Thyroid hormones regulate many metabolic and developmental processes, including key having functions in the brain, and mutations in a transporter specific for thyroid hormone leads to severe neurological impairment. This review article attempts to discuss the physiological importance and clinical implications of thyroid hormone transport, with a particular focus on brain development.
The thyroid hormones, T4 (3,5,3′,5′tetraiodo-L-thyronine) and T3 (3,5,3′tri-iodo-L-thyronine; also known as tri-iodothyronine) are iodinated amino acids produced and secreted by the thyroid gland. These hormones regulate many developmental and metabolic processes. The nuclear T3 receptors are ligand-modulated transcription factors encoded by two genes, THRA and THRB. These genes encode several receptor proteins, of which three (thyroid hormone receptor α1, thyroid hormone receptor β1 and thyroid hormone receptor β2) interact with T3, which results in tissue-specific and developmentally-dependent transcriptomic changes. In the developing cerebral cortex, 500–1,000 genes are directly or indirectly affected by thyroid hormones. In addition, both T4 and T3 perform nongenomic, extranuclear actions. For example, T3 might interact with a plasma-membrane-associated thyroid hormone receptor α variant, and with cytoplasmic thyroid hormone receptor β, while T4 interacts with integrin αvβ3 and activates diverse signalling pathways such as the phosphoinositide 3-kinase pathway and mitogen-activated protein kinase pathways.
Metabolism of thyroid hormones includes the processes of deiodination, deamination, decarboxylation, sulphation and glucuronidation, which have been extensively reviewed elsewhere. The most relevant pathway for the discussion in this Review is deiodination, a process that activates or inactivates thyroid hormones. Deiodinases are selenoproteins that catalyze the removal of specific iodine atoms from the phenolic or tyrosyl rings of the iodothyronine molecule. Type 1 iodothyronine deiodinase and type 2 iodothyronine deiodinase (DIO1 and DIO2, encoded by the DIO1 and DIO2 genes, respectively) have phenolic, or 'outer' ring, activity and convert T4 to T3. In extrathyroidal tissues, this pathway generates ∼80% of the total body pool of T3. Type 3 iodothyronine deiodinase (DIO3, encoded by the DIO3 gene) and DIO1 have tyrosyl, or 'inner' ring, activity and convert T4 and T3 to the inactive metabolites 3,3′5′-triiodo-L-thyronine (rT3) and 3,3′-diiodo-L-thyronine (T2), respectively; rT3 is then further metabolized by DIO1 to T2.
- Many proteins can mediate thyroid hormone transport, but only mutations in genes encoding MCT8, MCT10 and OATP1C1 have pathophysiological effects attributed to this process
- MCT8 mutations lead to Allan–Herndon–Dudley syndrome, which is characterized by truncal hypotonia and results in spastic quadriplegia, lack of speech, severe intellectual deficit and altered thyroid hormone concentrations
- MCT8 deficiency impairs the transfer of thyroid hormones across the blood–brain barrier
- Mct8-deficient mice lack neurological impairment possibly due to the presence of Oatp1c1, a T4 transporter, but levels of OATP1C1 in the primate blood–brain barrier are very low
- Histopathological studies of patients with mutations in MCT8 support the concept that defective thyroid hormone action in the brain during development leads to the neurological syndrome
