Resistance to thyroid hormone caused by a mutation in thyroid hormone receptor (TR)α1 and TRα2: clinical, biochemical, and genetic analyses of three related.

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Resistance to thyroid hormone caused by a mutation in thyroid hormone receptor (TR)α1 and TRα2: clinical, biochemical, and genetic analyses of three related patients  Carla Moran, MBBCh, Maura Agostini, PhD, W Edward Visser, MD, Erik Schoenmakers, PhD, Nadia Schoenmakers, PhD, Amaka C Offiah, PhD, Ken Poole, PhD, Odelia Rajanayagam, BSc, Greta Lyons, RGN, David Halsall, PhD, Mark Gurnell, PhD, Dionisios Chrysis, MD, Alexandra Efthymiadou, MD, Charles Buchanan, MBChB, Simon Aylwin, FRCP, Prof Krishna K Chatterjee, BMBCh  The Lancet Diabetes & Endocrinology  Volume 2, Issue 8, Pages 619-626 (August 2014) DOI: 10.1016/S2213-8587(14)70111-1 Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 1 Phenotypic features (A) Patients 1, 2, and 3. (B) Head circumferences by height and sex, divided into centiles (adapted with permission from Bushby and colleagues15). (C) Skull radiograph of patient 1. (D) Free thyroxine:free tri-iodothyronine ratios, compared with sex-matched healthy people of similar age (women 35–64 years, men 20–40 years).15 The Lancet Diabetes & Endocrinology 2014 2, 619-626DOI: (10.1016/S2213-8587(14)70111-1) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 2 Functional properties and molecular modelling of Ala263Val TRα1 (A) Results of transfection assay for T3-dependent activation in JEG-3 cells transfected with empty, wild-type, or Ala263Val TRα1 expression vectors together with a thyroid hormone-responsive reporter gene; the inset shows an electrophoretic mobility shift assay with comparable interaction of unliganded or hormone-bound normal TRα1 and RXR, and Ala263Val mutant TRα1 and RXR heterodimers with a direct repeat thyroid response element from the malic enzyme gene. (B) We tested dominant-negative inhibition in cells cotransfected with reporter gene and equal combinations of expression vectors. (C) Quantitative real-time PCR (internal control: 36B4, acidic ribosomal phosphoprotein) showing expression of KLF9 in peripheral blood mononuclear cells from the patients (Ala263Val) or control individuals with changing T3 concentrations. (D) Crystallographic modelling of the TRα1 ligand binding domain bound to tri-iodothyronine (blue). (E) Structures of TRα1, TRα2 and TRβ proteins. *p<0·05. †p<0·01. ‡p<0·001. DBD=DNA-binding domain. T3=tri-iodothyronine. RXR=retinoid X receptor. RL=reticulocyte lysate. The Lancet Diabetes & Endocrinology 2014 2, 619-626DOI: (10.1016/S2213-8587(14)70111-1) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 3 Functional properties of Ala263Val TRα2 (A) 293 cells transfected with either GFP, GFP-tagged normal TRα2, or Ala263Val mutant TRα2 expression vectors with visualisation of nuclei (blue), plasma membrane (red), and GFP fusion (green), and a composite merged image by immunofluorescence. We tested transcriptional function of wild-type TRα2 and Ala263Val mutant TRα2 proteins in JEG-3 cells cotransfected with reporter gene and increasing amounts (5–250 ng) of empty, normal, or Ala263Val TRα2 expression vectors in the absence of tri-iodothyronine (B), or a fixed amount of empty, TRα1, normal TRα2, and Ala263Val mutant TRα2 expression vectors with increasing T3 concentrations (C; inset show magnified vector, α2, Ala263Val α2 responses), or a fixed amount of wild-type TRα1 and increasing ratio (1:1 to 1:50) of TRα2 expression vectors (D; inset shows western blot of flag epitope-tagged TR and control [β actin] proteins). T3=tri-iodothyronine. The Lancet Diabetes & Endocrinology 2014 2, 619-626DOI: (10.1016/S2213-8587(14)70111-1) Copyright © 2014 Elsevier Ltd Terms and Conditions