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Alcántara-Ortigoza MA, Sánchez-Verdiguel I, Fernández-Hernández L, Enríquez-Flores S, González-Núñez A, Hernández-Martínez NL, Sánchez C, González-del Angel A. Further Evidence That Defects in Main Thyroid Dysgenesis-Related Genes Are an Uncommon Etiology for Primary Congenital Hypothyroidism in Mexican Patients: Report of Rare Variants in FOXE1, NKX2-5 and TSHR. Children (Basel) 2021; 8:children8060457. [PMID: 34070861 PMCID: PMC8227333 DOI: 10.3390/children8060457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
Mexico shows a high birth prevalence of congenital hypothyroidism (CH) due to thyroid dysgenesis (TD). PAX8 defects underlie only 1% of these cases and NKX2-1 does not seem to be involved. Here, we analyzed other TD-related genes in 128 non-related Mexican patients (females 77.3%; 6 months to 16.6 years) with non-syndromic CH-TD diagnosis established by clinical evaluation, thyroid hormone serum profiling, and scintigraphy (74%) or ultrasonography (26%). We performed Sanger sequencing of FOXE1, NKX2-5, and TSHR and evaluated copy number variations (CNVs) in TSHR, FOXE1, PAX8, and NKX2-1 by multiplex ligation-dependent probe amplification. Odds ratios for TD risk were explored for FOXE1 polyalanine stretches [polyAla-rs71369530] in cases and controls (N = 116). Five rare missense changes cataloged as benign (NKX2-5:p.(Ala119Ser)-rs137852684), of unknown significance (FOXE1:p.(Ala335Gly)-rs543372757; TSHR:p.(Asp118Asn)-rs1414102266), and likely pathogenic (FOXE1:p.(Gly124Arg)-rs774035532; TSHR:p.(Trp422Arg)-rs746029360) accounted for 1.5% (N = 2/128) of clinically relevant genotypes (supported in part by protein modeling) in CH-TD. No CNVs were identified, nor did polyAla > 14 alanines in FOXE1 significantly protect against TD. The present and previously published data collectively show that small clinically relevant germline variants in PAX8, FOXE1, and TSHR are found in only a very small proportion (2.5%) of isolated CH-TD Mexican patients.
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Affiliation(s)
- Miguel Angel Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico CP 04530, Mexico; (M.A.A.-O.); (L.F.-H.); (N.L.H.-M.)
| | - Iraís Sánchez-Verdiguel
- Consulta Externa, Instituto Nacional de Pediatría, Secretaría de Salud, Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, UNAM, Ciudad de Mexico CP 04530, Mexico;
| | - Liliana Fernández-Hernández
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico CP 04530, Mexico; (M.A.A.-O.); (L.F.-H.); (N.L.H.-M.)
| | - Sergio Enríquez-Flores
- Grupo de Investigación en Biomoléculas y Salud Infantil, Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Ciudad de Mexico CP 04530, Mexico;
| | - Aidy González-Núñez
- Hospital Regional Materno Infantil de Alta Especialidad de Nuevo León, Guadalupe CP 67140, Mexico;
| | - Nancy Leticia Hernández-Martínez
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico CP 04530, Mexico; (M.A.A.-O.); (L.F.-H.); (N.L.H.-M.)
| | - Carmen Sánchez
- Laboratorio de Seguimiento del Neurodesarrollo, Instituto Nacional de Pediatría, Ciudad de Mexico CP 04530, Mexico;
| | - Ariadna González-del Angel
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico CP 04530, Mexico; (M.A.A.-O.); (L.F.-H.); (N.L.H.-M.)
- Correspondence: ; Tel.: +52-55-1084-0900 (ext. 1306)
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Da DZ, Wang Y, Wang M, Long Z, Wang Q, Liu J. Congenital Hypothyroidism Patients With Thyroid Hormone Receptor Variants Are Not Rare: A Systematic Review. Inquiry 2021; 58:469580211067943. [PMID: 34919466 PMCID: PMC8721697 DOI: 10.1177/00469580211067943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Primary congenital hypothyroidism (CH) is a common endocrine and metabolic disease. Various genetic factors, including the thyroid hormone receptor (TSHR), play an important role in CH. Aim To explore the occurrence of pathogenic TSHR variants in CH. Methods We searched published articles in PubMed, Web of Science, and Cochrane Library databases, from the establishment of the database to September 26, 2021. Studies with sequencing partial or full exons of TSHR in CH patients were included. Gene polymorphism was excluded. Results A total of 66 articles (44 case-control studies and 22 case reports) were selected from the database. Though case-control studies, we found the incidence of pathogenic TSHR variants were not rare (range from 0% to 30.6%) and varied greatly in different countries and race. The pathogenic genotypes varied in different regions. All the variants were “loss-of-function” mutations, in which the p.(Arg450His) variant was the most common variant. In addition, we analyzed the case reports and found that CH patients with a family genetic background expressed homozygous genotypes. Homozygotes had more obvious symptoms of hypothyroidism and higher risk of comorbidities than heterozygotes. Conclusion Pathogenic TSHR variants are not uncommon cause of the CH, especially in the Arabs. The role of TSHR gene detection in the treatment of children with CH needs to be further studied.
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Affiliation(s)
- Dong-Zhu Da
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China.,Department of Breast and Thyroid Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ye Wang
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
| | - Min Wang
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
| | - Zhi Long
- Department of Pediatrics, Shanghai General Hospital, Shanghai, China
| | - Qian Wang
- Department of Pediatrics, Shanghai General Hospital, Shanghai, China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
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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. Arch Endocrinol Metab 2018; 62:466-471. [PMID: 30304112 PMCID: PMC10118737 DOI: 10.20945/2359-3997000000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Khatami M, Heidari MM, Tabesh F, Ordooei M, Salehifar Z. Mutation analysis of the NKX2.5 gene in Iranian pediatric patients with congenital hypothyroidism. J Pediatr Endocrinol Metab 2017; 30:857-862. [PMID: 28749785 DOI: 10.1515/jpem-2017-0084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/12/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The embryonic development of the thyroid gland is regulated by the expression of several candidate genes which are related to congenital hypothyroidism. These genes include the numerous critical thyroid transcription factors such as NKX2.1, NKX2.5, FOXE1, and PAX8. The molecular analysis of these loci will be essential to the explanation of the participation of these transcription activators in the etiology of hypothyroidism. Among them, the role of NKX2.5 is important during the early thyroid morphogenesis and in controlling thyroidal cell differentiation and migration. Importantly, NKX2.5 change nucleotides are recognized to be central to the genesis of congenital hypothyroidism. METHODS A case-control study was conducted in 65 unrelated patients, diagnosed with primary congenital hypothyroidism and all of them were diagnosed according to the clinical presentations of thyroid hypoplasia and without cardiovascular defects. Mutational screening of the entire NKX2-5 coding sequence was performed in a cohort of pediatric patients by PCR-SSCP and direct sequencing. RESULTS We identified two known variations 73C>T (R25C) and 63A>G (E21E) in patients with thyroid hypothyroidism. Both of them are located in conserved region of the gene and previously reported in cases with thyroid dysgenesis and congenital heart defects. There was a significance association between 63A>G variation with primary hypothyroidism (p=0.003). CONCLUSIONS These SNPs are probably related to thyroid hypoplasia because the allele frequency of the 63A>G polymorphism was significantly different in patients and controls and also R25C variation not observed in healthy cases.
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Abstract
Developmental anomalies of the thyroid gland, defined as thyroid dysgenesis, underlie the majority of cases of congenital hypothyroidism. Thyroid dysgenesis is predominantly a sporadic disorder although a reported familial enrichment, variation of incidence by ethnicity and the monogenic defects associated mainly with athyreosis or orthotopic thyroid hypoplasia, suggest a genetic contribution. Of note, the most common developmental anomaly, thyroid ectopy, remains unexplained. Ectopy may result from multiple genetic or epigenetic variants in the germline and/or at the somatic level. This review provides a brief overview of the monogenic defects in candidate genes that have been identified so far and of the syndromes which are known to be associated with thyroid dysgenesis.
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Affiliation(s)
- Rasha Abu-Khudir
- Endocrinology Service and Research Center, Sainte-Justine Hospital and Department of Pediatrics, University of Montreal, Montreal, H3T 1C5, Quebec, Canada; Chemistry Department, Biochemistry Division, Faculty of Science, Tanta University, Tanta, 31527, Egypt.
| | - Stéphanie Larrivée-Vanier
- Endocrinology Service and Research Center, Sainte-Justine Hospital and Department of Pediatrics, University of Montreal, Montreal, H3T 1C5, Quebec, Canada.
| | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
| | - Johnny Deladoëy
- Endocrinology Service and Research Center, Sainte-Justine Hospital and Department of Pediatrics, University of Montreal, Montreal, H3T 1C5, Quebec, Canada.
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Abstract
Resistance to thyrotropin (RTSH) is broadly defined as reduced sensitivity of thyroid follicle cells to stimulation by biologically active TSH due to genetic defects. Affected individuals have elevated serum TSH in the absence of goiter, with the severity ranging from nongoitrous isolated hyperthyrotropinemia to severe congenital hypothyroidism with thyroid hypoplasia. Conceptually, defects leading to RTSH impair both aspects of TSH-mediated action, namely thyroid hormone synthesis and gland growth. These include inactivating mutations in the genes encoding the TSH receptor and the PAX8 transcription factor. A common third cause has been genetically mapped to a locus on chromosome 15, but the underlying pathophysiology has not yet been elucidated. This review provides a succinct overview of currently defined causes of nonsyndromic RTSH, their differential diagnoses (autoimmune; partial iodine organification defects; syndromic forms of RTSH) and implications for the clinical approach to patients with RTSH.
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Affiliation(s)
- Helmut Grasberger
- University of Michigan, 6504 MSRB I, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Samuel Refetoff
- The University of Chicago, MC3090, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Cerqueira TLDO, Ramos Y, Strappa G, Martin DS, Jesus M, Gonzaga J, Ferreira P, Costa A, Fernandes V, Amorim T, Ladeia AM, Ramos H. The c.63A>G polymorphism in the NKX2.5 gene is associated with thyroid hypoplasia in children with thyroid dysgenesis. Arch Endocrinol Metab 2015; 59:562-7. [DOI: 10.1590/2359-3997000000100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/27/2015] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Anabel Costa
- Escola Bahiana de Medicina e Saúde Pública, Brasil
| | | | | | | | - Helton Ramos
- Universidade Federal da Bahia, Brasil; Fundação Oswaldo Cruz, Brasil
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Abstract
The most frequent cause of congenital hypothyroidism is thyroid dysgenesis. Thyroid dysgenesis summarizes a spectrum of developmental abnormalities of the embryonic thyroid ranging from complete absence of the thyroid gland (athyreosis), to a normally located but too small thyroid (hypoplasia), or an abnormally located thyroid gland (ectopy). Although considered a sporadic disease, distinct genetic forms of isolated or syndromic thyroid dysgenesis have been described in recent years. However, genetics of thyroid dysgenesis (TD) are mostly not following simple Mendelian patterns, and beside monogenic, multigenic and epigenetic mechanisms need to be considered. The review will highlight the molecular mechanisms of thyroid organogenesis, clinical and genetic features of the different monogenetic forms of thyroid dysgenesis, the aspects relevant for diagnosis and counseling of affected families and current research strategies to get more insight into the non-Medelian mechanisms of normal and abnormal thyroid development.
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Affiliation(s)
- Gabor Szinnai
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, Spitalstrasse 33, CH-4031 Basel, Switzerland; Department of Biomedicine, University Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland.
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Abstract
BACKGROUND Congenital hypothyroidism (CH) is a frequent disease occurring with an incidence of about 1/2500 newborns/year. In 80-85% of the cases CH is caused by alterations in thyroid morphogenesis, generally indicated by the term "thyroid dysgenesis" (TD). TD is generally a sporadic disease, but in about 5% of the cases a genetic origin has been demonstrated. In these cases, mutations in genes playing a role during thyroid morphogenesis (NKX2-1, PAX8, FOXE1, NKX2-5, TSHR) have been reported. AIM This work reviews the main steps of thyroid morphogenesis and all the genetic alterations associated with TD and published in the literature.
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Affiliation(s)
- I C Nettore
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini, 5 - 80131 Naples, Italy
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van Engelen K, Mommersteeg MTM, Baars MJH, Lam J, Ilgun A, van Trotsenburg ASP, Smets AMJB, Christoffels VM, Mulder BJM, Postma AV. The ambiguous role of NKX2-5 mutations in thyroid dysgenesis. PLoS One 2012; 7:e52685. [PMID: 23285148 PMCID: PMC3532205 DOI: 10.1371/journal.pone.0052685] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/19/2012] [Indexed: 12/20/2022] Open
Abstract
NKX2-5 is a homeodomain-containing transcription factor implied in both heart and thyroid development. Numerous mutations in NKX2-5 have been reported in individuals with congenital heart disease (CHD), but recently a select few have been associated with thyroid dysgenesis, among which the p.A119S variation. We sequenced NKX2-5 in 303 sporadic CHD patients and 38 families with at least two individuals with CHD. The p.A119S variation was identified in two unrelated patients: one was found in the proband of a family with four affected individuals with CHD and the other in a sporadic CHD patient. Clinical evaluation of heart and thyroid showed that the mutation did not segregate with CHD in the familial case, nor did any of the seven mutation carriers have thyroid abnormalities. We tested the functional consequences of the p.A119S variation in a cellular context by performing transactivation assays with promoters relevant for both heart and thyroid development in rat heart derived H10 cells and HELA cells. There was no difference between wildtype NKX2-5 and p.A119S NKX2-5 in activation of the investigated promoters in both cell lines. Additionally, we reviewed the current literature on the topic, showing that there is no clear evidence for a major pathogenic role of NKX2-5 mutations in thyroid dysgenesis. In conclusion, our study demonstrates that p.A119S does not cause CHD or TD and that it is a rare variation that behaves equal to wildtype NKX2-5. Furthermore, given the wealth of published evidence, we suggest that NKX2-5 mutations do not play a major pathogenic role in thyroid dysgenesis, and that genetic testing of NKX2-5 in TD is not warranted.
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