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Constantinescu SM, Hospel J, Daumerie C, Alexopoulou O, Maiter D, Burlacu MC. Significance of thyroperoxidase and thyroglobulin antibodies in medically treated Graves' disease. Eur Thyroid J 2023; 12:e230193. [PMID: 37930957 PMCID: PMC10762548 DOI: 10.1530/etj-23-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/08/2023] Open
Abstract
Background Thyroperoxidase (TPOAb) and thyroglobulin (TgAb) antibodies are highly prevalent in Graves' disease (GD), but their significance is controversial. Methods We retrospectively analyzed TPOAb and TgAb levels and evolution in 136 patients with newly diagnosed GD between 2000 and 2022, treated with anti-thyroid drugs (ATD) in a block-and-replace (B+R) regimen for at least 12 months and followed up for at least 1 year after ATD discontinuation or until disease relapse. Results At diagnosis, 98 out of 136 (72%) patients were TPOAb positive and 73 out of 136 (54%) patients were TgAb positive. The presence of TPOAb or TgAb antibodies at diagnosis was generally not related to GD presentation and did not influence the risk of relapse (P = 0.304 and P = 0.348, respectively). There was less TED (thyroid eye disease) in TgAb-positive patients than TgAb-negative patients at diagnosis (11 out of 73 (15.1%) versus 21 out of 63 (33.3%) P = 0.012). In contrast, the presence of TPOAb at diagnosis was not associated with TED (P = 0.354). The absence of TgAb at diagnosis (P = 0.05) and time to euthyroidism (P = 0.009), but not smoking or TRAb levels, were associated with TED in multivariate logistic regression. TPOAb and TgAb levels during treatment and after its discontinuation were not predictive of relapse, except for lower titers of TgAb at 18 months in patients who relapsed (P = 0.034). Conclusion In GD patients treated with a first course of ATD in a B+R regimen we observed lower titers of TgAb at the end of treatment in patients who relapsed and a significant protection against TED in patients with positive TgAb at diagnosis, irrespectively of TPOAb.
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Affiliation(s)
- Stefan Matei Constantinescu
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Julien Hospel
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Chantal Daumerie
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Orsalia Alexopoulou
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Maria-Cristina Burlacu
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
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Abstract
PURPOSE Our understanding of thyroid-associated ophthalmopathy (TAO, A.K.A Graves' orbitopathy, thyroid eye disease) has advanced substantially, since one of us (TJS) wrote the 2010 update on TAO, appearing in this journal. METHODS PubMed was searched for relevant articles. RESULTS Recent insights have resulted from important studies conducted by many different laboratory groups around the World. A clearer understanding of autoimmune diseases in general and TAO specifically emerged from the use of improved research methodologies. Several key concepts have matured over the past decade. Among them, those arising from the refinement of mouse models of TAO, early stage investigation into restoring immune tolerance in Graves' disease, and a hard-won acknowledgement that the insulin-like growth factor-I receptor (IGF-IR) might play a critical role in the development of TAO, stand out as important. The therapeutic inhibition of IGF-IR has blossomed into an effective and safe medical treatment. Teprotumumab, a β-arrestin biased agonist monoclonal antibody inhibitor of IGF-IR has been studied in two multicenter, double-masked, placebo-controlled clinical trials demonstrated both effectiveness and a promising safety profile in moderate-to-severe, active TAO. Those studies led to the approval by the US FDA of teprotumumab, currently marketed as Tepezza for TAO. We have also learned far more about the putative role that CD34+ fibrocytes and their derivatives, CD34+ orbital fibroblasts, play in TAO. CONCLUSION The past decade has been filled with substantial scientific advances that should provide the necessary springboard for continually accelerating discovery over the next 10 years and beyond.
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Affiliation(s)
- E J Neag
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Brehm Tower, 1000 Wall Street, Ann Arbor, MI, 48105, USA
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, 48105, USA
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - T J Smith
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Brehm Tower, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, 48105, USA.
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Teprotumumab in Thyroid-Associated Ophthalmopathy: Rationale for Therapeutic Insulin-Like Growth Factor-I Receptor Inhibition. J Neuroophthalmol 2021; 40:74-83. [PMID: 32040069 DOI: 10.1097/wno.0000000000000890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thyroid-associated ophthalmopathy (TAO) is an autoimmune component of Graves' disease for which no currently available medical therapy provides reliable and safe benefit. Based on insights generated experimentally over the past several decades, the insulin-like growth factor-I receptor (IGF-IR) has been implicated in the pathogenesis of TAO. Furthermore, an IGF-IR inhibitor, teprotumumab, has emerged from 2 clinical trials as a promising treatment for active, moderate to severe TAO. This brief review intends to provide an overview of the rationale underlying the development of teprotumumab for this disease. It is possible that teprotumumab will soon take its place in our therapeutic armamentarium for active TAO.
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Ferrari SM, Fallahi P, Elia G, Ragusa F, Camastra S, Paparo SR, Giusti C, Gonnella D, Ruffilli I, Shoenfeld Y, Antonelli A. Novel therapies for thyroid autoimmune diseases: An update. Best Pract Res Clin Endocrinol Metab 2020; 34:101366. [PMID: 31813786 DOI: 10.1016/j.beem.2019.101366] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A Th1 immune-preponderance has been shown in the immunopathogenesis of autoimmune thyroiditis (AT), Graves' disease (GD) and Graves' Ophthalmopathy (GO), in which the Th1-chemokines (CXCL9, CXCL10, CXCL11), and their (C-X-C)R3 receptor, have a crucial role. Methimazole, and corticosteroids have been shown to modulate these chemokines; several efforts have been done to modulate the autoimmune reaction with other drugs, i.e. PPAR-γ, or -α ligands, or antibodies, or small molecules directed against CXCL10, or CXCR3. Antigen-specific therapy for GD, by inducing T cell tolerance through an immunization with TSH-R peptides, has been published. Drugs targeting cytokines [anti-TNFα (Etanercept), and anti-IL-6 (Tocilizumab)], and RTX (a chimeric monoclonal antibody vs. CD20) have been used in GO, with promising results. Teprotumumab (a human monoclonal anti-IGF-1R blocking antibody) has been investigated in a trial, showing it was very effective in GO patients. Still, more studies are needed for new therapies targeting autoimmune thyroid disorders.
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Affiliation(s)
| | - Poupak Fallahi
- Department of Translational Research of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Stefania Camastra
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | - Claudia Giusti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Debora Gonnella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Ilaria Ruffilli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia.
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Smith TJ. Thyroid-associated ophthalmopathy: Emergence of teprotumumab as a promising medical therapy. Best Pract Res Clin Endocrinol Metab 2020; 34:101383. [PMID: 32088116 PMCID: PMC7344338 DOI: 10.1016/j.beem.2020.101383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid-associated ophthalmopathy (TAO) remains a vexing autoimmune component of Graves' disease that can diminish the quality of life as a consequence of its impact on visual function, physical appearance and emotional well-being. Because of its relative rarity and variable presentation, the development of highly effective and well-tolerated medical therapies for TAO has been slow relative to other autoimmune diseases. Contributing to the barriers of greater insight into TAO has been the historical absence of high-fidelity preclinical animal models. Despite these challenges, several agents, most developed for treatment of other diseases, have found their way into consideration for use in active TAO through repurposing. Among these, teprotumumab is a fully human inhibitory monoclonal antibody against the insulin-like growth factor I receptor. It has shown remarkable effectiveness in moderate to severe, active TAO in two completed multicenter, double masked, and placebo controlled clinical trials. The drug exhibits a favorable safety profile. Teprotumumab has recently been approved by the U.S. F.D.A, and may rapidly become the first line therapy for this disfiguring and potentially blinding condition.
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Affiliation(s)
- Terry J Smith
- Department of Ophthalmology and Visual Sciences, Room 7112, Brehm Tower, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
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Struja T, Jutzi R, Imahorn N, Kaeslin M, Boesiger F, Kutz A, Mundwiler E, Huber A, Kraenzlin M, Mueller B, Meier C, Bernasconi L, Schuetz P. Comparison of Five TSH-Receptor Antibody Assays in Graves' disease: results from an observational pilot study. BMC Endocr Disord 2019; 19:38. [PMID: 31023276 PMCID: PMC6482584 DOI: 10.1186/s12902-019-0363-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early diagnosis and relapse prediction in Graves' disease influences treatment. We assessed the abilities of four TSH-receptor antibody tests [TRAb] and one cyclic adenosine monophosphate bioassay to predict relapse of Graves' disease. METHODS Observational study investigating patients presenting with Graves' disease at a Swiss hospital endocrine referral center or an endocrine outpatient clinic. Main outcomes were diagnosis and relapse of Graves' disease after stop of anti-thyroid drugs. We used Cox regression to study associations of TRAb levels with relapse risk and calculated c-statistics [AUC] to assess discrimination. Blood draws took place as close as possible to treatment initiation. RESULTS AUCs ranged from 0.90 (TSAb Biossay by RSR) to 0.97 (IMMULITE TSI by Siemens). Highest sensitivity (94.0%) was observed for IMMULITE TSI and RSR TRAb Fast, while the greatest specificity (97.9%) was found with the EliA anti-TSH-R (by Thermo Fisher). In Cox regression analysis comparing the highest versus the lower quartiles, the highest hazard ratio [HR] for relapse was found for BRAHMS TRAK (by Thermo Fisher) (2.98, 95% CI 1.13-7.84), IMMULITE TSI (2.40, 95% CI 0.91-6.35), EliA anti-TSH-R (2.05, 95% CI 0.82-5.10), RSR Fast TRAb (1.80, 95% CI 0.73-4.43), followed by RSR STIMULATION (1.18, 95% CI 0.46-2.99). Discrimination analyses showed respective AUCs of 0.68, 0.65, 0.64, 0.64, and 0.59. CONCLUSION The assays tested had good diagnostic power and relapse risk prediction with few differences among the new assays. Due to the small sample size and retrospective design with possible selection bias, our data need prospective validation.
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Affiliation(s)
- Tristan Struja
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Rebecca Jutzi
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Noemi Imahorn
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Marina Kaeslin
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Fabienne Boesiger
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Esther Mundwiler
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Beat Mueller
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Christian Meier
- Medical Faculty of the University of Basel, Basel, Switzerland
- Endonet, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
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Stożek K, Bossowski A, Ziora K, Bossowska A, Mrugacz M, Noczyńska A, Walczak M, Petriczko E, Pyrżak B, Kucharska A, Szalecki M, Diana T, Kahaly GJ. Functional TSH receptor antibodies in children with autoimmune thyroid diseases. Autoimmunity 2018; 51:62-68. [DOI: 10.1080/08916934.2018.1431776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Karolina Stożek
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Ziora
- Department of Pediatric Nephrology and Endocrinology, Silesian Medical University, Zabrze, Poland
| | - Anna Bossowska
- Division of Cardiology, Internal Affairs Ministry Hospital in Bialystok, Białystok, Poland
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Visual Rehabilitation, Medical University of Bialystok, Białystok, Poland
| | - Anna Noczyńska
- Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wrocław, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Beata Pyrżak
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kucharska
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tanja Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - George J. Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
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8
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Bitcon V, Donnelly J, Kiaei D. Sensitivity of assays for TSH-receptor antibodies. J Endocrinol Invest 2016; 39:1195-6. [PMID: 27531172 PMCID: PMC5025503 DOI: 10.1007/s40618-016-0520-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/20/2016] [Indexed: 12/04/2022]
Affiliation(s)
- V Bitcon
- Siemens Healthcare Diagnostics Inc, Tarrytown, NY, USA.
| | - J Donnelly
- Siemens Healthcare Diagnostics Inc, Tarrytown, NY, USA
| | - D Kiaei
- Siemens Healthcare Diagnostics Inc, Tarrytown, NY, USA
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9
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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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