Horm Metab Res 2019; 51(12): 765-769
DOI: 10.1055/a-1057-9469
Review

Thyroid Peroxidase Revisited – Whatʼs New?

1   Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
1   Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
,
2   Department of Immunohematology, Centre of Postgraduate Medical Education, Warsaw, Poland
2   Department of Immunohematology, Centre of Postgraduate Medical Education, Warsaw, Poland
,
2   Department of Immunohematology, Centre of Postgraduate Medical Education, Warsaw, Poland
1   Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
,
J. Paul Banga
4   Kingʼs College London (Emeritus), London, UK
› Author Affiliations

Abstract

Thyroid peroxidase (TPO) is an enzyme that participates in thyroid hormone biosynthesis. TPO is also a major autoantigen in autoimmune thyroid diseases (AITD). In this review, we summarize the latest developments in the field of TPO research. We present the current understanding of immunodominant serologic determinants, frequency of TPO-specific autoantibodies in the population, as well as genetic and environmental factors contributing to their development. Moreover, we report recent progress in the clinical utilities of TPO autoantibody testing, including thyroid dysfunctions and extra-thyroidal disorders.



Publication History

Received: 18 August 2019

Accepted: 05 November 2019

Article published online:
11 December 2019

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Czarnocka B, Eschler DC, Godlewska M. et al. Thyroid autoantibodies: Thyroid peroxidase and thyroglobulin antibodies. In: Shoenfeld Y, Meroni PL, Gershwin ME, Eds. Autoantibodies Third Edition ed Oxford: Elsevier Inc; 2014: 365-373
  • 2 McLachlan SM, Rapoport B. Breaking tolerance to thyroid antigens: Changing concepts in thyroid autoimmunity. Endocr Rev 2014; 35: 59-105
  • 3 Rapoport B, McLachlan SM. Reflections on thyroid autoimmunity: A personal overview from the past into the future. Horm Metab Res 2018; 50: 840-852
  • 4 Williams DE, Le SN, Godlewska M. et al. Thyroid peroxidase as an autoantigen in Hashimotoʼs disease: Structure, function, and antigenicity. Horm Metab Res 2018; 50: 908-921
  • 5 Mondal S, Raja K, Schweizer U. et al. Chemistry and biology in the biosynthesis and action of thyroid hormones. Angew Chem Int Ed 2016; 55: 7606-7630
  • 6 Godlewska M, Banga PJ. Thyroid peroxidase as a dual active site enzyme: Focus on biosynthesis, hormonogenesis and thyroid disorders of autoimmunity and cancer. Biochimie 2019; 160: 34-45
  • 7 Targovnik HM, Citterio CE, Rivolta CM. Iodide handling disorders (NIS, TPO, TG, IYD). Best Pract Res Clin Endocrinol Metab 2017; 31: 195-212
  • 8 Persani L, Rurale G, de Filippis T. et al. Genetics and management of congenital hypothyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32: 387-396
  • 9 Begum MN, Islam MT, Hossain SR. et al. Mutation spectrum in TPO Gene of Bangladeshi patients with thyroid dyshormonogenesis and analysis of the effects of different mutations on the structural features and functions of TPO protein through. Biomed Res Int 2019; 9218903
  • 10 Le SN, Porebski BT, McCoey J. et al. Modelling of thyroid peroxidase reveals insights into its enzyme function and autoantigenicity. PLoS One 2015; 10: e0142615
  • 11 Godlewska M, Góra M, Buckle AM. et al. A redundant role of human thyroid peroxidase propeptide for cellular, enzymatic, and immunological activity. Thyroid 2014; 24: 371-382
  • 12 Amouzegar A, Ghaemmaghami Z, Beigy M. et al. Natural course of euthyroidism and clues for early diagnosis of thyroid dysfunction: Tehran thyroid study. Thyroid 2017; 27: 616-625
  • 13 Keyhanian M, Sarvghadi F, Mehran L. et al. Long-Term variations of antithyroperoxidase antibodies and its clinical significance. Horm Metab Res 2019; 51: 347-352
  • 14 Du Puy R, Poortvliet RKE, Snel M. et al. Associations of elevated anti-TPO antibodies with thyroid function, survival, functioning and depressive symptoms in the oldest old: The Leiden 85-plus study. Thyroid 2019; 29: 1201-1208
  • 15 Legakis I, Adamopoulos D, Stamatiou I. et al. Divergent patterns of thyrotropin and other thyroidal parameters in relationship with the sex of healthy neonates and infants less than two years old: A longitudinal study. Thyroid 2019; 29: 920-927
  • 16 Amouzegar A, Bakhtiyari M, Mansournia MA. et al. Sex- and age-specific reference values and cutoff points for TPOAb: Tehran thyroid study. Thyroid 2016; 26: 458-465
  • 17 Bromińska B, Bromiński G, Owecki M. et al. Anti-thyroidal peroxidase antibodies are associated with thyrotropin levels in hypothyroid patients and in euthyroid individuals. Ann Agric Environ Med 2017; 24: 431-434
  • 18 Tozzoli R, Villalta D, Bizzaro N. Challenges in the standardization of autoantibody testing: A comprehensive review. Clin Rev Allergy Immunol 2017; 53: 68-77
  • 19 Tozzoli R, DʼAurizio F, Ferrari A. et al. The upper reference limit for thyroid peroxidase autoantibodies is method-dependent: A collaborative study with biomedical industries. Clin Chim Acta 2016; 452: 61-65
  • 20 Li W, Fan G, Chen L. et al. A new type of natural bispecific antibody with potential protective effect in Hashimoto thyroiditis. J Clin Endocrinol Metab 2014; 99: E1602-E1609
  • 21 Medici M, Porcu E, Pistis G. et al. Identification of novel genetic Loci associated with thyroid peroxidase antibodies and clinical thyroid disease. PLoS Genet 2014; 10: e1004123
  • 22 Kuś A, Szymański K, Peeters RP. et al. The association of thyroid peroxidase antibody risk loci with susceptibility to and phenotype of Gravesʼ disease. Clin Endocrinol (Oxf) 2015; 83: 556-562
  • 23 Schultheiss UT, Teumer A, Medici M. et al. A genetic risk score for thyroid peroxidase antibodies associates with clinical thyroid disease in community-based populations. J Clin Endocrinol Metab 2015; 100: E799-E807
  • 24 Brčić L, Barić A, Gračan S. et al. Association of established thyroid peroxidase autoantibody (TPOAb) genetic variants with Hashimotoʼs thyroiditis. Autoimmunity 2016; 49: 480-485
  • 25 Barić A, Brčić L, Gračan S. et al. Association of established hypothyroidism-associated genetic variants with Hashimotoʼs thyroiditis. J Endocrinol Invest 2017; 40: 1061-1067
  • 26 Kuś A, Szymański K, Jurecka-Lubieniecka B. et al. Gender-dependent and age-of-onset-specific association of the rs11675434 single-nucleotide polymorphism near TPO with susceptibility to Gravesʼ ophthalmopathy. J Hum Genet 2017; 62: 373-377
  • 27 Tomari S, Watanabe M, Inoue N. et al. The polymorphisms in the thyroid peroxidase gene were associated with the development of autoimmune thyroid disease and the serum levels of anti-thyroid peroxidase antibody. Endocr J 2017; 64: 1025-1032
  • 28 Godlewska M, Czarnocka B, Gora M. Localization of key amino acid residues in the dominant conformational epitopes on thyroid peroxidase recognized by mouse monoclonal antibodies. Autoimmunity 2012; 45: 476-484
  • 29 Mikoś H, Mikoś M, Obara-Moszyńska M. et al. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol 2014; 65: 150-155
  • 30 Ruggeri RM, Vicchio TM, Cristani M. et al. Oxidative stress and advanced glycation end products in Hashimotoʼs thyroiditis. Thyroid 2016; 26: 504-511
  • 31 Habza-Kowalska E, Kaczor AA, Żuk J. Thyroid peroxidase activity is inhibited by phenolic compounds-impact of interaction. Molecules. 2019; 24 pii E2766. DOI: 10.3390/molecules24152766.
  • 32 Liu Y, Liu S, Mao J. et al. Serum trace elements profile in Gravesʼ disease patients with or without orbitopathy in northeast China. Biomed Res Int 2018; 3029379
  • 33 Wang W, Mao J, Zhao J. et al. Decreased thyroid peroxidase antibody titer in response to selenium supplementation in autoimmune thyroiditis and the influence of a SEPP Gene polymorphism: A prospective, multicenter study in China. Thyroid. 2018; DOI: 10.1089/thy.2017.0230.
  • 34 McLachlan SM, Aliesky H, Banuelos B. Variable effects of dietary selenium in mice that spontaneously develop a spectrum of thyroid autoantibodies. Endocrinology 2017; 158: 3754-3764
  • 35 Shan Z, Chen L, Lian X. et al. Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China: A cross-sectional study in 10 cities. Thyroid 2016; 26: 1125-1130
  • 36 Bliddal S, Boas M, Hilsted L. et al. Increase in thyroglobulin antibody and thyroid peroxidase antibody levels, but not preterm birth-rate, in pregnant Danish women upon iodine fortification. Eur J Endocrinol 2017; 176: 603-612
  • 37 Borowiec A, Labochka D, Milczarek M. et al. Gravesʼ disease in children in the two decades following implementation of an iodine prophylaxis programme. Cent Eur J Immunol 2018; 43: 399-404
  • 38 Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc 2019; 78: 34-44
  • 39 Ajjan RA, Weetman AP. The pathogenesis of Hashimotoʼs thyroiditis: Further developments in our understanding. Horm Metab Res 2015; 47: 702-710
  • 40 Diana T, Brown RS, Bossowski A. et al. Clinical relevance of thyroid-stimulating autoantibodies in pediatric Gravesʼ disease-a multicenter study. J Clin Endocrinol Metab 2014; 99: 1648-1655
  • 41 Lee JH, Park SH, Koh DG. et al. Thyroid peroxidase antibody positivity and triiodothyronine levels are associated with pediatric Gravesʼ ophthalmopathy. World J Pediatr 2014; 10: 155-159
  • 42 Jarusaitiene D, Verkauskiene R, Jasinskas V. et al. Predictive factors of development of Gravesʼ ophthalmopathy for patients with Juvenile Gravesʼ Disease. Int J Endocrinol 2016; 8129497
  • 43 Lantz M, Planck T, Asman P. et al. Increased TRAb and/or low anti-TPO titers at diagnosis of gravesʼ disease are associated with an increased risk of developing ophthalmopathy after onset. Exp Clin Endocrinol Diabetes 2014; 122: 113-117
  • 44 Turck N, Eperon S, De Los Angeles Gracia M. et al. Thyroid-associated orbitopathy and biomarkers: Where we are and what we can hope for the future. Dis Markers 2018; 7010196
  • 45 Chan S, Boelaert K. Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy. Clin Endocrinol (Oxf) 2015; 82: 313-326
  • 46 Vissenberg R, Manders VD, Mastenbroek S. et al. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update 2015; 21: 378-387
  • 47 Yehuda M, Wang CH, Pak Y. et al. Parity and risk of thyroid autoimmunity based on the NHANES (2001-2002, 2007-2008, 2009-2010, and 2011-2012). J Clin Endocrinol Metab 2017; 102: 3437-3442
  • 48 Bliddal S, Feldt-Rasmussen U, Rasmussen Å. et al. Thyroid peroxidase antibodies and prospective live birth – A cohort study of women with recurrent pregnancy loss. Thyroid 2019; 29: 1465-1474
  • 49 Alexander EK, Pearce EN, Brent GA. et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27: 315-389
  • 50 Derakhshan A, Korevaar TIM, Taylor PN. et al. The Association of maternal thyroid autoimmunity during pregnancy with child IQ. J Clin Endocrinol Metab 2018; 103: 3729-3736
  • 51 Seror J, Amand G, Guibourdenche J. et al. Anti-TPO antibodies diffusion through the placental barrier during pregnancy. PLoS One 2014; 9: e84647
  • 52 Korevaar TI, Steegers EA, Pop VJ. et al. Thyroid autoimmunity impairs the thyroidal response to human chorionic gonadotropin: Two population-based prospective cohort studies. J Clin Endocrinol Metab 2017; 102: 69-77
  • 53 Hou Y, Liu A, Li J. et al. Different thyroidal responses to human chorionic gonadotropin under different thyroid peroxidase antibody and/or thyroglobulin antibody positivity conditions during the first half of pregnancy. Thyroid 2019; 29: 577-585
  • 54 Zhang Y, Zhang C, Yang X. et al. Association of maternal thyroid function and thyroidal response to human chorionic gonadotropin with early fetal growth. Thyroid 2019; 29: 586-594
  • 55 Garin MC, Arnold AM, Lee JS. et al. Subclinical hypothyroidism, weight change, and body composition in the elderly: The cardiovascular health study. J Clin Endocrinol Metab 2014; 99: 1220-1226
  • 56 Liu J, Duan Y, Fu J. et al. Association between thyroid hormones, thyroid antibodies, and cardiometabolic factors in non-obese individuals with normal thyroid function. Front Endocrinol (Lausanne) 2018; 9: 130
  • 57 Ehlers M, Schott M. Hashimotoʼs thyroiditis and papillary thyroid cancer: Are they immunologically linked?. Trends Endocrinol Metab 2014; 25: 656-664
  • 58 Nagayama Y. Thyroid autoimmunity and thyroid cancer – the pathogenic connection: A 2018 update. Horm Metab Res 2018; 50: 922-931
  • 59 Muller I, Barrett-Lee PJ. The antigenic link between thyroid autoimmunity and breast cancer. Semin Cancer Biol. 2019; pii: S1044-579X(19)30043-4 DOI: 10.1016/j.semcancer.2019.05.013..
  • 60 Wu X, Lun Y, Jiang H. et al. Coexistence of thyroglobulin antibodies and thyroid peroxidase antibodies correlates with elevated thyroid-stimulating hormone level and advanced tumor stage of papillary thyroid cancer. Endocrine 2014; 46: 554-560
  • 61 Zhao H, Li H, Huang T. High urinary iodine, thyroid autoantibodies, and thyroid-stimulating hormone for papillary thyroid cancer risk. Biol Trace Elem Res 2018; 184: 317-324
  • 62 Selek A, Cetinarslan B, Tarkun I. et al. Thyroid autoimmunity: Is really associated with papillary thyroid carcinoma?. Eur Arch Otorhinolaryngol 2017; 274: 1677-1681
  • 63 Muller I, Kilburn LS, Taylor PN. et al. TPOAb and thyroid function are not associated with breast cancer outcome: Evidence from a large-scale study using data from the Taxotere as Adjuvant Chemotherapy Trial (TACT, CRUK01/001). Eur. Thyroid J 2017; 6: 197-207
  • 64 Muller I, Giani C, Zhang L. et al. Does thyroid peroxidase provide an antigenic link between thyroid autoimmunity and breast cancer?. Int J Cancer 2014; 134: 1706-1714
  • 65 Godlewska M, Arczewska KD, Rudzińska M. et al. Thyroid peroxidase (TPO) expressed in thyroid and breast tissues shows similar antigenic properties. PLoS One 2017; 12: e0179066
  • 66 Godlewska M, Krasuska W, Czarnocka B. Biochemical properties of thyroid peroxidase (TPO) expressed in human breast and mammary-derived cell lines. PLoS One 2018; 13: e0193624
  • 67 Witkowska-Sędek E, Borowiec A, Kucharska A. et al. Thyroid autoimmunity in girls with turner syndrome. Adv Exp Med Biol 2017; 1022: 71-76
  • 68 Zwaveling-Soonawala N, Witteveen ME, Marchal JP. et al. Early thyroxine treatment in Down syndrome and thyroid function later in life. Eur J Endocrinol 2017; 176: 505-513
  • 69 Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: The tallest tree in the forest of polyautoimmunity. F1000Res 2017; 6: 1776