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Muzza M, Pogliaghi G, Colombo C, Grassi ES, Carbone E, Palazzo S, Frattini F, Gazzano G, Persani L, Fugazzola L. Extra-nuclear TERT counteracts oxidative stress and promotes progression in papillary thyroid carcinoma. Transl Res 2024; 271:1-12. [PMID: 38670453 DOI: 10.1016/j.trsl.2024.04.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
The reactivation of TERT is associated with poor outcome in papillary thyroid cancer (PTC). Extra-telomeric functions of TERT were reported, with a protective role against oxidative stress (OS). The aim of the present study was to explore the extra-nuclear TERT localization in PTC and its role in cancer progression. TERT nuclear export under OS were analyzed in K1 PTC cell line. We investigated the role of different TERT localizations using specific TERT constructs that limit its localization to the nucleus or to the mitochondria. The effect of SRC kinase inhibitor PP2, which reduces TERT nuclear export, was investigated as well. Moreover, TERT localization was analyzed in 39 PTC tissues and correlated with the genetic profile and the level of OS, DNA damage and apoptosis in the tumors and with the clinical characteristics of the patients. We demonstrated that TERT is exported from the nucleus in response to OS induced either from H2O2 or the BRAF inhibitor PLX4720. We proved that extra-nuclear TERT reduces mitochondrial OS and induces mitochondrial fragmentation. Moreover, limiting mitochondrial TERT localization reduced proliferation, migration, AKT phosphorylation and glycolysis and increased DNA damage and p21 expression. Finally, in PTC tissues the fraction of mitochondrial/nuclear TERT resulted inversely correlated with OS and p21 expression and associated with tumor persistence. In conclusion, our data indicate that extra-nuclear TERT is involved in reducing the effect of excessive OS, thus promoting cancer cell survival. Extra-nuclear TERT may thus represent a marker of cancer progression and a possible therapeutic target in PTC.
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Affiliation(s)
- Marina Muzza
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Gabriele Pogliaghi
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carla Colombo
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisa Stellaria Grassi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Erika Carbone
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Sonia Palazzo
- Pathology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Giacomo Gazzano
- Pathology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luca Persani
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Campi I, Dell’Acqua M, Stellaria Grassi E, Cristina Vigone M, Persani L. Unusual causes of hyperthyrotropinemia and differential diagnosis of primary hypothyroidism: a revised diagnostic flowchart. Eur Thyroid J 2023; 12:e230012. [PMID: 37067253 PMCID: PMC10305563 DOI: 10.1530/etj-23-0012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/18/2023] Open
Abstract
The clinical consequences of primary hypothyroidism include cardiovascular morbidity, increased mortality, and poor quality of life; therefore guidelines endorsed by several Scientific Societies recommend measuring circulating thyroid-stimulating hormone (TSH) in patients at risk. The assessment of serum TSH levels is also deemed to be the most robust and accurate biomarker during the management of replacement therapy in patients with a previous diagnosis of primary hypothyroidism. In line with a reflex TSH laboratory strategy, free thyroxine is measured only if the TSH falls outside specific cutoffs, in order to streamline investigations and save unjustified costs. This serum TSH-based approach to both diagnosis and monitoring has been widely accepted by several national and local health services; nevertheless, false-negative or -positive testing may occur, leading to inappropriate management or treatment. This review aims to describe several infrequent causes of increased circulating TSH, including analytical interferences, resistance to TSH, consumptive hypothyroidism, and refractoriness to levothyroxine replacement treatment. We propose a clinical flowchart to aid correct recognition of these various conditions, which represent important potential pitfalls in the diagnosis and treatment of primary hypothyroidism.
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Affiliation(s)
- Irene Campi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Dell’Acqua
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Elisa Stellaria Grassi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | - Luca Persani
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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3
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Gentilini D, Muzza M, de Filippis T, Vigone MC, Weber G, Calzari L, Cassio A, Di Frenna M, Bartolucci M, Grassi ES, Carbone E, Olivieri A, Persani L. Stochastic epigenetic mutations as possible explanation for phenotypical discordance among twins with congenital hypothyroidism. J Endocrinol Invest 2023; 46:393-404. [PMID: 36071330 PMCID: PMC9859866 DOI: 10.1007/s40618-022-01915-2] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The elevated frequency of discordance for congenital hypothyroidism (CH) phenotype between monozygotic twins suggests the involvement of non-mendelian mechanisms. The aim of the study was to investigate the role of epigenetics in CH pathogenesis. METHODS A genome-wide DNA methylation analysis was performed on the peripheral blood of 23 twin pairs (10 monozygotic and 13 dizygotic), 4 concordant and 19 discordant pairs for CH at birth. RESULTS Differential methylation analysis did not show significant differences in methylation levels between CH cases and controls, but a different methylation status of several genes may explain the CH discordance of a monozygotic twin couple carrying a monoallelic nonsense mutation of DUOX2. In addition, the median number of hypo-methylated Stochastic Epigenetic Mutations (SEMs) resulted significantly increased in cases compared to controls. The prioritization analysis for CH performed on the genes epimutated exclusively in the cases identified SLC26A4, FOXI1, NKX2-5 and TSHB as the genes with the highest score. The analysis of significantly SEMs-enriched regions led to the identification of two genes (FAM50B and MEG8) that resulted epigenetically dysregulated in cases. CONCLUSION Epigenetic modifications may potentially account for CH pathogenesis and explain discordance among monozygotic twins.
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Affiliation(s)
- D Gentilini
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, Cusano Milanino, 20095, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M Muzza
- Laboratory of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - T de Filippis
- Laboratory of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - M C Vigone
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Weber
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Calzari
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, Cusano Milanino, 20095, Milan, Italy
| | - A Cassio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Di Frenna
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - M Bartolucci
- Department of Maternal and Child Sciences and Urology, University "La Sapienza", Rome, Italy
| | - E S Grassi
- Department of Medical Biotechnology and Experimental Medicine, University of Milan, 20122, Milan, Italy
| | - E Carbone
- Laboratory of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - A Olivieri
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00161, Rome, Italy
| | - L Persani
- Laboratory of Endocrine and Metabolic Research, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149, Milan, Italy.
- Department of Medical Biotechnology and Experimental Medicine, University of Milan, 20122, Milan, Italy.
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Grassi ES, Rurale G, de Filippis T, Gentilini D, Carbone E, Coscia F, Uraghi S, Bullock M, Clifton-Bligh RJ, Gupta AK, Persani L. The length of FOXE1 polyalanine tract in congenital hypothyroidism: Evidence for a pathogenic role from familial, molecular and cohort studies. Front Endocrinol (Lausanne) 2023; 14:1127312. [PMID: 37008944 PMCID: PMC10060985 DOI: 10.3389/fendo.2023.1127312] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION FOXE1 is required for thyroid function and its homozygous mutations cause a rare syndromic form of congenital hypothyroidism (CH). FOXE1 has a polymorphic polyalanine tract whose involvement in thyroid pathology is controversial. Starting from genetic studies in a CH family, we explored the functional role and involvement of FOXE1 variations in a large CH population. METHODS We applied NGS screening to a large CH family and a cohort of 1752 individuals and validated these results by in silico modeling and in vitro experiments. RESULTS A new heterozygous FOXE1 variant segregated with 14-Alanine tract homozygosity in 5 CH siblings with athyreosis. The p.L107V variant demonstrated to significantly reduce the FOXE1 transcriptional activity. The 14-Alanine-FOXE1 displayed altered subcellular localization and significantly impaired synergy with other transcription factors, when compared with the more common 16-Alanine-FOXE1. The CH group with thyroid dysgenesis was largely and significantly enriched with the 14-Alanine-FOXE1 homozygosity. DISCUSSION We provide new evidence that disentangle the pathophysiological role of FOXE1 polyalanine tract, thereby significantly broadening the perspective on the role of FOXE1 in the complex pathogenesis of CH. FOXE1 should be therefore added to the group of polyalanine disease-associated transcription factors.
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Affiliation(s)
- Elisa Stellaria Grassi
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Giuditta Rurale
- Laboratory of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | - Tiziana de Filippis
- Laboratory of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bioinformatics and Statistical Genomics Unit, Milano, Italy
| | - Erika Carbone
- Laboratory of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | | | - Sarah Uraghi
- Department of Health Science, University of Milan, Milan, Italy
| | - Martyn Bullock
- Cancer Genetics Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roderick J. Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Abhinav K. Gupta
- Department of Diabetes and Endocrine Sciences, CK Birla Hospitals, Jaipur, Rajasthan, India
| | - Luca Persani
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Laboratory of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Luca Persani,
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Dicitore A, Bacalini MG, Saronni D, Gaudenzi G, Cantone MC, Gelmini G, Grassi ES, Gentilini D, Borghi MO, Di Blasio AM, Persani L, Garagnani P, Franceschi C, Vitale G. Role of Epigenetic Therapy in the Modulation of Tumor Growth and Migration in Human Castration-Resistant Prostate Cancer Cells with Neuroendocrine Differentiation. Neuroendocrinology 2022; 112:580-594. [PMID: 34348348 DOI: 10.1159/000518801] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neuroendocrine transdifferentiation (NED) of prostate cancer (PC) cells is associated with the development of resistance to antiandrogen therapy and poor prognosis in patients with castration-resistant PC (CRPC). Many of the molecular events, involved in NED, appear to be mediated by epigenetic mechanisms. In this study, we evaluated the antitumor activity and epigenetic modulation of 2 epigenetic drugs, such as the demethylating agent 5-aza-2'-deoxycytidine (AZA) and the methyl donor S-adenosylmethionine (SAM), in 2 human CRPC cell lines with NED (DU-145 and PC-3). METHODS The effects of AZA and SAM on cell viability, cell cycle, apoptosis, migration, and genome-wide DNA methylation profiling have been evaluated. RESULTS Both drugs showed a prominent antitumor activity in DU-145 and PC-3 cells, through perturbation of cell cycle progression, induction of apoptosis, and inhibition of cell migration. AZA and SAM reversed NED in DU-145 and PC-3, respectively. Moreover, AZA treatment modified DNA methylation pattern in DU-145 cells, sustaining a pervasive hypomethylation of the genome, with a relevant effect on several pathways involved in the regulation of cell proliferation, apoptosis, and cell migration, in particular Wnt/β-catenin. CONCLUSIONS A relevant antitumor activity of these epigenetic drugs on CRPC cell lines with NED opens a new scenario in the therapy of this lethal variant of PC.
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Affiliation(s)
- Alessandra Dicitore
- Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
| | | | - Davide Saronni
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Germano Gaudenzi
- Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
| | - Maria Celeste Cantone
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Giulia Gelmini
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Elisa Stellaria Grassi
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Istituto Auxologico Italiano IRCCS, Bioinformatics and Statistical Genomics Unit, Milan, Italy
| | - Maria Orietta Borghi
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory of Immuno-rheumatology, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | | | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Claudio Franceschi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- Department of Applied Mathematics, Institute of Information Technology, Mathematics and Mechanics, Lobachevsky State University of Nizhny Novgorod-National Research University, Nizhny Novgorod, Russian Federation
| | - Giovanni Vitale
- Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
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Abstract
DLK1 is a maternally imprinted, paternally expressed gene coding for the transmembrane protein Delta-like homologue 1 (DLK1), a non-canonical NOTCH ligand with well-described roles during development, and tumor-supportive functions in several aggressive cancer forms. Here, we review the many functions of DLK1 as a regulator of stem cell pools and tissue differentiation in tissues such as brain, muscle, and liver. Furthermore, we review recent evidence supporting roles for DLK1 in the maintenance of aggressive stem cell characteristics of tumor cells, specifically focusing on central nervous system tumors, neuroblastoma, and hepatocellular carcinoma. We discuss NOTCH -dependent as well as NOTCH-independent functions of DLK1, and focus particularly on the complex pattern of DLK1 expression and cleavage that is finely regulated from a spatial and temporal perspective. Progress in recent years suggest differential functions of extracellular, soluble DLK1 as a paracrine stem cell niche-secreted factor, and has revealed a role for the intracellular domain of DLK1 in cell signaling and tumor stemness. A better understanding of DLK1 regulation and signaling may enable therapeutic targeting of cancer stemness by interfering with DLK1 release and/or intracellular signaling.
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Affiliation(s)
- Elisa Stellaria Grassi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Alexander Pietras
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
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Grassi ES, Lábadi A, Vezzoli V, Ghiandai V, Bonomi M, Persani L. Thyrotropin Receptor p.N432D Retained Variant Is Degraded Through an Alternative Lysosomal/Autophagosomal Pathway and Can Be Functionally Rescued by Chemical Chaperones. Thyroid 2021; 31:1030-1040. [PMID: 33446056 DOI: 10.1089/thy.2020.0415] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Loss-of-function mutations of thyrotropin receptor (TSHR) are one of the main causes of congenital hypothyroidism. As for many disease-associated G-protein coupled receptors (GPCRs), these mutations often affect the correct trafficking and maturation of the receptor, thus impairing the expression on the cell surface. Several retained GPCR mutants are able to effectively bind their ligands and to transduce signals when they are forced to the cell surface by degradation inhibition or by treatment with chaperones. Despite the large number of well-characterized retained TSHR mutants, no attempts have been made for rescue. Further, little is known about TSHR degradation pathways. We hypothesize that, similar to other GPCRs, TSHR retained mutants may be at least partially functional if their maturation and membrane expression is facilitated by chaperones or degradation inhibitors. Methods: We performed in silico predictions of the functionality of known TSHR variants and compared the results with available in vitro data. Western blot, confocal microscopy, enzyme-linked immunosorbent assays, and dual luciferase assays were used to investigate the effects of degradation pathways inhibition and of chemical chaperone treatments on TSHR variants' maturation and functionality. Results: We found a high discordance rate between in silico predictions and in vitro data for retained TSHR variants, a fact indicative of a conserved potential to initiate signal transduction if these mutants were expressed on the cell surface. We show experimentally that some maturation defective TSHR mutants are able to effectively transduce Gs/cAMP signaling if their maturation and expression are enhanced by using chemical chaperones. Further, through the characterization of the intracellular retained p.N432D variant, we provide new insights on the TSHR degradation mechanism, as our results suggest that aggregation-prone mutant can be directed toward the autophagosomal pathway instead of the canonical proteasome system. Conclusions: Our study reveals alternative pathways for TSHR degradation. Retained TSHR variants can be functional when expressed on the cell surface membrane, thus opening the possibility of further studies on the pharmacological modulation of TSHR expression and functionality in patients in whom TSHR signaling is disrupted.
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Affiliation(s)
- Elisa Stellaria Grassi
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Arpad Lábadi
- Department of Laboratory Medicine, University of Pécs, Pécs, Hungary
| | - Valeria Vezzoli
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Viola Ghiandai
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Marco Bonomi
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
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Grassi ES, Pantazopoulou V, Pietras A. Hypoxia-induced release, nuclear translocation, and signaling activity of a DLK1 intracellular fragment in glioma. Oncogene 2020; 39:4028-4044. [PMID: 32205867 PMCID: PMC7220882 DOI: 10.1038/s41388-020-1273-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
Glioblastoma multiforme is characterized in part by severe hypoxia associated with tumor necrosis. The cellular response to hypoxia can influence several properties of tumor cells associated with aggressive tumor growth, including metabolic adaptations and tumor cell migration and invasion. Here, we found that Delta Like Non-Canonical Notch Ligand 1 (DLK1) expression was elevated as compared with normal brain in a genetically engineered mouse model of glioma, and that DLK1 expression increased with tumor grade in human glioma samples. DLK1 expression was highest in hypoxic and perivascular tumor areas, and we found that hypoxia induced the release and nuclear translocation of an intracellular fragment of DLK1 in murine glioma as well as in human glioma cultures. Release of the intracellular fragment was dependent on ADAM17 and Hypoxia-inducible Factor 1alpha and 2alpha (HIF-1alpha/HIF-2alpha), as ADAM17 inhibitors and HIF1A/HIF2A siRNA blocked DLK1 cleavage. Expression of a cleavable form of DLK1 amplified several hypoxia-induced traits of glioma cells such as colony formation, stem cell marker gene expression, a PI3K-pathway-mediated metabolic shift, and enhanced invasiveness. Effects of DLK1 were dependent on DLK1-cleavage by ADAM17, as expression of non-cleavable DLK1 could not replicate the DLK1-induced hypoxic phenotype. Finally, forced expression of DLK1 resulted in more invasive tumor growth in a PDGFB-induced glioma mouse model without affecting overall survival. Together, our findings suggest a previously undescribed role for DLK1 as an intracellular signaling molecule.
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Affiliation(s)
- Elisa Stellaria Grassi
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Vasiliki Pantazopoulou
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden
| | - Alexander Pietras
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden.
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Cirello V, Vaira V, Grassi ES, Vezzoli V, Ricca D, Colombo C, Bosari S, Vicentini L, Persani L, Ferrero S, Fugazzola L. Multicellular spheroids from normal and neoplastic thyroid tissues as a suitable model to test the effects of multikinase inhibitors. Oncotarget 2018; 8:9752-9766. [PMID: 28039458 PMCID: PMC5354768 DOI: 10.18632/oncotarget.14187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022] Open
Abstract
Multicellular three-dimensional (3D) spheroids represent an experimental model that is intermediate in its complexity between monolayer cultures and patients’ tumor. In the present study, we characterize multicellular spheroids from papillary (PTC) and follicular (FTC) thyroid cancers and from the corresponding normal tissues. We show that these 3D structures well recapitulate the features of the original tissues, in either the differentiated and “stem-like” components. As a second step, we were aimed to test the effects of a small multikinase inhibitor, SP600125 (SP), previously shown to efficiently induce cell death in undifferentiated thyroid cancer monolayer cultures. We demonstrate the potent effect of SP on cell growth and survival in our 3D multicellular cultures. SP exerts its main effects through direct and highly significant inhibition of the ROCK pathway, known to be involved in the regulation of cell migration and β-catenin turnover. Consistently, SP treatment resulted in a significant decrease in β-catenin levels with respect to basal conditions in tumor but not in normal spheroids, indicating that the effect is promisingly selective on tumor cells. In conclusion, we provide the morphological and molecular characterization of thyroid normal and tumor spheroids. In this 3D model we tested in vitro the effects of the multikinase inhibitor SP and further characterized its mechanism of action in both normal and tumor spheroids, thus making it an ideal candidate for developing new drugs against thyroid cancer.
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Affiliation(s)
- Valentina Cirello
- Endocrine Unit, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Valentina Vaira
- Division of Pathology, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy
| | - Elisa Stellaria Grassi
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Valeria Vezzoli
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Dario Ricca
- Division of Pathology, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy
| | - Carla Colombo
- Endocrine Unit, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvano Bosari
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy
| | | | - Luca Persani
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Laura Fugazzola
- Endocrine Unit, Fondazione IRCCS Ca' Granda, 20122 Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Dicitore A, Grassi ES, Borghi MO, Gelmini G, Cantone MC, Gaudenzi G, Persani L, Caraglia M, Vitale G. Antitumor activity of interferon-β1a in hormone refractory prostate cancer with neuroendocrine differentiation. J Endocrinol Invest 2017; 40:761-770. [PMID: 28247216 DOI: 10.1007/s40618-017-0631-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/01/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Type I interferons (IFN-α and IFN-β) are a class of cytokines that exert several biological activities, such as modulation of cell proliferation and differentiation and of the immune system. Although these cytokines interact with a common receptor complex, IFN-β showed a more potent antitumor activity than IFN-α in several tumor models. New recombinant human IFN-β products, such as IFN-β1a and IFN-β1b, have been produced in order to improve the stability and bioavailability of natural IFN-β. In this report, we analyzed the effects of recombinant IFN-β1a on the cell proliferation of two human androgen-resistant prostate cancer cell lines with neuroendocrine differentiation (DU-145, PC-3) and related mechanisms of action. METHODS The effects of IFN-β1a on the cell growth proliferation, cell cycle, and apoptosis have been evaluated in DU-145 and PC-3 cells through MTT assay, DNA flow cytometry with propidium iodide, and Annexin V-FITC/propidium iodide staining, respectively. Moreover, the expression of neuron-specific enolase (NSE), cleaved caspase-3, caspase-8, and PARP was evaluated through Western blotting. RESULTS IFN-β1a showed a significant anti-proliferative activity in both androgen-resistant cell lines. This effect was related to cell cycle perturbation and induction in apoptosis, as shown by flow cytometric analysis, the activation of caspase-3 and caspase-8 and PARP cleavage during incubation with IFN-β1a. Moreover, this cytokine reduced the expression of NSE in both cell lines. CONCLUSIONS Recombinant IFN-β1a (Rebif) showed a potent in vitro anti-proliferative activity in androgen-resistant prostate cancer cells, and it could represent a promising tool for the treatment of this tumor.
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Affiliation(s)
- A Dicitore
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, via Zucchi 18, Cusano Milanino (Mi), 20095, Milan, Italy
| | - E S Grassi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - M O Borghi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
- Experimental Laboratory of Immuno-rheumatology, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - G Gelmini
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, via Zucchi 18, Cusano Milanino (Mi), 20095, Milan, Italy
| | - M C Cantone
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - G Gaudenzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - L Persani
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, via Zucchi 18, Cusano Milanino (Mi), 20095, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - M Caraglia
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
| | - G Vitale
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, via Zucchi 18, Cusano Milanino (Mi), 20095, Milan, Italy.
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy.
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11
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Grassi ES, Dicitore A, Negri I, Borghi MO, Vitale G, Persani L. 8-Cl-cAMP and PKA I-selective cAMP analogs effectively inhibit undifferentiated thyroid cancer cell growth. Endocrine 2017; 56:388-398. [PMID: 27460006 DOI: 10.1007/s12020-016-1057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/11/2016] [Indexed: 12/25/2022]
Abstract
The main purpose of our work was to evaluate the effects of different cyclic adenosine monophosphate analogs on thyroid cancer-derived cell lines. In particular we studied 8-chloroadenosine-3',5'-cyclic monophosphate, the most powerful cyclic adenosine monophosphate analog, and the protein kinase A I-selective combination of 8-hexylaminoadenosine-3',5'cyclic monophosphate and 8-piperidinoadenosine-3',5'-cyclic monophosphate. The cyclic adenosine monophosphate/protein kinase A pathway plays a fundamental role in the regulation of thyroid cells growth. Site-selective cyclic adenosine monophosphate analogs are a class of cyclic adenosine monophosphate-derivate molecules that has been synthesized to modulate protein kinase A activity. Although the cyclic adenosine monophosphate/protein kinase A pathway plays a fundamental role in the regulation of thyroid cells proliferation, there are currently no studies exploring the role of cyclic adenosine monophosphate analogs in thyroid cancer. We evaluated the effects on cell proliferation, apoptosis activation and alterations of different intracellular pathways using 3-(4,5-dimetylthiazole-2-yl)-2,5-diphenyltetrazolium bromide assay, flow cytofluorimetry, western blotting, and kinase inhibitors. Our results show that both compounds have antiproliferative potential. Both treatments were able to modify protein kinase A RI/RII ratio, thus negatively influencing cancer cells growth. Moreover, the two treatments differentially modulated various signaling pathways that regulate cell proliferation and apoptosis. Both treatments demonstrated interesting characteristics that prompt further studies aiming to understand the intimate interaction between different intracellular pathways and possibly develop novel anticancer therapies for undifferentiated thyroid cancer.
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Affiliation(s)
- Elisa Stellaria Grassi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Alessandra Dicitore
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Irene Negri
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Maria Orietta Borghi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Giovanni Vitale
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy.
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy.
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy.
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12
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Grassi ES, Vezzoli V, Negri I, Lábadi Á, Fugazzola L, Vitale G, Persani L. SP600125 has a remarkable anticancer potential against undifferentiated thyroid cancer through selective action on ROCK and p53 pathways. Oncotarget 2017; 6:36383-99. [PMID: 26415230 PMCID: PMC4742184 DOI: 10.18632/oncotarget.5799] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/11/2015] [Indexed: 12/11/2022] Open
Abstract
Thyroid cancer is the most common endocrine malignancy with increasing incidence worldwide. The majority of thyroid cancer cases are well differentiated with favorable outcome. However, undifferentiated thyroid cancers are one of the most lethal human malignancies because of their invasiveness, metastatization and refractoriness even to the most recently developed therapies. In this study we show for the first time a significant hyperactivation of ROCK/HDAC6 pathway in thyroid cancer tissues, and its negative correlation with p53 DNA binding ability. We demonstrate that a small compound, SP600125 (SP), is able to induce cell death selectively in undifferentiated thyroid cancer cell lines by specifically acting on the pathogenic pathways of cancer development. In detail, SP acts on the ROCK/HDAC6 pathway involved in dedifferentiation and invasiveness of undifferentiated human cancers, by restoring its physiological activity level. As main consequence, cancer cell migration is inhibited and, at the same time, cell death is induced through the mitotic catastrophe. Moreover, SP exerts a preferential action on the mutant p53 by increasing its DNA binding ability. In TP53-mutant cells that survive mitotic catastrophe this process results in p21 induction and eventually lead to premature senescence. In conclusion, SP has been proved to be able to simultaneously block cell replication and migration, the two main processes involved in cancer development and dissemination, making it an ideal candidate for developing new drugs against anaplastic thyroid cancer.
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Affiliation(s)
- Elisa Stellaria Grassi
- DISCCO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valeria Vezzoli
- DISCCO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Negri
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Current address: IRIBHM, Institute of Interdisciplinary Research in Molecular Human Biology, Université Libre de Bruxelles, Brussels, Belgium
| | - Árpád Lábadi
- Department of Laboratory Medicine, University of Pécs, Pécs, Hungary
| | - Laura Fugazzola
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Endocrine Unit-Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Giovanni Vitale
- DISCCO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luca Persani
- DISCCO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
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13
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Dicitore A, Grassi ES, Caraglia M, Borghi MO, Gaudenzi G, Hofland LJ, Persani L, Vitale G. The cAMP analogs have potent anti-proliferative effects on medullary thyroid cancer cell lines. Endocrine 2016; 51:101-12. [PMID: 25863490 DOI: 10.1007/s12020-015-0597-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
The oncogenic activation of the rearranged during transfection (RET) proto-oncogene has a main role in the pathogenesis of medullary thyroid cancer (MTC). Several lines of evidence suggest that RET function could be influenced by cyclic AMP (cAMP)-dependent protein kinase A (PKA) activity. We evaluated the in vitro anti-tumor activity of 8-chloroadenosine-3',5'-cyclic monophosphate (8-Cl-cAMP) and PKA type I-selective cAMP analogs [equimolar combination of the 8-piperidinoadenosine-3',5'-cyclic monophosphate (8-PIP-cAMP) and 8-hexylaminoadenosine-3',5'-cyclic monophosphate (8-HA-cAMP) in MTC cell lines (TT and MZ-CRC-1)]. 8-Cl-cAMP and the PKA I-selective cAMP analogs showed a potent anti-proliferative effect in both cell lines. In detail, 8-Cl-cAMP blocked significantly the transition of TT cell population from G2/M to G0/G1 phase and from G0/G1 to S phase and of MZ-CRC-1 cells from G0/G1 to S phase. Moreover, 8-Cl-cAMP induced apoptosis in both cell lines, as demonstrated by FACS analysis for annexin V-FITC/propidium iodide, the activation of caspase-3 and PARP cleavage. On the other hand, the only effect induced by PKA I-selective cAMP analogs was a delay in G0/G1-S and S-G2/M progression in TT and MZ-CRC-1 cells, respectively. In conclusion, these data demonstrate that cAMP analogs, particularly 8-Cl-cAMP, significantly suppress in vitro MTC proliferation and provide rationale for a potential clinical use of cAMP analogs in the treatment of advanced MTC.
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Affiliation(s)
- Alessandra Dicitore
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy.
| | - Elisa Stellaria Grassi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Michele Caraglia
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
| | - Maria Orietta Borghi
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Germano Gaudenzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Leo J Hofland
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Luca Persani
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Giovanni Vitale
- Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy.
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy.
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14
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Lábadi Á, Grassi ES, Gellén B, Kleinau G, Biebermann H, Ruzsa B, Gelmini G, Rideg O, Miseta A, Kovács GL, Patócs A, Felszeghy E, Nagy EV, Mezősi E, Persani L. Loss-of-Function Variants in a Hungarian Cohort Reveal Structural Insights on TSH Receptor Maturation and Signaling. J Clin Endocrinol Metab 2015; 100:E1039-45. [PMID: 25978107 DOI: 10.1210/jc.2014-4511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Congenital hypothyroidism (CH) is one of the most common inborn endocrine disorders with genetic background. Despite the well-established newborn CH screening program in Hungary, no systematic examination of the underlying genetic alterations has been performed as yet. OBJECTIVE We aimed to explore TSH receptor (TSHR) mutations in a cohort of Hungarian patients with CH. PATIENTS Eighty-five unrelated patients with permanent primary CH, all diagnosed at newborn screening, were selected. MAIN OUTCOME MEASURES Coding exons of the TSHR gene were sequenced and evaluated together with the thyroid-specific clinical parameters. Functional features of the novel mutations were experimentally examined, and their comparative molecular models were built. RESULTS In four patients (one heterozygous and three compound heterozygous), seven TSHR mutations were identified. Among these, N432(1.50)D and P449(2.39)L are novel missense alterations. Importantly, the N432(1.50) residue is highly conserved among G protein-coupled receptors, and its function has not been examined yet in human glycoprotein hormone receptors. Our results indicate that the N432(1.50)D mutation disrupts important, architecture-stabilizing intramolecular interactions and ultimately leads to the complete intracellular retention of the receptor. On the other hand, P449(2.39) is located in the intracellular part of the receptor, which is important in G protein coupling. The P449(2.39)L mutation results in signaling impairment, with a more profound effect on the Gq/11 pathway. CONCLUSION TSHR mutations are common among Hungarian patients with CH. The novel genetic alterations revealed an important structural role of the N432(1.50) and the P449(2.39) residues in receptor expression and signaling, respectively.
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Affiliation(s)
- Árpád Lábadi
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Elisa Stellaria Grassi
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Balázs Gellén
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Gunnar Kleinau
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Heike Biebermann
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Beáta Ruzsa
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Giulia Gelmini
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Orsolya Rideg
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Attila Miseta
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Gábor L Kovács
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Attila Patócs
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Enikő Felszeghy
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Endre V Nagy
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Emese Mezősi
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
| | - Luca Persani
- Department of Laboratory Medicine (A.L., O.R., A.M., G.L.K.), University of Pécs, 7624 Pécs, Hungary; Department of Clinical Sciences and Community Health (E.S.G., L.P.), University of Milan, 20122 Milan, Italy; Department of Pediatrics and Pediatric Health Care Center (B.G.), University of Szeged, 6720 Szeged, Hungary; Institute of Experimental Pediatric Endocrinology (G.K., H.B.), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; First Department of Internal Medicine (B.R., E.M.), University of Pécs, 7624 Pécs, Hungary; Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research (G.G., L.P.), Ospedale San Luca, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, 20149 Milan, Italy; Szentágothai Research Centre (G.L.K.), University of Pécs, 7624 Pécs, Hungary; HAS-SE "Lendület" Hereditary Endocrine Tumors Research Group (A.P.), 1085 Budapest, Hungary; and Departments of Pediatrics (E.F.) and Internal Medicine (E.V.N.), Faculty of Medicine, University of Debrecen, 4032 Debrecen Hungary
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