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Ogawa-Wong A, Carmody C, Le K, Marschner RA, Larsen PR, Zavacki AM, Wajner SM. Modulation of Deiodinase Types 2 and 3 during Skeletal Muscle Regeneration. Metabolites 2022; 12:metabo12070612. [PMID: 35888735 PMCID: PMC9323706 DOI: 10.3390/metabo12070612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The muscle stem-cell niche comprises numerous cell types, which coordinate the regeneration process after injury. Thyroid hormones are one of the main factors that regulate genes linked to skeletal muscle. In this way, deiodinase types 2 and 3 are responsible for the fine-tuning regulation of the local T3 amount. Although their expression and activity have already been identified during muscle regeneration, it is of utmost importance to identify the cell type and temporal pattern of expression after injury to thoroughly comprehend their therapeutic potential. Here, we confirmed the expression of Dio2 and Dio3 in the whole tibialis anterior muscle. We identified, on a single-cell basis, that Dio2 is present in paired box 7 (PAX7)-positive cells starting from day 5 after injury. Dio2 is present in platelet derived growth factor subunit A (PDGFA)-expressing fibro-adipogenic progenitor cells between days 7 and 14 after injury. Dio3 is detected in myogenic differentiation (MYOD)-positive stem cells and in macrophages immediately post injury and thereafter. Interestingly, Dio2 and Dio3 RNA do not appear to be present in the same type of cell throughout the process. These results provide further insight into previously unseen aspects of the crosstalk and synchronized regulation of T3 in injured muscle mediated by deiodinases. The set of findings described here further define the role of deiodinases in muscle repair, shedding light on potential new forms of treatment for sarcopenia and other muscular diseases.
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Affiliation(s)
- Ashley Ogawa-Wong
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
| | - Colleen Carmody
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
| | - Katherine Le
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
| | - Rafael Aguiar Marschner
- Endocrine Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 9000335, Brazil;
| | - P. Reed Larsen
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
| | - Ann Marie Zavacki
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
| | - Simone Magagnin Wajner
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.O.-W.); (C.C.); (K.L.); (P.R.L.); (A.M.Z.)
- Endocrine Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 9000335, Brazil;
- Correspondence:
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Seale LA, Gilman CL, Zavacki AM, Larsen PR, Inokuchi M, Breves JP, Seale AP. Regulation of thyroid hormones and branchial iodothyronine deiodinases during freshwater acclimation in tilapia. Mol Cell Endocrinol 2021; 538:111450. [PMID: 34506867 PMCID: PMC8551029 DOI: 10.1016/j.mce.2021.111450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/05/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Euryhaline fishes are capable of maintaining osmotic homeostasis in a wide range of environmental salinities. Several pleiotropic hormones, including prolactin, growth hormone, and thyroid hormones (THs) are mediators of salinity acclimation. It is unclear, however, the extent to which THs and the pituitary-thyroid axis promote the adaptive responses of key osmoregulatory organs to freshwater (FW) environments. In the current study, we characterized circulating thyroxine (T4) and 3-3'-5-triiodothyronine (T3) levels in parallel with the outer ring deiodination (ORD) activities of deiodinases (dios) and mRNA expression of dio1, dio2, and dio3 in gill during the acclimation of Mozambique tilapia (Oreochromis mossambicus) to FW. Tilapia transferred from seawater (SW) to FW exhibited reduced plasma T4 and T3 levels at 6 h. These reductions coincided with an increase in branchial dio2-like activity and decreased branchial dio1 gene expression. To assess whether dios respond to osmotic conditions and/or systemic signals, gill filaments were exposed to osmolalities ranging from 280 to 450 mOsm/kg in an in vitro incubation system. Gene expression of branchial dio1, dio2, and dio3 was not directly affected by extracellular osmotic conditions. Lastly, we observed that dio1 and dio2 expression was stimulated by thyroid-stimulating hormone in hypophysectomized tilapia, suggesting that branchial TH metabolism is regulated by systemic signals. Our collective findings suggest that THs are involved in the FW acclimation of Mozambique tilapia through their interactions with branchial deiodinases that modulate their activities in a key osmoregulatory organ.
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Affiliation(s)
- Lucia A Seale
- Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawai'i at Mānoa, 1933 East-West Road, Honolulu, HI, 96822, USA
| | - Christy L Gilman
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Ann Marie Zavacki
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Reed Larsen
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mayu Inokuchi
- Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, University of Tokyo, Bunkyo, Tokyo, 113-8657, Japan
| | - Jason P Breves
- Department of Biology, Skidmore College, 815 N. Broadway, Saratoga Springs, NY, 12866, USA
| | - Andre P Seale
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, 1955 East-West Road, Honolulu, HI, 96822, USA.
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Abstract
In this minireview, we provide a historical outline of the events that led to the identification and characterization of the deiodinases, the recognition that deiodination plays a major role in thyroid hormone action, and the cloning of the 3 deiodinase genes. The story starts in 1820, when it was first determined that elemental iodine was important for normal thyroid function. Almost 100 years later, it was found that the primary active principle of the gland, T4, contains iodine. Once radioactive iodine became available in the 1940s, it was demonstrated that the metabolism of T4 included deiodination, but at the time it was assumed to be merely a degradative process. However, this view was questioned after the discovery of T3 in 1952. We discuss in some detail the events of the next 20 years, which included some failures followed by the successful demonstration that deiodination is indeed essential to normal thyroid hormone action. Finally, we describe how the 3 deiodinases were identified and characterized and their genes cloned.
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Affiliation(s)
- Valerie Anne Galton
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Correspondence: Valerie Anne Galton, Geisel School of Medicine at Dartmouth, Department of Molecular and Systems Biology, Remsen Building, 66 College Street, Hanover, NH 03755, USA.
| | - P Reed Larsen
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marla J Berry
- Pacific Biosciences Research Center, SOEST, University of Hawaii at Manoa, Honolulu, HI, USA
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An X, Ogawa-Wong A, Carmody C, Ambrosio R, Cicatiello AG, Luongo C, Salvatore D, Handy DE, Larsen PR, Wajner SM, Dentice M, Zavacki AM. A Type 2 Deiodinase-Dependent Increase in Vegfa Mediates Myoblast-Endothelial Cell Crosstalk During Skeletal Muscle Regeneration. Thyroid 2021; 31:115-127. [PMID: 32787533 PMCID: PMC7840309 DOI: 10.1089/thy.2020.0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 02/05/2023]
Abstract
Background: The type 2 deiodinase (DIO2) converts thyroxine to 3,3',5-triiodothyronine (T3), modulating intracellular T3. An increase in DIO2 within muscle stem cells during skeletal muscle regeneration leads to T3-dependent potentiation of differentiation. The muscle stem cell niche comprises numerous cell types, which coordinate the regeneration process. For example, muscle stem cells provide secretory signals stimulating endothelial cell-mediated vascular repair, and, in turn, endothelial cells promote muscle stem differentiation. We hypothesized that Dio2 loss in muscle stem cells directly impairs muscle stem cell-endothelial cell communication, leading to downstream disruption of endothelial cell function. Methods: We assessed the production of proangiogenic factors in differentiated C2C12 cells and in a C2C12 cell line without Dio2 (D2KO C2C12) by real-time quantitative-polymerase chain reaction and enzyme-linked immunosorbent assay. Conditioned medium (CM) was collected daily in parallel to evaluate its effects on human umbilical vein endothelial cell (HUVEC) proliferation, migration and chemotaxis, and vascular network formation. The effects of T3-treatment on vascular endothelial growth factor (Vegfa) mRNA expression in C2C12 cells and mouse muscle were assessed. Chromatin immunoprecipitation (ChIP) identified thyroid hormone receptor (TR) binding to the Vegfa gene. Using mice with a targeted disruption of Dio2 (D2KO mice), we determined endothelial cell number by immunohistochemistry/flow cytometry and evaluated related gene expression in both uninjured and injured skeletal muscle. Results: In differentiated D2KO C2C12 cells, Vegfa expression was 46% of wildtype (WT) C2C12 cells, while secreted VEGF was 45%. D2KO C2C12 CM exhibited significantly less proangiogenic effects on HUVECs. In vitro and in vivo T3 treatment of C2C12 cells and WT mice, and ChIP using antibodies against TRα, indicated that Vegfa is a direct genomic T3 target. In uninjured D2KO soleus muscle, Vegfa expression was decreased by 28% compared with WT mice, while endothelial cell numbers were decreased by 48%. Seven days after skeletal muscle injury, D2KO mice had 36% fewer endothelial cells, coinciding with an 83% decrease in Vegfa expression in fluorescence-activated cell sorting purified muscle stem cells. Conclusion:Dio2 loss in the muscle stem cell impairs muscle stem cell-endothelial cell crosstalk via changes in the T3-responsive gene Vegfa, leading to downstream impairment of endothelial cell function both in vitro and in vivo.
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Affiliation(s)
- Xingxing An
- Key Laboratory of Transplant Engineering and Immunology, Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ashley Ogawa-Wong
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Colleen Carmody
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Cristina Luongo
- Department of Public Health, University of Naples “Federico II,” Naples, Italy
| | - Domenico Salvatore
- Department of Public Health, University of Naples “Federico II,” Naples, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - Diane E. Handy
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - P. Reed Larsen
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Simone Magagnin Wajner
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Endocrine Division, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Monica Dentice
- Department of Clinical Medicine and Surgery and University of Naples “Federico II,” Naples, Italy
| | - Ann Marie Zavacki
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Angell TE, Maurer R, Wang Z, Kim MI, Alexander CA, Barletta JA, Benson CB, Cibas ES, Cho NL, Doherty GM, Doubilet PM, Frates MC, Gawande AA, Krane JF, Marqusee E, Moore FD, Nehs MA, Larsen PR, Alexander EK. A Cohort Analysis of Clinical and Ultrasound Variables Predicting Cancer Risk in 20,001 Consecutive Thyroid Nodules. J Clin Endocrinol Metab 2019; 104:5665-5672. [PMID: 31310316 DOI: 10.1210/jc.2019-00664] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain. OBJECTIVES To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment. DESIGN Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected. MAIN OUTCOME MEASURES Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression. RESULTS In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables. CONCLUSIONS Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhihong Wang
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Thyroid Surgery, First Hospital of China Medical University, Shenyang, China
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caroline A Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeff F Krane
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Zevenbergen C, Groeneweg S, Swagemakers SMA, de Jong A, Medici-Van den Herik E, Rispens M, Klootwijk W, Medici M, de Rijke YB, Meima ME, Larsen PR, Chavatte L, Venter D, Peeters RP, Van der Spek PJ, Visser WE. Functional Analysis of Genetic Variation in the SECIS Element of Thyroid Hormone Activating Type 2 Deiodinase. J Clin Endocrinol Metab 2019; 104:1369-1377. [PMID: 30423129 DOI: 10.1210/jc.2018-01605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 07/24/2018] [Accepted: 11/08/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT Thyroid hormone is important for normal brain development. The type 2 deiodinase (D2) controls thyroid hormone action in the brain by activating T4 to T3. The enzymatic activity of D2 depends on the incorporation of selenocysteine for which the selenocysteine-insertion sequence (SECIS) element located in the 3' untranslated region is indispensable. We hypothesized that mutations in the SECIS element could affect D2 function, resulting in a neurocognitive phenotype. OBJECTIVE To identify mutations in the SECIS element of DIO2 in patients with intellectual disability and to test their functional consequences. DESIGN, SETTING, AND PATIENTS The SECIS element of DIO2 was sequenced in 387 patients with unexplained intellectual disability using a predefined pattern of thyroid function tests. SECIS element read-through in wild-type or mutant D2 was quantified by a luciferase reporter system in transfected cells. Functional consequences were assessed by quantifying D2 activity in cell lysate or intact cell metabolism studies. RESULTS Sequence analysis revealed 2 heterozygous mutations: c.5703C>T and c.5730A>T, which were also present in the unaffected family members. The functional evaluation showed that both mutations did not affect D2 enzyme activity in cell lysates or intact cells, although the 5730A>T mutation decreased SECIS element read-through by 75%. In the patient harboring the c.5730A>T variant, whole genome sequencing revealed a pathogenic deletion of the STXBP1 gene. CONCLUSIONS We report on two families with mutations in the SECIS element of D2. Although functional analysis showed that nucleotide 5730 is important for normal SECIS element read-through, the two variants did not segregate with a distinct phenotype.
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Affiliation(s)
- Chantal Zevenbergen
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Stefan Groeneweg
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Sigrid M A Swagemakers
- Department of Bioinformatics, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Department of Pathology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | | | - Evita Medici-Van den Herik
- Department of Child Neurology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | | | - Wim Klootwijk
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Marco Medici
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Marcel E Meima
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - P Reed Larsen
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laurent Chavatte
- Centre International de Recherche en Infectiologie, CIRI, INSERM U1111, CNRS/ENS/UCBL1 UMR5308, Lyon, France
| | - Deon Venter
- Department of Pathology, Mater Health Services, South Brisbane, Queensland, Australia
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Peter J Van der Spek
- Department of Bioinformatics, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
- Department of Pathology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
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7
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Carmody C, Ogawa-Wong AN, Martin C, Luongo C, Zuidwijk M, Sager B, Petersen T, Roginski Guetter A, Janssen R, Wu EY, Bogaards S, Neumann NM, Hau K, Marsili A, Boelen A, Silva JE, Dentice M, Salvatore D, Wagers AJ, Larsen PR, Simonides WS, Zavacki AM. A Global Loss of Dio2 Leads to Unexpected Changes in Function and Fiber Types of Slow Skeletal Muscle in Male Mice. Endocrinology 2019; 160:1205-1222. [PMID: 30951174 PMCID: PMC6482039 DOI: 10.1210/en.2019-00088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
Abstract
The type 2 iodothyronine-deiodinase (D2) enzyme converts T4 to T3, and mice deficient in this enzyme [D2 knockout (D2KO) mice] have decreased T3 derived from T4 in skeletal muscle despite normal circulating T3 levels. Because slow skeletal muscle is particularly susceptible to changes in T3 levels, we expected D2 inactivation to result in more pronounced slow-muscle characteristics in the soleus muscle, mirroring hypothyroidism. However, ex vivo studies of D2KO soleus revealed higher rates of twitch contraction and relaxation and reduced resistance to fatigue. Immunostaining of D2KO soleus showed that these properties were associated with changes in muscle fiber type composition, including a marked increase in the number of fast, glycolytic type IIB fibers. D2KO soleus muscle fibers had a larger cross-sectional area, and this correlated with increased myonuclear accretion in myotubes formed from D2KO skeletal muscle precursor cells differentiated in vitro. Consistent with our functional findings, D2KO soleus gene expression was markedly different from that in hypothyroid wild-type (WT) mice. Comparison of gene expression between euthyroid WT and D2KO mice indicated that PGC-1α, a T3-dependent regulator of slow muscle fiber type, was decreased by ∼50% in D2KO soleus. Disruption of Dio2 in the C2C12 myoblast cell line led to a significant decrease in PGC-1α expression and a faster muscle phenotype upon differentiation. These results indicate that D2 loss leads to significant changes in soleus contractile function and fiber type composition that are inconsistent with local hypothyroidism and suggest that reduced levels of PCG-1α may contribute to the observed phenotypical changes.
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Affiliation(s)
| | | | | | - Cristina Luongo
- Brigham and Women’s Hospital, Boston, Massachusetts
- University of Naples “Federico II,” Napoli, Italy
| | - Marian Zuidwijk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Rob Janssen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Sylvia Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Kaman Hau
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Anita Boelen
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J Enrique Silva
- Baystate Medical Center, Springfield, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
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8
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Aguayo-Mazzucato C, Lee TB, Matzko M, DiIenno A, Rezanejad H, Ramadoss P, Scanlan T, Zavacki AM, Larsen PR, Hollenberg A, Colton C, Sharma A, Bonner-Weir S. T 3 Induces Both Markers of Maturation and Aging in Pancreatic β-Cells. Diabetes 2018; 67:1322-1331. [PMID: 29625991 PMCID: PMC6014556 DOI: 10.2337/db18-0030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/29/2018] [Indexed: 12/25/2022]
Abstract
Previously, we showed that thyroid hormone (TH) triiodothyronine (T3) enhanced β-cell functional maturation through induction of Mafa High levels of T3 have been linked to decreased life span in mammals and low levels to lengthened life span, suggesting a relationship between TH and aging. Here, we show that T3 increased p16Ink4a (a β-cell senescence marker and effector) mRNA in rodent and human β-cells. The kinetics of Mafa and p16Ink4a induction suggested both genes as targets of TH via TH receptors (THRs) binding to specific response elements. Using specific agonists CO23 and GC1, we showed that p16Ink4a expression was controlled by THRA and Mafa by THRB. Using chromatin immunoprecipitation and a transient transfection yielding biotinylated THRB1 or THRA isoforms to achieve specificity, we determined that THRA isoform bound to p16Ink4a , whereas THRB1 bound to Mafa but not to p16Ink4a On a cellular level, T3 treatment accelerated cell senescence as shown by increased number of β-cells with acidic β-galactosidase activity. Our data show that T3 can simultaneously induce both maturation (Mafa) and aging (p16Ink4a ) effectors and that these dichotomous effects are mediated through different THR isoforms. These findings may be important for further improving stem cell differentiation protocols to produce functional β-cells for replacement therapies in diabetes.
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Affiliation(s)
| | - Terence B Lee
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | - Amanda DiIenno
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | | | - Preeti Ramadoss
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Thomas Scanlan
- Department of Physiology & Pharmacology, Oregon Health & Science University, Portland, OR
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Anthony Hollenberg
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Clark Colton
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Arun Sharma
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
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9
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Lechner MG, Vyas CM, Hamnvik OPR, Alexander EK, Larsen PR, Choueiri TK, Angell TE. Risk Factors for New Hypothyroidism During Tyrosine Kinase Inhibitor Therapy in Advanced Nonthyroidal Cancer Patients. Thyroid 2018; 28:437-444. [PMID: 29652599 DOI: 10.1089/thy.2017.0579] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 12/14/2022]
Abstract
BACKGROUND Thyroid dysfunction during tyrosine kinase inhibitor (TKI) cancer treatment is common, but predisposing risk factors have not been determined. Recommendations for monitoring patients treated with one or multiple TKI and in conjunction with other relevant cancer therapies could be improved. The study objective was to assess the risk factors for new thyroid dysfunction in TKI-treated previously euthyroid cancer patients. METHODS A retrospective cohort study of patients with advanced nonthyroidal cancer treated with TKI from 2000 to 2017, having available thyroid function tests showing initial euthyroid status, excluding patients with preexisting thyroid disease or lack of follow-up thyroid function tests. During TKI treatment, patients were classified as euthyroid (thyrotropin [TSH] normal), subclinical hypothyroidism (TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (TSH >10 mIU/L, low free thyroxine, or requiring thyroid hormone replacement). The timing of thyroid dysfunction and TKI used were assessed. Risk factors for incident hypothyroidism were evaluated using multivariate models. RESULTS In 538 adult patients included, subclinical hypothyroidism occurred in 71 (13.2%) and overt hypothyroidism occurred in 144 (26.8%) patients with TKI therapy, following a median cumulative TKI exposure of 196 days (interquartile range [IQR] 63.5-518.5 days). The odds of hypothyroidism were greatest during the first six months on a TKI. Median exposure time on the TKI concurrent with thyroid dysfunction in patients treated with only one TKI was 85 days (IQR 38-293.5 days) and was similar to the 74 days (IQR 38-133.3 days) in patients treated previously with other TKI (p = 0.41). Patients who developed hypothyroidism compared to those who remained euthyroid had greater odds of being female (odds ratio = 1.99 [confidence interval 1.35-2.93], p < 0.01), but greater cumulative TKI exposure and greater number of TKI received were not associated with thyroid dysfunction. CONCLUSIONS Thyroid dysfunction occurred in 40% of euthyroid patients. Monitoring thyroid function in TKI-treated patients is recommended, with particular attention to female patients and within the first six months of exposure to a new TKI.
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Affiliation(s)
- Melissa G Lechner
- 1 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Chirag M Vyas
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ole-Petter R Hamnvik
- 3 Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Erik K Alexander
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - P Reed Larsen
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Toni K Choueiri
- 4 Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute , Boston, Massachusetts
| | - Trevor E Angell
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
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10
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Wang Z, Vyas CM, Van Benschoten O, Nehs MA, Moore FD, Marqusee E, Krane JF, Kim MI, Heller HT, Gawande AA, Frates MC, Doubilet PM, Doherty GM, Cho NL, Cibas ES, Benson CB, Barletta JA, Zavacki AM, Larsen PR, Alexander EK, Angell TE. Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old. Thyroid 2018; 28:465-471. [PMID: 29608439 DOI: 10.1089/thy.2017.0655] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/08/2023]
Abstract
BACKGROUND In older patients, thyroid nodules are frequently detected and referred for evaluation, though usually prove to be benign disease or low-risk cancer. Therefore, management should be guided not solely by malignancy risk, but also by the relative risks of any intervention. Unfortunately, few such data are available for patients ≥70 years old. METHODS All consecutive patients ≥70 years old assessed by ultrasound (US) and fine-needle aspiration (FNA) between 1995 and 2015 were analyzed. Clinical, US, and histologic data, including patient comorbidities and outcomes, were obtained. Imaging and cytology results from initial evaluation were reviewed to detect significant-risk thyroid cancer (SRTC), which was defined as anaplastic, medullary, or poorly differentiated carcinoma, or the presence of distant metastases. Overall survival analyses were then performed to assist with risk-to-benefit assessment. RESULTS A total of 1129 patients ≥70 years old with 2527 nodules ≥1 cm were evaluated. FNA was safe in all, and cytology proved benign in 67.3% of patients. However, FNA led to surgery in 208 patients, of whom 93 (44.7%) had benign histopathology. Among all patients who underwent FNA, only 17 (1.5%) SRTC were identified, all of which were preoperatively identifiable by imaging and/or cytology. These SRTC were responsible for all (n = 10; 0.9%) thyroid cancer deaths. Among all other patients (n = 1112), 160 deaths (14.4%) were confirmed during a median follow-up of four years. None of these were thyroid cancer related. Survival analysis for these 1112 patients demonstrated that a separate non-thyroidal malignancy or coronary artery disease at the time of nodule evaluation was associated with increased mortality compared to those without these diagnoses (hazard ratio = 2.32 [confidence interval 1.66-3.26]; p < 0.01), confirming these are important variables to identify prior to thyroid nodule evaluation. CONCLUSIONS For patients ≥70 years old, US and FNA are safe and prove helpful in identifying SRTC and benign cytology. However, the surgical management of patients ≥70 years old presenting without high-risk findings should be tempered, especially when comorbid illness is identified.
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Affiliation(s)
- Zhihong Wang
- 1 Department of Thyroid Surgery, the First Hospital of China Medical University , Shenyang, China
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Chirag M Vyas
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Olivia Van Benschoten
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Matt A Nehs
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Francis D Moore
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ellen Marqusee
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Jeffrey F Krane
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Matthew I Kim
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Howard T Heller
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Atul A Gawande
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Mary C Frates
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Peter M Doubilet
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Gerard M Doherty
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Nancy L Cho
- 3 Department of Surgery, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Edmund S Cibas
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Carol B Benson
- 5 Department of Radiology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Justine A Barletta
- 4 Department of Pathology, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ann Marie Zavacki
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - P Reed Larsen
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Erik K Alexander
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Trevor E Angell
- 2 The Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, The Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
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11
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Lechner MG, Vyas CM, Hamnvik OPR, Alexander EK, Larsen PR, Choueiri TK, Angell TE. Hypothyroidism During Tyrosine Kinase Inhibitor Therapy Is Associated with Longer Survival in Patients with Advanced Nonthyroidal Cancers. Thyroid 2018; 28:445-453. [PMID: 29652597 DOI: 10.1089/thy.2017.0587] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/18/2023]
Abstract
BACKGROUND Tyrosine kinase inhibitor (TKI)-induced thyroid dysfunction is recognized as a common adverse effect of treatment, but the importance of incident hypothyroidism during TKI therapy remains unclear. This study analyzed the prognostic significance of hypothyroidism during TKI therapy in cancer patients. METHODS This was a retrospective cohort study of adult patients with advanced nonthyroidal cancer treated with TKI and available thyroid function testing at three affiliated academic hospitals from 2000 to 2017. Patients with preexisting thyroid disease were excluded. Demographic, clinical, and cancer treatment data were collected. Thyroid status with TKI treatment was determined from thyroid function testing and initiation of thyroid medication, and classified as euthyroid (thyrotropin [TSH] normal), subclinical hypothyroidism (SCH; TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (OH; TSH >10 mIU/L, low free thyroxine, or requiring replacement). Multivariate models were used to evaluate the effect of TKI-related hypothyroidism on overall survival (OS). RESULTS Of 1120 initial patients, 538 remained after exclusion criteria. SCH occurred in 72 (13%) and OH in 144 (27%) patients with TKI therapy. Patients with hypothyroidism had significantly longer OS, with median OS in euthyroid patients of 685 days [confidence interval (CI) 523-851] compared to 1005 days [CI 634-1528] in SCH and 1643 days [CI 1215-1991] in OH patients (p < 0.0001). After adjustment for age, sex, race/ethnicity, cancer type, cancer stage, ECOG performance status, and checkpoint inhibitor therapy, OH remained significantly associated with OS (hazard ratio = 0.561; p < 0.0001), whereas SCH did not (hazard ratio = 0.796; p = 0.165). Analysis of hypothyroid patients (SCH and OH) with TSH >5 and <10 mIU/L stratified by hormone replacement status showed improved survival associated with hormone replacement. CONCLUSIONS New hypothyroidism in cancer patients treated with TKI is associated with significantly improved OS, should not necessitate TKI dose reduction or discontinuation, and may provide independent prognostic information.
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Affiliation(s)
- Melissa G Lechner
- 1 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Chirag M Vyas
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Ole-Petter R Hamnvik
- 3 Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Erik K Alexander
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - P Reed Larsen
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Toni K Choueiri
- 4 Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute , Boston, Massachusetts
| | - Trevor E Angell
- 2 Thyroid Section, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
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12
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Angell TE, Vyas CM, Medici M, Wang Z, Barletta JA, Benson CB, Cibas ES, Cho NL, Doherty GM, Doubilet PM, Frates MC, Gawande AA, Heller HT, Kim MI, Krane JF, Marqusee E, Moore FD, Nehs MA, Zavacki AM, Larsen PR, Alexander EK. Differential Growth Rates of Benign vs. Malignant Thyroid Nodules. J Clin Endocrinol Metab 2017; 102:4642-4647. [PMID: 29040691 DOI: 10.1210/jc.2017-01832] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Received: 08/17/2017] [Accepted: 10/09/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT Thyroid nodule growth was once considered concerning for malignancy, but data showing that benign nodules grow questioned the use of this paradigm. To date, however, no studies have adequately evaluated whether growth rates differ in malignant vs. benign nodules. OBJECTIVE To sonographically evaluate growth rates in benign and malignant thyroid nodules ≥1 cm. DESIGN Prospective, cohort study of patients with tissue diagnosis of benign or malignant disease, with repeated ultrasound evaluation six or more months apart. MAIN OUTCOMES Growth rate in largest dimension of malignant compared with benign thyroid nodules. Regression models were used to evaluate predictors of growth. RESULTS Malignant nodules (126) met inclusion criteria (≥6-month nonoperative followup) and were compared with 1363 benign nodules. Malignant nodules were not found to be uniquely selected or prospectively observed solely for low-risk phenotype. Median ultrasound intervals were similar (21.8 months for benign nodules; 20.9 months for malignant nodules). Malignant nodules were more likely to grow >2 mm/y compared with benign nodules [relative risk (RR) = 2.5, 95% confidence interval (CI), 1.6 to 3.1; P < 0.001], which remained true after adjustment for clinical factors. The RR of a nodule being malignant increased with faster growth rates. Malignant nodules growing >2 mm/y had greater odds of being more aggressive cancers [intermediate risk: odds ratio (OR) = 2.99; 95% CI, 1.20 to 7.47; P = 0.03; higher risk: OR = 8.69; 95% CI, 1.78 to 42.34; P = 0.02]. CONCLUSIONS Malignant nodules, especially higher-risk phenotypes, grow faster than benign nodules. As growth >2 mm/y predicts malignant compared with benign disease, this clinical parameter can contribute to the assessment of thyroid cancer risk.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - Chirag M Vyas
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - Marco Medici
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zhihong Wang
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
- Department of Thyroid Surgery, First Hospital of China Medical University, Shenyang, China
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, and Harvard Medical School
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, and Harvard Medical School
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, and Harvard Medical School
| | - Howard T Heller
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, and Harvard Medical School
| | - Matt A Nehs
- Department of Surgery, Brigham and Women's Hospital, and Harvard Medical School
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Harvard Medical School
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13
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Kakarmath S, Heller HT, Alexander CA, Cibas ES, Krane JF, Barletta JA, Lindeman NI, Frates MC, Benson CB, Gawande AA, Cho NL, Nehs M, Moore FD, Marqusee E, Kim MI, Larsen PR, Kwong N, Angell TE, Alexander EK. Clinical, Sonographic, and Pathological Characteristics of RAS-Positive Versus BRAF-Positive Thyroid Carcinoma. J Clin Endocrinol Metab 2016; 101:4938-4944. [PMID: 27689252 PMCID: PMC5155682 DOI: 10.1210/jc.2016-2620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mutations in the BRAF and RAS oncogenes are responsible for most well-differentiated thyroid cancer. Yet, our clinical understanding of how BRAF-positive and RAS-positive thyroid cancers differ is incomplete. OBJECTIVE We correlated clinical, radiographic, and pathological findings from patients with thyroid cancer harboring a BRAF or RAS mutation. DESIGN Prospective cohort study. SETTING Academic, tertiary care hospital. PATIENTS A total of 101 consecutive patients with well-differentiated thyroid cancer. MAIN OUTCOME MEASURE We compared the clinical, sonographic, and pathological characteristics of patients with BRAF-positive cancer to those with RAS-positive cancer. RESULTS Of 101 patients harboring these mutations, 71 were BRAF-positive, whereas 30 were RAS-positive. Upon sonographic evaluation, RAS-positive nodules were significantly larger (P = .04), although BRAF-positive nodules were more likely to harbor concerning sonographic characteristics (hypoechogenicity [P < .001]; irregular margins [P = .04]). Cytologically, 70% of BRAF-positive nodules were classified positive for PTC, whereas 87% of RAS-positive nodules were indeterminate (P < .001). Histologically, 96% of RAS-positive PTC malignancies were follicular variants of PTC, whereas 70% of BRAF-positive malignancies were classical variants of PTC. BRAF-positive malignancies were more likely to demonstrate extrathyroidal extension (P = .003), lymphovascular invasion (P = .02), and lymph node metastasis (P < .001). CONCLUSIONS BRAF-positive malignant nodules most often demonstrate worrisome sonographic features and are frequently associated with positive or suspicious Bethesda cytology. In contrast, RAS-positive malignancy most often demonstrates indolent sonographic features and more commonly associates with lower risk, "indeterminate" cytology. Because BRAF and RAS mutations are the most common molecular perturbations associated with well-differentiated thyroid cancer, these findings may assist with improved preoperative risk assessment by suggesting the likely molecular profile of a thyroid cancer, even when postsurgical molecular analysis is unavailable.
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Affiliation(s)
- Sujay Kakarmath
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Howard T Heller
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Caroline A Alexander
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Edmund S Cibas
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Jeffrey F Krane
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Justine A Barletta
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Neal I Lindeman
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Mary C Frates
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Carol B Benson
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Atul A Gawande
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Nancy L Cho
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Matthew Nehs
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Francis D Moore
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Mathew I Kim
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Norra Kwong
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Trevor E Angell
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (S.K., T.E.A., N.K., C.A.A., E.M., M.I.K., P.R.L., E.K.A.), and Departments of Radiology (H.T.H., M.C.F., C.B.B.), Pathology (E.S.C., J.F.K., J.A.B., N.I.L.), and Surgery (A.A.G., N.L.C., M.N., F.D.M.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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14
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Abstract
BACKGROUND Computer simulation tools for education and research are making increasingly effective use of the Internet and personal devices. To facilitate these activities in endocrinology and metabolism, a mechanistically based simulator of human thyroid hormone and thyrotropin (TSH) regulation dynamics was developed and further validated, and it was implemented as a facile and freely accessible web-based and personal device application: the THYROSIM app. This study elucidates and demonstrates its utility in a research context by exploring key physiological effects of over-the-counter thyroid supplements. METHODS THYROSIM has a simple and intuitive user interface for teaching and conducting simulated "what-if" experiments. User-selectable "experimental" test-input dosages (oral, intravenous pulses, intravenous infusions) are represented by animated graphical icons integrated with a cartoon of the hypothalamic-pituitary-thyroid axis. Simulations of familiar triiodothyronine (T3), thyroxine (T4), and TSH temporal dynamic responses to these exogenous stimuli are reported graphically, along with normal ranges on the same single interface page; and multiple sets of simulated experimental results are superimposable to facilitate comparative analyses. RESULTS AND CONCLUSIONS This study shows that THYROSIM accurately reproduces a wide range of published clinical study data reporting hormonal kinetic responses to large and small oral hormone challenges. Simulation examples of partial thyroidectomies and malabsorption illustrate typical usage by optionally changing thyroid gland secretion and/or gut absorption rates--expressed as percentages of normal--as well as additions of oral hormone dosing, all directly on the interface, and visualizing the kinetic responses to these challenges. Classroom and patient education usage--with public health implications--is illustrated by predictive simulated responses to nonprescription thyroid health supplements analyzed previously for T3 and T4 content. Notably, it was found that T3 in supplements has potentially more serious pathophysiological effects than does T4--concomitant with low-normal TSH levels. Some preparations contain enough T3 to generate thyrotoxic conditions, with supernormal serum T3-spiking and subnormal serum T4 and TSH levels and, in some cases, with normal or low-normal range TSH levels due to thyroidal axis negative feedback. These results suggest that appropriate regulation of these products is needed.
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Affiliation(s)
- Simon X Han
- 1 Biocybernetics Laboratory, Departments of Computer Science and Medicine, UCLA , Los Angeles, California
| | - Marisa Eisenberg
- 2 Departments of Epidemiology and Mathematics, School of Public Health, University of Michigan , Ann Arbor, Michigan
| | - P Reed Larsen
- 3 Brigham and Women's Hospital/Harvard Medical School , Department of Medicine, Boston, Massachusetts
| | - Joseph DiStefano
- 1 Biocybernetics Laboratory, Departments of Computer Science and Medicine, UCLA , Los Angeles, California
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15
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Liu X, Medici M, Kwong N, Angell TE, Marqusee E, Kim MI, Larsen PR, Cho NL, Nehs MA, Ruan DT, Gawande A, Moore F, Barletta J, Krane JF, Cibas ES, Yang T, Alexander EK. Bethesda Categorization of Thyroid Nodule Cytology and Prediction of Thyroid Cancer Type and Prognosis. Thyroid 2016; 26:256-61. [PMID: 26563459 PMCID: PMC4754507 DOI: 10.1089/thy.2015.0376] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since its inception, the Bethesda System for Reporting Thyroid Cytopathology (TBS) has been widely adopted. Each category conveys a risk of malignancy and recommended next steps, though it is unclear if each category also predicts the type and extent of malignancy. If so, this would greatly expand the utility of the TBS by providing prognostic information in addition to baseline cancer risk. METHODS All patients prospectively enrolled into the authors' thyroid nodule database from 1995 to 2013 with histologically proven malignancy were analyzed. The primary ultrasound-guided fine-needle aspiration cytology (AUS, atypia of unknown significance; FN, follicular neoplasm; SUSP, suspicious; M, malignant) was correlated with the type of thyroid cancer and histological features known to impact prognosis and recurrence, including lymph node metastasis (LNM), lymphovascular invasion, and extrathyroidal extension (ETE). Primary cytology was separately correlated with higher risk malignancy. RESULTS A total of 1291 malignancies were identified, with primary cytology AUS in 130 cases, FN in 241 cases, SUSP in 411 cases, and M in 509 cases. AUS, SUSP, and M cytology were progressively associated with an increasing risk of high-risk disease (p < 0.001), LNM (p < 0.001), ETE (p < 0.001), and margin positivity (p < 0.001). Notably, 71% of malignancies with AUS cytology were follicular variants of papillary thyroid cancer compared with 63% with SUSP cytology and only 20% with M cytology. In contrast, high-risk malignancies were diagnosed in only 4% with AUS cytology, but 9% and 27% with SUSP and M cytology, respectively. FN conveyed a significantly increased risk of follicular thyroid carcinoma compared with all other types (28% vs. 2%; p < 0.001). A composite endpoint of recurrence, distant metastases, and death similarly increased as cytology progressed from AUS to SUSP to M (p < 0.001). CONCLUSION In addition to predicting cancer prevalence, the TBS also imparts important prognostic information about cancer type, variant, and risk of recurrence. These data extend the utility of TBS classification by fostering an improved understanding of the risk posed by any confirmed malignancy.
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Affiliation(s)
- Xiaoyun Liu
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Marco Medici
- Rotterdam Thyroid Center and Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Norra Kwong
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trevor E. Angell
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew I. Kim
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - P. Reed Larsen
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy L. Cho
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew A. Nehs
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel T. Ruan
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Atul Gawande
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francis Moore
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F. Krane
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S. Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tao Yang
- Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Erik K. Alexander
- Thyroid Unit, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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16
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Kwong N, Medici M, Angell TE, Liu X, Marqusee E, Cibas ES, Krane JF, Barletta JA, Kim MI, Larsen PR, Alexander EK. The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk. J Clin Endocrinol Metab 2015; 100:4434-40. [PMID: 26465395 PMCID: PMC4667162 DOI: 10.1210/jc.2015-3100] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although advancing age is known to influence the formation of thyroid nodules, the precise relationship remains unclear. Furthermore, it is uncertain whether age influences the risk that any thyroid nodule may prove cancerous. AIM The aim was to determine the impact of patient age on nodule formation, multinodularity, and risk of thyroid malignancy. METHOD We conducted a prospective cohort analysis of consecutive adults (ages 20-95 y) who presented for evaluation of nodular disease from 1995 to 2011. A total of 6391 patients underwent ultrasound and fine-needle aspiration of 12 115 nodules ≥ 1 cm. Patients were divided into six age groups and compared using sonographic, cytological, and histological endpoints. RESULT The prevalence of thyroid nodular disease increases with advancing age. The mean number of nodules at presentation increased from 1.5 in the youngest cohort (age, 20-30 y) to 2.2 in the oldest cohort (age, >70 y; P < .001), demonstrating a 1.6% annual increased risk for multinodularity (odds ratio, 1.02; P < .001). In contrast, the risk of malignancy in a newly identified nodule declined with advancing age. Thyroid cancer incidence per patient was 22.9% in the youngest cohort, but 12.6% in the oldest cohort (odds ratio, 0.972; P < .001), demonstrating a 2.2% decrease per year in the relative risk of malignancy between ages 20 and 60 years, which stabilized thereafter. Despite a lower likelihood of malignancy, identified cancers in older patients demonstrated higher risk histological phenotypes. Although nearly all malignancies in younger patients were well-differentiated, older patients were more likely to have higher risk papillary thyroid carcinoma variants, poorly differentiated cancer, or anaplastic carcinoma (P < .001). CONCLUSION With advancing age, the prevalence of clinically relevant thyroid nodules increases, whereas the risk that such nodules are malignant decreases. Nonetheless, when thyroid cancer is detected in older individuals, a higher-risk histological phenotype is more likely. These data provide insight into the clinical paradox that confronts physicians managing this common illness.
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Affiliation(s)
- Norra Kwong
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Marco Medici
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Trevor E Angell
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Xiaoyun Liu
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Edmund S Cibas
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Jeffrey F Krane
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Justine A Barletta
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (N.K., M.M., T.E.A., X.L., E.M., P.R.L., M.I.K., E.K.A.), and Department of Pathology (E.S.C., J.F.K., J.A.B.), The Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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17
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Affiliation(s)
- P Reed Larsen
- Brigham and Women's Hospital, Division of Endocrinology, Diabetes and Hypertension, 77 Avenue Louis Pasteur, HIM 641, Boston, MA 02115, USA
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18
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Luongo C, Martin C, Vella K, Marsili A, Ambrosio R, Dentice M, Harney JW, Salvatore D, Zavacki AM, Larsen PR. The selective loss of the type 2 iodothyronine deiodinase in mouse thyrotrophs increases basal TSH but blunts the thyrotropin response to hypothyroidism. Endocrinology 2015; 156:745-54. [PMID: 25456070 PMCID: PMC4298316 DOI: 10.1210/en.2014-1698] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/25/2014] [Indexed: 12/27/2022]
Abstract
The type 2 iodothyronine deiodinase (D2) is essential for feedback regulation of TSH by T4. We genetically inactivated in vivo D2 in thyrotrophs using a mouse model of Cga-driven cre recombinase. Pituitary D2 activity was reduced 90% in the Cga-cre D2 knockout (KO) mice compared with control Dio2(fl/fl) mice. There was no growth or reproductive phenotype. Basal TSH levels were increased 1.5- to 1.8-fold, but serum T4 and T3 were not different from the controls in adult mice. In hypothyroid adult mice, suppression of TSH by T4, but not T3, was impaired. Despite mild basal TSH elevation, the TSH increase in response to hypothyroidism was 4-fold reduced in the Cga-cre D2KO compared with control mice despite an identical level of pituitary TSH α- and β-subunit mRNAs. In neonatal Cga-cre D2KO mice, TSH was also 2-fold higher than in the controls, but serum T4 was elevated. Despite a constant TSH, serum T4 increased 2-3-fold between postnatal day (P) 5 and P15 in both genotypes. The pituitary, but not cerebrocortical, D2 activity was markedly elevated in P5 mice decreasing towards adult levels by P17. In conclusion, a congenital severe reduction of thyrotroph D2 causes a major impairment of the TSH response to hypothyroidism. This would be deleterious to the compensatory adaptation of the thyroid gland to iodine deficiency.
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Affiliation(s)
- Cristina Luongo
- Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine (C.L., C.M., A.M., J.W.H., A.M.Z., P.R.L.), Brigham and Women's Hospital and Harvard Medical School, and Division of Endocrinology, Diabetes, and Metabolism (K.V.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Studio di Diagnostica Nucleare "SDN" (R.A.), 80142 Naples, Italy; and Department of Clinical Medicine and Surgery (M.D., D.S.), University of Naples Federico II, 80131 Naples, Italy
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19
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Dentice M, Ambrosio R, Damiano V, Sibilio A, Luongo C, Guardiola O, Yennek S, Zordan P, Minchiotti G, Colao A, Marsili A, Brunelli S, Del Vecchio L, Larsen PR, Tajbakhsh S, Salvatore D. Intracellular inactivation of thyroid hormone is a survival mechanism for muscle stem cell proliferation and lineage progression. Cell Metab 2014; 20:1038-48. [PMID: 25456740 PMCID: PMC4261081 DOI: 10.1016/j.cmet.2014.10.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/17/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022]
Abstract
Precise control of the thyroid hormone (T3)-dependent transcriptional program is required by multiple cell systems, including muscle stem cells. Deciphering how this is achieved and how the T3 signal is controlled in stem cell niches is essentially unknown. We report that in response to proliferative stimuli such as acute skeletal muscle injury, type 3 deiodinase (D3), the thyroid hormone-inactivating enzyme, is induced in satellite cells where it reduces intracellular thyroid signaling. Satellite cell-specific genetic ablation of dio3 severely impairs skeletal muscle regeneration. This impairment is due to massive satellite cell apoptosis caused by exposure of activated satellite cells to the circulating TH. The execution of this proapoptotic program requires an intact FoxO3/MyoD axis, both genes positively regulated by intracellular TH. Thus, D3 is dynamically exploited in vivo to chronically attenuate TH signaling under basal conditions while also being available to acutely increase gene programs required for satellite cell lineage progression.
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Affiliation(s)
- Monica Dentice
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | | | - Valentina Damiano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Annarita Sibilio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Cristina Luongo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Ombretta Guardiola
- Stem Cell Fate Laboratory, Institute of Genetics and Biophysics "A. Buzzati-Traverso," CNR, Naples 80131, Italy
| | - Siham Yennek
- Stem Cells & Development, Pasteur Institute, Paris 75015, France
| | - Paola Zordan
- Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Milano 20132, Italy
| | - Gabriella Minchiotti
- Stem Cell Fate Laboratory, Institute of Genetics and Biophysics "A. Buzzati-Traverso," CNR, Naples 80131, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Silvia Brunelli
- Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Milano 20132, Italy; Dipartimento Scienze della Salute, Milano-Bicocca University, Milano 20126, Italy
| | | | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | | | - Domenico Salvatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy; CEINGE-Biotecnologie Avanzate Scarl, Naples 80131, Italy.
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Kwong N, Marqusee E, Gordon MS, Larsen PR, Garber JR, Kim MI, Alexander EK. Long-term, treatment-free survival in select patients with distant metastatic papillary thyroid cancer. Endocr Connect 2014; 3:207-14. [PMID: 25316293 PMCID: PMC4220299 DOI: 10.1530/ec-14-0097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Well-differentiated thyroid carcinoma (WDTC) generally has a favorable prognosis. However, patients with distant metastatic disease experience progression of disease with a higher mortality. A subset of patients not previously described may challenge the conventional dogma regarding the progressive nature of all metastatic WDTC. Through analysis of our database, we identified patients with distant metastatic WDTC and persistent, minimally progressive disease. In all patients, persistent metastatic disease was confirmed via tissue biopsy, abnormal PET scan, and/or biochemical elevations in thyroglobulin or antibody levels. Progression of disease was monitored clinically and with repeat imaging. We describe five patients with WDTC and pulmonary metastases, aged 8-43 years at diagnosis. All patients underwent initial surgery and radioactive iodine (RAI) ablation, with some receiving multiple treatments. Persistent pulmonary metastatic disease was confirmed over decades (mean 22 years, range 8-42 years) with minimal progression despite no further treatment beyond thyroid hormone suppression. Persistent disease was biopsy-proven in all patients at a mean of 9.6 years from last RAI treatment. All patients had elevated thyroglobulin or anti-thyroglobulin antibody levels, while three demonstrated metabolically active disease with positive FDG uptake on PET scan, and one patient with persistent radioactive iodine avid pulmonary metastasis 36 years after her last RAI treatment. This case series demonstrates that some patients with distant metastases, even if metabolically active and radioactive iodine resistant, remain stable for decades without further treatment. Clinical awareness of such patients and continual reassessment of disease risk following initial therapy are crucial as aggressive treatment may not be necessary.
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Affiliation(s)
- Norra Kwong
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Ellen Marqusee
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Michael S Gordon
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - P Reed Larsen
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Jeffrey R Garber
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Matthew I Kim
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Erik K Alexander
- Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA
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Vidart J, Wajner SM, Leite RS, Manica A, Schaan BD, Larsen PR, Maia AL. N-acetylcysteine administration prevents nonthyroidal illness syndrome in patients with acute myocardial infarction: a randomized clinical trial. J Clin Endocrinol Metab 2014; 99:4537-45. [PMID: 25148231 PMCID: PMC4255112 DOI: 10.1210/jc.2014-2192] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 12/26/2022]
Abstract
CONTEXT The acute phase of the nonthyroidal illness syndrome (NTIS) is characterized by low T3 and high rT3 levels, affecting up to 75% of critically ill patients. Oxidative stress has been implicated as a causative factor of the disturbed peripheral thyroid hormone metabolism. OBJECTIVE The objective of the study was to investigate whether N-acetylcysteine (NAC), a potent intracellular antioxidant, can prevent NTIS in patients with acute myocardial infarction. DESIGN This was a randomized, multicenter clinical trial. SETTINGS Consecutive patients admitted to the emergency and intensive care units of two tertiary hospitals in southern Brazil were recruited. Patients and intervention included 67 patients were randomized to receive NAC or placebo during 48 hours. Baseline characteristics and blood samples for thyroid hormones and oxidative parameters were collected. MAIN OUTCOME Variation of serum T3 and rT3 levels was measured. RESULTS Baseline characteristics were similar between groups (all P > .05). T3 levels decreased in the placebo group at 12 hours of follow-up (P = .002) but not in NAC-treated patients (P = .10). Baseline rT3 levels were elevated in both groups and decreased over the initial 48 hours in the NAC-treated patients (P = .003) but not in the control group (P = .75). The free T4 and TSH levels were virtually identical between the groups throughout the study period (P > .05). Measurement of total antioxidant status and total carbonyl content demonstrated that oxidative balance was deranged in acute myocardial infarction patients, whereas NAC corrected these alterations (P < .001). CONCLUSIONS NAC administration prevents the derangement in thyroid hormone concentrations commonly occurring in the acute phase of acute myocardial infarction, indicating that oxidative stress is involved in the NTIS pathophysiology.
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Affiliation(s)
- Josi Vidart
- Thyroid Unit (J.V., S.M.W., B.D.S., A.L.M.), Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, CEP 90620-000, Porto Alegre, RS, Brasil; Instituto de Cardiologia do RS/Fundação Universitária de Cardiologia (R.S.L., A.M.); and Division of Endocrinology, Diabetes, and Hypertension (P.R.L.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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22
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Zevenbergen C, Klootwijk W, Peeters RP, Medici M, de Rijke YB, Huisman SA, Goeman H, Boot E, de Kuijper G, de Waal KH, Meima ME, Larsen PR, Visser TJ, Visser WE. Functional analysis of novel genetic variation in the thyroid hormone activating type 2 deiodinase. J Clin Endocrinol Metab 2014; 99:E2429-36. [PMID: 25140401 DOI: 10.1210/jc.2014-2281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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 Thyroid hormones (TH) are important for normal brain development and abnormal TH regulation in the brain results in neurocognitive impairments. The type 2 deiodinase (D2) is important for local TH control in the brain by generating the active hormone T3 from its precursor T4. Dysfunction of D2 likely results in a neurocognitive phenotype. No mutations in D2 have been reported yet. OBJECTIVE The objective of the study was to identify D2 mutations in patients with intellectual disability and to test their functional consequences. DESIGN, SETTING, AND PATIENTS The patients were selected from the multicenter Thyroid Origin of Psychomotor Retardation study, which is a cohort of 946 subjects with unexplained intellectual disability. Based on characteristic serum TH values, the coding region of the DIO2 gene was sequenced in 387 patients. Functional consequences were assessed by in vitro D2 assays or intact cell metabolism studies using cells transfected with wild-type or mutant D2. RESULTS Sequence analysis revealed two heterozygous mutations: c.11T>A (p.L4H) in three subjects and c.305C>T (p.T102I) in one subject. Sequence analysis of family members revealed several carriers, but no segregation was observed with thyroid parameters or neurocognitive phenotype. Extensive tests with different in vitro D2 assays did not show differences between wild-type and mutant D2. CONCLUSION This study describes the identification and functional consequences of novel genetic variation in TH activating enzyme D2. Family studies and functional tests suggest that these variants do not underlie the neurocognitive impairment. Altogether our data provide evidence of the existence of rare but apparently harmless genetic variants of D2.
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Affiliation(s)
- Chantal Zevenbergen
- Department of Internal Medicine (C.Z., W.K., R.P.P., M.M., Y.B.d.R., M.E.M., T.J.V., W.E.V.), Rotterdam Thyroid Center (C.Z., W.K., R.P.P., M.M., M.E.M., T.J.V., W.E.V.), Department of Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Prinsenstichting (S.A.H.), Kwadijkerpark 8, 1444 JE Purmerend, The Netherlands; Ipse De Bruggen (H.G., E.B.), Spoorlaan 19, 2471 PB Zwammerdam, The Netherlands; Vanboeijenoord (G.d.K.), Industrieweg 14-16, 9400 RA Assen, The Netherlands; 's Heeren Loo Groot Schuilenburg (K.H.d.W.), Laan Van Groot Schuylenburg 310-320, 7325 BG Apeldoorn, The Netherlands; and Department of Internal Medicine (R.L.), Brigham and Women's Hospital, Boston, Massachusetts 02115
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23
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Wittmann G, Harney JW, Singru PS, Nouriel SS, Reed Larsen P, Lechan RM. Inflammation-inducible type 2 deiodinase expression in the leptomeninges, choroid plexus, and at brain blood vessels in male rodents. Endocrinology 2014; 155:2009-19. [PMID: 24601886 PMCID: PMC3990842 DOI: 10.1210/en.2013-2154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/23/2014] [Indexed: 11/19/2022]
Abstract
Thyroid hormone regulates immune functions and has antiinflammatory effects. In promoter assays, the thyroid hormone-activating enzyme, type 2 deiodinase (D2), is highly inducible by the inflammatory transcription factor nuclear factor-κ B (NF-κB), but it is unknown whether D2 is induced in a similar fashion in vivo during inflammation. We first reexamined the effect of bacterial lipopolysaccharide (LPS) on D2 expression and NF-κB activation in the rat and mouse brain using in situ hybridization. In rats, LPS induced very robust D2 expression in normally non-D2-expressing cells in the leptomeninges, adjacent brain blood vessels, and the choroid plexus. These cells were vimentin-positive fibroblasts and expressed the NF-κB activation marker, inhibitor κ B-α mRNA, at 2 hours after injection, before the increase in D2 mRNA. In mice, LPS induced intense D2 expression in the choroid plexus but not in leptomeninges, with an early expression peak at 2 hours. Moderate D2 expression along numerous brain blood vessels appeared later. D2 and NF-κB activation was induced in tanycytes in both species but with a different time course. Enzymatic assays from leptomeningeal and choroid plexus samples revealed exceptionally high D2 activity in LPS-treated rats and Syrian hamsters and moderate but significant increases in mice. These data demonstrate the cell type-specific, highly inducible nature of D2 expression by inflammation, and NF-κB as a possible initiating factor, but also warrant attention for species differences. The results suggest that D2-mediated T₃ production by fibroblasts regulate local inflammatory actions in the leptomeninges, choroid plexus and brain blood vessels, and perhaps also in other organs.
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Affiliation(s)
- Gábor Wittmann
- Department of Medicine (G.W., P.S.S., S.S.N., R.M.L.), Division of Endocrinology, Diabetes and Metabolism, Tupper Research Institute, Tufts Medical Center, and Department of Neuroscience (R.M.L.), Tufts University School of Medicine, Boston, Massachusetts 02111; Thyroid Section (J.W.H., P.R.L.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115; and School of Biological Sciences (P.S.S.), National Institute of Science Education and Research, Institute of Physics Campus, PO Sainik School, Bhubaneswar-751005, India
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24
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Maynard MA, Marino-Enriquez A, Fletcher JA, Dorfman DM, Raut CP, Yassa L, Guo C, Wang Y, Dorfman C, Feldman HA, Frates MC, Song H, Jugo RH, Taguchi T, Hershman JM, Larsen PR, Huang SA. Thyroid hormone inactivation in gastrointestinal stromal tumors. N Engl J Med 2014; 370:1327-34. [PMID: 24693892 PMCID: PMC4186889 DOI: 10.1056/nejmoa1308893] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are resistant to traditional chemotherapy but are responsive to the tyrosine kinase inhibitors imatinib and sunitinib. The use of these agents has improved the outcome for patients but is associated with adverse effects, including hypothyroidism. Multiple mechanisms of this effect have been proposed, including decreased iodine organification and glandular capillary regression. Here we report the finding of consumptive hypothyroidism caused by marked overexpression of the thyroid hormone-inactivating enzyme type 3 iodothyronine deiodinase (D3) within the tumor. Affected patients warrant increased monitoring and may require supernormal thyroid hormone supplementation.
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Affiliation(s)
- Michelle A Maynard
- From the Thyroid Program of the Division of Endocrinology (M.A.M., C.G., C.D., H.S., R.H.J., S.A.H.) and the Clinical Research Center (H.A.F.), Boston Children's Hospital, the Departments of Pathology (A.M.-E., J.A.F., D.M.D., Y.W.), Surgery (C.P.R.), and Radiology (M.C.F.), and the Thyroid Section of the Division of Endocrinology, Diabetes, and Hypertension (L.Y., P.R.L., S.A.H.), Brigham and Women's Hospital, and the Dana-Farber Cancer Institute (J.A.F., C.P.R., P.R.L., S.A.H.) - all in Boston; the Department of Neurobiology and Anatomy, Kochi Medical School, Nankoku, Japan (T.T.); and the Endocrinology and Diabetes Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (J.M.H.)
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25
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Abstract
Thyroid hormone signalling regulates crucial biological functions, including energy expenditure, thermogenesis, development and growth. The skeletal muscle is a major target of thyroid hormone signalling. The type 2 and 3 iodothyronine deiodinases (DIO2 and DIO3, respectively) have been identified in skeletal muscle. DIO2 expression is tightly regulated and catalyses outer-ring monodeiodination of the secreted prohormone tetraiodothyronine (T4) to generate the active hormone tri-iodothyronine (T3). T3 can remain in the myocyte to signal through nuclear receptors or exit the cell to mix with the extracellular pool. By contrast, DIO3 inactivates T3 through removal of an inner-ring iodine. Regulation of the expression and activity of deiodinases constitutes a cell-autonomous, pre-receptor mechanism for controlling the intracellular concentration of T3. This local control of T3 activity is crucial during the various phases of myogenesis. Here, we review the roles of T3 in skeletal muscle development and homeostasis, with a focus on the emerging local deiodinase-mediated control of T3 signalling. Moreover, we discuss these novel findings in the context of both muscle homeostasis and pathology, and examine how skeletal muscle deiodinase activity might be therapeutically harnessed to improve satellite-cell-mediated muscle repair in patients with skeletal muscle disorders, muscle atrophy or injury.
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Affiliation(s)
- Domenico Salvatore
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Building 1, 1st floor, Via Pansini 5, 80131 Naples, Italy
| | - Warner S Simonides
- Laboratory for Physiology, Institute for Cardiovascular Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Monica Dentice
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Building 1, 1st floor, Via Pansini 5, 80131 Naples, Italy
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, HIM room 641, Boston, MA 02115, USA
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, HIM room 641, Boston, MA 02115, USA
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26
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Hong EG, Kim BW, Jung DY, Kim JH, Yu T, Seixas Da Silva W, Friedline RH, Bianco SD, Seslar SP, Wakimoto H, Berul CI, Russell KS, Lee KW, Larsen PR, Bianco AC, Kim JK. Cardiac expression of human type 2 iodothyronine deiodinase increases glucose metabolism and protects against doxorubicin-induced cardiac dysfunction in male mice. Endocrinology 2013; 154:3937-46. [PMID: 23861374 PMCID: PMC4411365 DOI: 10.1210/en.2012-2261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/09/2013] [Indexed: 12/16/2022]
Abstract
Altered glucose metabolism in the heart is an important characteristic of cardiovascular and metabolic disease. Because thyroid hormones have major effects on peripheral metabolism, we examined the metabolic effects of heart-selective increase in T3 using transgenic mice expressing human type 2 iodothyronine deiodinase (D2) under the control of the α-myosin heavy chain promoter (MHC-D2). Hyperinsulinemic-euglycemic clamps showed normal whole-body glucose disposal but increased hepatic insulin action in MHC-D2 mice as compared to wild-type (WT) littermates. Insulin-stimulated glucose uptake in heart was not altered, but basal myocardial glucose metabolism was increased by more than two-fold in MHC-D2 mice. Myocardial lipid levels were also elevated in MHC-D2 mice, suggesting an overall up-regulation of cardiac metabolism in these mice. The effects of doxorubicin (DOX) treatment on cardiac function and structure were examined using M-mode echocardiography. DOX treatment caused a significant reduction in ventricular fractional shortening and resulted in more than 50% death in WT mice. In contrast, MHC-D2 mice showed increased survival rate after DOX treatment, and this was associated with a six-fold increase in myocardial glucose metabolism and improved cardiac function. Myocardial activity and expression of AMPK, GLUT1, and Akt were also elevated in MHC-D2 and WT mice following DOX treatment. Thus, our findings indicate an important role of thyroid hormone in cardiac metabolism and further suggest a protective role of glucose utilization in DOX-mediated cardiac dysfunction.
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Affiliation(s)
- Eun-Gyoung Hong
- University of Massachusetts Medical School, Program in Molecular Medicine, 368 Plantation Street, Sherman Center, AS9.1041, Worcester, Massachusetts 01605.
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27
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Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, Feldman HA, Wassner AJ, Smith JR, Marqusee E, Alexander EK, Barletta J, Doubilet PM, Peters HE, Webb S, Modi BP, Paltiel HJ, Kozakewich H, Cibas ES, Moore FD, Shamberger RC, Larsen PR, Huang SA. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab 2013; 98:3238-45. [PMID: 23737541 PMCID: PMC3733863 DOI: 10.1210/jc.2013-1796] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Thyroid cancer is the most common endocrine malignancy, but due to its rare occurrence in the pediatric population, the cancer risk of childhood thyroid nodules is incompletely defined, and optimal management of children with suspected nodules is debated. OBJECTIVE The aim was to study the presenting features and cancer risk of sporadic childhood thyroid nodules using a standardized clinical assessment and management plan. DESIGN AND SETTING Boston Children's Hospital and Brigham and Women's Hospital collaborated to create a multidisciplinary pediatric thyroid nodule clinic and implement a standardized assessment plan. Upon referral for a suspected nodule, serum TSH was measured and hypothyrotropinemic patients underwent (123)I scintigraphy. All others underwent thyroid ultrasonography, and if this confirmed nodule(s) ≥ 1 cm, ultrasound-guided fine-needle aspiration was performed. Medical records were retrospectively reviewed and compared to a control population of 2582 adults evaluated by identical methods. PATIENTS AND RESULTS Of 300 consecutive children referred for the initial evaluation of suspected thyroid nodules from 1997 to 2011, 17 were diagnosed with autonomous nodules by scintigraphy. Neck ultrasonography performed in the remainder revealed that biopsy was unnecessary in over half, either by documenting only sub-centimeter nodules or showing that no nodule was present. A total of 125 children met criteria for thyroid biopsy, which was performed without complication. Their rate of cancer was 22%, significantly higher than the adult rate of 14% (P = .02). CONCLUSIONS Neck ultrasonography and biopsy were key to the evaluation of children with suspected thyroid nodules. Although the relative cancer prevalence of sonographically confirmed nodules ≥ 1 cm is higher in pediatric patients than adults, most children referred for suspected nodules have benign conditions, and efforts to avoid unnecessary surgery in this majority are warranted.
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Affiliation(s)
- Anjuli Gupta
- Thyroid Program of the Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115, USA
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28
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Zavacki AM, Larsen PR. RTHα, a newly recognized phenotype of the resistance to thyroid hormone (RTH) syndrome in patients with THRA gene mutations. J Clin Endocrinol Metab 2013; 98:2684-6. [PMID: 23837191 PMCID: PMC3701265 DOI: 10.1210/jc.2013-2475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Aguayo-Mazzucato C, Zavacki AM, Marinelarena A, Hollister-Lock J, El Khattabi I, Marsili A, Weir GC, Sharma A, Larsen PR, Bonner-Weir S. Thyroid hormone promotes postnatal rat pancreatic β-cell development and glucose-responsive insulin secretion through MAFA. Diabetes 2013; 62:1569-80. [PMID: 23305647 PMCID: PMC3636623 DOI: 10.2337/db12-0849] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neonatal β cells do not secrete glucose-responsive insulin and are considered immature. We previously showed the transcription factor MAFA is key for the functional maturation of β cells, but the physiological regulators of this process are unknown. Here we show that postnatal rat β cells express thyroid hormone (TH) receptor isoforms and deiodinases in an age-dependent pattern as glucose responsiveness develops. In vivo neonatal triiodothyronine supplementation and TH inhibition, respectively, accelerated and delayed metabolic development. In vitro exposure of immature islets to triiodothyronine enhanced the expression of Mafa, the secretion of glucose-responsive insulin, and the proportion of responsive cells, all of which are effects that were abolished in the presence of dominant-negative Mafa. Using chromatin immunoprecipitation and electrophoretic mobility shift assay, we show that TH has a direct receptor-ligand interaction with the Mafa promoter and, using a luciferase reporter, that this interaction was functional. Thus, TH can be considered a physiological regulator of functional maturation of β cells via its induction of Mafa.
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Affiliation(s)
- Cristina Aguayo-Mazzucato
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alejandra Marinelarena
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Hollister-Lock
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Ilham El Khattabi
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gordon C. Weir
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Arun Sharma
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - P. Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Bonner-Weir
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Corresponding author: Susan Bonner-Weir,
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30
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Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, Benson CB, Doubilet PM, Cibas ES, Barletta J, Cho N, Gawande A, Ruan D, Moore FD, Pou K, Larsen PR, Alexander EK. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013; 98:564-70. [PMID: 23275525 DOI: 10.1210/jc.2012-2968] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [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: 02/01/2023]
Abstract
CONTEXT Thyroid nodule size is routinely measured, although its impact on thyroid cancer risk is unclear. OBJECTIVE Our objective was to evaluate the association of nodule size upon cancer risk. DESIGN, SETTING, AND PATIENTS We conducted a retrospective cohort analysis at an academic hospital with 4955 consecutive patients evaluated between 1995 and 2009. INTERVENTION Ultrasound and ultrasound-guided fine-needle aspiration of nodules >1 cm was done. Indeterminate and malignant nodules were referred for surgery, and histopathology was reviewed. MAIN OUTCOME MEASURE The presence and histological subtype of cancer was evaluated. RESULTS Of 7348 evaluated nodules, 927 (13%) were cancerous. Of those 1.0 to 1.9 cm in diameter, 10.5% were cancerous. In contrast, of those >2.0 cm, 15% were cancerous (P < .01). However, nodules 2.0 to 2.9, 3.0 to 3.9, and >4 cm were cancerous in 14%, 16%, and 15% of cases (P = .14), respectively, demonstrating no graded increase in risk beyond the 2-cm threshold. When malignant, the proportion of papillary carcinoma decreased (nodules 1.0-1.9 cm, 92% of cases; 2.0-2.9 cm, 88%; 3.0-3.9 cm, 83%; >4 cm, 74% [P < .01]), while follicular carcinoma increased (1.0-1.9 cm, 6%; 2.0-2.9 cm, 7%; 3.0-3.9 cm, 12%; >4 cm, 16% [P < .01]) as nodules enlarged. Nodules size did not influence cytology distribution or risk of false-negative aspirates. CONCLUSIONS Increasing thyroid nodule size impacts cancer risk in a nonlinear fashion. A threshold is detected at 2.0 cm, beyond which cancer risk is unchanged. However, the risk of follicular carcinomas and other rare thyroid malignancies increases as nodules enlarge.
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Affiliation(s)
- Sophia C Kamran
- Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, 75 Francis Street, PBB-B4, Room 417, Boston, Massachusetts 02115, USA
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31
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Dentice M, Luongo C, Ambrosio R, Sibilio A, Casillo A, Iaccarino A, Troncone G, Fenzi G, Larsen PR, Salvatore D. β-Catenin regulates deiodinase levels and thyroid hormone signaling in colon cancer cells. Gastroenterology 2012; 143:1037-47. [PMID: 22771508 DOI: 10.1053/j.gastro.2012.06.042] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [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] [Received: 10/17/2011] [Revised: 05/18/2012] [Accepted: 06/29/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Activation of the β-catenin/T-cell factor (TCF) complex occurs in most colon tumors, and its actions correlate with the neoplastic phenotype of intestinal epithelial cells. Type 3 deiodinase (D3), the selenoenzyme that inactivates thyroid hormone (3,5,3' triiodothyronine [T3]), is frequently expressed by tumor cells, but little is known about its role in the regulation of T3 signaling in cancer cells. METHODS We measured D3 expression in 6 colon cancer cell lines and human tumors and correlated it with the activity of the β-catenin/TCF complex. We also determined the effects of D3 loss on local thyroid hormone signaling and colon tumorigenesis. RESULTS We show that D3 is a direct transcriptional target of the β-catenin/TCF complex; its expression was higher in human intestinal adenomas and carcinomas than in healthy intestinal tissue. Experimental attenuation of β-catenin reduced D3 levels and induced type 2 deiodinase (the D3 antagonist that converts 3,5,3',5' tetraiodothyronine into active T3) thereby increasing T3-dependent transcription. In the absence of D3, excess T3 reduced cell proliferation and promoted differentiation in cultured cells and in xenograft mouse models. This occurred via induction of E-cadherin, which sequestered β-catenin at the plasma membrane and promoted cell differentiation. CONCLUSIONS Deiodinases are at the interface between the β-catenin and the thyroid hormone pathways. Their synchronized regulation of intracellular T3 concentration is a hitherto unrecognized route by which the multiple effects of β-catenin are generated and may be targeted to reduce the oncogenic effects of β-catenin in intestinal cells.
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Affiliation(s)
- Monica Dentice
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples "Federico II," Naples, Italy
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32
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Zhu B, Shrivastava A, Luongo C, Chen T, Harney JW, Marsili A, Tran TV, Bhadouria A, Mopala R, Steen AI, Larsen PR, Zavacki AM. Catalysis leads to posttranslational inactivation of the type 1 deiodinase and alters its conformation. J Endocrinol 2012; 214:87-94. [PMID: 22544951 PMCID: PMC3612969 DOI: 10.1530/joe-11-0459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 12/29/2022]
Abstract
Previously, it was shown that the type 1 deiodinase (D1) is subject to substrate-dependent inactivation that is blocked by pretreatment with the inhibitor of D1 catalysis, propylthiouracil (PTU). Using HepG2 cells with endogenous D1 activity, we found that while considerable D1-mediated catalysis of reverse tri-iodothyronine (rT(3)) is observed in intact cells, there was a significant loss of D1 activity in sonicates assayed from the same cells in parallel. This rT(3)-mediated loss of D1 activity occurs despite no change in D1 mRNA levels and is blocked by PTU treatment, suggesting a requirement for catalysis. Endogenous D1 activity in sonicates was inactivated in a dose-dependent manner in HepG2 cells, with a ∼50% decrease after 10 nM rT(3) treatment. Inactivation of D1 was rapid, occurring after only half an hour of rT(3) treatment. D1 expressed in HEK293 cells was inactivated by rT(3) in a similar manner. (75)Se labeling of the D1 selenoprotein indicated that after 4 h rT(3)-mediated inactivation of D1 occurs without a corresponding decrease in D1 protein levels, though rT(3) treatment causes a loss of D1 protein after 8-24 h. Bioluminescence resonance energy transfer studies indicate that rT(3) exposure increases energy transfer between the D1 homodimer subunits, and this was lost when the active site of D1 was mutated to alanine, suggesting that a post-catalytic structural change in the D1 homodimer could cause enzyme inactivation. Thus, both D1 and type 2 deiodinase are subject to catalysis-induced loss of activity although their inactivation occurs via very different mechanisms.
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Affiliation(s)
- Bo Zhu
- Division of Endocrinology, Diabetes and Hypertension, Thyroid Section, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Dentice M, Marsili A, Zavacki A, Larsen PR, Salvatore D. The deiodinases and the control of intracellular thyroid hormone signaling during cellular differentiation. Biochim Biophys Acta Gen Subj 2012; 1830:3937-45. [PMID: 22634734 PMCID: PMC3670672 DOI: 10.1016/j.bbagen.2012.05.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 12/04/2022]
Abstract
Background Thyroid hormone influences gene expression in virtually all vertebrates. Its action is initiated by the activation of T4 to T3, an outer ring deiodination reaction that is catalyzed by the type 1 or the type 2 iodothyronine selenodeiodinases (D1 or D2). Inactivation of T4 and T3 occurs via inner ring deiodination catalyzed by the type 3 iodothyronine selenodeiodinases (D3). The T4 concentration is generally quite stable in human plasma, with T3 levels also remaining constant. Deiodinase actions are tightly regulated in both pre- and post-natal life when they are required to make local adjustments of intracellular T3 concentrations in a precise spatio- and temporal manner. Although all the signals governing the dynamic expression of deiodinases in specific cell types are not known, many important regulatory factors have been deciphered. Scope of review This review provides striking examples from the recent literature illustrating how the expression of D2 and D3 is finely tuned during maturation of different organs, and how their action play a critical role in different settings to control intracellular T3 availability. Major conclusions Emerging evidence indicates that in various cell contexts, D2 and D3 are expressed in a dynamic balance, in which the expression of one enzyme is coordinately regulated with that of the other to tightly control intracellular T3 levels commensurate with cell requirements at that time. General significance Deiodinases control TH action in a precise spatio-temporal fashion thereby providing a novel mechanism for the local paracrine and autocrine regulation of TH action. This remarkable tissue-specific regulation of intracellular thyroid status remains hidden due to the maintenance of constant circulating TH concentrations by the hypothalamic–pituitary–thyroid axis. This article is part of a Special Issue entitled Thyroid hormone signalling.
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Affiliation(s)
- Monica Dentice
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Italy
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Larsen PR, Zavacki AM. The role of the iodothyronine deiodinases in the physiology and pathophysiology of thyroid hormone action. Eur Thyroid J 2012; 1:232-242. [PMID: 23750337 PMCID: PMC3673746 DOI: 10.1159/000343922] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/04/2012] [Indexed: 12/13/2022] Open
Abstract
Thyroxine (T4) is a prohormone and must be activated to 3,5,3' triodothyronine (T3) by either the type 1 (D1) or 2 (D2) selenodeiodinase. A third deiodinase (D3) inactivates T3 or T4 by removal of an inner ring iodine. These reactions require both a deiodinase enzyme and a cofactor, probably a thiol, to reduce the oxidized selenolyl group in the active center of each deiodinase. Thus, deiodination rates depend on both the enzyme and cofactor. The source of most of the circulating T3 is D1-mediated, while D2 provides nuclear receptor-bound hormone. Using sensitive and specific assays, it has become apparent that both D2 and D3 are widespread throughout vertebrate tissues. The complex interactions between the activating D2 and the inactivating D3 in tissues expressing these two enzymes determine the intracellular T3 concentration. This provides enormous flexibility for both developmental and tissue regeneration processes, allowing exquisite control of intracellular T3 concentrations. The endogenous factors regulating the activity of these enzymes, such as the hedgehog proteins, FoxO3, or the wnt/β catenin pathway together with the actions of thyroid hormone transporters, direct adjustments of nuclear receptor bound T3 which in turn can control the balance between cellular proliferation and differentiation. Their actions provide dynamic flexibility to what appears on the surface to be a very static hormonal system.
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Affiliation(s)
- P. Reed Larsen
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Institutes of Medicine, Boston, Mass., USA
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Patwari P, Emilsson V, Schadt EE, Chutkow WA, Lee S, Marsili A, Zhang Y, Dobrin R, Cohen DE, Larsen PR, Zavacki AM, Fong LG, Young SG, Lee RT. The arrestin domain-containing 3 protein regulates body mass and energy expenditure. Cell Metab 2011; 14:671-83. [PMID: 21982743 PMCID: PMC3216113 DOI: 10.1016/j.cmet.2011.08.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 04/29/2011] [Accepted: 08/24/2011] [Indexed: 10/16/2022]
Abstract
A human genome-wide linkage scan for obesity identified a linkage peak on chromosome 5q13-15. Positional cloning revealed an association of a rare haplotype to high body-mass index (BMI) in males but not females. The risk locus contains a single gene, "arrestin domain-containing 3" (ARRDC3), an uncharacterized α-arrestin. Inactivating Arrdc3 in mice led to a striking resistance to obesity, with greater impact on male mice. Mice with decreased ARRDC3 levels were protected from obesity due to increased energy expenditure through increased activity levels and increased thermogenesis of both brown and white adipose tissues. ARRDC3 interacted directly with β-adrenergic receptors, and loss of ARRDC3 increased the response to β-adrenergic stimulation in isolated adipose tissue. These results demonstrate that ARRDC3 is a gender-sensitive regulator of obesity and energy expenditure and reveal a surprising diversity for arrestin family protein functions.
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Affiliation(s)
- Parth Patwari
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Marsili A, Tang D, Harney JW, Singh P, Zavacki AM, Dentice M, Salvatore D, Larsen PR. Type II iodothyronine deiodinase provides intracellular 3,5,3'-triiodothyronine to normal and regenerating mouse skeletal muscle. Am J Physiol Endocrinol Metab 2011; 301:E818-24. [PMID: 21771965 PMCID: PMC3214000 DOI: 10.1152/ajpendo.00292.2011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 06/14/2011] [Accepted: 07/15/2011] [Indexed: 12/30/2022]
Abstract
The FoxO3-dependent increase in type II deiodinase (D2), which converts the prohormone thyroxine (T(4)) to 3,5,3'-triiodothyronine (T(3)), is required for normal mouse skeletal muscle differentiation and regeneration. This implies a requirement for an increase in D2-generated intracellular T(3) under these conditions, which has not been directly demonstrated despite the presence of D2 activity in skeletal muscle. We directly show that D2-mediated T(4)-to-T(3) conversion increases during differentiation in C(2)C(12) myoblast and primary cultures of mouse neonatal skeletal muscle precursor cells, and that blockade of D2 eliminates this. In adult mice given (125)I-T(4) and (131)I-T(3), the intracellular (125)I-T(3)/(131)I-T(3) ratio is significantly higher than in serum in both the D2-expressing cerebral cortex and the skeletal muscle of wild-type, but not D2KO, mice. In D1-expressing liver and kidney, the (125)I-T(3)/(131)I-T(3) ratio does not differ from that in serum. Hypothyroidism increases D2 activity, and in agreement with this, the difference in (125)I-T(3)/(131)I-T(3) ratio is increased further in hypothyroid wild-type mice but not altered in the D2KO. Notably, in wild-type but not in D2KO mice, the muscle production of (125)I-T(3) is doubled after skeletal muscle injury. Thus, D2-mediated T(4)-to-T(3) conversion generates significant intracellular T(3) in normal mouse skeletal muscle, with the increased T(3) required for muscle regeneration being provided by increased D2 synthesis, not by T(3) from the circulation.
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Affiliation(s)
- Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Unlike cytotoxic agents that indiscriminately affect rapidly dividing cells, newer antineoplastic agents such as targeted therapies and immunotherapies are associated with thyroid dysfunction. These include tyrosine kinase inhibitors, bexarotene, radioiodine-based cancer therapies, denileukin diftitox, alemtuzumab, interferon-α, interleukin-2, ipilimumab, tremelimumab, thalidomide, and lenalidomide. Primary hypothyroidism is the most common side effect, although thyrotoxicosis and effects on thyroid-stimulating hormone secretion and thyroid hormone metabolism have also been described. Most agents cause thyroid dysfunction in 20%-50% of patients, although some have even higher rates. Despite this, physicians may overlook drug-induced thyroid dysfunction because of the complexity of the clinical picture in the cancer patient. Symptoms of hypothyroidism, such as fatigue, weakness, depression, memory loss, cold intolerance, and cardiovascular effects, may be incorrectly attributed to the primary disease or to the antineoplastic agent. Underdiagnosis of thyroid dysfunction can have important consequences for cancer patient management. At a minimum, the symptoms will adversely affect the patient's quality of life. Alternatively, such symptoms can lead to dose reductions of potentially life-saving therapies. Hypothyroidism can also alter the kinetics and clearance of medications, which may lead to undesirable side effects. Thyrotoxicosis can be mistaken for sepsis or a nonendocrinologic drug side effect. In some patients, thyroid disease may indicate a higher likelihood of tumor response to the agent. Both hypothyroidism and thyrotoxicosis are easily diagnosed with inexpensive and specific tests. In many patients, particularly those with hypothyroidism, the treatment is straightforward. We therefore recommend routine testing for thyroid abnormalities in patients receiving these antineoplastic agents.
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Affiliation(s)
- Ole-Petter Riksfjord Hamnvik
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Marsili A, Sanchez E, Singru P, Harney JW, Zavacki AM, Lechan RM, Larsen PR. Thyroxine-induced expression of pyroglutamyl peptidase II and inhibition of TSH release precedes suppression of TRH mRNA and requires type 2 deiodinase. J Endocrinol 2011; 211:73-8. [PMID: 21788297 PMCID: PMC3558748 DOI: 10.1530/joe-11-0248] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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] [Indexed: 11/08/2022]
Abstract
Suppression of TSH release from the hypothyroid thyrotrophs is one of the most rapid effects of 3,3',5'-triiodothyronine (T(3)) or thyroxine (T(4)). It is initiated within an hour, precedes the decrease in TSHβ mRNA inhibition and is blocked by inhibitors of mRNA or protein synthesis. TSH elevation in primary hypothyroidism requires both the loss of feedback inhibition by thyroid hormone in the thyrotrophs and the positive effects of TRH. Another event in this feedback regulation may be the thyroid hormone-mediated induction of the TRH-inactivating pyroglutamyl peptidase II (PPII) in the hypothalamic tanycytes. This study compared the chronology of the acute effects of T(3) or T(4) on TSH suppression, TRH mRNA in the hypothalamic paraventricular nucleus (PVN), and the induction of tanycyte PPII. In wild-type mice, T(3) or T(4) caused a 50% decrease in serum TSH in hypothyroid mice by 5 h. There was no change in TRH mRNA in PVN over this interval, but there was a significant increase in PPII mRNA in the tanycytes. In mice with genetic inactivation of the type 2 iodothyronine deiodinase, T(3) decreased serum TSH and increased PPII mRNA levels, while T(4)-treatment was ineffective. We conclude that the rapid suppression of TSH in the hypothyroid mouse by T(3) occurs prior to a decrease in TRH mRNA though TRH inactivation may be occurring in the median eminence through the rapid induction of tanycyte PPII. The effect of T(4), but not T(3), requires the type 2 iodothyronine deiodinase.
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Affiliation(s)
- Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's, Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Edith Sanchez
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts 02111, USA
| | - Praful Singru
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts 02111, USA
| | - John W. Harney
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's, Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's, Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald M. Lechan
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts 02111, USA
| | - P. Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's, Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Ramadan W, Marsili A, Larsen PR, Zavacki AM, Silva JE. Type-2 iodothyronine 5'deiodinase (D2) in skeletal muscle of C57Bl/6 mice. II. Evidence for a role of D2 in the hypermetabolism of thyroid hormone receptor alpha-deficient mice. Endocrinology 2011; 152:3093-102. [PMID: 21652727 PMCID: PMC3138235 DOI: 10.1210/en.2011-0139] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/06/2011] [Indexed: 01/29/2023]
Abstract
Mice with ablation of the Thra gene have cold intolerance due to an as yet undefined defect in the activation of brown adipose tissue (BAT) uncoupling protein (UCP). They develop an alternate form of facultative thermogenesis, activated at temperatures below thermoneutrality and associated with hypermetabolism and reduced sensitivity to diet-induced obesity. A consistent finding in Thra-0/0 mice is increased type-2 iodothyronine deiodinase (D2) mRNA in skeletal muscle and other tissues. With an improved assay to measure D2 activity, we show here that this enzyme activity is increased in proportion to the mRNA and as a function of the ambient cold. The activation is mediated by the sympathetic nervous system in Thra-0/0, as it is in wild-type genotype mice, but the sympathetic nervous system effect is greater in Thra-0/0 mice. Using D2-ablated mice (Dio2-/-), we reported elsewhere and show here that, in spite of sharing a severe deficiency in BAT thermogenesis with Thra-0/0 and UCP1-knockout mice, they do not have an increase in oxygen consumption, and they gain more weight than wild-type controls when fed a high-fat diet. UCP3 mRNA is highly responsive to thyroid hormone, and it is increased in Thra-0/0 mice, particularly when fed high-fat diets. We show here that muscle UCP3 mRNA in hypothyroid Thra-0/0 mice is responsive to small dose-short regimens of T(4), indicating a role for locally, D2-generated T(3). Lastly, we show that bile acids stimulate not only BAT but also muscle D2 activity, and this is associated with stimulation of muscle UCP3 mRNA expression provided T(4) is present. These observations strongly support the concept that enhanced D2 activity in Thra-0/0 plays a critical role in their alternate form of facultative thermogenesis, stimulating increased fat oxidation by increasing local T(3) generation in skeletal muscle.
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Affiliation(s)
- W Ramadan
- Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA
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Ramadan W, Marsili A, Huang S, Larsen PR, Silva JE. Type-2 iodothyronine 5'deiodinase in skeletal muscle of C57BL/6 mice. I. Identity, subcellular localization, and characterization. Endocrinology 2011; 152:3082-92. [PMID: 21628384 PMCID: PMC3138240 DOI: 10.1210/en.2011-0137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/06/2011] [Indexed: 01/21/2023]
Abstract
RT-PCR shows that mouse skeletal muscle contains type-2 iodothyronine deiodinase (D2) mRNA. However, the D2 activity has been hard to measure. Except for newborn mice, muscle homogenates have no detectable activity. However, we have reported D2 activity in mouse muscle microsomes. As the mRNA, activity is higher in slow- than in fast-twitch muscle. We addressed here the major problems in measuring D2 activity in muscle by: homogenizing muscle in high salt to improve yield of membranous structures; separating postmitochondrial supernatant between 38 and 50% sucrose, to eliminate lighter membranes lacking D2; washing these with 0.1 M Na(2)CO(3) to eliminate additional contaminating proteins; pretreating all buffers with Chelex, to eliminate catalytic metals; and eliminating the EDTA from the assay, as this can bind iron that enhances dithiothreitol oxidation and promotes peroxidation reactions. Maximum velocity of T(3) generation by postgradient microsomes from red muscles was approximately 1100 fmol/(h · mg) protein with a Michaelis-Menten constant for T(4) of 1.5 nM. D2-specific activity of Na(2)CO(3)-washed microsomes was 6-10 times higher. The enrichment in D2 activity increased in parallel with the capacity of microsomes to load (sarco/endoplasmic reticulum Ca(2+)-ATPase) and bind Ca(2+) (calsequestrin), indicating that D2 resides in the inner sarcoplasmic reticulum, close to the nuclei. The presence of D3 in the sarcolemma suggests that the most of D2-generated T(3) acts locally. Estimates from maximum velocity, Michaelis-Menten constant, and muscle T(4) content suggest that mouse red, type-1, aerobic mouse muscle fibers can generate physiologically relevant amounts of T(3) and, further, that muscle D2 plays an important role in thyroid hormone-dependent muscle thermogenesis.
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Affiliation(s)
- W Ramadan
- Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA
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Abstract
T4 is a prohormone secreted by the thyroid. T4 has a long half life in circulation and it is tightly regulated to remain constant in a variety of circumstances. However, the availability of iodothyronine selenodeiodinases allow both the initiation or the cessation of thyroid hormone action and can result in surprisingly acute changes in the intracellular concentration of the active hormone T3, in a tissue- specific and chronologically-determined fashion, in spite of the constant circulating levels of the prohormone. This fine-tuning of thyroid hormone signaling is becoming widely appreciated in the context of situations where the rapid modifications in intracellular T3 concentrations are necessary for developmental changes or tissue repair. Given the increasing availability of genetic models of deiodinase deficiency, new insights into the role of these important enzymes are being recognized. In this review, we have incorporated new information regarding the special role played by these enzymes into our current knowledge of thyroid physiology, emphasizing the clinical significance of these new insights.
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Affiliation(s)
- Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Marie Zavacki
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - John W. Harney
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - P. Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Wajner SM, Goemann IM, Bueno AL, Larsen PR, Maia AL. IL-6 promotes nonthyroidal illness syndrome by blocking thyroxine activation while promoting thyroid hormone inactivation in human cells. J Clin Invest 2011; 121:1834-45. [PMID: 21540553 DOI: 10.1172/jci44678] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/16/2011] [Indexed: 12/19/2022] Open
Abstract
Nonthyroidal illness syndrome (NTIS) is a state of low serum 3,5,3' triiodothyronine (T₃) that occurs in chronically ill patients; the degree of reduction in T₃ is associated with overall prognosis and survival. Iodthyronine deiodinases are enzymes that catalyze iodine removal from thyroid hormones; type I and II deiodinase (D1 and D2, respectively) convert the prohormone thyroxine T₄ to active T₃, whereas the type III enzyme (D3) inactivates T₄ and T₃. Increased production of cytokines, including IL-6, is a hallmark of the acute phase of NTIS, but the role of cytokines in altered thyroid hormone metabolism is poorly understood. Here, we measured the effect of IL-6 on both endogenous cofactor-mediated and dithiothreitol-stimulated (DTT-stimulated) cell sonicate deiodinase activities in human cell lines. Active T₃ generation by D1 and D2 in intact cells was suppressed by IL-6, despite an increase in sonicate deiodinases (and mRNAs). N-acetyl-cysteine (NAC), an antioxidant that restores intracellular glutathione (GSH) concentrations, prevented the IL-6-induced inhibitory effect on D1- and D2-mediated T₃ production, which suggests that IL-6 might function by depleting an intracellular thiol cofactor, perhaps GSH. In contrast, IL-6 stimulated endogenous D3-mediated inactivation of T₃. Taken together, these results identify a single pathway by which IL-6-induced oxidative stress can reduce D1- and D2-mediated T₄-to-T₃ conversion as well as increasing D3-mediated T₃ (and T₄) inactivation, thus mimicking events during illness.
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Affiliation(s)
- Simone Magagnin Wajner
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Roh MH, Jo VY, Stelow EB, Faquin WC, Zou KH, Alexander EK, Larsen PR, Marqusee E, Benson CB, Frates MC, Gawande A, Moore FD, Cibas ES. The predictive value of the fine-needle aspiration diagnosis "suspicious for a follicular neoplasm, hurthle cell type" in patients with hashimoto thyroiditis. Am J Clin Pathol 2011; 135:139-45. [PMID: 21173136 DOI: 10.1309/ajcp0rw2wmduakgk] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A fine-needle aspiration sample composed exclusively of Hürthle cells is interpreted as "suspicious for a follicular neoplasm, Hürthle cell type" (SFNHCT). Because some nonneoplastic Hürthle cell proliferations in Hashimoto thyroiditis (HT) mimic this cytologic pattern, we examined the positive predictive value (PPV) for malignancy of SFNHCT in patients with HT. Between 1992 and 2007, 401 patients with cytologic findings of SFNHCT were identified at 3 institutions. Histologic follow-up was available for 287 (71.6%), and malignancy was diagnosed in 69 (24.0%). Malignancy was present in 2 (PPV = 9.5%) of 21 patients with HT compared with 67 (PPV = 25.2%) of 266 patients without HT (P = .081). Although the difference in the rate of malignancy between the HT and non-HT cohorts did not reach statistical significance, the lower risk of malignancy in the HT cohort more closely approximates the risk of cases interpreted as "atypia of undetermined significance." For this reason, it might be appropriate for Hürthle cell-only aspirates from patients with HT to be categorized as either atypia of undetermined significance or SFNHCT.
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Kádár A, Sánchez E, Wittmann G, Singru PS, Füzesi T, Marsili A, Larsen PR, Liposits Z, Lechan RM, Fekete C. Distribution of hypophysiotropic thyrotropin-releasing hormone (TRH)-synthesizing neurons in the hypothalamic paraventricular nucleus of the mouse. J Comp Neurol 2010; 518:3948-61. [PMID: 20737594 DOI: 10.1002/cne.22432] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypophysiotropic thyrotropin-releasing hormone (TRH) neurons, the central regulators of the hypothalamic-pituitary-thyroid axis, are located in the hypothalamic paraventricular nucleus (PVN) in a partly overlapping distribution with non-hypophysiotropic TRH neurons. The distribution of hypophysiotropic TRH neurons in the rat PVN is well understood, but the localization of these neurons is unknown in mice. To determine the distribution and phenotype of hypophysiotropic TRH neurons in mice, double- and triple-labeling experiments were performed on sections of intact mice, and mice treated intravenously and intraperitoneally with the retrograde tracer Fluoro-Gold. TRH neurons were located in all parts of the PVN except the periventricular zone. Hypophysiotropic TRH neurons were observed only at the mid-level of the PVN, primarily in the compact part. In this part of the PVN, TRH neurons were intermingled with oxytocin and vasopressin neurons, but based on their size, the TRH neurons were parvocellular and did not contain magnocellular neuropeptides. Co-localization of TRH and cocaine- and amphetamine-regulated transcript (CART) were observed only in areas where hypophysiotropic TRH neurons were located. In accordance with the morphological observations, hypothyroidism increased TRH mRNA content of neurons only at the mid-level of the PVN. These data demonstrate that the distribution of hypophysiotropic TRH neurons in mice is vastly different from the pattern in rats, with a dominant occurrence of these neurosecretory cells in the compact part and adjacent regions at the mid-level of the PVN. Furthermore, our data demonstrate that the organization of the PVN is markedly different in mice and rats.
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Affiliation(s)
- Andrea Kádár
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary 1083
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Marsili A, Ramadan W, Harney JW, Mulcahey M, Castroneves LA, Goemann IM, Wajner SM, Huang SA, Zavacki AM, Maia AL, Dentice M, Salvatore D, Silva JE, Larsen PR. Type 2 iodothyronine deiodinase levels are higher in slow-twitch than fast-twitch mouse skeletal muscle and are increased in hypothyroidism. Endocrinology 2010; 151:5952-60. [PMID: 20881246 PMCID: PMC2999482 DOI: 10.1210/en.2010-0631] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 08/30/2010] [Indexed: 12/28/2022]
Abstract
Because of its large mass, relatively high metabolic activity and responsiveness to thyroid hormone, skeletal muscle contributes significantly to energy expenditure. Despite the presence of mRNA encoding the type 2 iodothyronine-deiodinase (D2), an enzyme that activates T(4) to T3, very low or undetectable activity has been reported in muscle homogenates of adult humans and mice. With a modified D2 assay, using microsomal protein, overnight incubation and protein from D2 knockout mouse muscle as a tissue-specific blank, we examined slow- and fast-twitch mouse skeletal muscles for D2 activity and its response to physiological stimuli. D2 activity was detectable in all hind limb muscles of 8- to 12-wk old C57/BL6 mice. Interestingly, it was higher in the slow-twitch soleus than in fast-twitch muscles (0.40 ± 0.06 vs. 0.076 ± 0.01 fmol/min · mg microsomal protein, respectively, P < 0.001). These levels are greater than those previously reported. Hypothyroidism caused a 40% (P < 0.01) and 300% (P < 0.001) increase in D2 activity after 4 and 8 wk treatment with antithyroid drugs, respectively, with no changes in D2 mRNA. Neither D2 mRNA nor activity increased after an overnight 4 C exposure despite a 10-fold increase in D2 activity in brown adipose tissue in the same mice. The magnitude of the activity, the fiber specificity, and the robust posttranslational response to hypothyroidism argue for a more important role for D2-generated T(3) in skeletal muscle physiology than previously assumed.
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Affiliation(s)
- Alessandro Marsili
- Thyroid Section, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Institutes of Medicine, Boston, Massachusetts 02115, USA
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47
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Dentice M, Marsili A, Ambrosio R, Guardiola O, Sibilio A, Paik JH, Minchiotti G, DePinho RA, Fenzi G, Larsen PR, Salvatore D. The FoxO3/type 2 deiodinase pathway is required for normal mouse myogenesis and muscle regeneration. J Clin Invest 2010; 120:4021-30. [PMID: 20978344 PMCID: PMC2964991 DOI: 10.1172/jci43670] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 08/18/2010] [Indexed: 01/14/2023] Open
Abstract
The active thyroid hormone 3,5,3' triiodothyronine (T3) is a major regulator of skeletal muscle function. The deiodinase family of enzymes controls the tissue-specific activation and inactivation of the prohormone thyroxine (T4). Here we show that type 2 deiodinase (D2) is essential for normal mouse myogenesis and muscle regeneration. Indeed, D2-mediated increases in T3 were essential for the enhanced transcription of myogenic differentiation 1 (MyoD) and for execution of the myogenic program. Conversely, the expression of T3-dependent genes was reduced and after injury regeneration markedly delayed in muscles of mice null for the gene encoding D2 (Dio2), despite normal circulating T3 concentrations. Forkhead box O3 (FoxO3) was identified as a key molecule inducing D2 expression and thereby increasing intracellular T3 production. Accordingly, FoxO3-depleted primary myoblasts also had a differentiation deficit that could be rescued by high levels of T3. In conclusion, the FoxO3/D2 pathway selectively enhances intracellular active thyroid hormone concentrations in muscle, providing a striking example of how a circulating hormone can be tissue-specifically activated to influence development locally.
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Affiliation(s)
- Monica Dentice
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Alessandro Marsili
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Raffaele Ambrosio
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Ombretta Guardiola
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Annarita Sibilio
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Ji-Hye Paik
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Gabriella Minchiotti
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Ronald A. DePinho
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Gianfranco Fenzi
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - P. Reed Larsen
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
| | - Domenico Salvatore
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples “Federico II,” Naples, Italy.
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.
IRCCS Fondazione SDN, Naples, Italy.
Stem Cell Fate Laboratory, Institute of Genetics and Biophysics “A. Buzzati-Traverso,” CNR, Naples, Italy.
Belfer Institute for Applied Cancer Science, Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
CEINGE–Biotecnologie Avanzate s.c. a r.l., Naples, Italy
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Goemann IM, Gereben B, Harney JW, Zhu B, Maia AL, Larsen PR. Substitution of serine for proline in the active center of type 2 iodothyronine deiodinase substantially alters its in vitro biochemical properties with dithiothreitol but not its function in intact cells. Endocrinology 2010; 151:821-9. [PMID: 19966180 PMCID: PMC2817617 DOI: 10.1210/en.2009-0980] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
T(4) must be activated by its monodeiodination to T(3) by type 1 or 2 iodothyronine deiodinase (D1 and D2). Recent studies show that despite an approximately 2000-fold higher Michaelis constant (K(m); T(4)) for D1 than for D2 using dithiothreitol (DTT) as cofactor, D1 expressed in intact cells produces T(3) at free T(4) concentrations many orders of magnitude below its K(m). To understand the factors regulating D1 and D2 catalysis in vivo, we studied a mutant D2 with a proline at position 135 of the active center of D2 replaced with a serine, as found in D1. The P135S D2 enzyme has many D1-like properties, a K(m) (T(4)) in the micromolar range, ping-pong kinetics with DTT, and sensitivity to 6n-propylthiouracil (PTU) in vitro. Unexpectedly, when the P135S D2 was expressed in HEK-293 cells and exposed to 2-200 pm free T(4), the rate of T(4) to T(3) conversion was identical with D2 and conversion was insensitive to PTU. Using glutathione as a cofactor in vitro resulted in a marked decrease in the K(m) (T(4)) (as also occurs for D1), it showed sequential kinetics with T(4) and it was sensitive to PTU but was resistant when HEK-293 cytosol was used as a cofactor. Thus, the in vivo catalytic properties of the P135S D2 mutant are more accurately predicted from in vitro studies with weak reducing agents, such as glutathione or endogenous cofactors, than by those with DTT.
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Affiliation(s)
- Iuri Martin Goemann
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS-90035-903, Brazil
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49
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Patti ME, Houten SM, Bianco AC, Bernier R, Larsen PR, Holst JJ, Badman MK, Maratos-Flier E, Mun EC, Pihlajamaki J, Auwerx J, Goldfine AB. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity (Silver Spring) 2009; 17:1671-7. [PMID: 19360006 PMCID: PMC4683159 DOI: 10.1038/oby.2009.102] [Citation(s) in RCA: 428] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The multifactorial mechanisms promoting weight loss and improved metabolism following Roux-en-Y gastric bypass (GB) surgery remain incompletely understood. Recent rodent studies suggest that bile acids can mediate energy homeostasis by activating the G-protein coupled receptor TGR5 and the type 2 thyroid hormone deiodinase. Altered gastrointestinal anatomy following GB could affect enterohepatic recirculation of bile acids. We assessed whether circulating bile acid concentrations differ in patients who previously underwent GB, which might then contribute to improved metabolic homeostasis. We performed cross-sectional analysis of fasting serum bile acid composition and both fasting and post-meal metabolic variables, in three subject groups: (i) post-GB surgery (n = 9), (ii) without GB matched to preoperative BMI of the index cohort (n = 5), and (iii) without GB matched to current BMI of the index cohort (n = 10). Total serum bile acid concentrations were higher in GB (8.90 +/- 4.84 micromol/l) than in both overweight (3.59 +/- 1.95, P = 0.005, Ov) and severely obese (3.86 +/- 1.51, P = 0.045, MOb). Bile acid subfractions taurochenodeoxycholic, taurodeoxycholic, glycocholic, glycochenodeoxycholic, and glycodeoxycholic acids were all significantly higher in GB compared to Ov (P < 0.05). Total bile acids were inversely correlated with 2-h post-meal glucose (r = -0.59, P < 0.003) and fasting triglycerides (r = -0.40, P = 0.05), and positively correlated with adiponectin (r = -0.48, P < 0.02) and peak glucagon-like peptide-1 (GLP-1) (r = 0.58, P < 0.003). Total bile acids strongly correlated inversely with thyrotropic hormone (TSH) (r = -0.57, P = 0.004). Together, our data suggest that altered bile acid levels and composition may contribute to improved glucose and lipid metabolism in patients who have had GB.
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Toyoda N, Yasuzawa-Amano S, Nomura E, Yamauchi A, Nishimura K, Ukita C, Morimoto S, Kosaki A, Iwasaka T, Harney JW, Larsen PR, Nishikawa M. Thyroid hormone activation in vascular smooth muscle cells is negatively regulated by glucocorticoid. Thyroid 2009; 19:755-63. [PMID: 19508118 PMCID: PMC2857441 DOI: 10.1089/thy.2009.0044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Type 2 iodothyronine deiodinase (D2) catalyzes the production of triiodothyronine from thyroxine. D2 is present in rat aorta media, and there is a circadian variation in the D2 expression. In rat aorta media, the D2 activity exhibited the maximal value at 1200 hour and low value between 1800 and 2400 hour. To understand the mechanisms that induce the circadian variation in the D2 expression, we examined the effects of glucocorticoid on the D2 activity and mRNA in rat aorta media and cultured vascular smooth muscle cells (VSMCs). METHODS The effects of intrinsic and extrinsic glucocorticoid on the D2 activity and mRNA in rat aorta media were studied using metyrapone, a corticosterone synthesis inhibitor, and dexamethasone (DEX). Further, the effects of DEX on D2 expression were studied using the cultured rat VSMCs. RESULTS The trough values of D2 activity and mRNA at 2100 hour were increased by the treatment with metyrapone. On the other hand, the peak values of D2 activity and mRNA were decreased by the treatment with DEX. D2 activity and mRNA in cultured rat VSMCs were increased by the addition of 10(-3) M dibutyryl cyclic adenosine monophosphate [(Bu)(2)cAMP]. The increments were reduced by coincubation with 10(-6) M DEX. CONCLUSIONS These results suggest that glucocorticoids might directly suppress the D2 expression in rat VSMCs induced by a cAMP-dependent mechanism.
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Affiliation(s)
- Nagaoki Toyoda
- Department of Internal Medicine II, Kansai Medical University, Hirakata-City, Osaka, Japan.
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