L’Eye Tracking est une méthode de mesure précise et non invasive des mouvements oculaires permettant d’accéder aux paramètres neurophysiologiques du système oculomoteur. L’analyse des mouvements oculaires est un outil qui contribue au diagnostic des syndromes parkinsoniens. En Guadeloupe, les syndromes parkinsoniens atypiques, sont présents en proportion anormalement élevée. Ils représentent environ 70% des syndromes parkinsoniens. Notre travail a été de réaliser des normes oculomotrices des sujets sains et de caractériser les syndromes parkinsoniens sur le plan oculomoteur à partir des normes oculomotrices réalisées. Les normes oculomotrices des sujets sains antillais différents de celles des témoins d’origine tchèque. Ces différences suggèrent la possibilité d’une variabilité des standards oculomoteurs entre deux populations de sujets sains. Nos résultats témoignent de la nécessité de constituer des groupes témoins spécifiques à la population étudiée lors des études cliniques et les travaux de recherche sur les mouvements oculaires. Ils soulèvent également la question de l’influence de facteurs génétiques et/ou environnementaux sur les paramètres oculomoteurs. Les patients porteurs d’une maladie de Parkinson originaires et résidants aux Antilles présentent des anomalies oculomotrices plus fréquentes qu’attendues avec notamment un taux élevé d’erreurs aux antisaccades. Cette caractéristique ne semble pas corrélée aux performances cognitives. Chez les parkinsoniens atypiques l’altération parfois sévère de l’ensemble des paramètres oculomoteurs est en accord avec les données cliniques et d’imagerie cérébrale et témoignent de lésions diffuses corticales fronto-pariétales et sous corticales. / Eye Tracking is a precise and non-invasive method of measuring eye movements that provides access to the neurophysiological parameters of the oculomotor system. Eye movement analysis is a tool that contributes to the diagnosis of parkinsonian syndromes. In Guadeloupe, atypical parkinsonian syndromes are present in an abnormally high proportion. They represent about 70% of Parkinson's syndromes. Our work has been to achieve oculomotor standards of healthy subjects and characterize the parkinsonian syndromes on the oculomotor level from oculomotor standards. The oculomotor standards of Caraibbean healthy subjects differ from those of Czech origin. These differences suggest the possibility of variability of oculomotor standards between two populations of healthy subjects. Our results demonstrate the need to establish control groups specific to the population studied in clinical studies and research work on eye movements. They also raise the question of the influence of genetic and / or environmental factors on oculomotor parameters. Patients with Parkinson's disease coming from and residing in the Caribbean have more frequent oculomotor abnormalities than expected with a high percentage of error in antisaccade task. This characteristic does not seem to correlate with cognitive performance. In atypical parkinsonian patients, there are severe deterioration of all the oculomotor parameters is in agreement with the clinical and cerebral imaging data and show diffuse fronto-parietal and sub-cortical cortical lesions

A descoberta de que a expansão da repetição do hexanucleotídeo GGGGCC no gene C9ORF72 é uma das principais causas da Demência Frontotemporal (DFT) e da Esclerose Lateral Amiotrófica (ELA) foi um importante avanço para o entendimento dessas doenças. Essa mutação é responsável por grande parte dos casos hereditários e esporádicos. O indivíduo acometido pode se manifestar clinicamente como ELA, DFT e como a combinação fenotípica ELA-DFT. No entanto, vários outros fenótipos clínicos já foram descritos, como o de doenças que cursam com parkinsonismo atípico, ou mesmo formas que se assemelham à Doença de Parkinson e à Doença de Alzheimer. O objetivo do trabalho foi fazer uma revisão dos fenótipos associados à mutação do gene C9ORF72 descritos na literatura e descrever os casos associados à mutação identificados nos ambulatórios do Hospital das Clínicas de Ribeirão Preto (HCRP). A revisão foi feita a partir de artigos publicados entre 2011 e 2014, buscados na base de dados eletrônica PubMed. Foram selecionados 99 artigos em inglês, em que a mutação do gene C9ORF72 foi objetivo de estudo e, a partir destes, foram selecionados 44 artigos que apresentavam uma descrição individualizada dos fenótipos de um total de 219 pacientes. Nessa revisão, foram identificados 31 fenótipos. No HCRP, os pacientes com sintomas sugestivos eram encaminhados para coleta de sangue após consentimento informado. A extração do DNA a partir do material fornecido pelos pacientes foi realizada no Centro de Medicina Genômica do HCRP de forma automatizada e a amplificação dos fragmentos de interesse foi obtida pela reação de cadeia em polimerase (PCR) e pelo método qualitativo Repeat-Primed PCR (RPPCR). Foram identificados 17 pacientes com a mutação e as manifestações clínicas desses pacientes foram descritas. Foram identificados 6 fenótipos, dentre eles ELA, ELA-DFT, variante comportamental da DFT, Afasia Progressiva associada à ELA, Esquizofrenia e Esclerose Lateral Primária. Conclui-se que a variabilidade da apresentação clínica incial dos indivíduos com a mutação é extensa. Ainda não se sabe o que faz com que a mutação se manifeste de uma forma ou de outra. Saber o real tamanho da expansão do gene que causa essas doenças e ter um maior conhecimento sobre a penetrância do gene são fundamentais para aconselhamento genético das famílias acometidas. / Hexanucleotide repeat expansion GGGGCC in the C9ORF72 gene is one of the main causes of Frontotemporal Dementia (FTD) and Amyotrophic Lateral Sclerosis (ALS) being an important step towards the understanding of these disorders. This mutation is responsible for much of hereditary and sporadic cases. The affected subject may manifest ALS, FTD and ALS-FTD phenotype. However, several other clinical phenotypes have been described as atypical parkinsonism or forms that resemble Parkinson\'s disease and even Alzheimer\'s disease. The objective was to review phenotypes associated with C9ORF72 mutation described in literature and describe cases associated with the mutation identified in outpatient clinics of the Hospital das Clínicas de Ribeirão Preto (HCRP). The review was made from articles published between 2011 and 2014 searched on electronic database PubMed. We selected 99 papers in English in which mutation of the gene C9ORF72 was analyzed, and 44 were selected. We described phenotypes of 219 patients. We found 31 different phenotypes. In HCRP, patients with suggestive symptoms were selected to collect blood after informed consent. DNA extraction from the blood was done by an automated way in Genomic Medical Center in HCRP. Amplification of fragments of interest was obtained by polymerase chain reaction (PCR) and the qualitative method Repeat-primed PCR (RP-PCR). We identified 17 patients with mutation and their clinical manifestations were described. Six phenotypes were described including ALS, ALS-FTD, behavioral variant FTD, progressive aphasia associated with ALS, schizophrenia and Primary Lateral Sclerosis. We conclude variability of initial clinical presentation of patients with mutation is extensive. It is not known why this mutation manifests itself in different ways. Its important to understand how repeat expansion size causes distinct diseases, and to achieve a greater knowledge of the gene penetrance for genetic counseling of affected families.

A descoberta de que a expansão da repetição do hexanucleotídeo GGGGCC no gene C9ORF72 é uma das principais causas da Demência Frontotemporal (DFT) e da Esclerose Lateral Amiotrófica (ELA) foi um importante avanço para o entendimento dessas doenças. Essa mutação é responsável por grande parte dos casos hereditários e esporádicos. O indivíduo acometido pode se manifestar clinicamente como ELA, DFT e como a combinação fenotípica ELA-DFT. No entanto, vários outros fenótipos clínicos já foram descritos, como o de doenças que cursam com parkinsonismo atípico, ou mesmo formas que se assemelham à Doença de Parkinson e à Doença de Alzheimer. O objetivo do trabalho foi fazer uma revisão dos fenótipos associados à mutação do gene C9ORF72 descritos na literatura e descrever os casos associados à mutação identificados nos ambulatórios do Hospital das Clínicas de Ribeirão Preto (HCRP). A revisão foi feita a partir de artigos publicados entre 2011 e 2014, buscados na base de dados eletrônica PubMed. Foram selecionados 99 artigos em inglês, em que a mutação do gene C9ORF72 foi objetivo de estudo e, a partir destes, foram selecionados 44 artigos que apresentavam uma descrição individualizada dos fenótipos de um total de 219 pacientes. Nessa revisão, foram identificados 31 fenótipos. No HCRP, os pacientes com sintomas sugestivos eram encaminhados para coleta de sangue após consentimento informado. A extração do DNA a partir do material fornecido pelos pacientes foi realizada no Centro de Medicina Genômica do HCRP de forma automatizada e a amplificação dos fragmentos de interesse foi obtida pela reação de cadeia em polimerase (PCR) e pelo método qualitativo Repeat-Primed PCR (RPPCR). Foram identificados 17 pacientes com a mutação e as manifestações clínicas desses pacientes foram descritas. Foram identificados 6 fenótipos, dentre eles ELA, ELA-DFT, variante comportamental da DFT, Afasia Progressiva associada à ELA, Esquizofrenia e Esclerose Lateral Primária. Conclui-se que a variabilidade da apresentação clínica incial dos indivíduos com a mutação é extensa. Ainda não se sabe o que faz com que a mutação se manifeste de uma forma ou de outra. Saber o real tamanho da expansão do gene que causa essas doenças e ter um maior conhecimento sobre a penetrância do gene são fundamentais para aconselhamento genético das famílias acometidas. / Hexanucleotide repeat expansion GGGGCC in the C9ORF72 gene is one of the main causes of Frontotemporal Dementia (FTD) and Amyotrophic Lateral Sclerosis (ALS) being an important step towards the understanding of these disorders. This mutation is responsible for much of hereditary and sporadic cases. The affected subject may manifest ALS, FTD and ALS-FTD phenotype. However, several other clinical phenotypes have been described as atypical parkinsonism or forms that resemble Parkinson\'s disease and even Alzheimer\'s disease. The objective was to review phenotypes associated with C9ORF72 mutation described in literature and describe cases associated with the mutation identified in outpatient clinics of the Hospital das Clínicas de Ribeirão Preto (HCRP). The review was made from articles published between 2011 and 2014 searched on electronic database PubMed. We selected 99 papers in English in which mutation of the gene C9ORF72 was analyzed, and 44 were selected. We described phenotypes of 219 patients. We found 31 different phenotypes. In HCRP, patients with suggestive symptoms were selected to collect blood after informed consent. DNA extraction from the blood was done by an automated way in Genomic Medical Center in HCRP. Amplification of fragments of interest was obtained by polymerase chain reaction (PCR) and the qualitative method Repeat-primed PCR (RP-PCR). We identified 17 patients with mutation and their clinical manifestations were described. Six phenotypes were described including ALS, ALS-FTD, behavioral variant FTD, progressive aphasia associated with ALS, schizophrenia and Primary Lateral Sclerosis. We conclude variability of initial clinical presentation of patients with mutation is extensive. It is not known why this mutation manifests itself in different ways. Its important to understand how repeat expansion size causes distinct diseases, and to achieve a greater knowledge of the gene penetrance for genetic counseling of affected families.

Objective: Vestibular Evoked Myogenic Potentials (VEMP) were investigated to differentiate between parkinsonian syndromes. We correlated balance and VEMP parameters to investigate the VEMP brainstem circuits as possible origin for postural instability. Methods: We assessed clinical status, ocular and cervical VEMP (oVEMP, cVEMP) and a balance assessment (posturography, Activities-specific Balance Confidence Scale, Berg Balance Scale, modified Barthel Index) in 76 subjects: 30 with Parkinson’s disease (PD), 16 with atypical parkinsonism (AP) and 30 healthy controls. VEMP were elicited by using a mini-shaker on the forehead. Results: Patients with PD had a prolonged oVEMP n10 in comparison to controls and prolonged p15 compared to controls and AP. Patients with AP showed reduced oVEMP amplitudes compared to PD and controls. CVEMP did not differ between groups. Postural impairment was higher in AP compared to controls and PD, particularly in the rating scales. No correlations between VEMP and posturography were found. A classifier using support vector machine was able to automatically classify controls and patient subgroups with moderate to good accuracy based on oVEMP latencies and balance questionnaires. Conclusions: Both oVEMP and posturography, but not cVEMP, may be differentially affected in PD and AP. We did not find evidence that impairment of the cVEMP or oVEMP pathways is directly related to postural impairment. Significance: OVEMP and balance assessment could be implemented in the differential diagnostic work-up of parkinsonian syndromes.:1. Einleitung 2. Publikationsmanuskript 3. Zusammenfassung 4. Literaturverzeichnis 5. Anlagen 6. Darstellung des eigenen Beitrages 7. Selbstständigkeitserklärung 8. Lebenslauf 9. Danksagung

Une importante proportion de formes atypiques de parkinsonismes a été rapportée en Guadeloupe en 1999. Il ressort des études épidémiologiques menées sur place, que tous les patients atteints étaient de grands consommateurs de produits alimentaires et médicinaux de la famille des Annonaceae, et plus particulièrement du genre Annona. De nombreux genres appartenant à cette famille renferment des molécules fortement cytotoxiques : les acétogénines d’Annonaceae. Leur présence dans les fruits d’Annona muricata a déjà été mise en évidence. Cependant, peu de données existent sur leur teneur en acétogénines dans ces fruits ou dans ceux d’espèces proches. Par ailleurs, bien que l’annonacine, acétogénine principale d’A. muricata soit neurotoxique in vivo, aucune donnée quantitative de son accès au cerveau n’est disponible. Nous nous sommes donc attachés au cours de ce travail, à développer des méthodes de dosage de l’annonacine par LC-MS/MS dans le plasma et le cerveau de Rat pour déterminer sa biodisponibilité et la fraction à tropisme cérébral, dans le but de comprendre pourquoi des molécules si fortement cytotoxiques n’entraînaient pas d’intoxication aigue lors de l’exposition alimentaire. Nous avons par ailleurs développé une méthode de quantification des acétogénines totales par 1H RMN dans des extraits bruts de fruits, appliquée à des lots d’A. muricata d’origines variées. Une méthode par LC-MS/MS a également été développée pour une description plus approfondie des acétogénines présentes dans des extraits bruts de fruits, appliquée à différents lots d’A. squamosa. Les fruits d’A. reticulata et d’A. glabra ont également fait l’objet d’investigations. Ces deux approches combinées ont contribué à améliorer l’estimation de l’exposition aux acétogénines dans le cadre de l’alimentation. / Abstract : A high proportion of atypical parkinsonisms was reported in French West Indies in 1999. Epidemiological studies pointed out an association with the consumption of fruits and medicinal herbs from Annonaceae of the Annona genera. Numerous Annonaceae members contain Annonaceous acetogenins (AAGs), which are highly cytotoxic molecules. They were found in the pulp fruit of Annona muricata. However, scarce only quantitative exist for this fruit and those of related species. Moreover, although annonacin, the major AAG of A. muricata proved neurotoxic in vivo, no quantitative data is available towards its distribution to the brain. We therefore developed a method for annonacin quantitation in Rat plasma and brain homogenate, in order to determine its bioavailability and the fraction reaching the brain, to understand why those highly cytotoxic molecules are not responsible for acute toxicity when fruits are ingested. We then developed a quantitation method for global estimation of AAGs in crude fruit extracts by 1H NMR, which we applied to the fruit pulp of A. muricata batches from diverse locations. An LC-MS/MS method was also developed for the qualitative study of AAGs. It was applied to different batches from A. squamosa fruits. The species A. reticulata and A. glabra were also examined. Those two approaches contributed in a better estimation of AAGs exposure by fruit consumption.

Dans les Antilles françaises, une proportion anormalement élevée de parkinsonismes atypiques sporadiques – des tauopathies – est observée. Un lien avec la consommation de plantes de la famille des Annonaceae, en particulier Annona muricata L. (corossol) a été démontré. Les acétogénines d’Annonaceae, des inhibiteurs puissants du complexe I de la chaine respiratoire mitochondriale, sont considérées comme des toxines candidates. L’annonacine, une acétogénine représentative, majoritaire dans A. muricata, est neurotoxique in vitro et in vivo. L’Agence Française de Sécurité Sanitaire des Aliments a exprimé ses doutes quant à ce problème de santé publique. Elle insiste sur l’importance d’évaluer l’exposition des consommateurs d’Annonaceae aux acétogénines, et de déterminer les paramètres pharmacocinétiques de ces molécules. Au cours de cette thèse, nous avons cherché à répondre à ces interrogations, avec l’annonacine pour modèle. Après l’analyse structurale d’acétogénines étalons, une méthode de déréplication puissante et innovante a été mise au point par CLHP-ESI-LTQ-Orbitrap® avec infusion post-colonne de lithium. Les profils complets des acétogénines d’extraits bruts issus d’un nectar d’A. muricata et d’un alcool d’Annona cherimolia Mill. (annone, chérimole) ont été élucidés, mettant en évidence une composition plus complexe et plus variée que celle envisagée dans la littérature. A. cherimolia n’avait pas été identifiée comme une source d’exposition jusqu’à maintenant. Des données quantitatives ont été obtenues par CLHP-DAD-MS, à partir d’une quinzaine d’échantillons de produits commerciaux, confirmant une exposition humaine importante à ces molécules par voie alimentaire, via des produits d’origines géographiques, de statuts et de modes d’obtention variés. Des travaux préliminaires d’étude du passage de l’annonacine à travers des membranes biologiques ont été amorcés (modèles de barrières intestinale – Caco-2 – et hémato-encéphalique – hCMEC/D3). Une étude de métabolisation de phase I de l’annonacine sur microsomes de foie de Rat a permis d'identifier 25 métabolites mono-hydroxylés par CLHP-ESI-LTQ-Orbitrap®. Seuls trois d’entre eux sont observés avec des microsomes humains. Ces métabolites ont été obtenus par hémisynthèse (bioconversion, catalyse par porphyrines) et leur structure a été déterminée. Les résultats montrent que cette étape de métabolisation n’est pas cruciale dans le devenir de l’annonacine, et ne peut expliquer de susceptibilité différentielle aux acétogénines. Après la présentation de rappels concernant les Annonaceae, les parkinsonismes et leurs formes atypiques guadeloupéennes et tropicales, puis d’aspects méthodologiques en spectrométrie de masse, nos travaux de phytochimie analytique, d’analyse métabolique, d’hémisynthèse et de détermination structurale sont présentés, et discutés en regard d’un problème de santé publique potentiellement large et préoccupant. / In the French West Indies, an unusually high proportion of atypical sporadic parkinsonisms - tauopathies - is observed. A link between these atypical parkinsonisms and the consumption of plants of the Annonacea family, Annona muricata L. (soursop) was demonstrated. The Annonaceous acetogenins are potent inhibitors of complex I of mitochondrial respiratory chain and are considered to be in vitro toxins candidate. The major acetogenin in Annona muricata, annonacin, is neurotoxic in in vitro and in vivo models. Afssa (Agence Française de Sécurité Sanitaire des Aliments) expressed its concern regarding this public health problem. The Agency reports the importance of assessing consumers ‘exposure to Annonaceous acetogenins, and of determining the pharmacokinetic of these molecules. In this thesis, we sintended to answer these questions, with annonacine as a model. After the structural analysis of acetogenins standards, a powerful and innovative method of dereplication was developed by HPLC-ESI-LTQ-Orbitrap ® with post-column infusion of lithium. Complete acetogenins profile in crude extracts from nectar of A. muricata and from an alcohol of Annona cherimolia Mill. (Annona, cherimoya) were elucidated, revealing a more complex and more varied composition than that proposed in the literature. A. cherimolia had not been identified as a source of exposure to date. Quantitative data were obtained by HPLC-DAD-MS, from fifteen samples of commercial products, confirming an important human exposure to these molecules through food products of varied geographical origins, status and methods. Preliminary works to study ability of annonacin to cross biological membranes have been initiated (intestinal barrier models - Caco-2 - and blood-brain barrier - hCMEC/D3). A study of phase I metabolism of annonacin in rat liver microsomes allowed the identification of 25 mono-hydroxylated metabolites by HPLC-ESI-LTQ-Orbitrap®. Only three of them were observed with human microsomes. These metabolites were obtained by semisynthesis (bioconversion, porphyrin mediated catalysis) and their structure was determined. The results show that phase metabolism is not critical in the becoming of annonacin, and cannot explain a differential susceptibility of acetogenins. After a presentation of the Annonaceae family, of parkinsonism – including atypical and guadeloupean forms then of and methodological aspects of mass spectrometry, analytical phytochemistry of our work, metabolic analysis, semisynthesis and structure determination are proposed, and discussed in the context of a public health problem and potentially broad concern.