1. Central Hypothyroidism Due to a TRHR Mutation Causing Impaired Ligand Affinity and Transactivation of Gq
- Author
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Leonardo Pardo, Jesús González de Buitrago, José Moreno, Patricia M. Hinkle, Mireia Jiménez-Rosés, and Marta Cerezo García
- Subjects
0301 basic medicine ,Male ,Transcriptional Activation ,medicine.medical_specialty ,endocrine system ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Mutation, Missense ,Thyrotropin ,030209 endocrinology & metabolism ,Context (language use) ,Biology ,Thyroid Function Tests ,Biochemistry ,Thyroid function tests ,Short stature ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Rare Diseases ,Internal medicine ,medicine ,Central hypothyroidism ,Congenital Hypothyroidism ,Missense mutation ,Humans ,Computer Simulation ,Genetic Predisposition to Disease ,Child ,Clinical Research Articles ,medicine.diagnostic_test ,Receptors, Thyrotropin-Releasing Hormone ,Biochemistry (medical) ,Thyroid ,medicine.disease ,Congenital hypothyroidism ,Pedigree ,IGSF1 ,030104 developmental biology ,medicine.anatomical_structure ,GTP-Binding Protein alpha Subunits, Gq-G11 ,medicine.symptom ,hormones, hormone substitutes, and hormone antagonists - Abstract
Context:Central congenital hypothyroidism (CCH) is an underdiagnosed disorder characterized by deficient production and bioactivity of thyroid-stimulating hormone (TSH) leading to low thyroid hormone synthesis. Thyrotropin-releasing hormone (TRH) receptor (TRHR) defects are rare recessive disorders usually associated with incidentally identified CCH and short stature in childhood.Objectives:Clinical and genetic characterization of a consanguineous family of Roma origin with central hypothyroidism and identification of underlying molecular mechanisms.Design:All family members were phenotyped with thyroid hormone profiles, pituitary magnetic resonance imaging, TRH tests, and dynamic tests for other pituitary hormones. Candidate TRH, TRHR, TSHB, and IGSF1 genes were screened for mutations. A mutant TRHR was characterized in vitro and by molecular modeling.Results:A homozygous missense mutation in TRHR (c.392T > C; p.I131T) was identified in an 8-year-old boy with moderate hypothyroidism (TSH: 2.61 mIU/L, Normal: 0.27 to 4.2; free thyroxine: 9.52 pmol/L, Normal: 10.9 to 25.7) who was overweight (body mass index: 20.4 kg/m2, p91) but had normal stature (122 cm; –0.58 standard deviation). His mother, two brothers, and grandmother were heterozygous for the mutation with isolated hyperthyrotropinemia (TSH: 4.3 to 8 mIU/L). The I131T mutation, in TRHR intracellular loop 2, decreases TRH affinity and increases the half-maximal effective concentration for signaling. Modeling of TRHR-Gq complexes predicts that the mutation disrupts the interaction between receptor and a hydrophobic pocket formed by Gq.Conclusions:A unique missense TRHR defect identified in a consanguineous family is associated with central hypothyroidism in homozygotes and hyperthyrotropinemia in heterozygotes, suggesting compensatory elevation of TSH with reduced biopotency. The I131T mutation decreases TRH binding and TRHR-Gq coupling and signaling.
- Published
- 2017