Introdução: No Brasil há carência de instrumentos validados para a análise do curso da Demência Frontotemporal (DFT). Dessa forma, torna-se relevante a validação da Escala de Estadiamento e Progressão da Demência Frontotemporal (FTD-FRS). Em nosso meio, as escalas de estadiamento das demências, como a Clinical Dementia Rating (CDR), foram elaboradas para graduar a doença de Alzheimer (DA) e não incluem os sintomas específicos da DFT. Objetivos: 1. Realizar a tradução, adaptação transcultural e validação da FTD-FRS para o contexto brasileiro. 2. Avaliar a capacidade da FTD-FRS detectar alterações em pacientes com DFTvc, afasia progressiva primária (APP) e DA após 12 meses da avaliação inicial, em comparação com a escala CDR para DLFT, e com a CDR original. Métodos: Participaram do estudo 101 indivíduos com idade igual ou superior a 40 anos, com escolaridade formal acima de dois anos, sendo 31 pacientes com diagnóstico de DFT variante comportamental (DFTvc), doze pacientes com afasia progressiva primária (APP), 28 pacientes com doença de Alzheimer (DA), oito com comprometimento cognitivo leve (CCL) e 22 controles normais (CN). Foram entrevistados os familiares ou cuidadores que tinham contato frequente com o paciente. Os pacientes com DA, e com os subtipos de DFT foram pareados quanto à gravidade da doença, segundo a CDR. Resultados: Foi realizado o processo de adaptação transcultural da FTD-FRS. Consistiu em: tradução, retrotradução (realizadas por tradutores independentes), discussão com especialistas sobre a versão em português e equivalência com a versão original, e desenvolvimento da versão final. A consistência interna da FTD-FRS, estimada pelo alfa de Cronbach foi 0,975, e o coeficiente de correlação intra-classe, para a estabilidade no teste e reteste em seis meses foi de 0,977. A análise fatorial revelou a existência de quatro fatores que se correlacionaram significativamente com os domínios da CDR-DLFT. Os pacientes com DFTvc apresentaram progressão mais rápida em 12 meses do que os demais subtipos de demência na FTD-FRS, na CDR-DLFT e na CDR-original. Considerações finais: A FTD-FRS tem propriedades psicométricas adequadas para seu uso clínico no Brasil. Este instrumento pode auxiliar na caracterização de sintomas clínicos relevantes para o diagnóstico e estadiamento da DFT. Também pode documentar os resultados relacionados à intervenção terapêutica. Este estudo fornece aos clínicos e pesquisadores um instrumento válido para estadiamento e acompanhamentode de pacientes diagnosticados com DFT / Introduction: In Brazil there is a shortage of validated instruments for the analysis of the course of Frontotemporal Dementia (FTD). Thus, the validation of the Frontotemporal Dementia Staging and Progression Scale (FTD-FRS) becomes relevant. In our setting, dementia staging scales, such as the Clinical Dementia Rating (CDR), were designed to stage Alzheimer\'s disease (AD) and did not include the specific symptoms of FTD. Objectives: 1. To perform the translation, cross-cultural adaptation and validation of the FTD-FRS for the Brazilian context. 2. Evaluate the ability of the FTD-FRS to detect changes in patients with bvFTD, primary progressive aphasia (PPA) and AD after 12 months of the initial evaluation, compared to the CDR scale for FTLD, and with the original CDR. Methods: A total of 101 individuals aged 40 years and older, with formal schooling above two years of age, were included in the study. Twenty-one patients were diagnosed with bvFTD, twelve patients with PPA, 28 AD, eight with mild cognitive impairment (MCI) and 22 normal controls (NC). Family members or caregivers who had frequent contact with the patient were interviewed. Patients with AD and with FTD subtypes were matched for disease severity, according to CDR. Results: The process of cross-cultural adaptation of the FTD-FRS was carried out. It consisted of: translation, back-translation (carried out by independent translators), discussion with experts about the Portuguese version and equivalence with the original version, and development of the final version. The internal consistency of the FTD-FRS, estimated by the Cronbach\'s alpha was 0.975, and the intra-class correlation coefficient for the test and retest stability at six months was 0.977. Factor analysis revealed the existence of four factors that correlated significantly with the CDR-DLFT domains. Patients with bvFTD showed faster progression at 12 months than the other dementia subtypes in the FTD-FRS, CDR-DLFT and CDR-original version scales. Final considerations: FTD-FRS has psychometric properties suitable for clinical use in Brazil. This instrument may aid in the characterization of clinical symptoms relevant to the diagnosis and staging of FTD. It can also document the results related to therapeutic interventions. This study provides clinicians and researchers with a valid instrument for staging and follow-up of patients diagnosed with FTD

Introdução: A demência frontotemporal (DFT) inclui a variante comportamental da demência frontotemporal (vcDFT), a variante semântica da afasia progressiva primária (vsAPP), e a variante não fluente da APP (vnfAPP). Os genes em que são encontradas mutações causadoras de DFT mais frequentemente são: GRN (que codifica a progranulina), MAPT (que codifica a proteína tau) e C9orf72. Métodos: Foram incluídos probandos diagnosticados com vcDFT, vsAPP ou vnfAPP, com base com os critérios diagnósticos mais recentes, e um grupo de indivíduos cognitivamente normais. Os éxons 2-12 de GRN e os éxons 1, 9-13 de MAPT foram sequenciados pelo método de Sanger, e foi realizada dosagem de progranulina no plasma. Resultados: foram incluídos 62 probandos, sendo 44 com vcDFT, 9 com vsAPP, e 9 com vnfAPP. Antecedente familiar de demência foi positivo em 45,1% dos probandos, e de DFT, em 24,1%. Os 60 indivíduos do grupo controle tinham idade média de 60,8±8,5 anos. Foram identificadas seis mutações nulas em GRN (p.Q130X, p.V200Gfs*18, p.Q257Pfs*26, p.Q300X, p.S301Cfs*60 e p.D317Afs*11) e uma mutação patogênica em MAPT (p.N279K). A dosagem média de progranulina plasmática nos pacientes com mutações de GRN foi de 29,8±11,9ng/ml Conclusões: A frequência de mutações patogênicas em GRN nesta casuística foi de 9,6%, e a de mutações em MAPT foi de 1,6%. Entre casos familiais de DFT, a frequência de mutações em GRN foi de 33,3%, e em MAPT foi de 6,7%. Duas das mutações encontradas em GRN (p.Q130X e p.D317Afs*11) ainda não foram descritas em casos de DFT. O valor de corte de 70ng/ml identificou as mutações nulas de GRN com sensibilidade e especificidade de 100% / Introduction: Frontotemporal dementia (FTD) encompasses behavioral variant of frontotemporal dementia (bvFTD), semantic variant of primary progressive aphasia (svPPA), and nonfluent variant PPA (nfvPPA). The genes in which FTD-causing mutations are most frequently found are: GRN (which encodes progranulin), MAPT (which encodes tau protein) and C9orf72. Methods: We included probands diagnosed with bvFTD, svPPA or nfvPPA, based on the most recent diagnostic criteria, and a group of cognitively normal individuals. GRN exons 2-12 and MAPT exons 1, 9-13 were sequenced by the Sanger method, and plasma progranulin levels were measured. Results: we included 62 probands (44 with bvFTD, 9 with svPPA, and 9 with nfvPPA). Family history of dementia was positive in 45.1% of probands, and of DFT, in 24.1%. The control group of 60 individuals had a mean age of 60.8±8.5 years. Six null GRN mutations were identified in (p.Q130X, p.V200Gfs*18, p.Q257Pfs*26, p.Q300X, p.S301Cfs*60 e p.D317Afs*11) and one MAPT pathogenic mutation (p.N279K). The mean plasma progranulin level in patients with GRN mutations was 29.8±11,9ng/ml. Conclusions: The frequency of pathogenic mutations in GRN was 9.6%, and of MAPT mutations was 1.6%. Among cases of familial FTD, the frequency of GRN mutations was 33.3%, and of MAPT mutations was 6.7%. Two of the mutations found in GRN (p.Q130X and p.D317Afs*11) are novel. The cutoff value of 70ng/ml identified null GRN mutations with sensitivity and specificity of 100%

Para avaliar a eficácia do método de pré-degeneração em nervos ciáticos de ratos durante diferentes intervalos de tempo, foram realizados estudos histomorfométricos de cortes laminares obtidos ao nível do enxerto e no segmento distal do nervo receptor. Os resultados foram comparados com a técnica convencional de enxertia nervosa. Verificou-se que o tempo de pré-degeneração interfere na regeneração de novos axônios e que o período mais adequado para sua utilização situou-se ao redor de 2 semanas no modelo experimental adotado / In order to evaluate the efficacy of a predegeneration method in rat sciatic nerves during different periods of time, histomorphometric studies were performed at the graft and distal segment sites of the recipient nerves. The results were compared with the conventional nerve grafting technique. It was shown that the period of predegeneration interfered in the regeneration of new axons and the most favorable time for its use is around 2 weeks, in this experimental model

Abstract Frontotemporal lobar degeneration (FTLD) is the second most common neurodegenerative disease leading to early-onset dementia (< 65 years), next to Alzheimer’s disease. FTLD is substantially a genetic disorder with up to 50% of cases having a positive family history. Mutations in the genes microtubule-associated protein tau (MAPT) and progranulin (PGRN) account for about 10–20% of all cases of FTLD. Hexanucleotide repeat expansion mutation within the gene C9ORF72 has recently been identified as the major cause of FTLD, FTLD with amyotrophic lateral sclerosis (ALS) and pure ALS. During this study, hexanucleotide repeat expansion within the C9ORF72 gene was shown to explain nearly 50% of familial and 30% of all FTLD cases in the Finnish population. Otherwise, the genetic background of Finnish FTLD is largely unknown. The object of the present work was to disentangle the genetic aetiology of FTLD in the Finnish population. We studied a cohort of patients with a clinical diagnosis of FTLD from the province of Northern Ostrobothnia, Finland. Sequencing analysis of the genes MAPT, charged multi-vesicular body protein 2B (CHMP2B) and TAR DNA binding protein (TARDBP) were performed and the MAPT haplotypes were analysed. Correlations between genotype and phenotype were studied in patients with C9ORF72 repeat expansion mutation. C9ORF72 expansion mutation explained nearly 30% of cases of FTLD in our cohort. Concomitant ALS and positive family history of the disease increased the possibility of carrying expanded C9ORF72. The clinical phenotype of C9ORF72 expansion carriers varied at presentation: both behavioural and language variants were detected with or without ALS. The behavioural presentations included prominent psychotic features, although psychiatric presentations were not overrepresented in expansion carriers. No pathogenic mutations were identified in the MAPT, CHMP2B and TARDBP genes in our series of FTLD patients. The H2 MAPT haplotype was associated with FTLD in the series. Our findings emphasise the importance of C9ORF72 expansion mutation in FTLD. While mutations in MAPT and PGRN cause a significant proportion of cases of FTLD worldwide, they seem to be rare causes of FTLD in the Finnish population. Besides being infrequent in other populations, mutations in CHMP2B and TARDBP are rare causes of FTLD in the Finnish population as well. Our findings have clinical implications for recognising phenotypic features characteristic of expanded C9ORF72 as well as for genetic counselling of Finnish patients with FTLD. Even though a considerable proportion of our cases of familial FTLD is caused by the C9ORF72 expansion, over 50 % of our familial cases are without a molecular genetic diagnosis, suggesting that there are other unidentified causal genes to be found. / Tiivistelmä Otsa-ohimolohkorappeumat on toiseksi yleisin työikäisten dementiaa aiheuttava etenevä aivojen rappeumasairaus. Toisinaan otsa-ohimolohkorappeumat esiintyvät yhdessä liikehermorappeuman, amyotrofisen lateraaliskleroosin (ALS), kanssa. Perinnöllisillä tekijöillä on todennäköisesti keskeinen merkitys taudin taustalla. Mutaatiot microtubule-associated protein tau (MAPT)- ja progranulin (PGRN) geeneissä aiheuttavat yhteensä 10–20 % otsa-ohimolohkorappeumista maailmalla. C9ORF72-geenissä sijaitsevan toistojaksomonistuman on vastikään todettu olevan yleisin otsa-ohimolohkorappeumia ja ALS:a aiheuttava mutaatio. Mutaatio on erityisen yleinen suomalaisessa väestössä selittäen lähes 50 % suvuittaisista ja 30 % kaikista otsa-ohimolohkorappeumista. Oireyhtymän perinnöllisyys on muutoin huonosti tunnettu suomalaisessa väestössä. Tutkimuksen tavoitteena oli selvittää otsa-ohimolohkorappeumien geneettisiä syitä aineistossa, joka koostui vuosina 1999–2010 Oulun yliopistollisessa sairaalassa tutkituista potilaista. Tutkimuksessa selvitettiin MAPT-, charged multi-vesicular body protein 2B (CHMP2B)- ja TAR DNA-binding protein (TARDBP) geenien mutaatioiden esiintyvyyttä ja määritettiin MAPT-geenin haplotyypit. Lisäksi tutkittiin taudin kliinisiä erityispiirteitä C9ORF72-mutaation kantajilla. C9ORF72-mutaatio selitti lähes 30 % otsa-ohimolohkorappeumista aineistossamme. Tutkimuksessa havaittiin, että suvuittain esiintyvä tautimuoto ja ALS yhdistyneenä otsa-ohimolohkorappeumaan liittyivät merkittävästi C9ORF72-mutaatioon. Monistuman kantajien fenotyyppi oli moninainen – ensioireina oli sekä käytösongelmia että kielellisiä vaikeuksia. Vaikka C9ORF72-mutaation kantajilla on kuvattu runsaasti psykoottisia oireita, psykoottiset oireet eivät olleet selvästi yliedustettuna mutaation kantajilla aineistossamme. Tutkimuksessa ei löydetty tautia aiheuttavia mutaatioita MAPT-, CHMP2B- tai TARDBP-geeneistä. Havaitsimme kuitenkin tilastollisesti merkittävän yhteyden MAPT-geenin H2-haplotyypin ja otsa-ohimolohkorappeumien välillä. Tuloksemme antavat uutta tietoa C9ORF72-mutaation kantajien kliinisistä erityispiirteistä. MAPT-geenin mutaatioiden merkitys otsa-ohimolohkorappeumien synnyssä ei näyttäisi olevan suomalaisessa väestössä niin merkittävä kuin muissa väestöissä. CHMP2B- ja TARDBP-mutaatiot ovat harvinainen oireyhtymän syy myös suomalaisessa väestössä. Tuloksiamme voidaan hyödyntää suomalaisten otsa-ohimolohkorappeumapotilaiden perinnöllisessä neuvonnassa. Huomattavista edistysaskelista huolimatta yli puolet suvuittain esiintyvistä tautitapauksistamme on vailla geneettistä diagnoosia, mikä antaa aihetta jatkotutkimuksille.

La dégénérescence maculaire liée à l’âge ou DMLA représente la première cause de cécité légale dans les pays industrialisés. C’est une affection multifactorielle (facteurs environnementaux et génétiques), caractérisée par la dégénérescence des photorécepteurs et une dysfonction de l’épithélium pigmentaire de la rétine (EPR). La présence de dépôts sous-rétiniens, les drusen, qui sont un facteur de risque de développer la DMLA contiennent de l’amyloïde-b (Ab), le peptide neurotoxique impliqué dans la maladie d’Alzheimer (MA) et le facteur H du complément (CFH), qui est un des inhibiteurs solubles majeurs de l’activation de la voie du complément. L’Aβ est capable de lier le CFH et il existe une corrélation inverse entre les taux de CFH et d’Aβ dans le cerveau et la rétine de modèles murins de la MA, de plus, le polymorphisme H402Y dans le gène codant pour le CFH est associé à la moitié des cas de DMLA et est aussi un facteur de risque pour la MA. Au début de ma thèse, rien n’était connu sur les fonctions de la protéine précurseur de l’amyloïde β (APP), et du CFH dans la rétine. Ainsi, le but de ma thèse a été d’étudier d’une part le rôle physiologique de l’APP au cours de la différenciation de la rétine et à l’âge adulte chez la souris, et d’autre part le CFH dans la rétine normale chez la souris normale adulte et chez la souris Rd10, un modèle de dégénérescence des photorécepteurs. Nous avons montré par l’utilisation d’une souris dont le gène de l’APP est invalidé (APPko), une diminution stable de 35% de nombre de cellules amacrines glycinergiques et de 36% de celui des cellules bipolaires, associé à une désorganisation importante des laminations des synapses au stade adulte, et une augmentation transitoire à 50% du nombre cellules horizontales au cours de la phase précoce de la différenciation rétinienne. Nous avons identifié Ptf1a, facteur de transcription indispensable à la différenciation des cellules amacrines, comme la cible de l’APP. De plus, non montrons que SorLA, le récepteur de l’APP, est indispensable à la fonction de différenciation rétinienne de l’APP. Dans la deuxième partie de mon étude, j’ai montré que le CFH protége in vitro les cellules de l’EPR contre les effets létaux du stress oxydant. Après avoir caractérisé les processus associés à la dégénérescence des photorécepteurs chez la souris Rd10 (activation gliale, microgliale, activation de l’inflammation et de la voie du complément), j’ai montré que l’injection intrapéritonéale répétée de CFH humain durant la dégénérescence protège partiellement les photorécepteurs de la mort. L’ensemble de mon étude montre pour la première fois un rôle important de l’APP dans la différenciation de la rétine et un nouveau rôle, comme antioxydant, pour le CFH, qui pourrait être un agent thérapeutique ciblant des photorécepteurs et l’EPR dans les pathologies dégénératives rétiniennes. / Age-related macular degeneration (AMD) is the first cause of central vision loss, due to photoreceptor degeneration and retinal pigmented epithelium (RPE) dysfunction. It is a multifactorial disease (genetic and environmental factors) and subretinal deposits of materials called drusen, is a major risk to develop AMD. Drusen contain amyloïd β (Aβ), the major neurotoxic peptide involved in Alzheimer disease (AD), and complement factor H (CFH), one of the major inhibitor of the complement pathway. Aβ and CFH interact and there is an inverse correlation between CFH and Aβ in the brain and retina of mouse models of AD. Polymorphism H402Y of CFH may be a cause of AMD in as many as 50% of cases. At the beginning of my thesis, nothing was known about the role of the amyloid precursor protein (APP) in the retina, as well as CFH. Therefore, the aim of my work was to investigate the retinal functions of both APP during retinal development and in adult mouse and CFH in normal mouse and in the Rd10 mouse model of photoreceptor degeneration. By using a mouse knock-out for app, we showed that APP regulates differentiation of retinal interneurons: it positively controls differentiation of glycinergic amacrine cells and bipolar cells, whereas it negatively controls differentiation of horizontal cells. Moreover, we identified the transcription factor, Ptf1-1, as a main transcriptional target of APP. Finally, we demonstrated that SorLA, an APP receptor, participates to the differentiation role of APP in the retina. In the second part of the study, I demonstrated that CFH protects RPE cells from lethal oxidative stress in cultures. Moreover, I showed that expression of CFH is very low in neural retina in comparison to the RPE/choroid/sclera complex in normal mice, and that CFH expression increases in both the neural retina and the RPE/choroid/sclera complex during photoreceptor degeneration in the Rd10 mice, suggesting an adaptive response of these tissues to degeneration. Intrapéritonéale injections of CFH partially protect photoreceptors from degeneration, suggesting a protective effect of CFH against retinal degeneration. Altogether, my study showed for the first time a physiological function of APP in the retina, and a new role for CFH in the protection of photoreceptors against degeneration, suggesting that it may be a therapeutic target against retinal degeneration.

Adult neural precursor cells (NPCs) are a heterogeneous population of mitotically active, self-renewing multipotent cells of both adult and developing CNS. They can be expanded in vitro in the presence of mitogens. The B05 transgenic SCA1 mice, expressing human ataxin-1 with an expanded polyglutamine tract in cerebellar Purkinje cells (PCs), recapitulate many pathological and behavioral characteristics of the neurodegenerative disease spinocerebellar ataxia type 1 (SCA1), including progressive ataxia and PC loss. We transplanted neural precursor cells (NPCs) derived from the subventricular zone of GFP-expressing adult mice into the cerebellar white matter of SCA1 mice when they showed absent (5 weeks), initial (13 weeks) and significant PC loss (24 weeks). A stereological count demonstrates that mice with significant cell loss exhibit highest survival of grafted NPCs and migration to the vicinity of PCs as compared to wt and younger grafted animals. These animals showed improved motor skills as compared to sham animals. Confocal analysis and profiling shows that many of implanted cells present in the cerebellar cortex have formed gap junctions with host PCs and express connexin43. Grafted cells did not adopt characteristics of PCs, but stereological and morphometric analysis of the cerebellar cortex revealed that grafted animals had more surviving PCs and a better preserved morphology of these cells than the control groups. Perforated patch clamp recordings revealed a normalization of the PC basal membrane potential, which was abnormally depolarized in sham-treated animals. No significant increase in levels of several neurotrophic factors was observed, suggesting, along with morphological observation, that the neuroprotective effect of grafted NPCs was mediated by direct contact with the host PCs. In this study, evidence for a neuroprotective effect came, in addition to motor behavior improvement, from stereological and electrophysiological analyses and suggest that timing of stem cell delivery is important to determine its therapeutic effect.<p>In a brain stem cell niche, NSCs reside in a complex cellular and extracellular microenvironment comprising their own progeny, ependymal cells, numerous blood vessels and various extracellular matrix molecules. Recently, it was reported that blood vessel ECs-NSCs crosstalk plays an important role in tissue homeostasis. Bloodstream offers a natural delivery vehicle especially in case of diffuse neurodegenerative diseases which require widespread distribution of exogenous cells. As NSCs are confronted with blood-brain barrier endothelial cells (BBB-ECs) before they can enter into brain parenchyma, we investigated their interaction using primary cultures in an in vitro BBB model. We isolated human fetal neural precursor cells (hfNPCs) from aborted fetal brain tissues and expanded in vitro. We showed that in an in vitro model, human BBB endothelium induces the rapid differentiation of hfNPCs and allows them to cross the endothelial monolayer, with the differentiated progeny remaining in close contact with endothelial cells. These results are not reproduced when using a non-BBB endothelium and are partly dependent on the cytokine MCP1. Our data suggest that, in the presence of attractive signals released by a damaged brain, intravascularly administered NPCs can move across an intact BBB endothelium and differentiate in its vicinity. Overall, our findings have implications for the development of cellular therapies for cerebellar degenerative diseases and understanding of the brain stem cell niche. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

La dégénérescence maculaire liée à l’âge ou DMLA est une pathologie oculaire qui touche près d’un million de personnes en France, et représente la première cause de cécité légale dans les pays industrialisés. C’est une affection multifactorielle (environnement, génétique), dans laquelle les stress inflammatoires, métaboliques et oxydants interviennent et aboutissent à la mort des photorécepteurs. L’apparition des drusen (dépôts de matériel extracellulaire contenant de l’amyloïde-β (Aβ)), entre les cellules de l’épithélium pigmentaire de la rétine (EPR) et la membrane de Brush, représente un facteur de risque de développement de la DMLA. De plus, le 4-hydroxynonenal (4-HNE) est un marqueur de stress oxydant dans la rétine de patients de différentes pathologies dégénératives comme la DLMA. L’identification des mécanismes moléculaires et cellulaires impliqués dans les dégénérescences rétiniennes la pathogenèse de la DMLA constitue un enjeu de santé publique, puisqu’elle permettrait de développer de nouvelles stratégies thérapeutiques anti-dégénératives.Le but de mon travail de thèse a été dans un premier temps de mieux comprendre le rôle de l’Aβ dans la dégénérescence rétinienne.Nous avons montré que l’Aβ induit une activation rapide des cellules microgliales, une gliose soutenue des cellules gliales de Müller (CGM), un œdème dans la rétine interne et une apoptose des photorécepteurs. La dégénérescence des photorécepteurs est en corrélation avec une activation soutenue de PERK, impliquée dans la voie pro-apoptotique de la réponse UPR. Par ailleurs la gliose des CGM est caractérisé par une délocalisation des canaux Kir4.1, une diminution de l’expression d’AQP4 et de la glutamine synthetase (GS), et une augmentation de l’expression des canaux Kir2.1 et du transporteur GLAST1, suggérant une dérégulation de l’homéostasie rétinienne contrôlée par ces protéines. Nous avons montré que l’inhibition de la réponse inflammatoire, par l’utilisation de l’indomethacine, un inhibiteur non stéroïdien de de la cyclooxygénase (COX) 2, réverse l’effet de l’Aβ sur l’expression des canaux Kir4.1 et sur GLAST1 mais pas celle de la GS et d’AQP4, suggérant un couplage partiel entre la gliose et la réponse inflammatoire dans notre modèle d’injection sous-rétinienne d’Aβ.Dans un deuxième temps, nous nous sommes intéressés au rôle du 4-HNE dans les CGM, un produit de peroxydation lipidique, qui est produit dans la rétine sous l’effet de l’Aβ. Nous avons observé qu’un stress oxydant unique et létal induit par le 4-HNE, entraîne la mort des CGM par apoptose dépendante de l’activation des caspases. L’utilisation d’antioxydants impliqués dans la régénération du glutathion (GSH), protège contre la mort des CGM. L’analyse du transcriptome des CGM soumises au 4-HNE a permis de mettre en évidence une réponse transcriptionnelle adaptative des CGM : une activation de la défense anti-oxydante, de la réponse UPR (unfolded protein response) au stress du réticulum endoplasmique, et un phénotype anti-inflammatoire. Par ailleurs, la surexpression de l’APP (amyloid protein precursor), dont l’expression du transcrit est augmentée sous l’effet du stress oxydant dans les CGM, protège ces cellules contre la mort induite par le 4-HNE. Cette protection est associée à une augmentation des capacités anti-oxydantes et à une activation de la voie de survie de la réponse UPR. L’ensemble de nos résultats montre un rôle de l’Aβ dans la dégénérescence des photorécepteurs et indique que le métabolisme de l’APP, ainsi que les voies de survie et pro-apoptotique de la réponse UPR pourraient constituer des cibles thérapeutiques contre la dégénérescence rétinienne induite par l’Aβ ou les stress oxydants. / Age related macular degeneration (AMD) is a leading cause of blindness in western countries and affects one million people in France. Multiple risk factors (genetics, environment) are involved in the pathogenesis of AMD. In addition, the AMD pathogenesis is strongly associated with chronic oxidative stress and inflammation that ultimately lead to photoreceptor death. AMD is characterized by the formation of drusen, extracellular deposits, including amyloid-β (Aβ), between the retinal pigmented epithelium and Bruch’s membrane. Moreover, 4-hydroxynonenal (4-HNE) is an oxidative stress marker of different retinal diseases including AMD. The determination of molecular and cell mechanisms involved in retinal degeneration and the pathogenesis of AMD is required in order to develop new therapeutic anti-degenerative approaches. The aim of our study was first to investigate the role of Aβ in retinal degeneration. We demonstrated that subretinal injection of Aβ induces an early activation of microglial cells, a sustained retinal Müller glial (RMG) cells gliosis, an oedema in the internal part of retina and photoreceptors apoptosis. The photoreceptors apoptosis was correlated with a sustained activation of PERK, a kinase implicated in the pro-apoptotic pathway of UPR (unfolded protein response). In addition, RMG gliosis has been characterized by a Kir4.1 channel redistribution, a down-regulation of AQP4 and glutamine synthetase (GS) expression, and an up-regulation of Kir2.1 channel and GLAST1 transporter expression, suggesting a dysregulation of the retinal homeostasis which is controlled by these proteins. The inhibition of the inflammatory response using indomethacin, a non-steroidal and non-specific cyclooxygenase (COX) 2 inhibitor, reversed Aβ-induced Kir4.1 channel redistribution and GLAST1 up-regulation but not GS and AQP4 down-regulation, suggesting a partial coupling between gliosis and inflammatory response in retinal degeneration after subretinal injection of Aβ in mice. The second part of our study aimed to investigate the effects on RMG cells of 4-HNE, a lipid peroxidation product that is up-regulated in retina after Aβ injection. We have shown that a single lethal oxidative stress using 4-HNE induces RMG cells apoptosis associated with caspase 3 and caspase 9 activation. Pre-treatment of RMG cells with anti-oxidative molecules involved in glutathione regeneration restored cell viability. Transcriptome analysis of RMG cells treated with 4-HNE showed an adaptive transcriptional response consisting in an activation of anti-oxidative stress cell defense, activation of UPR in response to endoplasmic reticulum stress and anti-inflammatory phenotype. APP (amyloid protein precursor) overexpression, which the transcript is up-regulated in RMG cells under oxidative stress, protects from 4-HNE-induced cell death. This protection is associated with an up-regulation of anti-oxidative cell defense and an activation of the pro-survival pathway of UPR. Our study pinpoints the role of Aβ in photoreceptors degeneration and suggests that targeting APP metabolism, pro and anti-apoptotic pathways of the UPR response may hel develop selective methods against retinal degeneration implicating Aβ and oxidative stress.

La longévité est un enjeu majeur des prochaines décennies. La conséquence de cette longévité est l’émergence des maladies chroniques. Il est aujourd’hui admis que le vieillissement individuel est fortement influencé par des variables biologiques, psychologiques, environnementales et sociales. La prévention commence à la naissance pour se poursuivre tout au long de la vie. C’est pourquoi, une consultation de prévention à des moments clés du parcours de vie notamment au moment de la retraite est largement conseillée. Notre travail de doctorat a consisté, grâce à la mise en place de plusieurs recherches-actions dans les Centres d’examens de santé de l’Assurance maladie, à documenter par la preuve scientifique, démarche qui rejoint celle de l’Evidence-Based Medecine, la construction d’un examen périodique de santé dédié aux séniors. Les recherches-actions ont concerné trois problématiques de santé publique des personnes âgées que sont la chute, les troubles cognitifs et la dégénérescence maculaire liée à l’âge. Chaque recherche-action a apporté sa contribution à la construction de cet examen de santé senior : une meilleure connaissance des caractéristiques des chuteurs avec élaboration d’un score prédictif de chute et de stratégies de prise en charge de ce risque, des outils simples de repérage des troubles cognitifs légers, un dépistage de la dégénérescence maculaire liée à l’âge via la télémédecine. D’autres thématiques de santé seront à explorer mais les Centres d’examens de santé se positionnent d’ores et déjà, comme des acteurs déterminants de la prise en charge des populations vieillissantes / The increase of life expectancy is a major issue to face in the decades to come. A consequence of this increasing life expectancy is the emergence of chronic diseases. It is now acknowledged that individual ageing is strongly influence by biological, psychological, environmental and social variables. Prevention begins at birth and continues throughout life. It is for this reason, that a prevention consultation at certain key moments in life, such as at retirement, is strongly advised. Our doctorate work consisted of documenting the setup of periodic health examinations dedicated to seniors. This was supported by scientific proof provided by carrying out many action researches in the Health Examination centres of French Health Insurance, an approach similar to ‘Evidence Based Medicine’. The action researches were directed towards three main public health issues amongst the elderly which include falling, memory cognitive impairment and macular degeneration related to age. Each action research contributed to the establishment of this health examination for seniors. Indeed, now there is a better recognition of characteristics amongst seniors who have suffered falls thanks to the development of a tool which gives a predictive score a falling, and in turn action strategies. In addition, there is a tool to spot and identify mild cognitive impairment and screening for macular degeneration related to age through the use of telemedicine. Other health topics will need to be explored but French Health Examination Centres already position themselves as responsible decisive actors for the ageing population

Many neurodegenerative diseases are characterized by the accumulation of misfolded proteins that often share common morphological and biochemical features, and can similarly co-localize with several other proteins, including various chaperone proteins. Chaperone proteins, like heat shock protein 27 (HSP27), heme oxygenase 1 (HO-1) and clusterin, have been implicated as potent modulators of misfolded proteins, thus may play important roles in the pathogenesis of neurodegenerative diseases. The present study aims to investigate their roles in the pathogenesis of Frontotemporal lobar degeneration (FTLD), Alzheimer's disease (AD), Parkinson's disease (PD), and Motor neuron disease (MND) by determining their distribution and amount via immunohistochemical staining and western blotting in diseased and control subjects.There were distinct patterns of HSP27 and clusterin immunostaining in different brain regions. For HSP27, patients with AD and FTLD were in general more severely affected than were patients with MND and control subjects. For clusterin, patients with AD and FTLD were more severely affected than control subjects where neurons and glial cells were concerned, while patients with AD and control subjects were more severely affected than those with FTLD where diffuse and cored plaques were concerned. However, there were no obvious differences in the pattern of HO-1 immunostaining in various brain regions in patients with AD or FTLD relative to control subjects. Moreover, there was no association between HSP27, HO-1 and clusterin with disease or histological type, and the ‘classic’ neuropathological changes in FTLD, AD and MND were not immunoreactive to any of these proteins. There were significant correlations between the degrees of HO-1 and clusterin immunostaining in many brain areas for both AD and FTLD cases, and for all cases overall, but none between HSP27 and clusterin or HSP27 and HO-1. Present results suggest an involvement with ongoing cellular stress, misfolded or unfolded protein accumulation or the deficits/failure of other relevant protein quality control systems, in the pathogenesis of these neurodegenerative diseases. Present work may therefore have implications for the further development of ideas concerning the cause or treatment of neurodegenerative diseases where there is aberrant accumulation of misfolded, aggregated protein, and perhaps for conformational diseases in general. However, there are still many issues remain to be elucidated. Further research aimed at understanding the function and mechanisms of the chaperone system, and other protein quality control mechanisms, in the pathogenesis of neurodegenerative diseases is still needed.

O disco intervertebral é uma estrutura cuja função é receber, amortecer e distribuir o impacto das cargas impostas sobre a coluna vertebral. O aumento da idade e a postura adotada pelo indivíduo podem levar à degeneração do disco intervertebral. Atualmente, a Ressonância Magnética (RM) é considerada o melhor e mais sensível método não invasivo de avaliação por imagem do disco intervertebral. Neste trabalho foram desenvolvidos métodos quantitativos computadorizados para auxílio ao diagnóstico da degeneração do disco intervertebral em imagens de ressonância magnética ponderadas em T2 da coluna lombar, de acordo com a escala de Pfirrmann, uma escala semi-quantitativa, com cinco graus de degeneração. Os algoritmos computacionais foram testados em um conjunto de dados que consiste de imagens de 300 discos, obtidos de 102 indivíduos, com diferentes graus de degeneração. Máscaras binárias de discos segmentados manualmente foram utilizadas para calcular seus centroides, visando criar um ponto de referência para possibilitar a extração de atributos. Uma análise de textura foi realizada utilizando a abordagem proposta por Haralick. Para caracterização de forma, também foram calculados os momentos invariantes definidos por Hu e os momentos centrais para cada disco. A classificação do grau de degeneração foi realizada utilizando uma rede neural artificial e o conjunto de atributos extraídos de cada disco. Uma taxa média de acerto na classificação de 87%, com erro padrão de 6,59% e uma área média sob a curva ROC (Receiver Operating Characteristic) de 0,92 indicam o potencial de aplicação dos algoritmos desenvolvidos como ferramenta de apoio ao diagnóstico da degeneração do disco intervertebral. / The intervertebral disc is a structure whose function is to receive, absorb and transmit the impact loads imposed on the spine. Increasing age and the posture adopted by the individual can lead to degeneration of the intervertebral disc. Currently, Magnetic Resonance Imaging (MRI) is considered the best and most sensitive noninvasive method to imaging evaluation of the intervertebral disc. In this work were developed methods for quantitative computer-aided diagnosis of the intervertebral disc degeneration in MRI T2 weighted images of the lumbar column according to Pfirrmann scale, a semi-quantitative scale with five degrees of degeneration. The algorithms were tested on a dataset of 300 images obtained from 102 subjects with varying degrees of degeneration. Binary masks manually segmented of the discs were used to calculate their centroids, to create a reference point to enable extraction of attributes. A texture analysis was performed using the approach proposed by Haralick. For the shape characterization, invariant moments defined by Hu and central moments were also calculated for each disc. The rating of the degree of degeneration was performed using an artificial neural network and the set of extracted attributes of each disk. An average rate of correct classification of 87%, with standard error 6.59% and an average area under the ROC curve (Receiver Operating Characteristic) of 0.92 indicates the potential application of the algorithms developed as a diagnostic support tool to the degeneration of the intervertebral disc.