Exploration génétique de l'hypothyroïdie congénitale par dysgénésie thyroïdienne
Congenital hypothyroidism by thyroid dysgenesis (CHTD) is a common disorder with prevalence at birth of 1 in 4000 live births. CHTD is the consequence of a failure of embryonic thyroid to differentiate or to migrate to its anatomical location (front of the neck), which leads to a total lack of thyroid (athyreosis) or an ectopic thyroid (lingual or sublingual). The most common category is ectopic thyroid diagnosis (up 85%). Most cases of CHTD have no known cause, but are associated with severe deficiency of thyroid hormones (hypothyroidism). The clinical diagnosis of hypothyroidism is usually possible only when permanent brain damage is already present. On the other hand, biochemical screening on the second day of life allows initiating replacement therapy from the second week of life, pre-empting severe intellectual deficit associated with the congenital hypothyroidism. Even with early treatment (an average of 9 days), loss of IQ, which is not exclusively due to the severity of hypothyroidism, can still be observed. Molecular markers may identify patients at risk for intellectual deficit (by e.g., genes involved in neuronal migration and the thyroid during development). These patients might benefit from early intervention to stimulate their neurocognitive development. Cases of CHTD are mainly non-syndromic and sporadic (in 98% of cases, there is no other affected in the family), have a discordant rate of 92% in monozygotic twins, and a female and ethnic (Caucasian) dominance. Germline mutations in thyroid-related transcription factors have been identified in only 3% of patients with sporadic CHTD, and linkage analysis has excluded these genes in rare multiplex families with CHTD. In addition, non-penetrating mutations among close relatives (for Nkx2.5 gene) suggest that modifying genes as germline variants de novo copy number (CNV) and / or somatic mutations are associated with CHTD. To respond to this research questions, we used two different approaches: 1) a candidate gene approach studying FOXE1, the only gene involved in ectopic thyroid in the mouse model and, 2) an approach using next generation sequencing techniques (NGS) to find genetic variants that could explain this pathology using a cohort of mostly sporadic CHTD. Variants and genes discovered by these two different approaches have been validated and their functional impact on the thyroid gland was evaluated by several experiments.
Migration FOXE1 Congenital hypothyroidism Ectopic thyroid Next generation sequencing Exome sequencing RNA sequencing Migration FOXE1