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Biondi B, Celi FS, McAninch EA. Critical Approach to Hypothyroid Patients With Persistent Symptoms. J Clin Endocrinol Metab 2023; 108:2708-2716. [PMID: 37071856 PMCID: PMC10686697 DOI: 10.1210/clinem/dgad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/20/2023]
Abstract
Hypothyroidism is a common condition, and numerous studies have been published over the last decade to assess the potential risks associated with this disorder when inappropriately treated. The standard of care for treatment of hypothyroidism remains levothyroxine (LT4) at doses to achieve biochemical and clinical euthyroidism. However, about 15% of hypothyroid patients experience residual hypothyroid symptoms. Some population-based studies and international population-based surveys have confirmed dissatisfaction with LT4 treatment in some hypothyroid patients. It is well established that hypothyroid patients treated with LT4 exhibit higher serum thyroxine:triiodothyronine ratios and can have a persistent increase in cardiovascular risk factors. Moreover, variants in deiodinases and thyroid hormone transporter genes have been associated with subnormal T3 concentrations, persistent symptoms in LT4-treated patients, and improvement in response to the addition of liothyronine to LT4 therapy. The American (ATA) and European Thyroid Association (ETA) guidelines have recently evolved in their recognition of the potential limitations of LT4. This shift is reflected in prescribing patterns: Physicians' use of combination therapy is prevalent and possibly increasing. Randomized clinical trials have recently been published and, while they have found no improvement in treating hypothyroid patients, a number of important limitations did not allow generalizability. Meta-analyses have reported a preference rate for combination therapy in 46.2% hypothyroid patients treated with LT4. To promote discussions about an optimal study design, the ATA, ETA, and British Thyroid Association have recently published a consensus document. Our study provides a useful counterpoint on the controversial benefits of treating hypothyroid patients with combination therapy.
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Affiliation(s)
- Bernadette Biondi
- Division of Internal Medicine and Cardiovascular Endocrinology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy
| | - Francesco S Celi
- Division of Endocrinology and Metabolism, Department of Medicine UConn Health, Farmington, CT 06030-8075, USA
| | - Elizabeth A McAninch
- Division of Endocrinology, Metabolism and Gerontology, Stanford University Medical Center, Stanford, CA 94305, USA
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McAninch EA, Desai K, McCowen KC, Orloff LA. Hyperthyroidism Due to Graves Disease After Radiofrequency Ablation. JCEM Case Rep 2023; 1:luad056. [PMID: 37908568 PMCID: PMC10580446 DOI: 10.1210/jcemcr/luad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 11/02/2023]
Abstract
Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile. Hyperthyroidism due to transient thyroiditis is a known risk of RFA, secondary to direct trauma and subsequent thyroid hormone release. Here we present a case of an adult with large, symptomatic, multinodular goiter, with no prior history of thyroid autoimmunity, who underwent RFA with successful volume reduction of two nodules, but who developed acute hyperthyroidism due to Graves disease eight weeks after RFA. Larger studies evaluating the risks of RFA should evaluate for incident hyperthyroidism, specifically for Graves disease/thyroid autoimmunity, as this could represent an additional risk of the procedure.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology, Gerontology and Metabolism, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Kaniksha Desai
- Division of Endocrinology, Gerontology and Metabolism, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Karen C McCowen
- Division of Endocrinology, University of California San Diego, San Diego, CA 92093, USA
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305, USA
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Rajan KB, McAninch EA, Aggarwal NT, Barnes LL, Wilson RS, Weuve J, DeCarli CS, Evans DA. Longitudinal Changes in Blood Biomarkers of Clinical Alzheimer Disease in a Biracial Population Sample. Neurology 2023; 100:e874-e883. [PMID: 36446595 PMCID: PMC9984218 DOI: 10.1212/wnl.0000000000201289] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/22/2020] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies suggest the utility of blood biomarkers in detecting changes in neurodegenerative disorders. The objective of our research was to test the hypothesis that the longitudinal changes in total tau (t-tau), neurofilament light chain (Nf-L), and glial fibrillary acidic protein (GFAP) are associated with structural MRI and the development of clinical Alzheimer disease (AD) and cognitive decline. METHODS Data came from a population-based sample with serum concentrations of t-tau, Nf-L, and GFAP and cognitive characteristics measured over 17 years. The inclusion criteria for this investigation were based on participants with blood samples, cognitive function testing, and clinical diagnosis for AD. The longitudinal changes in the serum biomarkers were examined using linear mixed models for log10-transformed concentrations. RESULTS In 1,327 participants (60% Black participants and 60% women, the concentration of t-tau increased annually by 4.8% (95% CI = 4.0-5.6) and Nf-L by 5.9% (95% CI = 5.4-6.4). The longitudinal change in GFAP was higher among Black participants than among White participants (4.4% vs 3.5% per year, p = 0.028). Baseline MRI characteristics were associated with the longitudinal changes in serum biomarkers of clinical AD. Specifically, a higher baseline third ventricular volume was associated with a higher rate of increase in the concentration of t-tau, and white matter hyperintensities predicted a higher rate of increase in Nf-L. The rate of change in concentrations of t-tau, Nf-L, and GFAP was significantly higher among those who developed clinical AD than in those with no cognitive impairment. For each standard deviation unit decline in global cognition, longitudinal change in t-tau increased by 81% (95% CI = 76-86), Nf-L by 113% (95% CI = 105-120), and GFAP by 66% (95% CI = 62-70). DISCUSSION Blood biomarkers showed significant longitudinal changes corresponding to cognitive decline, clinical AD, and structural MRI characteristics. Our findings show that longitudinal changes in serum biomarkers were associated with several cognitive endophenotypes. CLASSIFICATION OF EVIDENCE The study found Class II evidence that longitudinal changes in serum t-tau, Nf-L, and GFAP were associated with cognitive decline and the development of clinical AD in people older than 65 years.
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Affiliation(s)
- Kumar B Rajan
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis.
| | - Elizabeth A McAninch
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Neelum T Aggarwal
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Lisa L Barnes
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Robert S Wilson
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Jennifer Weuve
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Charles S DeCarli
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
| | - Denis A Evans
- From the Rush Institute for Healthy Aging (K.R., D.E.), Rush University Medical Center, Chicago IL; Stanford University (E.A.M.), Palo Alto, CA; Rush Alzheimer's Disease Center (N.A., L.L.B., R.W.), Chicago IL; Boston University (J.W.), Boston, MA; and Department of Neurology (C.S.D.), University of California, Davis
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Seib CD, Meng T, Cisco RM, Lin DT, McAninch EA, Chen J, Tamura MK, Trickey AW, Kebebew E. Risk of Permanent Hypoparathyroidism Requiring Calcitriol Therapy in a Population-Based Cohort of Adults Older Than 65 Undergoing Total Thyroidectomy for Graves' Disease. Thyroid 2023; 33:223-229. [PMID: 36416252 PMCID: PMC9963476 DOI: 10.1089/thy.2022.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Total thyroidectomy for Graves' disease (GD) is associated with rapid treatment of hyperthyroidism and low recurrence rates. However, it carries the risk of surgical complications including permanent hypoparathyroidism, which contributes to long-term impaired quality of life. The objective of this study was to determine the incidence of permanent hypoparathyroidism requiring calcitriol therapy among a population-based cohort of older adults undergoing total thyroidectomy for GD in the United States. Methods: We performed a population-based cohort study using 100% Medicare claims from beneficiaries older than 65 years with GD who underwent total thyroidectomy from 2007 to 2017. We required continuous enrollment in Medicare Parts A, B, and D for 12 months before and after surgery to ensure access to comprehensive claims data. Patients were excluded if they had a preoperative diagnosis of thyroid cancer or were on long-term preoperative calcitriol. Our primary outcome was permanent hypoparathyroidism, which was identified based on persistent use of calcitriol between 6 and 12 months following thyroidectomy. We used multivariable logistic regression to identify characteristics associated with permanent hypoparathyroidism, including patient age, sex, race/ethnicity, neighborhood disadvantage, Charlson-Deyo Comorbidity Index, urban or rural residence, and frailty. Results: We identified 4650 patients who underwent total thyroidectomy for GD during the study period and met the inclusion criteria (mean age = 72.8 years [standard deviation = 5.5], 86% female, and 79% white). Among this surgical cohort, 104 (2.2% [95% confidence interval, CI = 1.8-2.7%]) patients developed permanent hypoparathyroidism requiring calcitriol therapy. Patients who developed permanent hypoparathyroidism were on average older (mean age 74.1 vs. 72.8 years) than those who did not develop permanent hypoparathyroidism (p = 0.04). On multivariable regression, older age was the only patient characteristic associated with permanent hypoparathyroidism (odds ratio age ≥76 years = 1.68 [CI = 1.13-2.51] compared with age 66-75 years). Conclusions: The risk of permanent hypoparathyroidism requiring calcitriol therapy among this national, U.S. population-based cohort of older adults with GD treated with total thyroidectomy was low, even when considering operations performed by a heterogeneous group of surgeons. These findings suggest that the risk of hypoparathyroidism should not be a deterrent to operative management for GD in older adults who are appropriate surgical candidates.
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Affiliation(s)
- Carolyn Dacey Seib
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA
| | - Tong Meng
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Robin M. Cisco
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dana T. Lin
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Elizabeth A. McAninch
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie Chen
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA
| | - Manjula Kurella Tamura
- Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California, USA
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Desai P, Dhana K, DeCarli C, Wilson RS, McAninch EA, Evans DA, Rajan KB. Examination of Neurofilament Light Chain Serum Concentrations, Physical Activity, and Cognitive Decline in Older Adults. JAMA Netw Open 2022; 5:e223596. [PMID: 35315915 PMCID: PMC8941360 DOI: 10.1001/jamanetworkopen.2022.3596] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Little is known about the association of serum neurofilament light chain (NfL) concentrations and physical activity with the rate of cognitive decline in older adults. OBJECTIVE To examine the association of physical activity and NfL concentrations with cognitive decline in older adults over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Chicago Health and Aging Project (CHAP), a population-based cohort study that recruited participants through door-to-door census in 4 Chicago-area communities and collected data between 1993 and 2012 in cycles of 3 years. Participants in CHAP who had 2 or more cognitive function assessments and at least 1 blood sample collected for NfL measurement were selected for inclusion in the current study. Data were analyzed from January to December 2021. EXPOSURES Self-reported physical activity (minutes per week) and serum NfL concentration (pg/mL). MAIN OUTCOMES AND MEASURES Associations of baseline physical activity and NfL concentrations with changes in global cognitive function over time as evaluated using the East Boston Memory Test for episodic memory, the Symbol Digit Modalities Test for perceptual speed, and the Mini-Mental State Examination. Mixed-effects regression analyses were conducted to examine associations at baseline and longitudinally. RESULTS The study sample included 1158 participants (695 [60%] African American; 728 [63%] female), with a mean (SD) age of 77.4 (6.0) years and a mean educational level of 12.6 (3.5) years. Among participants with high NfL concentrations (>25 pg/mL), those who engaged in medium physical activity (<150 minutes per week) had a 12% slower rate of global cognitive decline (SD units, or β, -0.065; 95% CI, -0.099 to -0.032) and participants who engaged in high physical activity (≥150 minutes per week) had a 36% slower rate of decline (β, -0.048; 95% CI, -0.080 to -0.016) than did participants with low physical activity (no reported participation) (β, -0.075; 95% CI, -0.108 to -0.041). For participants with low NfL concentrations (≤25 pg/mL), those who took part in medium physical activity had 43% slower global cognitive decline (β, -0.025; 95% CI, -0.043 to -0.007) and individuals who participated in high physical activity had 30% slower decline (β, -0.031; 95% CI, -0.048 to -0.014) than did those who participated in low physical activity (β, -0.046; 95% CI, -0.066 to -0.025). CONCLUSIONS AND RELEVANCE The findings suggest that physical activity is associated with diminished cognitive decline among older adults with increased serum NfL concentrations. The results support the potential use of blood biomarkers in measuring the benefits of health behaviors, such as physical activity, and early intervention for older adults at risk for cognitive decline.
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Affiliation(s)
- Pankaja Desai
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Klodian Dhana
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | | | - Denis A. Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Kumar B. Rajan
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
- Department of Neurology, University of California at Davis
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Shakir MKM, Brooks DI, McAninch EA, Fonseca TDL, Mai VQ, Bianco AC, Hoang TD. Response to Letter to the Editor From Bonnema et al: "Comparative Effectiveness of Levothyroxine, Desiccated Thyroid Extract, and Levothyroxine + Liothyronine in Hypothyroidism". J Clin Endocrinol Metab 2022; 107:e1327-e1328. [PMID: 34718640 PMCID: PMC8852202 DOI: 10.1210/clinem/dgab779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mohamed K M Shakir
- Walter Reed National Military Medical Center, Bethesda, Maryland 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
| | - Daniel I Brooks
- Walter Reed National Military Medical Center, Bethesda, Maryland 20889-5600, USA
| | - Elizabeth A McAninch
- Divsion of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois 60612, USA
| | | | - Vinh Q Mai
- Walter Reed National Military Medical Center, Bethesda, Maryland 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology, University of Chicago, Chicago, Illinois 60637, USA
| | - Thanh D Hoang
- Walter Reed National Military Medical Center, Bethesda, Maryland 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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Krueger KR, Wilson RS, Barnes LL, McAninch EA, Evans DA, DeCarli CS, Fletcher EM, Rajan KB. Cognitive activity, cognitive function, and structural MRI findings. Alzheimers Dement 2021. [DOI: 10.1002/alz.052370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kristin R. Krueger
- Rush University Medical Center Chicago IL USA
- Rush Institute for Healthy Aging Chicago IL USA
| | - Robert S. Wilson
- Rush University Medical Center Chicago IL USA
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA
| | - Lisa L. Barnes
- Rush University Medical Center Chicago IL USA
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA
| | - Elizabeth A. McAninch
- Rush University Medical Center Chicago IL USA
- Rush Institute for Healthy Aging Chicago IL USA
| | - Denis A. Evans
- Rush University Medical Center Chicago IL USA
- Rush Institute for Healthy Aging Chicago IL USA
| | | | | | - Kumar B. Rajan
- Rush University Medical Center Chicago IL USA
- Rush Institute for Healthy Aging Chicago IL USA
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Shakir MKM, Brooks DI, McAninch EA, Fonseca TL, Mai VQ, Bianco AC, Hoang TD. Comparative Effectiveness of Levothyroxine, Desiccated Thyroid Extract, and Levothyroxine+Liothyronine in Hypothyroidism. J Clin Endocrinol Metab 2021; 106:e4400-e4413. [PMID: 34185829 PMCID: PMC8530721 DOI: 10.1210/clinem/dgab478] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Studies comparing levothyroxine (LT4) therapy with LT4 + liothyronine (LT3) or desiccated thyroid extract (DTE) did not detect consistent superiority of either treatment. Here, we investigated these therapies, focusing on the whole group of LT4-treated hypothyroid patients, while also exploring the most symptomatic patients. METHODOLOGY Prospective, randomized, double-blind, crossover study of 75 hypothyroid patients randomly allocated to 1 of 3 treatment arms, LT4, LT4 + LT3, and DTE, for 22 weeks. The primary outcomes were posttreatment scores on the 36-point thyroid symptom questionnaire (TSQ-36), 12-point quality of life general health questionnaire (GHQ-12), the Wechsler memory scale-version IV (VMS-IV), and the Beck Depression Inventory (BDI). Secondary endpoints included treatment preference, biochemical and metabolic parameters, etiology of hypothyroidism, and Thr92Ala-DIO2 gene polymorphism. Analyses were performed with a linear mixed model using subject as a random factor and group as a fixed effect. RESULTS Serum TSH remained within reference range across all treatment arms. There were no differences for primary and secondary outcomes, except for a minor increase in heart rate caused by DTE. Treatment preference was not different and there were no interferences of the etiology of hypothyroidism or Thr92Ala-DIO2 gene polymorphism in the outcomes. Subgroup analyses of the 1/3 most symptomatic patients on LT4 revealed strong preference for treatment containing T3, which improved performance on TSQ-36, GHQ-12, BDI, and visual memory index (VMS-IV component). CONCLUSIONS As a group, outcomes were similar among hypothyroid patients taking DTE vs LT4 + T3 vs LT4. However, those patients that were most symptomatic on LT4 preferred and responded positively to therapy with LT4 + LT3 or DTE.
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Affiliation(s)
- Mohamed K M Shakir
- Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Daniel I Brooks
- Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL 60612, USA
| | - Tatiana L Fonseca
- Section of Adult and Pediatric Endocrinology, University of Chicago, Chicago, IL 60637, USA
| | - Vinh Q Mai
- Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology, University of Chicago, Chicago, IL 60637, USA
| | - Thanh D Hoang
- Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Butterfield NC, Curry KF, Steinberg J, Dewhurst H, Komla-Ebri D, Mannan NS, Adoum AT, Leitch VD, Logan JG, Waung JA, Ghirardello E, Southam L, Youlten SE, Wilkinson JM, McAninch EA, Vancollie VE, Kussy F, White JK, Lelliott CJ, Adams DJ, Jacques R, Bianco AC, Boyde A, Zeggini E, Croucher PI, Williams GR, Bassett JHD. Publisher Correction: Accelerating functional gene discovery in osteoarthritis. Nat Commun 2021; 12:3302. [PMID: 34050183 PMCID: PMC8163861 DOI: 10.1038/s41467-021-23768-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Natalie C Butterfield
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Katherine F Curry
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Julia Steinberg
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- Cancer Council NSW, Sydney, NSW, 2000, Australia
| | - Hannah Dewhurst
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Davide Komla-Ebri
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Naila S Mannan
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Anne-Tounsia Adoum
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Victoria D Leitch
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - John G Logan
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Julian A Waung
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Elena Ghirardello
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Scott E Youlten
- The Garvan Institute of Medical Research and St. Vincent's Clinical School, University of New South Wales Medicine, Sydney, NSW, 2010, Australia
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK
- Centre for Integrated Research into Musculoskeletal Ageing and Sheffield Healthy Lifespan Institute, University of Sheffield, Sheffield, S10 2TN, UK
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, 60612, USA
| | | | - Fiona Kussy
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Jacqueline K White
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- The Jackson Laboratory, Bar Harbor, ME, 04609, USA
| | | | - David J Adams
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Alan Boyde
- Dental Physical Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Peter I Croucher
- The Garvan Institute of Medical Research and St. Vincent's Clinical School, University of New South Wales Medicine, Sydney, NSW, 2010, Australia
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.
| | - J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.
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10
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Rajan KB, Weuve J, Barnes LL, McAninch EA, Wilson RS, Evans DA. Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020-2060). Alzheimers Dement 2021; 17:1966-1975. [PMID: 34043283 DOI: 10.1002/alz.12362] [Citation(s) in RCA: 338] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The estimate of people with clinical Alzheimer's disease (AD) and mild cognitive impairment provides an understanding of the disease burden. METHODS We estimated people with cognitive impairment using a quasibinomial regression model in 10,342 participants with cognitive test scores. RESULTS The 2020 US Census-adjusted prevalence of clinical AD was 11.3% (95% confidence interval [CI] = 10.7-11.9): 10.0% among non-Hispanic Whites, 14.0% among Hispanics, and 18.6% among non-Hispanic Blacks. We estimate that in 2020, 6.07 (95% CI = 5.75-6.38) million people were living with clinical AD, which increases to 13.85 (95% CI = 12.98-14.74) million in 2060, 423% higher among Hispanics, 192% higher among Blacks, and 63% higher among Whites. However, there are predicted to be more significant increases in later years among those over 85 and women compared to men. DISCUSSION The number of people with clinical AD will increase as the "baby boom" generation reaches older ages, exerting a strong upward influence on disease burden.
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Affiliation(s)
- Kumar B Rajan
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth A McAninch
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
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11
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Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, McAninch EA, Moeller LC, Nygaard B, Sawka AM, Watt T, Dayan CM. Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Eur Thyroid J 2021; 10:10-38. [PMID: 33777817 PMCID: PMC7983670 DOI: 10.1159/000512970] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. METHODS The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. RESULTS Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. DISCUSSION This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
- *Jacqueline Jonklaas, Division of Endocrinology, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007 (USA),
| | - Antonio C. Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesco S. Celi
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Heike Heuer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | | | - Lars C. Moeller
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Colin M. Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
- **Colin M. Dayan, Thyroid Research Group, School of Medicine, Cardiff University, C2 Link, Heath Park, Cardiff CF14 4XN (UK),
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12
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Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, McAninch EA, Moeller LC, Nygaard B, Sawka AM, Watt T, Dayan CM. Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Thyroid 2021; 31:156-182. [PMID: 33276704 PMCID: PMC8035928 DOI: 10.1089/thy.2020.0720] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods: The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results: Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 μg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion: This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
- Address correspondence to: Jacqueline Jonklaas, MD, PhD, Division of Endocrinology, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007, USA
| | - Antonio C. Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesco S. Celi
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Netherlands
| | - Heike Heuer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | | | - Lars C. Moeller
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Canada
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Colin M. Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Address correspondence to: Colin M. Dayan, MD, PhD, Thyroid Research Group, School of Medicine, Cardiff University, C2 Link, Heath Park, Cardiff CF14 4XN, UK
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13
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Butterfield NC, Curry KF, Steinberg J, Dewhurst H, Komla-Ebri D, Mannan NS, Adoum AT, Leitch VD, Logan JG, Waung JA, Ghirardello E, Southam L, Youlten SE, Wilkinson JM, McAninch EA, Vancollie VE, Kussy F, White JK, Lelliott CJ, Adams DJ, Jacques R, Bianco AC, Boyde A, Zeggini E, Croucher PI, Williams GR, Bassett JHD. Accelerating functional gene discovery in osteoarthritis. Nat Commun 2021; 12:467. [PMID: 33473114 PMCID: PMC7817695 DOI: 10.1038/s41467-020-20761-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/14/2020] [Indexed: 01/29/2023] Open
Abstract
Osteoarthritis causes debilitating pain and disability, resulting in a considerable socioeconomic burden, yet no drugs are available that prevent disease onset or progression. Here, we develop, validate and use rapid-throughput imaging techniques to identify abnormal joint phenotypes in randomly selected mutant mice generated by the International Knockout Mouse Consortium. We identify 14 genes with functional involvement in osteoarthritis pathogenesis, including the homeobox gene Pitx1, and functionally characterize 6 candidate human osteoarthritis genes in mouse models. We demonstrate sensitivity of the methods by identifying age-related degenerative joint damage in wild-type mice. Finally, we phenotype previously generated mutant mice with an osteoarthritis-associated polymorphism in the Dio2 gene by CRISPR/Cas9 genome editing and demonstrate a protective role in disease onset with public health implications. We hope this expanding resource of mutant mice will accelerate functional gene discovery in osteoarthritis and offer drug discovery opportunities for this common, incapacitating chronic disease.
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Affiliation(s)
- Natalie C Butterfield
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Katherine F Curry
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Julia Steinberg
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- Cancer Council NSW, Sydney, NSW, 2000, Australia
| | - Hannah Dewhurst
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Davide Komla-Ebri
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Naila S Mannan
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Anne-Tounsia Adoum
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Victoria D Leitch
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - John G Logan
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Julian A Waung
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Elena Ghirardello
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Scott E Youlten
- The Garvan Institute of Medical Research and St. Vincent's Clinical School, University of New South Wales Medicine, Sydney, NSW, 2010, Australia
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK
- Centre for Integrated Research into Musculoskeletal Ageing and Sheffield Healthy Lifespan Institute, University of Sheffield, Sheffield, S10 2TN, UK
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, 60612, USA
| | | | - Fiona Kussy
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Jacqueline K White
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- The Jackson Laboratory, Bar Harbor, ME, 04609, USA
| | | | - David J Adams
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Alan Boyde
- Dental Physical Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Peter I Croucher
- The Garvan Institute of Medical Research and St. Vincent's Clinical School, University of New South Wales Medicine, Sydney, NSW, 2010, Australia
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.
| | - J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.
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14
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Aggarwal NT, Barnes LL, Wilson RS, Weuve J, McAninch EA, Evans DA, Rajan KB. Sex differences in the association of APOE E4 allele and cognitive decline in a biracial population sample. Alzheimers Dement 2020. [DOI: 10.1002/alz.046743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center Rush University Medical Center Chicago IL USA
| | | | | | | | - Kumar B. Rajan
- Rush University Medical Center Chicago IL USA
- University of California Davis Davis CA USA
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15
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Rajan KB, McAninch EA, Wilson RS, Weuve J, Barnes LL, Evans DA. Race, APOEɛ4, and Long-Term Cognitive Trajectories in a Biracial Population Sample. J Alzheimers Dis 2020; 72:45-53. [PMID: 31561363 DOI: 10.3233/jad-190538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association of the APOEɛ4 allele with incident Alzheimer's dementia is higher among European Americans (EAs) than African Americans (AAs), but similar for the rate of cognitive decline. OBJECTIVE To examine the racial differences in the association of the APOEɛ4 allele with incident Alzheimer's dementia and cognitive decline. METHODS Using a population-based sample of 5,117 older adults (66% AAs and 63% females), we identified cognitive trajectory groups from a latent class mixed model and examined the association of the APOEɛ4 allele with these groups. RESULTS The frequency of the APOEɛ4 allele was higher among AAs than EAs (37% versus 26%). Four cognitive trajectories were identified: slow, mild, moderate, and rapid. Overall, AAs had a lower baseline global cognition than EAs, and a higher proportion had rapid (7% versus 5%) and moderate (20% versus 15%) decline, but similar mild (44% versus 46%), and lesser slow (29% versus 34%) decline compared to EAs. Additionally, 25% of AAs (13% of EAs) with mild and 5% (<1% of EAs) with slow decline were diagnosed with incident Alzheimer's dementia. The APOEɛ4 allele was associated with higher odds of rapid and moderate decline compared to slow decline among AAs and EAs, but not with mild decline. CONCLUSIONS AAs had lower cognitive levels and were more likely to meet the cognitive threshold for Alzheimer's dementia among mild and slow decliners, explaining the attenuated association of the ɛ4 allele with incident Alzheimer's dementia among AAs.
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Affiliation(s)
- Kumar B Rajan
- Department of Public Health Sciences, UC Davis, Davis, CA, USA
| | - Elizabeth A McAninch
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University, Boston, MA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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16
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Marcelino CP, McAninch EA, Fernandes GW, Bocco BMLC, Ribeiro MO, Bianco AC. Temporal Pole Responds to Subtle Changes in Local Thyroid Hormone Signaling. J Endocr Soc 2020; 4:bvaa136. [PMID: 33123655 PMCID: PMC7575126 DOI: 10.1210/jendso/bvaa136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
To study thyroid hormone (TH) signaling in the human brain, we analyzed published microarray data sets of the temporal pole (Brodmann area 38) of 19 deceased donors. An index of TH signaling built on the expression of 19 well known TH-responsive genes in mouse brains (T3S+) varied from 0.92 to 1.1. After Factor analysis, T3S+ correlated independently with the expression of TH transporters (MCT8, LAT2), TH receptor (TR) beta and TR coregulators (CARM1, MED1, KAT2B, SRC2, SRC3, NCOR2a). Unexpectedly, no correlation was found between T3S+ vs DIO2, DIO3, SRC1, or TRα. An unbiased systematic analysis of the entire transcriptome identified a set of 1649 genes (set #1) with strong positive correlation with T3S+ (r > 0.75). Factor analysis of set #1 identified 2 sets of genes that correlated independently with T3S+, sets #2 (329 genes) and #3 (191 genes). When processed through the Molecular Signatures Data Base (MSigDB), both sets #2 and #3 were enriched with Gene Ontology (GO)-sets related to synaptic transmission and metabolic processes. Ranking individual human brain donors according to their T3S+ led us to identify 1262 genes (set #4) with >1.3-fold higher expression in the top half. The analysis of the overlapped genes between sets #1 and #4 resulted in 769 genes (set #5), which have a very similar MSigDB signature as sets #2 and #3. In conclusion, gene expression in the human temporal pole can be assessed through T3S+ and fluctuates with subtle variations in local TH signaling.
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Affiliation(s)
- Cícera P Marcelino
- Department of Health and Biological Sciences - CCBS, Mackenzie Presbyterian University, Sao Paulo, Sao Paulo, Brazil
- Department of Translational Medicine, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Gustavo W Fernandes
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, Illinois
| | - Barbara M L C Bocco
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, Illinois
| | - Miriam O Ribeiro
- Department of Health and Biological Sciences - CCBS, Mackenzie Presbyterian University, Sao Paulo, Sao Paulo, Brazil
- Department of Translational Medicine, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Antonio C Bianco
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, Illinois
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17
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Rajan KB, Aggarwal NT, McAninch EA, Weuve J, Barnes LL, Wilson RS, DeCarli C, Evans DA. Remote Blood Biomarkers of Longitudinal Cognitive Outcomes in a Population Study. Ann Neurol 2020; 88:1065-1076. [PMID: 32799383 DOI: 10.1002/ana.25874] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/11/2020] [Accepted: 08/09/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The longitudinal association of the blood biomarkers total tau (t-tau), neurofilament light (Nf-L), and glial fibrillary acidic protein (GFAP) with common sporadic Alzheimer disease (AD) and cognitive decline is not established. METHODS Using a single molecule array technology, ultrasensitive immunoassays for serum concentrations of t-tau, Nf-L, and GFAP were measured in a population sample of 1,327 participants (60% African Americans and women) who had a clinical evaluation for AD, had completed in-home cognitive assessments, and had undergone 1.5T structural magnetic resonance imaging. RESULTS Higher concentrations of serum biomarkers were associated with the development of clinical AD; especially, the time-specific associations were notable: t-tau 8 to 16 years, and Nf-L and GFAP 4 to 8 years prior to clinical AD. Serum biomarkers were associated with faster cognitive decline over 16 years; baseline t-tau > 0.40pg/ml had 30% faster decline, Nf-L > 25.5pg/ml had 110% faster decline, and GFAP > 232pg/ml had 130% faster decline compared to those in the lowest quartile. Participants with baseline GFAP > 232pg/ml showed 160% faster decline in hippocampal volume compared to those with values < 160pg/ml. Additionally, higher baseline t-tau was associated with faster increase in 3rd ventricular volume, and baseline Nf-L and GFAP were associated with faster decline in cortical thickness. INTERPRETATION Serum t-tau, Nf-L, and GFAP predict the development of sporadic AD and cognitive decline, and changes in structural brain characteristics, suggesting their usefulness not only as screening and predictive biomarkers, but also in capturing the pathogenesis of Alzheimer dementia. ANN NEUROL 2020;88:1065-1076.
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Affiliation(s)
- Kumar B Rajan
- Department of Public Health Sciences, University of California, Davis, CA, USA.,Alzheimer's Disease Center, University of California, Sacramento, CA, USA
| | | | - Elizabeth A McAninch
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Charles DeCarli
- Department of Neurology, University of California at Davis, Sacramento, CA, USA
| | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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18
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Rajan KB, Weuve J, Wilson RS, Barnes LL, McAninch EA, Evans DA. Temporal changes in the likelihood of dementia and MCI over 18 years in a population sample. Neurology 2019; 94:e292-e298. [PMID: 31806693 DOI: 10.1212/wnl.0000000000008731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the temporal changes in the likelihood of dementia and mild cognitive impairment (MCI) between 1993 and 2012 using a short battery of cognitive tests. METHODS A cohort of 10,342 participants underwent a short battery of cognitive tests collected during triennial in-home interviews with 2,794 of those evaluated for the clinical diagnosis of dementia and MCI. We used a generalized logit regression model to estimate the likelihood of dementia and MCI, and a quasibinomial regression model to examine the temporal changes in those likelihood scores. RESULTS A short battery of cognitive tests-delayed story recall test, Symbol Digit Modalities Test, and the Mini-Mental State Examination-were associated with the clinical diagnosis of dementia and MCI. The classification accuracy of likelihood scores was 0.92 for dementia and 0.85 for MCI. After adjusting for age, race/ethnicity, and education, the likelihood of dementia in the population decreased from 21.6% (95% confidence interval [CI] 20.9%-22.3%) to 18.9% (95% CI 18.1%-19.7%) between 1993-1996 and 2000-2002 and showed no significant decline between 2000-2002 and 2009-2012 (-0.2%, 95% CI -1.1% to 0.7%). The estimated likelihood of MCI remained similar between 1993-1996 and 2009-2012 (29.0%, 95% CI 27.9%-30.1%), but showed a nonsignificant decrease in 2000-2002. CONCLUSION The likelihood scores based on a short battery of cognitive tests can serve as a measure of dementia and MCI in epidemiologic studies. The decline in the likelihood of dementia and MCI over earlier years was not sustained in later years.
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Affiliation(s)
- Kumar B Rajan
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL.
| | - Jennifer Weuve
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL
| | - Elizabeth A McAninch
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL
| | - Denis A Evans
- From the Department of Public Health Sciences (K.B.R.) and Alzheimer's Disease Center (K.B.R.), University of California at Davis; Department of Epidemiology (J.W.), Boston University School of Public Health, MA; Rush Alzheimer's Disease Center (R.S.W., L.L.B.); and Department of Internal Medicine (E.A.M., D.A.E.), Rush University Medical Center, Chicago, IL
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19
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McAninch EA, Bianco AC. The Swinging Pendulum in Treatment for Hypothyroidism: From (and Toward?) Combination Therapy. Front Endocrinol (Lausanne) 2019; 10:446. [PMID: 31354624 PMCID: PMC6629976 DOI: 10.3389/fendo.2019.00446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/20/2019] [Indexed: 12/26/2022] Open
Abstract
Thyroid hormone replacement for hypothyroidism can be achieved via several approaches utilizing different preparations of thyroid hormones, T3, and/or T4. "Combination therapy" involves administration of both T3 and T4, and was technically the first treatment for hypothyroidism. It was lauded as a cure for the morbidity and mortality associated with myxedema, the most severe presentation of overt hypothyroidism. In the late nineteenth and the early Twentieth centuries, combination therapy per se could consist of thyroid gland transplant, or more commonly, consumption of desiccated animal thyroid, thyroid extract, or thyroglobulin. Combination therapy remained the mainstay of therapy for decades despite development of synthetic formulations of T4 and T3, because it was efficacious and cost effective. However, concerns emerged about the consistency and potency of desiccated thyroid hormone after cases were reported detailing either continued hypothyroidism or iatrogenic thyrotoxicosis. Development of the TSH radioimmunoassay and discovery of conversion of T4-to-T3 in humans led to a major transition in clinical practices away from combination therapy, to adoption of levothyroxine "monotherapy" as the standard of care. Levothyroxine monotherapy has a favorable safety profile and can effectively normalize the serum TSH, the most sensitive marker of hypothyroidism. Whether levothyroxine monotherapy restores thyroid hormone signaling within all tissues remains controversial. Evidence of persistent signs and symptoms of hypothyroidism during levothyroxine monotherapy at doses that normalize serum TSH is mounting. Hence, in the last decade there has been acknowledgment by all thyroid professional societies that there may be a role for the use of combination therapy; this represents a significant shift in the clinical practice guidelines. Further bolstering this trend are the recent findings that the Thr92AlaD2 polymorphism may reduce thyroid hormone signaling, resulting in localized and systemic hypothyroidism. This strengthens the hypothesis that treatment options could be personalized, taking into consideration genotypes and comorbidities. The development of long-acting formulations of liothyronine and continued advancements in development of thyroid regenerative therapy, may propel the field closer to adoption of a physiologic thyroid hormone replacement regimen with combination therapy.
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Affiliation(s)
- Elizabeth A. McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, United States
| | - Antonio C. Bianco
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, IL, United States
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20
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Jo S, Fonseca TL, Bocco BMLC, Fernandes GW, McAninch EA, Bolin AP, Da Conceição RR, Werneck-de-Castro JP, Ignacio DL, Egri P, Németh D, Fekete C, Bernardi MM, Leitch VD, Mannan NS, Curry KF, Butterfield NC, Bassett JD, Williams GR, Gereben B, Ribeiro MO, Bianco AC. Type 2 deiodinase polymorphism causes ER stress and hypothyroidism in the brain. J Clin Invest 2019; 129:230-245. [PMID: 30352046 PMCID: PMC6307951 DOI: 10.1172/jci123176] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022] Open
Abstract
Levothyroxine (LT4) is a form of thyroid hormone used to treat hypothyroidism. In the brain, T4 is converted to the active form T3 by type 2 deiodinase (D2). Thus, it is intriguing that carriers of the Thr92Ala polymorphism in the D2 gene (DIO2) exhibit clinical improvement when liothyronine (LT3) is added to LT4 therapy. Here, we report that D2 is a cargo protein in ER Golgi intermediary compartment (ERGIC) vesicles, recycling between ER and Golgi. The Thr92-to-Ala substitution (Ala92-D2) caused ER stress and activated the unfolded protein response (UPR). Ala92-D2 accumulated in the trans-Golgi and generated less T3, which was restored by eliminating ER stress with the chemical chaperone 4-phenyl butyric acid (4-PBA). An Ala92-Dio2 polymorphism-carrying mouse exhibited UPR and hypothyroidism in distinct brain areas. The mouse refrained from physical activity, slept more, and required additional time to memorize objects. Enhancing T3 signaling in the brain with LT3 improved cognition, whereas restoring proteostasis with 4-PBA eliminated the Ala92-Dio2 phenotype. In contrast, primary hypothyroidism intensified the Ala92-Dio2 phenotype, with only partial response to LT4 therapy. Disruption of cellular proteostasis and reduced Ala92-D2 activity may explain the failure of LT4 therapy in carriers of Thr92Ala-DIO2.
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Affiliation(s)
- Sungro Jo
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Tatiana L. Fonseca
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Barbara M. L. C. Bocco
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gustavo W. Fernandes
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Elizabeth A. McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Anaysa P. Bolin
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pharmacology, Biomedical Science Institute, University of São Paulo, and
| | - Rodrigo R. Da Conceição
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Daniele L. Ignacio
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Péter Egri
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Dorottya Németh
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Csaba Fekete
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Maria Martha Bernardi
- Graduate Program of Environmental and Experimental Pathology, Graduate Program of Dentistry, Universidade Paulista, São Paulo, SP, Brazil
| | - Victoria D. Leitch
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Naila S. Mannan
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Katharine F. Curry
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Natalie C. Butterfield
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - J.H. Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Graham R. Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, United Kingdom
| | - Balázs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Miriam O. Ribeiro
- Developmental Disorders Program, Center of Biological Science and Health, Mackenzie Presbyterian University, São Paulo, SP, Brazil
| | - Antonio C. Bianco
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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21
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Rajan KB, Barnes LL, Wilson RS, Weuve J, McAninch EA, Evans DA. Apolipoprotein E Genotypes, Age, Race, and Cognitive Decline in a Population Sample. J Am Geriatr Soc 2018; 67:734-740. [PMID: 30584655 DOI: 10.1111/jgs.15727] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effects of age and race on the association of apolipoprotein E (APOE) genotypes with cognitive decline in a population sample. DESIGN Longitudinal study of 18 years' duration. SETTING Biracial urban US population sample. PARTICIPANTS There were a total of 5807 participants, 60% African American (AA) and 40% European American (EA). MEASUREMENTS A composite cognitive function based on individual tests of episodic memory, perceptual speed, and the Mini-Mental State Examination. RESULTS The frequencies of APOE ε2/ε3 (14% vs 12%), ε2/ε4 (4% vs 2%), ε3/ε4 (29% vs 22%), and ε4/ε4 (4% vs 2%) genotypes were higher among AAs than EAs. After adjusting for demographic factors, the rate of decline in global cognition was twice as high among participants with the APOE ε4/ε4 genotype compared to participants with the APOE ε3/ε3 genotype (0.097 vs 0.048 SD units [SDUs] per year; P < .0001). This doubling was not different between AAs (0.091 vs 0.045 SDUs per year) and EAs (0.118 vs 0.059 SDUs per year) (Pinteraction = .63). The APOE ε3/ε4 genotype was associated with a higher rate of decline with age (Pinteraction = .021), while the APOE ε2/ε4 genotype (Pinteraction = .016) and the APOE ε2/ε3 genotype (Pinteraction = .043) were associated with a lower rate of decline with higher age. The APOE ε2/ε2 genotype was associated with a lower rate of decline in episodic memory, while the APOE ε2/ε4 was associated with a higher rate of decline in episodic memory and perceptual speed. CONCLUSIONS The association of the APOE genotypes with cognitive decline was not different between AAs and EAs. However, individuals with different APOE genotypes showed a lower or a higher rate of decline with age. J Am Geriatr Soc 67:734-740, 2019.
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Affiliation(s)
- Kumar B Rajan
- Department of Public Health Sciences, University of California at Davis, Davis, California
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Jennifer Weuve
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Elizabeth A McAninch
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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22
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Trohman RG, Sharma PS, McAninch EA, Bianco AC. Amiodarone and thyroid physiology, pathophysiology, diagnosis and management. Trends Cardiovasc Med 2018; 29:285-295. [PMID: 30309693 DOI: 10.1016/j.tcm.2018.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/15/2018] [Accepted: 09/06/2018] [Indexed: 12/14/2022]
Abstract
Although amiodarone is considered the most effective antiarrhythmic agent, its use is limited by a wide variety of potential toxicities. The purpose of this review is to provide a comprehensive "bench to bedside" overview of the ways amiodarone influences thyroid function. We performed a systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2017. Amiodarone was searched using the terms adverse effects, hypothyroidism, myxedema, hyperthyroidism, thyroid storm, atrial fibrillation, ventricular arrhythmia, and electrical storm. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. We included 163 germane references in this review. Because amiodarone is one of the most frequently prescribed antiarrhythmic drugs in the United States, the mechanistic, diagnostic and therapeutic information provided is relevant for practicing clinicians in a wide range of medical specialties.
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Affiliation(s)
- Richard G Trohman
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States.
| | - Parikshit S Sharma
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth A McAninch
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Antonio C Bianco
- Divisions of Cardiology and Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
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23
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McAninch EA, Rajan KB, Miller CH, Bianco AC. Systemic Thyroid Hormone Status During Levothyroxine Therapy In Hypothyroidism: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2018; 103:5074280. [PMID: 30124904 PMCID: PMC6226605 DOI: 10.1210/jc.2018-01361] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
CONTEXT The standard of care for overt hypothyroidism is levothyroxine at doses that normalize serum TSH levels. Whether this approach universally restores thyroid hormone signaling is unknown. OBJECTIVE To review studies of overt hypothyroidism in which participants were treated with levothyroxine to normalize serum TSH levels and measured other objective markers of thyroid hormone signaling. DESIGN Databases were searched for studies that reported objective markers of thyroid hormone signaling (serum low-density lipoprotein (LDL), total cholesterol (TC), sex hormone-binding globulin (SHBG), creatine kinase and/or ferritin levels; cognition, energy expenditure, and/or renal function) in levothyroxine monotherapy for overt, primary hypothyroidism among nonpregnant adults with normal serum TSH levels. For studies with LDL, TC and SHBG outcomes, data were pooled using random effects meta-analysis. RESULTS A total of 99 studies met inclusion criteria, including 65 that reported serum cholesterol data. Meta-analysis showed that levothyroxine-treated hypothyroid participants with normal serum TSH levels had 3.31 ± 1.64 mg/dL higher serum LDL levels (p=0.044) and 9.60 ± 3.55 mg/dL higher serum TC levels (p=0.007) compared to controls. In studies that did not concomitantly assess healthy controls, serum LDL levels were 138.3 ± 4.6 mg/dL (p<0.001) and serum TC levels were 209.6 ± 3.4 mg/dL (p<0.001). Meta-analysis of 2 studies showed no significant difference between SHBG levels of levothyroxine-treated participants and controls. CONCLUSIONS In studies that utilized levothyroxine monotherapy at doses that normalized the serum TSH for overt, primary hypothyroidism, not all systemic biological markers of thyroid hormone signaling were normalized, including serum LDL and TC levels.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Kumar B Rajan
- Division of Biostatistics, University of California, Davis, School of Medicine, Davis, California
| | - Corinne H Miller
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
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24
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Nascimento BPP, Bocco BMLC, Fernandes GW, Fonseca TL, McAninch EA, Cardoso CV, Bondan EF, Nassif RJ, Cysneiros RM, Bianco AC, Ribeiro MO. Induction of Type 2 Iodothyronine Deiodinase After Status Epilepticus Modifies Hippocampal Gene Expression in Male Mice. Endocrinology 2018; 159:3090-3104. [PMID: 29905787 PMCID: PMC6669821 DOI: 10.1210/en.2018-00146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
Abstract
Status epilepticus (SE) is an abnormally prolonged seizure that results from either a failure of mechanisms that terminate seizures or from initiating mechanisms that inherently lead to prolonged seizures. Here we report that mice experiencing a 3 hours of SE caused by pilocarpine exhibit a rapid increase in expression of type 2 iodothyronine deiodinase gene (Dio2) and a decrease in the expression of type 3 iodothyronine deiodinase gene in hippocampus, amygdala and prefrontal cortex. Type 3 iodothyronine deiodinase in hippocampal sections was seen concentrated in the neuronal nuclei, typical of ischemic injury of the brain. An unbiased analysis of the hippocampal transcriptome of mice undergoing 3 hours of SE revealed a number of genes, including those involved with response to oxidative stress, cellular homeostasis, cell signaling, and mitochondrial structure. In contrast, in mice with targeted disruption of Dio2 in astrocytes (Astro D2KO mouse), the highly induced genes in the hippocampus were related to inflammation, apoptosis, and cell death. We propose that Dio2 induction caused by SE accelerates production of T3 in different areas of the central nervous system and modifies the hippocampal gene expression profile, affecting the balance between adaptive and maladaptive mechanisms.
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Affiliation(s)
- Bruna P P Nascimento
- Graduate Program of Translational Medicine, Department of Medicine, Federal University of São Paulo, São Paulo-SP, Brazil
- Developmental Disorders Program, Center of Biological Sciences and Health, Mackenzie Presbyterian University, São Paulo-SP, Brazil
| | - Barbara M L C Bocco
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Gustavo W Fernandes
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Tatiana L Fonseca
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Carolina V Cardoso
- Department of Environmental and Experimental Pathology, Paulista University, São Paulo-SP, Brazil
| | - Eduardo F Bondan
- Department of Environmental and Experimental Pathology, Paulista University, São Paulo-SP, Brazil
| | - Renata J Nassif
- Neuroscience Sector, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo-SP, Brazil
| | - Roberta M Cysneiros
- Developmental Disorders Program, Center of Biological Sciences and Health, Mackenzie Presbyterian University, São Paulo-SP, Brazil
| | - Antonio C Bianco
- Division of Endocrinology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Miriam O Ribeiro
- Graduate Program of Translational Medicine, Department of Medicine, Federal University of São Paulo, São Paulo-SP, Brazil
- Developmental Disorders Program, Center of Biological Sciences and Health, Mackenzie Presbyterian University, São Paulo-SP, Brazil
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25
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Abstract
The current state of the diagnosis and management of thyroid disease cannot be separated from the larger context of women’s health for the following reasons: (1) the disproportionate incidence and prevalence of functional and structural thyroid diseases among women vs men; (2) the role of thyroid health on fertility, pregnancy, and postpartum; and (3) the challenge posed in managing the nonspecific symptoms of functional thyroid disease in the context of menopause. Here, we explore the hypothesis that sex bias has played a role in the management of thyroid diseases historically and has extended into the modern medical era. Once knowledge gaps that may have resulted from sex bias are recognized, we can strive to overcome this bias and develop better treatments to improve patient outcomes universally.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Jennifer S Glueck
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
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26
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Rajan KB, Barnes LL, Wilson RS, Weuve J, McAninch EA, Evans DA. Blood pressure and risk of incident Alzheimer's disease dementia by antihypertensive medications and APOE ε4 allele. Ann Neurol 2018; 83:935-944. [PMID: 29637601 DOI: 10.1002/ana.25228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/05/2018] [Accepted: 04/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the association of blood pressure (BP) with incident Alzheimer's disease (AD) dementia. METHODS This work is based on a longitudinal, cohort study of 18 years, the Chicago Health and Aging Project (CHAP) performed in 2,137 participants (55% black) with systolic BP measured around 8.1 years before incident AD dementia. RESULTS The association of BP with risk of AD dementia was U-shaped, with the lowest risks of AD dementia near the center of the systolic BP (SBP) and diastolic BP (DBP) distributions, and modestly elevated risk at lower BPs, and greater risk at higher BPs. The degree of U-shape and the range of lowest risk (threshold ranges) varied with antihypertensive medication use and presence of the APOE ε4 allele. The U-shape was most prominent for the subgroup not taking antihypertensive medications and having an APOE ε4 allele. At higher BPs, those having the APOE ε4 allele and not receiving antihypertensive medication were at greater risk of AD dementia than other groups: The risk of incident AD dementia increased by 100% (relative risk [RR] = 2.00; 95% confidence interval [CI] = 1.70, 2.31) for every 10 mm Hg increase in SBP above 140 mm Hg. For DBP, the risk of incident of AD dementia increased by 57% (RR = 1.57; 95% CI = 1.33, 1.86) for every 5 mm Hg increase in DBP above 76 mm Hg. INTERPRETATION The BP risk of AD dementia association is U-shaped, with elevated risk at lower and higher BPs. People having the APOE ε4 allele and not receiving antihypertensive medication with higher BPs have notably elevated risk of AD dementia. Ann Neurol 2018;83:935-944.
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Affiliation(s)
- Kumar B Rajan
- Department of Public Health Sciences, University of California at Davis, Davis, CA.,Alzheimer's Disease Center, University of California at Davis, Chicago, IL
| | - Lisa L Barnes
- Alzheimer's Disease Center, University of California at Davis, Chicago, IL
| | | | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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27
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McAninch EA, Rajan KB, Evans DA, Jo S, Chaker L, Peeters RP, Bennett DA, Mash DC, Bianco AC. A Common DIO2 Polymorphism and Alzheimer Disease Dementia in African and European Americans. J Clin Endocrinol Metab 2018; 103:1818-1826. [PMID: 29481662 PMCID: PMC6276710 DOI: 10.1210/jc.2017-01196] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 05/24/2017] [Accepted: 02/16/2018] [Indexed: 02/02/2023]
Abstract
Context A common single nucleotide polymorphism in DIO2, Thr92AlaD2, has been associated with a transcriptome typically found in neurodegenerative diseases in postmortem human brain tissue. Objective To determine whether Thr92AlaD2 is associated with incident Alzheimer disease (AD). Design Population-based study; human brain tissue microarray. Setting Community-based cohorts from Chicago and northeastern Illinois and religious clergymen from across the United States constituted the primary population. A representative sample of the U.S. population was used for secondary analyses. Participants 3054 African Americans (AAs) and 9304 European Americans (EAs). Main Outcome Measure Incident AD. Results In the primary population, AAs with Thr92AlaD2 had 1.3 times [95% confidence interval (CI), 1.02 to 1.68; P = 0.048] greater odds of developing AD. AAs from a second population with Thr92AlaD2 showed a trend toward increased odds of dementia (odds ratio, 1.33; 95% CI, 0.99 to 1.78; P = 0.06) and 1.35 times greater odds of developing cognitive impairment not demented (CIND; 95% CI, 1.09 to 1.67; P = 0.006). Meta-analysis showed that AAs with Thr92AlaD2 had 1.3 times increased odds of developing AD/dementia (95% CI, 1.07 to 1.58; P = 0.008). In EAs, no association was found between Thr92AlaD2 and AD, dementia, or CIND. Microarray of AA brain tissue identified transcriptional patterns linked to AD pathogenesis. Conclusions Thr92AlaD2 was associated with molecular markers known to underlie AD pathogenesis in AAs, translating to an observed phenotype of increased odds of developing AD/dementia in AAs in these populations. Thr92AlaD2 might represent one factor contributing to racial discrepancies in incident AD.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center,
Chicago, Illinois
| | - Kumar B Rajan
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush
University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush
University Medical Center, Chicago, Illinois
| | - Sungro Jo
- Division of Endocrinology and Metabolism, Rush University Medical Center,
Chicago, Illinois
| | - Layal Chaker
- Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, The
Netherlands
| | - Robin P Peeters
- Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, The
Netherlands
| | - David A Bennett
- Department of Neurologic Sciences, Rush Alzheimer's Disease Center, Rush
University Medical Center, Chicago, Illinois
| | - Deborah C Mash
- Department of Neurologic Sciences, University of Miami Miller School of
Medicine, Miami, Florida
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center,
Chicago, Illinois
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28
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Rajan KB, Barnes LL, Wilson RS, McAninch EA, Weuve J, Sighoko D, Evans DA. Racial Differences in the Association Between Apolipoprotein E Risk Alleles and Overall and Total Cardiovascular Mortality Over 18 Years. J Am Geriatr Soc 2017; 65:2425-2430. [PMID: 28898389 DOI: 10.1111/jgs.15059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine the difference in the association between apolipoprotein (APO)E allele and overall and cardiovascular mortality between African Americans (AAs) and European Americans (EAs). DESIGN Longitudinal, cohort study of 18 years. SETTING Biracial urban US population sample. PARTICIPANTS 4,917, 68% AA and 32% EA. MEASUREMENTS APOE genotype and mortality based on National Death Index. RESULTS A higher proportion of AAs than of EAs had an APOE ε2 allele (ε2ε2/ε2ε3/ε2ε4; 22% vs 13%) and an APOE ε4 allele (ε3ε4/ε4ε4; 33% vs 24%). After adjusting for known risk factors, the risk of mortality was 19% less with the APOE ε2 allele (hazard ratio (HR) = 0.81, 95% confidence interval (CI) = 0.76-0.87), and the risk of cardiovascular mortality was 35% less (HR = 0.65, 95% CI = 0.58-0.76) than with the ε3ε3 allele. The risk of mortality was 10% greater with the APOE ε4 allele (HR = 1.10, 95% CI = 1.04-1.16), and the risk of cardiovascular mortality was 20% greater (HR = 1.20, 95% CI = 1.07-1.29) than with the ε3ε3 allele. No difference in the association between APOE allele and mortality was observed between AAs and EAs. CONCLUSION The APOE ε4 allele increased the risk of overall and cardiovascular mortality, whereas the APOE ε2 allele decreased the risk of overall and cardiovascular mortality. There was no racial difference in the association between these alleles and mortality.
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Affiliation(s)
- Kumar B Rajan
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Jennifer Weuve
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Dominique Sighoko
- Breast Cancer Task Force, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
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Abstract
CONTEXT Levothyroxine (LT4) monotherapy is the standard of care for hypothyroidism. OBJECTIVE To determine whether LT4 at doses that normalize the serum TSH is associated with normal markers of thyroid status. DESIGN Cross-sectional data from the US National Health and Nutrition Examination Survey (2001-2012) was used to evaluate 52 clinical parameters. LT4 users were compared to healthy controls and controls matched for age, sex, race, and serum TSH. Regression was used to evaluate for correlation with T4 and T3 levels. PARTICIPANTS A total of 9981 participants with normal serum TSH were identified; 469 were LT4-treated. RESULTS Participants using LT4 had higher serum total and free T4 and lower serum total and free T3 than healthy or matched controls. This translated to approximately 15-20% lower serum T3:T4 ratios in LT4 treatment, as has been shown in other cohorts. In comparison to matched controls, LT4-treated participants had higher body mass index despite report of consuming fewer calories/day/kg; were more likely to be taking beta-blockers, statins, and antidepressants; and reported lower total metabolic equivalents. A serum TSH level below the mean in LT4-treated participants was associated with a higher serum free T4 but similar free and total T3; yet those with lower serum TSH levels exhibited higher serum high-density lipoprotein and lower serum low-density lipoprotein, triglycerides, and C-reactive protein. Age was negatively associated with serum free T3:free T4 ratio in all participants; caloric intake was positively associated in LT4-treated individuals. CONCLUSIONS In a large population study, participants using LT4 exhibited lower serum T3:T4 ratios and differed in 12/52 objective and subjective measures.
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Affiliation(s)
- Sarah J Peterson
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
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Rajan KB, Arvanitakis Z, Lynch EB, McAninch EA, Wilson RS, Weuve J, Barnes LL, Bianco AC, Evans DA. Cognitive decline following incident and preexisting diabetes mellitus in a population sample. Neurology 2016; 87:1681-1687. [PMID: 27655734 DOI: 10.1212/wnl.0000000000003226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/07/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To examine if incident and preexisting diabetes mellitus (DM) were associated with cognitive decline among African Americans (AAs) and European Americans (EAs). METHODS Based on a prospective study of 7,740 older adults (mean age 72.3 years, 64% AA, 63% female), DM was ascertained by hypoglycemic medication use and Medicare claims during physician or hospital visits, and cognition by performance on a brief battery for executive functioning, episodic memory, and Mini-Mental State Examination (MMSE). Decline in composite and individual tests among those with incident DM, with preexisting DM, and without DM was studied using a linear mixed effects model with and without change point. RESULTS At baseline, 737 (15%) AAs and 269 (10%) EAs had preexisting DM. Another 721 (17%) AAs and 289 (12%) EAs had incident DM in old age. Following incident DM, cognitive decline increased by 36% among AAs and by 40% among EAs compared to those without DM. No significant difference was observed between AAs and EAs (p = 0.64). However, cognitive decline increased by 17% among AAs with preexisting DM compared to those without DM, but no increased decline was observed among EAs with preexisting DM. In secondary analyses, faster decline in executive functioning and episodic memory was observed following incident DM. CONCLUSIONS In old age, faster cognitive decline was present among AAs and EAs following incident DM, compared to cognitive decline prior to DM, and among those without DM. This underscores the need for stronger prevention and control of DM in old age.
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Affiliation(s)
- Kumar B Rajan
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL.
| | - Zoe Arvanitakis
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Elizabeth B Lynch
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Elizabeth A McAninch
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Jennifer Weuve
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Antonio C Bianco
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
| | - Denis A Evans
- From the Rush Institute for Healthy Aging (K.B.R., J.W., D.A.E.), Rush Alzheimer's Disease Center (Z.A., R.S.W., L.L.B.), Departments of Neurological Sciences (Z.A., R.S.W., L.L.B.) and Preventive Medicine (E.B.L.), and Division of Endocrinology and Metabolism (E.A.M., A.C.B.), Rush University Medical Center, Chicago, IL
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Bocco BMLC, Werneck-de-Castro JP, Oliveira KC, Fernandes GW, Fonseca TL, Nascimento BPP, McAninch EA, Ricci E, Kvárta-Papp Z, Fekete C, Bernardi MM, Gereben B, Bianco AC, Ribeiro MO. Type 2 Deiodinase Disruption in Astrocytes Results in Anxiety-Depressive-Like Behavior in Male Mice. Endocrinology 2016; 157:3682-95. [PMID: 27501182 PMCID: PMC5007895 DOI: 10.1210/en.2016-1272] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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] [Received: 04/27/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022]
Abstract
Millions of levothyroxine-treated hypothyroid patients complain of impaired cognition despite normal TSH serum levels. This could reflect abnormalities in the type 2 deiodinase (D2)-mediated T4-to-T3 conversion, given their much greater dependence on the D2 pathway for T3 production. T3 normally reaches the brain directly from the circulation or is produced locally by D2 in astrocytes. Here we report that mice with astrocyte-specific Dio2 inactivation (Astro-D2KO) have normal serum T3 but exhibit anxiety-depression-like behavior as found in open field and elevated plus maze studies and when tested for depression using the tail-suspension and the forced-swimming tests. Remarkably, 4 weeks of daily treadmill exercise sessions eliminated this phenotype. Microarray gene expression profiling of the Astro-D2KO hippocampi identified an enrichment of three gene sets related to inflammation and impoverishment of three gene sets related to mitochondrial function and response to oxidative stress. Despite normal neurogenesis, the Astro-D2KO hippocampi exhibited decreased expression of four of six known to be positively regulated genes by T3, ie, Mbp (∼43%), Mag (∼34%), Hr (∼49%), and Aldh1a1 (∼61%) and increased expression of 3 of 12 genes negatively regulated by T3, ie, Dgkg (∼17%), Syce2 (∼26%), and Col6a1 (∼3-fold) by quantitative real-time PCR. Notably, in Astro-D2KO animals, there was also a reduction in mRNA levels of genes known to be affected in classical animal models of depression, ie, Bdnf (∼18%), Ntf3 (∼43%), Nmdar (∼26%), and GR (∼20%), which were also normalized by daily exercise sessions. These findings suggest that defects in Dio2 expression in the brain could result in mood and behavioral disorders.
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Affiliation(s)
- Barbara M L C Bocco
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - João Pedro Werneck-de-Castro
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Kelen C Oliveira
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Gustavo W Fernandes
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Tatiana L Fonseca
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Bruna P P Nascimento
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Esther Ricci
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Zsuzsanna Kvárta-Papp
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Csaba Fekete
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Maria Martha Bernardi
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Balázs Gereben
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
| | - Miriam O Ribeiro
- Division of Endocrinology and Metabolism (B.M.L.C.B., J.P.W.-d.C., G.W.F., T.L.F., E.A.M., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Translational Medicine (B.M.L.C.B., G.W.F., B.P.P.N.), Federal University of Sao Paulo, Sao Paulo SP, 04039-002, Brazil; Biophysics Institute and School of Physical Education and Sports (J.P.W.-d.C.), Federal University of Rio de Janeiro, RJ 21941-599, Brazil; Department of Clinic Endocrinology (K.C.O.), Federal University of Sao Paulo, Sao Paulo SP 04039-032, Brazil; Developmental Disorders Program (B.P.P.N., E.R., M.O.R.), Center of Biological Science and Health, Mackenzie Presbyterian University, Sao Paulo SP 01302-900 Brazil; Department of Endocrine Neurobiology (Z.K.-P., C.F., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest H-1083, Hungary; Department of Medicine (C.F.), Division of Endocrinology, Diabetes, and Metabolism, Tupper Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; and Graduate Program of Environmental and Experimental Pathology (M.M.B.), Graduate Program of Dentistry, Universidade Paulista, Sao Paulo SP 04026-002, Brazil
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McAninch EA. An active life is a sweet life. Lancet Diabetes Endocrinol 2016; 4:548. [PMID: 26928652 DOI: 10.1016/s2213-8587(15)00516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 11/29/2022]
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Abstract
BACKGROUND The American Thyroid Association (ATA) has recently revised its guidance pertaining to thyroid nodules and follicular cell-derived thyroid cancer. The 2015 guidelines are massive in both scope and scale, with changes in the organizational approach to risk stratification of nodules and cancer, as well as multiple sections covering new material. This review highlights the major structural and organizational changes, focusing attention on the most dramatically changed recommendations, that is, those recommendations that clinicians will find striking because they call for significant divergence from prior clinical practice. SUMMARY The revised approach to thyroid nodule risk stratification is based on sonographic pattern, with an emphasis on pattern rather than growth in the long-term surveillance of nodules. Accumulating data have also been incorporated into an updated risk stratification scheme for thyroid cancer that increases the size of the low-risk pool, in part because low-volume lymph nodal metastases are now considered low risk. The most fundamentally altered recommendation is that lobectomy might be considered as the initial surgical approach for follicular cell-derived thyroid cancers from 1 to 4 cm in size. CONCLUSIONS The underlying theme of the 2015 ATA guidelines is that "less is more." As these new recommendations are adopted, fewer fine-needle aspiration biopsies will need to be done, less extensive surgeries will become more common, less radioactive iodine will be used either for treatment or for diagnostics, and less stimulated thyroglobulin testing will be done. Mastery of these guidelines will help clinicians know when it is reasonable to do less, thus providing responsibly individualized therapy for their patients.
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Affiliation(s)
- Brian W Kim
- 1 Division of Endocrinology, Diabetes, and Metabolism, Rush University Medical Center , Chicago, Illinois
| | - Wina Yousman
- 2 Department of Physiology, University of Arizona , Tucson, Arizona
| | - Wei Xiang Wong
- 3 Department of Internal Medicine, University of Arizona , Tucson, Arizona
| | - Cheng Cheng
- 4 Department of Internal Medicine, Rush University Medical Center , Chicago, Illinois
| | - Elizabeth A McAninch
- 1 Division of Endocrinology, Diabetes, and Metabolism, Rush University Medical Center , Chicago, Illinois
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Abstract
Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine monotherapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone-treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism.
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McAninch EA, Kim BW. Symptomatic Syndrome of Inappropriate Antidiuretic Hormone Secretion in Pituitary Apoplexy: A Case Report and Literature Review. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15755.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL 60612, USA
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McAninch EA, Miller BT, Ueta CB, Jo S, Kim BW. Thyroid Hormone at Near Physiologic Concentrations Acutely Increases Oxygen Consumption and Extracellular Acidification in LH86 Hepatoma Cells. Endocrinology 2015; 156:4325-35. [PMID: 26287403 DOI: 10.1210/en.2015-1221] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thyroid hormone (T3) has been known to regulate the basal metabolic rate for more than a century, but mechanistic understanding is lacking both at the level of the intact organism and in terms of how T3 alters energy expenditure in individual tissues. The current studies investigate the question of which metabolically relevant genes respond acutely as T3 concentrations increase through the physiologic range in liver cells. Because this has been technically unfeasible historically, we developed a modified protocol for extracellular flux analysis using a 96-well Extracellular Flux Analyzer (Seahorse Bioscience). Using a modified extracellular flux protocol and LH86 human hepatoma cells, we established an experimental system where small but significant changes in O2 consumption could be reproducibly quantified as hypothyroid cells were exposed to near-physiologic final concentrations of T3 approximately 2 orders of magnitude lower than most studies (0.04 nM free T3), in only 6-7 hours. Taking advantage of the nondestructive nature of 96-well Extracellular Flux Analyzer measurements, the acute, direct, transcriptional changes that occur were measured in the exact same cells demonstrating increased O2 consumption. An unbiased, genome-wide microarray analysis identified potential candidate genes related to fatty acid oxidation, angiogenesis, nucleotide metabolism, immune signaling, mitochondrial respiration, and cell proliferation. The identified transcriptome is likely enriched in the genes most important for mediating the energetic effects of T3 in hepatoma cells.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism (E.A.M., S.J., B.W.K.), Rush University Medical Center, Chicago, Illinois 60612; University of South Florida Morsani College of Medicine (B.T.M.), Tampa, Florida 33612; and Institute of Biomedical Science (C.B.U.), University of São Paulo, São Paulo SP 05508-000, Brazil
| | - Bradford T Miller
- Division of Endocrinology and Metabolism (E.A.M., S.J., B.W.K.), Rush University Medical Center, Chicago, Illinois 60612; University of South Florida Morsani College of Medicine (B.T.M.), Tampa, Florida 33612; and Institute of Biomedical Science (C.B.U.), University of São Paulo, São Paulo SP 05508-000, Brazil
| | - Cintia B Ueta
- Division of Endocrinology and Metabolism (E.A.M., S.J., B.W.K.), Rush University Medical Center, Chicago, Illinois 60612; University of South Florida Morsani College of Medicine (B.T.M.), Tampa, Florida 33612; and Institute of Biomedical Science (C.B.U.), University of São Paulo, São Paulo SP 05508-000, Brazil
| | - Sungro Jo
- Division of Endocrinology and Metabolism (E.A.M., S.J., B.W.K.), Rush University Medical Center, Chicago, Illinois 60612; University of South Florida Morsani College of Medicine (B.T.M.), Tampa, Florida 33612; and Institute of Biomedical Science (C.B.U.), University of São Paulo, São Paulo SP 05508-000, Brazil
| | - Brian W Kim
- Division of Endocrinology and Metabolism (E.A.M., S.J., B.W.K.), Rush University Medical Center, Chicago, Illinois 60612; University of South Florida Morsani College of Medicine (B.T.M.), Tampa, Florida 33612; and Institute of Biomedical Science (C.B.U.), University of São Paulo, São Paulo SP 05508-000, Brazil
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Abstract
The coordinated expression and activity of the iodothyronine deiodinases regulate thyroid hormone levels in hypothyroidism. Once heralded as the pathway underpinning adequate thyroid-hormone replacement therapy with levothyroxine, the role of these enzymes has come into question as they have been implicated in both an inability to normalize serum levels of tri-iodothyronine (T3) and the incomplete resolution of hypothyroid symptoms. These observations, some of which were validated in animal models of levothyroxine monotherapy, challenge the paradigm that tissue levels of T3 and thyroid-hormone signalling can be fully restored by administration of levothyroxine alone. The low serum levels of T3 observed among patients receiving levothyroxine monotherapy occur as a consequence of type 2 iodothyronine deiodinase (DIO2) in the hypothalamus being fairly insensitive to ubiquitination. In addition, residual symptoms of hypothyroidism have been linked to a prevalent polymorphism in the DIO2 gene that might be a risk factor for neurodegenerative disease. Here, we discuss how these novel findings underscore the clinical importance of iodothyronine deiodinases in hypothyroidism and how an improved understanding of these enzymes might translate to therapeutic advances in the care of millions of patients with this condition.
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Affiliation(s)
- Balázs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Szigony Street 43, Budapest H-1083, Hungary
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, 212 Cohn Building, 1735 West Harrison Street, Chicago, IL 60612, USA
| | - Miriam O Ribeiro
- Developmental Disorders Program, Center for Biological and Health Science, Mackenzie Presbyterian University, Rua da Consolação 930, Building 16, São Paulo, SP 01302, Brazil
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, 212 Cohn Building, 1735 West Harrison Street, Chicago, IL 60612, USA
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McAninch EA, Bianco AC. New insights into the variable effectiveness of levothyroxine monotherapy for hypothyroidism. Lancet Diabetes Endocrinol 2015; 3:756-8. [PMID: 26362364 PMCID: PMC5006060 DOI: 10.1016/s2213-8587(15)00325-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL 60612, USA
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McAninch EA, Fonseca TL, Poggioli R, Panos AL, Salerno TA, Deng Y, Li Y, Bianco AC, Iacobellis G. Epicardial adipose tissue has a unique transcriptome modified in severe coronary artery disease. Obesity (Silver Spring) 2015; 23:1267-78. [PMID: 25959145 PMCID: PMC5003780 DOI: 10.1002/oby.21059] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/26/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To explore the transcriptome of epicardial adipose tissue (EAT) as compared to subcutaneous adipose tissue (SAT) and its modifications in a small number of patients with coronary artery disease (CAD) versus valvulopathy. METHODS SAT and EAT samples were obtained during elective cardiothoracic surgeries. The transcriptome of EAT was evaluated, as compared to SAT, using an unbiased, whole-genome approach in subjects with CAD (n = 6) and without CAD (n = 5), where the patients without CAD had cardiac valvulopathy. RESULTS Relative to SAT, EAT is a highly inflammatory tissue enriched with genes involved in endothelial function, coagulation, immune signaling, potassium transport, and apoptosis. EAT is lacking in expression of genes involved in protein metabolism, tranforming growth factor-beta (TGF-beta) signaling, and oxidative stress. Although underpowered, in subjects with severe CAD, there is an expression trend suggesting widespread downregulation of EAT encompassing a diverse group of gene sets related to intracellular trafficking, proliferation/transcription regulation, protein catabolism, innate immunity/lectin pathway, and ER stress. CONCLUSIONS The EAT transcriptome is unique when compared to SAT. In the setting of CAD versus valvulopathy, there is possible alteration of the EAT transcriptome with gene suppression. This pilot study explores the transcriptome of EAT in CAD and valvulopathy, providing new insight into its physiologic and pathophysiologic roles.
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Affiliation(s)
- Elizabeth A. McAninch
- Department of Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Tatiana L. Fonseca
- Department of Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Raffaella Poggioli
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Anthony L. Panos
- Department of Surgery, Division of Thoracic and Cardiac Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Tomas A. Salerno
- Department of Surgery, Division of Thoracic and Cardiac Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Youping Deng
- Department of Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yan Li
- Department of Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Antonio C. Bianco
- Department of Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Gianluca Iacobellis
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Corresponding author: Gianluca Iacobellis, MD, PhD, 1400 NW 10th Avenue, Suite 805A, Miami, Florida 33136, USA, Phone: 305.243.3636; Fax: 305.243.6575;
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McAninch EA, Jo S, Preite NZ, Farkas E, Mohácsik P, Fekete C, Egri P, Gereben B, Li Y, Deng Y, Patti ME, Zevenbergen C, Peeters RP, Mash DC, Bianco AC. Prevalent polymorphism in thyroid hormone-activating enzyme leaves a genetic fingerprint that underlies associated clinical syndromes. J Clin Endocrinol Metab 2015; 100:920-33. [PMID: 25569702 PMCID: PMC4333048 DOI: 10.1210/jc.2014-4092] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 11/13/2014] [Accepted: 12/30/2014] [Indexed: 01/14/2023]
Abstract
CONTEXT A common polymorphism in the gene encoding the activating deiodinase (Thr92Ala-D2) is known to be associated with quality of life in millions of patients with hypothyroidism and with several organ-specific conditions. This polymorphism results in a single amino acid change within the D2 molecule where its susceptibility to ubiquitination and proteasomal degradation is regulated. OBJECTIVE To define the molecular mechanisms underlying associated conditions in carriers of the Thr92Ala-D2 polymorphism. DESIGN, SETTING, PATIENTS Microarray analyses of 19 postmortem human cerebral cortex samples were performed to establish a foundation for molecular studies via a cell model of HEK-293 cells stably expressing Thr92 or Ala92 D2. RESULTS The cerebral cortex of Thr92Ala-D2 carriers exhibits a transcriptional fingerprint that includes sets of genes involved in CNS diseases, ubiquitin, mitochondrial dysfunction (chromosomal genes encoding mitochondrial proteins), inflammation, apoptosis, DNA repair, and growth factor signaling. Similar findings were made in Ala92-D2-expressing HEK-293 cells and in both cases there was no evidence that thyroid hormone signaling was affected ie, the expression level of T3-responsive genes was unchanged, but that several other genes were differentially regulated. The combined microarray analyses (brain/cells) led to the development of an 81-gene classifier that correctly predicts the genotype of homozygous brain samples. In contrast to Thr92-D2, Ala92-D2 exhibits longer half-life and was consistently found in the Golgi. A number of Golgi-related genes were down-regulated in Ala92-D2-expressing cells, but were normalized after 24-h-treatment with the antioxidant N-acetylecysteine. CONCLUSIONS Ala92-D2 accumulates in the Golgi, where its presence and/or ensuing oxidative stress disrupts basic cellular functions and increases pre-apoptosis. These findings are reminiscent to disease mechanisms observed in other neurodegenerative disorders such as Huntington's disease, and could contribute to the unresolved neurocognitive symptoms of affected carriers.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology and Metabolism (E.A.M., S.J., N.Z.P., A.C.B.), Rush University Medical Center, Chicago, Illinois 60612; Department of Endocrine Neurobiology (E.F., P.M., C.F., P.E., B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083, Hungary; Péter Pázmány Catholic University (E.F.), Multidisciplinary Doctoral School of Sciences and Technology, Budapest, H-1083 Hungary; Semmelweis University (P.M., P.E.), János Szentágothai PhD School of Neurosciences, Budapest, H-1085 Hungary; Division of Endocrinology (C.F.), Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts 02111; Department of Medicine (Y.L., Y.D.), Rush University Medical Center, Chicago, Illinois 60612; Joslin Diabetes Center (M.E.P.), Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (C.Z., R.P.P.), Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands; and Department of Neurology (D.C.M.), University of Miami Miller School of Medicine, Miami, Florida 33136
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Werneck de Castro JP, Fonseca TL, Ueta CB, McAninch EA, Abdalla S, Wittmann G, Lechan RM, Gereben B, Bianco AC. Differences in hypothalamic type 2 deiodinase ubiquitination explain localized sensitivity to thyroxine. J Clin Invest 2015; 125:769-81. [PMID: 25555216 PMCID: PMC4319436 DOI: 10.1172/jci77588] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [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: 06/18/2014] [Accepted: 11/20/2014] [Indexed: 12/20/2022] Open
Abstract
The current treatment for patients with hypothyroidism is levothyroxine (L-T4) along with normalization of serum thyroid-stimulating hormone (TSH). However, normalization of serum TSH with L-T4 monotherapy results in relatively low serum 3,5,3'-triiodothyronine (T3) and high serum thyroxine/T3 (T4/T3) ratio. In the hypothalamus-pituitary dyad as well as the rest of the brain, the majority of T3 present is generated locally by T4 deiodination via the type 2 deiodinase (D2); this pathway is self-limited by ubiquitination of D2 by the ubiquitin ligase WSB-1. Here, we determined that tissue-specific differences in D2 ubiquitination account for the high T4/T3 serum ratio in adult thyroidectomized (Tx) rats chronically implanted with subcutaneous L-T4 pellets. While L-T4 administration decreased whole-body D2-dependent T4 conversion to T3, D2 activity in the hypothalamus was only minimally affected by L-T4. In vivo studies in mice harboring an astrocyte-specific Wsb1 deletion as well as in vitro analysis of D2 ubiquitination driven by different tissue extracts indicated that D2 ubiquitination in the hypothalamus is relatively less. As a result, in contrast to other D2-expressing tissues, the hypothalamus is wired to have increased sensitivity to T4. These studies reveal that tissue-specific differences in D2 ubiquitination are an inherent property of the TRH/TSH feedback mechanism and indicate that only constant delivery of L-T4 and L-T3 fully normalizes T3-dependent metabolic markers and gene expression profiles in Tx rats.
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Affiliation(s)
- Joao Pedro Werneck de Castro
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Tatiana L. Fonseca
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Cintia B. Ueta
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
| | - Elizabeth A. McAninch
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Sherine Abdalla
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
| | - Gabor Wittmann
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ronald M. Lechan
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Balazs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Antonio C. Bianco
- Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida, USA
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
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Abstract
CONTEXT Acute infectious thyroiditis, particularly fungal thyroiditis, is rare and typically presents in immunocompromised individuals. Here we report the first case of coccidiomycosis thyroiditis occurring in an organ recipient as a consequence of likely allograft contamination and discuss the management strategies for thyroid masses in the setting of disseminated infection. EVIDENCE ACQUISITION AND SYNTHESIS In this clinical case seminar, we summarize the previously published cases of coccidiomycosis thyroiditis based on a MEDLINE search of all peer-reviewed publications (original articles and reviews) on this topic. We identified six other cases, five of which also occurred in immunocompromised hosts, although none occurred in organ recipients. CONCLUSION A case of coccidiomycosis thyroiditis occurring in a post-liver transplant immunocompromised host is reported. Analysis of donor serum revealed the liver allograft as the likely infectious source, resulting in hematological spread to the thyroid. Although our patient's thyroid gland was lacking gross structural abnormalities at presentation, new-onset thyroid masses developed after relative immune restoration and initiation of antifungal therapies. The differential diagnosis of new-onset thyroid masses in immunocompromised hosts is discussed, with a focus on immune reconstitution inflammatory syndrome. The role of thyroidectomy in the management of fungal thyroiditis is also discussed.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami, Miami, Florida 33136
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Fonseca TL, Werneck-De-Castro JP, Castillo M, Bocco BM, Fernandes GW, McAninch EA, Ignacio DL, Moises CC, Ferreira A, Gereben B, Bianco AC. Tissue-specific inactivation of type 2 deiodinase reveals multilevel control of fatty acid oxidation by thyroid hormone in the mouse. Diabetes 2014; 63:1594-604. [PMID: 24487027 PMCID: PMC3994955 DOI: 10.2337/db13-1768] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Received: 11/19/2013] [Accepted: 01/26/2014] [Indexed: 01/05/2023]
Abstract
Type 2 deiodinase (D2) converts the prohormone thyroxine (T4) to the metabolically active molecule 3,5,3'-triiodothyronine (T3), but its global inactivation unexpectedly lowers the respiratory exchange rate (respiratory quotient [RQ]) and decreases food intake. Here we used FloxD2 mice to generate systemically euthyroid fat-specific (FAT), astrocyte-specific (ASTRO), or skeletal-muscle-specific (SKM) D2 knockout (D2KO) mice that were monitored continuously. The ASTRO-D2KO mice also exhibited lower diurnal RQ and greater contribution of fatty acid oxidation to energy expenditure, but no differences in food intake were observed. In contrast, the FAT-D2KO mouse exhibited sustained (24 h) increase in RQ values, increased food intake, tolerance to glucose, and sensitivity to insulin, all supporting greater contribution of carbohydrate oxidation to energy expenditure. Furthermore, FAT-D2KO animals that were kept on a high-fat diet for 8 weeks gained more body weight and fat, indicating impaired brown adipose tissue (BAT) thermogenesis and/or inability to oxidize the fat excess. Acclimatization of FAT-D2KO mice at thermoneutrality dissipated both features of this phenotype. Muscle D2 does not seem to play a significant metabolic role given that SKM-D2KO animals exhibited no phenotype. The present findings are unique in that they were obtained in systemically euthyroid animals, revealing that brain D2 plays a dominant albeit indirect role in fatty acid oxidation via its sympathetic control of BAT activity. D2-generated T3 in BAT accelerates fatty acid oxidation and protects against diet-induced obesity.
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Affiliation(s)
- Tatiana L. Fonseca
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Joao Pedro Werneck-De-Castro
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
- Biophysics Institute and School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Melany Castillo
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Barbara M.L.C. Bocco
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Gustavo W. Fernandes
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Elizabeth A. McAninch
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Daniele L. Ignacio
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
- Biophysics Institute and School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caio C.S. Moises
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Alexandre Ferreira
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | - Balázs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Antonio C. Bianco
- Division of Endocrinology, Diabetes, and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
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45
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Abstract
The thyroid hormone (TH) plays a significant role in diverse processes related to growth, development, differentiation, and metabolism. TH signaling modulates energy expenditure through both central and peripheral pathways. At the cellular level, the TH exerts its effects after concerted mechanisms facilitate binding to the TH receptor. In the hypothalamus, signals from a range of metabolic pathways, including appetite, temperature, afferent stimuli via the autonomic nervous system, availability of energy substrates, hormones, and other biologically active molecules, converge to maintain plasma TH at the appropriate level to preserve energy homeostasis. At the tissue level, TH actions on metabolism are controlled by transmembrane transporters, deiodinases, and TH receptors. In the modern environment, humans are susceptible to an energy surplus, which has resulted in an obesity epidemic and, thus, understanding the contribution of the TH to cellular and organism metabolism is increasingly relevant.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida
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46
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Abstract
The presence of brown adipose tissue (BAT) in adults has become increasingly well defined as a result of functional imaging studies of thermogenically active BAT. Findings from these studies have created a surge of scientific interest in BAT, because it represents a potential therapeutic target for obesity--a condition with profound health consequences and few successful therapies. BAT contributes to overall energy expenditure in small mammals and neonates through adaptive thermogenesis. Thyroid-hormone signalling, particularly through induction of type II deiodinase, has a central role in brown adipogenesis in vitro and BAT development in mouse embryos. Additionally, because of high intracellular expression of type II deiodinase, adult BAT has enhanced thyroid-hormone signalling with several thyroid-hormone-dependent thermogenic pathways, including expression of the genes Ppargc1a and Ucp1. BAT thermogenesis explains the essential part played by thyroid hormone in energy homoeostasis and adaptation to cold. Stimulation of BAT in adults, specifically through thyroid-hormone-mediated pathways, is a promising therapeutic target for obesity.
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Affiliation(s)
- Antonio C Bianco
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Elizabeth A McAninch
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL, USA
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