Aop: 152

AOP Title


Interference with thyroid serum binding protein transthyretin and subsequent adverse human neurodevelopmental toxicity

Short name:


Transthyretin interference

Graphical Representation


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Erik R. Janus; M3 Technical & Regulatory Services; Shepherdstown, WV; <erik@mcubedservices.com>

Kristie Sullivan; Physicians Committee for Responsible Medicine; Washington, DC; <ksullivan@pcrm.org>

Katie Paul-Friedman; US Environmental Protection Agency; Research Triangle Park, NC

Mary Gilbert; National Health and Environmental Effects Research Laboratory; US Environmental Protection Agency; Research Triangle Park, NC; <gilbert.mary@epa.gov>

Kevin M. Crofton; National Center for Computational Toxicology; US Environmental Protection Agenc; Research Triangle Park, NC; <crofton.kevin@epa.gov>

Point of Contact


Erik Janus   (email point of contact)



  • Erik Janus



Author status OECD status OECD project SAAOP status
Under development: Not open for comment. Do not cite Under Development 1.41 Included in OECD Work Plan

This AOP was last modified on March 20, 2017 09:47


Revision dates for related pages

Page Revision Date/Time
Binding, Transthyretin in serum September 16, 2017 10:16
Displacement, Serum thyroxine (T4) from transthyretin December 17, 2016 17:03
Increased, Free serum thyroxine (T4) September 16, 2017 10:16
Increased, Uptake of thyroxine into tissue December 17, 2016 17:04
Increased, Clearance of thyroxine from tissues September 16, 2017 10:16
Thyroxine (T4) in serum, Decreased September 17, 2017 18:37
Thyroxine (T4) in neuronal tissue, Decreased September 17, 2017 17:11
Hippocampal gene expression, Altered September 17, 2017 17:14
Hippocampal anatomy, Altered September 16, 2017 10:14
Hippocampal Physiology, Altered September 17, 2017 17:17
Cognitive Function, Decreased April 16, 2017 13:45
Halogenated phenols March 09, 2017 23:55
Polychlorinated biphenyl November 29, 2016 18:42
Polychlorinated dibenzodioxins March 09, 2017 20:38
Polybrominated diphenyl ethers March 09, 2017 20:40
Isoflavones March 09, 2017 21:14
Perflourinated chemicals March 09, 2017 22:36
Phthalates March 09, 2017 22:37
Tetrabromobisphenol A March 10, 2017 00:10
Clonixin March 10, 2017 00:50
Meclofenamic acid March 10, 2017 00:51
2,6-dinitro-p-cresol March 10, 2017 00:53
Triclopyr March 10, 2017 00:59
2,2',4,4'-Tetrahydroxybenzophenone November 29, 2016 18:42



This AOP describes adverse neurodevelopemental effects that may result from xenobiotic interference with thyroid serum binding protein transthyretin (TTR). Binding of TTR by a xenobiotic (the MIE) during certain developmental windows may disrupt the normal neurodevelopment of mammals through a transient increase in free thyroxine (T4) levels, permitting increased tissue uptake of thyroid hormone (TH), followed by a decrease in both serum and neuronal tissue concentrations. Due to the highly conserved nature of the TTR protein, birds, reptiles, fish and amphibians can also express TTR and be impacted by interference by xeniobiotics. The adverse consequences of TH insufficiency depend both on the severity and developmental timing, indicating that exposure to thyroid toxicants may produce different effects at different developmental windows of exposure. This AOP discusses the potential for developmental TTR interference to adversely impact hippocampal anatomy, function, gene expression and, ultimately, cognitive function.

Background (optional)


Transthyretin is one of three ancient, highly conserved serum binding proteins that collectively act to transport thyroid hormone (TH) and thus help maintain normal homeostasis via modulation of the hypothalamic/pituitary/thyroid axis. In addition to TTR, albumin (ALB) and thyroxine-binding globulin (TBG) also serve to transport TH in serum and the relative contribution of each binding protein differs across species. In man, TBG has the greatest affinity for thyroxine (T4), followed by TTR and ALB shows the lowest affinity for T4 while prevalence in serum is the opposite, while in rat, TTR is the major serum transport protein (as rats lack TBG). Interference with TH serum binding proteins is one of several mechanisms through which xenobiotics and environmental contaminants can disrupt normal thyroid endocrine function ("thyroid disruptors") and development of this AOP is expected to contribute towards a fuller understanding of the mechanism of TTR interference and how it may be measured in vitro as part of a larger screening battery for thyroid toxicants.

Summary of the AOP


Events: Molecular Initiating Events (MIE)


Key Events (KE)


Adverse Outcomes (AO)


Sequence Type Event ID Title Short name
1 MIE 957 Binding, Transthyretin in serum Binding, Transthyretin in serum
2 KE 958 Displacement, Serum thyroxine (T4) from transthyretin Displacement, Serum thyroxine (T4) from transthyretin
3 KE 959 Increased, Free serum thyroxine (T4) Increased, Free serum thyroxine (T4)
4 KE 960 Increased, Uptake of thyroxine into tissue Increased, Uptake of thyroxine into tissue
5 KE 961 Increased, Clearance of thyroxine from tissues Increased, Clearance of thyroxine from tissues
6 KE 281 Thyroxine (T4) in serum, Decreased T4 in serum, Decreased
7 KE 280 Thyroxine (T4) in neuronal tissue, Decreased T4 in neuronal tissue, Decreased
8 KE 756 Hippocampal gene expression, Altered Hippocampal gene expression, Altered
9 KE 757 Hippocampal anatomy, Altered Hippocampal anatomy, Altered
10 KE 758 Hippocampal Physiology, Altered Hippocampal Physiology, Altered
11 AO 402 Cognitive Function, Decreased Cognitive Function, Decreased

Relationships Between Two Key Events
(Including MIEs and AOs)


Network View





Life Stage Applicability


Taxonomic Applicability


Sex Applicability


Overall Assessment of the AOP


Domain of Applicability


Essentiality of the Key Events


Molecular Initiating Event Summary, Key Event Summary
Provide an overall assessment of the essentiality for the key events in the AOP. Support calls for individual key events can be included in the molecular initiating event, key event, and adverse outcome tables above.

In vivo evidence for MIE

Kohrle et al (1989) added 10 μmol/L 3-methyl-4’,6-dihydroxy-3’,5-dibromo-flavone (EMD 21388) to pooled rat serum and measured displacement of [125I]-T4 from TTR. EMD21388 was synthesized using “molecular drug design” (and resembles T4) to help confirm previous findings that certain flavonoid deiodinase inhibitors also displaced thyroxine (T4) for TTR (or T3-binding prealbumin). Displacement of [125I] from TTR in rat serum was analyzed by gel electrophoresis (PAGE) and individual serum samples were assayed for T3 and T4 content by RIA and % free TH by equilibrium dialysis (lower limit of detectability 0.3 ug/dL for T4). There was a significant increase in % free T4 (0.031 to 0.124), which was dose-dependent and resulted in complete inhibition of [125I]-T4/TTR at 8-10 umol (radiolabeled TH were displaced primarily to albumin).

insert Fig 2 from Kohrle et al 1989

One to 4 hours following ip delivery of 2 μmol/100 g BW to euthyroid Sprague-Dawley rats (a dose that is 1000x higher than daily T4 production in rat), inhibition of [125I]-T4/TTR binding was observed. T4 decreased from 5.6 to 2.3 ug/dl after 1 hour and remained low while % free T4 increased from 0.035 to 0.091 and remained high; however, free T4 did not change. TSH decreased to very low values after 2 hours and increased slightly, despite no change in the free TH concentration (hypothyroid rats did not show changes in serum TSH following EMD 21388 administration). Lueprasitsakul et al (1990) performed a series of experiments with Sprague-Dawley rats using smaller doses of EMD 21388 (up to 2 μmol /100 g BW) and the same measurement methods (RIA, equilibrium dialysis). Administration of 2 μmol of EMD 21388 inhibited [125I]-T4/TTR binding within a few minutes, displacing [125I] to albumin to a greater degree of magnitude, due to slight differences in preparing the EMD 21388 solutions. Dose-dependent decreases in displacement were found with decreasing dose.

insert Figure 1 & Figure 2

Following a single dose of 2 μmol, a significant decrease was seen in total serum T4 after 10 minutes that persisted, % free T4 also increased immediately (peaked after 10 minutes) and stayed elevated and a significant increase in free T4 was observed within three minutes that stayed elevated for 60 minutes. Following a single dose of 0.3 μmol, decreased [125I]-T4/TTR binding was observed reaching a nadir after 10 minutes and slowly recovering over the 180-minute experiment. The % free T4 and serum free T4 both increased and returned to normal after 180 minutes as well while total serum T4 hit a nadir after 10 minutes and mostly recovered. Serum TSH decreased after 20 minutes, significantly at the nadir hit after 60 minutes.

Evidence Assessment


Quantitative Understanding


Considerations for Potential Applications of the AOP (optional)




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