Novas abordagens terapêuticas vêm sendo introduzidas para doenças musculares genéticas como distrofias musculares e miopatias congênitas, distúrbios que permanecem sem cura até o momento. Estes recentes avanços motivaram um interesse renovado e crescente por métodos não invasivos para a caracterização e monitoramento do músculo afetado, particularmente durante e após intervenções terapêuticas. Neste contexto, modelos animais são essenciais para uma melhor compreensão dos mecanismos das doenças e para testar novas terapias. Recentemente, avanços significativos na avaliação não invasiva de modelos murinos para doenças musculares genéticas foram alcançados. Entretanto, diversas linhagens de camundongos ainda não foram caracterizadas de maneira não invasiva, e ainda é necessário o desenvolvimento de métodos sensíveis para a identificação precoce de alterações sutis no músculo de camundongos afetados. A proposta desta tese é aplicar técnicas não invasivas inovadoras no estudo do músculo de modelos murinos para doenças musculares genéticas com fenótipos variados. Três modelos murinos para distrofias musculares (mdx, Largemyd, mdx/ Largemyd) e um modelo murino para miopatia congênita (KI-Dnm2R465W) foram estudados com métodos de Ressonância Magnética Nuclear (RMN). Duas linhagens distróficas (Largemyd, mdx/ Largemyd) e camundongos normais após injúria foram estudados através de micro-Tomografia Computadorizada (micro-CT). Em RMN, todas as linhagens de camundongos afetados apresentaram aumento de T2 muscular, o que foi relacionado a diversas anomalias na análise histológica, como necrose e inflamação, mas também a conjuntos de fibras em regeneração ou a fibras com citoarquitetura alterada. A combinação de RMN com análise de textura permitiu a identificação não ambígua de todas as linhagens distróficas, sendo que apenas a comparação dos valores de T2 muscular não permitiu esta diferenciação. Camundongos mdx mostraram alterações funcionais e morfológicas na rede vascular do músculo. Estudo piloto em camundongos KI-Dnm2R465W revelou tendências de comprometimento da função muscular. Por fim, imagens de micro-CT não permitiram a detecção de diferenças na composição muscular em camundongos distróficos. Este conjunto de resultados não apenas enriquece o painel de modelos murinos para doenças musculares genéticas caracterizados de maneira não invasiva, mas também demonstra um certo grau de especificidade nas anomalias observadas nas imagens, como revelado pela análise de textura. Estes resultados também mostraram que métodos não invasivos de RMN podem ser suficientemente sensíveis para identificar alterações sutis no fenótipo muscular murino, mesmo em estágios precoces. Esta tese foi desenvolvida sob acordo de co-tutela internacional entre a França e o Brasil, e compreendeu uma importante transferência de conhecimento, com os primeiros estudos não invasivos de músculo murino realizados no Brasil. / Novel therapeutic approaches are being introduced for genetic muscle diseases such as muscle dystrophies and congenital myopathies, all of them having remained without cure so far. These recent developments have motivated a renewed and augmented interest in non-invasive methods for muscle characterization and monitoring, particularly during and after therapeutic intervention. In this context, animal models are essential to better understand the disease mechanisms and to test new therapies. Recently, significant advances in the non-invasive evaluation of mouse models for genetic muscle diseases have been achieved. Nevertheless, there were still several mouse strains not characterized non-invasively, and it was necessary to develop sensitive methods to identify subtle alterations in the murine affected muscle. The purpose of this thesis was to apply non-invasive techniques in the study of murine models for genetic muscle diseases with variable phenotypes. Three mouse models for muscle dystrophy (mdx, Largemyd, mdx/ Largemyd) and one mouse model for congenital myopathy (KI-Dnm2R465W) were studied with Nuclear Magnetic Resonance (NMR) methods. Two dystrophic strains (Largemyd, mdx/ Largemyd) and normal mice after injury were studied through micro-Computed Tomography (micro-CT). On NMR, all affected mouse strains presented increased muscle T2, which could be related to variable features in the histological evaluation, including necrosis and inflammation, but also to clusters of fibers under regeneration or with altered cytoarchitecture. The combination of NMR and texture analyses allowed the unambiguous differential identification of all the dystrophic strains, although it was not feasible when comparing the muscle T2 measurements only. Mdx mice showed functional and morphological alterations of vascular network. In the KI-Dnm2R465W mice, a pilot study revealed tendencies of functional impairment. Finally, micro-CT images were unable to detect differences in muscle´s content in dystrophic mice. Altogether, these results not only increased the number of murine models for genetic muscle diseases non-invasively characterized, it also demonstrated some degree of specificity of the imaging anomalies, as revealed by texture analysis. It also showed that non-invasive NMR methods can be sensitive enough to identify subtle alterations in murine muscle phenotype, even in early stages. This thesis was developed under an international joint supervision between France and Brazil, and comprised an important transfer of technology, with the first non-invasive studies of murine muscles performed in Brazil.

[Truncated abstract] Mutations in the skeletal muscle -actin gene (ACTA1) have been shown to be one cause of a broad group of muscle disorders all termed the congenital myopathies. Over 170 different mutations have now been identified across all 6 coding exons of ACTA1 in patients presenting with muscle weakness and any one or more of the following histopathological features: nemaline rods, intranuclear rods, fibre-type disproportion, excess of thin filaments and central cores. While the identification of the causative gene has been of great comfort for affected patients and their families, with pre-natal genetic testing becoming available, the ultimate aim is to develop a therapy for these disorders. Of the therapies currently being explored for the muscular dystrophies, up-regulation of an alternative gene seemed to be one of the most promising avenues for treatment of the ACTA1 diseases. Up-regulation of utrophin, the foetal homologue of dystrophin, has been shown to be a promising therapy for the treatment of Duchenne muscular dystrophy. The main aim of my research was to determine whether up-regulation of cardiac -actin, the predominant -actin expressed in foetal skeletal muscle and in the adult heart, could be used as a therapy for the ACTA1 diseases. A proof-of-concept experiment was performed whereby skeletal muscle -actin knock-out (KO) mice (all of which die by postnatal day 9) were crossed with transgenic mice over-expressing cardiac -actin (known as Coco mice) in postnatal skeletal muscle. ... While patients that are ACTA1 nulls have been identified in a number of mainly consanguineous populations, the majority of ACTA1 mutations result in dominant disease in which the mutant protein interferes with the function of the wild-type skeletal muscle -actin. Research described in this thesis also focuses on characterizing two transgenic mouse models of dominant ACTA1 disease at the ultra-structural, cellular and functional level; this is the first step towards a proof-of-concept experiment to determine whether cardiac -actin up-regulation can dilute out the pathogenesis of dominant ACTA1 disease. It has long been noted that patients with ACTA1 disease do not have ophthalmoplegia, even in the most-severely affected individuals. Protein analysis performed on extraocular muscle (EOM) biopsies obtained from humans, sheep and pigs showed that the EOMs co-express cardiac and skeletal muscle -actin, with cardiac -actin comprising 70 % of the striated -actin pool. Thus we propose that sparing of the EOMs in ACTA1 disease is at least in part due to cardiac -actin diluting out the pathogenesis associated with expression of the mutant skeletal muscle -actin. This finding provides further support for the hypothesis that dilution of mutant skeletal muscle -actin in dominant ACTA1 disease by up-regulation of cardiac -actin may be a viable therapy for this group of devastating muscle diseases. The research contained herein has advanced the understanding of the pathobiology of skeletal muscle -actin diseases and provides strong evidence in support of cardiac -actin up-regulation as a promising therapy for these diseases.

Les myopathies congénitales sont des maladies neuromusculaires dont le diagnostic est établi grâce aux données cliniques, histologiques et génétique. Cependant, le diagnostic génétique est manquant pour la moitié des patients, ce qui suggère de nouveaux gènes impliqués. Le but de mon projet était d'identifier de nouveaux gènes de myopathies congénitales et de valider l'impact des mutations trouvées. En utilisant une stratégie d'analyse de séquençage d'exomes de patients déjà exclus pour les gènes connus, nous avons mis en évidence deux nouveaux gènes impliqués dans les myopathies congénitales. Des mutations récessives dans le gène PYROXD1, codant pour une oxydoréductase, causent une myopathie apparaissant à l'enfance avec des défauts spécifiques en histologie. Grâce à un modèle animal, nous avons montré que les mutations impactaient l'activité enzymatique de la protéine. Des mutations dominantes ou récessives dans le gène CACNA1S causent une myopathie avec un phénotype similaire pour toutes les mutations. Les études fonctionnelles ont montré que les mutations causaient un défaut dans le couplage excitation-contraction. / Congenital myopathies are neuromuscular diseases diagnosed by clinical, histological and genetic data. However, the genetic diagnosis is missing for half of the patients, suggesting new genes involved. The goal of my project was to identify new genes of congenital myopathies and validate the impact of the mutations. Using a strategy of analyzing DNA sequencing of patients already excluded for known genes, we have identified two new genes involved in congenital myopathies. Recessive mutations in the PYROXD1 gene, encoding an oxidoreductase, cause a myopathy with childhood-onset and a histology specific spectra. Functionnal studies showed that the mutations have an effect on the enzymatic activity of the protein. We showed that dominant or recessive mutations in the CACNA1S gene cause a neonatal onset myopathy with a similar phenotype for all found mutations.

Novas abordagens terapêuticas vêm sendo introduzidas para doenças musculares genéticas como distrofias musculares e miopatias congênitas, distúrbios que permanecem sem cura até o momento. Estes recentes avanços motivaram um interesse renovado e crescente por métodos não invasivos para a caracterização e monitoramento do músculo afetado, particularmente durante e após intervenções terapêuticas. Neste contexto, modelos animais são essenciais para uma melhor compreensão dos mecanismos das doenças e para testar novas terapias. Recentemente, avanços significativos na avaliação não invasiva de modelos murinos para doenças musculares genéticas foram alcançados. Entretanto, diversas linhagens de camundongos ainda não foram caracterizadas de maneira não invasiva, e ainda é necessário o desenvolvimento de métodos sensíveis para a identificação precoce de alterações sutis no músculo de camundongos afetados. A proposta desta tese é aplicar técnicas não invasivas inovadoras no estudo do músculo de modelos murinos para doenças musculares genéticas com fenótipos variados. Três modelos murinos para distrofias musculares (mdx, Largemyd, mdx/ Largemyd) e um modelo murino para miopatia congênita (KI-Dnm2R465W) foram estudados com métodos de Ressonância Magnética Nuclear (RMN). Duas linhagens distróficas (Largemyd, mdx/ Largemyd) e camundongos normais após injúria foram estudados através de micro-Tomografia Computadorizada (micro-CT). Em RMN, todas as linhagens de camundongos afetados apresentaram aumento de T2 muscular, o que foi relacionado a diversas anomalias na análise histológica, como necrose e inflamação, mas também a conjuntos de fibras em regeneração ou a fibras com citoarquitetura alterada. A combinação de RMN com análise de textura permitiu a identificação não ambígua de todas as linhagens distróficas, sendo que apenas a comparação dos valores de T2 muscular não permitiu esta diferenciação. Camundongos mdx mostraram alterações funcionais e morfológicas na rede vascular do músculo. Estudo piloto em camundongos KI-Dnm2R465W revelou tendências de comprometimento da função muscular. Por fim, imagens de micro-CT não permitiram a detecção de diferenças na composição muscular em camundongos distróficos. Este conjunto de resultados não apenas enriquece o painel de modelos murinos para doenças musculares genéticas caracterizados de maneira não invasiva, mas também demonstra um certo grau de especificidade nas anomalias observadas nas imagens, como revelado pela análise de textura. Estes resultados também mostraram que métodos não invasivos de RMN podem ser suficientemente sensíveis para identificar alterações sutis no fenótipo muscular murino, mesmo em estágios precoces. Esta tese foi desenvolvida sob acordo de co-tutela internacional entre a França e o Brasil, e compreendeu uma importante transferência de conhecimento, com os primeiros estudos não invasivos de músculo murino realizados no Brasil. / Novel therapeutic approaches are being introduced for genetic muscle diseases such as muscle dystrophies and congenital myopathies, all of them having remained without cure so far. These recent developments have motivated a renewed and augmented interest in non-invasive methods for muscle characterization and monitoring, particularly during and after therapeutic intervention. In this context, animal models are essential to better understand the disease mechanisms and to test new therapies. Recently, significant advances in the non-invasive evaluation of mouse models for genetic muscle diseases have been achieved. Nevertheless, there were still several mouse strains not characterized non-invasively, and it was necessary to develop sensitive methods to identify subtle alterations in the murine affected muscle. The purpose of this thesis was to apply non-invasive techniques in the study of murine models for genetic muscle diseases with variable phenotypes. Three mouse models for muscle dystrophy (mdx, Largemyd, mdx/ Largemyd) and one mouse model for congenital myopathy (KI-Dnm2R465W) were studied with Nuclear Magnetic Resonance (NMR) methods. Two dystrophic strains (Largemyd, mdx/ Largemyd) and normal mice after injury were studied through micro-Computed Tomography (micro-CT). On NMR, all affected mouse strains presented increased muscle T2, which could be related to variable features in the histological evaluation, including necrosis and inflammation, but also to clusters of fibers under regeneration or with altered cytoarchitecture. The combination of NMR and texture analyses allowed the unambiguous differential identification of all the dystrophic strains, although it was not feasible when comparing the muscle T2 measurements only. Mdx mice showed functional and morphological alterations of vascular network. In the KI-Dnm2R465W mice, a pilot study revealed tendencies of functional impairment. Finally, micro-CT images were unable to detect differences in muscle´s content in dystrophic mice. Altogether, these results not only increased the number of murine models for genetic muscle diseases non-invasively characterized, it also demonstrated some degree of specificity of the imaging anomalies, as revealed by texture analysis. It also showed that non-invasive NMR methods can be sensitive enough to identify subtle alterations in murine muscle phenotype, even in early stages. This thesis was developed under an international joint supervision between France and Brazil, and comprised an important transfer of technology, with the first non-invasive studies of murine muscles performed in Brazil.