Objectives: The introduction of neonatal screening programs (NSP) led to an increased in detection of congenital hypothyroidism (CH). This increase may be due to ethnic composition (predominance of Iberian and Asian people), environmental factors (temperature and iodine intake) and inclusion of cases of transient CH and hyperthyrotropinemia, defined by moderate elevation of TSH with normal T4. The main objectives of this study were to evaluate, in children with altered neonatal screening tests in the NSP in the Northeastern Brazilian Sergipe state, the evolution for permanent or temporary condition and to evaluate the mean incidence of permanent CH, hyperthyrotropinemia and transient TSH elevation. Subjects and methods: Review of medical records of children with altered neonatal and confirmatory TSH from 2004 to 2010 (levels more than 5.2 μU/ml and 4.2 μU/ml, respectively), followed at the Clinic of Pediatric Endocrinology of the University Hospital of the Federal University of Sergipe. From the confirmatory serum TSH values, children were classified as initial CH: serum TSH > 10.0 μU/ml; or suspect CH: serum TSH > 4.2 μU/ml and ≤ 10.0 μU/ml. According to follow-up parameters, the final diagnosis included three categories. Permanent CH: Serum TSH > 10.0 μU/ml, independent of T4 levels or current use of thyroxine; or without l-thyroxine use serum TSH level between 4.2 μU/ml and 10.0 μU/ml, but with low free T4 or total T4. Hyperthyrotropinemia: children without l-thyroxine use with serum TSH level between 4.2 μU/ml and 10.0 μU/ml with normal free T4 and total T4. Transient TSH elevation: Initial CH or suspect CH children which normalized in the follow up without l-thyroxine treatment (serum TSH ≤ 4.2 μU/ml, free T4 ≥ 0.79 ng/dl and total T4 ≥ 7.2 μg/dl). The mean incidence of permanent CH, hyperthyrotropinemia and transient TSH elevation in the period was calculated by dividing the number of children with each category for the total number of children screened. Results: The initial diagnosis included 37 cases of initial CH (18.1%) and 167 suspect CH (81.9%). The final diagnosis included 46 cases of permanent CH (22.5%); 56 hyperthyrotropinemia (27.5%) and 102 transient TSH elevation (50.0%). Out of the 37 cases of initial CH, it was found 23 (62.2%) of permanent CH; 9 (24.3%) of hyperthyrotropinemia; and 5 (13.5%) of transient TSH elevation. Out of the 167 suspects, it was found 23 (13.8%) of permanent CH, 47 (28.1%) of hyperthyrotropinemia and 97 (58.1%) of transient TSH elevation. We found a mean incidence of 1:4166 of permanent CH, 1:3448 of hyperthyrotropinemia and 1:1887 of transient TSH elevation. 86.5% of children with an initial diagnosis of CH and 41.9% of suspicions have permanent condition (CH or hyperthyrotropinemia). Conclusions: The follow-up of children with initial diagnosis and suspicion is necessary to characterize the permanence or not of the disorder, since the prediction of the evolution of children with initial CH or suspect is difficult. / Objetivos: A introdução dos programas de triagem neonatal (PTN) propiciou o aumento na detecção do hipotireoidismo congênito (HC). Este aumento pode estar ligado à composição étnica (predomínio em ibéricos e asiáticos), fatores ambientais (temperatura e ingestão de iodo) e inclusão de casos de HC transitório e da hipertirotropinemia, definida pela elevação moderada do TSH com T4 normal. Os objetivos principais deste estudo foram avaliar em crianças com teste de triagem neonatal alterado no PTN em Sergipe, no nordeste do Brasil, a evolução para condição permanente ou transitória e avaliar a incidência média do HC permanente, da hipertirotropinemia e da elevação transitória do TSH. Sujeitos e métodos: Foi realizada revisão dos prontuários das crianças convocadas no período de 2004 a 2010, com TSH neonatal e confirmatório alterados (maior que 5,2 μU/ml e 4,2 μU/ml, respectivamente), acompanhados no Ambulatório de Endocrinologia Pediátrica do Hospital Universitário da Universidade Federal de Sergipe. A partir dos valores do TSH sérico confirmatório, as crianças foram classificadas como HC inicial: TSH sérico > 10,0 μU/ml; ou suspeito HC: TSH sérico > 4,2 μU/ml e ≤ 10,0 μU/ml. De acordo com parâmetros do seguimento, o diagnóstico final incluiu três categorias. HC permanente: TSH sérico > 10,0 μU/ml, independente de valores de T4 ou do uso de l-tiroxina; ou sem l-tiroxina com TSH sérico entre 4,2 μU/ml e 10,0 μU/ml, mas com T4 livre ou T4 total baixos; Hipertirotropinemia: Criança sem l-tiroxina, com TSH sérico entre 4,2 μU/ml e 10,0 μU/ml, com T4 livre e T4 total normais; Elevação transitória do TSH: Criança HC inicial ou suspeito HC que normalizou no seguimento, sem a l-tiroxina (TSH sérico ≤ 4,2 μU/ml, T4 livre ≥ 0,79 ng/dl e T4 total ≥ 7,2 μg/dl). A incidência média do HC permanente, da hipertirotropinemia e da elevação transitória do TSH no período foi calculada dividindo-se o número de crianças com cada uma das três condições pelo número total de crianças triadas. Resultados: No diagnóstico inicial tivemos 37 casos de HC inicial (18,1%) e 167 suspeitos HC (81,9%). No diagnóstico final tivemos 46 casos de HC permanente (22,5%); 56 de hipertirotropinemia (27,5%) e 102 de elevação transitória do TSH (50,0%). Dos 37 casos HC inicial encontramos 23 (62,2%) de HC permanente; 9 (24,3%) de hipertirotropinemia; e 5 (13,5%) de elevação transitória do TSH. Dos 167 suspeitos encontramos 23 (13,8%) de HC permanente, 47 (28,1%) de hipertirotropinemia e 97 (58,1%) de elevação transitória do TSH. Encontramos uma incidência média de 1:4166 de HC permanente, 1:3448 de hipertirotropinemia e 1:1887 de elevação transitória do TSH. 86,5 % das crianças com diagnóstico inicial de HC e 41,9 % das suspeitas apresentam condição permanente (HC ou hipertirotropinemia). Conclusões: O seguimento das crianças seja com o diagnóstico inicial de HC ou de suspeição é necessário para caracterizar a permanência ou transitoriedade do distúrbio, haja vista que a predição da evolução destas crianças é difícil.

O hormônio tireotrófico (TSH) é o principal regulador da síntese e da secreção dos hormônios tireoidianos (HTs), os quais exercem um mecanismo de feedback negativo na hipófise reduzindo a síntese das cadeias <font face=\"Symbol\">&#946 e <font face=\"Symbol\">&#945 (CGA - Glycoprotein hormones Alpha Chain) por meio de mecanismos que envolvem modificações na transcrição de genes que codificam essas proteínas (ações genômicas). Na última década tem aumentado o número de evidências de que, em paralelo as ações genômicas clássicas, algumas ações dos HTs são desencadeadas na presença de inibidores da transcrição gênica e em curto espaço de tempo (segundos a minutos), caracterizando-se assim as ações não genômicas dos HTs. Este trabalho tem como foco avaliar a possibilidade de que os HTs regulem a expressão desses genes não genomicamente. Para tal avaliamos as alterações decorrentes do hipotiroidismo, seguido ou não do tratamento agudo com T3 em dose fisiológica ou saturante, sobre o grau de poliadenilação e a expressão do mRNA das subunidades alfa (CGA) e <font face=\"Symbol\">&#946TSH, bem como sua repercussão sobre a síntese e secreção de <font face=\"Symbol\">&#946TSH. Através da metodologia de PCR em Tempo Real observamos nos animais tireoidectomizados tratados com salina (Tx) um aumento de 10 e 4 vezes no conteúdo de mRNA do <font face=\"Symbol\">&#946TSH e CGA, respectivamente, e na razão <font face=\"Symbol\">&#946TSH/CGA quando comparado ao animal eutireoideo. A administração da dose saturante de T3 em 30 min não alterou o conteúdo do mRNA de <font face=\"Symbol\">&#946TSH e CGA, enquanto a dose fisiológica reduziu 52 e 34%, respectivamente, sem alterar a razão <font face=\"Symbol\">&#946TSH/CGA, comparando com o grupo Tx. Com o ensaio RACE-PAT, observou-se que o grupo Tx apresentou um aumento no comprimento da cauda poli-A do mRNA de <font face=\"Symbol\">&#946TSH, não havendo alterações semelhantes para o mRNA de CGA. A administração aguda de T3, apenas na dose saturante, provocou uma redução de 17% no comprimento da cauda poli-A do mRNA do <font face=\"Symbol\">&#946TSH nos animais hipotiroideos comparados com o grupo Tx. Nenhuma alteração foi observada no comprimento da cauda poli-A do mRNA de CGA, indicando um possível efeito específico do T3 sobre a poliadenilação da subunidade <font face=\"Symbol\">&#946. Através dos ensaios Western Blot / ECL, Imunohistoquímica e Histoquímica foi observado que as duas doses de T3 utilizadas promoveram um aumento de 30% no conteúdo protéico de TSH, uma redução na marcação de <font face=\"Symbol\">&#946TSH na periferia dos tireotrofos e aumento na polimerização de actina na hipófise dos animais hipotiroideos tratados, possivelmente por inibir a secreção deste hormônio. Como estes resultados foram observados em 30 min, e parte deles envolveu alterações em etapas pós-transcricionais da regulação da expressão de genes (poliadenilação), podemos inferir que o T3 esteja agindo por uma via não genômica regulando a síntese e secreção do TSH. / The thyroid-stimulating hormone (TSH) is the main regulator of the synthesis and secretion of thyroid hormones (TH), which exert a negative feedback mechanism in the pituitary by reducing the synthesis of <font face=\"Symbol\">&#946 and <font face=\"Symbol\">&#945 (CGA - Glycoprotein hormones alpha chain) chains through mechanisms that involve changes in the transcription of genes that encode these proteins (known as genomic action). However, in the last decade, an increasing body of evidence has shown that, in parallel with the classical genomic mechanisms, some TH actions might be elicited in a short period time (seconds to minutes), and in the presence of gene transcription inhibitors, which indicates that TH can also act nongenomically. In the present study we evaluate if TH could regulate some steps of the expression of <font face=\"Symbol\">&#946 TSH and CGA in a short period of time, which might provide evidence that they could act by non genomic mechanisms. For this, the expression and polyadenylation of alpha (CGA) and <font face=\"Symbol\">&#946 subunits of TSH mRNA, and TSH content, were evaluated by real time PCR and western blot, respectively, in thyroidectomized (hypothyroid) rats, 30 min after they were subjected or not to physiological or saturating doses of T3. It was observed that hyroidectomyzed animals treated with saline (Tx) presented an increase of 10 and 4 times in the content of <font face=\"Symbol\">&#946TSH and CGA mRNA, respectively, and in the <font face=\"Symbol\">&#946TSH / CGA ratio compared with control group. The saturating dose of T3 did not alter the <font face=\"Symbol\">&#946TSH and CGA mRNAs content, but the physiological dose reduced them at 52 and 34% respectively, without changing the <font face=\"Symbol\">&#946TSH / CGA ratio, compared with Tx group. The RACE-PAT assay showed that the Tx rats presented an increase in the mRNA <font face=\"Symbol\">&#946TSH poly-A tail length, whereas no change was observed to the mRNA of CGA. The acute and saturating dose of T3 caused a 17% reduction in the length of mRNA <font face=\"Symbol\">&#946TSH poly-A tail in hypothyroid animals compared with hypothyroid group. No changes were observed in the length of the poly-A tail of mRNA CGA, suggesting a specific effect of T3 on the <font face=\"Symbol\">&#946 subunit polyadenylation. Through the Western blot/ECL, histochemistry and immunohistochemistry methods we could observe that T3 (in both doses used) promoted a 30% increase in TSH protein content, a decrease in <font face=\"Symbol\">&#946TSH labeling near thyrotrophs plasma membrane and increased the actin polymerization in the pituitary of hypothyroid animals, possibly by inhibiting the secretion of this hormone. Considering that these results were observed in 30 min, and some of them involve changes in post-transcriptional regulation of gene expression (polyadenylation), we can infer that in parallel to its genomic action, T3 acts by non genomic pathways in the regulation of the TSH synthesis and secretion.

L’hypopituitarisme se définit par le déficit d’une ou plusieurs hormones hypophysaires.L’hypopituitarisme congénital est lié à des mutations de facteurs de transcriptionimpliqués dans le développement hypophysaire. Identifier les mécanismes et étiologiesd’hypopituitarisme congénital doit permettre d’améliorer les traitements des patients.Dans cette optique, ce travail a porté sur 3 aspects :Clarifier les mécanismes permettant la différenciation des lignées hypophysaires. Aucours du développement hypophysaire chez la souris, il existe un phénomène complexed’interaction entre 2 facteurs de transcription à homéodomaine paired (Prop1 et Hesx1),la voie Wnt-ßcaténine et les co-répresseurs de la famille Groucho/TLE. Ces interactionssont nécessaires à l’expression d’un autre facteur de transcription hypophysaire, Pit-1(Pou1f1), impliqué dans la différentiation des lignées hypophysaires somato-lactotropeset thyréotropes. Nous avons démontré in vitro, que les co-répresseurs de la famille TLEjouaient un rôle inhibiteur direct sur l’activation de l’early enhancer de POU1F1 à e12-e13, indépendamment de l’action de HESX1. Nos modèles de souris transgéniquesavec expression permanente de HESX1 et TLE3 permettent de mettre en évidence lerôle inhibiteur majeur de HESX1, et le rôle accessoire de TLE3. Les mutations dePROP1 étant à l’origine d’une expression persistante de HESX1 et TLE3, il est probablequ’ils jouent un rôle dans le déficit en sous-unité alpha observé chez les patientsdéficitaires en PROP1.Identifier et analyser la signification fonctionnelle de nouveaux variants alléliques dugène d’un facteur de transcription à homéodomaine LIM, LHX4. La mutation T99fs deLHX4 est à l’origine d’un phénotype hypophysaire très variable au sein d’une mêmefamille, en termes de déficits et de morphologie hypophysaires, et d’anomalies extrahypophysairesassociées. Les études fonctionnelles ont montré que cette mutation étaitresponsable d’un phénomène d’haplo-insuffisance. Cette nouvelle mutation permetd’enrichir le spectre phénotypique des patients chez lesquels doit être effectué unséquençage du gène LHX4 à la recherche d’étiologie de déficit hypophysaire combinémultiple.Identifier des mécanismes nécessaires au développement de l’axe thyréotrope. Dessouris exprimant une nouvelle recombinase Cre sous contrôle du promoteur de la Tshßont été croisées avec des souris transgéniques pour lesquelles les gènes de Pitx2 oud’Isl1 (2 facteurs de transcription impliqués dans le développement hypophysaire)étaient encadrés de séquences flox. Les modèles permettaient ainsi l’inactivation dePitx2 et Isl1 au sein des cellules thyréotropes au cours de l’embryogenèse. L’étudephénotypique retrouve un déficit de croissance compatible avec un déficit thyréotropepartiel en cas d’inactivation de Pitx2 : ce phénotype est probablement lié à unmécanisme compensateur assuré par PITX1, un facteur de transcription àhoméodomaine bicoïde possédant le même homéodomaine et domaine C terminal quePITX2. A l’inverse, l’inactivation de Isl& se traduit par un déficit thyréotrope complet. Lefait que les transcrits de l’ensemble des facteurs de transcription nécessaires audéveloppement de l’axe thyréotrope soient diminués dans ce modèle souligne le rôlemajeur de ISL1 dans la fonction et la maintenance de l’axe thyréotrope.Nos résultats permettent de mieux appréhender certains des nombreux mécanismes etfacteurs impliqués dans le développement hypophysaire chez la souris, et dans lapathologie hypophysaire chez l’homme. / Hypopituitarism is defined by one or several pituitary deficiencies. Congenital hypopituitarism is mostly due to transcription factors mutations. Our aims were to try to better identify some of the mechanisms involved in pituitary ontogenesis and pituitary diseases, mainly pituitary deficiencies: new pathways, new transcription factors, new mutations. - First we identified novel mechanisms necessary for the differenciation of the Pou1f1 lineages (ie somatolactotroph and thyrotroph cells). The role of TLE co-repressors is crucial, as they are able by themselves to inhibit the stimulatory actions of PROP1 on POU1F1 promoter. This is necessary to obtain a correct timing of differentiation during pituitary development (Carvalho, Brinkmeier, castinetti et al., Molecular Endocrinology, 2010). - Second, we showed the roles of 2 transcription factors, PITX2 and ISL1, in thyrotrophs maintenance and function. By using a new cre recombinase driven by the TSHb promoter, we managed to inactivate each of these transcription factors in the thyrotrophs. Inactivation of PITX2 led to a partial thyrotroph deficiency, counterbalanced by an overexpression of PITX1 (Castinetti et al., Molecular Endocrinology, submitted). Inactivation of ISL1 led to a complete thyrotroph deficiency (Castinetti et al., Molecular Endocrinology, in preparation). - Finally, we reported 1 new mutation of the LIM transcription factor LHX4, responsible for combined pituitary hormone deficiencies in a family. New phenotypic traits will help the physician improve the way to select which patients to screen for LHX4 mutations (Castinetti, Saveanu et al., JCEM, 2008).

This diploma thesis deals with the analysis of structural and dynamic organization of thyrotropin releasing hormone receptor (TRH-R) and δ-opioid receptor (DOR) within plasma membrane (PM) in relation to the specific sub-compartments of PM denominated as domains or membrane rafts. Modern fluorescence microscopy techniques FLIM, FRAP and RICS were used for this purpose. The experiments were performed on the live cells derived from HEK293 cell line. To reach the main goal of this work, the integrity of PM structure was altered by depletion of cholesterol which was performed by incubation of cells with β cyclodextrin. Results clearly support our previously suggested idea that the vast majority of TRH-R is localized in non-raft regions of plasma membrane. This work also compared different modes of performance of FRAP and results obtained by FRAP and RICS because these methods are to some extent analogous. This is one of the first works that used the RICS approach to characterize the G protein-coupled receptors. In the second part of this work, the setup of transient transfection of the HEK293 cells with DOR-ECFP and DOR EYFP constructs was established. Simultaneously, the functionality of these constructs, i.e. the ability of DOR to activate the cognate G protein was determined. Powered by TCPDF (www.tcpdf.org)

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

[Truncated abstract] G-protein coupled receptors (GPCRs) form one of the largest superfamilies of cell-surface receptors and respond to a vast range of stimuli including light, hormones and neurotransmitters. Although structurally similar, GPCRs are regulated by many diverse proteins, which allow the specific functions of each receptor to be carried out. This thesis focussed on two well-documented GPCRs, the thyrotropin releasing hormone receptor (TRHR) and gonadotrophin-releasing hormone receptor (GnRHR), which control the thyroid and reproductive endocrine pathways respectively. Although each of these anterior pituitary receptors is responsible for distinct physiological responses, both are integral to normal development and homeostasis. This thesis focused on three areas of GPCR regulation: ?-arrestin recruitment, transcription factor regulation and receptor up-regulation. The role of the cytoplasmic protein, ?-arrestin, has perhaps been previously underestimated in GPCR regulation, but it is now increasingly apparent that ?-arrestins not only inhibit further G-protein activation and assist in GPCR internalisation but also act as complex scaffolding platforms to mediate and amplify downstream signalling networks for hours after initial GPCR activation. It is therefore becoming increasingly important to be able to monitor such complexes in live cells over longer time-frames. ... Members of the E2F transcription family have been previously identified by this laboratory as potential GnRHR interacting proteins, via a yeast-2-hybrid screen and BRET. This thesis further investigated the role of E2F family members and demonstrates that a range of GPCRs are able to activate E2F transcriptional activity when stimulated by agonist. However, despite GnRHR displaying robust E2F transcriptional activation upon agonist stimulation, this did not result in any conclusive evidence for functional regulation, although it is possible E2F may modulate and assist in GnRHR trafficking. Furthermore it is apparent that E2F family members are highly redundant, as small effects in GnRHR binding and cell growth were only observed when protein levels of both E2F4 and E2F5 were altered. During the course of the investigation into the effect of E2F transcription on GPCR function, it was evident that long-term agonist stimulation of GnRHR had a profound effect on its expression. As this was explored further, it became clear that this agonist-induced up-regulation was both dose- and time-dependent. Furthermore, altering levels of intracellular calcium and receptor recycling/synthesis could modulate GnRHR up-regulation. In addition, an extremely sensitive CCD camera has been used for the first time to visualise the luciferase activity attributed to GnRHR up-regulation. Overall, this thesis demonstrates the complex nature of GPCR regulation. For the first time, long-term BRET analysis on ?-arrestin interactions with both classes of GPCRs has been examined in a variety of cellular formats. This has given valuable insights into the roles of phosphorylation and internalisation on ?-arrestin interaction. Additionally, this thesis has revealed that prolonged agonist exposure increases receptor expression levels, which has major implications for drug therapy regimes in the treatment of endocrine-related disorders and tumours.

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

The glycoprotein hormones, Luteinizing Hormone (LH), human Chorionic Gonadotropin (hCG), Follicle Stimulating Hormone (FSH) and Thyroid Stimulating Hormone (TSH) are heterodimeric proteins with an identical α-subunit associated non-covalently with the hormone specific β-subunit and play important roles in reproduction and overall physiology of the organism [1]. The receptors of these hormones belong to the family of G-protein coupled receptors (GPCR) and have a large extracellular domain (ECD) comprising of 9-10 leucine rich repeats (LRR) followed by a flexible hinge region, a seven helical transmembrane domain (TMD) and a C terminal cytoplasmic tail [2]. Despite significant sequence and structural homologies observed between the ECDs of the receptors and the specific β-subunits of the hormones, the hormone-receptor pairs exhibit exquisite specificity with very low cross-reactivity with other members of the family. The TSH receptor (TSHR) is an especially interesting member of this family as it not only recognizes is cognate ligand, i.e. TSH, but also binds to the non-cognate ligands such as autoantibodies. TSHR autoantibodies come in different flavors; inhibitory antibodies that compete with the hormone for receptor binding and block its action, stimulatory antibodies that activate the receptor in a hormone independent manner and neutral antibodies that bind to the receptor but do not directly influence its functions. The inhibitory autoantibodies cause hypothyroidism and are responsible for Hashimoto’s Thyroiditis, whereas the stimulatory autoantibodies cause Graves’ thyrotoxicosis characterized by hyperthyroid condition [3]. The exact epitopes of these autoantibodies are not well delineated although it has been hypothesized that the blocking type- and the stimulatory type- autoantibodies have predominant epitopes in the TSHR ECD that overlap with hormone binding regions [4]. Insights into the mode of hormone or autoantibody binding to the receptor was primarily derived from the crystal structure of FSHR leucine rich repeat domain (LRRD) bound to single chain analog of FSH, and the crystal structures of TSHR LRRD bound to the stimulatory type human monoclonal antibody M22 [5] and the inhibitory type- monoclonal antibody K1-70 [6]. Both these crystal structures propose LRRDs as the primary ligand binding site which interacts with the hormone through its determinant loop in a hand-clasp fashion [7] while the autoantibodies mimics the hormone binding to a large extent [8] . These structures, while providing detailed understanding of the molecular interactions of the LRRs with the hormone, shed little light on the mechanism by which the signal generated at the LRRD are transduced to the downstream effector regions at the distally situated TMD. Hence, while one understands the ligand binding to a large extent, the activation process is not well understood, one of the central objective of the present study. Ligand-receptor interactions are typically studied by perturbing ligand/receptor structure by mutagenesis or by mapping conformational changes by biophysical or computational approaches. In addition to the above-mentioned approaches, the present work also uses highly specific antibodies against different domains of the receptor as molecular probes due to the ability of antibodies to distinguish between conformations likely to arise during the activation process. Use of antibodies to understand the receptor activation process is especially apt for TSHR due to the presence of physiologically relevant TSHR autoantibodies and their ability to influence hormone binding and receptor activation [9, 10]. Chapter 2 attempts to provide a comparison between the interactions of the hormone and the autoantibodies with TSHR. For this purpose, two assays were developed for identification of TSHR autoantibodies in the sera of patients suffering from autoimmune thyroid diseases (AITD), the first assay is based on the ability of TSHR autoantibodies to compete for radiolabeled hormone (The TSH binding inhibition (TBI), assay) and the second based on the capability of stimulatory antibody to produce cAMP in cells expressing TSHR (TSHR stimulatory immunoglobin (TSI) assay). A stable cell line expressing TSHR capable of recognizing both TSH and TSHR autoantibodies was thus created and used for prospective and retrospective analysis of AITD patients. Based on the TBI and TSI profiles of IgGs, purified from AITD patient's sera, it was recognized that TSHR stimulatory and TSH binding inhibitory effects of these antibodies correlated well, indicating overlap between hormone binding and IgG binding epitopes. It was also recognized that stimulatory IgGs are not affected by negative regulatory mechanism that governs TSH secretion substantiating the persistence of these antibodies in circulation. Kinetics of cAMP production by Graves’ stimulatory IgG was found to be fundamentally distinct, where the autoantibodies displayed pronounce hysteresis during the onset of the activation process when compared to the hormone. This could possibly be explained by the oligoclonality of the autoantibody population, a different mechanism of receptor activation or dissimilarity in autoantibody and hormone epitopes. To gain additional insights into the epitopes of TSHR autoantibodies and the regions that might be critical in the activation process, different overlapping fragments encompassing the entire TSH receptor ECD were cloned, expressed in E.coli as GST fusion proteins and purified: 1] the first three LRRs (TLRR 1-3, amino acid (aa) 21-127), 2] the first six LRRs (TLRR 1-6, aa 21-200), 3] the putative major hormone binding domain (TLRR 4-6, aa 128-200), and 4] the hinge region of TSH receptor along with LRR 7 to 9, (TLRR 7-HinR, aa 201-413). The receptor fragment TLRR 7-HinR was further subdivided into LRR 7-9 (TLRR 7-9, aa 201-161) and the hinge region (TSHR HinR, aa 261-413), expressed as N-terminal His-Tagged protein and purified using IMAC chromatography. Simultaneously, the full-length TSHR ECD was cloned, expressed and purified using the Pichia pastoris expression system. ELISA or immunoblot analysis of autoantibodies with the TSHR exodomain fragments suggested that Graves’ stimulatory antibody epitopes were distributed throughout the ECD with LRR 4-9 being the predominant site of binding. Interestingly, experiments involving neutralization of Graves’ IgG stimulated cAMP response by different receptor fragment indicated that fragments corresponding to the TSHR hinge region were better inhibitors of autoantibody stimulated receptor response than corresponding LRR fragments, suggesting that the hinge region might be an important component of the receptor activation process. This was in contrast to prevalent beliefs that considered the hinge region to be an inert linker connecting the LRRs to the TMD, a structural entity without any known functional significance. Mutagenesis in TSHR hinge region and agonistic antibodies against FSHR and LHR hinge regions, reported by the laboratory, recognized the importance of the hinge regions as critical for receptor activation and may not simply be a scaffold [11-13]. Unfortunately, the mechanism by which the hinge region regulates binding or response or both have not been well understood partially due to unavailability of structural information about this region. In addition poor sequence similarity within the GpHR family and within proteins of known structure, make this region difficult to model structurally. In chapter 3, effort is made to model the hinge regions of the three GpHR based on the knowledge driven and Ab initio protocols. An assembled structure comprising of the LRR domain (derived from the known structures of FSHR and TSHR LRR domains) and the modeled hinge region and transmembrane domain presents interesting differences between the three receptors, especially in the manner the hormone bound LRRD is oriented towards the TMD. These models also suggested that the α-subunit interactions in these three receptors are fundamentally different and this was verified by investigating the effects of two α-subunit specific MAbs C10/2A6 on hCG-LHR and hTSH-TSHR interactions. These two α-subunit MAbs had inverse effects on binding of hormone to the receptor. MAb C10 inhibited TSH binding to TSHR but not that of hCG, whereas MAb 2A6 inhibited binding of hCG to LHR but not of hTSH. Investigation into the accessibility of their epitopes in a preformed hormone receptor complex indicated that the α-subunit may become buried or undergo conformational change during the activation process and interaction may be different for LHR and TSHR. Fundamental differences in TSHR and LHR were further investigated in the next chapter (Chapter 4), especially with regards to the ligand independent receptor activation. Polyclonal antibodies were developed against LRR 1-6, TLRR 7-HinR and the TSHR HinR receptor fragments. The LRR 1-6 antibodies were potent inhibitor of receptor binding as well as response, similar to that observed with antibodies against the corresponding regions of LHR. Interestingly, the antibodies against the hinge region of TSHR were unable to inhibit hTSH binding, but were effective inhibitors of cAMP production suggesting that this region may be involved in a later stage of a multi-step activation process. This was also verified by studying the mechanism of inhibition of receptor response and their effect on ligand-receptor association and dissociation kinetics. Hinge region-specific antibodies immunopurified from TLRR 7-HinR antibodies behaved akin to those of the pure hinge region antibodies providing independent validation of the above results. This result was, however, in contrast to those observed with a similar antibody against LHR hinge region. As compared to the TSHR antibody, the LHR antibody inhibited both hormone binding and response. In addition, this antibody could dissociate a preformed hormone-receptor complex which was not observed for TSHR hinge region antibodies. Although unable to dissociate preformed hormone-receptor complex by itself, the TSHR HinR antibodies augmented hormone induced dissociation of the hormone-receptor complex suggesting that this region may be involved in modulation of negative cooperativity associated with TSHR. Molecular dissection of the role of hinge region of TSHR was further carried out by using monoclonal antibodies against LRR 1-3 (MAb 413.1.F7), LRR 7-9 (MAb 311.87), TSHR hinge region (MAb 311.62 and MAb PD1.37). MAb 311.62 which identifies the LRR/Cb-2 junction (aa 265-275), increased the affinity of TSHR for the hormone while concomitantly decreasing its efficacy, whereas MAb 311.87 recognizing LRR 7-9 (aa 201-259) acted as a non-competitive inhibitor of TSH binding. MAb 413.1.F7 did not affect hormone binding or response and was used as the control antibody for different experiments. Binding of MAbs was sensitive to the conformational changes caused by the activating and inactivating mutations and exhibited differential effects on hormone binding and response of these mutants. By studying the effects of these MAbs on truncation and chimeric mutants of thyroid stimulating hormone receptor (TSHR), this study confirms the tethered inverse agonistic role played by the hinge region and maps the interactions between TSHR hinge region [14] and exoloops responsible for maintenance of the receptor in its basal state. Mechanistic studies on the antibody-receptor interactions suggest that MAb 311.87 is an allosteric insurmountable antagonist and inhibits initiation of the hormone induced conformational changes in the hinge region, whereas MAb 311.62 acts as a partial agonist that recognizes a conformational epitope critical for coupling of hormone binding to receptor activation. Estimation of apparent affinities of the antibody to the receptor and the cooperativity factor suggests that epitope of MAb 311.87 (LRR 7-9) may act as a pivot involved in the initial events immediate to hormone binding at the LRRs. The anatgonsitic effect of MAB 311.62 on binding and response also suggested that binding of hormone is conformationally selective rather than an induced event. The hinge region, probably in close proximity with the α-subunit in the hormone-receptor complex, acts as a tunable switch between hormone binding and receptor activation. In contrast to the stimulatory nature of Cb-2 antibody such as MAb 311.62, MAb PD1.37, which identified residues aa 366–384 near Cb-3, was found to be inverse agonistic. Unlike other known inverse agonistic MAbs such as CS-17 [15] and 5C9 [16], MAb PD1.37 did not compete for TSH binding to TSHR, although it could inhibit hormone stimulated response. Moreover, unlike CS-17, MAb PD1.37 was able to decrease elevated basal cAMP of hinge region constitutively activated mutations only but not those in the extracellular loops. This is particularly important as interaction of hinge region residues with those of ECLs had been thought to be critical in maintenance of the basal level of receptor activation and are responsible for attenuating the constitutive basal activity of the mutant and wild-type receptors in the absence of the hormone. This was demonstrated by a marked increase in the basal constitutive activity of the receptor upon the complete removal of its extracellular domain, which returned to the wild-type levels upon reintroduction of the hinge region. However, careful comparison of the activities of the mutants (receptors harboring deletions and gain-of-function mutations) with maximally stimulated wild-type TSHR indicated that these mutations of the receptor resulted primarily in partial activation of the serpentine domain suggesting that only the ECD in complex with the hormone is the full agonist of the receptor. Confirmation of the above proposition has been difficult to verify primarily due to a highly transient conformational change in the tripartite interaction of the hinge region/hormone and the ECLs. The current approaches of using antibodies to probe the ECLs are difficult due to the conformational nature of the antigen as well as difficulty in obtaining a soluble protein. In chapter 5, the ligand induced conformational alterations in the hinge regions and inter-helical loops of LHR/FSHR/TSHR were mapped using the exoloop specific antibodies generated against a mini-Transmembrane domain (mini-TMD) protein. This mini-TMD protein, designed to mimic the native exoloop conformations, was created by joining the TSHR exoloops, constrained through the helical tethers and library derived linkers. The antibody against mini-TMD specifically recognized all three GpHRs and inhibited the basal and hormone stimulated cAMP production without affecting hormone binding. Interestingly, binding of the antibody to all three receptors was abolished by prior incubation of the receptors with the respective hormones suggesting that the exoloops are buried in the hormone-receptor complexes. The antibody also suppressed the high basal activities of gain-of-function mutations in the hinge regions, exoloops and TMDs such as those involved precocious puberty and thyroid toxic adenomas. Using the antibody and point/deletion/chimeric receptor mutants, dynamic changes in hinge region-exoloop interactions were mapped. The computational analysis suggests that mini-TMD antibodies act by conformationally locking the transmembrane helices by restraining the exoloops and juxta-membrane regions. This computational approach of generating synthetic TMDs bears promise in development of interesting antibodies with therapeutic potential, as well as, explains the role of exoloops during receptor activation. In conclusion (Chapter 6), the study provides a comprehensive outlook on the highly dynamic interaction of ligand and different subdomains of the TSHR (and to a certain extent of LHR and FSHR) and proposes a model of receptor activation where the receptor is in a dynamic equilibrium between the low affinities constrained state and the high affinity unconstrained state and bind to the hormone through the LRR 4-6. Upon binding the βL2 loop of the hormone contact LRR 8-10 that triggers a conformational change in the hinge region driving the α-subunit to contact the ECLs. Upon contact, the ECLs cooperatively causes helix movement in the TMH and ultimately in ICLs causing the inbuilt GTP-exchange function of a GPCR.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23078号 / 医博第4705号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 稲垣 暢也, 教授 万代 昌紀, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Indiana University-Purdue University Indianapolis (IUPUI) / Acute and chronic activation of both ionotropic and metabotropic glutamate (glut) receptors is implicated in many neurodegenerative disorders including AD, dementia, epilepsy, stroke and neurotrauma. TRH and glut receptors (ionotropic & metabotropic) receptors are differentially coexpressed in granule and pyramidal neurons of the hippocampus. The author shows TRH to be protective when added to cultured pituitary adenoma (GH-3) cells and neuron-like pheochromocytoma (PC12) cells either prior to, during, or after glut-induced toxicity (Endo. Soc. Abs. 01), and also shows that the possible neuroprotective mechanism may involve heterologous downregulation of the metabotropic glut receptors, using superfused hippocampal slices and noting a reduction of Gαq/11 (SFN Abs. 02). He has also demonstrated that TRH protected against glut toxicity in fetal cortical cultures (Endo. Soc. Abs. 04). To extend these studies he used 14-day cultured rat fetal hippocampal neurons (Day E17) to determine if TRH is protective against toxicity induced by specific ionotropic and metabotropic glut agonists. Neuronal viability and integrity were assessed by trypan blue exclusion and LDH release after 18 hrs following 30 min exposure to glut agonists. Ten µM dihydroxyphenylglycine (DHPG, a Group 1 receptor agonist) + 30 µM N-methyl-D-aspartate (NMDA)-induced toxicity (42% vs contr. P<0.05); whereas, concurrent and continued treatment with 10 uM but not 1uM 3Me-HTRH resulted in less neuronal death and damage (86% vs contr P<0.05; 53% vs contr. P>0.05) respectively. DHPG treatment alone (10 µM) for 30 min. was non-toxic by both criteria (90% vs contr. P<0.05). The data suggest that TRH may be a selective modulator of glut-induced toxicity.