HLA-B40-, HLA-Cw3-, and HLA-DR5-associated susceptibility to amiodarone-induced thyroid dysfunction

Prognostic signature construction and immunotherapy response analysis for Uterine Corpus Endometrial Carcinoma based on cuproptosis-related lncRNAs

BACKGROUND

As a general female malignant tumor, Uterine Corpus Endometrial Carcinoma (UCEC) has high mortality and relapses. Cuproptosis was found to play an essential role in tumor by more and more researches. However, it is still unclear of the prognostic value and function of cuproptosis related Long non-coding RNA (lncRNA) in UCEC.

METHODS

Sequencing data with the corresponding clinical data and cuproptosis-related genes (CRGs) data were obtained from the Cancer Gene Atlas (TCGA) database and cuproptosis related studies. Pearson test was applied to select cuproptosis-related lncRNAs (CRLs). Prognosis associated CRLs was identified by univariate Cox analysis and the predictors were determined by least absolute shrinkage and selection operator (Lasso)-Cox and multivariate Cox analyses to construct the cuproptosis-related lncRNA prognostic signature (CRLPS). The performance of the CRLPs was evaluated by consistency index (C-index) and Kaplan-Meier analysis. A nomogram model was constructed for survival prediction and the accuracy of the model was evaluated by calibration curve. Finally, immune related analyses were applied to predict immune responses and identify drugs with potential efficacy for the overall survival (OS).

RESULTS

A total of 734 CRLs were found and 29 of them were identified as prognosis related lncRNAs. 12 CRLs were finally determined to build the CRLPS which revealed good ability on prognosis predicting. Subsequently, risk score of the CRLPS and grade were assessed as independent prognosis factors for UCEC, based on which the prognostic model provided the highest prediction accuracy of 99.7%. The calibration curve suggested that the prediction results consisted well with the observation. Enrichment analysis showed the CRLPS was mainly associated with tumor development and immune response. Patients in low tumor mutation burden (TMB) group had poorer OS. Significant difference was found in tumor immune dysfunction and exclusion (TIDE) score between different risk score groups. Finally, based on the CRLPs, drug sensitivity analysis identified nine anticancer drugs with potential efficacy on prognosis.

CONCLUSION

Cuproptosis-related lncRNA prognostic signature was constructed for UCEC for the first time. Its high reliability and accuracy on predicting prognosis and immunotherapy response provided new perspective to explore the tumor mechanism and improve clinical prognosis. Nine discovered sensitive drugs provided important clues for personalized treatment of UCEC.

Association of polymorphism at position 49 in exon 1 of the cytotoxic T-lymphocyte-associated factor 4 gene with Graves' disease refractory to medical treatment, but not with amiodarone-associated thyroid dysfunction

BACKGROUND

Recently, the G allele of the cytotoxic T-lymphocyte-associated factor 4 (CTLA-4) exon 1 single-nucleotide polymorphism (CTLA-4 A/G(49)) has been identified as the most informative marker in patients with Graves' disease. Patients with the G/G genotype are refractory to medical treatment and frequently relapse after discontinuation of antithyroid drugs. Therefore, we analyzed CTLA-4 A/G(49) in patients who had been treated with (131)I. Further, a preliminary report has suggested that amiodarone-associated thyroid dysfunction (AATD) has a relationship with human leukocyte antigen (HLA) class I and class II.

METHOD

CTLA-4 genotypes in exon 1 (A/G(49)) and CT60 were analyzed in 415 Japanese patients with Graves' disease and 65 patients with AATD.

RESULTS

The frequencies of the G alleles and G/G genotype at the both polymorphisms were significantly higher in Graves' patients compared with normal subjects. Compared with CT60, the frequencies of the G alleles and G/G genotypes at the A/G(49) were more significantly higher in patients with persistently positive thyrotropin receptor antibody despite >5 years of antithyroid drug therapy, compared with those whose thyrotropin receptor antibody became negative in <5 years (p < 0.0001). Consequently, the frequencies of the G/G genotype and G allele at the A/G(49) were also significantly higher in patients with Graves' disease who received (131)I therapy (p < 0.05). However, there was no significant difference in the A/G polymorphisms in the 65 patients with AATD.

CONCLUSIONS

The G/G genotype in exon 1 (A/G(49)) is frequently expressed in Graves' disease patients who are refractory to antithyroid drug treatment. Therefore, the G/G genotype in A/G(49) would be a useful predictor of Graves' patients who are suitable for radioiodine therapy. Although the number of analyzed patients was small, our preliminary data suggest that the CTLA-4 gene polymorphisms might be unassociated with AATD.

Amiodarone-induced thyroid dysfunction in a tertiary center in south Brazil

Amiodarone, used in the treatment of cardiac arrhythmias, is associated with thyroid dysfunction. No reports exist on its frequency in southern Brazil, nor studies evaluating the usefulness of clinical scores to diagnose thyroid abnormalities in these patients. This study aimed at determining the prevalence of amiodarone-induced thyroid dysfunction in a representative sample from a tertiary center, to study the conditions associated to this dysfunction and to evaluate the reliability of clinical scores of hypo and hyperthyroidism. One hundred ninety-five amiodarone users were submitted to a clinical and laboratory evaluation. Of these, 2.1% were hyperthyroid, 25.1% hypothyroid and 9.2% had only a high T4. Considering thyroid dysfunction variables researched, thyroid autoimmunity was positively associated (OR 4.8; p= 0.02), and male gender had a trend to a positive association (OR 1.86; p= 0.06). Clinical scores were highly sensitive for hyperthyroidism (100%), but not for hypothyroidism (8%). The low prevalence of amiodarone-induced hypothyroidism suggests that this specific region is iodine-sufficient. All patients receiving chronic amiodarone therapy should be checked for clinical scores for hyperthyroidism and laboratory evaluation should be performed, as a screening for thyroid dysfunction, especially if they are male or have positive microsomal antibodies.

A stepwise approach to the treatment of amiodarone-induced thyrotoxicosis

Amiodarone-induced thyrotoxicosis (AIT) is a complex therapeutic challenge. Two major forms have been described: type I and type II. Methimazole (MMI) and potassium perchlorate (KCLO(4)) is the treatment of choice for the former, whereas corticosteroids are used for the latter. However, mixed forms appear frequently and it is not easy to prescribe corticosteroids because of side effects. The present study investigated the validity of a stepwise therapeutic approach to AIT. Twenty patients with AIT were given 30-50 mg/d of MMI and 1000 mg/d of KCLO(4) initially for a month. Euthyroidism or a significant decrease in serum thyroid hormone levels could be achieved in 12 of the patients (7 with type I, 5 type II). Prednisolone, 40-48 mg/d was added for the 8 nonresponding patients (7 type I, 1 type II) and euthyroidism was achieved in all. The prednisolone dose was decreased when free thyroxine (T(4)) levels normalized, and MMI was titrated, maintaining euthyroidism until urinary iodine excretion normalized. Mixed forms of AIT may prevail in iodine-deficient areas. Initial classification of the patients may cause unnecessary corticosteroid use in a substantial number of patients with AIT. A stepwise approach is feasible; however, when the patient is gravely ill, MMI, KCLO(4), and prednisolone could be prescribed simultaneously.

Amiodarone stimulates interleukin-6 production in cultured human thyrocytes, exerting cytotoxic effects on thyroid follicles in suspension culture

To investigate whether amiodarone increases interleukin-6 (IL-6) production in thyrocytes, human follicles obtained from subtotally thyroidectomized patients with Graves' disease were cultured in serum-free medium supplemented with various concentrations of bovine thyrotropin (bTSH) and amiodarone. The follicles gradually formed monolayer cells and secreted triiodothyronine (T3), thyroglobulin (Tg), and IL-6 for at least 14 days. TSH dose-dependently increased T3 and Tg but not IL-6 levels in the conditioned medium. Amiodarone exerted no significant effect on T3, Tg, or IL-6 concentrations at 0.1-1 microM. In contrast, at 10-20 microM, it decreased T3 and Tg, but increased IL-6 levels, and these changes were accompanied by increased expression of IL-6 mRNA. Amiodarone-induced IL-6 production was inhibited by prednisolone at 10(-7) M. Electron microscopic examination revealed that the thyroid follicles in the suspension culture remained intact at 1 microM, but that cytotoxic effects (decreased microvilli and increased onion-like inclusion bodies) occurred at higher concentrations (10-25 microM). These in vitro findings indicate that amiodarone does not impair thyroid function at clinically attainable serum levels (1 microM), but exerts cytotoxic effect by inducing the production of a proinflammatory cytokine (IL-6) at higher concentrations. Because amiodarone-induced IL-6 production was inhibited by prednisolone, it is reasonable to administer glucocorticoids to patients with amiodarone-induced destructive thyrotoxicosis (type II).