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Detection of Major T Cell Epitopes on Human Thyroid Stimulating Hormone Receptor by Overriding Immune Heterogeneity in Patients with Graves’ Disease¹

Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574

Address all correspondence and requests for reprints to: Dr. Andreas Martin, Department of Medicine, Box 1055, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York 10029-6574. E-mail: amartin{at}smtplink.mssm.edu

To examine the major immunogenic regions of the human TSH receptor (hTSHR), we examined 14 patients with Graves’ disease and 14 healthy control subjects for their peripheral blood T cell proliferative responses to 29 synthetic peptides representing the entire ectodomain of the hTSHR (TSHR-ecd). By combining an analytical approach encompassing the grading of peptide-induced responses and nonparametric testing, we obtained evidence for highly significant differences (P = <0.000001) in the patient group compared with minor differences in the control group (P = 0.045). To account for this difference, we identified four major T cell epitopes (amino acid 247–266, 202–221, 142–161, and 52–71), by multiple comparison analysis, in the patient group. Furthermore, we demonstrated by radiolabeled PCR that the responding T cells were clonally expanding.

These findings demonstrate that despite likely differences in human leukocyte antigen type among patients with Graves’ disease, several distinct hTSHR epitopes elicited significant responses in the immune system of patients with Graves’ disease, and that such patients are most often poorly tolerant to particular epitopes of the TSH receptor ectodomain, The data support the notion of TSHR peptide antigens overriding human immune heterogeneity in patients with Graves’ disease, and raise the possibility of applying analog peptide blockade to suppress T cell responsivity.

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