PARALLEL SESSIONS
Session Type
PARALLEL SESSIONS
Session Time
13:30 - 15:30
Session Icon
Pre Recorded

THYROID AUTOIMMUNE DISORDERS AND SYSTEMIC AUTOIMMUNE DISEASE: A LARGE LONGITUDINAL STUDY

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
13:30 - 13:50
Presenter
  • Alessandro Antonelli, Italy
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Pre Recorded

THYROID GLAND, BRAIN AND AUTOIMMUNITY

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
13:50 - 14:10
Presenter
  • Leonid P. Churilov, Russian Federation
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Pre Recorded

AUTOIMMUNE THYROID DISORDERS ASSOCIATED WITH RHEUMATOLOGIC, OR DERMATOLOGIC, AUTOIMMUNE DISEASES

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
14:10 - 14:20
Presenter
  • Poupak Fallahi, Italy
Session Icon
Pre Recorded

Abstract

Background and Aims

Autoimmune thyroid disorders (AITD) are organ-specific autoimmune diseases-Th1 orientated. Hashimoto’s thyroiditis (HT), and Graves’ disease (GD) are the principal clinical presentations of AITD, that have been also shown in systemic rheumatologic diseases (as Sjögren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, or cryoglobulinemia), together with thyroid autoantibodies and thyroid dysfunctions. New associations of AITD with other autoimmune diseases are being discovered, for example with psoriatic arthritis and dermatological diseases.

Methods

We have searched on Pubmed about associations of AITD with other autoimmune diseases.

Results

Several investigations suggested the importance of a shared genetic susceptibility and of environmental factors in patients in whom a coexistence of autoimmune diseases is present. A major Th1 autoimmune response occurs in the initial, and/or active phases of organ-specific autoimmune disorders and/or systemic rheumatologic diseases with increased serum, or tissue, expressions of the Th1 chemokine CXCL10.

Conclusions

Thyroid disorders might have an important clinical impact, therefore patients with rheumatologic or dermatologic autoimmune diseases, overall if females and with circulating thyroid autoantibodies, need to be periodically evaluated for thyroid dysfunctions. Furthermore, drugs targeting the Th1 immune response should be evaluated in patients with AITD to prevent the appearance of other autoimmune disorders.

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EVALUATION OF INTRAVENOUS TOCILIZUMAB FOR THE THERAPY OF MODERATE TO SEVERE GRAVES' OPHTHALMOPATHY

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
14:20 - 14:30
Presenter
  • Javier Carbone, Spain
Session Icon
Pre Recorded

Abstract

Background and Aims

Thyroid-associated ophthalmopathy is an extrathyroidal manifestation of Graves disease, occasionally severe and refractory to treatment. The complications of this disease have a high negative impact in the quality of life of the patients. A infiltrating cytokine in the orbital tissue is interleukin-6. We here report efficacy and safety of the use of intravenous tocilizumab in moderate to severe Graves' ophthalmopathy in a single center.

Methods

Prospective case report. Clinical and Immunological data of 5 cases. Patients with moderate to severe Graves' ophthalmopathy were subsequently included to receive a protocol of monthly intravenous tocilizumab at a dose of 8 mg/kg/dose (total 4 doses). All reported a past or present history of dysthyroidism. Safety evaluation before tocilizumab infusions was performed.

Results

The administration of interleukin-6-receptor monoclonal antibody treatment was associated with a significant improvement in CAS scores (ocular symptoms, proptosis), and functional prognosis in all patients. Improvement of myxedema was also observed in a patient with this extrathyroidal manifestation of Graves disease. Improvement in the European Group on GO-proposed composite ophthalmic score was also observed. Patients communicated better quality of life after therapy. Infusions were tolerated well. In one patient a reduction to 4mg/kg/dose was introduced due to increase of liver transaminase levels. No infectious complications were observed. A significant decrease of anti-TSH-receptor antibody titers was documented (13.26 vs 3.6 IU/L, 2-sided T-test p=0.019).

Conclusions

These data further support the efficacy and tolerability profile of intravenous tocilizumab in moderate to severe or corticosteroid-resistant Graves' ophthalmopathy.

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A POTENTIAL RISK OF FALSE POSITIVE RESULTS WHEN UTILIZING PURIFIED HUMAN THYROID PEROXIDASE AS ANTIGEN IN ANTI-THYROID PEROXIDASE ANTIBODY TESTS

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
14:30 - 14:40
Presenter
  • Christian Konrad, Germany
Session Icon
Pre Recorded

Abstract

Background and Aims

The quality of antigen is believed to be important to an in vitro diagnostic test. Protein purification from human/animal tissue and recombinant expression technology are the two commonly used techniques to acquire antigens. Purification of certain antigens does not completely eliminate the contamination with other cell components which might cause falsely elevated signals. Here, we aim to compare the way how antigens are purified and how this affects the results of routine samples.

Methods

First, we compared two commercially available tests for the measurement of anti-human thyroid peroxidase (TPO) antibodies. While one test applies TPO purified from human thyroid gland, the other applies recombinant human TPO. Various samples containing anti-TPO and/or anti-thyroglobulin (TG) antibodies were measured with both tests.

Results

When testing serum samples solely containing anti-TG antibodies, a strong signal was observed with the test applying purified TPO but not with the test that applies recombinant TPO. This indicates a potential interference of anti-TG antibodies on an anti-TPO diagnostic test that is dependent on the applied TPO antigen. To determine if this signal was indeed caused by anti-TG antibodies, these antibodies were depleted from samples containing anti-TG and/or anti-TPO antibodies by incubating the with soluble TG. Anti-TG-antibody-deplete samples, independent of anti-TPO antibody concentrations, showed a clear decrease in signal in the test using purified TPO, whereas the concentration remained unchanged when TPO was recombinant.

Conclusions

These results highlight that the antigen preparation significantly affects an antibody test’s performance. Test applying purified TPO could give false positive results when samples contain anti-TG antibodies.

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IMPLICATION OF RANTES IN THE DEVELOPMENT OF AUTOIMMUNE THYROIDITIS VIA CHEMOKINE PRODUCTION DOWN-REGULATION BY HHV-6

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
14:40 - 14:50
Presenter
  • Lība Sokolovska, Latvia
Session Icon
Pre Recorded

Abstract

Background and Aims

Incidence of autoimmune thyroiditis (AIT) dramatically arises with time worldwide. Some studies bring evidences of human herpesvirus-6 (HHV-6) involvement in AIT development. HHV- 6 has two genes (U12 and U51) that encode putative homologs of cellular G-protein-coupled receptors (GPCR). It was shown in vitro that these viral GPCRs could interact with cytokine signalling pathways down-regulating RANTES.

Aim of this study was to investigate HHV-6 involvement in AIT development through interactions with RANTES signaling pathways.

Methods

Blood samples were collected from 110 patients (8 males and 102 females) with autoimmune thyroiditis following thyroidectomy. The control group included 30 healthy blood donors (25 females and 5 males). Commercial kits for suspension multiplex immunological assays were used to detect RANTES, INF-γ, IL-6 and TNFα levels in blood plasma.

Results

Data from previous studies showed that 98% of AIT patients’ samples are positive for HHV-6 genome sequence. RANTES median level was found to be significantly lower in AIT patients than in control group's plasma samples (150.3 [IQR: 71.6-418.2] vs 1359 [IQR: 844.2-2596.0] pg/ml; p<0.0001). However, INF-γ and TNFα median levels were found to be significantly higher in patients' samples.

Conclusions

Significant difference of RANTES and two pro-inflammatory cytokine levels in AIT patients’ samples may point to the role of RANTES levels in AIT development. In addition, data from prior studies showed that 43% of AIT patients with low RANTES levels were positive on HHV-6 U12/U51 mRNA in thyroid gland tissue samples, which brings evidences of possible HHV-6 GPCR involvement in RANTES signaling pathway modulation.

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PREVALENCE OF LATENT AND OVERT POLYAUTOIMMUNITY IN AUTOIMMUNE THYROID DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
14:50 - 15:00
Presenter
  • Manuel Rojas, Colombia
Session Icon
Pre Recorded

Abstract

Background and Aims

Thyroid autoimmunity is the most frequent condition involved into polyautoimmunity (PolyA). However, the frequency of latent and overt PolyA in autoimmune thyroid disease (AITD) as index condition is unknown.

Methods

This study adhered to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Searches through MEDLINE, EMBASE, and LILACS were performed to include articles in Spanish and English, and published up to August 8, 2018. Relevant vocabulary terms and key terms related to AITD and other autoimmune diseases were used. Fixed and random effects models were used accordingly.

Results

A total of 46 articles fulfilled inclusion criteria, of which 24 were case-controls, 17 were cohorts, and 5 were cross-sectional studies. These studies included a total of 38,921 patients with a mean age of 32.26 years. Female was the predominant gender including 31,251 patients (81.15%, 95% CI: 80.75-81.54). Graves’ disease was the most common type of AITD (64.72%, 95% CI: 63.45-65.98). Overt PolyA was found in 13.09% of patients (95% CI: 12.5-13.71). This type of PolyA was principally represented by type 1 diabetes (4.36%, 95% CI: 3.84-4.95) and autoimmune gastritis (4.24%, 95% CI: 3.63-4.95) (Figure 1A). Latent PolyA was presented in 17.59% of patients (95% CI: 16.64-18.58), in which anti-nuclear antibodies (23.39%, CI: 7.78-52.50), and anti-proinsulin antibodies (18.64%, 95% CI: 13.57-25.07) were the most common (Figure 1B).

figure 1.jpg

Conclusions

Latent and overt PolyA are common in patients with AITD. These results provide insightful information for early diagnosis and management of concurrent ADs in patients with AITD.

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ANTI-ALPHA-ENOLASE ANTIBODIES IN CNS IMPAIRMENTS OF HASHIMOTO’S THYROIDITIS

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
15:00 - 15:10
Presenter
  • Polina Sobolevskaia, Russian Federation
Session Icon
Pre Recorded

Abstract

Background and Aims

Hashimoto's encephalopathy (HE) is an extrathyroidal autoimmune brain disorder. The presense of anti-alpha enolase antibodies (ENO1Ab) was detected in cases of HE, thus it may be a key component in the pathogenesis of HE.

The aim of the study was to analyse possible association between ENO1Ab and anti-thyroid autoantibodies, hormones, psychiatric manifestations.

Methods

We studied 117 patients with Hashimoto's thyroiditis (HT). First group of the patients (n=33) had an HT and different psychiatric disorders (PD). Another group (n=84) had an HT without any psychiatric disorders. Anti-thyroid peroxidase antibodies (antiTPO), anti-thyroglobulin antibodies (antiTG), thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), prolactin and ENO1Ab were studied.

Results

In the group with HT and PD ENO1Ab were positive in 33,3% in another group-in 12%. The level of antiTPO was increased in both groups. We found significant positive correlations between ENO1Ab and antiTG (r=0,31; p=0,002), prolactin (r=0,39; p<0,001) in general group (n=117). In the group with HT was a positive significant correlations between ENO1Ab and antiTG (r=0,39; p=0,002), prolactin (r=0,29; p=0,034). Positive correlations in general group between ENO1Ab and hallucination (p=0,034), generalized anxiety (p=0,011), delirium (p=0,018), attention deficit (p=0,033) were found.

Conclusions

Positive correlation of ENO1Ab and antiTG Ab, prolactin in HT patients confirms the hypothesis that ENO1Ab can be a kind of non-classical autoantibody secondary to autoimmune responses to Tg in pathogenesis of HT.

ENO1Ab were associated with psychiatric symptoms in general group of patients, but it was not confirmed in each group separately. Thus, this association is smoothed out as psychic symptoms progress and psychosis treatment begins

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PREDICTING THE COURSE OF GRAVES´ ORBITOPATHY AND GRAVES DISEASE BY ANTI-TSH-RECEPTOR AUTOANTIBODY MEASUREMENTS- BINDING ASSAYS VERSUS FUNCTIONAL BIOASSAY

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
15:10 - 15:20
Presenter
  • Simon D. Lytton, Germany
Session Icon
Pre Recorded

Abstract

Background and Aims

The automated electrochemical luminescence immunoassays (ECLIA) of TSH receptor autoantibody binding (TRAb) and the functional measurements of stimulating and blocking TSH-receptor autoantibodies by cAMP reporter commercial cell-based bioassay have vastly improved the efficiency of Graves Disease-Orbitopathy (GD-GO) diagnosis. The aim of this study was to investigate the potential of the the funcational bioassay versus the TRAb ECLIA to predict remission or relapse of hyperthyroidism and GD-GO during the course of antithyroid drug therapy.

Methods

Biobank serum of GD-GO patients (n=254) at 24 month relapse vs remission of hyperthyroidism and 12 month mild versus severe eye inflammation were evaluated in TRAb Elecys® (Cobas Roche) and TRAb bridge assay (IMMULITE ®, Siemens) ECLIA. TSH-receptor stimulating immunoglobulins (TSAb) were assessed in the cell-based bioassay (Thyretain ®, Quidel).

Results

The predictive potentials of the TRAb ECLIA and the bioassay did not markedly differ. More than half of the patients with relapsing hyperthyroidism were identified according to high TRAb values at 6 months after the beginning of ATD. At all measured timepoints the cell-based bioassay was most sensitive – and still positive 13-16 months after the diagnosis of GD in 90% of the patients compared with ECLIA; 70% (Immulite) and 65% (Elecys).

Conclusions

The predictability of relapse vs remission of hyperthyroidism or mild vs severe GO is 50-60% and independent of anti-TSH-R assay technology at six months. Thyretain®Bioassay shows highest diagnostic sensitivity ( >80%, 2 yrs). Patients whom test within the risk range (> cut-off) are recommended to undergo intensified treatment of orbital inflammation by immunomodulatory drug and/or steroids.

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NEW THERAPIES FOR THE TREATMENT OF THYROID AUTOIMMUNE DISEASES

Session Type
PARALLEL SESSIONS
Date
29.05.2021, Saturday
Session Time
13:30 - 15:30
Room
HALL A
Lecture Time
15:20 - 15:30
Presenter
  • Silvia Martina Ferrari, Italy
Session Icon
Pre Recorded

Abstract

Background and Aims

Interferon (IFN)-γ, IFN-γ-dependent chemokines (CXCL9, CXCL10, CXCL11) and the CXCR3 receptor have a crucial role in the pathogenesis of autoimmune thyroid diseases (AITD), in which the predominance of a Th1 immune related response has been reported. Both methimazole, and corticosteroids, have been shown to modulate the Th1-dependent chemokines.

Methods

We have searched on Pubmed about novel therapeutic targets in AITD.

Results

The new knowledge about the immunopathogenesis of AITD leads to the study of new drugs able to modulate the autoimmune reaction, such as peroxisome proliferator-activated receptor (PPAR)-γ or -α ligands, or antibodies, or small molecules directed against CXCL10, or CXCR3. Drugs targeting cytokines [anti-Tumor necrosis factor (TNF)-α (Etanercept), anti-IL-6 (Tocilizumab)], and rituximab (a chimeric monoclonal antibody vs. CD20) have shown promising results in Graves’ Ophthalmopathy (GO). Also an antigen-specific therapy for Graves’ disease (GD), by inducing T cell tolerance through an immunization with TSH-R peptides, has been published. Teprotumumab (a human monoclonal anti-IGF-1R blocking antibody) has been investigated in a multicenter, double-masked, randomized, placebo-controlled trial, showing its effectiveness in GO patients.

Conclusions

More studies are needed to identify new therapies for the treatment of autoimmune thyroid disorders.

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