Division of Endocrinology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
J Autoimmun. 2013 Aug;44:61-70. doi: 10.1016/j.jaut.2013.04.002. Epub 2013 May 15.
Autoimmune thyroid diseases (AITD) have become increasingly recognized as a complication of interferon-alpha (IFNα) therapy in patients with chronic Hepatitis C virus (HCV) infection. Interferon-induced thyroiditis (IIT) can manifest as clinical thyroiditis in approximately 15% of HCV patients receiving IFNα and subclinical thyroiditis in up to 40% of patients, possibly resulting in either dose reduction or discontinuation of IFNα treatment. However, the exact mechanisms that lead to the development of IIT are unknown and may include IFNα-mediated immune-recruitment as well as direct toxic effects on thyroid follicular cells. We hypothesized that IIT develops in genetically predisposed individuals whose threshold for developing thyroiditis is lowered by IFNα. Therefore, our aim was to identify the susceptibility genes for IIT. We used a genomic convergence approach combining genetic association data with transcriptome analysis of genes upregulated by IFNα. Integrating results of genetic association, transcriptome data, pathway, and haplotype analyses enabled the identification of 3 putative loci, SP100/110/140 (2q37.1), HLA (6p21.3), and TAP1 (6p21.3) that may be involved in the pathogenesis of IIT. Immune-regulation and apoptosis emerged as the predominant mechanisms underlying the etiology of IIT.
自身免疫性甲状腺疾病(AITD)已成为慢性丙型肝炎病毒(HCV)感染患者接受干扰素-α(IFNα)治疗的一种越来越被认识到的并发症。干扰素诱导的甲状腺炎(IIT)可在接受 IFNα 的约 15% HCV 患者中表现为临床甲状腺炎,在多达 40%的患者中表现为亚临床甲状腺炎,可能导致 IFNα 治疗的剂量减少或停止。然而,导致 IIT 发展的确切机制尚不清楚,可能包括 IFNα 介导的免疫募集以及对甲状腺滤泡细胞的直接毒性作用。我们假设 IIT 发生在遗传易感性个体中,这些个体的甲状腺炎发展阈值因 IFNα 而降低。因此,我们的目的是确定 IIT 的易感基因。我们使用了一种基因组收敛方法,将遗传关联数据与 IFNα 上调的基因的转录组分析相结合。遗传关联、转录组数据、途径和单倍型分析的综合结果,确定了 3 个可能参与 IIT 发病机制的候选基因座,SP100/110/140(2q37.1)、HLA(6p21.3)和 TAP1(6p21.3)。免疫调节和细胞凋亡是 IIT 病因的主要机制。