Analyzing genetic and environmental molecular mechanisms causing autoimmune thyroid diseases

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The autoimmune thyroid diseases (AITD), Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), are the most common autoimmune diseases. Because their mechanisms are not fully understood, AITD are treated symptomatically (hormone replacement in HT or hormone suppression in GD) and as a result, patients are often difficult to manage. Therefore, new therapies are needed that target the autoimmune mechanisms causing AITD. AITD are complex diseases caused by interactions between susceptibility genes and environmental triggers. We and others have mapped & confirmed several AITD genes, including thyroglobulin (Tg). We have also shown that interferon alpha (IFNα), produced during viral infections, is the key cytokine triggering AITD. The current proposal aims to dissect the genetic and environmental mechanisms causing AITD in order to target them with novel therapies. Our focus is on genetic mechanisms predisposing to AITD (Aim 1), environmental triggers of AITD (Aim 2), and medication triggers of AITD (Aim 3). In Aim 1 we will test the hypothesis that missense SNPs in Tg that are associated with AITD predispose to AITD by increasing Tg misfolding and enhancing its degradation into immunogenic peptides. We will use a novel muse model of AITD developed by us, in which autoimmune thyroiditis is induced by immunization with human Tg cDNA in a non-replicating Adenovirus vector. This model enables us to test the effects of different Tg SNPs shown to be susceptible or protective for AITD, and to assess in vivo mechanisms by which these Tg variants trigger AITD. In Aim 2 we will test the hypothesis that IFNα triggers AITD by engaging the autophagic degradation of Tg into immunogenic peptides. We will use cell lines and a mouse model with thyroid over-expression of IFNα to define the autophagy-lysosomal pathways of Tg degradation; we will also test the immunogenicity of the generated Tg peptides in mouse models and PBMC’s from AITD patients. This aim will define a new unifying mechanism for triggering autoimmunity by IFNα-mediated autoantigen degradation. In Aim 3 we will test the hypothesis that Programmed death-ligand 1 (PD-L1) expressed on thyrocytes has intrinsic activity protecting them from intracellular stress during inflammation, and that Immune Checkpoint Inhibitors (ICI’s) trigger thyroiditis by blocking these intrinsic protective effects of PD-L1. We will use a new mouse model of ICI-thyroiditis we developed to dissect the mechanisms by which PD-L1 blockade triggers thyroiditis in vivo. This aim will define the mechanisms of ICI-induced thyroiditis as well as the role of thyroidal PD-L1 in AITD. Collectively, the studies in this proposal will help advance our long-term goal, to design targeted mechanism-based therapies for autoimmune thyroid diseases.