Sažetak | Uvod: Tireoglobulin (Tg) je glikoprotein koji sintetiziraju folikularne stanice štitne žlijezde i služi kao ključni preteča u sintezi hormona štitne žlijezde. Naša istraživačka skupina provela je dosada jedinu cjelogenomsku analizu povezanosti za koncentraciju Tg u plazmi. Iskoristivši napredak u računalnim metodama i modeliranju, primijenili smo Bayesovski pristup kako bismo dodatno istražili genetičku pozadinu Tg. Brojne presječne studije sugerirale su povezanost između funkcije štitne žlijezde i metaboličkog sindroma (MetS), kao i razina serumskog 25-hidroksivitamina D [25(OH)D], no smjer tih učinaka i točni uzročni mehanizmi ostaju nejasni. Na temelju znanja u području statističke genetike stečenih našom cjelogenomskom studijom povezanosti, primijenili smo Mendelovu randomizaciju (MR) kako bismo dodatno istražili uzročne odnose između funkcije štitne žlijezde, MetS i serumskih koncentracija 25(OH)D. Metode: Proveli smo cjelogenomsku analizu povezanosti za Tg koristeći Bajesovski rijetki linearni mješoviti model (BSLMM) i frekvencionistički LMM kako bismo analizirali 7 289 083 genetskih polimorfizama u 1 096 zdravih ispitanika europskog podrijetla iz Hrvatske biobanke. Proveli smo i meta-analizu s dvije neovisne kohorte (ukupno n = 2 109) kako bismo identificirali polimorfizme povezane s razinama Tg. U prvoj MR studiji koristili smo sumarne statistike najvećih cjelogenomskih studija povezanosti za tireotropin (TSH), slobodni tiroksin (fT4), MetS i njegove komponente. U drugoj MR studiji uključili smo dodatne pokazatelje funkcije štitne žlijezde kao što su slobodni trijodtironin (fT3), ukupni trijodtironin (TT3), razine protutijela na štitnu peroksidazu (TPOAt), pozitivnost TPOAt, sniženi TSH, povišeni TSH, autoimuni hipotireoidizam i autoimuni hipertireoidizam te razinu serumskog 25(OH)D. Za primarnu analizu koristili smo metodu inverzne varijance (IVW), nadopunjenu metodom medijana, modalnom metodom, MR-Egger, MR-PRESSO i CAUSE metodama kako bismo osigurali robusnost rezultata. Rezultati: Naša meta-analiza otkrila je 83 polimorfizma unutar gena ST6GAL1 (p < 5 × 10⁻⁸) koji su bili značajno povezani s koncentracijom Tg u plazmi. Nasljednost Tg procijenjena je na 17%, pri čemu je 52% ove varijacije pripisano malom broju od 16 polimorfizama s velikim učinkom na koncentraciju Tg. MR analize pokazale su da je viša razina fT4 uzročno povezana s nižim rizikom razvoja MetS (OR = 0,96, p = 0,037). Osim toga, fT4 je bio pozitivno povezan s koncentracijom HDL kolesterola (β = 0,02, p = 0,008), dok je TSH pozitivno povezan s trigliceridima (β = 0,01, p = 0,044). Reverzna MR analiza pokazala je da je HDL kolesterol negativno povezan s TSH (β = −0,03, p = 0,046), što sugerira dvosmjernu uzročnu povezanost između funkcije štitne žlijezde i MetS. Nadalje, naše MR analize pokazale su uzročni učinak serumske koncentracije 25(OH)D na povišen TSH, pri čemu je svako povećanje od 1 SD u koncentraciji 25(OH)D bilo povezano s smanjenjem rizika od povišenog TSH za 12% (p = 0,02). Također, povećanje od 1 SD u koncentraciji 25(OH)D bilo je povezano s smanjenjem rizika od razvoja autoimunog hipotireoidizma za 16,34% (p = 0,02). Zaključak: Naša cjelogenomska analiza povezanosti otkrila je važne genetske polimorfizme i pružila vrijedne uvide u genetičku pozadinu koncetracije Tg. Dodatno, pokazali smo uzročne povezanosti između varijacija u funkciji štitne žlijezde i rizika od MetS, kao i utjecaj koncetracije vitamina D na pokazatelje funkcije štitne žlijezde. Integracija ovih saznanja u kliničku praksu mogla bi unaprijediti personalizirani pristup u medicini, otvarajući put za ciljane terapijske i preventivne strategije u liječenju poremećaja štitne žlijezde i srodnih metaboličkih stanja. |
Sažetak (engleski) | Introduction: Thyroglobulin (Tg) is an iodoglycoprotein synthesized by thyroid follicular cells and serves as a crucial precursor for thyroid hormone production. To date, our research group has conducted the only genome-wide association study (GWAS) on plasma Tg levels. Leveraging recent advancements in computational methods and modelling, we employed a Bayesian approach to probabilistically infer the genetic architecture of Tg. Numerous observational studies have suggested a link between thyroid function and metabolic syndrome (MetS), as well as with serum 25- hydroxyvitamin D [25(OH)D] levels, but the direction of these effects and the precise causal mechanisms remain unclear. Building on the expertise in statistical genetics acquired from our GWAS study, we subsequently applied Mendelian randomization (MR) to further explore the causal relationships between thyroid function, MetS, and serum 25(OH)D concentrations. Methods: In our initial study, we performed a GWAS of plasma Tg levels using a Bayesian sparse linear mixed model (BSLMM) and a frequentist linear mixed model (LMM) to analyze 7,289,083 genetic variants in 1,096 healthy European-ancestry participants from the Croatian Biobank. This was followed by a meta-analysis with two independent cohorts (total n=2,109) to identify genome-wide significant variants associated with Tg levels. In the first MR analysis, we utilized summary statistics from the most comprehensive GWAS available for thyroid-stimulating hormone (TSH), free thyroxine (fT4), MetS, and its components. In the second MR study, we included additional thyroid function indicators such as free triiodothyronine (fT3), total triiodothyronine (TT3), thyroid peroxidase antibody levels (TPOAb), TPOAb positivity, low TSH, high TSH, autoimmune hypothyroidism and autoimmune hyperthyroidism, as well as 25(OH)D levels. We employed the multiplicative random-effects inverse variance weighted (IVW) method for primary analysis, supplemented by weighted mode, weighted median, MR-Egger, MR-PRESSO, and CAUSE methods to ensure robust results. Results: Our meta-analysis of the GWAS data identified 83 genome-wide significant variants within the ST6GAL1 gene (p < 5 × 10-8 ) that were associated with plasma Tg levels. The SNP-heritability of Tg was estimated to be 17%, with 52% of this variation attributed to a small number of 16 variants with major effects on Tg levels. MR analyses revealed that higher fT4 levels were causally linked to a lower risk of developing MetS (OR = 0.96, p = 0.037). Additionally, fT4 was positively associated with high-density lipoprotein cholesterol (HDL-C) (β = 0.02, p = 0.008), while TSH was positively associated with triglycerides (TG) (β = 0.01, p = 0.044). Reverse MR analysis indicated that HDL-C was negatively associated with TSH (β = −0.03, p = 0.046), suggesting a bidirectional relationship between thyroid function and lipid profile. Furthermore, our MR analyses demonstrated a causal effect of serum 25(OH)D levels on high TSH, with each 1 SD increase in 25(OH)D being associated with a 12% decrease in the risk of high TSH (p = 0.02). Moreover, a 1 SD increase in serum 25(OH)D was linked to a 16.34% reduction in the risk of developing autoimmune hypothyroidism (p = 0.02). Conclusion: Our GWAS on Tg levels identified key genetic variants and provided valuable insights into the genetic architecture of Tg. We also demonstrated causal associations between variations in thyroid function and the risk of MetS, as well as the impact of vitamin D levels on thyroid function. Integrating these insights into clinical practice could enhance personalized medicine approaches, paving the way for more targeted therapeutic and preventive strategies in managing thyroid-related disorders and associated metabolic conditions. |