Graves'disease (GD) is a common autoimmune syndrome affecting the thyroid and orbit. The orbital manifestations, termed thyroid associated ophthalmopathy (TAO), are heterogeneous, but can include strabismus and loss of vision from expansion of the extraocular muscles and orbital fat. Currently, there are no therapies shown to prevent, slow or reverse the progressive and permanent effects of TAO. Furthermore, there are no surrogate markers of disease activity or severity to guide treatment. The mechanisms of immune infiltration of TAO are unclear, but fibroblasts are proposed as the orbital cell targets. Over-representation of cytokines also appears to play a critical role in both the inflammatory and fibrotic manifestations of disease. Our long-term goal is to understand the unifying mechanisms underlying the thyroidal and orbital involvement in GD. These insights should provide biomarkers for assessment of disease activity and promote the development of targeted treatment. We have recently implicated bone marrow-derived fibroblast precursors, called fibrocytes in TAO. Specifically, we identified increased levels of fibrocytes in the peripheral blood and orbital tissue of patients with TAO compared to healthy controls. We also demonstrate that these cells are phenotypically and functionally similar to TAO fibroblasts and constitutively express CD40. Moreover, fibrocyte activation via CD40 elicits several cytokines which bear pathologic relevance to TAO. We hypothesize that highly abundant circulating fibrocytes preferentially infiltrate the TAO orbital tissue and through activation of CD40, mediate inflammation and fibrosis through local production of cytokines. We propose to identify the clinical parameters associated with increased fibrocyte levels from TAO patients. Based upon our preliminary data, we have identified that TAO patients with severe disease have increased fibrocytes levels compared to patients with stable TAO. Our working hypothesis is that fibrocyte level is altered during the disease process and/or treatment. We also propose to determine the mechanism and role of CD40-mediated fibrocyte expression of select cytokines implicated in TAO. We have demonstrated CD40 expression by fibrocytes for the first time in this proposal, therefore the signaling mechanisms are yet unexplored. However, we hypothesize that CD40 activation of fibrocytes is mediated by canonical signal transduction pathways. The studies proposed will identify the clinical manifestations associated with increased fibrocyte levels and the CD40-mediated mechanisms of fibrocyte cytokine production. We anticipate these findings will lead to biomarker development and the introduction of novel therapies for TAO.

Public Health Relevance

Graves'disease is an autoimmune disease which affects the thyroid and can cause the tissue around the eye to become swollen and inflamed and for the eyes to bulge. We have found a unique cell type (fibrocyte) which is present in patients with the disease. We are proposing to investigate whether the number of fibrocytes in the blood predicts the severity of disease or response to treatment. We are also proposing to identify the signals these cells use to cause the eyes to bulge. We feel these experiments will lead to better treatment for patients with the disease.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Research Project (R01)
Project #
1R01EY021197-01
Application #
8024206
Study Section
Anterior Eye Disease Study Section (AED)
Program Officer
Araj, Houmam H
Project Start
2010-12-01
Project End
2015-11-30
Budget Start
2010-12-01
Budget End
2011-11-30
Support Year
1
Fiscal Year
2011
Total Cost
$379,054
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Smith, Terry J; Kahaly, George J; Ezra, Daniel G et al. (2017) Teprotumumab for Thyroid-Associated Ophthalmopathy. N Engl J Med 376:1748-1761
Chen, Hong; Shan, Shannon J C; Mester, Tünde et al. (2015) TSH-Mediated TNF? Production in Human Fibrocytes Is Inhibited by Teprotumumab, an IGF-1R Antagonist. PLoS One 10:e0130322
Lee, Brian J; Atkins, Stephen; Ginter, Anna et al. (2015) Increased CD40+ Fibrocytes in Patients With Idiopathic Orbital Inflammation. Ophthal Plast Reconstr Surg 31:202-6
Stein, Joshua D; Childers, David; Gupta, Shivani et al. (2015) Risk factors for developing thyroid-associated ophthalmopathy among individuals with Graves disease. JAMA Ophthalmol 133:290-6
Douglas, Raymond S; Mester, Tünde; Ginter, Anna et al. (2014) Thyrotropin receptor and CD40 mediate interleukin-8 expression in fibrocytes: implications for thyroid-associated ophthalmopathy (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 112:26-37
McCoy, Allison N; Kim, Denise S; Gillespie, Erin F et al. (2014) Rituximab (Rituxan) therapy for severe thyroid-associated ophthalmopathy diminishes IGF-1R(+) T cells. J Clin Endocrinol Metab 99:E1294-9
Chen, Hong; Mester, Tünde; Raychaudhuri, Nupur et al. (2014) Teprotumumab, an IGF-1R blocking monoclonal antibody inhibits TSH and IGF-1 action in fibrocytes. J Clin Endocrinol Metab 99:E1635-40
Briceño, César A; Gupta, Shivani; Douglas, Raymond S (2013) Advances in the management of thyroid eye disease. Int Ophthalmol Clin 53:93-101
Gillespie, Erin F; Smith, Terry J; Douglas, Raymond S (2012) Thyroid eye disease: towards an evidence base for treatment in the 21st century. Curr Neurol Neurosci Rep 12:318-24
Hoa, Neil; Tsui, Shanli; Afifiyan, Nikoo F et al. (2012) Nuclear targeting of IGF-1 receptor in orbital fibroblasts from Graves' disease: apparent role of ADAM17. PLoS One 7:e34173

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