucan.
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MESH Headings
- Antigens, Bacterial/chemistry
- Antigens, Bacterial/immunology
- Antigens, Bacterial/isolation & purification
- Antigens, Bacterial/metabolism
- Autoantibodies/metabolism
- Autoimmune Diseases/etiology
- Autoimmune Diseases/microbiology
- Bifidobacterium/chemistry
- Bifidobacterium/immunology
- Chromatography, Affinity
- Chromatography, Gel
- Humans
- Iodide Peroxidase/immunology
- Magnetic Resonance Spectroscopy
- Molecular Weight
- Polysaccharides, Bacterial/chemistry
- Polysaccharides, Bacterial/immunology
- Polysaccharides, Bacterial/isolation & purification
- Polysaccharides, Bacterial/metabolism
- Protein Binding
- Thyroglobulin/immunology
- Thyroid Diseases/etiology
- Thyroid Diseases/microbiology
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Affiliation(s)
- E P Kiseleva
- The Institute of Bioorganic Chemistry, National Academy of Sciences of Belaru, Acad. Kuprevicha 5/2, 220141 Minsk, Republic of Belarus
| | - K I Mikhailopulo
- The Institute of Bioorganic Chemistry, National Academy of Sciences of Belaru, Acad. Kuprevicha 5/2, 220141 Minsk, Republic of Belarus
| | - G I Novik
- The Institute of Microbiology, National Academy of Sciences of Belarus, Acad. Kuprevicha 5/2, 220141 Minsk, Republic of Belarus
| | - E Szwajcer Dey
- Division of Pure and Applied Biochemistry, Lund University, P.O. Box 124, 22100 Lund, Sweden
| | - E L Zdorovenko
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospekt 47, 119991 Moscow, Russia
| | - A S Shashkov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospekt 47, 119991 Moscow, Russia
| | - Y A Knirel
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospekt 47, 119991 Moscow, Russia
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16
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Thyroid autoantibodies in pregnancy: their role, regulation and clinical relevance. J Thyroid Res 2013; 2013:182472. [PMID: 23691429 PMCID: PMC3652173 DOI: 10.1155/2013/182472] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 03/11/2013] [Accepted: 03/20/2013] [Indexed: 12/21/2022] Open
Abstract
Autoantibodies to thyroglobulin and thyroid peroxidase are common in the euthyroid population and are considered secondary responses and indicative of thyroid inflammation. By contrast, autoantibodies to the TSH receptor are unique to patients with Graves' disease and to some patients with Hashimoto's thyroiditis. Both types of thyroid antibodies are useful clinical markers of autoimmune thyroid disease and are profoundly influenced by the immune suppression of pregnancy and the resulting loss of such suppression in the postpartum period. Here, we review these three types of thyroid antibodies and their antigens and how they relate to pregnancy itself, obstetric and neonatal outcomes, and the postpartum.
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McLachlan SM, Aliesky HA, Chen CR, Rapoport B. Role of self-tolerance and chronic stimulation in the long-term persistence of adenovirus-induced thyrotropin receptor antibodies in wild-type and transgenic mice. Thyroid 2012; 22:931-7. [PMID: 22827528 PMCID: PMC3429281 DOI: 10.1089/thy.2012.0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Graves'-like disease, reflected by thyrotropin receptor (TSHR) antibodies and hyperthyroidism in some mouse strains, can be induced by immunization with adenovirus-expressing DNA for the human TSHR or its A-subunit. The conventional approach involves two or three adenovirus injections at 3-week intervals and euthanasia 10 weeks after the first injection. To investigate TSHR antibody persistence in mice with differing degrees of self-tolerance to the TSHR A-subunit, we studied the effect of delaying euthanasia until 20 weeks after the initial immunization. METHODS Wild-type (WT) mice and transgenic (tg) mice expressing low intrathyroidal levels of the human TSHR A-subunit were immunized with A-subunit-adenovirus on two occasions; a second group of mice was immunized on three occasions. Sera obtained 4, 10, and 20 weeks (euthanasia) after the initial immunization were tested for thyrotropin (TSH) binding inhibition (TBI), antibody binding to TSHR A-subunit protein-coated enzyme-linked immunosorbent assay (ELISA) plates, and thyroid stimulating antibody activity (TSAb; cyclic adenosine monophosphate [cAMP] generation). Serum thyroxine (T4) and thyroid histology were studied at euthanasia. RESULTS THE majority of WT mice retained high TSHR antibody levels measured by TBI or ELISA at euthanasia but only about 50% were TSAb positive. Low-expressor tgs exhibited self-tolerance, with fewer mice positive by TBI or ELISA and antibody levels were lower than in WT littermates. In WT mice, antibody persistence was similar after two or three immunizations; for tgs, only mice immunized three times had detectable TSAb at 20 weeks. Unlike our previous observations of hyperthyroidism in WT mice examined 4 or 10 weeks after immunization, all mice were euthyroid at 20 weeks. CONCLUSIONS Our findings for induced TSHR antibodies in mice, similar to data for human thyroid autoantibodies, indicate that the parameters that contribute to the concentration of the antibody and thereby play a critical role in long-term persistence of TSHR antibodies are the degree of self-tolerance to the TSHR and chronic stimulation.
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Affiliation(s)
- Sandra M McLachlan
- Thyroid Autoimmune Disease Unit, Cedars-Sinai Research Institute, Los Angeles, CA 90048, USA.
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Abstract
Thyroid disease is a common paediatric disorder that affects up to 3.7% of school-aged children, and it usually presents with a goitre. By far, the most frequent cause of a goitre is autoimmune thyroid disease, although a benign colloid goitre is also a common cause. The present review focuses on the diagnostic approach to a child with a hypothyroid, hyperthyroid or euthyroid goitre.
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Affiliation(s)
- S Muirhead
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario
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19
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Hamada N, Noh JY, Okamoto Y, Ueda M, Konishi T, Fujisawa T, Ito K, Ito K. Measuring thyroglobulin autoantibodies by sensitive assay is important for assessing the presence of thyroid autoimmunity in areas with high iodine intake. Endocr J 2010; 57:645-9. [PMID: 20467162 DOI: 10.1507/endocrj.k09e-353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is some debate over the clinical utility of measuring serum TgAb to assess the presence of thyroid autoimmunity. To clarify the relationship between TgAb levels and thyroid autoimmunity, a histological examination of thyroid tissue was carried out on unselected living individuals with detectable serum TgAb. 146 patients with a pathological diagnosis of follicular adenoma were selected as subjects. Focal lymphocytic infiltration (FLI) was defined as lymphocytic aggregates of more than 200 in number. A thyroid gland in which 0-1 FLI was observed in a few visual fields of low magnification (20 x 4) in thyroid tissue adjacent to a tumor was judged to be normal and a thyroid gland in which 2 or more FLI were observed was diagnosed as focal lymphocytic thyroiditis (FLT). Serum levels of TgAb and TPOAb were measured by radioimmunoassay. Out of the 146 patients, 18 had detectable serum TgAb and 16 had detectable serum TPOAb. All but one (i.e. 94%) of the 18 TgAb positive patients had FLT and 14 out of the 16 TPOAb positive patients had FLT. The sensitivity (17/32; 53.1%) and specificity (113/114; 99.1%) of TgAb for detecting FLT were higher than those (14/32; 43.7% and 112/114; 98.2%) of TPOAb, but the differences were not significant. In 9 patients who were TgAb positive (but TPOAb negative), 8 (88.9%) had FLT. These results throw doubt on the Laboratory medicine practice guidelines published in Thyroid 2003, in which measuring TgAb is not usually necessary for detecting autoimmune thyroid disease. At least measuring TgAb by sensitive assay is useful for assessing the presence of thyroid autoimmunity in Japan, an area with high iodine intakes.
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Affiliation(s)
- Noboru Hamada
- Sumire Hospital, Osaka Social Welfare Foundation, Joto-ku, Osaka, Japan.
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20
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Diagnosis and discrimination of autoimmune Graves' disease and Hashimoto's disease using thyroid-stimulating hormone receptor-containing recombinant proteoliposomes. J Biosci Bioeng 2009; 108:551-6. [DOI: 10.1016/j.jbiosc.2009.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 05/30/2009] [Accepted: 06/04/2009] [Indexed: 11/20/2022]
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Kasagi K, Takahashi N, Inoue G, Honda T, Kawachi Y, Izumi Y. Thyroid function in Japanese adults as assessed by a general health checkup system in relation with thyroid-related antibodies and other clinical parameters. Thyroid 2009; 19:937-44. [PMID: 19678737 DOI: 10.1089/thy.2009.0205] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A limited number of epidemiological studies have attempted to assess thyroid function in the general population of iodine-sufficient countries. The aim of the present study was to determine the underlying thyroid diseases responsible for abnormal thyroid function detected by a general health checkup system in Japan, and to characterize the lipid metabolism in subjects found to have thyroid dysfunction. METHODS Serum thyrotropin (TSH), free thyroxine, anti-thyroglobulin antibodies (TgAb), anti-thyroid peroxidase antibodies (TPOAb), and TSH-binding inhibitor immunoglobulins (TBII) were determined in 1818 Japanese adults (804 men and 1014 women; mean age 51.3 +/- 9.0 years) who undertook a general health checkup. RESULTS Of the 1818 examinees, 12 (0.7%) had overt hypothyroidism (OH), 105 (5.8%) subclinical hypothyroidism, 13 (0.7%) overt thyrotoxicosis, and 39 (2.1%) subclinical thyrotoxicosis. TgAb or TPOAb tests were positive in 17.7% of men and 31.4% of women. The prevalence of positive tests for TgAb or TPOAb was 14.8% for men and 23.4% for women without palpable goiter. Positive tests for TgAb, TPOAb, TBII, and a palpable goiter were more common in subjects with abnormal thyroid function tests than in subjects with normal thyroid function. At the time that abnormal thyroid function test results were first obtained, the signs of thyrotoxicosis were mild or even absent in all 13 subjects with overt thyrotoxicosis, 8 of whom had Graves' disease and 5 of whom had painless thyroiditis. Of the 12 patients with OH, only 2 patients had a palpable goiter. In the OH group, TgAb tests were positive in eight, TPOAb tests were positive in eight, and TBII tests were positive in two. The prevalence of disturbed lipid metabolism, when adjusted for age, was significantly higher in the subclinical hypothyroidism group than in normal controls (p < 0.001; odds ratio, 1.67; 95% confidence interval, 1.10-2.51). CONCLUSIONS In Japanese adults who chose to be screened by a general health checkup system, the prevalence of abnormal thyroid function was nearly 10%. In a high percentage of these patients, abnormal thyroid function could not be detected by their history or physical examination. Just a physical examination without thyroid function tests, particularly serum TSH levels, was not adequate even when performed by a thyroid specialist.
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Affiliation(s)
- Kanji Kasagi
- Department of Health Care, Takamatsu Red Cross Hospital, Takamatsu, Japan.
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McDonald DO, Pearce SHS. Thyroid peroxidase forms thionamide-sensitive homodimers: relevance for immunomodulation of thyroid autoimmunity. J Mol Med (Berl) 2009; 87:971-80. [PMID: 19669106 PMCID: PMC2757584 DOI: 10.1007/s00109-009-0511-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 07/01/2009] [Accepted: 07/14/2009] [Indexed: 11/29/2022]
Abstract
Thyroid peroxidase (TPO) is the key enzyme in thyroid hormone production and a universal autoantigen in Graves’ and other autoimmune thyroid diseases. We wished to explore the expression of TPO and whether it was affected by thionamide antithyroid drugs. We studied recombinant TPO, stably expressed by a Chinese hamster ovary cell line (CHO-TPO) and transiently expressed TPO-enhanced green fluorescent protein (eGFP) and -FLAG fusion proteins. Immunoblotting of CHO-TPO cell extracts showed high-molecular weight (HMW) TPO isoforms that were resistant to reduction, as well as 110 kDa monomeric TPO. Co-immunoprecipitation and enzyme-linked-immunosorbent assay (ELISA) binding studies of FLAG- and eGFP-tagged TPO demonstrated TPO dimerisation. CHO-TPO cells cultured in methimazole (MMI) for 10 days showed a significant reduction in HMW-TPO isoforms at MMI concentrations of 1 µM and above (p < 0.01), whereas monomeric TPO expression was unchanged. We observed a similar reduction in HMW-TPO in CHO-TPO cells cultured in propylthiouracil (10 µM and above). Binding of Graves’ disease patient sera and TPO-Fabs to enzymatically active TPO that was captured onto solid phase was not abrogated by MMI. The cellular localisation of TPO in CHO-TPO cells was unchanged by MMI treatment. Our demonstration of homodimeric TPO and the reduction in HMW-TPO isoforms during thionamide treatment of CHO-TPO cells shows, for the first time, an effect of thionamides on TPO structure. This suggests a structural correlate to the effect of thionamides on TPO enzymatic activity and opens up a novel potential mechanism for thionamide immunomodulation of autoimmune thyroid disease.
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Affiliation(s)
- David O. McDonald
- Institute of Human Genetics, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ UK
| | - Simon H. S. Pearce
- Institute of Human Genetics, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ UK
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Nakamura H, Usa T, Motomura M, Ichikawa T, Nakao K, Kawasaki E, Tanaka M, Ishikawa K, Eguchi K. Prevalence of interrelated autoantibodies in thyroid diseases and autoimmune disorders. J Endocrinol Invest 2008; 31:861-5. [PMID: 19092289 DOI: 10.1007/bf03346432] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We determined the autoantibody profile in autoimmune thyroid diseases (AITD) and examined the distribution of thyroid-related autoantibodies in other autoimmune disorders. METHODS We tested sera from 234 patients with Graves' disease (GD), 130 with Hashimoto's thyroiditis (HT), 249 with other autoimmune diseases, and 50 healthy controls by enzyme-linked immunosorbent assay or radioimmunoassay. RESULTS Autoantibodies except TSH receptor antibody (Ab), anti-thyroglobulin (Tg) Ab and anti-thyroid peroxidase (TPO) Ab were not significantly prevalent in patients with AITD despite a significantly high elevation of thyroid-related Ab. Significant prevalence of autoantibodies related to AITD was observed in type 1 diabetes patients. Elevation of anti-Tg Ab was seen in patients with primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH), and anti-TPO Ab was elevated in patients with PBC. Although the prevalence of anti-acetylcholine receptor Ab and systemic lupus erythematosus (SLE)- related Ab was significant in AIH, primary Sjögren's syndrome (pSS)-related Ab were also found in both liver diseases. In myasthenia gravis (MG) patients, thyroid-related Ab and pSS-related Ab were detected in both MG groups, although SLE-related Ab were limited to the anti-muscle specific kinase Ab-positive MG patients. In patients with connective tissue diseases, anti- Tg Ab and anti-TPO Ab were significantly prevalent. CONCLUSION Thyroid-related Ab were significantly elevated in all autoimmune diseases. Conversely, the elevations of Ab were not significant in the patients with AITD, suggesting a close relationship between AITD and other immune-mediated diseases.
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Affiliation(s)
- H Nakamura
- The First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Nagasaki, Japan.
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Sanders J, Evans M, Betterle C, Sanders P, Bhardwaja A, Young S, Roberts E, Wilmot J, Richards T, Kiddie A, Small K, Platt H, Summerhayes S, Harris R, Reeve M, Coco G, Zanchetta R, Chen S, Furmaniak J, Smith BR. A human monoclonal autoantibody to the thyrotropin receptor with thyroid-stimulating blocking activity. Thyroid 2008; 18:735-46. [PMID: 18631002 DOI: 10.1089/thy.2007.0327] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human monoclonal autoantibodies (MAbs) are valuable tools to study autoimmune responses. To date only one human MAb to the thyrotropin (TSH) receptor (TSHR) with stimulating activity has been available. We now describe the detailed characterization of a blocking type human MAb to the TSHR. METHODS A single heterohybridoma cell line was isolated from the peripheral blood lymphocytes of a patient with severe hypothyroidism (TSH 278 mU/L) using standard techniques. The line stably expresses a TSHR autoantibody (5C9; IgG1/kappa). Ability of 5C9 to bind and compete with 125I-TSH or TSHR antibodies binding to the TSHR was tested using tubes coated with solubilized TSHR. Furthermore, the blocking effects of 5C9 on stimulation of cyclic AMP production was assessed using Chinese hamster ovary (CHO) cells expressing the wild-type human TSHR or TSHRs with amino acid mutations. MAIN OUTCOME 5C9 IgG bound to the TSHR with high affinity (4 x 10(10) L/mol) and inhibited binding of TSH and a thyroid-stimulating human monoclonal autoantibody (M22) to the receptor. 5C9 IgG preparations inhibited the cyclic AMP-stimulating activities of TSH, M22, serum TSHR autoantibodies and thyroid-stimulating mouse monoclonal antibodies. Furthermore 5C9 reduced the constitutive activity of wild-type TSHR and TSHR with some activating mutations. The effect of different amino acid mutations in the TSHR on 5C9 biological activity was studied and TSHR Lys129Ala or Asp203Ala completely abolished the ability of 5C9 to block TSH-mediated stimulation of cyclic AMP production. CONCLUSIONS The availability of 5C9 provides new opportunities to investigate the binding and biological activity of TSHR blocking type autoantibodies including studies at the molecular level. Furthermore, monoclonal antibodies such as 5C9 may well provide the basis of new drugs to control TSHR activity including applications in thyroid cancer and Graves' ophthalmopathy.
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Affiliation(s)
- Jane Sanders
- FIRS Laboratories, RSR Ltd, Llanishen, Cardiff, United Kingdom
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25
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Premawardhana LDKE, Wijeyaratne CN, Chen S, Wijesuriya M, Illangasekera U, Brooking H, Amoroso M, Jeffreys J, Bolton J, Lazarus JH, Furmaniak J, Rees Smith B. Islet cell, thyroid, adrenal and celiac disease related autoantibodies in patients with Type 1 diabetes from Sri Lanka. J Endocrinol Invest 2006; 29:968-74. [PMID: 17259793 DOI: 10.1007/bf03349209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS The prevalence of islet cell, thyroid, adrenal and celiac disease related autoantibodies in patients with Type 1 diabetes mellitus (Type 1 DM) from Sri Lanka is described. DESIGN AND METHODS Autoantibodies to glutamic acid decarboxylase 65 (GAD65Ab), protein tyrosine phosphatase IA-2 (IA-2Ab), insulin (IAAb), thyroglobulin (TgAb), thyroid peroxidase (TPOAb), TSH receptor (TRAb), 21-hydroxylase (21-OHAb) and tissue transglutaminase (tTGAb) were measured in 122 Type 1 DM patients who had low C-peptide activity or were >20 yr old at the time of diagnosis and in 100 non-diabetic blood donors. RESULTS GAD65Ab and/or IA-2Ab were present in 74/122 (60.7%) Type 1 DM subjects with a significantly higher prevalence compared to non-diabetic controls (no. 100) (GAD65Ab-59 vs 4%; IA-2Ab-14 vs 0%; respectively) (p<0.001). The median (inter-quartile range) Type 1 DM duration in antibody positive subjects was 3.3 (0.99-6.9) vs 4.9 (1.7-7.5) yr in antibody negative subjects (p=0.23). IA-2Ab prevalence decreased with disease duration > or =5 yr (19 vs 4%) (p<0.001). There was no difference in the prevalence of TgAb (25 vs 33%)(p=0.21) and TPOAb (22 vs 18%) (p=0.48) in Type 1 DM and non-diabetic subjects. Also, there was no difference in TgAb and TPOAb prevalence in antibody positive Type 1 DM (34.7%) compared to antibody negative Type 1 DM (24.4%) subjects (p=0.24). tTGAb (3/119) and TRAb (1/119) were found in low prevalence and 21-OHAb were not detected. CONCLUSIONS Diabetes associated autoantibodies were detected in the majority of Type 1 DM subjects, suggesting a major role for autoimmunity in the pathogenesis of Type 1 DM in Sri Lankans. The prevalence of TgAb and TPOAb in Type 1 DM subjects and non-diabetic controls was relatively high and similar in both groups.
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Nakatake N, Sanders J, Richards T, Burne P, Barrett C, Pra CD, Presotto F, Betterle C, Furmaniak J, Smith BR. Estimation of serum TSH receptor autoantibody concentration and affinity. Thyroid 2006; 16:1077-84. [PMID: 17123333 DOI: 10.1089/thy.2006.16.1077] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We have used the human monoclonal TSH receptor (TSHR) autoantibody (M22) as a labeled ligand in competition with individual patient TSHR autoantibodies (TRAb) to estimate their serum concentrations and affinities. TSHR coated tubes, (125)I-labeled M22 IgG and Fab, and patient sera IgG and Fab were used in these studies. In 15 patients with Graves' disease, TRAb concentrations ranged from 50 to 500 ng/mL of serum (5- 60 parts per million of total serum IgG) and TRAb IgG affinities from 3.0 +/- 1.0-6.7 +/- 1.54-10(10) L/mol (mean +/- SD; n=3). Fab fragment affinities were similar to those of intact IgG. Serum TRAb with blocking (TSH antagonist; 4 patients) activity had similar affinities (3.0 +/- 0.25-7.2 +/- 2.2-10(10) L/mol) to TRAb IgG from patients with Graves' disease, but blocking TRAb concentrations were higher (1.7 - 27 mg/mL of serum). The concentrations of TRAb that we observed in the sera of the 15 Graves' patient (0.33 - 3.3 nmol/L) can be compared with that of circulating TSH. In particular, a serum TSH concentration of 100mU/L (0.7 nmol/L) is in the same range as the concentrations of TRAb we observed. Such a TSH concentration (similar to that observed after injection of 0.9 mg of recombinant human TSH) would be expected to cause a similar degree of thyrotoxicosis as seen in Graves' disease. Consequently, the thyroid-stimulating potencies (i.e., activity per mol) of patient serum TRAb and human TSH appear to be of a similar magnitude in vivo as well as in vitro. Overall, our results indicate that serum TRAb affinities are high and show only limited variations between different sera whereas concentrations of the autoantibodies vary widely.
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Guilhem I, Massart C, Poirier JY, Maugendre D. Differential evolution of thyroid peroxidase and thyrotropin receptor antibodies in Graves' disease: thyroid peroxidase antibody activity reverts to pretreatment level after carbimazole withdrawal. Thyroid 2006; 16:1041-5. [PMID: 17042691 DOI: 10.1089/thy.2006.16.1041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study, we compared the evolution of thyroid peroxidase antibody (TPOAb) and thyroid-stimulating antibody (TSAb) activities before, during, and after treatment of Graves' disease (GD) with carbimazole. TPOAb and TSAb were measured in sera from 75 patients with GD, during an 18-month block-replace regimen and after drug withdrawal (12, 24, and 36 months). At diagnosis, TPOAb were present in 85% of the patients versus 99% for TSAb. During the treatment, TPOAb values and prevalence significantly decreased, as observed with TSAb. After drug withdrawal, TPOAb levels increased once again to reach the pretreatment values, whereas TSAb remained unchanged. TPOAb values and prevalence at drug withdrawal were not significantly different between patients who remained euthyroid and those who had a relapse of hyperthyroidism. In contrast, TSAb values and prevalence were higher at drug withdrawal in relapse patients. In conclusion, TPOAb and TSAb changes are similar during GD treatment by carbimazole but diverge after drug withdrawal. TPOAb might reflect autoimmune perturbations independently of the clinical status and of the thyroid-stimulating activity.
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Affiliation(s)
- Isabelle Guilhem
- Unité d'Endocrinologie, Département de Médecine, Hôpital Sud, CHU Rennes, France.
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Hewer R, Matthews I, Chen S, McGrath V, Evans M, Roberts E, Nute S, Sanders J, Furmaniak J, Smith BR. A sensitive non-isotopic assay for acetylcholine receptor autoantibodies. Clin Chim Acta 2006; 364:159-66. [PMID: 16051208 DOI: 10.1016/j.cccn.2005.05.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 05/13/2005] [Accepted: 05/18/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Detection and measurement of serum acetylcholine receptor autoantibodies (AChRAb) are useful in the diagnosis and management of myasthenia gravis (MG). An immunoprecipitation assay (IPA) based on AChR labelled with 125I-alpha bungarotoxin is widely used for measurement of AChRAb, but a non-isotopic assay of sensitivity and specificity comparable to IPA is not available as yet. METHODS A new AChRAb ELISA, which is based on the ability of AChRAb to compete with 3 different AChR monoclonal antibodies (MAbs 1-3) for binding sites on affinity purified fetal and adult-type AChR preparations, is described. The sensitivity and specificity of the ELISA were assessed by comparing assay results with a conventional IPA. RESULTS There was good agreement between the IPA and the ELISA for measurement of AChRAb (r = 0.85; n = 83; p <0.001). 76/83 MG sera were positive in the ELISA, whilst 72/83 were positive by IPA. Eight sera were positive in the ELISA (inhibition range 18%-46%) but negative by IPA (0.33-0.47 nmol/L toxin bound) and 4 sera were negative in the ELISA (inhibition range -1% to15%) whilst positive by IPA (0.56-2.9 nmol/L toxin bound). Overall 80/83 (96%) of the MG sera were AChRAb positive in one or both assays. In addition, all 191 control serum samples which were negative for AChRAb by IPA were below or equal to 16% of inhibition in our ELISA. The AChRAb ELISA also showed good inter-assay and intra-assay precision. CONCLUSION The AChRAb ELISA we have described has sensitivity and specificity at least as high as our current radioactive IPA. It has good precision and good handling characteristics making it suitable for routine use.
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Affiliation(s)
- Rachel Hewer
- FIRS Laboratories, RSR Ltd., Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
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29
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Burne P, Mitchell S, Rees Smith B. Point-of-care assays for autoantibodies to thyroid peroxidase and to thyroglobulin. Thyroid 2005; 15:1005-10. [PMID: 16187908 DOI: 10.1089/thy.2005.15.1005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Point-of-care (POC) assays for autoantibodies to thyroid peroxidase (TPOAb) and to thyroglobulin (TgAb) are described. Both assays are based on the ability of autoantibodies in test samples (whole blood, plasma, or sera) to inhibit the binding of monoclonal antibodies to TPO or to Tg. The assays require no special equipment and give results in 10 minutes. Analysis of samples from healthy blood donors (n = 80), patients with autoimmune thyroid disease (n = 97) and nonthyroid autoimmune diseases (n = 20) showed that results with the POC tests compared well to those obtained by agglutination assay and enzyme-linked immunosorbent assay (ELISA). The reference immunoprecipitation assays (IPA) based on 125I-labeled TPO or Tg were more sensitive than the POC tests particularly in the case of TgAb measurements. However, no samples were found positive by POC test and negative by IPA emphasizing the high specificity of the POC assays. Our results suggest that POC testing for TPOAb and TgAb with assays such as those we describe could be useful in certain situations. These include prediction of postpartum thyroiditis and the development of interferon-alpha-related thyroid disease.
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Alnaqdy A, Al-Maskari M. Determination of the levels of anti-thyroid-stimulating hormone receptor antibody with thyroid peroxidase antibody in Omani patients with Graves' disease. Med Princ Pract 2005; 14:209-12. [PMID: 15961927 DOI: 10.1159/000085736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the levels of anti-thyroid-stimulating hormone receptor antibody (TRAb) and thyroid peroxidase antibodies (TPO) in Omani patients with Graves' disease (GD). SUBJECTS AND METHODS ELISA was used to measure the levels of TRAb and TPO in sera of 111 patients with GD, 40 patients with systemic lupus erythematosus (SLE) and 50 healthy normal subjects. Seventy-eight GD patients received iodine-131 treatment while 33 newly diagnosed patients did not receive any treatment. RESULTS The levels of TRAb in the patients with GD, SLE and normal subjects were 7.24 9+/-0.623, 1.04+/-0.179 and 0.539+/-0.070 units/liter, respectively. Elevated levels of TRAb were found in 75, 5 and 2% of patients with GD, SLE and normal subjects, respectively. For anti-TPO antibodies, the levels were 713.331+/-97.905, 85.575+/-34.936 and 22.96+/-4.544 lU/ml, for patients with GD, SLE and normal subjects, respectively. The elevated level of anti-TPO antibodies were found in 72, 15 and 6% of patients with GD, SLE and normal subjects. Statistically significant differences in positive levels of TRAb and anti-TPO antibodies were found in patients with GD as compared to SLE and normal subjects (p<0.001). The treated GD patients had lower levels of TRAb than untreated, but no difference was detected in the levels of anti-TPO antibodies between the treated and not treated. CONCLUSION High levels of TRAb and TPO were detected in Omani patients with GD. TRAb may be helpful in the diagnosis and monitoring the efficacy of iodine-131 treatment in GD patients.
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Affiliation(s)
- Adel Alnaqdy
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khod, Sultanate of Oman.
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Ananieva-Jordanova R, Evans M, Nakamatsu T, Premawardhana LDKE, Sanders J, Powell M, Chen S, McGrath V, Belton C, Arnold C, Baker S, Betterle C, Zanchetta R, Smith BR, Furmaniak J. Isolation and characterisation of a human monoclonal autoantibody to the islet cell autoantigen IA-2. J Autoimmun 2005; 24:337-45. [PMID: 15869863 DOI: 10.1016/j.jaut.2005.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 01/31/2005] [Accepted: 03/01/2005] [Indexed: 11/20/2022]
Abstract
A hybridoma secreting a human monoclonal autoantibody to the islet cell autoantigen IA-2 was prepared from peripheral lymphocytes of a patient with type 1 diabetes and Graves' disease using EBV infection followed by fusion with a mouse/human hybrid cell line. The monoclonal antibody (M13) is an IgG1/kappa and in an immunofluorescence test M13 at 1 microg/mL showed islet cell antibody reactivity equivalent to 40 JDF units. M13 IgG bound (35)S-labelled IA-2 (26% at 100 microg/mL) and (125)I-labelled IA-2 (34% at 100 microg/mL) in an immunoprecipitation assay and reacted well with IA-2 in western blotting analysis. Amino acids 777-808 in the PTP domain of IA-2 were found to be important for M13 binding in an analysis using modified (35)S-labelled IA-2 proteins. M13 V region genes were from VH1-3, D3-22, JH4b, VKI DPK8/Vd+ and JK3 genes and showed a high replacement/silent mutation ratio for both the heavy (11.0) and the light (6.0) chain genes. Mouse monoclonal antibodies (mMAbs) reactive with at least three different epitopes within IA-2 aa 604-686 corresponding to the juxtamembrane domain were also obtained. F(ab')(2) or Fab from the mMAbs inhibited serum IA-2 autoantibody binding to IA-2 in 20/22 diabetic sera whereas M13 F(ab')(2) caused inhibition in only 6/22 sera. M13 is representative of some patient serum IA-2 autoantibodies and as such provides a useful tool to study autoimmune responses to IA-2.
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Abstract
OBJECTIVE To determine the incidence, natural history, and clinical characteristics of Hashitoxicosis (Htx) in pediatric patients with autoimmune thyroiditis. STUDY DESIGN Medical records of children diagnosed with Hashimoto thyroiditis between 1993 and 2002 were reviewed. The clinical course of patients presenting with hyperthyroidism was determined. Variables including sex, age, family history, thyroid hormone levels, anti-thyroid antibody titers, 123 I thyroid scan results, and presenting features were investigated as possible predisposing factors for the development of Htx. RESULTS Out of 69 patients with autoimmune thyroiditis, 8 were diagnosed with Htx. The duration of hyperthyroidism ranged from 31 to 168 days. Three patients became hypothyroid after an average of 46.3 +/- 13.2 days, and 5 patients became euthyroid after an average of 112.8 +/- 59.8 days. Additional findings included an elevated thyroid stimulating immunoglobulin (TSI) titer in 3 of the 8 patients with Htx, and increased uptake on 123 I scan in 2 patients. CONCLUSION Htx is an uncommon yet important cause of hyperthyroidism in children that has a variable clinical course. The diagnosis may be complicated, as presenting features sometimes exhibit significant overlap with Graves' disease. No factors predisposing to the development of Htx were identified.
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Affiliation(s)
- Zeina M Nabhan
- Department of Pediatric Endocrinology, James Whitcomb Riley Hospital for Children, Indiana University School Of Medicine, 702 Barnhill Drive, Indianapolis, IN 46202, USA
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Abstract
OBJECTIVE To present an overview of autoimmune thyroid disease (AITD) that can occur in pregnancy. METHODS The major thyroid antibodies that can traverse the maternal-fetal circulation and affect the fetus are summarized, those women at risk of having affected fetuses are identified, and the diagnosis, course, and treatment of AITD in maternal and neonatal patients are discussed. SUMMARY AITD, including Graves' disease and autoimmune thyroiditis, is common in women of childbearing age. Rarely, the fetus can be affected because of transplacental passage of maternal IgG. Of the thyroid autoantibodies found in AITD, only those directed against the thyroid-stimulating hormone (TSH) receptor have been shown to cause fetal thyroid dysfunction. Both transient neonatal hyperthyroidism and hypothyroidism have been described, as has delayed onset of neonatal hyperthyroidism due to the coexistence of stimulating and blocking TSH receptor antibodies. In general, affected infants are those born to mothers with the most potent antibody activity, and the duration of the neonatal thyroid dysfunction is dependent on the antibody titer and the rate of metabolic clearance from the infant's circulation. If fetal hyperthyroidism is suspected, maternal TSH receptor antibodies should be measured during the third trimester of pregnancy. For neonatal hypothyroidism, this measurement in the mother or baby soon after birth will suffice. Screening for the presence of TSH receptor antibodies by radioreceptor assay is the most cost-effective approach. If results are positive, bioassay should be done to determine the nature of the antibody activity. Women at risk of having babies with neonatal hyperthyroidism include those with a history of previous affected infants, with difficult to control thyrotoxicosis, or with a history of Graves' disease and development of hypothyroidism either spontaneously or as a result of thyroid gland ablation. Transient neonatal hypothyroidism due to TSH receptor-blocking antibodies should be suspected in any infant with hypothyroidism born to a mother with AITD (particularly those with previously affected offspring). CONCLUSION Treatment of maternal hyperthyroidism must consider both maternal and fetal thyroid status. In general, the lowest dose of antithyroid medication sufficient to produce maternal euthyroidism or slight hyperthyroidism is used. In pregnant women with hypothyroidism, doses of L-thyroxine should be sufficient to normalize maternal thyroid function without regard to the fetus. Identification and treatment of affected infants soon after birth will ensure a normal outcome. Whether inadequately treated maternal hypothyroidism is associated with a permanent intellectual deficit in the offspring is currently unknown.
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Affiliation(s)
- R S Brown
- Division of Pediatric Endocrinology/Diabetes, University of Massachusetts Medical Center, Worcester, MA 01655, USA
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Ota T, Takamura T, Nagai Y, Bando Y, Usuda R. Significance of IA-2 antibody in Japanese type 1 diabetes: its association with GAD antibody. Diabetes Res Clin Pract 2005; 67:63-9. [PMID: 15620435 DOI: 10.1016/j.diabres.2004.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2003] [Revised: 04/19/2004] [Accepted: 05/11/2004] [Indexed: 11/15/2022]
Abstract
To investigate the presence and level of serum antibodies to IA-2 (IA-2A) in Japanese patients with adult type 1 diabetes in order to clarify its association with glutamic acid decarboxylase (GAD) antibody. Serum samples were obtained from 101 Japanese patients with type 1 diabetes, including 37 patients with slowly progressive form of type 1 diabetes. Serum levels of IA-2A and GADA were determined by radioimmunoassay. The study had a cross-sectional design. IA-2A and GADA were detected in 37 and 59% of these patients, respectively. Of the 37 slowly progressive form of patients, IA-2A and GADA were present in 49 and 86%, respectively (NS). GADA levels were significantly higher (P<0.05) in IA-2A positive than in IA-2A negative patients in slowly progressive form, but IA-2A levels did not differ significantly between GADA positive and GADA negative patients. Measuring IA-2A in combination with GADA is useful for the diagnosis and prognosis of type 1 diabetes in Japanese.
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Affiliation(s)
- Tsuguhito Ota
- Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
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Nakachi K, Powell M, Swift G, Amoroso MA, Ananieva-Jordanova R, Arnold C, Sanders J, Furmaniak J, Rees Smith B. Epitopes recognised by tissue transglutaminase antibodies in coeliac disease. J Autoimmun 2004; 22:53-63. [PMID: 14709413 DOI: 10.1016/j.jaut.2003.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The interaction between IgA tissue transglutaminase (tTG) antibodies (Abs) and 35S-labelled tTG produced in a transcription/translation (TnT) system with various amino acid (aa) deletions has been studied. These experiments showed that the tTG N-terminal aa 1-89 were important for tTG Ab binding in all 15 coeliac disease sera studied and the central residues (aa 401-491) were important for binding of tTG Abs in all but one sera. The contribution of C-terminal residues to tTG Ab binding varied in different coeliac sera but overall was less than the contributions of the N terminal and central regions. Mouse monoclonal antibodies (MAbs) to tTG were produced and the tTG aa sequences recognised by the MAbs determined using modified 35S-labelled tTG proteins. Analysis of the inhibiting effects of patient sera tTG Ab on binding of tTG MAbs to tTG confirmed the importance of the N-terminal and central regions of tTG in forming serum tTG Ab binding sites. Recombinant human tTG was expressed in yeast and purified to better than 95% homogeneity using MAb affinity chromatography as a final purification step. This material was highly suitable for use in an ELISA for tTGAb.
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Affiliation(s)
- Ken Nakachi
- FIRS Laboratories, RSR Ltd, Parc Ty Glas, Llanishen, Cardiff CF14 5DU, UK
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Smith BR, Bolton J, Young S, Collyer A, Weeden A, Bradbury J, Weightman D, Perros P, Sanders J, Furmaniak J. A new assay for thyrotropin receptor autoantibodies. Thyroid 2004; 14:830-5. [PMID: 15588379 DOI: 10.1089/thy.2004.14.830] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A new procedure for measuring patient serum thyrotropin receptor (TSHR) autoantibodies is described in which the autoantibodies inhibit binding of a human monoclonal thyroid stimulating antibody M22 (labeled with biotin) to TSHR-coated enzyme-linked immunosorbent assay (ELISA) plate wells. In the assay, M22-biotin binding is detected by addition of streptavidin peroxidase. The M22 based assay was more sensitive than a similar ELISA based on inhibition of TSH-biotin binding to TSHR coated wells with 1 U/L of NIBSC 90/672 giving approximately 35% inhibition in the M22-based system compared to approximately 15% inhibition in the TSH-based ELISA. This had an important impact on the precision of the 2 assays with the M22-based ELISA showing an interassay coefficient of variation (CV) of 10% at 1 U/L whereas the TSH-based ELISA had an interassay CV of 20% at 1 U/L. Analysis of sera from 307 control subjects without a diagnosis of Graves' disease indicated that only 2 (0.65%) gave inhibition of M22 binding values of greater than 10% (11% and 12% inhibition). In the case of sera from 108 patients with Graves' disease (treated and untreated) 103 (95%) gave inhibition of M22 binding values of 14% or greater. Receiver operating characteristic (ROC) plot analysis showed that 100% specificity for TSHR autoantibody detection in Graves' disease was obtained at 95% sensitivity for the M22-based ELISA and 89% sensitivity for the TSH-biotin-based ELISA. Inhibition of M22 binding to the TSHR was closely correlated to inhibition of TSH binding in the 108 Graves' sera (r = 0.99). However, inhibition of M22 binding was almost always greater resulting in improved sensitivity and precision.
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Matthews I, Chen S, Hewer R, McGrath V, Furmaniak J, Rees Smith B. Muscle-specific receptor tyrosine kinase autoantibodies—a new immunoprecipitation assay. Clin Chim Acta 2004; 348:95-9. [PMID: 15369741 DOI: 10.1016/j.cccn.2004.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 05/03/2004] [Accepted: 05/04/2004] [Indexed: 01/12/2023]
Abstract
BACKGROUND It has been reported that measurement of autoantibodies to a muscle-specific receptor tyrosine kinase (MuSK) may be useful in the assessment and management of patients with acetylcholine receptor antibody (AChRAb)-negative myasthenia gravis (MG). METHODS A new and convenient assay for MuSKAb measurement based on 125I-labeled purified recombinant MuSK is described. In the assay, serum samples (5 microl) were incubated with 50 microl of 125I-MuSK and any immune complexes formed precipitated with antihuman IgG (50 microl). RESULTS With this assay, MuSKAbs were detected in 8/33 (24%) sera from AChRAb-negative MG patients studied. In contrast, no MuSKAb was detected in 53 AChRAb-positive MG patient sera; furthermore, 0/18 Lambert-Eaton myasthenic syndrome sera, 0/5 non-MG neuromuscular disease sera, 0/95 control autoimmune disease sera, and 0/50 healthy blood donor sera contained detectable MuSKAb. In this assay, inter-assay coefficients of variation (n = 5) were 6.8%, 5.9%, and 3.6% for samples with MuSKAbs at 0.73, 0.32, and 0.11 nmol/l, respectively. Similar results were obtained with 125I-labeled rat and human MuSK. CONCLUSION The 125I-MuSK immunoprecipitation assay we have described provides a simple, specific, and precise procedure for detecting MuSKAbs.
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Affiliation(s)
- Ian Matthews
- FIRS Laboratories, RSR Ltd., Parc Ty Glas, Llanishen, Cardiff CF14 5DU, UK
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McLachlan SM, Rapoport B. Thyroid stimulating monoclonal antibodies: overcoming the road blocks and the way forward. Clin Endocrinol (Oxf) 2004; 61:10-8. [PMID: 15212639 DOI: 10.1111/j.1365-2265.2004.02028.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sandra M McLachlan
- Autoimmune Disease Unit, Cedars-Sinai Research Institute and UCLA School of Medicine, Los Angeles, California, USA.
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39
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Abstract
Autoantibodies to thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) are of immunoglobulin G (IgG) class and have high affinities for their respective autoantigens. Both autoantibodies are markers of thyroid autoimmunity and they can be measured by a variety of assays. From the clinical perspective, TgAb are less prevalent than TPOAb and less useful than TPOAb for prediction of thyroid dysfunction. Moreover, TgAb interfere with Tg measurements to monitor metastases in thyroid cancer. However, increasing evidence suggests that these TgAb provide a surrogate for Tg. In terms of disease pathogenesis, Tg has been suggested to play a role in Graves' ophthalmopathy. Pending further studies, TgAb epitopes could distinguish between individuals who are euthyroid or who have clinical disease. A final, intriguing reason for measuring and characterizing TgAb is the interest these autoantibodies have rekindled in their autoantigen. It is conceivable that Tg polymorphisms, combined with the explosive mix of iodine, TPO and H2O2 necessary for thyroid hormone synthesis, inadvertently provide the trigger for the autoimmune thyroid response.
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Affiliation(s)
- Sandra M McLachlan
- Autoimmune Disease Unit, Cedars-Sinai Research Institute and UCLA School of Medicine, Los Angeles, California, USA.
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40
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Zöphel K, Wunderlich G, Smith BR. Serum thyroglobulin measurements with a high sensitivity enzyme-linked immunosorbent assay: is there a clinical benefit in patients with differentiated thyroid carcinoma? Thyroid 2003; 13:861-5. [PMID: 14588100 DOI: 10.1089/105072503322401050] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Serial serum thyroglobulin (Tg) measurements with a highly sensitive enzyme-linked immunosorbent assay (ELISA; functional sensitivity 0.03 ng/mL) in 126 patients (Tg autoantibody negative) with treated differentiated thyroid cancer (DTC) are described. At the beginning of the retrospective study, all 126 patients were in remission and Tg was detectable by ELISA in 92 (73%; range, 0.03-0.8 ng/mL). Over the following 4-year period, Tg levels remained essentially unchanged (i.e., any increases were less than 2 times the Tg level at the start of the study) in 121 of 126 (96%) and all 121 patients remained well. In 5 patients, Tg levels increased to more than 2 times the starting Tg level over the study period and in 4 of these 5, there was recurrence of DTC. The fifth patient in this group remains well as evidenced by extensive diagnostic imaging, although his serum Tg level continues to increase and can be stimulated by thyrotropin (TSH). Our results suggest that serial measurements of low levels of Tg by ELISA in treated patients with DTC enable detection of recurrence (without using TSH stimulation) 6-12 months earlier than would have been possible using a conventional Tg immuno-radiometric assay (IRMA). A prospective study is now needed to confirm these observations.
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MESH Headings
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/surgery
- Enzyme-Linked Immunosorbent Assay/methods
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnosis
- Retrospective Studies
- Sensitivity and Specificity
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/surgery
- Thyroxine/therapeutic use
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Affiliation(s)
- Klaus Zöphel
- Department of Nuclear Medicine, Carl Gustav Carus Medical School, University of Technology, Dresden, Germany.
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41
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Abstract
A renewal of the search for a link between breast cancer and thyroid disease has once again demonstrated an increased prevalence of autoimmune thyroid disease in patients with breast cancer. This is the most recent of many studies showing an association between a variety of thyroid disorders and breast cancer. Such an association is not surprising as both diseases are female predominant with a similar postmenopausal peak incidence. The significance of the presence of thyroid autoantibodies, particularly thyroid peroxidase antibodies, in serum from patients with breast cancer is unknown, but it has been suggested that antibody positivity is associated with better prognosis. One area in which thyroid and breast functions overlap is in the uptake and utilization of dietary iodide. Experimental findings showing the ability of iodine or iodine-rich seaweed to inhibit breast tumour development is supported by the relatively low rate of breast cancer in Japanese women who consume a diet containing iodine-rich seaweed. However, there is as yet no direct evidence that iodine, iodinated compounds, or a combination of iodine and selenium is the antimammary carcinogenic element in the Japanese diet. It remains to be resolved whether the perceived breast cancer-thyroid disease relationship is thyroid or iodine related or, in the case of thyroid autoantibodies, is the consequence of an immune response to the carcinoma. Is this response breast specific and does it relate to iodine status? These and many other questions await resolution before a definitive role in the natural history of breast carcinoma can be assigned to the thyroid.
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Affiliation(s)
- Peter P A Smyth
- Endocrine laboratory, Department of Medicine and Therapeutics, and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland.
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42
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Abstract
Previous studies have disclosed that a substantial percentage of infants from mothers with thyroid autoimmunity have antibodies to thyroid peroxidase (TPOAb) at birth. Furthermore, these antibodies have been shown to be of maternal origin. In view of this we thought it would be of interest to determine the prevalence of TPOAb in newborns from an unselected population of women. This was done by retrieving stored dried blood specimens from 240 full-term healthy infants, which had been obtained during 1999 for routine newborn screening. Ten percent of the randomly selected specimens tested TPOAb positive. Thyroid function in the mothers could not be evaluated because all specimens had been tested anonymously. In summary, our results indicate that a significant percentage of newborns were TPOAb positive. It is unclear at this time whether such antibodies reflected maternal thyroid autoimmunity and/or other autoimmune disorders. However, the close association between autoimmune thyroid disease and TPOAb positivity raises the possibility of abnormal thyroid function in some of the mothers.
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Affiliation(s)
- Marvin L Mitchell
- New England Newborn Screening Program, University of Massachusetts Medical School, Jamaica Plain, Massachusetts 02130, USA.
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43
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Tozzoli R, Bizzaro N, Tonutti E, Pradella M, Manoni F, Vilalta D, Bassetti D, Piazza A, Rizzotti P. Immunoassay of anti-thyroid autoantibodies: high analytical variability in second generation methods. Clin Chem Lab Med 2002; 40:568-73. [PMID: 12211650 DOI: 10.1515/cclm.2002.098] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of highly sensitive immunometric methods in clinical laboratories to assay anti-thyroid antibodies has progressively expanded in recent years but it is not known whether the new techniques have improved the analytical variability connected with the preceding methodologies. The Italian Society of Laboratory Medicine Study Group on Autoimmune Diseases conducted a collaborative study with the biomedical industry to evaluate the degree of standardization of the new analytical procedures. Twelve companies agreed to participate in the study on the search for anti-thyroglobulin (anti-Tg) and anti-thyroperoxidase (anti-TPO) antibodies in nine sera from patients with autoimmune thyroiditis, and in six sera from patients with non-autoimmune thyroid disease; ten immunometric and three immunofluorescence methods were employed. Agreement of qualitative results was close to 90% for anti-Tg and 97% for anti-TPO, with no important differences between the methods; variability of the quantitative results, expressed as CV% of absolute (in lU/ml) and relative (in cut-off concentration multiples) values was 93.9% and 102.3%, respectively, for anti-Tg, and 75.5% and 62.9%, respectively, for anti-TPO. These findings show that despite the progressive improvement in the analytical techniques, the variability between methods for the assay of anti-Tg and anti-TPO is still unexpectedly high, and probably due to several factors such as uncertainty in defining the positive cutoff concentration, absence of adequate international reference preparations, modality of autoantigen purification, and analytical variability in the assay procedures.
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Affiliation(s)
- Renato Tozzoli
- Laboratorio Analisi Chimico-cliniche e Microbiologia, Ospedale Civile, Latisana, UD, Italy
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Abstract
The characteristics of thyroid autoantibodies are reviewed and new assays for the autoantibodies described, in particular point of care (POC) tests for thyroid peroxidase (TPO) autoantibodies and for thyroglobulin (Tg) autoantibodies. These POC tests depend on the ability of the autoantibodies to inhibit gold labelled human monoclonal antibodies binding to TPO or to Tg. The POC tests show similar sensitivity and specificity to conventional ELISA for the autoantibodies. A new ELISA to measure autoantibodies to the TSH receptor (TRAb) is described, is based on TSH receptor coated onto plate wells by way of a monoclonal antibody. Comparison of porcine and human TSH receptors indicates that there is no advantage in using human TSHR in assay systems based on competition between TRAb and bovine or porcine TSH for immobilised TSHR. In terms of the origins of Graves' disease, it is speculated that this most common overt autoimmune disease in man might have occurred first when Homo sapiens sapiens migrated rapidly out of Africa about 100,000 years ago.
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Phillips DIW, Osmond C, Baird J, Huckle A, Rees-Smith B. Is birthweight associated with thyroid autoimmunity? A study in twins. Thyroid 2002; 12:377-80. [PMID: 12097197 DOI: 10.1089/105072502760043440] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although extensive studies have suggested that an individual's predisposition to develop autoantibodies to thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) has a genetic component, a recent report has suggested that growth restriction during fetal life may also contribute. We have therefore measured TPOAb and TgAb in a population-based study of twins (44 monozygous and 91 dizygous) born between 1950 and 1955 who were identified through a registry of birth records in Birmingham, United Kingdom. TPOAb and TgAb were measured by a highly sensitive immunoprecipitation assay in which 0.01 U/mL and 0.1 U/mL, respectively, were detectable. TPOAb were found in 49 of 156 (31%) of women and 7 of 116 (6%) of men with similar values for TgAb (31% and 9%, respectively). Of 28 monozygous pairs, 10 were concordant for TgAb and 7 discordant giving a probandwise concordance rate of 74%. Concordance rates for TPOAb were similar (64%) and were higher than concordance rates in dizygous twins. Monozygous twins had a higher prevalence of TgAb than dizygous twins (30% vs. 17%, p = 0.01). In addition, we found that where there was discordance in birth size within monozygous twin pairs, the smaller twin had a higher prevalence of TPOAb (p = 0.01). Our results suggest that both heritable and early environmental components contribute to the susceptibility to thyroid autoimmunity.
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Thrasher JD, Heuser G, Broughton A. Immunological abnormalities in humans chronically exposed to chlorpyrifos. ARCHIVES OF ENVIRONMENTAL HEALTH 2002; 57:181-7. [PMID: 12507170 DOI: 10.1080/00039890209602934] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Twenty-nine individuals with chronic health complaints following exposure to chlorpyrifos were compared with 3 control groups (i.e., 1 positive and 2 negative) with respect to the following: (1) peripheral lymphocyte phenotypes; (2) autoantibodies (nucleic acids and nucleoproteins, parietal cell, brush border, mitochondria, smooth muscle, thyroid gland, and central nervous system/peripheral nervous system myelin); (3) mitogenesis to phytohemagglutinin and concanavillin. The data revealed an increase in CD26 expression, a decrease in percentage of CD5 phenotype, decreased mitogenesis in response to phytohemagglutinin and concanavillin, and an increased frequency of autoantibodies. The alterations in these peripheral blood markers were unaffected by medications, age, sex, or season. The authors concluded that chronic exposure to chlorpyrifos causes immunological changes.
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Kasamatsu TS, Maciel RM, Vieira JGH. Desenvolvimento e Validação de Um Método Imunofluorométrico Para a Pesquisa de Anticorpos Antiperoxidase Tiroidiana no Soro. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0004-27302002000200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Desenvolvemos um ensaio onde TPO altamente purificada, obtida a partir de tecido humano, é adsorvida em poços de placas de microtitulação; após incubação com os soros a serem estudados, a revelação da presença de anticorpos específicos é feita com o emprego de anticorpo monoclonal anti-IgG humana marcado com európio. A sensibilidade do teste é da ordem de 0,6U/mL, e as características de reprodutibilidade bastante aceitáveis. Foram analisadas amostras de soro de 188 indivíduos normais de ambos os sexos (74 com >65 anos), de 54 pacientes com doença de Graves (DG) e de 13 com tiroidite de Hashimoto (TH). O método foi comparado, com base em 97 amostras, com um RIE comercial, encontrando-se alta concordância com índice kappa de 0,959. O estudo do valor de corte para definir a presença de anticorpos anti-TPO em níveis significativos baseou-se na curva ROC, e foi fixado em 10U/mL. A freqüência de anti-TPO positivo na população normal foi de 9,6% em indivíduos até 64 anos e de 16,5% nos com >65 anos; nos pacientes com DG 85,2% apresentaram anti-TPO positivo, sendo 100% nos pacientes com TH. O ensaio descrito mostrou-se sensível e específico e de fácil execução para a detecção de autoanticorpos contra a peroxidase tiroidiana presentes na maioria dos indivíduos com doença auto-imune tiroidiana.
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Hendry E, Taylor G, Grennan-Jones F, Sullivan A, Liddy N, Godfrey J, Hayakawa N, Powell M, Sanders J, Furmaniak J, Smith BR. X-ray crystal structure of a monoclonal antibody that binds to a major autoantigenic epitope on thyroid peroxidase. Thyroid 2001; 11:1091-9. [PMID: 12186495 DOI: 10.1089/10507250152740920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Thyroid peroxidase (TPO) catalyzes the production of thyroid hormones and is a major autoantigen in autoimmune thyroid disease (AITD). It is believed that the majority of TPO autoantibodies bind to an immunodominant region consisting of two overlapping domains. Precise location of these domains would help our understanding of the interaction between TPO and TPO autoantibodies. 4F5 is a mouse monoclonal antibody (IgG1, kappa) that reacts with high affinity (2.6 x 10(10) mol/L(-1)) with one of the major autoantigenic regions on TPO. Heavy chain genes of 4F5 were from the VH1 germline gene family, germline genes for the D region could not be assigned and the J region was from the JH2 germline. Light chain genes were from Vkappa4/5 and Jkappa2, germline gene families. The Fab fragment of 4F5 was prepared by papain digestion, purified, crystallized, and the structure solved to 1.9 A using molecular replacement. The refined structure had an R factor of 19.5% and a free R factor of 23.9%. Deduced amino acid sequence and amino acid sequence obtained from diffraction analysis were compared and used to finalize the 4F5 Fab model. Structural analysis indicated that the structure of 4F5 is that of a standard Fab and its combining site is flat and is rich in tyrosine residues. Comparison of the structure of 4F5 with that of a TPO autoantibody Fab, TR1.9 suggests that the two antibodies are unlikely to recognise the same structures on TPO.
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Affiliation(s)
- E Hendry
- The Centre for Biomolecular Sciences, University of St Andrews, Fife, United Kingdom
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Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev 2001; 22:605-30. [PMID: 11588143 DOI: 10.1210/edrv.22.5.0441] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery and based on an autoimmune inflammation of the thyroid. The prevalence ranges from 5-7%. We discuss the role of antibodies (especially thyroid peroxidase antibodies), complement, activated T cells, and apoptosis in the outbreak of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an acute phase of autoimmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune tolerance ensues. A rebound reaction to this pregnancy-associated immune suppression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasingly recognized as a serious health problem. 1) Thyroid autoimmunity increases the probability of spontaneous fetal loss. 2) Thyroid failure due to autoimmune thyroiditis-often mild and subclinical-can lead to permanent and significant impairment in neuropsychological performance of the offspring. 3) Evidence is emerging that as women age subclinical hypothyroidism-as a sequel of postpartum thyroiditis-predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered.
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Affiliation(s)
- A F Muller
- Department of Immunology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
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Wunderlich G, Zöphel K, Crook L, Smith S, Smith BR, Franke WG. A high-sensitivity enzyme-linked immunosorbent assay for serum thyroglobulin. Thyroid 2001; 11:819-24. [PMID: 11575850 DOI: 10.1089/105072501316973064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A sensitive enzyme-linked immunosorbent assay (ELISA) for measuring serum thyroglobulin (Tg) is described. The assay has a functional sensitivity of 0.03 ng/mL and values obtained in sera from patients with treated differentiated thyroid cancer (DTC; n = 24, 17 of whom showed some evidence of recurrence) and from healthy blood donors (n = 48) were in agreement with those obtained by Tg immunoradiometric assay (IRMA) (functional sensitivity = 0.6 ng/ml) (r = 0.99 and 0.98 for the two groups, respectively). The Tg levels measured by ELISA in 47 of the healthy blood donor sera ranged from 2.3 to 139 ng/ml with 1 serum giving a value of 0.03 ng/mL. The mean +/- standard deviation (SD) Tg concentration for the healthy blood donors was 20.3+/-23 ng/mL. Studies with a recovery test suggest that Tg measurements by ELISA were not always reliable when Tg autoantibodies were present. Analysis of samples from 167 patients treated successfully for DTC (papillary carcinoma, 94; follicular carcinoma, 73) showed that 139 were negative for Tg autoantibodies and of these 106 (76%) had Tg levels measurable by ELISA (0.03 ng/mL or greater). In contrast, only 7 (5%) of these 139 sera had Tg levels measurable by IRMA (0.6 ng/mL or greater). It is possible that this ability to measure Tg simply and easily in most treated DTC patients will have significant advantages for patient care. In particular, the Tg level after initial ablative treatment will usually be measurable rather than undetectable. Furthermore, any increases in serum Tg levels which may herald relapse will be detectable earlier.
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Affiliation(s)
- G Wunderlich
- Department of Nuclear Medicine, Carl Gustav Carus Medical School, University of Technology, Dresden, Germany.
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