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Em nosso laboratório foi demonstrado que ratos submetidos à restrição crônica de sal na dieta apresentaram maior peso corpóreo (PC), menor sensibilidade à insulina e alterações pressóricas em comparação com ratos submetidos à sobrecarga crônica de sal na dieta. No presente estudo, o objetivo foi avaliar alguns mecanismos de obesidade e alterações hormonais associados à dieta hipossódica. Foram utilizados ratos Wistar machos submetidos à dieta hipo (HO: 0,15% NaCl), normo (NO: 1,27% NaCl) ou hipersódica (HR: 7,94% NaCl) desde o desmame até 12 semanas de idade. Nestes animais foram realizadas medidas de pressão arterial (PA), freqüência cardíaca (FC), consumo de ração, PC, perfil dos hormônios [leptina (LEP), GH, insulina (INSh - anticorpo anti-insulina humana), T3, T4 e TSH] e decaimento da 125I-insulina (DEC-INS). O consumo de ração foi avaliado durante sete dias consecutivos com um (1G) ou quatro (4G) ratos por gaiola de plástico e com um rato por gaiola metabólica (1GM). O PC também foi medido neste período. Glicemia (GLI) e insulinemia (INSr - anticorpo anti-insulina de rato) basais foram quantificadas antes da realização do estudo do DEC-INS. Para avaliar o DEC-INS, foi injetado 1mCi de 125I-insulina humana pelo cateter implantado na veia jugular, após 6 a 8 horas de jejum fisiológico. As amostras de sangue foram coletadas pelo cateter implantado na carótida a cada 30 segundos durante 2 minutos e depois a cada 1 minuto até 10 minutos de experimento. Os resultados obtidos demonstraram que ratos submetidos à dieta HR apresentaram maior PA em comparação a ratos em dieta NO e HO. Os ratos submetidos à dieta HO apresentaram menor FC cardíaca em relação ao grupo NO. A avaliação de ingestão alimentar revelou que ratos em dieta HR consumiram maiores quantidades de ração (1G e 4G) em comparação com ratos em dieta NO e HO. O grupo HO apresentou maior PC em comparação com os grupos de ratos NO e HR. Os ratos em dieta HR ou HO apresentaram níveis diminuídos de LEP em comparação com ratos submetidos à dieta NO. Os ratos que receberam dieta HO apresentaram níveis elevados de INSr em comparação com ratos em dieta HR e NO. Os ratos em dieta HR apresentaram níveis elevados de T4 total e níveis reduzidos de TSH em comparação com animais em dieta NO e HO. INSr e GLI basais foram maiores nos ratos em dieta HO do que nos ratos que receberam dieta HR e NO. O DEC-INS (decaimento exponencial) foi mais rápido no grupo HR demonstrado por meio de menor meia-vida da 125I-insulina. Os resultados sugerem que maior PC nos ratos sob restrição salina crônica é devido a maior eficiência metabólica (maior PC e menor consumo de dieta) que pode estar relacionada com alterações hormonais e com a dieta HO. Palavras-chave: Pressão arterial, sal, sódio, ingestão alimentar e perfil hormonal. / Previous studies from our laboratory have shown that chronic salt restriction decreases blood pressure, increases insulin resistance, and body weight (BW) in Wistar rats. The aim of this study was to evaluate some mechanisms of obesity and hormonal alterations associated with chronic salt restriction. Male Wistar rats were fed a low (LSD: 0,15% NaCl), normal (NSD: 1,27% NaCl), or high salt diet (HSD: 7,94% NaCl) from weaning. At the 12th week of age, tail-cuff blood pressure (TCBP), intra arterial blood pressure (BP), heart rate ((HR), food intake, BW, hormonal levels [leptin (LEP), growth hormone (GH), insulin (INSh - antibody anti-human insulin), T3, T4 and TSH] and 125I insulin decay study (DECAY-INS) were measured. To evaluate the food intake and body weight, each dietary group was divided in 3 subgroups, according to housing conditions: one (1C) or four (4C) rats per cage and one rat per metabolic cage (1MC) for daily food consumption and BW determinations during 7 days. Fasting plasma glucose (GLU) and insulin (INSr - antibody anti-rat insulin) were measured before the DECAY-INS. To evaluate the DECAY-INS, 1mCi human 125I-insulin was injected through the jugular catheter after 6-8 hours of food restriction. Blood samples were withdrawn through the carotid catheter every 30 sec during 2min, and in sequence, every 1 min for additional 10 minutes. 125Iinsulin was determined by RIA for human insulin. Rats on HSD had higher intra arterial BP and TCBP compared to rats on NSD and LSD. Heart rate was lower on LSD than on NSD. In all housing conditions, BW was higher on LSD than on NSD and HSD. Food intake was higher on HSD (1C and 4C) than on NSD and LSD. Plasma GH and LEP were higher on NSD than on the 68 other two groups. Plasma INSh was higher in LSD compared to HSD and NSD rats. Plasma total T4 was higher on HSD than on the NSD and LSD, TSH was lower on HSD than on NSD and HSD, and T3 was not different among all groups. Fasting GLU and INSr were higher on LSD compared to HSD and NSD rats. The exponential insulin decay was faster on HSD demonstrated by a lower 125I-INS half-life. These results suggest that obesity in rats on chronic LSD is due to a higher metabolic efficiency (higher body weight and lower diet consumption), that may be related to the hormonal consequences of LSD. Key Words: blood pressure, salt, sodium, food intake and hormonal profile.

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La progression dans le cycle cellulaire est gouvernée par l’activation séquentielle d’une série de complexes cycline/CDK. La CDK4 initie le passage du point de restriction (point R, à partir duquel l’achèvement du cycle cellulaire devient indépendant des facteurs extracellulaires) en phosphorylant les protéines « antioncogéniques » de la famille pRb. Dans les thyrocytes de chien en culture primaire, l’AMPc (TSH ou forskoline) induit la prolifération et la différenciation alors que la voie mitogénique des facteurs de croissance (l’EGF, par exemple) est associée à une dédifférenciation. Dans ce modèle physiologiquement relevant, la stimulation mitogénique par l’AMPc diffère des cascades des facteurs de croissance puisqu'elle n’induit pas les cyclines D mais au contraire augmente l’accumulation de l’inhibiteur de CDK p27 kip1. Le contrôle positif du cycle cellulaire par l’AMPc requiert néanmoins l’activité de la CDK4. L’AMPc stimule l’assemblage des complexes cycline D3-CDK4 ainsi que leur translocation nucléaire associée à leur liaison à p27. Notre but était d’élucider les différents mécanismes menant au passage du point de restriction dans les cellules épithéliales thyroïdiennes stimulées par l’AMPc ou les facteurs de croissance. <p>Dans ce travail, nous montrons que l’arrêt de la stimulation des thyrocytes de chien par l’AMPc entraîne une diminution rapide de la phosphorylation de pRb et de l’activité de la CDK4 sans affecter la formation des complexes cycline D3-CDK4-p27. Par une approche utilisant le haut pouvoir de résolution de l’électrophorèse bidimensionnelle, nous avons identifié la phosphorylation activatrice de la CDK4 comme cible du contrôle par l’AMPc du passage du point de restriction. Ceci constitue un premier exemple d’une régulation de la phosphorylation et de l’activité de la CDK4 indépendante de son association avec une cycline ou un inhibiteur de CDK. Ces résultats contrastent avec l’absence de modulation d’expression, de localisation subcellulaire et d’assemblage des complexes cycline H-CDK7-Mat1, la CAK considérée comme responsable de la phosphorylation activatrice de la CDK4. Ceci suggère que les CAKs régulées activant la CDK4 n’ont pas encore été identifiées.<p>D’autre part, alors que la TSH induit une accumulation de p27, nous montrons à présent que l’expression de la p21 apparentée est augmentée par l’EGF + sérum et réprimée par la TSH. En réponse à l’EGF + sérum ou à la TSH, respectivement, la p21 ou la p27 supportent la localisation nucléaire, la phosphorylation et l’activité de la CDK4. Les « inhibiteurs » de CDK p21 et p27 pourraient donc être utilisés différentiellement comme régulateurs positifs de la CDK4 lors des stimulations des cellules épithéliales thyroïdiennes de chien par la TSH (p27) ou par l’EGF + sérum (p21). <p>Nous avons également montré que les complexes cycline D1-CDK4 et cycline D3-CDK4 phosphorylent pRb sur des sites partiellement différents. Cette nouvelle observation a été reproduite pour des complexes cycline D-CDK4 surexprimés en cellules CHO ainsi que pour des complexes exprimés de manière endogène dans différents types cellulaires. Cette différence de spécificité de substrat entre la cycline D1 et la cycline D3 conduit à différents profils de phosphorylation de pRb dans les thyrocytes de chien stimulés par la TSH ou les facteurs de croissance, ce qui est dû à l’utilisation préférentielle de la cycline D3 dans les thyrocytes stimulés par la TSH alors que les facteurs de croissance induisent surtout la cycline D1. Comme différentes fonctions de pRb sont régulées par phosphorylation sur différents résidus, ce résultat indique que les complexes cycline D1-CDK et cycline D3-CDK pourraient affecter de manière partiellement différente la fonction de cette protéine. <p>Enfin, nous avons comparé les stimulations mitogéniques par la TSH ou l’EGF + sérum dans les thyrocytes humains normaux en culture primaire. En accord avec leurs modulations différentes, la cycline D3 et la cycline D1 sont utilisées différentiellement dans les voies mitogéniques stimulées par la TSH ou l’EGF + sérum respectivement. De plus, ce système nous a permis de confirmer la régulation de l’activité de la CDK4 au niveau de sa phosphorylation activatrice comme mécanisme déterminant de la réponse mitogénique.<p><p> / Doctorat en sciences biomédicales / info:eu-repo/semantics/nonPublished

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.

Thesis (M.Med. (Radiation Oncology)) -- University of Limpopo, 2022 / Background Hypothyroidism in head and neck cancer patients after radiotherapy is known to occur, yet thyroid function tests are not routinely monitored in all patients post radiation therapy. Routine post radiation therapy thyroid function testing is currently not part of the follow-up protocol in these patients at Pietersburg Hospital. The aim of this study is to evaluate post radiation therapy hypothyroidism among head and neck cancer patients treated with radiotherapy at Pietersburg Hospital Methods A prospective (cohort) observational study was carried out among head and neck cancer patients receiving radiotherapy at the radiation oncology department in Pietersburg Hospital. Sample size of n=37 was calculated using Statistica V13.0. Thyroid function tests were performed at the start of radiation therapy and repeated on the first day of follow up, 6 weeks after completing radiation therapy. During follow up, participants were also interviewed for the presence of symptoms of hypothyroidism such as dry skin, dry hair, fatigue, cold intolerance, or weight gain. Data analysis was done with STATA version 16. Descriptive statistics were used to characterise variables, and summarised in tables, graphs and charts. Changes in thyroid function tests and other variables were analysed. A p-value of 0.05 was deemed statistically significant. Results Thirty-seven patients were enrolled in the study, 26 males and 11 females. The mean age of the patients was 53.1 ±12.3 standard deviation [SD]) with a range of 40.8 to 65.4 years. The most common diagnoses were cancer of the larynx and hypopharynx, forming 29.7% and oral cavity cancer, 29.7%. Only three patients (8%) had an early stage cancer (Stages 1 and 2), 11 patients (29.7%) moderately advanced cancer (Stage 3) while the majority (62%; n =23) had locally advanced cancer (Stage 4). Majority of the patients received 70Gy in 35 daily fractions, five fractions per week via 3-D conformal radiotherapy. Only 29 patients who had complete pre- and post radiotherapy thyroid function tests were included in the final analysis. Of these, none had clinical hypothyroidism at 3 months. Two patients (6.8%) had sub-clinical hypothyroidism, with post radiation therapy TSH values greater than 3.5mIU/ml. The mean post radiation therapy TSH values increased by 8.3% and the mean fT4 values decreased by 2.05% compared to the pre-radiation therapy values. Both changes were not statistically significant (p=0.99 and p=0.82 respectively). There was no statistically significant correlation between changes in TSH and fT4 versus age (p=0.88 and p=0.92 respectively), sex (p=0.55 and p=0.15 respectively), cancer stage (p=0.21 and p=0.78 respectively), and cancer site (p=0.17 and p=0.74 respectively). The most common post radiotherapy symptom was fatigue (62%) followed by cold intolerance (54%), weight gain (43%) and dry skin or dry hair (43% each). Conclusion The results of the study suggest that sub-clinical hypothyroidism is detectable early post radiation therapy presenting as clinical symptoms.

Congenital Hypothyroidism (CH) is the most common endocrine disorder, affecting one out of 2000-4000 newborns. Most CH are due to a defect in thyroid embryonic development and they can lead to severe phenotypes if not treated correctly. Multiple observations argue in favor of a genetic cause in a minority of thyroid dysgenesis, but to date, only few cases could be explained by a mutation in one of the genes coding for the factors known to be important in thyroid development and/or function (NKX2-1, PAX8, FOXE1, TSHR). This is the reason why it was important to develop new models allowing the discovery of new genes/mechanisms potentially implicated in the gland organogenesis. To that purpose, we set up in the laboratory a structure enabling the use of zebrafish as an animal model. The latter is indeed more and more used by developmental biologists, including by scientists interested in thyroid development.<p><p>The first step of our project consisted in a deeper characterization of the model, notably by the study of the expression patterns of the thyroid functional differentiation markers. Furthermore, the exact role of the Tsh/Tshr signaling – main regulator of thyroid growth and function in mammals – was dissected. In a second part of the project, we generated a stable transgenic line (tg(tg:mCherry)) allowing the visualization of thyroid development in living embryos and in a dynamic manner, thanks to real-time imaging techniques. On the one hand, this tool enabled us to better understand the morphological aspect of the different stages of thyroid development, such as the budding, evagination, relocalization or folliculogenesis. On the other hand, the use of double transgenic fishes obtained by crossing tg(tg:mCherry) with other lines expressing GFP in surrounding structures of interest, allowed us to highlight the contacts between the cardiovascular system and thyroid, and this along the whole gland development. The introduction of this model within the laboratory paves the way for the discovery and the study of thyroid intrinsic and extrinsic genes/mechanisms which might play a role on its development.<p><p>L’hypothyroïdie congénitale (HC) est une maladie relativement fréquente, touchant un nouveau-né sur 2000-4000. La majorité des HC sont dues à un défaut dans le développement embryonnaire de la glande, et peuvent mener à des phénotypes sévères si elles ne sont pas correctement traitées. Il existe plusieurs arguments en faveur d’une cause génétique dans une minorité de ces dysgénésies thyroïdiennes mais, à ce jour, seuls quelques cas ont pu être reliés à une mutation dans un des gènes codant pour des facteurs connus pour être importants dans le développement/la fonction de la glande (NKX2-1, PAX8, FOXE1, TSHR). C’est pour cette raison qu’il est important de développer de nouveaux modèles pouvant permettre la découverte de nouveaux gènes/mécanismes potentiellement impliqués dans l’organogénèse de la glande. A cette fin, nous avons mis en place au sein du laboratoire une structure permettant l’utilisation du poisson-zèbre comme modèle animal. Ce dernier est en effet de plus en plus utilisé par les biologistes du développement, y compris par les scientifiques qui s’intéressent au développement thyroïdien.<p><p>La première étape de notre travail a consisté en une caractérisation approfondie du modèle, notamment par l’étude du réseau d’expression des marqueurs de différenciation fonctionnelle de la glande. En outre, le rôle exact de la signalisation par la TSH – principal régulateur de la croissance et de la fonction de la thyroïde des mammifères – a été étudié. Dans la deuxième partie du projet, nous avons généré une ligne transgénique stable (tg(tg:mCherry)) permettant la visualisation du développement thyroïdien dans des embryons vivants et ce, de manière dynamique, grâce au principe d’imagerie en temps réel. D’une part, cet outil nous a permis de mieux comprendre l’aspect morphologique des différentes étapes du développement thyroïdien, telles que la formation du bourgeon, l’invagination, la relocalisation ou la folliculogénèse. D’autre part, l’utilisation de poissons doublement transgéniques obtenus par le croisement de tg(tg:mCherry) avec d’autres lignées où les structures environnantes d’intérêt expriment la GFP nous a permis de mettre en avant les contacts entre le système cardiovasculaire et la thyroïde, et ce, tout au long de son développement. La mise en place de ce modèle au sein de notre laboratoire ouvre la voie à la découverte et à l’étude de mécanismes/gènes extrinsèques à la thyroïde mais pouvant jouer un rôle sur son développement. / Doctorat en Sciences agronomiques et ingénierie biologique / info:eu-repo/semantics/nonPublished

We present the case of a 7-month-old baby with Cushing’s disease due to an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma combined with cells producing thyreotropin-secreting hormone (TSH). In MRI scans, a contrast-enhancing lesion was seen inside the pituitary fossa, and it extended into the suprasellar region. On the assumption of a pituitary adenoma, surgery was performed. Corresponding with biochemical findings, histopathological evaluation revealed an ACTH- and TSH-producing tumor. Genetic analysis did not demonstrate an alteration at codon 201 (Arg) and 227 (Glu). To our knowledge, this is the first case described in a child of this age. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.