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Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review. Int Ophthalmol 2022; 43:1437-1449. [PMID: 36272013 PMCID: PMC10113320 DOI: 10.1007/s10792-022-02537-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/15/2022] [Indexed: 10/24/2022]
Abstract
Graves ophthalmopathy (GO), which occurs in autoimmune thyroid disease, can reduce patients' quality of life due to its impact on visual function, physical appearance, and emotional health. Corticosteroids have been the first-line treatment for GO. More recently, the pathogenesis of GO has made significant progress. Various targeting biological agents and immunosuppressive agents make GO management more promising. Fully understanding GO pathogenesis and precise clinical management are beneficial for the prognosis of patients. Therefore, we conducted a comprehensive review of the medical management of GO and summarized research developments to highlight future research issues.
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Krieger CC, Sui X, Kahaly GJ, Neumann S, Gershengorn MC. Inhibition of TSH/IGF-1 Receptor Crosstalk by Teprotumumab as a Treatment Modality of Thyroid Eye Disease. J Clin Endocrinol Metab 2022; 107:e1653-e1660. [PMID: 34788857 PMCID: PMC8947786 DOI: 10.1210/clinem/dgab824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT We previously presented evidence that TSH receptor (TSHR)-stimulating autoantibodies (TSAbs) bind to and activate TSHRs but do not bind to IGF1 receptors (IGF1Rs). Nevertheless, we showed that IGF1Rs were involved in thyroid eye disease (TED) pathogenesis because TSAbs activated crosstalk between TSHR and IGF1R. Teprotumumab, originally generated to inhibit IGF1 binding to IGF1R, was recently approved for the treatment of TED (Tepezza). OBJECTIVE To investigate the role of TSHR/IGF1R crosstalk in teprotumumab treatment of TED. DESIGN We used orbital fibroblasts from patients with TED (TEDOFs) and measured stimulated hyaluronan (HA) secretion as a measure of orbital fibroblast activation by TED immunoglobulins (TED-Igs) and monoclonal TSAb M22. We previously showed that M22, which does not bind to IGF1R, stimulated HA in a biphasic dose-response with the higher potency phase dependent on TSHR/IGF1R crosstalk and the lower potency phase independent of IGF1R. Stimulation by TED-Igs and M22 was measured in the absence or presence of teprotumumab biosimilar (Tepro) or K1-70, an antibody that inhibits TSHR. RESULTS We show: (1) Tepro dose-dependently inhibits stimulation by TED-Igs; (2) Tepro does not bind to TSHRs; (3) Tepro inhibits IGF1R-dependent M22-induced HA production, which is mediated by TSHR/IGF1R crosstalk, but not IGF1R-independent M22 stimulation; and (4) β-arrestin 1 knockdown, which blocks TSHR/IGF1R crosstalk and prevents Tepro inhibition of HA production by M22 and by a pool of TED-Igs. CONCLUSION We conclude that Tepro inhibits HA production by TEDOFs by inhibiting TSHR/IGF1R crosstalk and suggest that inhibition of TSHR/IGF1R crosstalk is the mechanism of its action in treating TED.
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Affiliation(s)
- Christine C Krieger
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiangliang Sui
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - George J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz 55131, Germany
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marvin C Gershengorn
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
- Correspondence: Marvin C. Gershengorn, MD, Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 50 South Dr., Building 50, Room 4134, Bethesda, MD 20892, USA.
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Ugradar S, Kossler AL, Douglas R, Cockerham K. A Paradigm Shift in the Management of Thyroid Eye Disease How Teprotumumab Has Changed the Therapeutic Interface. J Neuroophthalmol 2022; 42:26-34. [PMID: 35500236 DOI: 10.1097/wno.0000000000001515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teprotumumab, a monoclonal antibody that blocks the insulin-like growth factor-1 receptor, has recently been approved by the US Food and Drug Administration (FDA) for the treatment of thyroid eye disease (TED). Since its approval, aside from data on the safety and clinical efficacy of teprotumumab from Phase-2 and Phase-3 trials, only a handful of reports have been published regarding its use in the wider population. In this review, we briefly describe the mechanism of action of teprotumumab and review the literature to provide an overview of published clinical experience. This information was used to provide recommendations for patient selection, management of patient expectations, infusion details and site options, tips to optimize the authorization process, and how to monitor and mitigate side effects. EVIDENCE ACQUISITION A systemic review of the literature was performed regarding teprotumumab, focusing on its mechanisms of action and published reports on its use on patients with TED. A review of Embase, Medline (PubMed), Web of Science, and Google Scholar was conducted. RESULTS Clinical experience following the approval of teprotumumab has confirmed its efficacy in reducing inflammation and proptosis in patients with acute TED (<2 years). The reduction in proptosis occurs due to a reduction in orbital fat and muscle volume. Furthermore, there is evidence for its use in patients with compressive optic neuropathy. There are also reports that show its efficacy in reducing proptosis, inflammation, and diplopia in patients with chronic TED (>2 years). Teprotumumab was associated with side effects, such as muscle spasm, hearing loss, and hyperglycemia. To date, 2 case reports have shown a possible association with flares of inflammatory bowel disease. CONCLUSIONS Teprotumumab is a powerful therapeutic option for the treatment of TED. Clinical experience following FDA approval has demonstrated efficacy in treating patients with acute and chronic TED. It is the only therapeutic option that has been shown to reduce orbital soft tissue expansion in TED. However, it is expensive, and sometimes, obtaining insurance authorization can be time consuming and difficult. Further work will reveal its full side effect profile and help to establish its role in the armamentarium used to treat TED.
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Affiliation(s)
- Shoaib Ugradar
- Department of ophthalmology (SU), the Jules Stein Eye Institute, University of California, Los Angeles, California; Byers Eye Institute at Stanford University School of Medicine (ALK, KC), Palo Alto, California; Cedars Sinai Medical Center (RD), Los Angeles, California; Central Valley Eye Medical Group (KC), Stockton, California
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Yoon J, Kikkawa D. Thyroid eye disease: From pathogenesis to targeted therapies. Taiwan J Ophthalmol 2022; 12:3-11. [PMID: 35399971 PMCID: PMC8988977 DOI: 10.4103/tjo.tjo_51_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022] Open
Abstract
Thyroid eye disease (TED) is the most common extrathyroidal manifestation of autoimmune Graves’ hyperthyroidism. TED is a debilitating and potentially blinding disease with unclear pathogenesis. Autoreactive inflammatory reactions targeting orbital fibroblasts (OFs) lead to the expansion of orbital adipose tissues and extraocular muscle swelling within the fixed bony orbit. There are many recent advances in the understating of molecular pathogenesis of TED. The production of autoantibodies to cross-linked thyroid-stimulating hormone receptor and insulin-like growth factor-1 receptor (IGF-1R) activates OFs to produce significant cytokines and chemokines and hyaluronan production and to induce adipocyte differentiation. In moderately severe active TED patients, multicenter clinical trials showed that inhibition of IGF-1R with teprotumumab was unprecedentedly effective with minimal side effects. The emergence of novel biologics resulted in a paradigm shift in the treatment of TED. We here review the literature on advances of pathogenesis of TED and promising therapeutic targets and drugs.
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Kang J, Lechuga M, Braun J, Kossler A, Douglas R, Cockerham K. Infusion Center Guidelines for Teprotumumab Infusions: Informed Consent, Safety, and Management of Side Effects. JOURNAL OF INFUSION NURSING 2021; 44:331-338. [PMID: 34753152 PMCID: PMC10853843 DOI: 10.1097/nan.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Teprotumumab was the first and only medication approved by the US Food and Drug Administration for the treatment of thyroid eye disease in January 2020. Thyroid eye disease is a complex autoimmune inflammatory disease that can be sight-threatening, debilitating, and disfiguring to affected patients. Although biologic therapies are a preferred treatment option for many complex immunologic and oncologic conditions, their use in ophthalmology and endocrinology may be more novel. The goals of this article are to introduce this new therapeutic option; discuss its mechanism of action, indications for use, administration protocol, infusion precautions, and informed consent; and review common side effects and management.
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Affiliation(s)
- Julia Kang
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Maria Lechuga
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Jenna Braun
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Andrea Kossler
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Raymond Douglas
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Kimberly Cockerham
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
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Kim DW, Taneja K, Hoang T, Santiago CP, McCulley TJ, Merbs SL, Mahoney NR, Blackshaw S, Rajaii F. Transcriptomic Profiling of Control and Thyroid-Associated Orbitopathy (TAO) Orbital Fat and TAO Orbital Fibroblasts Undergoing Adipogenesis. Invest Ophthalmol Vis Sci 2021; 62:24. [PMID: 34269815 PMCID: PMC8297424 DOI: 10.1167/iovs.62.9.24] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Orbital fat hyperplasia commonly occurs in thyroid-associated orbitopathy (TAO). To understand molecular mechanisms underlying orbital adipogenesis, we used transcriptomics to compare gene expression in controls and patients with TAO, as well as in orbital fibroblasts (OFs) undergoing adipogenic differentiation. Methods We performed bulk RNA sequencing (RNA-Seq) on intraconal orbital fat from controls and patients with TAO. We treated cultured OFs derived from patients with TAO with adipogenic media to induce adipogenesis. We used single nucleus RNA-Seq (snRNA-Seq) to profile treated and control OFs, identifying genes that are dynamically expressed during orbital adipogenesis in vitro, and compared these results to data from control and TAO orbital fat. Results Gene expression profiles in control and TAO orbital fat are distinct. Signaling pathways including PI3K-Akt signaling, cAMP signaling, AGE-RAGE signaling, regulation of lipolysis, and thyroid hormone signaling are enriched in orbital fat isolated from patients with TAO. SnRNA-Seq of orbital fibroblasts undergoing adipogenesis reveals differential expression of the adipocyte-specific genes FABP4/5, APOE, PPARG, and ADIPOQ during adipogenic differentiation. The insulin-like growth factor-1 receptor and Wnt signaling pathways appear to be enriched early in adipogenesis. Gene modules that are enriched in TAO orbital fat are upregulated in orbital adipocytes during differentiation in vitro, whereas genes that are enriched in control orbital fat are enriched in undifferentiated OFs. Conclusions We identified pathways enriched in TAO orbital fat, and dynamic changes in gene expression that occur during adipogenic differentiation of orbital fibroblasts. These findings may help guide functional studies of genes and pathways critical for orbital adipogenesis.
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Affiliation(s)
- Dong Won Kim
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Kamil Taneja
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Thanh Hoang
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Clayton P Santiago
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Timothy J McCulley
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shannath L Merbs
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Nicholas R Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Seth Blackshaw
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Kavli Neuroscience Discovery Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Fatemeh Rajaii
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Shi L, Ye H, Huang J, Li Y, Wang X, Xu Z, Chen J, Xiao W, Chen R, Yang H. IL-38 Exerts Anti-Inflammatory and Antifibrotic Effects in Thyroid-Associated Ophthalmopathy. J Clin Endocrinol Metab 2021; 106:e3125-e3142. [PMID: 33693700 DOI: 10.1210/clinem/dgab154] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Thyroid-associated ophthalmopathy (TAO) is an organ-specific autoimmune disease closely associated with Graves' disease. IL-38, a novel cytokine in the IL-1 superfamily, has been reported to be involved in the pathogenesis of various autoimmune diseases. OBJECTIVE We aimed to evaluate the relationship between IL-38 and TAO disease activity and its role in inflammation and fibrosis in TAO. METHODS Blood samples and orbital connective tissues were collected from TAO patients and controls. Orbital fibroblasts were isolated from patients with TAO. Enzyme-linked immunosorbent assay, immunohistochemistry, flow cytometry, immunofluorescence, quantitative real-time PCR and Western blot analysis were performed. RESULTS Here, we demonstrated that IL-38 levels decreased in the circulation and orbital connective tissues of patients with TAO compared with the controls, and levels were negatively correlated with the clinical activity score. In vitro, potent anti-inflammatory and antifibrotic effects of IL-38 were observed. Furthermore, we revealed that IL-38 can counteract the phosphorylation of star molecules in multiple classical pathways. CONCLUSION IL-38 plays a protective role in TAO and is associated with its pathogenesis. Our data suggest that IL-38 may be a promising marker of TAO disease activity and a potential target for TAO therapy.
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Affiliation(s)
- Lu Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jun Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Xing Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Zhihui Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jingqiao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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Lee ACH, Kahaly GJ. Novel Approaches for Immunosuppression in Graves' Hyperthyroidism and Associated Orbitopathy. Eur Thyroid J 2020; 9:17-30. [PMID: 33511082 PMCID: PMC7802437 DOI: 10.1159/000508789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Both Graves' hyperthyroidism (GH) and Graves' orbitopathy (GO) are associated with significant adverse health consequences. All conventional treatment options have limitations regarding efficacy and safety. Most importantly, they do not specifically address the underlying immunological mechanisms. We aim to review the latest development of treatment approaches in these two closely related disorders. SUMMARY Immunotherapies of GH have recently demonstrated clinical efficacy in preliminary studies. They include ATX-GD-59, an antigen-specific immunotherapy which restores immune tolerance to the thyrotropin receptor; iscalimab, an anti-CD40 monoclonal antibody which blocks the CD40-CD154 costimulatory pathway in B-T cell interaction; and K1-70, a thyrotropin receptor-blocking monoclonal antibody. Novel treatment strategies have also become available in GO. Mycophenolate significantly increased the overall response rate combined with standard glucocorticoid (GC) treatment compared to GC monotherapy. Tocilizumab, an anti-interleukin 6 receptor monoclonal antibody, displayed strong anti-inflammatory action in GC-resistant cases. Teprotumumab, an anti-insulin-like growth factor 1 receptor monoclonal antibody, resulted in remarkable improvement in terms of disease activity, proptosis, and diplopia. Further, rituximab appears to be useful in active disease of recent onset without impending dysthyroid optic neuropathy. KEY MESSAGES Therapeutic advances will continue to optimize our management of GH and associated orbitopathy in an effective and safe manner.
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Affiliation(s)
- Alan Chun Hong Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Queen Mary Hospital, Hong Kong, China
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
- *George J. Kahaly, Department of Medicine I, Johannes Gutenberg University Medical Center, Langenbeckstraße 1, DE–55131 Mainz (Germany),
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Kahaly GJ. Management of Graves Thyroidal and Extrathyroidal Disease: An Update. J Clin Endocrinol Metab 2020; 105:5905591. [PMID: 32929476 PMCID: PMC7543578 DOI: 10.1210/clinem/dgaa646] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Invited update on the management of systemic autoimmune Graves disease (GD) and associated Graves orbitopathy (GO). EVIDENCE ACQUISITION Guidelines, pertinent original articles, systemic reviews, and meta-analyses. EVIDENCE SYNTHESIS Thyrotropin receptor antibodies (TSH-R-Abs), foremost the stimulatory TSH-R-Abs, are a specific biomarker for GD. Their measurement assists in the differential diagnosis of hyperthyroidism and offers accurate and rapid diagnosis of GD. Thyroid ultrasound is a sensitive imaging tool for GD. Worldwide, thionamides are the favored treatment (12-18 months) of newly diagnosed GD, with methimazole (MMI) as the preferred drug. Patients with persistently high TSH-R-Abs and/or persistent hyperthyroidism at 18 months, or with a relapse after completing a course of MMI, can opt for a definitive therapy with radioactive iodine (RAI) or total thyroidectomy (TX). Continued long-term, low-dose MMI administration is a valuable and safe alternative. Patient choice, both at initial presentation of GD and at recurrence, should be emphasized. Propylthiouracil is preferred to MMI during the first trimester of pregnancy. TX is best performed by a high-volume thyroid surgeon. RAI should be avoided in GD patients with active GO, especially in smokers. Recently, a promising therapy with an anti-insulin-like growth factor-1 monoclonal antibody for patients with active/severe GO was approved by the Food and Drug Administration. COVID-19 infection is a risk factor for poorly controlled hyperthyroidism, which contributes to the infection-related mortality risk. If GO is not severe, systemic steroid treatment should be postponed during COVID-19 while local treatment and preventive measures are offered. CONCLUSIONS A clear trend towards serological diagnosis and medical treatment of GD has emerged.
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Affiliation(s)
- George J Kahaly
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
- Correspondence and Reprint Requests: George J. Kahaly, MD, PhD, JGU Medical Center, Mainz 55101, Germany. E-mail:
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Neumann S, Krieger CC, Gershengorn MC. Targeting TSH and IGF-1 Receptors to Treat Thyroid Eye Disease. Eur Thyroid J 2020; 9:59-65. [PMID: 33511086 PMCID: PMC7802449 DOI: 10.1159/000511538] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022] Open
Abstract
Graves' disease (GD) is an autoimmune disease caused in part by thyroid-stimulating antibodies (TSAbs) that activate the thyroid-stimulating hormone receptor (TSHR). In Graves' hyperthyroidism (GH), TSAbs cause persistent stimulation of thyroid cells leading to continuous thyroid hormone synthesis and secretion. Thyroid eye disease (TED), also called Graves' orbitopathy, is an orbital manifestation of GD. We review the important roles of the TSHR and the insulin-like growth factor 1 receptor (IGF-1R) in the pathogenesis of TED and discuss a model of TSHR/IGF-1R crosstalk that considers two pathways initiated by TSAb activation of TSHR in the eye, an IGF-1R-independent and an IGF-1R-dependent signaling pathway leading to hyaluronan (HA) secretion in orbital fibroblasts. We discuss current and future therapeutic approaches targeting the IGF-1R and TSHR. Teprotumumab, a human monoclonal anti-IGF-1R-blocking antibody, has been approved as an effective treatment in patients with TED. However, as the TSHR seems to be the primary target for TSAbs in patients with GD, future therapeutic interventions directly targeting the TSHR, e.g. blocking antibodies and small molecule antagonists, are being developed and have the advantage to inhibit the IGF-1R-independent as well as the IGF-1R-dependent component of TSAb-induced HA secretion. Antigen-specific immunotherapies using TSHR peptides to reduce serum TSHR antibodies are being developed also. These TSHR-targeted strategies also have the potential to treat both GH and TED with the same drug. We propose that combination therapy targeting TSHR and IGF-1R may be an effective and better tolerated treatment strategy for TED.
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Affiliation(s)
| | | | - Marvin C. Gershengorn
- *Marvin C. Gershengorn, 50 South Dr., Building 50, Room 4134, Bethesda, MD 20892 (USA),
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11
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Thyroid eye disease: current and potential medical management. Int Ophthalmol 2020; 40:1035-1048. [PMID: 31919775 DOI: 10.1007/s10792-019-01258-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 12/28/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Thyroid eye disease (TED) is the most frequent extra-thyroid manifestation of Graves' disease and it is more frequent in middle age and in female gender. Nowadays, the causal mechanisms of this disease are not completely understood, but the current available studies suggest that the main causative factor is the thyroid stimulating hormone receptor. MATERIALS AND METHODS To collect reports on TED medical management, a thorough literature search was performed in PubMed database. An additional search was made in Google Scholar to complete the collected items. RESULTS Among the indentified risk factors, tobacco habit is the most relevant. The main criteria to choose a suitable treatment are the activity and severity of the disease. Support measures can be used to improve the patient's symptoms in any phase of the disease. There is a large number of drugs proposed to manage TED, although with different reported rates of success. CONCLUSIONS Currently, the drugs of choice are corticosteroids in moderate-to-severe and in sight-threatening forms. The main problem of corticosteroids is their spectrum of side effects. Therefore, other alternatives are being suggested for medical management of this disease. The efficacy of these alternatives remains unclear.
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12
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Schrijver B, Kooiman MA, Kasteleijn E, van Holten-Neelen C, Virakul S, Paridaens D, Peeters RP, van Hagen PM, Dalm VASH, Dik WA. Basic Fibroblast Growth Factor Induces Adipogenesis in Orbital Fibroblasts: Implications for the Pathogenesis of Graves' Orbitopathy. Thyroid 2019; 29:395-404. [PMID: 30724135 DOI: 10.1089/thy.2018.0544] [Citation(s) in RCA: 8] [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: 01/24/2023]
Abstract
BACKGROUND Basic fibroblast growth factor (bFGF) has been implicated in the pathogenesis of Graves' orbitopathy (GO). It stimulates several processes, including hyaluronan synthesis, involved in orbital tissue volume expansion and may act synergistically with platelet-derived growth factor (PDGF)-BB. PDGF-BB is known to stimulate adipogenesis in orbital fibroblasts, but the effect of bFGF on adipogenesis in orbital fibroblasts is so far unknown. This study was conducted to determine whether (i) bFGF induces adipogenesis in orbital fibroblasts, (ii) bFGF and PDGF-BB together exert an additive or synergistic effect on adipogenesis, and (iii) treatment directed at bFGF- and PDGF-BB signaling may potentially be of interest for the treatment of GO. METHODS Orbital fibroblasts from GO patients and controls were cultured in adipocyte differentiation medium with or without bFGF and/or PDGF-BB at different concentrations. Adipogenesis was determined by Oil Red O staining and messenger RNA expression of the late adipocyte differentiation markers cell death-inducing DFFA-like effector C (CIDEC) and adiponectin (ADIPOQ). To demonstrate involvement of FGF-receptor and PDGF-receptor signaling, experiments were also conducted in the presence of dasatinib (inhibitor of PDGF-receptor) or nintedanib (inhibitor of PDGF-receptor and FGF-receptor). RESULTS bFGF significantly stimulated adipogenesis by orbital fibroblasts, as shown by increased Oil Red O staining and CIDEC and ADIPOQ expression after 14 days of differentiation. Furthermore, an additive effect of bFGF/PDGF-BB co-stimulation on adipogenesis was observed at the lowest concentration (12.5 ng/mL) of the growth factors tested. Nintedanib completely inhibited bFGF-, PDGF-BB-, and bFGF/PDGF-BB-induced adipogenesis, while dasatinib only fully abrogated PDGF-BB-induced adipogenesis. CONCLUSION bFGF induces adipogenesis in orbital fibroblasts and as such may contribute to GO. The additive effect of bFGF and PDGF-BB on adipogenesis, along with the observed inhibitory effects of dasatinib and nintedanib, point at independent receptor-mediated effects. This supports the hypothesis that multi-target directed therapy might be more efficient in the treatment of GO.
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Affiliation(s)
- Benjamin Schrijver
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
| | - Merel A Kooiman
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
| | - Esmee Kasteleijn
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
| | | | - Sita Virakul
- 2 Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Dion Paridaens
- 4 Academic Center for Thyroid Diseases; Rotterdam, The Netherlands
- 3 Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Robin P Peeters
- 4 Academic Center for Thyroid Diseases; Rotterdam, The Netherlands
- 5 Department of Internal Medicine; Erasmus MC, Rotterdam, The Netherlands
| | - P Martin van Hagen
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
- 4 Academic Center for Thyroid Diseases; Rotterdam, The Netherlands
- 5 Department of Internal Medicine; Erasmus MC, Rotterdam, The Netherlands
| | - Virgil A S H Dalm
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
- 4 Academic Center for Thyroid Diseases; Rotterdam, The Netherlands
- 5 Department of Internal Medicine; Erasmus MC, Rotterdam, The Netherlands
| | - Willem A Dik
- 1 Department of Immunology, Laboratory Medical Immunology; Rotterdam, The Netherlands
- 4 Academic Center for Thyroid Diseases; Rotterdam, The Netherlands
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Krieger CC, Morgan SJ, Neumann S, Gershengorn MC. Thyroid Stimulating Hormone (TSH)/Insulin-like Growth Factor 1 (IGF1) Receptor Cross-talk in Human Cells. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2018; 2:29-33. [PMID: 30547142 PMCID: PMC6287758 DOI: 10.1016/j.coemr.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thyroid stimulating hormone and insulin-like growth factor 1 receptors (TSHRs and IGF1Rs, respectively) interact leading to additive or synergistic stimulation of cellular responses. Recent findings provide evidence that the interaction between TSHRs and IGF1Rs is similar to that described for other G protein-coupled receptors and receptor tyrosine kinases. These types of interactions occur at or proximal to the receptors and are designated "receptor cross-talk." Herein, we describe our studies in human thyrocytes, human retro-orbital fibroblasts from Graves' orbitopathy patients and a model cell line that support the concept of TSHR/IGF1R cross-talk. We also discuss how receptor cross-talk is involved in stimulation by a monoclonal TSHR-stimulating antibody and how targeting both receptors may lead to novel treatments of Graves' orbitopathy.
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Affiliation(s)
- Christine C. Krieger
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarah J. Morgan
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marvin C. Gershengorn
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Giuliani C, Bucci I, Napolitano G. The Role of the Transcription Factor Nuclear Factor-kappa B in Thyroid Autoimmunity and Cancer. Front Endocrinol (Lausanne) 2018; 9:471. [PMID: 30186235 PMCID: PMC6110821 DOI: 10.3389/fendo.2018.00471] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/31/2018] [Indexed: 12/30/2022] Open
Abstract
Nuclear factor-kappa B (NF-κB) is a ubiquitous transcription factor that is involved in inflammatory and immune responses, as well as in regulation of expression of many other genes related to cell survival, proliferation, and differentiation. In mammals, NF-κB comprises five subunits that can bind to promoter regions of target genes as homodimers or heterodimers. The most common dimer is the p50/p65 heterodimer. The several combinations of dimers that can be formed contribute to the heterogeneous regulation of NF-κB target genes, and this heterogeneity is further increased by interactions of the NF-κB dimers with other transcription factors, such as steroid hormone receptors, activator protein-1 (AP-1), and cAMP response element binding protein (CREB). In the thyroid, several studies have demonstrated the involvement of NF-κB in thyroid autoimmunity, thyroid cancer, and thyroid-specific gene regulation. The role of NF-κB in thyroid autoimmunity was hypothesized more than 20 years ago, after the finding that the binding of distinct NF-κB heterodimers to the major histocompatibility complex class I gene is hormonally regulated. Further studies have shown increased activity of NF-κB in thyroid autoimmune diseases and in thyroid orbitopathy. Increased activity of NF-κB has also been observed in thyroid cancer, where it correlates with a more aggressive pattern. Of particular interest, mutation of some oncogenes or tumor suppressor genes involved in thyroid carcinogenesis results in constitutive activation of the NF-κB pathway. More recently, it has been shown that NF-κB also has a role in thyroid physiology, as it is fundamental for the expression of the main thyroid-specific genes, such as sodium iodide symporter, thyroid peroxidase, thyroglobulin, Pax8, and TTF-1 (NKX2-1).
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15
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Place RF, Krieger CC, Neumann S, Gershengorn MC. Inhibiting thyrotropin/insulin-like growth factor 1 receptor crosstalk to treat Graves' ophthalmopathy: studies in orbital fibroblasts in vitro. Br J Pharmacol 2017; 174:328-340. [PMID: 27987211 DOI: 10.1111/bph.13693] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Crosstalk between thyrotropin (TSH) receptors and insulin-like growth factor 1 (IGF-1) receptors initiated by activation of TSH receptors could be important in the development of Graves' ophthalmopathy (GO). Specifically, TSH receptor activation alone is sufficient to stimulate hyaluronic acid (HA) secretion, a major component of GO, through both IGF-1 receptor-dependent and -independent pathways. Although an anti-IGF-1 receptor antibody is in clinical trials, its effectiveness depends on the relative importance of IGF-1 versus TSH receptor signalling in GO pathogenesis. EXPERIMENTAL APPROACH TSH and IGF-1 receptor antagonists were used to probe TSH/IGF-1 receptor crosstalk in primary cultures of Graves' orbital fibroblasts (GOFs) following activation with monoclonal TSH receptor antibody, M22. Inhibition of HA secretion following TSH receptor stimulation was measured by modified HA elisa. KEY RESULTS TSH receptor antagonist, ANTAG3 (NCGC00242364), inhibited both IGF-1 receptor -dependent and -independent pathways at all doses of M22; whereas IGF-1 receptor antagonists linsitinib and 1H7 (inhibitory antibody) lost efficacy at high M22 doses. Combining TSH and IGF-1 receptor antagonists exhibited Loewe additivity within the IGF-1 receptor-dependent component of the M22 concentration-response. Similar effects were observed in GOFs activated by autoantibodies from GO patients' sera. CONCLUSIONS AND IMPLICATIONS Our data support TSH and IGF-1 receptors as therapeutic targets for GO, but reveal putative conditions for anti-IGF-1 receptor resistance. Combination treatments antagonizing both receptors yield additive effects by inhibiting crosstalk triggered by TSH receptor stimulatory antibodies. Combination therapy may be an effective strategy for dose reduction and/or compensate for any loss of anti-IGF-1 receptor efficacy.
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Affiliation(s)
- Robert F Place
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Christine C Krieger
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marvin C Gershengorn
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
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Mester T, Raychaudhuri N, Gillespie EF, Chen H, Smith TJ, Douglas RS. CD40 Expression in Fibrocytes Is Induced by TSH: Potential Synergistic Immune Activation. PLoS One 2016; 11:e0162994. [PMID: 27631497 PMCID: PMC5025085 DOI: 10.1371/journal.pone.0162994] [Citation(s) in RCA: 7] [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: 06/01/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
Context Fibrocytes appear to participate in inflammation and tissue remodeling in patients with thyroid-associated ophthalmopathy (TAO). These patients have increased frequencies of circulating TSH receptor (TSHR)- and CD40-positive fibrocytes, suggesting TSHR and CD40 may play roles in proinflammatory cytokine production, which ultimately leads to orbital inflammation and tissue remodeling. Objective To investigate the potential interactions between the TSHR and CD40 signaling pathways and their roles in IL-6 and TNF-α production. Design and Outcome Measures CD40 expression on fibrocytes was assessed using flow cytometry; IL-6 and TNF-α protein release using Luminex technology; increased IL-6 and TNF-α mRNA abundance, using real-time PCR; TSH- and CD40 ligand (CD40L)-stimulated Akt phosphorylation in fibrocytes, by western blot analysis; TSHR-CD40 protein-protein interaction, using co-immunoprecipitation, and CD40-TSHR co-localization, using immunocytochemistry. Results TSH enhances CD40 expression at a pre-translational level in fibrocytes. Production of IL-6 and TNF-α after costimulation with TSH and CD40L was greater than that after TSH or CD40L stimulation alone. TSH and CD40L costimulation also resulted in greater Akt phosphorylation. Akt and nuclear factor (NF)-κB inhibitors significantly reduced cytokine production after TSH and CD40L costimulation. TSHR and CD40L are colocalized on the cell surface and form a complex. Conclusions TSHR and CD40 in fibrocytes appear to be physically and functionally related. TSH stimulates CD40 production on the fibrocyte surface. Cytokine expression upon simultaneous stimulation of TSHR and CD40 is greater than levels achieved with TSH or CD40L alone. Increased expression of CD40 by TSH is a potential mechanism for this process.
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Affiliation(s)
- Tünde Mester
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
| | - Nupur Raychaudhuri
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
| | - Erin F. Gillespie
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
| | - Hong Chen
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
- Department of Ophthalmology of Union Hospital, Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People's Republic of China
| | - Terry J. Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
| | - Raymond S. Douglas
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, 48105, United States of America
- Ann Arbor Veterans Administration Medical Center, Ann Arbor, Michigan, 48105, United States of America
- * E-mail:
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Krieger CC, Place RF, Bevilacqua C, Marcus-Samuels B, Abel BS, Skarulis MC, Kahaly GJ, Neumann S, Gershengorn MC. TSH/IGF-1 Receptor Cross Talk in Graves' Ophthalmopathy Pathogenesis. J Clin Endocrinol Metab 2016; 101:2340-7. [PMID: 27043163 PMCID: PMC4891793 DOI: 10.1210/jc.2016-1315] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT The TSH receptor (TSHR) is considered the main target of stimulatory autoantibodies in the pathogenesis of Graves' ophthalmopathy (GO); however, it has been suggested that stimulatory IGF-1 receptor (IGF-1R) autoantibodies also play a role. OBJECTIVE We previously demonstrated that a monoclonal stimulatory TSHR antibody, M22, activates TSHR/IGF-1R cross talk in orbital fibroblasts/preadipocytes obtained from patients with GO (GO fibroblasts [GOFs]). We show that cross talk between TSHR and IGF-1R, not direct IGF-1R activation, is involved in the mediation of GO pathogenesis stimulated by Graves' autoantibodies. DESIGN/SETTING/PARTICIPANTS Immunoglobulins were purified from the sera of 57 GO patients (GO-Igs) and tested for their ability to activate TSHR and/or IGF-1R directly and TSHR/IGF-1R cross talk in primary cultures of GOFs. Cells were treated with M22 or GO-Igs with or without IGF-1R inhibitory antibodies or linsitinib, an IGF-1R kinase inhibitor. MAIN OUTCOME MEASURES Hyaluronan (hyaluronic acid [HA]) secretion was measured as a major biological response for GOF stimulation. IGF-1R autophosphorylation was used as a measure of direct IGF-1R activation. TSHR activation was determined through cAMP production. RESULTS A total of 42 out of 57 GO-Ig samples stimulated HA secretion. None of the GO-Ig samples exhibited evidence for IGF-1R autophosphorylation. Both anti-IGF-1R antibodies completely inhibited IGF-1 stimulation of HA secretion. By contrast, only 1 IGF-1R antibody partially blocked HA secretion stimulated by M22 or GO-Igs in a manner similar to linsitinib, whereas the other IGF-1R antibody had no effect on M22 or GO-Ig stimulation. These findings show that the IGF-1R is involved in GO-Igs stimulation of HA secretion without direct activation of IGF-1R. CONCLUSIONS IGF-1R activation by GO-Igs occurs via TSHR/IGF-1R cross talk rather than direct binding to IGF-1R, and this cross talk is important in the pathogenesis of GO.
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Affiliation(s)
- Christine C Krieger
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Robert F Place
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Carmine Bevilacqua
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Bernice Marcus-Samuels
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Brent S Abel
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Monica C Skarulis
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - George J Kahaly
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
| | - Marvin C Gershengorn
- Laboratory of Endocrinology and Receptor Biology (C.C.K., R.F.P., C.B., B.M.-S., S.N., M.C.G.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Nova Therapeutics LLC (R.F.P.), Pasadena, California; Diabetes, Endocrinology, and Obesity Branch (B.S.A., M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; and Johannes Gutenberg University Medical Center (G.J.K.), Mainz, Germany
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18
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Fallahi P, Ferrari SM, Elia G, Nasini F, Colaci M, Giuggioli D, Vita R, Benvenga S, Ferri C, Antonelli A. Novel Therapies for Thyroid Autoimmune Diseases. Expert Rev Clin Pharmacol 2016; 9:853-61. [PMID: 26900630 DOI: 10.1586/17512433.2016.1157468] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
C-X-C chemokine receptor (CXCR)3 and its interferon(IFN)γ-dependent chemokines (CXCL10, CXCL9, CXCL11) are implicated in the immune-pathogenesis of autoimmune thyroiditis (AT), Graves disease (GD) and Graves Ophthalmopathy (GO). In tissue, recruited Th1 lymphocytes produce IFNγ, enhancing the tissue secretion of IFNγ-inducible chemokines, initiating and perpetuating the autoimmune process. Patients with AT (with hypothyroidism), and with GO and GD, particularly in the active phase, have high IFNγ-inducible chemokines. Peroxisome proliferator-activated receptor (PPAR)γ or -α agonists and methimazole exert an immune-modulation on CXCR3 chemokines in AT, GD and GO. Other studies are ongoing to evaluate new molecules acting as antagonists of CXCR3, or blocking CXCL10, in Hashimoto thyroiditis (HT), GD and GO. Recently, novel molecules targeting the various agents involved in the pathogenesis of GO, such as rituximab, have been proposed as an alternative to corticosteroids. However, randomized and controlled studies are needed to generalize these interesting results.
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Affiliation(s)
- Poupak Fallahi
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | | | - Giusy Elia
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Francesco Nasini
- b Department of Surgical, Medical, Molecular Pathology and of Emergency , University of Pisa , Pisa , Italy
| | - Michele Colaci
- c Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences , University of Modena & Reggio Emilia , Modena , Italy
| | - Dilia Giuggioli
- c Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences , University of Modena & Reggio Emilia , Modena , Italy
| | - Roberto Vita
- d Department of Clinical and Experimental Medicine, Section of Endocrinology , University of Messina , Messina , Italy
| | - Salvatore Benvenga
- d Department of Clinical and Experimental Medicine, Section of Endocrinology , University of Messina , Messina , Italy
| | - Clodoveo Ferri
- c Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences , University of Modena & Reggio Emilia , Modena , Italy
| | - Alessandro Antonelli
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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