The peripheral and highly lipid-exposed M4 α-helix, although distant from the agonist binding site, channel gate, and other important gating structures, is involved in modulating function of the nicotinic acetylcholine receptor. M4 "senses" changes in the surrounding lipid environment and may consequently affect receptor function by altering specific interactions between the M4 C-terminus and the Cys-loop. An example of this lipid sensing ability is demonstrated by a lipid-facing Cys418 to Trp substitution on αM4 (αM4 C418W) of the muscle-type receptor, which subtly alters protein-lipid interactions and potentiates channel function 16-fold, leading to a slow-channel congenital myasthenic syndrome. Through the use of mutational studies and mutant cycle analysis, I determine that, contrary to previous studies, M4–Cys-loop interactions are not critical to wild-type muscle-type receptor function, nor are they involved in C418W-induced potentiation. Instead, C418W potentiates channel activity by enhancing local M4-M1 interactions mediated by three polar side-chains, which are absolutely critical to potentiation. I show that altered M4-M1 interactions are ultimately translated to two important gating structures, which work in tandem to stabilize the open conformation of the receptor. These studies highlight how altered protein-lipid interactions can affect channel function and contribute to our understanding of the underlying gating mechanism of the muscle-type receptor.

Orientador: José Paes de Oliveira Filho / Resumo: A doença de acúmulo de glicogênio tipo II (GSD-II) e a síndrome miastênica congênita (CMS) são enfermidades autossômicas recessivas importantes no gado Brahman. Nenhum estudo avaliou previamente a prevalência de mutações responsáveis pelo GSD II (E7, c.1057_1058delTA e E13, c.1783C> T) ou CMS (CHRNE, c.470del20) nos bovinos Brahman brasileiro. O objetivo deste estudo foi investigar a presença dessas mutações em 276 amostras de bulbos pilosos de bovinos PO brasileiros e em 35 amostras de sêmen de touros da raça Brahman, rotineiramente utilizadas em programas de melhoramento genético no Brasil. Dos 276 bovinos Brahman testados, 7,3% foram identificados como heterozigotos para E7. Enquanto, todos os bovinos Brahman estudados eram wild-type para E13. Para as amostras de sêmen foi identificado 8,6% (3/35) heterozigotos para a E7 e para a E13 nenhum animal foi identificado. A mutação CHRNE, 0,73% das amostras de bulbo piloso são heterozigotos, enquanto para as amostras de sêmen, nenhum animal foi considerado heterozigoto. Este resultado indica que as mutações E7 e CHRNE estão presentes no rebanho Brahman brasileiro, e medidas de controle devem ser adotadas para evitar um aumento na incidência de GSD-II e CMS no gado Brahman no Brasil. / Abstract: Glycogen storage disease type II (GSD-II) and congenital myasthenic syndrome (CMS) are important autosomal recessive disorders in Brahman cattle. No study has previously evaluated the prevalence of mutations responsible for GSD II (E7, c.1057_1058delTA; and E13, c.1783C>T) or CMS (CHRNE, c.470del20) in Brazilian Brahman cattle. The objective of this study was to investigate the presence of these mutations in 276 hair roots from purebred Brazilian Brahman cattle and in 35 semen samples from purebred Brahman bulls that were routinely used in breeding programmes in Brazil. Of the 276 Brahman cattle tested, 7.3% were identified as heterozygous for E7. All Brahman cattle studied were homozygous for the wild-type E13 allele. The E7 mutations was identified as heterozygous in 8.6% (3/35) of the commercial semen samples, whereas the E13 mutations was not identified. The CHRNE mutation was identified as heterozygous in 0.73% of the hair root samples, but this mutation was not present in any semen sample assessed. In summary, the E7 and CHRNE mutations are present in the Brazilian Brahman herd, and control measures should be adopted to prevent an increase in the incidence of GSD-II and CMS in Brahman cattle in Brazil. / Mestre

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Congenital myasthenic syndromes (CMS) are a rare group of heterogeneous disorders, characterised by compromised neuromuscular transmission and symptoms of fatiguable muscle weakness. CMS is caused by mutations in genes that affect the structure and function of the neuromuscular junction (NMJ). In about 20% of CMS cases, patients have mutations in the gene DOK7; the protein product, DOK7, is crucial for maintaining the dense aggregation of acetylcholine receptor (AChR) clusters at the NMJ. DOK7-CMS patients do not respond to treatment with acetylcholinesterase inhibitors which are the first line treatment for most forms of CMS. Instead, a dramatic response to beta-2 adrenergic receptor (ADRB2) agonists, such as salbutamol, is observed. The aim of this project was to investigate the molecular mechanisms that underlie the beneficial effects of ADRB2 agonists. Firstly, NMJ functioning was modelled in vitro by studying AChR clusters formed on cultured C2C12 mouse myotubes in the presence of WT DOK7. Overexpression of mutant DOK7 led to a significant reduction in the number of AChR clusters, explaining the pathogenic effect of the mutation. Importantly, incubation of myotubes with salbutamol increased the number of AChR clusters and their stability. The results provide the first evidence that ADRB2 agonists directly affect proteins located at the NMJ. However, this disease model suffers from limitations. The rest of the thesis focussed on developing alternative cell culture models to explore the AChR clustering pathway. The first model combined optogenetics and fluorescence lifetime microscopy to study the effects of ADRB2 activation on AChR cluster stability in single live cells. The second used CRISPR/Cas9 genome editing tools to directly introduce Dok7 mutations to the genome of C2C12 cells, thereby overcoming some of the drawbacks associated with DOK7 overexpression. Further manipulations of these novel model systems will be used in the future to examine in more detail the molecular events underlying the pathogenic effects of DOK7 mutations and the mechanisms of ADRB2 agonists.

Abstract Collagen XIII is a transmembrane protein consisting of intracellular, transmembrane and extracellular domains. The latter can be cleaved by proteases of the furin family at the plasma membrane and in the trans-Golgi network. Both the transmembrane and shed collagen XIII are expressed at the neuromuscular junctions of mice and humans. Such motor synapse passes the contraction signal from the central nervous system to the muscles and brings about all voluntary movements. Loss of both forms of collagen XIII in mice and loss-of-function mutations in the COL13A1 gene in humans leads to congenital myasthenic syndrome characterized by decreased neuromuscular transmission and muscle weakness. To study the roles of the two collagen XIII forms, a novel mouse line was engineered to harbor only the transmembrane collagen XIII by mutating the furin cleavage site. Transmembrane collagen XIII was discovered to be sufficient to prevent adhesion defects, Schwann cell invagination, the ineffective vesicle accumulation and dispersion of both acetylcholinesterase and acetylcholine receptors, phenotypes seen in the complete lack of collagen XIII. On the other hand, lack of shedding led to acetylcholine receptor fragmentation, aberrantly increased neurotransmission and presynaptic complexity. Remarkably, in vivo and in vitro interaction of collagen XIII and acetylcholinesterase-anchoring ColQ was detected. Furthermore, muscle and neuromuscular junction phenotype in the lack of both forms of collagen XIII closely resembled those in the human patients harboring mutations in the COL13A1 gene and these mice were validated as a good model for studying the human disease. Misexpression of collagen XIII was studied with mice exhibiting transgenic overexpression of the protein. Overexpression of collagen XIII was detected to be mostly extrasynaptic in the muscles of such mice. Exogenous collagen XIII was found at the myotendinous junctions, tenocytes and fibroblast-like cells, in addition to some localization in the near vicinity of the neuromuscular junctions. Collagen XIII expression was found, for the most part, to be normal at the neuromuscular junctions, although some were devoid of collagen XIII. The neuromuscular junction phenotype resembled in many ways the findings made in the lack of collagen XIII. Furthermore, acetylcholine receptor and nerve pattern was discovered to be widened. / Tiivistelmä Kollageeni XIII on solukalvoproteiini, jonka rakenne koostuu solunsisäisestä, solukalvon läpäisevästä ja solun ulkoisesta osasta, joka pystytään entsymaattisesti irrottamaan solukalvoilta. Täten se esiintyy kahdessa eri muodossaan; solukalvomuotoisena ja soluvälitilan lihasperäisenä proteiinina hiirten ja ihmisten hermolihasliitoksessa. Tässä motorisessa synapsissa keskushermostosta peräisin oleva lihaksen supistumiskäsky välittyy lihakseen ja aikaan saa tahdonalaiset liikkeet. Molempien kollageeni XIII:n muotojen puute hiirillä ja COL13A1 geenin mutaatiot ihmisillä johtavat synnynnäiseen myasteeniseen oireyhtymään, jossa heikentynyt hermolihasliitoksen toiminta johtaa lihasheikkouteen. Kollageeni XIII:n eri muotojen hermolihasliitosvaikutusten selvittämiseksi luotiin hiirilinja, jossa kollageeni XIII ilmenee geneettisen manipulaation seurauksena ainoastaan solukalvomuodossaan. Tutkimukset osoittivat solukalvomuotoisen kollageeni XIII:n tarvittavan hermon ja lihaksen kiinnittymiseen toisiinsa, hermovälittäjäainerakkuloiden ankkuroimiseen hermopäätteeseen, estämään Schwannin solujen tunkeutuminen synapsirakoon, asetyylikoliiniesteraasin sitomiseen ja asetyylikoliinireseptorien vakaantumiseen. Soluvälitilan kollageeni XIII:n puutos puolestaan johti lihaksen puolen liitoksen pirstaloitumiseen sekä hermopäätteiden liialliseen kasvuun ja aktiivisuuteen. Kollageeni XIII todettiin sitoutuvan asetyylikoliiniesteraasia hermolihasliitokseen ankkuroivan kollageeni Q:n kanssa. Lisäksi molempien kollageeni XIII:n muotojen suhteen poistogeenisten hiirten hermolihas- ja lihaslöydökset todettiin muistuttavan COL13A1 geenin mutaatioista kärsivien ihmisten vastaavia löydöksiä todistaen nämä hiiret hyväksi tautimalliksi tulevaisuuden hoitomuotojen suunnitteluun. Kollageeni XIII:n ylimäärän vaikutusta hermolihasliitokseen ja lihaskudokseen tutkittiin kollageeni XIII:a ylenmäärin ilmentävillä hiirillä. Kollageeni XIII todettiin ilmentyvän ylenmäärin lihaksessa fibroblastinkaltaisissa soluissa, lihasjänneliitoksessa ja hermolihasliitoksen lähettyvillä, mutta ei hermolihasliitoksessa. Osa hermolihasliitoksista näissä hiirissä ilmensi jopa vähemmän kollageeni XIII:a kuin normaalisti. Asetyylikoliinireseptorien ja hermojen valtaama alue todettiin leventyneeksi ja hermolihasliitoslöydökset muistuttivat molempien kollageeni XIII:n muotojen suhteen poistogeenisien hiirten löydöksiä.

Congenital myasthenic syndrome (CMS) and myasthenia gravis (MG) are, respectively, inherited or autoimmunological disorders caused by aberrant neuromuscular transmission, which manifests as fatiguable muscle weakness. A novel subtype of CMS, resulting from mutations in GFPT1 and characterised by a limb girdle pattern of muscle weakness, has been described. The gene encodes L glutamine:D fructose-6-phosphate amidotransferase 1 (GFAT1) – a key rate limiting enzyme in the hexosamine biosynthetic pathway, providing building blocks for glycosylation of proteins and lipids. The research focused on the molecular bases of the CMS resulting from mutations in the ubiquitously expressed gene, but with symptoms largely restricted to the neuromuscular junction (NMJ). The work has established a link between the NMJ and GFPT1 CMS by demonstrating that the AChR cell surface is decreased in GFPT1 patient muscle cells and in GFPT1-silenced cell lines. The decrease is likely to be caused by reduced steady-state levels of individual AChR α, δ and ε, but not β, subunits. To optimise treatment for myasthenic disorders, a comparative in vivo trial of therapy with pyridostigmine bromide and salbutamol sulphate, and pyridostigmine bromide alone, was conducted. Supplementation of the AChE inhibitor-based therapy with the β2-adrenergic receptor agonist had a beneficial effect. This offers promise for more effective treatments for CMS and MG affected individuals. Molecular causes of MG were also investigated. The search for novel antibody targets was conducted with the use of a designed cell-based assay for the detection of anti COLQ autoimmunoglobulins in MG patient sera. The antibodies were detected in 24 out of 418 analysed samples, but their pathogenicity has not been determined.

Congenital myasthenic syndromes (CMS) are a group of heterogeneous disorders caused by mutations in genes encoding for proteins that are essential for neuromuscular transmission. All CMS share the clinical feature of fatigable muscle weakness. The differential diagnosis of CMS is wide, with a range of diseases going from autoimmune myasthenia gravis to muscle disorders. In this thesis, it was shown that measuring antibodies to clustered acetylcholine receptors (AChRs) by cell-based assay is helpful in the differential diagnosis of CMS. The findings of the current investigations showed that mutations in COL13A1, encoding the Collagen Type XIII α1 chain, were responsible for the symptoms of several patients with previously undefined myasthenias. In addition, this work described the clinical and complementary features of a novel CMS subtype due to mutations in the glycosylation pathway gene GMPPB. Investigations on a novel MUSK missense mutation (p.Ala617Val) uncovered previously unrecognised mechanisms of how levels of MuSK phosphorylation are critical to maintain synaptic structure, and guided suitable treatment for the patient. The study on the clinical and molecular basis of stridor, a novel clinical feature recently identified in patients with DOK7-CMS, prompted the identification of a novel DOK7 isoform, which warrants further investigation to elucidate its role in AChR clustering. Finally, the therapy of patients with severe AChR-deficiency was optimised thanks to a case series study that showed a robust improvement following the addition of β2-adrenergic agonists to their long-term treatment regime that included pyridostigmine.

ColQ est un collagène spécifique qui ancre l’acétylcholinestérase (AChE) dans la fente synaptique de la jonction neuromusculaire (JNM). L'importance du complexe AChE-ColQ dans la physiologie humaine de cette synapse est soulignée par l’identification de mutations dans le gène codant pour ColQ qui conduisent à un syndrome myasthénique congénital (SMC) associé à une déficience en AChE. Le déficit en AChE a, jusqu’à présent, été considéré comme l’unique facteur responsable des symptômes observés chez les patients ainsi que des défauts de la JMN chez le modèle de souris SMC (souris déficiente pour ColQ). Toutefois, ces symptômes sont complexes et l’absence d’AChE ne peut probablement pas expliquer tous les symptômes. Nous avons montré auparavant que ColQ participait à la formation de la synapse ce qui expliquerait les symptômes observés chez les patients et la souris modèle. En effet, nous avons pu montrer que ColQ contrôle l’agrégation du récepteur à l’acétylcholine (RACh) et de l’expression de gènes spécifiques de la synapse. En particulier, nous avons montré in vitro et in vivo, que l’absence de ColQ induit une augmentation du niveau des ARNm codant pour toutes les sous-unités de RACh et une expression réduite du niveau de leurs protéines. Des résultats préliminaires indiquent que cette augmentation de ces ARNm n’est pas transcriptionnelle. L’objectif de cette thèse est d’expliquer les mécanismes qui induisent l’augmentation du niveau des ARNm de AChR en l’absence de ColQ et les voies de signalisation qui relient ColQ au métabolisme des ARN du RACh. Notre hypothèse de travail a été que l'absence de ColQ stimule la stabilisation post-transcriptionnelle des ARNm codant pour les sous-unités du RACh via la protéine HuR. HuR est une protéine qui stabilise les ARNm quand elle se fixe sur les AU-richelement (ARE) dans la séquence 3’UTR. HuR est une protéine clé dans la myogenèse et la formation de la JNM parce qu’elle stabilise de manière post-transcriptionnelle de nombreux transcrits tels que myogénine, MyoD et AChE. Dans cette étude, nous montrons pour la première fois qu’un mécanisme post-transcriptionnel de stabilisation des ARNm est responsable de l’augmentation du niveau des ARNm du RACh via ColQ. De plus, nous constatons qu’en absence de ColQ, il y a une augmentation aux niveaux d’ARNm et de protéine de HuR. HuR est également capable de se lier au domaine ARE dans le 3’UTR des ARNm des sous-unités de AChR. De plus, l’interaction entre HuR et les ARNm du RACh augmente la stabilité et par conséquence les niveaux des transcrits du RACh. Trois conclusions importantes ressortent de ma thèse : nous démontrons que (1) en plus de la régulation transcriptionnelle, il existe des mécanismes de régulation post-transcriptionnlle du RACh (2) ColQ régule la stabilité des ARNm RACh via HuR médiée par MuSK (3) la voie de signalisation p38 contrôle les niveaux de HuR de manière dépendante de ColQ. Ensemble, ces résultats donnent un aperçu des voies de signalisation du muscle qui sont affectées par les mutations de ColQ conduisant à des SMC avec une déficience en AChE. Nos résultats mettront en évidence des nouvelles cibles moléculaires spécifiques qui peuvent conduire au développement des interventions thérapeutiques dans le cadre de myasthénies congénitales. / ColQ is a specific collagen that anchors acetylcholinesterase (AChE) in the synaptic cleft of the neuromuscular junction (NMJ). The importance of AChE-ColQ complex in the physiology of this synapse has been highlighted by the identification of COLQ mutations in the human gene, leading to a congenital myasthenic syndrome (CMS) with AChE deficiency. The lack of AChE has been incriminated for the symptoms observed in patients along with NMJ defects in the CMS mouse model (ColQ-deficient). However, symptoms observed in the patients and mouse model of CMS with AChE deficiency are complex and AChE deficiency cannot account for all of them. We have demonstrated that ColQ could play a role per se in synapse formation which would explain some of the defects observed in patients and model mice. Indeed, we have shown that ColQ controls the clustering of Acetylcholine Receptors (AChR) and the expression of a number of specific synaptic genes. The most striking effect of the absence of ColQ is an upregulation of all AChR subunit mRNAs correlated by an increase in their protein levels. Preliminary results indicate that AChR mRNA upregulation is not transcriptional. This thesis deciphers the mechanisms that drive AChR mRNA upregulation in the absence of ColQ and the pathways that connect ColQ to the AChR RNA metabolism. Accordingly, we hypothesize that the absence of ColQ induces an upregulation of the stabilization of AChR subunit mRNAs, a post-transcriptional mechanism mediated by HuR. HuR is an RNA binding protein which stabilizes its target transcript by binding AU-rich elements (AREs) in their 3’UTR. HuR is critical during skeletal myogenesis and post-synaptic NMJ formation due to its stabilization of such transcripts as myogenin, MyoD and AChE. In this study, we show for the first time that a post-transcriptional mechanism of AChR mRNA stabilization is responsible for the ColQ mediated increase of AChR mRNAs. In support of these findings, the absence of ColQ also increased HuR mRNA and protein levels. We demonstrate that HuR is capable of binding to conserved ARE elements in the 3’UTR of AChR subunit mRNA. HuR’s interaction with AChR mRNA increased the stability of the transcripts, resulting in an increase in mRNA levels. Three major conclusions emerge from my thesis: we provide evidence that (1) in addition to transcriptional and assembly regulation of AChR, post-transcriptional mechanisms of AChR mRNA exist (2) ColQ regulates HuR mediated AChR stability through MuSK and (3) the p38 signalling pathway controls the levels of HuR in a ColQ dependent manner. Collectively, our data provides insight into the muscle signaling pathways which are affected by ColQ mutations leading to CMS with AChE deficiency. Thus, we have identified specific new molecular targets that may become important for the development of therapeutic interventions for patients with CMS.

La formation de la jonction neuromusculaire des vertébrés (JNM), une synapse cholinergique périphérique entre les motoneurones et les fibres musculaires squelettiques repose sur la reconnaissance et l’apposition précise des motoneurones présynaptiques sur leurs cibles musculaires postsynaptiques. Les données de la littérature montrent que les morphogènes Wnt agissent comme des régulateurs clés de la formation de la JNM. Cependant, l'identité précise des Wnts, leur collaboration et les mécanismes moléculaires de la signalisation Wnt régissant la formation de la JNM restent encore incompris. A la JNM, la transduction du signal Wnt s’effectue par l'intermédiaire de l’interaction des Wnt soit avec le complexe formé par le récepteur tyrosine kinase MuSK et la lipoprotéine Lrp4 ou les récepteurs classiques Frizzled (Fzd). Dans cette thèse, nous avons étudié les mécanismes moléculaires de la formation de la JNM médiés par les Wnts. Nous avons montré que Wnt4 et Wn11 sont nécessaires pour l’étape indépendante du nerf de prepatterning musculaire, caractérisée par l’agrégation des récepteurs de l’acétylcholine (RACh) dans des domaines discrets de la surface du muscle où la future synapse va se former, via l'activation différentielle des voies canonique et polarité cellulaire planaire (PCP). De plus, Fzd3 et Vangl2, deux composantes essentielles de la voie PCP, sont accumulées à la JNM et sont impliquées distinctement dans la formation de la JNM, Fzd3 étant nécessaire à la croissance des axones moteurs alors que Vangl2 joue un rôle dans l’agrégation du RACh et la restriction de la croissance des axones moteurs une fois leur cible musculaire atteinte. Pour étudier le rôle fonctionnel de l'interaction Wnt/MuSK, nous avons généré une souris transgénique délétée du domaine de liaison de MuSK aux Wnts (CRD, domaine riche en cystéines). Nous avons démontré que l'absence du CRD de MuSK affecte la formation de la JNM dès l’étape deprepatterning jusqu’à la maintenance de la JNM chez l’adulte, aboutissant à un phénotype pathogène. De plus, nous avons montré que le lithium, un inhibiteur réversible de la glycogène synthase kinase-3 restaure les défauts de formation de la JNM chez les embryons mutants et pourrait constituer un nouveau réactif thérapeutique pour le traitement des maladies neuromusculaires liées à une déficience de la voie de signalisation Wnt/MuSK. / Formation of the vertebrate neuromuscular junction (NMJ), a peripheral cholinergic synapse between motoneurons and skeletal muscle fibers relies on the accurate recognition and apposition of presynaptic motoneurons on postsynaptic muscle target. Recently, a growing body of evidence indicates that Wnt morphogens act as key regulators of NMJ formation. Yet, the specific Wnts identity, their collaborative function and the downstream molecular mechanisms of Wnt signaling regulating NMJ formation still remain elusive. At the NMJ, Wnt ligands transduce their signal through interaction of either the receptor complex formed by the muscle specific tyrosine kinase MuSK and the low density lipoprotein (Lrp) Lrp4 or the classical frizzled receptors. In this thesis, we have investigated the molecular mechanisms of Wnt-induced NMJ formation. We found that both Wnt4 and Wn11 are required for the nerve-independent muscle prepatterning step, characterized by acetylcholine receptor (AChR) aggregation in discrete domains of the muscle surface where the synapse will form, via differential activation of either canonical and/or planar cell polarity (PCP) pathways. Moreover, Fzd3 and Vangl2, two core components of the PCP pathway, are accumulated at the developing NMJ and play distinct roles in NMJ formation, with Fz3 required for motor axon growth and Vangl2 involved in AChR clustering and motor axon growth restriction within the target field. To further study the functional role of Wnt/MuSK interaction, we generated a transgenic mice deleted from MuSK Wnt binding domain (CRD, cysteine rich domain). We demonstrated that the absence of MuSK CRD affected NMJ formation from the prepatterning step to NMJ maintenance in adult leading to a pathogenic phenotype. Moreover, we found that lithium, a reversible inhibitor of the glycogen synthase kinase-3 fully rescued NMJ defects in mutant embryos and therefore may constitutes a novel therapeutic reagent for the treatment of neuromuscular disorders linked to Wnt/MuSK signaling pathway deficiency.