La dystrophie myotonique de type 1 (DM1), est une maladie génétique héréditaire affectant environ 1/8000 personnes. Les patients souffrant de DM1 développent essentiellement des troubles musculaires tels qu’une faiblesse et une atrophie musculaire. La cause de la DM1 est expliquée par la mutation du gène "DMPK". Lors de ma thèse, j’ai pu démontrer que l’épissage de l’ARNm BIN1 était altéré dans le muscle DM1. En effet, l’exon 7 de BIN1, qui est absent du muscle normal, est exprimé de façon aberrante chez les patients DM1. En utilisant un modèle murin, j’ai prouvé que l’expression forcée de l’exon 7 de BIN1 altérait simultanément la structure et la fonction du muscle. Nous avons notamment observés une diminution de la taille des fibres musculaires et une augmentation de la faiblesse musculaire, comparé à des souris normales. Par conséquent, ce travail aidera à la compréhension du mécanisme de la maladie et pourrait expliquer les causes de la faiblesse musculaire et de l’atrophie. / Myotonic dystrophy of type 1 (DM1), is an inherited genetic disease affecting around 1 in 8000 person. Patients suffering from DM1 develop essentially muscle disorders such as muscle weakness, muscle loss and atrophy. The cause of DM1 is explained by the mutation of a gene called “DMPK“.During my thesis, I discovered that the alternative splicing of BIN1 mRNA was altered in the muscle of DM1 patients. Indeed, the BIN1 exon 7, which is normally absent in healthy muscle, is aberrantly expressed in DM1 muscle. By using a mouse model, I found that the forced expression of BIN1 exon 7 was responsible of the alteration of both muscle structure and function. Notably, we found a decrease in muscle fibers area (atrophy) and an increase of muscle weakness, compared to wild-type mice. Therefore, this work will help in the understanding of the disease mechanism and could explain the causes of muscle weakness and atrophy, which have never been elucidated to this date.

Les myopathies centro-nucléaires (CNM) sont un groupe de maladies musculaires sévères caractérisées par une faiblesse musculaire générale. La forme la plus sévère est la CNM liée à l’X (XLCNM), causée par des mutations de la Myotubularine (MTM1). D’autres formes autosomales existent et sont causées par des mutations de l’Amphiphysine2 (BIN1) et de la Dynamine2 (DNM2). Les mécanismes pathologiques menant aux CNMs restent à éclaircir et à ce jour aucune thérapie n’est disponible pour traiter les patients. Nous avons modulé les niveaux de protéines de MTM1, BIN1 et DNM2 dans des modèles murins de CNMs. Nous avons découvert que la sous-régulation de DNM2 sauvait le modèle murin de XLCNM et que la sur-expression de la protéine BIN1 humaine sauvait le modèle murin XLCNM ainsi que la forme autosomale causée par les mutations DNM2. Nous avons montré que MTM1 contrôlait l’adhésion cellulaire et le recyclage de l’intégrine dans les cellules musculaires. Nous avons observé que la sur-expression de BIN1 sauvait la dérégulation du recyclage de l’intégrine dans le modèle murin de XLCNM, ce qui suggère un lien fonctionnel entre BIN1 et MTM1 nécessaire pour l’adhésion focale au niveaux musculaire. Notre étude montre que MTM1, BIN1 et DNM2 participe à une voie de signalisation commune et que BIN1 et DNM2 représentent de nouvelles cibles thérapeutiques pour le traitement des CNM. / Centronuclear myopathies (CNM) are a group of severe muscle disorder characterized by general muscle weakness. The most severe form is the X-linked CNM (XLCNM), caused by mutations in Myotubularin (MTM1). Others autosomal forms are caused by mutations in Amphiphysin 2 (BIN1) and Dynamin 2 (DNM2). The CNM pathomechanisms are still unclear and to date there are no therapies available to the disease. To investigate the pathways dysregulated in CNM and to identify new therapeutic strategies, we modulated MTM1, BIN1 and DNM2 protein levels in the CNM mouse models. We discovered that DNM2 downregulation rescued the XLCNM mouse model and that the overexpression of human BIN1 rescued the XLCNM and the autosomal dominant CNM form due to DNM2 mutations. We have also showed that MTM1 controls cell adhesion and integrin recycling in mammalian skeletal muscle and BIN1 overexpression rescued the integrin recycling alteration in XLCNM mouse model suggesting that MTM1 and BIN1 are functionally linked and necessary for focal adhesions in muscle. Therefore, our studies highlight that MTM1, BIN1 and DNM2 are in a common pathway and, BIN1 and DNM2 could be new therapeutic targets to treat the different CNM forms.

Centronuclear myopathy (CNM) is a genetically heterogeneous disorder associated with general skeletal muscle weakness, type I fiber predominance and atrophy, and abnormally centralized nuclei. Autosomal dominant CNM is due to mutations in the large GTPase dynamin 2 (DNM2), a mechanochemical enzyme regulating cytoskeleton and membrane trafficking in cells. To date, 40 families with CNM-related DNM2 mutations have been described, and here we report 60 additional families encompassing a broad genotypic and phenotypic spectrum. In total, 18 different mutations are reported in 100 families and our cohort harbors nine known and four new mutations, including the first splice-site mutation. Genotype-phenotype correlation hypotheses are drawn from the published and new data, and allow an efficient screening strategy for molecular diagnosis. In addition to CNM, dissimilar DNM2 mutations are associated with Charcot-Marie-Tooth (CMT) peripheral neuropathy (CMTD1B and CMT2M), suggesting a tissue-specific impact of the mutations. In this study, we discuss the possible clinical overlap of CNM and CMT, and the biological significance of the respective mutations based on the known functions of dynamin 2 and its protein structure. Defects in membrane trafficking due to DNM2 mutations potentially represent a common pathological mechanism in CNM and CMT.

Examination of the genes DNM2, GARS, MORC2, TRPV4 and SOD1 among Czech patients with hereditary neuropathy axonal type For my PhD thesis I chose to work with patients with axonal form of CMT, because at that time axonal forms were less likely to be clarified by classical methods of molecular genetics. For further examination in patients with unclear cause of the axonal CMT, the genes DNM2, GARS and TRPV4 were selected. The aim was to determine the significance of pathogenic mutations in these genes as the cause of CMT2 in Czech patients. In the course, we identified causal variants in the genes MORC2 and SOD1 with WES. Therefore, we have tested additional CMT2 patients for the presence of these variants. Using Sanger sequencing, I examined a representative set of patients for the DNM2 (37), GARS (10) and TRPV4 (24) genes without finding a causal mutation, then we investigated genes SOD1 (43 patients) and MORC2 (161 patients). The cohort (50 patients) was also subjected to MLPA analysis using a P406-A1 CMT2 duplication and deletion detection kit for genes RAB7A, GARS, HSPB1, HSBP8 and SPTLC1 (kit P406-A1 CMT2). At that time, massively parallel sequencing (MPS) was becoming important. We compared the cost of classical sequencing versus MPS, and accordingly, we decided that the genes DNM2, GARS, MORC2, TRPV4...