Allan-Herndon-Dudley综合征诊疗现状

Allan-Herndon-Dudley综合征(AHDS)是因甲状腺激素(TH)转运体基因SLC16A2突变, 致其编码单羧酸转运蛋白8(MCT8)功能失活, 不能介导TH进入靶细胞引起的内分泌罕见病。主要临床表现为脑甲状腺功能减退(甲减)所致的严重神经运动发育异常, TH分泌代谢异常所致血清学(高T3、低T4、正常或轻度升高的促甲状腺激素)改变及外周组织甲状腺毒症。基因检测证实SLC16A2基因变异可确诊。有效的治疗应以改善脑甲减和外周甲状腺毒症以及恢复蛋白功能为目标。相比于激素替代治疗, T3类似物三碘甲状腺乙酸可以不依赖MCT8进入细胞, 激活TH受体而发挥TH样作用, 在改善患者外周甲状腺功能亢进症状上疗效显著, 对神经表型可能也有效, 是目前治疗AHDS较好的方法;旨在恢复MCT8功能的基因替代和伴侣分子治疗仍处于研究阶段。     

5-羟色胺转运体与糖尿病

5-羟色胺(5-HT)在维持葡萄糖内环境稳态中起重要作用,研究显示存在于β细胞内的5-HT可以促进胰岛素释放,而广泛存在于细胞膜和神经突触上的5-HT转运体(SERT)蛋白可以重摄取5-HT,通过转运灭活机制调控5-HT使生理功能.近来研究发现SERT蛋白及其基因多态性与糖尿病的发生、发展存在一定关联性.因此对SERT与糖尿病的研究有助于揭示神经系统与糖代谢的联系,为治疗糖尿病寻找新的靶点.     

5-羟色胺转运体基因多态性与肠易激综合征

肠易激综合征(IBS)是临床最常见的功能性肠病,其病因及发病机制还不完全清楚。5-羟色胺(5-HT)是参与调节胃肠道运动和分泌功能的重要神经递质,在IBS的发病中有重要意义。5-羟色胺转运体(SERT或5-HTT)蛋白再摄取神经突触间隙的5-HT,对其起灭活作用。大量研究表明,SERT基因多态性与IBS各型间可能存在联系。     

PI3K对分化型甲状腺癌中NIS表达调节的研究进展

钠碘转运体(NIS)介导甲状腺滤泡细胞的碘浓聚,从而成为多种甲状腺良恶性疾病诊断和治疗的分子生物学基础.促甲状腺激素(TSH)是调节NIS表达的主要因子,TSH同受体结合,通过相应的信号级联反应来调节NIS的表达,磷脂酰肌醇-3-激酶(PI3K)信号转导途径介导TSH对NIS mRNA和蛋白表达的抑制.分化型甲状腺癌(DTC)中PI3K途径的激活极为常见,PI3K抑制剂促进DTC功能性NIS的表达,提高其对放射碘的摄取,对提高DTC患者的疗效、改善预后有重要意义.     

锌转运体8及其自身抗体

锌是胰岛素储存和分泌机制中的一个重要组分,β细胞需要有效且特异的转运体来累积足够量的锌.锌转运体8(ZnT8)是新近发现的一种1型糖尿病自身抗原,具有高度β细胞特异性,通过影响锌离子浓度而在胰岛素合成和分泌中发挥重要作用.ZnT8自身抗体对自身免疫性糖尿病(尤其对其他自身抗体阴性者)有着重要的诊断与预测价值.ZnT8基因(SLC30A8基因)多态性影响ZnT8自身抗体的特异性.     

siRNA沉默Annexin-1基因对膀胱癌T24细胞顺铂耐药的影响

目的 观察RNA干扰沉默膜联蛋白-1(Annexin-1)基因表达技术对膀胱癌T24细胞Annexin-1基因表达和顺铂耐药的影响.方法 针对Annexin-1基因不同部位设计并化学合成3对不同的靶向小分子干扰RNA(siRNA),脂质体介导瞬时转染膀胱癌T24细胞,转染后应用半定量RT-PCR和Western印迹检测Annexin-1 mRNA 和蛋白的改变,用MTT法检测沉默Annexin-1表达在膀胱癌T24细胞对顺铂敏感性的变化.结果 转染siRNA后膀胱癌T24细胞Annexin-1的mRNA和蛋白水平显著下降(P＜0.05),增强细胞对顺铂的敏感性(P＜0.05).结论 RNA 干扰Annexin-1基因后其mRNA 和蛋白水平显著下降,并且增强T24细胞对顺铂的敏感性.     

肝X受体激动剂对载脂蛋白E基因敲除小鼠动脉粥样硬化发生发展的影响

目的观察肝X受体激动剂T0901317对载脂蛋白E基因敲除小鼠动脉粥样硬化发生发展的影响,以探讨肝X受体激动剂在防治动脉粥样硬化中的作用。方法将52只载脂蛋白E基因敲除小鼠随机分为四组:基础组(n=10)8周末处死;对照组(n=14)给予赋型剂灌胃14周;预防组(n=14)给予T0901317灌胃[10mg/(kg.d)]14周;治疗组(n=14)给予赋型剂灌胃8周,自第9周开始给予T0901317灌胃[10mg/(kg.d)]。后三组都于14周末安乐处死,苏丹Ⅳ染色检测主动脉内膜动脉粥样硬化病变面积,油红O染色动脉粥样硬化斑块和肝脏,光镜下观察斑块和肝脏内脂滴。氧化酶法测定载脂蛋白E基因敲除小鼠血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白AⅠ和载脂蛋白B水平。基因芯片检测相关基因表达情况。实时定量PCR检测载脂蛋白E基因敲除小鼠肝脏、小肠、主动脉和脑组织肝X受体α、β、ATP结合盒转运体A1、G1、G5和G8基因表达。结果T0901317能减轻主动脉内膜动脉粥样硬化病变;光镜下可见斑块和肝脏内有染成红色的脂滴,且T0901317能增加斑块和肝脏内脂质的蓄积,并能增加预防组和治疗组载脂蛋白E基因敲除小鼠血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白AⅠ水平;引起肝X受体靶基因如肝X受体α、ATP结合盒转运体A1等基因表达上调,同时引起某些炎症基因如白细胞介素1α和白细胞介素6等基因表达下调;增加载脂蛋白E基因敲除小鼠肝脏、小肠、主动脉和脑组织脂质代谢相关基因的表达,如肝X受体α、肝X受体β、ATP结合盒转运体A1、ATP结合盒转运体G1、ATP结合盒转运体G5、ATP结合盒转运体G8等基因表达。结论肝X受体α激动剂T0901317能减轻载脂蛋白E基因敲除小鼠主动脉内膜动脉粥样硬化病变;增加载脂蛋白E基因敲除小鼠血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白AⅠ水平;肝X受体α激动剂T0901317能增加载脂蛋白E基因敲除小鼠肝脏、小肠、主动脉和脑组织肝X受体α、β、ATP结合盒转运体A1、G1、G5和G8基因的表达。     

肺动脉高压的5-羟色胺/5-羟色胺转运体机制研究进展

肺动脉高压是临床常见的以肺血管阻力进行性增加并伴有不可逆的血管构型重塑为特征的疾病.5-羟色胺作为一种血管活性物质,可以通过5-羟色胺转运体介导,诱导肺动脉平滑肌细胞增殖,促进肺中小动脉构型重塑.因此,揭示5-羟色胺及5-羟色胺转运体在肺动脉高压形成发展中的重要作用,探讨其成为抗肺动脉高压药物治疗新靶点的可能性具有重要意义.     

脂质体介导人NIS基因转染肺癌A549细胞及其蛋白表达

目的 研究人钠/碘同向转运体(NIS)基因转染肺癌细胞及其蛋白表达.方法 鉴定质粒pcDAN3-hNIS中的插入基因NIS基因.培养的肺癌A549分为两组:实验组(转染pcDAN3-hNIS),对照组(转染pcDAN3).脂质体介导NIS基因转染肺癌细胞,采用Western Blot免疫印迹法和免疫组化法检测肺癌细胞中NIS蛋白的表达.结果 验组的肺癌细胞有NIS蛋白的表达,而对照组无表达,两组比较差异有显著性(P=0.000).结论 转染人NIS基因的肺癌细胞可表达NIS蛋白,为探索放射性碘治疗肺癌的研究提供理论依据.     

谷氨酸转运体-1与脑缺血

谷氨酸转运体-1（glutamate transporter-1,GLT-1）是脑组织内的一种重要谷氨酸转运体,可将胞外谷氨酸转运至星形胶质细胞内.在谷氨酰胺合成酶的作用下,谷氨酸转化为可被神经元利用的谷氨酰胺.脑缺血时,细胞外谷氨酸浓度急剧升高,从而对神经元产生兴奋性毒性作用.头孢曲松、亚致死性缺血、低压低氧等预处理均可通过调节GLT-1的表达和改善其功能而起神经保护作用.     

Monocarboxylate transporter 10 functions as a thyroid hormone transporter in chondrocytes

Thyroid hormone is essential for normal proliferation and differentiation of chondrocytes. Thus, untreated congenital hypothyroidism is marked by severe short stature. The monocarboxylate transporter 8 (MCT8) is a highly specific transporter for thyroid hormone. The hallmarks of Allan-Herndon-Dudley syndrome, caused by MCT8 mutations, are severe psychomotor retardation and elevated T(3) levels. However, growth is mostly normal. We therefore hypothesized that growth plate chondrocytes use transporters other than MCT8 for thyroid hormone uptake. Extensive analysis of thyroid hormone transporter mRNA expression in mouse chondrogenic ATDC5 cells revealed that monocarboxylate transporter 10 (Mct10) was most abundantly expressed among the transporters known to be highly specific for thyroid hormone, namely Mct8, Mct10, and organic anion transporter 1c1. Expression levels of Mct10 mRNA diminished with chondrocyte differentiation in these cells. Accordingly, Mct10 mRNA was expressed most abundantly in the growth plate resting zone chondrocytes in vivo. Small interfering RNA-mediated knockdown of Mct10 mRNA in ATDC5 cells decreased [(125)I]T(3) uptake up to 44% compared with negative control (P < 0.05). Moreover, silencing Mct10 mRNA expression abolished the known effects of T(3), i.e. suppression of proliferation and enhancement of differentiation, in ATDC5 cells. These results suggest that Mct10 functions as a thyroid hormone transporter in chondrocytes and can explain at least in part why Allan-Herndon-Dudley syndrome patients do not exhibit significant growth impairment.     

Expression of the thyroid hormone transporters monocarboxylate transporter-8 (SLC16A2) and organic ion transporter-14 (SLCO1C1) at the blood-brain barrier

Thyroid hormones require transport across cell membranes to carry out their biological functions. The importance of transport for thyroid hormone signaling was highlighted by the discovery that inactivating mutations in the human monocarboxylate transporter-8 (MCT8) (SLC16A2) cause severe psychomotor retardation due to thyroid hormone deficiency in the central nervous system. It has been reported that Mct8 expression in the mouse brain is restricted to neurons, leading to the model that organic ion transporter polypeptide-14 (OATP14, also known as OATP1C1/SLCO1C1) is the primary thyroid hormone transporter at the blood-brain barrier, whereas MCT8 mediates thyroid hormone uptake into neurons. In contrast to these reports, we report here that in addition to neuronal expression, MCT8 mRNA and protein are expressed in cerebral microvessels in human, mouse, and rat. In addition, OATP14 mRNA and protein are strongly enriched in mouse and rat cerebral microvessels but not in human microvessels. In rat, Mct8 and Oatp14 proteins localize to both the luminal and abluminal microvessel membranes. In human and rodent choroid plexus epithelial cells, MCT8 is concentrated on the epithelial cell apical surface and OATP14 localizes primarily to the basal-lateral surface. Mct8 and Oatp14 expression was also observed in mouse and rat tanycytes, which are thought to form a barrier between hypothalamic blood vessels and brain. These results raise the possibility that reduced thyroid hormone transport across the blood-brain barrier contributes to the neurological deficits observed in affected patients with MCT8 mutations. The high microvessel expression of OATP14 in rodent compared with human brain may contribute to the relatively mild phenotype observed in Mct8-null mice, in contrast to humans lacking functional MCT8.     

Tissue-specific thyroid hormone deprivation and excess in monocarboxylate transporter (mct) 8-deficient mice

Mutations of the X-linked thyroid hormone (TH) transporter (monocarboxylate transporter, MCT8) produce in humans unusual abnormalities of thyroid function characterized by high serum T3 and low T4 and rT3. The mechanism of these changes remains obscure and raises questions regarding the regulation of intracellular availability and metabolism of TH. To study the pathophysiology of MCT8 deficiency, we generated Mct8 knockout mice. Male mice deficient in Mct8 (Mct8(-/y)) replicate the thyroid abnormalities observed in affected men. TH deprivation and replacement with L-T3 showed that suppression of TSH required higher serum levels T3 in Mct8(-/y) than wild-type (WT) littermates, indicating hypothalamus and/or thyrotroph resistance to T3. Furthermore, T4 is required to maintain the high serum T3 level because the latter was not different between the two genotypes during administration of T3. Mct8(-/y) mice have 2.3-fold higher T3 content in liver associated with 6.1- and 3.1-fold increase in deiodinase 1 mRNA and enzymatic activity, respectively. The relative T3 excess in liver of Mct8(-/y) mice produced a decrease in serum cholesterol (79 +/- 18 vs. 137 +/- 38 mg/dl in WT) and an increase in alkaline phosphatase (107 +/- 23 vs. 58 +/- 3 U/liter in WT) levels. In contrast, T3 content in cerebrum was 1.8-fold lower in Mct8(-/y) mice, associated with a 1.6- and 10.6-fold increase in D2 mRNA and enzymatic activity, respectively, as previously observed in TH-deprived WT mice. We conclude that cell-specific differences in intracellular TH content due to differences in contribution of the various TH transporters are responsible for the unusual clinical presentation of this defect, in contrast to TH deficiency.     

Lack of action of exogenously administered T3 on the fetal rat brain despite expression of the monocarboxylate transporter 8

Mutations of the monocarboxylate transporter 8 gene (MCT8, SLC16A2) cause the Allan-Herndon-Dudley syndrome, an X-linked syndrome of severe intellectual deficit and neurological impairment. Mct8 transports thyroid hormones (T4 and T3), and the Allan-Herndon-Dudley syndrome is likely caused by lack of T3 transport to neurons during critical periods of fetal brain development. To evaluate the role of Mct8 in thyroid hormone action in the fetal brain we administered T4 or T3 to thyroidectomized pregnant dams treated with methyl-mercapto-imidazol to produce maternal and fetal hypothyroidism. Gene expression was then measured in the fetal cerebral cortex. T4 increased Camk4, Sema3c, and Slc7a3 expression, but T3 was without effect. To investigate the cause for the lack of T3 action we analyzed the expression of organic anion transport polypeptide (Oatp14, Slco1c1), a T4 transporter, and Mct8 (Slc16a2), a T4 and T3 transporter, by confocal microscopy. Both proteins were present in the brain capillaries forming the blood-brain barrier and in the epithelial cells of the choroid plexus forming the blood-cerebrospinal fluid barrier. It is concluded that T4 from the maternal compartment influences gene expression in the fetal cerebral cortex, possibly after transport via organic anion transporter polypeptide and/or Mct8, and conversion to T3 in the astrocytes. On the other hand, T3 does not reach the target neurons despite the presence of Mct8. The data indicate that T4, through local deiodination, provides most T3 in the fetal rat brain. The role of Mct8 as a T3 transporter in the fetal rat brain is therefore uncertain.     

PTTG-binding factor (PBF) is a novel regulator of the thyroid hormone transporter MCT8

Within the basolateral membrane of thyroid follicular epithelial cells, two transporter proteins are central to thyroid hormone (TH) biosynthesis and secretion. The sodium iodide symporter (NIS) delivers iodide from the bloodstream into the thyroid, and after TH biosynthesis, monocarboxylate transporter 8 (MCT8) mediates TH secretion from the thyroid gland. Pituitary tumor-transforming gene-binding factor (PBF; PTTG1IP) is a protooncogene that is up-regulated in thyroid cancer and that binds NIS and modulates its subcellular localization and function. We now show that PBF binds MCT8 in vitro, eliciting a marked shift in MCT8 subcellular localization and resulting in a significant reduction in the amount of MCT8 at the plasma membrane as determined by cell surface biotinylation assays. Colocalization and interaction between PBF and Mct8 was also observed in vivo in a mouse model of thyroid-specific PBF overexpression driven by a bovine thyroglobulin (Tg) promoter (PBF-Tg). Thyroidal Mct8 mRNA and protein expression levels were similar to wild-type mice. Critically, however, PBF-Tg mice demonstrated significantly enhanced thyroidal TH accumulation and reduced TH secretion upon TSH stimulation. Importantly, Mct8-knockout mice share this phenotype. These data show that PBF binds and alters the subcellular localization of MCT8 in vitro, with PBF overexpression leading to an accumulation of TH within the thyroid in vivo. Overall, these studies identify PBF as the first protein to interact with the critical TH transporter MCT8 and modulate its function in vivo. Furthermore, alongside NIS repression, PBF may thus represent a new regulator of TH biosynthesis and secretion.     

The importance of thyroid hormone transporters for brain development and function

Thyroid hormone is essential for proper brain development and function. As a prerequisite for its action, transporters must exist to mediate its cellular entry. As impaired uptake of thyroid hormone into the CNS causes severe neurological symptoms, it is of utmost importance to identify these carriers. The monocarboxylate transporter 8 (MCT8) was recently characterized as a very specific thyroid hormone transporter. Inactivating mutations in the MCT8 gene are associated with a severe syndrome of psychomotor retardation and abnormal thyroid hormone parameters. To elucidate the underlying pathogenic mechanisms, MCT8-deficient mice that replicate the human thyroid phenotype, despite the absence of overt neurological symptoms, have been generated. Here, we summarize recent findings obtained by analyzing these animals and discuss their potential impact for the treatment of affected patients.     

Thyroid hormone transport by monocarboxylate transporters

Thyroid hormone (TH) is essential for the normal development and metabolism of different tissues. TH action and metabolism take place intracellularly, which requires cellular uptake via transporters. Several transporter families have been identified, of which the monocarboxylate transporter (MCT) family deserves special attention. So far, only MCT1, MCT2, MCT3, MCT4 and MCT6 have been demonstrated to transport monocarboxylates; MCT8 has been identified as a specific TH transporter. MCT8 mutations in humans are associated with severe psychomotor retardation and elevated 3,3',5-triiodothyronine (T(3)) levels. Recently, MCT8 knockout mice have been shown to perfectly imitate the thyroid state in patients with MCT8 mutations; however, they lack the neurological defects. Although it was long hypothesized that a T-type amino acid transporter also transports iodothyronines, it only recently became clear that MCT10 is involved in the bidirectional transport of aromatic amino acids and iodothyronines. MCT10 preferentially transports T(3) even more effectively than does MCT8. However, its precise function in the human body is poorly understood.     

Distinct roles of deiodinases on the phenotype of Mct8 defect: a comparison of eight different mouse genotypes

Mice deficient in the thyroid hormone (TH) transporter Mct8 (Mct8KO) have increased 5'-deiodination and impaired TH secretion and excretion. These and other unknown mechanisms result in the low-serum T(4), high T(3), and low rT(3) levels characteristic of Mct8 defects. We investigated to what extent each of the 5'-deiodinases (D1, D2) contributes to the serum TH abnormalities of the Mct8KO by generating mice with all combinations of Mct8 and D1 and/or D2 deficiencies and comparing the resulting eight genotypes. Adding D1 deficiency to that of Mct8 corrected the serum TH abnormalities of Mct8KO mice, normalized brain T(3) content, and reduced the impaired expression of TH-responsive genes. In contrast, Mct8D2KO mice maintained the serum TH abnormalities of Mct8KO mice. However, the serum TSH level increased 27-fold, suggesting a severely impaired hypothalamo-pituitary-thyroid axis. The brain of Mct8D2KO manifested a pattern of more severe impairment of TH action than Mct8KO alone. In triple Mct8D1D2KO mice, the markedly increased serum TH levels produced milder brain defect than that of Mct8D2KO at the expense of more severe liver thyrotoxicosis. Additionally, we observed that mice deficient in D2 had an unexplained marked reduction in the thyroid growth response to TSH. Our studies on these eight genotypes provide a unique insight into the complex interplay of the deiodinases in the Mct8 defect and suggest that D1 contributes to the increased serum T(3) in Mct8 deficiency, whereas D2 mainly functions locally, converting T(4) to T(3) to compensate for distinct cellular TH depletion in Mct8KO mice.     

Thyroid hormone transport in and out of cells.

Thyroid hormone (TH) is essential for the proper development of numerous tissues, notably the brain. TH acts mostly intracellularly, which requires transport by TH transporters across the plasma membrane. Although several transporter families have been identified, only monocarboxylate transporter (MCT)8, MCT10 and organic anion-transporting polypeptide (OATP)1C1 demonstrate a high degree of specificity towards TH. Recently, the biological importance of MCT8 has been elucidated. Mutations in MCT8 are associated with elevated serum T(3) levels and severe psychomotor retardation, indicating a pivotal role for MCT8 in brain development. MCT8 knockout mice lack neurological damage, but mimic TH abnormalities of MCT8 patients. The exact pathophysiological mechanisms in MCT8 patients remain to be elucidated fully. Future research will probably identify novel TH transporters and disorders based on TH transporter defects.     

Novel mutation in MCT8 gene in a Brazilian boy with thyroid hormone resistance and severe neurologic abnormalities

MCT8 is a cellular transporter of thyroid hormones important in their action and metabolization. We report a male patient with the novel inactivating mutation 630insG in the coding region in exon 1 of MCT8. He was characterized clinically by severe neurologic impairment (initially with global hypotonia, later evolving with generalized hypertonia), normal growth during infancy, reduced weight gain, and absence of typical signs and symptoms of hypothyroidism, while the laboratory evaluation disclosed elevated T3, low total and free T4, and mildly elevated TSH serum levels. Treatment with levothyroxine improved thyroid hormone profile but was not able to alter the clinical picture of the patient. These data reinforce the concept that the role of MCT8 is tissue-dependent: while neurons are highly dependent on MCT8, bone tissue, adipose tissue, muscle, and liver are less dependent on MCT8 and, therefore, may suffer the consequences of the exposition to high serum T3 levels.