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Jaeschke H, Undeutsch H, Patyra K, Löf C, Eszlinger M, Khalil M, Jännäri M, Makkonen K, Toppari J, Zhang FP, Poutanen M, Paschke R, Kero J. Hyperthyroidism and Papillary Thyroid Carcinoma in Thyrotropin Receptor D633H Mutant Mice. Thyroid 2018; 28:1372-1386. [PMID: 30132406 DOI: 10.1089/thy.2018.0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Constitutively active thyrotropin receptor (TSHR) mutations are the most common etiology of non-autoimmune hyperthyroidism (NAH). Thus far, the functionality of these mutations has been tested in vitro, but the in vivo models are lacking. METHODS To understand the pathophysiology of NAH, the patient-derived constitutively active TSHR D633H mutation was introduced into the murine Tshr by homologous recombination. RESULTS In this model, both subclinical and overt hyperthyroidism was observed, depending on the age, sex, and genotype. Homozygous mice presented hyperthyroidism at two months of age, while heterozygous animals showed only suppressed thyrotropin. Interestingly, at six months of age, thyroid hormone concentrations in all mutant mice were analogous to wild-type mice, and they showed colloid goiter with flattened thyrocytes. Strikingly, at one year of age, nearly all homozygous mice presented large papillary thyroid carcinomas. Mechanistically, this papillary thyroid carcinoma phenotype was associated with an overactive thyroid and strongly increased stainings of proliferation-, pERK-, and NKX2-1 markers, but no mutations in the "hot-spot" areas of common oncogenes (Braf, Nras, and Kras) were found. CONCLUSIONS This is the first study to reveal the dynamic age-, sex-, and genotype-dependent development of NAH. Furthermore, the study shows that a constitutively active TSHR can trigger a malignant transformation of thyrocytes.
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Affiliation(s)
- Holger Jaeschke
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Henriette Undeutsch
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Konrad Patyra
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Christoffer Löf
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Markus Eszlinger
- 2 Departments of Medicine, Oncology, Pathology, and Biochemistry, and Molecular Biology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Moosa Khalil
- 3 Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Meeri Jännäri
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Kristiina Makkonen
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Jorma Toppari
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
- 4 Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Fu-Ping Zhang
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Matti Poutanen
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
| | - Ralf Paschke
- 2 Departments of Medicine, Oncology, Pathology, and Biochemistry, and Molecular Biology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jukka Kero
- 1 Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku , Turku, Finland
- 4 Department of Pediatrics, Turku University Hospital, Turku, Finland
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Moore MD, Panjwani S, Gray KD, Finnerty BM, Zarnegar R, Fahey TJ. The role of molecular diagnostic testing in the management of thyroid nodules. Expert Rev Mol Diagn 2017; 17:567-576. [PMID: 28423960 DOI: 10.1080/14737159.2017.1321987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Fine needle aspiration (FNA) with cytologic examination remains the standard of care for investigation of thyroid nodules. However, as many as 30% of FNA samples are cytologically indeterminate for malignancy, which confounds clinical management. To reduce the burden of repeat diagnostic testing and unnecessary surgery, there has been extensive investigation into molecular markers that can be detected on FNA specimens to more accurately stratify a patient's risk of malignancy. Areas covered: In this review, the authors discuss recent evidence and progress in molecular markers used in the diagnosis of thyroid cancer highlighting somatic gene alterations, molecular technologies and microRNA analysis. Expert commentary: The goal of molecular markers is to improve diagnostic accuracy and aid clinicians in the preoperative management of thyroid lesions. Modalities such as direct mutation analysis, mRNA gene expression profiling, next-generation sequencing, and miRNA expression profiling have been explored to improve the diagnostic accuracy of thyroid nodule FNA. Although no perfect test has been discovered, molecular diagnostic testing has revolutionized the management of thyroid nodules.
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Affiliation(s)
- Maureen D Moore
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
| | - Suraj Panjwani
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
| | - Katherine D Gray
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
| | - Brendan M Finnerty
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
| | - Rasa Zarnegar
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
| | - Thomas J Fahey
- a Department of Surgery , New York Presbyterian-Weill Cornell Medicine , New York , NY , USA
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Núñez Miguel R, Sanders J, Furmaniak J, Smith BR. Structure and activation of the TSH receptor transmembrane domain. AUTOIMMUNITY HIGHLIGHTS 2016; 8:2. [PMID: 27921237 PMCID: PMC5136658 DOI: 10.1007/s13317-016-0090-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE The thyroid-stimulating hormone receptor (TSHR) is the target autoantigen for TSHR-stimulating autoantibodies in Graves' disease. The TSHR is composed of: a leucine-rich repeat domain (LRD), a hinge region or cleavage domain (CD) and a transmembrane domain (TMD). The binding arrangements between the TSHR LRD and the thyroid-stimulating autoantibody M22 or TSH have become available from the crystal structure of the TSHR LRD-M22 complex and a comparative model of the TSHR LRD in complex with TSH, respectively. However, the mechanism by which the TMD of the TSHR and the other glycoprotein hormone receptors (GPHRs) becomes activated is unknown. METHODS We have generated comparative models of the structures of the inactive (TMD_In) and active (TMD_Ac) conformations of the TSHR, follicle-stimulating hormone receptor (FSHR) and luteinizing hormone receptor (LHR) TMDs. The structures of TMD_Ac and TMD_In were obtained using class A GPCR crystal structures for which fully active and inactive conformations were available. RESULTS Most conserved motifs observed in GPCR TMDs are also observed in the amino acid sequences of GPHR TMDs. Furthermore, most GPCR TMD conserved helix distortions are observed in our models of the structures of GPHR TMDs. Analysis of these structures has allowed us to propose a mechanism for activation of GPHR TMDs. CONCLUSIONS Insight into the mechanism of activation of the TSHR by both TSH and TSHR autoantibodies is likely to be useful in the development of new treatments for Graves' disease.
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Affiliation(s)
| | - Jane Sanders
- FIRS Laboratories, RSR Ltd, Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
| | - Jadwiga Furmaniak
- FIRS Laboratories, RSR Ltd, Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK
| | - Bernard Rees Smith
- FIRS Laboratories, RSR Ltd, Parc Ty Glas, Llanishen, Cardiff, CF14 5DU, UK.
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Eszlinger M, Niedziela M, Typlt E, Jaeschke H, Huth S, Schaarschmidt J, Aigner T, Trejster E, Krohn K, Bösenberg E, Paschke R. Somatic mutations in 33 benign and malignant hot thyroid nodules in children and adolescents. Mol Cell Endocrinol 2014; 393:39-45. [PMID: 24915144 DOI: 10.1016/j.mce.2014.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/26/2014] [Accepted: 05/26/2014] [Indexed: 11/15/2022]
Abstract
Hot thyroid nodules (HTNs) in children are rare. Their reported malignancy rate is higher than in adults. However molecular data are rare. We present clinical and molecular data for 33 consecutive (29 benign and 4 malignant) HTNs. 17/29 Benign HTNs (59%) harbored somatic TSHR mutations. The most commonly observed mutation was M453T (in 8/29 samples). T632I and D633Y mutations were each detected twice. All other TSHR mutations were each found in one sample, including the new A538T mutation. One NRAS mutation was detected in a benign HTN with a M453T mutation. A PAX8/PPARG rearrangement was found in one malignant HTN. A T632I mutation was detected in one hot papillary thyroid carcinoma. The percentage of TSHR mutation positive HTNs in children and adolescents is within the range observed in adults. Contrary to adults, the M453T mutation is the predominant TSHR mutation in HTNs of children and adolescents. The increased malignancy rate of HTNs of children does not appear to be associated with RAS, BRAF, PAX8/PPARG and RET/PTC mutations.
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Affiliation(s)
- Markus Eszlinger
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland.
| | - Eva Typlt
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Holger Jaeschke
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Sandra Huth
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Jörg Schaarschmidt
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Thomas Aigner
- Institute of Pathology, University of Leipzig, Liebigstr., D-04103 Leipzig, Germany.
| | - Ewa Trejster
- Laboratory of Pathology, Karol Jonscher's Clinical Hospital of Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland
| | - Knut Krohn
- IZKF Leipzig, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Eileen Bösenberg
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 21, D-04103 Leipzig, Germany.
| | - Ralf Paschke
- Division of Endocrinology and Nephrology, University of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany.
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Benvenga S, Koch CA. Molecular pathways associated with aggressiveness of papillary thyroid cancer. Curr Genomics 2014; 15:162-70. [PMID: 24955023 PMCID: PMC4064555 DOI: 10.2174/1389202915999140404100958] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/26/2014] [Accepted: 03/03/2014] [Indexed: 02/07/2023] Open
Abstract
The most common thyroid malignancy is papillary thyroid cancer (PTC). Mortality rates from PTC mainly depend on its aggressiveness. Geno- and phenotyping of aggressive PTC has advanced our understanding of treatment failures and of potential future therapies. Unraveling molecular signaling pathways of PTC including its aggressive forms will hopefully pave the road to reduce mortality but also morbidity from this cancer. The mitogen-activated protein kinase and the phosphatidylinositol 3-kinase signaling pathway as well as the family of RAS oncogenes and BRAF as a member of the RAF protein family and the aberrant expression of microRNAs miR-221, miR-222, and miR-146b all play major roles in tumor initiation and progression of aggressive PTC. Small molecule tyrosine kinase inhibitors targeting BRAF-mediated events, vascular endothelial growth factor receptors, RET/PTC rearrangements, and other molecular targets, show promising results to improve treatment of radioiodine resistant, recurrent, and aggressive PTC.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical & Experimental Medicine, Section of Endocrinology, University of Messina, Messina, Italy
| | - Christian A Koch
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA ; GV (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
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Paschke R, Niedziela M, Vaidya B, Persani L, Rapoport B, Leclere J. 2012 European thyroid association guidelines for the management of familial and persistent sporadic non-autoimmune hyperthyroidism caused by thyroid-stimulating hormone receptor germline mutations. Eur Thyroid J 2012; 1:142-7. [PMID: 24783013 PMCID: PMC3821481 DOI: 10.1159/000342982] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/27/2012] [Indexed: 11/19/2022] Open
Abstract
All cases of familial thyrotoxicosis with absence of evidence of autoimmunity and all children with persistent isolated neonatal hyperthyroidism should be evaluated for familial non-autoimmune autosomal dominant hyperthyroidism (FNAH) or persistent sporadic non-autoimmune hyperthyroidism (PSNAH). First, all index patients should be analysed for the presence/absence of a thyroid-stimulating hormone (TSH) receptor (TSHR) germline mutation, and if they display a TSHR germline mutation, all other family members including asymptomatic and euthyroid family members should also be analysed. A functional characterization of all new TSHR mutations is necessary. Appropriate ablative therapy is recommended to avoid relapses of hyperthyroidism and its consequences, especially in children. Therefore, in children the diagnosis of FNAH or PSNAH needs to be established as early as possible in the presence of the clinical hallmarks of the disease.
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Affiliation(s)
- R. Paschke
- Department of Endocrinology and Nephrology, Leipzig University, Leipzig, Germany
- *Prof. Ralf Paschke, Leipzig University, Department of Endocrinology and Nephrology, Liebigstrasse 20, DE–04103 Leipzig (Germany), E-Mail
| | - M. Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - B. Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital, Peninsula Medical School, Exeter, UK
| | - L. Persani
- Department of Clinical Sciences, and Community Health, University of Milan, and Istituto Auxologico Italiano, Milan, Italy
| | - B. Rapoport
- Autoimmune Disease Unit, Cedars-Sinai Research Institute and School of Medicine, University of California, Los Angeles, Calif., USA
| | - J. Leclere
- Centre Hospitalier Universitaire de Nancy, Nancy, France
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Chalançon A, Raingeard I, Sadoul JL. [The multifaceted TSH receptor]. ANNALES D'ENDOCRINOLOGIE 2011; 72 Suppl 1:S29-S35. [PMID: 22008275 DOI: 10.1016/s0003-4266(11)70007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The TSH receptor is a key element of thyroid homeostasis and many gain or loss of function mutations have been described since its cloning in 1989. Behind classical and severe forms like toxic adenomas, non-autoimmune familial or sporadic hyperthyroidism or inversely complete TSH resistance syndromes, new methodological approaches allow now the functional characterization of milder clinical situations : linear regression analysis of activating mutations can differentiate mutations with moderate constitutive activity and non functional receptor's variants ; the early oligomerization of wild-type and mutated receptors in intracellular compartments explain the dominant inheritance of mild form of TSH resistance. However many aspects of TSH receptor signalization remain to be explored, for example its persistent activity after internalization, and their clinical implications to be determined. Finally, new modulators of TSH receptor with attractive therapeutic potential are being developed.
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Affiliation(s)
- A Chalançon
- Maladies Endocriniennes, Hôpital Lapeyronie, avenue Doyen Gaston Giraud, Montpellier cedex 5, France.
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Biebermann H, Winkler F, Handke D, Grüters A, Krude H, Kleinau G. Molecular description of non-autoimmune hyperthyroidism at a neonate caused by a new thyrotropin receptor germline mutation. Thyroid Res 2011; 4 Suppl 1:S8. [PMID: 21835055 PMCID: PMC3155114 DOI: 10.1186/1756-6614-4-s1-s8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Constitutively activating germline mutations in the thyrotropin receptor (TSHR) gene result in non-autoimmune hyperthyroidism and can be transmitted as a dominant trait or occur sporadically. These mutations are mostly located in the serpentine part of this G-protein coupled receptor. Methods Sequencing exon 9 and 10 of the thyrotropin receptor gene in a two months old patient identified a mutation which was functionally characterized after transient transfection into COS-7 cells. Cell surface localization was investigated by an ELISA approach and for signalling properties we measured cAMP by alpha screen technology for Gs/adenylyl cyclase activation and use a reporter gene assay for determination of Gq/11 phospholipase C-β activation. Results We detected a heterozygous mutation in the first extracellular loop of the TSHR gene leading to an exchange of an isoleucine residue for asparagine at amino acid position 486 (I486N). Cell surface localization was reduced to 51% of wild-type TSHR. Functional characterization of the mutant receptor revealed constitutive activation of the Gs/adenylyl cyclase pathway, in contrast basal activity of the Gq/11 pathway was comparable to the wild-type. The bovine TSH-induced cAMP accumulation was slightly reduced, but IP3 signaling was impaired. Conclusion We identified a new TSHR germline mutation (I486N) in a neonate with non-autoimmune sporadic hyperthyroidism. The mutation is located at the extracellular loop 1 and exhibits an increase in basal cAMP accumulation, but unexpectedly impairs the capability for TSH induced Gq mediated signaling. The TSHR homology model suggests isoleucine 486 as a potential key-player for induction of signal transduction by an interplay with further activation sensitive extracellular parts.
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Affiliation(s)
- Heike Biebermann
- Institute of Experimental Paediatric Endocrinology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Mueller S, Jaeschke H, Paschke R. Current standards, variations, and pitfalls for the determination of constitutive TSHR activity in vitro. Methods Enzymol 2010; 485:421-36. [PMID: 21050930 DOI: 10.1016/b978-0-12-381296-4.00023-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Constitutively activating mutations of the TSHR are the major cause for nonautoimmune hyperthyroidism, which is based on ligand independent, permanent receptor activation. Several reports have highlighted the difficulties to determine whether a TSHR mutation is constitutively active or not especially for borderline cases with only a slight increase of the basal cAMP activity. Current methods to precisely classify such mutants as constitutively active or not, are limited. In some cases, in vitro characterization of TSHR mutants has led to false positive conclusions regarding constitutive TSHR activity and subsequently the molecular origin of hyperthyroidism. For characterization of constitutive TSHR activity, a particular point to consider is that basal receptor activity tightly correlates with the receptor number expressed on the cell surface. Therefore, a comparison of the receptors basal activity in relation to the wild type is only possible with determination of the receptor cell surface expression. Thus, the experimental approaches to determine constitutive TSHR activity should consider the receptor's cell surface expression. We here provide a description of three methods for the determination of constitutive TSHR activity: (A) the evaluation of constitutive TSHR activity under conditions of equal receptor expression; (B) computation of the specific constitutive activity; and (C) the linear regression analysis (LRA). To date, LRA is the best experimental approach to characterize the mutant's basal activity as a function of TSHR cell surface expression. This approach utilizes a parallel measurement of basal cAMP values and receptor cell surface expression and therefore provides a more reliable decision with respect to the presence or absence of constitutive activity.
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Affiliation(s)
- Sandra Mueller
- Department for Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
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