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Two Novel Cysteine Substitutions (C1263R and C1995S) of Thyroglobulin Cause a Defect in Intracellular Transport of Thyroglobulin in Patients with Congenital Goiter and the Variant Type of Adenomatous Goiter¹

Department of Clinical Pathology, Dokkyo University School of Medicine (A.H., T.I.), Mibu, Tochigi; the First Department of Internal Medicine, Osaka Medical College (J.T., S.Y.), Takatsuki, Osaka; the Department of Pediatrics, Kitasato University School of Medicine (Y.O., N.M.), Sagamihara, Kanagawa; Kuma Hospital (T.Y., K.K.), Kobe, Hyogo; and Sumitomo Metal Bio-Science, Inc. (Y.K), Tokyo, Japan

Address all correspondence and requests for reprints to: Akira Hishinuma, M.D., Ph.D., Department of Clinical Pathology, Dokkyo University School of Medicine, Mibu, Tochigi 321-0293, Japan.

We analyzed the thyroglobulin (Tg) gene of 2 unrelated patients with congenital goiter and the Tg gene of 2 siblings with the variant type of adenomatous goiter. The clinical characteristics of the patients with congenital goiter and the variant type of adenomatous goiter were very similar, except for serum Tg levels, which were less than 15 pmol/L in the patients with congenital goiter, but 117–181 pmol/L in the patients with the variant type of adenomatous goiter (normal, 15–50 pmol/L). The tissue content of Tg in the thyroid glands of all 4 patients was reduced at 0.9–3.8% of total protein (normal, 19–40%). The missense mutation C1263R was detected in the 2 unrelated patients with congenital goiter; the pedigree study showed an autosomal recessive pattern of inheritance. In the 2 siblings with the variant type of adenomatous goiter, the missense mutation C1995S was homozygously detected. In the Tg complementary DNA of 110 normal subjects, the allelic frequencies of the C1263R and C1995S mutations were each less than 0.5%. Also in the normal subjects were detected 35 nucleotide polymorphisms, the insertion of 3 nucleotides, and 1 alternative splicing, each of which was not associated with any specific thyroid disease. From these data, the molecular mechanism of the C1263R and C1995S mutations was elucidated. We first analyzed the carbohydrate residues of C1263R Tg and C1995S Tg. Sensitivity to treatment by endoglycosidase H suggests that C1263R Tg and C1995S Tg were retained in the endoplasmic reticulum (ER). Also, the presence of endoglycosidase H-resistant Tg as well as endoglycosidase H-sensitive Tg in the patients with the variant type of adenomatous goiter suggests that a fraction of C1995S Tg was transported to the Golgi and associated with the mildly increased serum Tg levels. Native PAGE and Western blot analysis with anti-Tg antibody showed that C1263R Tg and C1995S Tg form high mol wt aggregates in the ER.

Our results suggest that missense mutations that replace cysteine with either arginine or serine cause an abnormal three-dimensional structure of Tg. Such misfolded Tg polypeptides are retained in the ER as high mol wt aggregates.

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