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Baz-Redón N, Antolín M, Clemente M, Campos A, Mogas E, Fernández-Cancio M, Zafon E, García-Arumí E, Soler L, González-Llorens N, Aguilar-Riera C, Camats-Tarruella N, Yeste D. Patients with Thyroid Dyshormonogenesis and DUOX2 Variants: Molecular and Clinical Description and Genotype-Phenotype Correlation. Int J Mol Sci 2024; 25:8473. [PMID: 39126042 PMCID: PMC11313534 DOI: 10.3390/ijms25158473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Thyroid dyshormonogenesis (THD) is a heterogeneous group of genetic diseases caused by the total or partial defect in the synthesis or secretion of thyroid hormones. Genetic variants in DUOX2 can cause partial to total iodination organification defects and clinical heterogeneity, from transient to permanent congenital hypothyroidism. The aim of this study was to undertake a molecular characterization and genotype-phenotype correlation in patients with THD and candidate variants in DUOX2. A total of 31 (19.38%) patients from the Catalan Neonatal Screening Program presented with variants in DUOX2 that could explain their phenotype. Fifteen (48.39%) patients were compound heterozygous, 10 (32.26%) heterozygous, and 4 (12.90%) homozygous. In addition, 8 (26.67%) of these patients presented variants in other genes. A total of 35 variants were described, 10 (28.57%) of these variants have not been previously reported in literature. The most frequent variant in our cohort was c.2895_2898del/p.(Phe966SerfsTer29), classified as pathogenic according to reported functional studies. The final diagnosis of this cohort was permanent THD in 21 patients and transient THD in 10, according to reevaluation and/or need for treatment with levothyroxine. A clear genotype-phenotype correlation could not be identified; therefore, functional studies are necessary to confirm the pathogenicity of the variants.
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Affiliation(s)
- Noelia Baz-Redón
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - María Antolín
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.A.); (E.Z.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - María Clemente
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Ariadna Campos
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Eduard Mogas
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Mónica Fernández-Cancio
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Elisenda Zafon
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.A.); (E.Z.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Elena García-Arumí
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.A.); (E.Z.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Laura Soler
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
| | - Núria González-Llorens
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
| | - Cristina Aguilar-Riera
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
| | - Núria Camats-Tarruella
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Diego Yeste
- Growth and Development Group, Vall d’Hebron Research Institute (VHIR), Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (M.C.); (A.C.); (E.M.); (M.F.-C.); (N.C.-T.); (D.Y.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Pediatric Endocrinology Section, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.S.); (N.G.-L.); (C.A.-R.)
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Arteaga-Jacobo MC, Roco-Videla Á, Villota Arcos C, González-Hormazábal P, Gonzalo-Castro V, Pérez-Flores MV. Frequency of Mutations in the TPO Gene in Patients with Congenital Hypothyroidism Due to Dyshormonogenesis in Chile. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1145. [PMID: 39064575 PMCID: PMC11279067 DOI: 10.3390/medicina60071145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Congenital thyroid dyshormonogenesis is caused by alterations in the synthesis of thyroid hormones in a newborn. Additionally, 10 to 20% of these cases are hereditary, caused by defects in proteins involved in hormonal synthesis. One of the most common causes is mutations in the thyroid peroxidase (TPO) enzyme gene, an autosomal recessive disease. We aimed to detect mutations of the TPO gene in 12 Chilean patients with congenital hypothyroidism due to dyshormonogenesis (CHD) and to characterize these patients clinically and molecularly. Materials and Methods: Twelve patients under 20 years of age with CHD, controlled at San Juan de Dios Hospital in Santiago, Chile, were selected according to the inclusion criteria: elevated neonatal TSH, persistent hypothyroidism, and thyroid normotopic by imaging study. Those with deafness, Down syndrome, and central or transient congenital hypothyroidism were excluded. Blood samples were taken for DNA extraction, and the 17 exons and exon-intron junctions of the TPO gene were amplified by PCR. The PCR products were sequenced by Sanger. Results: Two possibly pathogenic mutations of the TPO gene were detected: c.2242G>A (p.Val748Met) and c.1103C>T (p.Pro368Leu). These mutations were detected in 2 of 12 patients (16.6%): 1 was compound heterozygous c.1103C>T/c.2242G>A, and the other was heterozygous for c.2242G>A. In the diagnostic confirmation test, both patients presented diffuse hyper-uptake goiter on thyroid scintigraphy and high TSH in venous blood (>190 uIU/mL). Conclusions: The frequency of patients with possibly pathogenic mutations in TPO with CHD was 16.6%. Its study would allow for genetic counseling to be offered to the families of affected patients.
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Affiliation(s)
- María Clara Arteaga-Jacobo
- Programa de Genética Humana, Institute of Biomedical Science (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile;
| | - Ángel Roco-Videla
- Vicerectoria de Investigación e Innovación, Universidad Arturo Prat, Iquique 1110939, Chile
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4030000, Chile
| | - Claudio Villota Arcos
- Escuela de Nutrición y Dietética, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile;
| | - Patricio González-Hormazábal
- Programa de Genética Humana, Institute of Biomedical Science (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile;
| | - Víctor Gonzalo-Castro
- Programa de Genética Humana, Institute of Biomedical Science (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile;
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Samir S. Human DNA Mutations and their Impact on Genetic Disorders. Recent Pat Biotechnol 2024; 18:288-315. [PMID: 37936448 DOI: 10.2174/0118722083255081231020055309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/25/2023] [Accepted: 09/18/2023] [Indexed: 11/09/2023]
Abstract
DNA is a remarkably precise medium for copying and storing biological information. It serves as a design for cellular machinery that permits cells, organs, and even whole organisms to work. The fidelity of DNA replication results from the action of hundreds of genes involved in proofreading and damage repair. All human cells can acquire genetic changes in their DNA all over life. Genetic mutations are changes to the DNA sequence that happen during cell division when the cells make copies of themselves. Mutations in the DNA can cause genetic illnesses such as cancer, or they could help humans better adapt to their environment over time. The endogenous reactive metabolites, therapeutic medicines, and an excess of environmental mutagens, such as UV rays all continuously damage DNA, compromising its integrity. One or more chromosomal alterations and point mutations at a single site (monogenic mutation) including deletions, duplications, and inversions illustrate such DNA mutations. Genetic conditions can occur when an altered gene is inherited from parents, which increases the risk of developing that particular condition, or some gene alterations can happen randomly. Moreover, symptoms of genetic conditions depend on which gene has a mutation. There are many different diseases and conditions caused by mutations. Some of the most common genetic conditions are Alzheimer's disease, some cancers, cystic fibrosis, Down syndrome, and sickle cell disease. Interestingly, scientists find that DNA mutations are more common than formerly thought. This review outlines the main DNA mutations that occur along the human genome and their influence on human health. The subject of patents pertaining to DNA mutations and genetic disorders has been brought up.
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Affiliation(s)
- Safia Samir
- Department of Biochemistry and Molecular Biology, Theodor Bilharz Research Institute, Giza, Egypt
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Huang J, Wu H, Zhao G, Ma Y, An Y, Sun L, Li F, Wang S. A Case-Control Study of the Relationship Between Genetic Polymorphism and Cretinism in Xinjiang. Pharmgenomics Pers Med 2023; 16:785-794. [PMID: 37641720 PMCID: PMC10460608 DOI: 10.2147/pgpm.s418722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Background Cretinism is a subtype of congenital hypothyroidism, an endocrine disorder resulting from inadequate thyroid hormone production or receptor deficiency. Genetic abnormalities play a major role in the development of thyroid dysfunction. Methods We recruited 183 participants with cretinism and 119 healthy participants from the Xinjiang Uyghur Autonomous Region and randomly selected 29 tag single nucleotide polymorphisms (tSNPs) in TSHB, PAX8, TPO, NKX2-5, and TSHR in all participants. We compared genotype and allele frequencies between cases and controls utilizing the chi-squared test, logistic regression analysis, and haplotype analysis. Results Using the chi-squared test, a single SNP was found to be associated with cretinism (recessive model: rs3754363, OR = 0.46, 95% CI = 0.27-0.80, P = 0.00519; genotype model: P = 0.01677). We stratified neurological, myxedematous, and mixed type and determined that another SNP was associated with a higher risk when comparing myxedematous type to the neurological type (rs2277923). Conclusion rs3754363 has a statistically significant protective effect on people with cretinism, while rs2277923 may play a greater role in promoting the development of neurocretinism.
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Affiliation(s)
- Jia Huang
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
- Division of Endemic Disease Prevention, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, Xinjiang, 830002, People’s Republic of China
| | - Haiyan Wu
- Division of Endemic Disease Prevention, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, Xinjiang, 830002, People’s Republic of China
| | - Guiqiang Zhao
- Infection Management Department, Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People’s Republic of China
| | - Yan Ma
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Yunping An
- Kashgar District Center for Disease Control and Prevention, Kashgar, Xinjiang, 844000, People’s Republic of China
| | - Li Sun
- Ingisha County Center for Disease Control and Prevention, Kashgar, Xinjiang, 844500, People’s Republic of China
| | - Fuye Li
- Department of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Shengling Wang
- Division of Endemic Disease Prevention, Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, Xinjiang, 830002, People’s Republic of China
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Levaillant L, Bouhours-Nouet N, Illouz F, Amsellem Jager J, Bachelot A, Barat P, Baron S, Bensignor C, Brac De La Perriere A, Braik Djellas Y, Caillot M, Caldagues E, Campas MN, Caquard M, Cartault A, Cheignon J, Decrequy A, Delemer B, Dieckmann K, Donzeau A, Doye E, Fradin M, Gaudillière M, Gatelais F, Gorce M, Hazart I, Houcinat N, Houdon L, Ister-Salome M, Jozwiak L, Jeannoel P, Labarthe F, Lacombe D, Lambert AS, Lefevre C, Leheup B, Leroy C, Maisonneuve B, Marchand I, Marquant E, Muszlak M, Pantalone L, Pochelu S, Quelin C, Radet C, Renoult-Pierre P, Reynaud R, Rouleau S, Teinturier C, Thevenon J, Turlotte C, Valle A, Vierge M, Villanueva C, Ziegler A, Dieu X, Bouzamondo N, Rodien P, Prunier-Mirebeau D, Coutant R. The Severity of Congenital Hypothyroidism With Gland-In-Situ Predicts Molecular Yield by Targeted Next-Generation Sequencing. J Clin Endocrinol Metab 2023; 108:e779-e788. [PMID: 36884306 PMCID: PMC10438870 DOI: 10.1210/clinem/dgad119] [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: 04/12/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Congenital hypothyroidism with gland-in-situ (CH-GIS) is usually attributed to mutations in the genes involved in thyroid hormone production. The diagnostic yield of targeted next-generation sequencing (NGS) varied widely between studies. We hypothesized that the molecular yield of targeted NGS would depend on the severity of CH. METHODS Targeted NGS was performed in 103 CH-GIS patients from the French national screening program referred to the Reference Center for Rare Thyroid Diseases of Angers University Hospital. The custom targeted NGS panel contained 48 genes. Cases were classified as solved or probably solved depending on the known inheritance of the gene, the classification of the variants according to the American College of Medical Genetics and Genomics, the familial segregation, and published functional studies. Thyroid-stimulating hormone at CH screening and at diagnosis (TSHsc and TSHdg) and free T4 at diagnosis (FT4dg) were recorded. RESULTS NGS identified 95 variants in 10 genes in 73 of the 103 patients, resulting in 25 solved cases and 18 probably solved cases. They were mainly due to mutations in the TG (n = 20) and TPO (n = 15) genes. The molecular yield was, respectively, 73% and 25% if TSHsc was ≥ and < 80 mUI/L, 60% and 30% if TSHdg was ≥ and < 100 mUI/L, and 69% and 29% if FT4dg was ≤ and > 5 pmol/L. CONCLUSION NGS in patients with CH-GIS in France found a molecular explanation in 42% of the cases, increasing to 70% when TSHsc was ≥ 80 mUI/L or FT4dg was ≤ 5 pmol/L.
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Affiliation(s)
- Lucie Levaillant
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
| | - Natacha Bouhours-Nouet
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
| | - Frédéric Illouz
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Angers, 49000 Angers, France
| | - Jessica Amsellem Jager
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
| | - Anne Bachelot
- Department of Endocrinology and Reproductive Medicine, Hôpital Pitié-Salpêtrière, ICAN, 75651 Paris, France
| | - Pascal Barat
- Pediatric Endocrinology, CHU de Bordeaux, 33000 Bordeaux, France
| | - Sabine Baron
- Pediatrics Department, CHU Nantes, 44000 Nantes, France
| | | | - Aude Brac De La Perriere
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, 69677 Bron, France
| | - Yasmine Braik Djellas
- Department of Endocrinology and Reproductive Medicine, Hôpital Pitié-Salpêtrière, ICAN, 75651 Paris, France
| | - Morgane Caillot
- Pediatrics Department, CH de Martigues, 13500 Martigues, France
| | | | | | | | - Audrey Cartault
- Endocrine, Genetics, Bone Diseases, and Paediatric Gynecology Unit, Children's Hospital, CHU Toulouse, 31059 Toulouse, France
| | - Julie Cheignon
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
| | - Anne Decrequy
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
| | - Brigitte Delemer
- Department of Endocrinology, Diabetes and Nutrition, CHU de Reims-Hôpital Robert-Debré, 51100 Reims, France
| | | | - Aurélie Donzeau
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
| | | | - Mélanie Fradin
- Service de Génétique, CLAD Ouest, CHU Rennes, 35200 Rennes, France
| | - Mélanie Gaudillière
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, 69677 Bron, France
| | | | - Magali Gorce
- Service de Génétique, 49000 Angers Cedex 9, France
| | | | - Nada Houcinat
- CHU Dijon, Centre de référence maladies rares Anomalies du Développement et Syndromes Malformatifs, Centre de Génétique, FHU TRANSLAD, CHU Dijon Bourgogne 21000, France
| | - Laure Houdon
- Pediatric Diabetology, University Hospital, St Pierre de la Reunion 97410, France
| | | | - Lucie Jozwiak
- Pediatrics Department, CH de Roubaix, 59100 Roubaix, France
| | | | - Francois Labarthe
- Reference Center for Inborn Errors of Metabolism, Tours University Hospital, 37044 Tours, France
| | - Didier Lacombe
- Department of Medical Genetics, CHU Bordeaux INSERM U1211, Université de Bordeaux, 33076 Bordeaux, France
| | - Anne-Sophie Lambert
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre 94270, France
| | - Christine Lefevre
- Pediatric Endocrinology, Jeanne de Flandre Hospital, 59037 Lille, France
| | - Bruno Leheup
- Service de Génétique clinique, Höpital Brabois, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine 54500, France
| | - Clara Leroy
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Régional Universitaire de Lille, Hôpital Huriez, 59037 Lille, France
| | | | - Isis Marchand
- Pediatrics Department, CHI de Créteil, 94010 Créteil, France
| | - Emeline Marquant
- Assistance-Publique des Hôpitaux de Marseille, Department of Pediatrics, Hôpital de la Timone Enfants, 13005 Marseille, France
| | | | | | - Sandra Pochelu
- Pediatric Endocrinology, CHU de Bordeaux, 33000 Bordeaux, France
| | - Chloé Quelin
- Service de Génétique, CLAD Ouest, CHU Rennes, 35200 Rennes, France
| | | | - Peggy Renoult-Pierre
- Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, 37044 Tours, France
| | - Rachel Reynaud
- Assistance-Publique des Hôpitaux de Marseille, Department of Pediatrics, Hôpital de la Timone Enfants, 13005 Marseille, France
| | - Stéphanie Rouleau
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
| | - Cécile Teinturier
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre 94270, France
| | - Julien Thevenon
- Inserm UMR 1231 GAD Team, Genetics of Developmental Anomalies, and FHU-TRANSLAD, CHU/Université de Bourgogne-Franche Comté, 21000 Dijon, France
| | | | - Aline Valle
- Pediatrics Department, CH de Douai, 59187 Douai, France
| | - Melody Vierge
- Assistance-Publique des Hôpitaux de Marseille, Department of Pediatrics, Hôpital de la Timone Enfants, 13005 Marseille, France
| | - Carine Villanueva
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, 69677 Bron, France
| | | | - Xavier Dieu
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
- Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, 49000 Angers, France
| | - Nathalie Bouzamondo
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
- Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, 49000 Angers, France
| | - Patrice Rodien
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Angers, 49000 Angers, France
| | - Delphine Prunier-Mirebeau
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
- Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, 49000 Angers, France
| | - Régis Coutant
- Department of Pediatric Endocrinology and Diabetology, University Hospital of Angers, 49000 Angers, France
- Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, University Hospital of Angers, 49000 Angers, France
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Li M, Li Z, Chen M, Hu Z, Zhou M, Wu L, Zhang C, Liang D. Novel Missense Variants in PAX8 and NKX2-1 Cause Congenital Hypothyroidism. Int J Mol Sci 2023; 24:ijms24010786. [PMID: 36614229 PMCID: PMC9821711 DOI: 10.3390/ijms24010786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Primary congenital hypothyroidism (CH) is a common neonatal endocrine disorder characterized by elevated concentrations of thyroid stimulating hormone (TSH) and low concentrations of free thyroxine (FT4). PAX8 and NKX2-1 are important transcription factors involved in thyroid development. In this study, we detected three novel variants in PAX8 (c.149A > C and c.329G > A) and NKX2-1 (c.706A > G) by whole exome sequencing (WES) in three unrelated CH patients with variable phenotypes. The results of Western blot and immunofluorescence analysis showed that the three variants had no effect on protein expression and subcellular localization. However, the results of the electrophoretic mobility shift assay (EMSA) and dual-luciferase reporter assay suggested that the three variants in PAX8 and NKX2-1 both affected their DNA-binding ability and reduced their transactivation capacity. Moreover, a dominant-negative effect in K236E−NKX2-1 was identified by dual-luciferase reporter assay. To sum up, our findings extend our knowledge of the current mutation spectrum of PAX8 and NKX2-1 and provide important information for diagnosing, treating, and preventing CH in these families.
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Affiliation(s)
| | | | | | | | | | | | - Chunhua Zhang
- Correspondence: (C.Z.); (D.L.); Tel.: +86-871-65174598 (C.Z.); +86-731-84805252 (D.L.)
| | - Desheng Liang
- Correspondence: (C.Z.); (D.L.); Tel.: +86-871-65174598 (C.Z.); +86-731-84805252 (D.L.)
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Liu R, Tian JL, Huang XL, Song YZ. Genetic Factors Causing Thyroid Dyshormonogenesis as the Major Etiologies for Primary Congenital Hypothyroidism: Clinical and Genetic Characterization of 33 Patients. J Clin Med 2022; 11:7313. [PMID: 36555929 PMCID: PMC9786654 DOI: 10.3390/jcm11247313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Although the significance of primary congenital hypothyroidism (CH) is supported by an increasing amount of evidence, the clinical and genetic characteristics of this condition are still poorly understood. This study aimed to explore the underlying genetic etiologies in a cohort of primary CH patients. SUBJECTS AND METHODS The clinical data of 33 patients with primary CH were collected and analyzed via a cross-sectional study. Genetic analysis was performed by high-throughput sequencing and Sanger verification, and the pathogenicity of the novel missense variants was predicted using a variety of comprehensive bioinformatic tools. RESULTS Among the 33 patients, 22 (22/33, 66.7%) harbored pathogenic variants in the causative genes of thyroid dysgenesis or dyshormonogenesis, with DUOX2 (15/33, 45.5%) topping the list, followed by TG, TPO, DUOXA2 and PAX8. Four novel genetic variants were detected, including a pathogenic frameshift and three likely pathogenic missense variants. Positive neonatal screening for TSH, neonatal jaundice and abnormal thyroid morphology were the main positive findings among all cases. Although 31 of the total 33 CH patients exhibited normal anthropometric and social performance, the other 2 had poor prognosis in this study. CONCLUSIONS This study reported 33 new CH patients bearing four novel genetic variants, which enriched the variant spectrum of CH genes. In this cohort, genetic factors causing thyroid dyshormonogenesis were the main etiologies of CH development. Most patients exhibited a favorable prognosis; however, systematic management remains a challenge in achieving improved clinical outcomes for CH patients.
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Affiliation(s)
- Rui Liu
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jing-Li Tian
- Department of Pediatrics, Huizhou No. 2 Women’s and Children’s Healthcare Hospital, Huizhou 516000, China
| | - Xiao-Ling Huang
- Neonatal Screening Center, Dongguan Maternal and Child Healthcare Hospital, Dongguan 523125, China
| | - Yuan-Zong Song
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
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8
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Stoupa A, Kariyawasam D, Nguyen Quoc A, Polak M, Carré A. Approach to the Patient With Congenital Hypothyroidism. J Clin Endocrinol Metab 2022; 107:3418-3427. [PMID: 36107810 DOI: 10.1210/clinem/dgac534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 02/13/2023]
Abstract
Congenital hypothyroidism (CH) is the most frequent neonatal endocrine disorder and the most common preventable cause of development delay and growth failure if diagnosed and treated early. The thyroid is the first endocrine gland to develop during embryonic life and to be recognizable in humans. Thyroid development and maturation can be divided into 2 phases: a first phase of embryogenesis and a second phase of folliculogenesis and differentiation with thyroid hormone production at the final steps. Regulation of the thyroid function requires normal development of the hypothalamic-pituitary-thyroid axis, which occurs during the embryonic and neonatal period. Defects in any of steps of thyroid development, differentiation, and regulation lead to permanent CH. Newborn screening programs, established in only one-third of countries worldwide, detect CH and are cost-effective and highly sensitive and specific. During the last decade, epidemiology of CH has changed with increased frequency of thyroid in situ in primary CH. Advances in molecular testing have expanded knowledge and understanding of thyroid development and function. However, a molecular cause is identified in only 5% of CH due to thyroid dysgenesis. The purpose of this article is to describe the clinical approach to the child with CH, focusing on diagnostic work-up and future challenges on optimizing thyroid replacement therapy and regenerative medicine. The review is written from the perspective of the case of 2 girls referred for CH after newborn screening and diagnosed with thyroid ectopy. The genetic work-up revealed novel mutations in TUBB1 gene, associated with large platelets and abnormal platelet physiology.
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Affiliation(s)
- Athanasia Stoupa
- Pediatric Endocrinology, Gynecology and Diabetology Department, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS, U1016 INSERM, Cochin Institute and U1163 INSERM, Imagine Institute affiliate, Paris, France
| | - Dulanjalee Kariyawasam
- Pediatric Endocrinology, Gynecology and Diabetology Department, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS, U1016 INSERM, Cochin Institute and U1163 INSERM, Imagine Institute affiliate, Paris, France
| | - Adrien Nguyen Quoc
- Pediatric Endocrinology, Gynecology and Diabetology Department, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS, U1016 INSERM, Cochin Institute and U1163 INSERM, Imagine Institute affiliate, Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Centre régional de dépistage néonatal (CRDN), Ile-de-France, Fédération parisienne pour le dépistage et la prévention des handicaps de l'enfant (FPDPHE), Paris, France
| | - Aurore Carré
- Université Paris Cité, CNRS, U1016 INSERM, Cochin Institute and U1163 INSERM, Imagine Institute affiliate, Paris, France
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Stoupa A, Kariyawasam D, Polak M, Carré A. Genetics of congenital hypothyroidism: Modern concepts. Pediatr Investig 2022; 6:123-134. [PMID: 35774517 PMCID: PMC9218988 DOI: 10.1002/ped4.12324] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Congenital hypothyroidism (CH) is the most common neonatal endocrine disorder and one of the most common preventable causes of intellectual disability in the world. CH may be due to developmental or functional thyroid defects (primary or peripheral CH) or be hypothalamic-pituitary in origin (central CH). In most cases, primary CH is caused by a developmental malformation of the gland (thyroid dysgenesis, TD) or by a defect in thyroid hormones synthesis (dyshormonogenesis, DH). TD represents about 65% of CH and a genetic cause is currently identified in fewer than 5% of patients. The remaining 35% are cases of DH and are explained with certainty at the molecular level in more than 50% of cases. The etiology of CH is mostly unknown and may include contributions from individual and environmental factors. In recent years, the detailed phenotypic description of patients, high-throughput sequencing technologies, and the use of animal models have made it possible to discover new genes involved in the development or function of the thyroid gland. This paper reviews all the genetic causes of CH. The modes by which CH is transmitted will also be discussed, including a new oligogenic model. CH is no longer simply a dominant disease for cases of CH due to TD and recessive for cases of CH due to DH, but a far more complex disorder.
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Affiliation(s)
- Athanasia Stoupa
- Department of Paediatric EndocrinologyGynaecology and DiabetologyIle de France Regional Neonatal Screening Centre (CRDN)Necker Enfants‐Malades University HospitalParisFrance
- Institut IMAGINEINSERM U1163ParisFrance
- Institut CochinINSERM U1016ParisFrance
- Centre des maladies endocriniennes rares de la croissance et du dévelopementParisFrance
| | - Dulanjalee Kariyawasam
- Department of Paediatric EndocrinologyGynaecology and DiabetologyIle de France Regional Neonatal Screening Centre (CRDN)Necker Enfants‐Malades University HospitalParisFrance
- Institut IMAGINEINSERM U1163ParisFrance
- Institut CochinINSERM U1016ParisFrance
- Centre des maladies endocriniennes rares de la croissance et du dévelopementParisFrance
| | - Michel Polak
- Department of Paediatric EndocrinologyGynaecology and DiabetologyIle de France Regional Neonatal Screening Centre (CRDN)Necker Enfants‐Malades University HospitalParisFrance
- Institut IMAGINEINSERM U1163ParisFrance
- Institut CochinINSERM U1016ParisFrance
- Centre des maladies endocriniennes rares de la croissance et du dévelopementParisFrance
- Université de Paris CitéParisFrance
| | - Aurore Carré
- Institut IMAGINEINSERM U1163ParisFrance
- Institut CochinINSERM U1016ParisFrance
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10
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Acar S, Gürsoy S, Arslan G, Nalbantoğlu Ö, Hazan F, Köprülü Ö, Özkaya B, Özkan B. Screening of 23 candidate genes by next-generation sequencing of patients with permanent congenital hypothyroidism: novel variants in TG, TSHR, DUOX2, FOXE1, and SLC26A7. J Endocrinol Invest 2022; 45:773-786. [PMID: 34780050 DOI: 10.1007/s40618-021-01706-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To date, many genes have been associated with congenital hypothyroidism (CH). Our aim was to identify the mutational spectrum of 23 causative genes in Turkish patients with permanent CH, including thyroid dysgenesis (TD) and dyshormonogenesis (TDH) cases. METHODS A total of 134 patients with permanent CH (130 primary, 4 central) were included. To identify the genetic etiology, we screened 23 candidate genes associated with CH by next-generation sequencing. For confirmation and to detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. RESULTS Possible pathogenic variants were found in 5.2% of patients with TD and in 64.0% of the patients with normal-sized thyroid or goiter. In all patients, variants were most frequently found in TSHR, followed by TPO and TG. The same homozygous TSHB variant (c.162 + 5G > A) was identified in four patients with central CH. In addition, we detected novel variants in the TSHR, TG, SLC26A7, FOXE1, and DUOX2. CONCLUSION Genetic causes were determined in the majority of CH patients with TDH, however, despite advances in genetics, we were unable to identify the genetic etiology of most CH patients with TD, suggesting the effect of unknown genes or environmental factors. The previous studies and our findings suggest that TSHR and TPO mutations is the main genetic defect of CH in the Turkish population.
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Affiliation(s)
- S Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey.
| | - S Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - G Arslan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - F Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Ö Köprülü
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
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11
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Newborn Screening in Pediatric Endocrine Disorders. ENDOCRINES 2022. [DOI: 10.3390/endocrines3010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two endocrine disorders, congenital hypothyroidism (CH) and congenital adrenal hyperplasia (CAH), when untreated, can have devastating, irreversible and fatal outcomes. Permanent cognitive impairment, growth failure and dysmorphic appearance are seen in congenital hypothyroidism (CH) and early infant death in males with salt wasting CAH (as most females are discovered by presence of atypical genital appearance, while males appeared normal). Newborn screening (NBS) for CH was developed with broader engagement of centers, and was more rapidly adopted throughout the US and other large or developed countries, while NBS for CAH was pioneered by relatively few and was not fully adopted in the US until the initiation of Universal Expanded Newborn Screening Panel in 2005. Advances in genetic understanding of CH and CAH continue with NBS. Cost–benefit analysis, showing CH NBS as more successful than CAH NBS, may not fully recognize the cost of a life saved with CAH NBS. Early treatment of CH is much simpler with taking a pill a day unlike CAH requiring multiple medication doses, and possibly surgery apart from enteral and parenteral stress doses during adrenal crisis. CAH management outcomes with gender identity matters in persons with atypical genital appearance and androgen effects are still being studied.
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12
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Петеркова ВА, Безлепкина ОБ, Ширяева ТЮ, Вадина ТА, Нагаева ЕВ, Чикулаева ОА, Шредер ЕВ, Конюхова МБ, Макрецкая НА, Шестопалова ЕА, Митькина ВБ. [Clinical guideline of «congenital hypothyroidism»]. PROBLEMY ENDOKRINOLOGII 2022; 68:90-103. [PMID: 35488760 PMCID: PMC9764271 DOI: 10.14341/probl12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/09/2023]
Abstract
Congenital hypothyroidism is an important issue of pediatric endocrinology at which timely diagnosis and treatment can prevent the development of severe cases of the disease. The developed clinical guidelines are a working tool for a practicing physician. The target audience is pediatric endocrinologists and pediatricians. They briefly and logically set out the main definition of the disease, epidemiology, classification, methods of diagnosis and treatment, based on the principles of -evidence-based medicine.
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Affiliation(s)
| | | | | | | | | | | | | | - М. Б. Конюхова
- Московский центр неонатального скрининга Морозовской детской городской клинической больницы
| | | | | | - В. Б. Митькина
- Московский центр неонатального скрининга Морозовской детской городской клинической больницы
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13
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Koch G, Steffens B, Leroux S, Gotta V, Schropp J, Gächter P, Bachmann F, Welzel T, Janner M, L'Allemand D, Konrad D, Szinnai G, Pfister M. Modeling of levothyroxine in newborns and infants with congenital hypothyroidism: challenges and opportunities of a rare disease multi-center study. J Pharmacokinet Pharmacodyn 2021; 48:711-723. [PMID: 34117565 PMCID: PMC8405503 DOI: 10.1007/s10928-021-09765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
Modeling of retrospectively collected multi-center data of a rare disease in pediatrics is challenging because laboratory data can stem from several decades measured with different assays. Here we present a retrospective pharmacometrics (PMX) based data analysis of the rare disease congenital hypothyroidism (CH) in newborns and infants. Our overall aim is to develop a model that can be applied to optimize dosing in this pediatric patient population since suboptimal treatment of CH during the first 2 years of life is associated with a reduced intelligence quotient between 10 and 14 years. The first goal is to describe a retrospectively collected dataset consisting of 61 newborns and infants with CH up to 2 years of age. Overall, 505 measurements of free thyroxine (FT4) and 510 measurements of thyrotropin or thyroid-stimulating hormone were available from patients receiving substitution treatment with levothyroxine (LT4). The second goal is to introduce a scale/location-scale normalization method to merge available FT4 measurements since 34 different postnatal age- and assay-specific laboratory reference ranges were applied. This method takes into account the change of the distribution of FT4 values over time, i.e. a transformation from right-skewed towards normality during LT4 treatment. The third goal is to develop a practical and useful PMX model for LT4 treatment to characterize FT4 measurements, which is applicable within a clinical setting. In summary, a time-dependent normalization method and a practical PMX model are presented. Since there is no on-going or planned development of new pharmacological approaches for CH, PMX based modeling and simulation can be leveraged to personalize dosing with the goal to enhance longer-term neurological outcome in children with the rare disease CH.
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Affiliation(s)
- Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
| | - Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Stephanie Leroux
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Pascal Gächter
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Marco Janner
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital , University of Bern, Bern, Switzerland
| | - Dagmar L'Allemand
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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14
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Albano F, Tucci V, Blackshear PJ, Reale C, Roberto L, Russo F, Marotta P, Porreca I, Colella M, Mallardo M, de Felice M, Ambrosino C. ZFP36L2 Role in Thyroid Functionality. Int J Mol Sci 2021; 22:9379. [PMID: 34502288 PMCID: PMC8431063 DOI: 10.3390/ijms22179379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Thyroid hormone levels are usually genetically determined. Thyrocytes produce a unique set of enzymes that are dedicated to thyroid hormone synthesis. While thyroid transcriptional regulation is well-characterized, post-transcriptional mechanisms have been less investigated. Here, we describe the involvement of ZFP36L2, a protein that stimulates degradation of target mRNAs, in thyroid development and function, by in vivo and in vitro gene targeting in thyrocytes. Thyroid-specific Zfp36l2-/- females were hypothyroid, with reduced levels of circulating free Thyroxine (cfT4) and Triiodothyronine (cfT3). Their hypothyroidism was due to dyshormonogenesis, already evident one week after weaning, while thyroid development appeared normal. We observed decreases in several thyroid-specific transcripts and proteins, such as Nis and its transcriptional regulators (Pax8 and Nkx2.1), and increased apoptosis in Zfp36l2-/- thyroids. Nis, Pax8, and Nkx2.1 mRNAs were also reduced in Zfp36l2 knock-out thyrocytes in vitro (L2KO), in which we confirmed the increased apoptosis. Finally, in L2KO cells, we showed an altered response to TSH stimulation regarding both thyroid-specific gene expression and cell proliferation and survival. This result was supported by increases in P21/WAF1 and p-P38MAPK levels. Mechanistically, we confirmed Notch1 as a target of ZFP36L2 in the thyroid since its levels were increased in both in vitro and in vivo models. In both models, the levels of Id4 mRNA, a potential inhibitor of Pax8 activity, were increased. Overall, the data indicate that the regulation of mRNA stability by ZFP36L2 is a mechanism that controls the function and survival of thyrocytes.
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Affiliation(s)
- Francesco Albano
- IEOS-CNR, 80131 Naples, Italy;
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
| | - Valeria Tucci
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Perry J. Blackshear
- Signal Transduction Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC 27709, USA;
- Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC 27710, USA
| | - Carla Reale
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
| | - Luca Roberto
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
| | - Filomena Russo
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
| | - Pina Marotta
- Stazione Zoologica Anton Dohrn, 80121 Napoli, Italy;
| | - Immacolata Porreca
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
| | - Marco Colella
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
- Department of Science and Technology, University of Sannio, 82100 Benevento, Italy
| | - Massimo Mallardo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Mario de Felice
- IEOS-CNR, 80131 Naples, Italy;
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Concetta Ambrosino
- Biogem, Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy; (V.T.); (C.R.); (L.R.); (F.R.); (I.P.); (M.C.)
- Department of Science and Technology, University of Sannio, 82100 Benevento, Italy
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15
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Wang F, Xiaole L, Ma R, Zhao D, Liu S. Dual Oxidase System Genes Defects in Children With Congenital Hypothyroidism. Endocrinology 2021; 162:6149935. [PMID: 33631011 DOI: 10.1210/endocr/bqab043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The objectives of this study were to analyze the distribution of dual oxidase (DUOX) system genes (containing DUOX2, DUOX1, DUOXA2, and DUOXA1) variants in children with congenital hypothyroidism (CH) and their phenotypes. METHODS Target region sequencing technology was performed on DUOX system genes among 606 CH subjects covering all the exon and intron regions. Detailed clinical data were collected for statistical analysis. RESULTS A total of 95 suspected pathogenic variants were detected in the DUOX system genes, showing a 39.11% rate in variant carrying (237/606). DUOX2 had the highest rate in this study. There were statistical differences in maximum adjusted dose and current dose of levothyroxine between the DUOX system genes nonmutated group with the mutated group (both Ps < 0.001). The cases in the DUOX system genes mutated group were more likely to develop into transient CH (χ 2 = 23.155, P < 0.001) and more likely to manifested as goiter or gland-in-situ (χ 2 = 66.139, P < 0.001). In addition, there was no significant difference in clinical characteristics between DUOX system genes monoallelic and non-monoallelic. Although 20% of the variants affected the functional domain regions (EF hand, flavin adenine dinucleotide and nicotinamide adenine dinucleotide binding sites), there was no significant effect on the phenotype severity whether the variation is located in the functional domain regions. CONCLUSIONS Our results showed the high variation rate of DUOX2 in the DUOX system genes among Chinese CH patients. The complex genotype-phenotype relationship of DUOX system genes broadened the understanding of CH phenotype spectrum.
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Affiliation(s)
- Fengqi Wang
- Department of Medical Genetic, the Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Xiaole
- Neonatal Screening Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixin Ma
- Department of Endocrinology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dehua Zhao
- Neonatal Screening Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shiguo Liu
- Department of Medical Genetic, the Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, the Affiliated Hospital of Qingdao University, Qingdao, China
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16
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Dom G, Dmitriev P, Lambot MA, Van Vliet G, Glinoer D, Libert F, Lefort A, Dumont JE, Maenhaut C. Transcriptomic Signature of Human Embryonic Thyroid Reveals Transition From Differentiation to Functional Maturation. Front Cell Dev Biol 2021; 9:669354. [PMID: 34249923 PMCID: PMC8270686 DOI: 10.3389/fcell.2021.669354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
The human thyroid gland acquires a differentiation program as early as weeks 3-4 of embryonic development. The onset of functional differentiation, which manifests by the appearance of colloid in thyroid follicles, takes place during gestation weeks 10-11. By 12-13 weeks functional differentiation is accomplished and the thyroid is capable of producing thyroid hormones although at a low level. During maturation, thyroid hormones yield increases and physiological mechanisms of thyroid hormone synthesis regulation are established. In the present work we traced the process of thyroid functional differentiation and maturation in the course of human development by performing transcriptomic analysis of human thyroids covering the period of gestation weeks 7-11 and comparing it to adult human thyroid. We obtained specific transcriptomic signatures of embryonic and adult human thyroids by comparing them to non-thyroid tissues from human embryos and adults. We defined a non-TSH (thyroid stimulating hormone) dependent transition from differentiation to maturation of thyroid. The study also sought to shed light on possible factors that could replace TSH, which is absent in this window of gestational age, to trigger transition to the emergence of thyroid function. We propose a list of possible genes that may also be involved in abnormalities in thyroid differentiation and/or maturation, hence leading to congenital hypothyroidism. To our knowledge, this study represent the first transcriptomic analysis of human embryonic thyroid and its comparison to adult thyroid.
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Affiliation(s)
- Geneviève Dom
- School of Medicine, IRIBHM, Université libre de Bruxelles, Brussels, Belgium
- Institute of Interdisciplinary Research in Human and Molecular Biology, Brussels, Belgium
| | - Petr Dmitriev
- School of Medicine, IRIBHM, Université libre de Bruxelles, Brussels, Belgium
- Institute of Interdisciplinary Research in Human and Molecular Biology, Brussels, Belgium
| | | | - Guy Van Vliet
- Département de Pédiatrie, Université de Montréal, Montreal, QC, Canada
- CHU Sainte-Justine, Montreal, QC, Canada
| | - Daniel Glinoer
- Hôpital Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium
| | | | - Anne Lefort
- School of Medicine, IRIBHM, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques E. Dumont
- School of Medicine, IRIBHM, Université libre de Bruxelles, Brussels, Belgium
- Institute of Interdisciplinary Research in Human and Molecular Biology, Brussels, Belgium
| | - Carine Maenhaut
- School of Medicine, IRIBHM, Université libre de Bruxelles, Brussels, Belgium
- Institute of Interdisciplinary Research in Human and Molecular Biology, Brussels, Belgium
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17
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McNally RJ, Jones JH, Shaikh MG, Donaldson MD, Blakey K, Cheetham TD. Congenital Hypothyroidism: Space-Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology. Thyroid 2021; 31:876-883. [PMID: 33183175 PMCID: PMC8215409 DOI: 10.1089/thy.2020.0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis (DG) is unknown. If transient environmental factors can impact on thyroid gland development, then clustering of cases in time and/or space may occur, and this would be more likely in thyroid DG than dyshormonogenesis (DHG). Methods: The newborn screening program for CHT in Scotland is linked to a central database that includes case details such as postcode. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on K-functions, with nearest neighbor thresholds) of CHT in Scotland between 1979 and 2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Results: Of 531 cases with CHT during the study period, 290 cases had been categorized as DG (n = 229) or DHG (n = 61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology, but there was no seasonality. There was no evidence of overall space-time clustering (p = 0.06), but there was evidence of clustering in babies with DG (p = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases (p < 0.001). Clustering of these cases was restricted to females but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of DHG. Conclusions: These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid DG in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.
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Affiliation(s)
- Richard J.Q. McNally
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | - Malcolm D.C. Donaldson
- Section of Child Health, Royal Hospital for Children, University of Glasgow School of Medicine, Glasgow, United Kingdom
| | - Karen Blakey
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tim D. Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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18
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Zervas A, Chrousos G, Livadas S. Snow White and the Seven Dwarfs: a fairytale for endocrinologists. Endocr Connect 2021; 10:R189-R199. [PMID: 33878729 PMCID: PMC8183629 DOI: 10.1530/ec-20-0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
'Snow White and the Seven Dwarfs', a fairytale that is widely known across the Western world, was originally written by the Brothers Grimm, and published in 1812 as 'Snow White'. Though each dwarf was first given an individual name in the 1912 Broadway play, in Walt Disney's 1937 film 'Snow White and the Seven Dwarfs', they were renamed, and the dwarfs have become household names. It is well known that myths, fables, and fairytales, though appearing to be merely children's tales about fictional magical beings and places, have, more often than not, originated from real facts. Therefore, the presence of the seven brothers with short stature in the story is, from an endocrinological point of view, highly intriguing, in fact, thrilling. The diversity of the phenotypes among the seven dwarfs is also stimulating, although puzzling. We undertook a differential diagnosis of their common underlying disorder based on the original Disney production's drawings and the unique characteristics of these little gentlemen, while we additionally evaluated several causes of short stature and, focusing on endocrine disorders that could lead to these clinical features among siblings, we have, we believe, been able to reveal the underlying disease depicted in this archetypal tale.
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Affiliation(s)
| | - George Chrousos
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
- National and Kapodistrian University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Sarantis Livadas
- Endocrine Unit, Athens Medical Centre, Athens, Greece
- Correspondence should be addressed to S Livadas:
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19
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Choukair D, Eberle B, Vick P, Hermanns P, Weiss B, Paramasivam N, Schlesner M, Lornsen K, Roeth R, Klutmann C, Kreis J, Hoffmann GF, Pohlenz J, Rappold GA, Bettendorf M. Identification of Transient Receptor Potential Channel 4-Associated Protein as a Novel Candidate Gene Causing Congenital Primary Hypothyroidism. Horm Res Paediatr 2021; 93:16-29. [PMID: 32428920 DOI: 10.1159/000507114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital primary hypothyroidism (CH) is the most common endocrine disorder in neonates. METHODS To identify novel genes, we performed whole exome sequencing (WES) in 6 patients with CH due to thyroid dysgenesis (TD). The potential effects of the most relevant variants were analyzed using in silico prediction tools. The most promising candidate gene, transient receptor potential channel 4-associated protein (TRPC4AP), was sequenced in 179 further patients with TD. Expression of TRPC4AP in human thyroid was investigated using RT-PCR. Trpc4ap- functional analysis was performed in Xenopus laevis using Morpholino (MO) antisense oligomers. RESULTS WES identified a likely damaging mutation in TRPC4AP leading to a de novo stop codon p.Q552*. Targeted sequencing of TRPC4AP demonstrated gene variants with predicted damaging potential in 5 patients resulting each in an amino acid exchange (p.P706S, p.F729L, p.S777C, and p.N229S). We demonstrated that TRPC4AP is expressed in human thyroid gland tissue. Using Xenopus laevis, we showed that the volume of the tadpole thyroid anlage was reduced by 20% in Trpc4ap MO knockdowns compared to controls and by 41% in "Clustered Regularly Interspaced Short Palindromic Repeats"/Cas9-mediated gene knockout experiments. DISCUSSION A recognized interaction of TRPC4AP and the NF-kappa-B-essential-modulator encoded by IKBKG gene was identified by IPA analysis. IKBKG plays a role in activation of the NF-κB-signaling pathway and regulates genes involved in proliferation and survival of thyrocytes and expression of key enzymes of thyroid hormone synthesis. CONCLUSION TRPC4AP was identified as a novel candidate gene in TD, but further studies are needed to validate its role in thyroid function.
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Affiliation(s)
- Daniela Choukair
- Division of Paediatric Endocrinology, Children's Hospital, University of Heidelberg, Heidelberg, Germany,
| | - Birgit Eberle
- Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Vick
- Department of Zoology, University of Hohenheim, Stuttgart, Germany
| | - Pia Hermanns
- Division of Paediatric Endocrinology, Children's Hospital, University of Mainz, Mainz, Germany
| | - Birgit Weiss
- Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany
| | - Nagarajan Paramasivam
- Theoretical Bioinformatics Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Schlesner
- Bioinformatics and Omics Data Analytics (B240), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katharina Lornsen
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ralph Roeth
- Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany
| | - Carina Klutmann
- Division of Paediatric Endocrinology, Children's Hospital, University of Mainz, Mainz, Germany
| | - Jennifer Kreis
- Department of Zoology, University of Hohenheim, Stuttgart, Germany
| | - Georg F Hoffmann
- Division of Paediatric Endocrinology, Children's Hospital, University of Heidelberg, Heidelberg, Germany
| | - Joachim Pohlenz
- Division of Paediatric Endocrinology, Children's Hospital, University of Mainz, Mainz, Germany
| | - Gudrun A Rappold
- Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology, Children's Hospital, University of Heidelberg, Heidelberg, Germany
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20
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Li L, Jia C, Li X, Wang F, Wang Y, Chen Y, Liu S, Zhao D. Molecular and clinical characteristics of congenital hypothyroidism in a large cohort study based on comprehensive thyroid transcription factor mutation screening in Henan. Clin Chim Acta 2021; 518:162-169. [PMID: 33773966 DOI: 10.1016/j.cca.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH), the most common neonatal endocrine disorder worldwide, can be caused by variants in thyroid transcription factor (TTF) genes including NKX2-1, FOXE1, PAX8, NKX2-5 and HHEX. This study aims to perform targeted next-generation sequencing (NGS) panel for comprehensive mutation screening on these genes in a cohort of 606 CH patients with various types from Henan Province, China, to investigate the mutation rate of TTF genes, and to analyze the clinical, biochemical and molecular characteristics of our CH cohort. METHODS High-throughput sequencing combined with statistical calculation were applied for mutation screening and analyses of the clinical data. RESULTS Twenty-two likely disease-causing monoallelic mutations in the TTF genes were identified in our cohort (3.63%, 22/606). Mutated PAX8 was the most predominant genetic alteration among these TTF mutations. Interestingly, PAX8 defects were only found in TD cases and variants in the five TTF genes were detected in gland in situ (GIS) patients. CH patients with the same genotype may have significant phenotypic variability and permanent CH (PCH) patients in the GIS group were significantly fewer than those in the TD group. CONCLUSIONS Our study showed the estimated TTF mutation rate among CH cases was 3.63% in Henan Province and genetic alternations in TTF genes played a role not only in TD but also in GIS, especially in goiter. Although we speculated that the five TTF genes may be involved in certain steps of thyroid hormone biosynthesis, more researches are needed to verify the conclusions of the present study.
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Affiliation(s)
- Liangshan Li
- Medical Genetic Department, the Affiliated Hospital of Qingdao University, Qingdao, China; Department of Clinical Laboratory, Medical College of Qingdao University, Qingdao, China
| | - Chenlu Jia
- Department of Henan Newborn Screening Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaole Li
- Department of Henan Newborn Screening Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Endocrinology Department, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Endocrinology Department, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanping Chen
- Neonatal Disease Screening Center, Qingdao Women and Children's Hospital, Qingdao, China
| | - Shiguo Liu
- Medical Genetic Department, the Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Dehua Zhao
- Department of Henan Newborn Screening Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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21
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Ashtiwi NM, Sarr D, Rada B. DUOX1 in mammalian disease pathophysiology. J Mol Med (Berl) 2021; 99:743-754. [PMID: 33704512 PMCID: PMC8315118 DOI: 10.1007/s00109-021-02058-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/17/2023]
Abstract
Dual oxidase 1 (DUOX1) is a member of the protein family of nicotinamide adenine dinucleotide phosphate (NADPH) oxidases. DUOX1 has several normal physiological, immunological, and biochemical functions in different parts of the body. Dysregulated oxidative metabolism interferes with various disease pathologies and numerous therapeutic options are based on targeting cellular redox pathways. DUOX1 forms an important enzymatic source of biological oxidants, and DUOX1 expression is frequently dysregulated in various diseases. While this review shortly addresses the biochemical and cellular properties and proposed physiological roles of DUOX1, its main purpose is to summarize the current knowledge with respect to the potential role of DUOX1 enzyme in disease pathology, especially in mammalian organisms. Although DUOX1 is normally prominently expressed in epithelial lineages, it is frequently silenced in epithelial-derived cancers by epigenetic mechanisms. While an abundance of information is available on DUOX1 transcription in different diseases, an increasing number of mechanistic studies indicate a causative relationship between DUOX1 function and disease pathophysiology. Additionally, specific functions of the DUOX1 maturation factor, DUOXA1, will also be addressed. Lastly, urgent and outstanding questions on the field of DUOX1 will be discussed that could provide valuable new diagnostic tools and novel therapeutic options.
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Affiliation(s)
- Nuha Milad Ashtiwi
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Demba Sarr
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Balázs Rada
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
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22
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Stoupa A, Kariyawasam D, Muzza M, de Filippis T, Fugazzola L, Polak M, Persani L, Carré A. New genetics in congenital hypothyroidism. Endocrine 2021; 71:696-705. [PMID: 33650047 DOI: 10.1007/s12020-021-02646-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Congenital hypothyroidism (CH) is the most frequent neonatal endocrine disorder and one of the most common preventable forms of mental retardation worldwide. CH is due to thyroid development or thyroid function defects (primary) or may be of hypothalamic-pituitary origin (central). Primary CH is caused essentially by abnormal thyroid gland morphogenesis (thyroid dysgenesis, TD) or defective thyroid hormone synthesis (dyshormonogenesis, DH). TD accounts for about 65% of CH, however a genetic cause is identified in less than 5% of patients. PURPOSE The pathogenesis of CH is largely unknown and may include the contribution of individual and environmental factors. During the last years, detailed phenotypic description of patients, next-generation sequence technologies and use of animal models allowed the discovery of novel candidate genes in thyroid development, function and pathways. RESULTS AND CONCLUSION We provide an overview of recent genetic causes of primary and central CH. In addition, mode of inheritance and the oligogenic model of CH are discussed.
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Affiliation(s)
- Athanasia Stoupa
- Pediatric Endocrinology, Gynecology, and Diabetology Department, Necker Children's University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- IMAGINE Institute affiliate, INSERM U1163, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
| | - Dulanjalee Kariyawasam
- Pediatric Endocrinology, Gynecology, and Diabetology Department, Necker Children's University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- IMAGINE Institute affiliate, INSERM U1163, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
| | - Marina Muzza
- Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milan, Italy
| | - Tiziana de Filippis
- Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milan, Italy
| | - Laura Fugazzola
- Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20100, Milan, Italy
| | - Michel Polak
- Pediatric Endocrinology, Gynecology, and Diabetology Department, Necker Children's University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- IMAGINE Institute affiliate, INSERM U1163, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Luca Persani
- Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, 20100, Milan, Italy
| | - Aurore Carré
- IMAGINE Institute affiliate, INSERM U1163, Paris, France.
- Cochin Institute, INSERM U1016, Paris, France.
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23
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van Trotsenburg P, Stoupa A, Léger J, Rohrer T, Peters C, Fugazzola L, Cassio A, Heinrichs C, Beauloye V, Pohlenz J, Rodien P, Coutant R, Szinnai G, Murray P, Bartés B, Luton D, Salerno M, de Sanctis L, Vigone M, Krude H, Persani L, Polak M. Congenital Hypothyroidism: A 2020-2021 Consensus Guidelines Update-An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology. Thyroid 2021; 31:387-419. [PMID: 33272083 PMCID: PMC8001676 DOI: 10.1089/thy.2020.0333] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.
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Affiliation(s)
- Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Athanasia Stoupa
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
| | - Juliane Léger
- Department of Pediatric Endocrinology and Diabetology, Reference Center for Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Paris, France
| | - Tilman Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Catherine Peters
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, Department of Medical & Surgical Sciences, University of Bologna, Bologna Italy
| | - Claudine Heinrichs
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Beauloye
- Unité d'Endocrinologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Joachim Pohlenz
- Department of Pediatrics, Johannes Gutenberg University Medical School, Mainz, Germany
| | - Patrice Rodien
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service EDN, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
| | - Regis Coutant
- Unité d' Endocrinologie Diabetologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, Angers, France
| | - Gabor Szinnai
- Department of Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Murray
- European Society for Pediatric Endocrinology
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Beate Bartés
- Thyroid Group, European Patient Advocacy Group Patient Representative (ePAG), Association Vivre sans Thyroide, Léguevin, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine (HUPNVS), Assistance Publique Hôpitaux de Paris (APHP), Bichat Hospital, Paris, France
- Department Risks and Pregnancy (DHU), Université de Paris, Inserm U1141, Paris, France
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Mariacristina Vigone
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Heiko Krude
- Institut für Experimentelle Pädiatrische Endokrinologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
- Paris Regional Newborn Screening Program, Centre régional de dépistage néonatal, Paris, France
- Centre de Référence Maladies Endocriniennes de la Croissance et du Développement, INSERM U1016, IMAGINE Institute, Paris, France
- ENDO-European Reference Network, Main Thematic Group 8, Paris, France
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24
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Xiao FF, Wang YZ, Dong F, Li XL, Zhang T. Congenital hepatic fibrosis in a young boy with congenital hypothyroidism: A case report. World J Clin Cases 2021; 9:1475-1482. [PMID: 33644218 PMCID: PMC7896672 DOI: 10.12998/wjcc.v9.i6.1475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital hepatic fibrosis (CHF) is a rare autosomal recessive disorder characterized by variable degrees of periportal fibrosis and malformation of bile ducts. CHF is generally accompanied by a variety of conditions or syndromes with other organ involvement.
CASE SUMMARY We report a 5-year-4-month-old Chinese boy with congenital hypothyroidism (CH) diagnosed with CHF. The patient was diagnosed with CH by a newborn screening test and has since been taking levothyroxine. He has developed normally without neurocognitive deficits. Abnormal liver function was observed in the patient at the age of 4 years and 11 mo, and elevated levels of liver function indices were persistent for 5 mo. Radiological imaging indicated hepatospleno-megaly without narrowing of the portal vein but dilated splenic vein. A liver biopsy confirmed the pathological features of CHF. Genetic testing revealed two novel homozygous mutations, namely, c.2141-3T>C variant in PKHD1 related to CHF and c.2921G>A (p.R974H) in DUOX2 related to CH. The patient was treated with compound glycyrrhizin tablet, ursodeoxycholic acid, and levothyroxine after diagnosis. The patient achieved a favorable clinical outcome during a follow-up period of over 2 years.
CONCLUSION Herein, we report the first case of a Chinese boy with comorbidity of CHF and CH, carrying both PKHD1 gene and DUOX2 gene novel mutations. Liver biopsy and genetic testing should be considered for the diagnosis of coexistent liver disease in CH patients with unexplained abnormal liver function.
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Affiliation(s)
- Fang-Fei Xiao
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Yi-Zhong Wang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Fang Dong
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Xiao-Lu Li
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Ting Zhang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
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Camats N, Baz-Redón N, Fernández-Cancio M, Clemente M, Campos-Martorell A, Jaimes N, Antolín M, Garcia-Arumí E, Blasco-Pérez L, Paramonov I, Mogas E, Soler-Colomer L, Yeste D. Phenotypic Variability of Patients With PAX8 Variants Presenting With Congenital Hypothyroidism and Eutopic Thyroid. J Clin Endocrinol Metab 2021; 106:e152-e170. [PMID: 33029631 DOI: 10.1210/clinem/dgaa711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Thyroid dyshormonogenesis is a heterogeneous group of hereditary diseases produced by a total/partial blockage of the biochemical processes of thyroid-hormone synthesis and secretion. Paired box 8 (PAX8) is essential for thyroid morphogenesis and thyroid hormone synthesis. We aimed to identify PAX8 variants in patients with thyroid dyshormonogenesis and to analyze them with in vitro functional studies. PATIENTS AND METHODS Nine pediatric patients with a eutopic thyroid gland were analyzed by the Catalan screening program for congenital hypothyroidism. Scintigraphies showed absent, low, or normal uptake. Only one patient had a hypoplastic gland. On reevaluation, perchlorate discharge test was negative or compatible with partial iodine-organization deficit. After evaluation, 8 patients showed permanent mild or severe hypothyroidism. Massive-sequencing techniques were used to detect variants in congenital hypothyroidism-related genes. In vitro functional studies were based on transactivating activity of mutant PAX8 on a TG-gene promoter and analyzed by a dual-luciferase assays. RESULTS We identified 7 heterozygous PAX8 exonic variants and 1 homozygous PAX8 splicing variant in 9 patients with variable phenotypes of thyroid dyshormonogenesis. Five were novel and 5 variants showed a statistically significant impaired transcriptional activity of TG promoter: 51% to 78% vs the wild type. CONCLUSIONS Nine patients presented with PAX8 candidate variants. All presented with a eutopic thyroid gland and 7 had deleterious variants. The phenotype of affected patients varies considerably, even within the same family; but, all except the homozygous patient presented with a normal eutopic thyroid gland and thyroid dyshormonogenesis. PAX8 functional studies have shown that 6 PAX8 variants are deleterious. Our studies have proven effective in evaluating these variants.
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Affiliation(s)
- Núria Camats
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERER, ISCIII, Madrid, Spain
| | - Noelia Baz-Redón
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mónica Fernández-Cancio
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERER, ISCIII, Madrid, Spain
| | - María Clemente
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERER, ISCIII, Madrid, Spain
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Endocrinology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ariadna Campos-Martorell
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Endocrinology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nadya Jaimes
- Department of Pediatric Endocrinology, Hospital Fundación la Misericordia HOMI, Bogotá, Colombia
| | - María Antolín
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group, VHIR, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elena Garcia-Arumí
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group, VHIR, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Research Group on Neuromuscular and Mitochondrial Disorders, VHIR, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Blasco-Pérez
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group, VHIR, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ida Paramonov
- Department of Clinical and Molecular Genetics and Rare Disease, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eduard Mogas
- Pediatric Endocrinology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Soler-Colomer
- Pediatric Endocrinology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Diego Yeste
- Growth and Development group, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERER, ISCIII, Madrid, Spain
- Pediatrics, Obstetrics and Gynecology and Preventive Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Endocrinology Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Tuli G, Munarin J, Tessaris D, Matarazzo P, Einaudi S, de Sanctis L. Incidence of primary congenital hypothyroidism and relationship between diagnostic categories and associated malformations. Endocrine 2021; 71:122-129. [PMID: 32507964 DOI: 10.1007/s12020-020-02370-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The incidence of primary congenital hypothyroidism (CH) has grown progressively and literature data indicate an association between CH and congenital malformations. The purpose of this study is to establish the current incidence of CH in the Italian Region of Piedmont and verify the relationship between CH diagnostic categories and associated malformations. METHODS The biochemical and clinical data of 105 newborns with CH diagnosed in the period January 2014 to December 2019 were analyzed. RESULTS The incidence of CH in the Italian Piedmont region in the 2014-2019 period increased to 1:1090. Thyroid dysgenesis was responsible for 47.6% (50/105) of all cases, with agenesis in 14.3% (15/105), while ectopia and hypoplasia in 23.8% (25/105) and 9.5% (10/105) of the cases, respectively; dyshormonogenesis defects were found in 52.4% (55/105) of cases. Congenital extra-thyroid anomalies were identified in 33/105 (31.4%) of newborns with CH and mainly involve the cardiac system (17/85, 16.1%), urogenital tract (7/85, 6.7%), gastrointestinal tract (5/105, 4.8%), and the musculoskeletal system (5/105, 4.8%). The highest rate of malformations was observed in patients with thyroid agenesis and dyshormonogenesis, respectively, in 53.5% and 36.4% of cases, while in the presence of thyroid ectopia and hypoplasia, the rate was 12% and 20%, respectively, (p = 0.03). CONCLUSION In the Italian region of Piedmont, the incidence of primary CH has been increased over time, with a variation in the percentage of the different forms of CH. Congenital malformations, especially affecting the cardiovascular, urogenital, gastrointestinal, and musculoskeletal systems, seem to be mainly associated with thyroid agenesis or defects in hormonogenesis.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy.
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Daniele Tessaris
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Silvia Einaudi
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, City of Health and Science University Hospital of Turin, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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Posabella A, Alber AB, Undeutsch HJ, Droeser RA, Hollenberg AN, Ikonomou L, Kotton DN. Derivation of Thyroid Follicular Cells From Pluripotent Stem Cells: Insights From Development and Implications for Regenerative Medicine. Front Endocrinol (Lausanne) 2021; 12:666565. [PMID: 33959101 PMCID: PMC8095374 DOI: 10.3389/fendo.2021.666565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Stem cell-based therapies to reconstitute in vivo organ function hold great promise for future clinical applications to a variety of diseases. Hypothyroidism resulting from congenital lack of functional thyrocytes, surgical tissue removal, or gland ablation, represents a particularly attractive endocrine disease target that may be conceivably cured by transplantation of long-lived functional thyroid progenitors or mature follicular epithelial cells, provided a source of autologous cells can be generated and a variety of technical and biological challenges can be surmounted. Here we review the emerging literature indicating that thyroid follicular epithelial cells can now be engineered in vitro from the pluripotent stem cells (PSCs) of mice, normal humans, or patients with congenital hypothyroidism. We review the in vivo embryonic development of the thyroid gland and explain how emerging discoveries in developmental biology have been utilized as a roadmap for driving PSCs, which resemble cells of the early embryo, into mature functional thyroid follicles in vitro. Finally, we discuss the bioengineering, biological, and clinical hurdles that now need to be addressed if the goals of life-long cure of hypothyroidism through cell- and/or gene-based therapies are to be attained.
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Affiliation(s)
- Alberto Posabella
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, United States
- University Center of Gastrointestinal and Liver Diseases—Clarunis, University of Basel, Basel, Switzerland
| | - Andrea B. Alber
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, United States
| | - Hendrik J. Undeutsch
- Division of Endocrinology, Diabetes and Metabolism, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Raoul A. Droeser
- University Center of Gastrointestinal and Liver Diseases—Clarunis, University of Basel, Basel, Switzerland
| | - Anthony N. Hollenberg
- Division of Endocrinology, Diabetes and Metabolism, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Laertis Ikonomou
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, United States
- The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Darrell N. Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, United States
- The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- *Correspondence: Darrell N. Kotton,
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Zheng Z, Yang L, Sun C, Wu J, Luo F, Zhou W, Lu W. Genotype and phenotype correlation in a cohort of Chinese congenital hypothyroidism patients with DUOX2 mutations. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1649. [PMID: 33490161 PMCID: PMC7812163 DOI: 10.21037/atm-20-7165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to explore the relationship between the phenotype and genotype of congenital hypothyroidism (CH) caused by dual oxidase 2 (DUOX2) mutation in Chinese children, and to investigate the genetic causes of permanent and transient hypothyroidism through next-generation genetic testing technology and long-term clinical follow-up data. METHODS We recruited 61 patients with thyroid stimulating hormone (TSH) levels of >10 mIU/mL during newborn screening, clinical diagnosis of CH, and L-thyroxine (L-T4) oral treatment within 1 month of birth; they were followed up until the present. All CH infants and their parents were genotyped using whole-exome sequencing (WES); DUOX2 variants were detected in 20 infants, and the longitudinal prognosis, genotype, and phenotype correlations were analyzed. RESULTS Biallelic DUOX2 mutations were detected in 20 participants. All of them were born full term. All patients were treated with L-T4 when diagnosed with CH; 9 of them stopped L-T4 eventually before 3 years old; and 2 were treated with a reduced dose of L-T4 (12.5 µg per day). The others were still treated with L-T4 at a dose of 37.5-87.5 µg per day. Of these 20 participants, 5 carried an R1110Q variant and 5 carried K530X variants. A total of 7 novel variants were discovered in our cohort. The variants carried in transient CH patients were located extracellularly and not near the functional domain. CONCLUSIONS Most CH patients with DUOX2 mutations were those with transient or subclinical CH. The R1110Q, R885L, and K530X were the most common variants in our Chinese cohort. The R1110Q and K530X variants may play a founder effect in the transient CH. The R885L variant may play a benign role in transient CH. Intracellular variants or those near the functional domain may cause permanent CH.
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Affiliation(s)
- Zhangqian Zheng
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yang
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Chengjun Sun
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Wu
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Feihong Luo
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Lu
- Department Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
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Tanaka T, Aoyama K, Suzuki A, Saitoh S, Mizuno H. Clinical and genetic investigation of 136 Japanese patients with congenital hypothyroidism. J Pediatr Endocrinol Metab 2020; 33:691-701. [PMID: 32469330 DOI: 10.1515/jpem-2019-0433] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/07/2020] [Indexed: 12/18/2022]
Abstract
Objectives Congenital hypothyroidism (CH) is the most common congenital endocrine disorder. Recent advances in genetic testing have revealed its causative mutations in some CH patients. However, the underlying etiology remains unknown in most patients. This study aimed to perform clinical and genetic investigation in Japanese CH patients to uncover genotype-phenotype correlations. Methods We enrolled 136 Japanese patients with transient or permanent CH between April 2015 and March 2017, and performed next-generation sequencing of 19 genes implicated in CH. Results We identified potentially pathogenic bi-allelic variants in DUOX2, TSHR, and TPO in 19, 5, and 1 patient, respectively (autosomal recessive), and a potentially pathogenic mono-allelic variant in NKX2-1 (autosomal dominant) in 1 patient. Molecular genetic diagnosis was highly suggested in 26 patients (19%) from 23 families. We also detected a potentially pathogenic mono-allelic variant in five recessive genes (DUOX2, TSHR, TG, DUOXA2, and TPO) in 31 unrelated patients (23%), although the pathogenicity of these variants remains inconclusive. Patients with bi-allelic DUOX2 variants showed a more severe clinical presentation in infancy than those with bi-allelic TSHR variants. However, this trend reversed beyond infancy. There were no statistical differences in initial thyroid stimulating hormone, free thyroxine, thyroglobulin, and levothyroxine dose as of March 2017 between patients with bi-allelic and mono-allelic DUOX2 variants. Conclusions The prevalence of potentially-pathogenic variants in Japanese CH patients was similar to that found by previous reports. Our study demonstrates a genotype-phenotype correlation in Japanese CH patients.
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Affiliation(s)
- Tatsushi Tanaka
- Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Kohei Aoyama
- Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Suzuki
- Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Haruo Mizuno
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Jung SY, Lee J, Lee DH. Persistent goiter with congenital hypothyroidism due to mutation in DUOXA2 gene. Ann Pediatr Endocrinol Metab 2020; 25:57-62. [PMID: 32252219 PMCID: PMC7136507 DOI: 10.6065/apem.2020.25.1.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/14/2019] [Indexed: 11/26/2022] Open
Abstract
Thyroid hormones are crucial for development of the central nervous system. Congenital hypothyroidism (CH) is the most common preventable disease resulting in mental retardation. A neonatal screening test (NST) can detect a mild form of CH that can be treated at an early age. Generally after 3 years of age, when most of the brain has matured, clinicians consider reevaluation of thyroid function for CH patients that have been identified with a normal thyroid gland at a normal position. This report presents three CH patients that developed normally, with persistent goiter despite thyroid hormone supplements. The patients' initial thyroid-stimulating hormone (TSH) level after NST was 47, 157, and 57 mIU/L, respectively. Levothyroxine administration began at 1 or 2 months of age and was terminated after reevaluation at the age of 3, 15, and 5 years, respectively. However, 1 or 2 years later, they all resumed their medication due to increased TSH level coupled with newly developed or enlarged goiter. They all showed dual oxidase maturation factor 2 (DUOXA2) gene mutation: a homozygous mutation with DUOXA2 (c.413dupA; p.Tyr138*) in case 1, a presumed compound heterozygotic mutation with DUOXA2 (p.Tyr138*/p.Tyr246*) in case 2, and heterozygous mutations with DUOXA2 (c.738C>G; p.Tyr246*) and TPO (c.2268dupT; p.Glu757*) in case 3. When goiter persists or is newly developed despite a maintained euthyroid status, for those with transient CH history, follow-up to assess the thyroid function is recommended for at least 1 or 2 years, and genetic testing would be helpful. This study presents the first clinical cases of DUOXA2 mutation in Korea.
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Affiliation(s)
| | | | - Dong Hwan Lee
- Address for correspondence: Dong Hwan Lee, MD, PhD Department of Pediatrics, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea Tel: +82-2-709-9341 Fax: +82-2-709-9135 E-mail:
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Karimi A, Hashemipour M, Asadollahi K, Daliri S. Investigating the incidence rate and geographical distribution of congenital hypothyroidism among neonates in Isfahan province using geographic information system (GIS) between 2002 and 2015. J Pediatr Endocrinol Metab 2020; 33:35-45. [PMID: 31821166 DOI: 10.1515/jpem-2019-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/01/2019] [Indexed: 11/15/2022]
Abstract
Background Congenital hypothyroidism (CH) is one of the main causes of mental retardation in neonates. The disease is associated with genetic, climatic and environmental factors. Accordingly, the present study was conducted to determine the incidence rate and correlation of geographic factors with CH in Isfahan province in order to explain the role of climatic factors in the incidence of disease in this province. Methods This cross-sectional study was conducted to determine the incidence rate and geographical distribution of CH in neonates born in the Isfahan province from the beginning of 2002 to the end of 2015. To estimate the geographic distribution, the ArcGIS software (version 10.3) was used and to investigate the relationship between geographical factors and CH, the Poisson regression test and dispersion diagrams were used. Data analysis was done using the SPSS16 software. Results According to the results of the screening of 1,006,404 neonates born in Isfahan, the mean incidence rate of CH in all infants was 2.3, and that in male and female infants was 2.39 and 2.2 per 1000 live births, respectively. There was a statistically significant correlation between the city of residence (p = 0.01), climatic conditions (p = 0.044), annual precipitation (p = 0.027), sunlight (p = 0.01) and CH. However, there was no significant relationship between the mean altitude above sea level (p = 0.6), land use (p = 0.4) and relative humidity (p = 0.24). Conclusions Based on the findings of this study, the incidence rate of CH in Isfahan province was higher than the average of the country. Moreover, among the geographical factors, climatic conditions, annual precipitation and sunlight were associated with CH.
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Affiliation(s)
- Arezoo Karimi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahin Hashemipour
- Department of Peadiatric Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khairollah Asadollahi
- Department of Clinical Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Salman Daliri
- Department of Epidemiology, Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.,Professor of Peadiatric Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Phone: +989179272507, Fax: +982332390277
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Long W, Zhou L, Wang Y, Liu J, Wang H, Yu B. Complicated Relationship between Genetic Mutations and Phenotypic Characteristics in Transient and Permanent Congenital Hypothyroidism: Analysis of Pooled Literature Data. Int J Endocrinol 2020; 2020:6808517. [PMID: 32565793 PMCID: PMC7275948 DOI: 10.1155/2020/6808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Mutations and phenotypic characteristics remain unclear in patients with congenital hypothyroidism (CH), and no study concerning whether the outcome of transient CH (TCH) or permanent CH (PCH) is determined by mutations has been reported. METHODS We searched the literature up to April 2019. Eligible studies and data extraction were performed. We estimated the relationship between mutations and phenotypic characteristics in pooled patients with CH. RESULTS Two hundred forty-one cases were pooled from 41 eligible studies. The thyroid morphology, classification of mutated genes, and types of mutations were different between 94 patients with TCH and 147 patients with PCH. Heterozygous missense mutations prevailed in PAX8, TSHR, FOXE1, and NKX2-5, and patients with these mutated genes had a higher risk of PCH (OR = 37.38, 95% CI 5.04-277.21, P < 0.001). TCH and PCH have equal shares in patients with mutated DUOX2 or DUOXA2. Dual-site and multisite mutations were frequently detected in DUOX2. High phenotypic heterogeneity was observed in mutated DUOX2 even in the same mutations. However, there was no relationship found between mutations and transient or permanent outcome in patients with mutated DUOX2. CONCLUSION Transient or permanent outcomes were influenced by the biological function of mutated genes instead of types of mutations among patients with CH. Patients whose mutations were related to thyroid dysgenesis (TD) were more likely to have PCH. The relationship between mutations and phenotypic characteristics is complicated, and phenotypic characteristics may be affected by mutations and other factors.
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Affiliation(s)
- Wei Long
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Lingna Zhou
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Ying Wang
- Department of Pediatrics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Jiaxuan Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Huaiyan Wang
- Department of Pediatrics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
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Wang F, Zang Y, Li M, Liu W, Wang Y, Yu X, Li H, Wang F, Liu S. DUOX2 and DUOXA2 Variants Confer Susceptibility to Thyroid Dysgenesis and Gland- in-situ With Congenital Hypothyroidism. Front Endocrinol (Lausanne) 2020; 11:237. [PMID: 32425884 PMCID: PMC7212429 DOI: 10.3389/fendo.2020.00237] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Thyroid dysgenesis (TD), which is caused by gland developmental abnormalities, is the most common cause of congenital hypothyroidism (CH). In addition, advances in diagnostic techniques have facilitated the identification of mild CH patients with a gland-in-situ (GIS) with normal thyroid morphology. Therefore, TD and GIS account for the vast majority of CH cases. Methods: Sixteen known genes to be related to CH were sequenced and screened for variations by next-generation sequencing (NGS) in a cohort of 377 CH cases, including 288 TD cases and 89 GIS cases. Results: In our CH cohort, we found that DUOX2 (21.22%) was the most commonly variant pathogenic gene, while DUOXA2 was prominent in TD (18.75%) and DUOX2 was prominent in GIS (34.83%). Both biallelic and triple variants of DUOX2 were found to be most common in children with TD and children with GIS. The most frequent combination was DUOX2 with DUOXA1 among the 61 patients who carried digenic variants. We also found for the first time that biallelic TG, DUOXA2, and DUOXA1 variants participate in the pathogenesis of TD. In addition, the variant p.Y246X in DUOXA2 was the most common variant hotspot, with 58 novel variants identified in our study. Conclusion: We meticulously described the types and characteristics of variants from sixteen known gene in children with TD and GIS in the Chinese population, suggesting that DUOXA2 and DUOX2 variants may confer susceptibility to TD and GIS via polygenic inheritance and multiple factors, which further expands the genotype-phenotype spectrum of CH in China.
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Affiliation(s)
- Fengqi Wang
- Medical Genetic Department, The Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yucui Zang
- Medical Genetic Department, The Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Miaomiao Li
- Medical Genetic Department, The Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenmiao Liu
- Medical Genetic Department, The Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolong Yu
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hua Li
- Department of Rheumatology and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Fang Wang
| | - Shiguo Liu
- Medical Genetic Department, The Affiliated Hospital of Qingdao University, Qingdao, China
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, China
- Shiguo Liu
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H. Ansari SA, Momin Y. Dyshormonongenetic goiter: A rare and important entity. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_152_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Medda E, Vigone MC, Cassio A, Calaciura F, Costa P, Weber G, de Filippis T, Gelmini G, Di Frenna M, Caiulo S, Ortolano R, Rotondi D, Bartolucci M, Gelsomino R, De Angelis S, Gabbianelli M, Persani L, Olivieri A. Neonatal Screening for Congenital Hypothyroidism: What Can We Learn From Discordant Twins? J Clin Endocrinol Metab 2019; 104:5765-5779. [PMID: 31287502 DOI: 10.1210/jc.2019-00900] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Newborn screening program for congenital hypothyroidism (CH) adopting rescreening in at-risk neonates. OBJECTIVES To estimate the concordance rate for CH in twin pairs discordant at the first screening; to verify whether long-term follow-up of healthy cotwins belonging to CH discordant pairs may be useful to diagnose thyroid hypofunction during development; to evaluate the importance of genetic and environmental influences on liability to permanent and transient CH. DESIGN AND PATIENTS Forty-seven screening discordant twin pairs were investigated. Proband was defined as the twin in the pair with a positive test at the first screening and a confirmed diagnosis of CH. RESULTS Seven screening discordant twin pairs became concordant for CH within the first month of life (pairwise concordance of 14.9%) because seven screening negative cotwins showed high TSH values when retested. During long-term follow-up (range, 3 to 21 years), hypothyroidism was diagnosed in two monozygotic screening negative cotwins at the age of 9 months and 12 years, respectively. Furthermore, the twin analysis showed that 95% of liability to transient CH was explained by genetic factors and 5% by environmental (unshared) factors, whereas 64% of phenotypic variance of permanent CH was explained by common environmental factors (shared during the fetal life) and 36% by unshared environmental factors. CONCLUSIONS This study showed that the introduction of rescreening permits the diagnosis of CH in a greater number of twins. It also showed the importance of long-term follow-up in both twins in the pair, and the role of nongenetic factors in the etiology of permanent CH.
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Affiliation(s)
- Emanuela Medda
- Reference Center for Behavioral Sciences and Mental Health, National Institutes of Health, Rome, Italy
| | - Maria Cristina Vigone
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Cassio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Calaciura
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pietro Costa
- Department of Maternal and Child Sciences and Urology, University "La Sapienza," Rome, Italy
| | - Giovanna Weber
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Tiziana de Filippis
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giulia Gelmini
- Department of Maternal and Child Sciences and Urology, University "La Sapienza," Rome, Italy
| | - Marianna Di Frenna
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvana Caiulo
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Rotondi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institutes of Health, Rome, Italy
| | - Monica Bartolucci
- Department of Maternal and Child Sciences and Urology, University "La Sapienza," Rome, Italy
| | - Rossella Gelsomino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Simona De Angelis
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institutes of Health, Rome, Italy
| | - Marco Gabbianelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institutes of Health, Rome, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonella Olivieri
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institutes of Health, Rome, Italy
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Sasivari Z, Szinnai G, Seebauer B, Konrad D, Lang-Muritano M. Double variants in TSHR and DUOX2 in a patient with hypothyroidism: case report. J Pediatr Endocrinol Metab 2019; 32:1299-1303. [PMID: 31541602 DOI: 10.1515/jpem-2019-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022]
Abstract
Thyroid dyshormonogenesis (TDH) is characterized by the defective synthesis of thyroid hormones. We present a patient with congenital hypothyroidism (CH) who presented in newborn screening with elevated serum thyroid-stimulating hormone (TSH), decreased free thyroxine (fT4) and increased thyroglobulin (Tg) concentrations. Ultrasound scan revealed a properly structured thyroid gland. Treatment with L-thyroxine was initiated. At the age of 2 years, thyroxine replacement was stopped. The patient remained untreated until 6 years of age when TSH levels progressively increased and L-thyroxine treatment was restarted at a dose of 12.5 μg/day. Genetic analysis revealed a double heterozygosity for likely pathogenic variants of dual oxidase 2 (DUOX2) and thyroid stimulating hormone receptor (TSHR). Both genes were earlier shown to be associated with CH. In a literature review, our patient was compared to previously published patients with similar clinical characteristics, and a good genotype-phenotype correlation was identified.
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Affiliation(s)
- Zerin Sasivari
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Basel, Switzerland
| | - Britta Seebauer
- Department of Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Konrad
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Mariarosaria Lang-Muritano
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital, Zurich, Switzerland
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Entire FGF12 duplication by complex chromosomal rearrangements associated with West syndrome. J Hum Genet 2019; 64:1005-1014. [PMID: 31311986 DOI: 10.1038/s10038-019-0641-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 11/09/2022]
Abstract
Complex rearrangements of chromosomes 3 and 9 were found in a patient presenting with severe epilepsy, developmental delay, dysmorphic facial features, and skeletal abnormalities. Molecular cytogenetic analysis revealed 46,XX.ish der(9)(3qter→3q28::9p21.1→9p22.3::9p22.3→9qter)(RP11-368G14+,RP11-299O8-,RP11-905L2++,RP11-775E6++). Her dysmorphic features are consistent with 3q29 microduplication syndrome and inv dup del(9p). Trio-based WES of the patient revealed no pathogenic single nucleotide variants causing epilepsy, but confirmed a 3q28q29 duplication involving FGF12, which encodes fibroblast growth factor 12. FGF12 positively regulates the activity of voltage-gated sodium channels. Recently, only one recurrent gain-of-function variant [NM_021032.4:c.341G>A:p.(Arg114His)] in FGF12 was found in a total of 10 patients with severe early-onset epilepsy. We propose that the patient's entire FGF12 duplication may be analogous to the gain-of-function variant in FGF12 in the epileptic phenotype of this patient.
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Leung AKC, Leung AAC. Evaluation and management of the child with hypothyroidism. World J Pediatr 2019; 15:124-134. [PMID: 30734891 DOI: 10.1007/s12519-019-00230-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout childhood. Prompt recognition and treatment of hypothyroidism is, therefore, of utmost importance to optimize physical and neurodevelopmental outcomes. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "hypothyroidism". RESULTS Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism, respectively. More than 95% of infants with congenital hypothyroidism have few, if any, clinical manifestations of hypothyroidism. Newborn screening programs allow early detection of congenital hypothyroidism. In developed countries, Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and adolescents. Globally, iodine deficiency associated with goiter is the most common cause of hypothyroidism. Central hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary hormones. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. CONCLUSIONS To optimize neurocognitive outcome in infants with congenital hypothyroidism, treatment with levothyroxine should be started as soon as possible, preferably within the first 2 weeks of life. Children with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive outcome. The target is to keep serum TSH < 5 mIU/L and to maintain serum free T4 or total T4 within the upper half of the age-specific reference range, with elimination of all symptoms and signs of hypothyroidism.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, #200, 233 - 16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
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Cerqueira TLDO, Ramos YR, Strappa GB, Jesus MSD, Santos JG, Sousa C, Carvalho G, Fernandes V, Boa-Sorte N, Amorim T, Silva TM, Ladeia AMT, Acosta AX, Ramos HE. Mutation screening in the genes PAX-8, NKX2-5, TSH-R, HES-1 in cohort of 63 Brazilian children with thyroid dysgenesis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:466-471. [PMID: 30304112 PMCID: PMC10118737 DOI: 10.20945/2359-3997000000065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the candidate genes PAX-8, NKX2-5, TSH-R and HES-1 in 63 confirmed cases of thyroid dysgenesis. SUBJECTS AND METHODS Characterization of patients with congenital hypothyroidism into specific subtypes of thyroid dysgenesis with hormone levels (TT4 and TSH), thyroid ultrasound and scintigraphy. DNA was extracted from peripheral blood leukocytes and the genetic analysis was realized by investigating the presence of mutations in the transcription factor genes involved in thyroid development. RESULTS No mutations were detected in any of the candidate genes. In situ thyroid gland represented 71.1% of all cases of permanent primary congenital hypothyroidism, followed by hypoplasia (9.6%), ectopia (78%), hemiagenesis (6.0%) and agenesis (5.5%). The highest neonatal screening TSH levels were in the agenesis group (p < 0.001). CONCLUSIONS Thyroid dysgenesis is possibly a polygenic disorder and epigenetic factors could to be implicated in these pathogeneses.
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Affiliation(s)
- Taíse Lima de Oliveira Cerqueira
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil.,Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
| | - Yanne Rocha Ramos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Giorgia Bruna Strappa
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Mariana Souza de Jesus
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Jailciele Gonzaga Santos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Camila Sousa
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Gildásio Carvalho
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | | | - Ney Boa-Sorte
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | - Tatiana Amorim
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | - Thiago Magalhães Silva
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Ana Marice Teixeira Ladeia
- Programa de Pós-Graduação em Saúde Humana e Medicina, Escola Bahiana de Saúde e Medicina, Salvador, BA, Brasil
| | - Angelina Xavier Acosta
- Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
| | - Helton Estrela Ramos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil.,Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
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Peters C, van Trotsenburg ASP, Schoenmakers N. DIAGNOSIS OF ENDOCRINE DISEASE: Congenital hypothyroidism: update and perspectives. Eur J Endocrinol 2018; 179:R297-R317. [PMID: 30324792 DOI: 10.1530/eje-18-0383] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Congenital hypothyroidism (CH) may be primary, due to a defect affecting the thyroid gland itself, or central, due to impaired thyroid-stimulating hormone (TSH)-mediated stimulation of the thyroid gland as a result of hypothalamic or pituitary pathology. Primary CH is the most common neonatal endocrine disorder, traditionally subdivided into thyroid dysgenesis (TD), referring to a spectrum of thyroid developmental abnormalities, and dyshormonogenesis, where a defective molecular pathway for thyroid hormonogenesis results in failure of hormone production by a structurally intact gland. Delayed treatment of neonatal hypothyroidism may result in profound neurodevelopmental delay; therefore, CH is screened for in developed countries to facilitate prompt diagnosis. Central congenital hypothyroidism (CCH) is a rarer entity which may occur in isolation, or (more frequently) in association with additional pituitary hormone deficits. CCH is most commonly defined biochemically by failure of appropriate TSH elevation despite subnormal thyroid hormone levels and will therefore evade diagnosis in primary, TSH-based CH-screening programmes. This review will discuss recent genetic aetiological advances in CH and summarize epidemiological data and clinical diagnostic challenges, focussing on primary CH and isolated CCH.
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Affiliation(s)
- C Peters
- Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - A S P van Trotsenburg
- Department of Paediatric Endocrinology, Emma Children’s Hospital Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - N Schoenmakers
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research
Council Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
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Kwak MJ. Clinical genetics of defects in thyroid hormone synthesis. Ann Pediatr Endocrinol Metab 2018; 23:169-175. [PMID: 30599477 PMCID: PMC6312914 DOI: 10.6065/apem.2018.23.4.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023] Open
Abstract
Thyroid dyshormonogenesis is characterized by impairment in one of the several stages of thyroid hormone synthesis and accounts for 10%-15% of congenital hypothyroidism (CH). Seven genes are known to be associated with thyroid dyshormonogenesis: SLC5A5 (NIS), SCL26A4 (PDS), TG, TPO, DUOX2, DUOXA2, and IYD (DHEAL1). Depending on the underlying mechanism, CH can be permanent or transient. Inheritance is usually autosomal recessive, but there are also cases of autosomal dominant inheritance. In this review, we describe the molecular basis, clinical presentation, and genetic diagnosis of CH due to thyroid dyshormonogenesis, with an emphasis on the benefits of targeted exome sequencing as an updated diagnostic approach.
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Affiliation(s)
- Min Jung Kwak
- Address for correspondence: Min Jung Kwak, MD, PhD Department of Pediatrics, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7298 Fax: +82-51-248-6205 E-mail:
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Makretskaya N, Bezlepkina O, Kolodkina A, Kiyaev A, Vasilyev EV, Petrov V, Kalinenkova S, Malievsky O, Dedov II, Tiulpakov A. High frequency of mutations in 'dyshormonogenesis genes' in severe congenital hypothyroidism. PLoS One 2018; 13:e0204323. [PMID: 30240412 PMCID: PMC6150524 DOI: 10.1371/journal.pone.0204323] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Results of the screening of disease causative mutations in congenital hypothyroidism (CH) vary significantly, depending on the sequence strategy, patients' inclusion criteria and bioinformatics. The objective was to study the molecular basis of severe congenital hypothyroidism, using the next generation sequencing (NGS) and the recent guidelines for assessment of sequence variants. DESIGN 243 patients with CH (TSH levels at neonatal screening or retesting greater than 90 mU/l) and 56 control subjects were included in the study. METHODS A custom NGS panel targeting 12 CH causative genes was used for sequencing. The sequence variants were rated according to American College of Medical Genetics and Genomics (ACMG) guidelines. RESULTS In total, 48 pathogenic, 7 likely pathogenic and 57 variants of uncertain significance were identified in 92/243 patients (37.9%), while 4 variants of uncertain significance were found in 4/56 control subjects (7.1%). 13.1% (12/92) of the cases showed variants in 'thyroid dysgenesis' (TD) genes: TSHR, n = 6; NKX2-1, n = 2; NKX2-5, n = 1; PAX8, n = 3. The variants in 'dyshormonogenesis' (DH) genes were found in 84.8% (78/92) of cases: TPO, n = 30; DUOX2, n = 24; TG, n = 8; SLC5A5, n = 3; SLC26A4, n = 6; IYD, n = 1. 8 patients showed oligonenic variants. The majority of variants identified in DH genes were monoallelic. CONCLUSIONS In contrast to earlier studies demonstrating the predominance of TD in severe CH, the majority of variants identified in our study were in DH genes. A large proportion of monoallelic variants detected among DH genes suggests that non-mendelian mechanisms may play a role in the development of CH.
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Affiliation(s)
- Nina Makretskaya
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Olga Bezlepkina
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Anna Kolodkina
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Alexey Kiyaev
- Department of Polyclinic Pediatrics, Ural State Medical University, Ekaterinburg, Russian Federation
| | - Evgeny V. Vasilyev
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Vasily Petrov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Svetlana Kalinenkova
- Genetics Laboratory, Moscow Regional Research and Clinical Institute, Moscow, Russian Federation
| | - Oleg Malievsky
- Department of Hospital Pediatrics, Republican Children’s Clinical Hospital, Ufa, Russian Federation
| | - Ivan I. Dedov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Anatoly Tiulpakov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
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Stoupa A, Chaabane R, Guériouz M, Raynaud-Ravni C, Nitschke P, Bole-Feysot C, Mnif M, Ammar Keskes L, Hachicha M, Belguith N, Polak M, Carré A. Thyroid Hypoplasia in Congenital Hypothyroidism Associated with Thyroid Peroxidase Mutations. Thyroid 2018; 28:941-944. [PMID: 29790453 DOI: 10.1089/thy.2017.0502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primary congenital hypothyroidism (CH) affects about 1:3000 newborns worldwide and is mainly caused by defects in thyroid gland development (thyroid dysgenesis [TD]) or hormone synthesis. A genetic cause is identified in <10% of TD patients. The aim was to identify novel candidate genes in patients with TD using next-generation sequencing tools. PATIENT FINDINGS Whole exome sequencing was used to study two families: a consanguineous Tunisian family (one child with severe thyroid hypoplasia) and a French family (two newborn siblings, with a thyroid in situ that was not enlarged on ultrasound at diagnosis). Variants in candidate genes were filtered according to type of variation, frequency in public and in-house databases, in silico prediction tools, and inheritance mode. Unexpectedly, three different variants of the thyroid peroxidase (TPO) gene were identified. A homozygous missense mutation (c.875C>T, p.S292F) was found in the Tunisian patient with severe thyroid hypoplasia. The two French siblings were compound heterozygotes (c.387delC/c.2578G>A, p.N129Kfs*80/p.G860R) for TPO mutations. All three mutations have been previously described in patients with goitrous CH. In these patients, treatment was initiated immediately after diagnosis, and the effect, if any, of thyrotropin stimulation of these thyroids remains unclear. CONCLUSIONS The first cases are reported of thyroid hypoplasia at diagnosis during the neonatal period in patients with CH and TPO mutations. These cases highlight the importance of screening for TPO mutations not only in goitrous CH, but also in normal or small-size thyroids, and they broaden the clinical spectrum of described phenotypes.
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Affiliation(s)
- Athanasia Stoupa
- 1 Pediatric Endocrinology, Diabetology, and Gynecology Department, Necker Children's University Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
- 2 INSERM U1163, IMAGINE Institute , Paris, France
- 3 INSERM U1016, Cochin Institute , Paris, France
| | - Rim Chaabane
- 4 Laboratory of Human Molecular Genetics, Medicine School, University of Sfax , Sfax, Tunisia
| | | | - Catherine Raynaud-Ravni
- 5 Pediatric Endocrinology Department, Saint Etienne University Hospital , Saint Etienne, France
| | - Patrick Nitschke
- 6 Bioinformatics Platform, INSERM U1163, IMAGINE Institute , Paris, France
| | | | - Mouna Mnif
- 8 Department of Endocrinology, CHU Hedi Chaker , Sfax, Tunisia
| | - Leila Ammar Keskes
- 4 Laboratory of Human Molecular Genetics, Medicine School, University of Sfax , Sfax, Tunisia
| | | | - Neila Belguith
- 4 Laboratory of Human Molecular Genetics, Medicine School, University of Sfax , Sfax, Tunisia
- 10 Department of Medical Genetics, CHU Hedi Chaker , Sfax, Tunisia
| | - Michel Polak
- 1 Pediatric Endocrinology, Diabetology, and Gynecology Department, Necker Children's University Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
- 2 INSERM U1163, IMAGINE Institute , Paris, France
- 3 INSERM U1016, Cochin Institute , Paris, France
- 11 Rare Growth and Development Diseases Center, Centre de référence des maladies endocriniennes rares de la croissance et du développement , Paris, France
- 12 Paris Descartes University , Sorbonne Paris Cité, Paris, France
| | - Aurore Carré
- 2 INSERM U1163, IMAGINE Institute , Paris, France
- 3 INSERM U1016, Cochin Institute , Paris, France
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Jaruratanasirikul S, Piriyaphan J, Saengkaew T, Janjindamai W, Sriplung H. The etiologies and incidences of congenital hypothyroidism before and after neonatal TSH screening program implementation: a study in southern Thailand. J Pediatr Endocrinol Metab 2018; 31:609-617. [PMID: 29750647 DOI: 10.1515/jpem-2017-0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 04/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is one of the common causes of intellectual disability which can be prevented by early detection of an elevated thyroid stimulating hormone (TSH) level in the newborn and by treatment with thyroxine. In Thailand, neonatal TSH screening was implemented nationwide in 2005. The objective of the study was to determine the etiologies and the estimated incidences of CH in southern Thailand before and after the implementation of a neonatal TSH screening program in 2005. METHODS The medical records of pediatric patients who were diagnosed with primary CH at Songklanagarind Hospital during 1995-2013 were retrospectively reviewed. The study was divided into two time periods: study period 1 (SP1) (1995-2004) and study period 2 (SP2) (2005-2013), the time before and after TSH program implementation. RESULTS The most common form of CH during SP1 was overt permanent CH (66%), mostly caused by athyreosis or ectopic thyroid. In SP2, the most common form of CH was mild permanent CH (39%) (mostly due to dyshormonogenesis), followed by overt CH (32%) and transient CH (29%). The overall annual estimated incidence of CH per 10,000 live births in Songkhla Province was 1.69 (1:5021) in SP1, increasing to 4.77 (1:2238) in SP2; in all 14 provinces in southern Thailand, the estimated incidence was 1.24 (1:8094) in SP1 and 2.33 (1:4274) in SP2. CONCLUSIONS Neonatal TSH screening has a significant impact on the increased detection of the mild form of permanent and transient CH cases, which may be important for the prevention of brain damage from less severe CH although this remains to be documented.
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Affiliation(s)
| | - Jutarat Piriyaphan
- Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tansit Saengkaew
- Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Waricha Janjindamai
- Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Sun F, Zhang JX, Yang CY, Gao GQ, Zhu WB, Han B, Zhang LL, Wan YY, Ye XP, Ma YR, Zhang MM, Yang L, Zhang QY, Liu W, Guo CC, Chen G, Zhao SX, Song KY, Song HD. The genetic characteristics of congenital hypothyroidism in China by comprehensive screening of 21 candidate genes. Eur J Endocrinol 2018; 178:623-633. [PMID: 29650690 PMCID: PMC5958289 DOI: 10.1530/eje-17-1017] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Congenital hypothyroidism (CH), the most common neonatal metabolic disorder, is characterized by impaired neurodevelopment. Although several candidate genes have been associated with CH, comprehensive screening of causative genes has been limited. DESIGN AND METHODS One hundred ten patients with primary CH were recruited in this study. All exons and exon-intron boundaries of 21 candidate genes for CH were analyzed by next-generation sequencing. And the inheritance pattern of causative genes was analyzed by the study of family pedigrees. RESULTS Our results showed that 57 patients (51.82%) carried biallelic mutations (containing compound heterozygous mutations and homozygous mutations) in six genes (DUOX2, DUOXA2, DUOXA1, TG, TPO and TSHR) involved in thyroid hormone synthesis. Autosomal recessive inheritance of CH caused by mutations in DUOX2, DUOXA2, TG and TPO was confirmed by analysis of 22 family pedigrees. Notably, eight mutations in four genes (FOXE1, NKX2-1, PAX8 and HHEX) that lead to thyroid dysgenesis were identified in eight probands. These mutations were heterozygous in all cases and hypothyroidism was not observed in parents of these probands. CONCLUSIONS Most cases of congenital hypothyroidism in China were caused by thyroid dyshormonogenesis rather than thyroid dysgenesis. This study identified previously reported causative genes for 57/110 Chinese patients and revealed DUOX2 was the most frequently mutated gene in these patients. Our study expanded the mutation spectrum of CH in Chinese patients, which was significantly different from Western countries.
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Affiliation(s)
- Feng Sun
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun-Xiu Zhang
- Department of EndocrinologyMaternal and Child Health Institute of Bozhou, Bozhou, China
| | - Chang-Yi Yang
- Department of EndocrinologyFujian Province Maternity & Children Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Guan-Qi Gao
- Department of EndocrinologyThe Linyi People’s Hospital, Linyi, Shandong Province, China
| | - Wen-Bin Zhu
- Department of EndocrinologyFujian Province Maternity & Children Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Bing Han
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Le-Le Zhang
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue-Yue Wan
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Ping Ye
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu-Ru Ma
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Man-Man Zhang
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liu Yang
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian-Yue Zhang
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Liu
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cui-Cui Guo
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Gang Chen
- Department of EndocrinologyFujian Province Hospital, Fuzhou, Fujian Province, China
| | - Shuang-Xia Zhao
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ke-Yi Song
- Department of EndocrinologyThe People’s Hospital of Bozhou, Bozhou, Anhui Province, China
| | - Huai-Dong Song
- The Core Laboratory in Medical Center of Clinical ResearchDepartment of Endocrinology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Correspondence should be addressed to H-D Song;
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Abstract
Congenital hypothyroidism is common and can cause severe neurodevelopmental morbidity. Prompt diagnosis and treatment are critical to optimizing long-term outcomes. Universal newborn screening is an important tool for detecting congenital hypothyroidism, but awareness of its limitations, repeated screening in high-risk infants, and a high index of clinical suspicion are needed to ensure that all affected infants are appropriately identified and treated. Careful evaluation will usually reveal the etiology of congenital hypothyroidism, which may inform treatment and prognosis. Early and adequate treatment with levothyroxine results in excellent neurodevelopmental outcomes for most patients with congenital hypothyroidism.
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Affiliation(s)
- Ari J Wassner
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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47
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Chen XY, Qin XS. [Advances in genetic research of congenital hypothyroidism in China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:243-250. [PMID: 29530127 PMCID: PMC7389777 DOI: 10.7499/j.issn.1008-8830.2018.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/23/2018] [Indexed: 11/12/2023]
Abstract
Congenital hypothyroidism (CH), which results from insufficient thyroid hormone biosynthesis, is one of the most common neonatal endocrine disorders. Thyroid dysgenesis and thyroid dyshormonogenesis are the two causes of CH and either one will lead to deficiencies of enzymes during thyroid hormone biosynthesis and insufficient thyroid hormone biosynthesis. Recently, researchers have performed extensive studies on genetics of CH. This paper reviews genes reported to be associated with CH in China.
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Affiliation(s)
- Xiao-Yu Chen
- Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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Abstract
More than a century after the discovery of L-Thyroxine, the main thyroid hormone secreted solely by the thyroid gland, several metabolites of this iodinated, tyrosine-derived ancestral hormone have been identified. These are utilized as hormones during development, differentiation, metamorphosis, and regulation of most biochemical reactions in vertebrates and their precursor species. Among those metabolites are the thyromimetically active 3,3',5-Triiodo-L-thyronine (T3) and 3,5-Diiodo-L-thronine, reverse-T3 (3,3',5'-Triiodo-L-thyronine) with still unclear function, the recently re-discovered thyronamines (e.g., 3-Iodo-thyronamine), which exert in part T3-antagonistic functions, the thyroacetic acids (e.g., Tetrac and Triac), as well as various sulfated or glucuronidated metabolites of this panel of iodinated signaling compounds. In the blood most of these hydrophobic metabolites are tightly bound to the serum distributor proteins thyroxine binding globulin (TBG), transthyretin (TTR), albumin or apolipoprotein B100. Cellular import and export of these charged, highly hydrophobic amino acid derivatives requires a number of cell-membrane transporters or facilitators such as MCT8 or MCT10 and members of the OATP and LAT families of transporters. Depending on their structure, the thyroid hormone metabolites exert their cellular action by binding and thus modulating the function of various receptors systems (e.g., ανβ3 integrin receptor and transient receptor potential channels (TRPM8) of the cell membrane), in part linked to intracellular downstream kinase signaling cascades, and several isoforms of membrane-associated, mitochondrial or nuclear thyroid hormone receptors (TR), which are members of the c-erbA family of ligand-modulated transcription factors. Intracellular deiodinase selenoenzymes, which obligatory are membrane integrated enzymes, ornithine decarboxylase and monoamine oxidases control local availability of biologically active thyroid hormone metabolites. Inactivation of thyroid hormone metabolites occurs mainly by deiodination, sulfation or glucuronidation, reactions which favor their renal or fecal elimination.
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Affiliation(s)
- Josef Köhrle
- Charité-Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zuBerlin, and Berlin Institute of Health, Institut für Experimentelle Endokrinologie, Berlin, Germany.
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49
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Affiliation(s)
- Young-Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
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Chen X, Kong X, Zhu J, Zhang T, Li Y, Ding G, Wang H. Mutational Spectrum Analysis of Seven Genes Associated with Thyroid Dyshormonogenesis. Int J Endocrinol 2018; 2018:8986475. [PMID: 30154845 PMCID: PMC6098846 DOI: 10.1155/2018/8986475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/22/2018] [Accepted: 06/24/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Thyroid dyshormonogenesis (DH) is a genetically heterogeneous inherited disorder caused by thyroid hormone synthesis abnormalities. This study aims at comprehensively characterizing the mutation spectrum in Chinese patients with DH. SUBJECTS AND METHODS We utilized next-generation sequencing to screen for mutations in seven DH-associated genes (TPO, DUOX2, TG, DUOXA2, SLC26A4, SLC5A5, and IYD) in 21 Chinese Han patients with DH from Xinjiang Province. RESULTS Twenty-eight rare nonpolymorphic variants were found in 19 patients (90.5%), including 19, 5, 3, and 1 variants in DUOX2, TG, DUOXA2, and SLC26A4, respectively. Thirteen (62%) patients carried monogenic mutations, and six (28.5%) carried oligogenic mutations. Fifteen (71%) patients carried 2 or more DUOX2 (14) or DUOXA2 (1) variants. The genetic basis of DH in nine (43%) patients harboring biallelic or triallelic pathogenic variants was resolved. Seventeen patients (81%) carried DUOX2 mutations, most commonly p.R1110Q or p.K530X. No correlations were found between DUOX2 mutation types or numbers and clinical phenotypes. CONCLUSIONS DUOX2 mutations were the most predominant genetic alterations of DH in the study cohort. Oligogenicity may explain the genetic basis of disease in many DH patients. Functional studies and further clinical studies with larger DH patient cohorts are needed to validate the roles of the mutations identified in this study.
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Affiliation(s)
- Xi Chen
- Center for Genetic & Metabolic Disorders, Maternal and Child Health Care Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Xiaohong Kong
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Jie Zhu
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Tingting Zhang
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Yanwei Li
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Guifeng Ding
- Center for Genetic & Metabolic Disorders, Maternal and Child Health Care Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
| | - Huijuan Wang
- The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, China
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