Multiple Sclerosis (MS) is an inflammatory disease which causes areas of demyelination in the Central Nervous System (CNS) and affects only humans. Current therapies for MS are focused on anti-inflammatory treatment, which reduce the occurrence and clinical relapses of the disease. However, progressive disability of the disease is related to axonal degeneration. After demyelination, remyelination occurs, which helps repair the demyelinated lesions and protects axons from degeneration. However, this endogenous remyelination is inefficient, and currently there are no therapies available to enhance remyelination. The aim of this thesis was to first characterize a fast and reliable model to study CNS remyelination in vitro, and second to investigate the role of semaphorin 3a (Sema3A) and semaphorin 3f (Sema3F) signaling in CNS remyelination. Various in vivo models have been developed to investigate the pathology of multiple sclerosis, and can be used to test remyelination therapies. However, in vivo models are expensive, animal- and time- consuming. Until now, there has been no well-characterized and robust in vitro model for remyelination study. In this thesis, an ex vivo slice culture system with mouse brain and spinal cord was developed, and characterized by immunofluorescent microscopy and transmission electron microscopy, for CNS remyelination study. Automated (re)myelinating quantification by image pro plus software was developed and validated to provide a fast and reliable way for testing factors that change remyelination efficiency. Two such factors are Sema3A and 3F, which were initially identified as axon guidance cues during development. Sema3A (repulsive) and 3F (attractive) were proved to play a role in oligodendrocyte precursor cell (OPC) migration during development, and hypothesized to be important in remyelination. In this thesis, I investigated the effects and mechanisms for this by adding recombinant SEMA3A or SEMA3F or by knockdown their obligatory receptors Neuropilin (Nrp) 1 and 2, using lentivirus induced miRNAi. Slice culture and primary OPC culture were used to determine the effect on OPC survival, migration, proliferation, differentiation and myelination.

No description available.

Multiple sclerosis and other myelin diseases affect the quality of life many people. In the United States alone, multiple sclerosis afflicts as many as 400,000 individuals. Myelin, which is attacked by multiple sclerosis, plays a critical role in maintaining the healthy function of the adult nervous system. There are many model systems that study myelin and its formation and loss. Our lab investigates the cuprizone model of demyelination and remyelination. The cuprizone model is commonly believed only to affect adult oligodendrocytes, which it kills. The current study investigates whether other cells in the oligodendrocyte line, such as oligodendrocyte progenitor cells, might also be susceptible to the toxic effects of cuprizone. Oligodendrocyte progenitor cells may play an important role in repairing and replacing myelin after demyelinating insults. So any effect that the model has on these cells may be relevant to the use of the model for studying remyelination. In order to evaluate the potential effects of cuprizone, dividing cells in adult mice were labeled with the proliferation marker, Bromodeoxyuridine (BrdU). Immunohistochemical labeling of BrdU shows that the number of actively dividing cells seen in the subventricular and subgranular zones sharply and dramatically decreases after just 1 week on cuprizone. In the following weeks, the number of dividing cells increases, but even after 3 weeks of recovery without cuprizone, the number of BrdU+ cells does not return to control levels. These results may have significant ramifications in the interpretation of results obtained from the cuprizone model, and this finding must be considered in selecting a model for future demyelination studies.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system characterized by inflammation and demyelination. In addition to these hallmark features, MS also presents with axonal pathology, which is likely responsible for the signs and symptoms of the disease. Although prominent in MS, axonal pathology is frequently considered a consequence of demyelination and not a primary event. This conclusion is consistent with demyelination inducing the loss of specific axonal domains, known as the nodes of Ranvier that are responsible for the propagation of action potentials along the axon. In contrast, we propose that axonal pathology associated with MS is a primary pathological event, independent of demyelination, and not a product of it. In support of our hypothesis, we have analyzed a different axonal domain known as the axon initial segment. Whereas a single axon has numerous nodes of Ranvier uniformly distributed along the axon, each axon contains only a single axon initial segment that is positioned immediately distal to the neuronal cell body. The axon initial segment is responsible for action potential generation and modulation, and hence is essential for normal neuronal function. Background studies conducted by our lab, employing a murine model of demyelination/remyelination, revealed no correlation between axon initial segment stability and myelin integrity. Here we investigate the fate of the axon initial segment in human multiple sclerosis. While not statistically significant, we provide data demonstrating an apparent 40% reduction in AIS numbers in MS. We further provide qualitative evidence that AIS integrity in MS is not dependent on myelination suggestive that axonal pathology may be a primary event in MS, independent of demyelination. Our current findings are intriguing, but unfortunately this study is underpowered, and more samples will be required to determine whether this apparent reduction is statistically significant.

Environmental air pollution is one risk factor associated with the onset and progression of multiple sclerosis (MS). In this project, we investigated the effects of ubiquitous traffic-generated pollutants, namely a mixture of gasoline and diesel vehicle exhaust (MVE), on signaling pathways associated with the pathophysiology of MS in the central nervous system (CNS) of either ovary intact (ov+) or ovariectomized (ov-) female Apolipoprotein (Apo) E-/-. Specifically, we investigated whether a subchronic inhalation exposure to MVE (200 PM μg/m3; 6 hr/d, 7d/wk, 30d) vs. filtered air (FA) controls altered myelination, T cell infiltration, blood-brain barrier (BBB) integrity, or production of reactive oxygen species (ROS) and expression of neuroinflammation markers in the CNS ov+ and ov- Apo E-/- mice. Our results revealed that inhalation exposure to MVE resulted in increased demyelination and CD4+ and CD8+ T cell infiltration, associated with alterations in BBB integrity. Disruption of the BBB was evidenced by decreased tight junction (TJ) protein expression, increased matrix metalloproteinase (MMPs) activity, and increased permeability of immunoglobin (Ig) G, which were more pronounced in the MVE ov- group. Moreover, MVE-exposure also promoted ROS and neuroinflammatory signaling in the CNS of ov+ and ov- mice, compared to FA groups. To analyze mechanisms that may contribute to MVE-exposure mediated inflammatory signaling in the CNS, we examined the NF-κB signaling pathway components, namely IKK subunits, IKKα, and IKKβ, as well as RelA. MVE -exposure did not alter the expression of either IKKα and IKKβ or RelA. However, increased expression of IKKα and IKKβ mRNA was observed in both FA ov- and MVE ov- groups, indicating female sex steroid hormone signaling involvement. Investigation of hormone receptors expression revealed a reduction in cerebral ERα mRNA expression, compared to ov+ mice; however, MVE-exposure resulted in an even further decrease in expression of ERα mRNA, while ERβ and PRO A/B transcript expressions were unchanged across groups. Collectively, these study findings revealed that subchronic inhalation exposure to MVE mediates alterations in ER expression in the CNS of ApoE-/- female mice, associated with altered cerebrovascular integrity and increased ROS production and inflammatory signaling. These detrimental outcomes in the CNS, resulting from MVE-exposure, are further associated with increased CD4+/CD8+ infiltration and local demyelination in the CNS of female ApoE-/-mice, which are hallmarks of MS. Such findings suggest that exposure to ubiquitous traffic-generated air pollutants may contribute to pathologies that exacerbate demyelinating diseases in the CNS of females.

La Neuromyélite Optique (NMO) est une maladie auto-immune démyélinisante, rare et grave, du système nerveux central (SNC). Elle est caractérisée par une démyélinisation et une perte axonale ciblant principalement le nerf optique et la moelle épinière. La découverte d'un auto-anticorps (IgG-NMO) dirigé contre l'aquaporine-4 (AQP4), un canal hydrique exprimé par l'astrocyte, a été une étape clé dans la compréhension de la physiopathologie de la NMO, actuellement définie comme une astrocytopathie. La pathogénicité de l'IgG-NMO a été démontrée : il induit une internalisation d'AQP4 et des transporteurs au glutamate, provoquant une altération de la fonction astrocytaire. Cependant les mécanismes permettant de lier la dysfonction astrocytaire aux altérations caractéristiques de la NMO, notamment la démyélinisation, restent méconnus. Les astrocytes sont des cellules gliales essentielles à l'établissement et au maintien de l'homéostasie du SNC. Ils permettent la régulation des flux hydriques et ioniques, le contrôle extracellulaire des neuromédiateurs ainsi que l'apport de métabolites énergétiques aux neurones et aux oligodendrocytes. Ils sont aussi caractérisés par une très forte expression de connexines (Cx), des molécules transmembranaires s'assemblant sous une forme hexamérique : le connexon. Les connexines forment soit des hémicanaux, permettant l'échange de petites molécules entre les milieux intra- et extra-cellulaires, soit des jonctions communicantes par la juxtaposition de connexons appartenant à deux cellules, assurant le couplage intercellulaire avec le passage de petites molécules et d'ions (ATP, glutamate, lactate, calcium). Les fonctions hemicanal et jonction communicante sont fortement régulées en condition physiologique et altérées en condition pathologique, notamment en contexte neuroinflammatoire. Nous émettons l'hypothèse que les IgG-NMO altèrent l'expression et la fonction des connexines, et conduisent ainsi à la production d'un environnement toxique pour les oligodendrocytes et la myéline, et délétère pour le fonctionnement neuronal. Mon projet de thèse avait trois objectifs : i) la caractérisation du phénotype astrocytaire induit par les IgGNMO ; ii) l'identification d'altérations des connexines et leur implication dans la pathologie ; iii) la mise en évidence d'altérations de la transmission synaptique induites par les IgG-NMO et l'implication de connexines dans cet effet. Des modèles de cultures primaires gliales traitées par des IgG-NMO issue d'une cohorte de patients m'ont permis de caractériser le phénotype acquis par les astrocytes, et de proposer le concept d'un astrocyte réactif spécifique de pathologie. Les astrocytes réactifs spécifiques de la NMO induisent un milieu inflammatoire spécifique et toxique, provoquant une démyélinisation. Grâce au développement d'une coculture gliale et neuronale produisant des neurones myélinisés, et à l'utilisation de peptides inhibiteurs des Cx, j'ai pu montrer que les NMO-IgG ont un effet démyélinisant et que celui-ci implique les Cx. La démyélinisation est en effet associée à des modifications structurales et fonctionnelles des Cx astrocytaires, observées à la fois in vitro et dans notre modèle in vivo, le rat-NMO. Enfin, la mise en place d'une étude électrophysiologique en potentiel de champs local sur des tranches d'hippocampe de rats m'a permis d'étudier l'effet des IgG-NMO sur la transmission glutamatergique basale. J'ai pu mettre en évidence un effet dépresseur des IgG-NMO, partiellement bloqué par un inhibiteur de connexines, la carbenoxolone. Comme il a déjà été démontré par des études cliniques dans des pathologies neurodégénératives, l'utilisation de modulateurs de Cx semble être une voie thérapeutique prometteuse afin de prévenir la démyélinisation et les altérations du fonctionnement neuronal de la NMO / Neuromyelitis Optica (NMO) is a rare and severe auto-immune demyelinating disease of the central nervous system (CNS). It is characterized by demyelination and axonal loss targeted to the optic nerve dans the spinal cord. The identification of a specific autoantibody (NMO-IgG) directed against the astrocytic protein AQP4 was a key step in the understanding of NMO physiopathology: it is now considered as an astrocytopathy. NMO-IgG is also a biomarker of NMO, and its pathogenicity has been demonstrated. NMO-IgG induce an internalization of AQP4 together with other membrane proteins such à glutamate transport GLT1. This could alter astrocyte functions but the mechanisms connecting astrocytopathy and demyelination remain unclear. Astrocytes are abundant glial cells crucial for the establishment and the maintenance of CNS homeostasis. They regulate water flux and ion homeostasis and control extracellular volume and neurotransmitter concentrations. They also provide neurons and oligodendrocytes with energy substrates. Astrocytes are characterized by a high expression of connexins (Cx), transmembrane proteins assembling in hexameric form, called connexon. Cx form either hemichannels, unopposed connexon at the membrane, allowing the exchange of small molecules (<1,2kDa e.g. glutamate, ATP) and ions (Ca2+, K+) between extra- and intra-cellular compartments. Cx also form gap junctions, formed by the juxtaposition of two connexons at the membrane of two different cells, and allow the quick cell to cell exchange of small molecules, metabolites and ions (e.g. glucose, lactate, Ca2+). Hemichannel and gap junction functions are tightly regulated under physiological conditions and can be altered in pathological condition for example during neuroinflammation. We proposed that NMO-IgG by altering connexins expression and/or function could lead to the production of a toxic environment for oligodendrocytes and myelin but also for neuronal functioning. This feature of astrocyte dysfunction could participate to NMO alterations. My thesis project had three main goals: i) the characterisation of astrocyte phenotype induced buy NMO-IgG, ii) the identification of connexins alterations and their implication NMO physiopathology, iii) the highlight of synaptic alterations induced by NMO-IgG and the involvement of connexins in this effect. Primary glial cell cultures treated with NMO-IgG from a cohort of NMO patients, were used to characterize astrocyte phenotype and we proposed the concept of a specific reactive dysfunctioning astrocyte induced by NMO-IgG. Those astrocytes, called “NMO-astrocytes” are responsible for the production of a proinflammatory toxic microenvironment for oligodendrocytes and leading to demyelination. With the development of a myelinated culture model, composed of glial cells and neurons with myelinated axons, together with the use of specific inhibitors of Cx functions, we showed that NMO-IgG induced demyelination involved connexin dysfunction. In fact, demyelination was associated with structural and functional alterations of astrocytic connexins observed both in vitro and in vivo in the NMO-rat model. Electrophysiological recording of basal glutamatergic synaptic activity in the rat hippocampus showed a strong depression of synaptic responses induced by NMO-IgG. Connexins could be implicated in this alteration since blocking all connexins with carbenoxolone blocked NMO-IgG effect

A esclerose múltipla é a principal doença desmielinizante do sistema nervoso central (SNC). É considerada a principal causa de incapacidade neurológica em adultos jovens. O comprometimento cognitivo é muito comum nessa doença, envolvendo o aprendizado, a memória e a organização cortical do movimento, funções vitais que são reguladas pelo sistema colinérgico. O modelo de desmielinização tóxica induzida pelo brometo de etídio (BE) foi utilizado neste estudo, para avaliar a atividade da enzima acetilcolinesterase (AChE) no estriado (ST), hipocampo (HP), córtex cerebral (CC), hipotálamo (HY) e ponte (PN) associado ao tratamento com interferon beta (IFN-b), ciclosporina A (CsA), vitamina E (vit E) e ebselen (Ebs). Além disso, também foi investigado o efeito in vitro do BE na atividade da AChE, juntamente com os parâmetros cinéticos dessa enzima no ST, HP, CC e CB de ratos adultos. Os resultados demonstraram que o BE inibiu significativamente a atividade da AChE no ST, HP, CC e CB nas concentrações de 0,00625, 0,0125, 0,025, 0,05 e 0,1mM e a análise dos dados cinéticos mostraram uma inibição do tipo incompetitiva no ST, HP e CC, enquanto no CB a inibição foi do tipo mista. No estudo in vivo, foi observado uma inibição na atividade da AChE no CC, ST, HP, HY, PN e CB nos diferentes períodos avaliados pós-injeção do BE (3, 7, 15, 21 e 30 dias). Quando ratos desmielinizados com BE foram tratados com IFN-b e CsA, não houve alteração na atividade dessa enzima. Por outro lado, o tratamento com Vit E e Ebs foram capazes de aumentar a atividade da AChE no ST, CC e HP. Estudos imuno-histoquímicos demonstraram que nos ratos tratados com Vit E e Ebs as lesões induzidas pelo BE foram menores, sugerindo que estes compostos interferem no desenvolvimento de lesões desmielinizantes. Foi também avaliado o efeito per se do IFN-b, da CsA, da Vit E e do Ebs na atividade da AChE, os quais demonstraram um efeito inibitório sobre a atividade dessa enzima. Em plaquetas de ratos desmielinizados, foi observado uma diminuição na atividade da NTPDase e o tratamento com a Vit E e o Ebs modularam a hidrólise dos nucleotídeos de adenina. O presente trabalho demonstrou que o BE é um potente inibidor da atividade da AChE in vitro e os resultados in vivo demonstraram que a atividade dessa enzima está alterada após um evento de desmielinização tóxica no SNC. Os resultados deste estudo ajudaram a confirmar que drogas utilizadas no tratamento de pacientes com esclerose múltipla tais como o IFN-b e a CsA causam efeitos na atividade da AChE. A Vit E e o Ebs, além de demonstrarem uma interação com a neurotransmissão colinérgica, também modularam a hidrólise dos nucleotídeos de adenina em plaquetas de ratos, contribuindo no controle da coagulação plaquetária em processos desmielinizantes. Neste contexto, sugere-se que o IFN-b, a CsA, a vitamina E e o ebselen podem ser investigados em estudos futuros com a intenção de encontrar uma melhor terapia para beneficiar pacientes com patologias desmielinizantes. / Multiple sclerosis is the main demyelinating disease of the central nervous system (CNS). It is the most common cause of neurological disability among young adults. The cognitive impairment is very commum in this illness, involving learning, memory and cortical organization of the movement, vital functions regulated by the cholinergic system. The model of toxic demyelination induced by ethidium bromide (EB) was used to evaluate brain acetylcholinesterase (AChE) activity in the striatum (ST), hippocampus (HP), cerebral cortex (CC), cerebellum (CB), hypothalamus (HY) and pons (PN), associated with treatment with interferon beta (IFN-b), ciclosporine A (CsA), vitamin E (Vit E) and ebselen (Ebs). In addition, the per se effect of EB on AChE activity was studied in vitro together with the kinetic parameters of this enzyme in the ST, HP, CC and CB of adult rats. The results showed that EB in vitro significantly inhibited AChE activity in the ST, HP, CC and CB at concentrations of 0.00625, 0.0125, 0.025, 0.05 and 0.1mM. The kinetic analysis demonstrated an uncompetitive inhibition in the ST, HP and CC, whereas in the CB the inhibition type was mixed. In relation to the in vivo results, AChE activity was inhibited after demyelination by EB in the CC, ST, HP, HY, PN and CB at the post-injection points of time evaluated (3-7-15-21 and 30 days). When demyelinated rats were submitted to the treatment with IFN-b and CsA, the results demonstrated that these compounds did not alter AChE activity. However, Vit E and Ebs were able to increase AChE activity in the ST, CC and HP. In addition, immunohistochemistry studies demonstrated that in Vit E and Ebs treated rats, the lesions induced by EB were smaller suggesting that these compounds somehow interfered in the development of the lesions. The per se effect of IFN-b, CsA, Vit E and Ebs were also evaluated, demonstrating that these compounds have an inhibitory effect on AChE activity. Platelets of the demyelinated rats demonstrated a reduction in NTPDase activity and the treatments with Ebs and Vit E modulated adenine nucleotide hydrolysis. The present investigation demonstrated that EB is a strong inhibitor of AChE activity in vitro and the results in vivo showed that the activity of this enzyme is altered after an event of toxic demyelination in the CNS. The results this study help the confirm that drugs used in the treatment of the patients with multiple sclerosis such as IFN-b and CsA cause effects in the AChE activity. The Vit E and Ebs besides of interaction with the cholinergic neurotransmission also modulated adenine nucleotide hydrolysis in platelets of the rats, contributing to the control of the platelet coagulant status in the demyelinating process. In this context, we can suggest that IFN-b, CsA, Vit E and Ebs may be investigated in future studies with the intention of finding a better therapy for to improve patients with demyelinating pathologies.

Bien que les vaccins représentent une avancée majeure pour la santé publique, le risque d’effets secondaires constitue une menace réelle pour leur acceptation par le grand public et les professionnels de santé. La France se classe, d’ailleurs, comme le pays manifestant la plus grande défiance envers le vaccin. Cela s’est souvent traduit pas des couvertures vaccinales faibles. L’origine de cette perte de confiance est, entre autres, liée à la polémique intense autour du vaccin anti-hépatite B (HB) et le risque de sclérose en plaques dans les années 1990. Le but de cette thèse est d’évaluer le lien potentiel entre vaccination et démyélinisation, en considérant deux exemples : les vaccins anti-VHB et anti-papillomavirus (HPV). Une approche méthodologique, progressive, fondée sur les preuves a été utilisée pour les deux vaccins. La génération d’hypothèse a considéré la plausibilité biologique, les rapports de cas publiés, les analyses de disproportionnalité conduites dans le système américain de pharmacovigilance des vaccins (i.e., Vaccine Adverse Event Reporting System (VAERS)), et l’analyse des signaux détectés par la surveillance passive. Concernant la vaccination anti-VHB, des analyses attendu/observé ont également été menées à partir des cas confirmés rapportés à la pharmacovigilance française dans les années 1990. Des revues systématiques de toutes les études individuelles ayant évalué la plausibilité de l’association entre démyélinisation et les deux vaccins considérés ont été réalisées, tandis que des méta-analyses ont permis d’obtenir des estimations de risque « poolées » à partir des preuves accumulées à ce jour. Les résultats restent mitigés pour les deux vaccins. Pour la vaccination anti-VHB, une plausibilité biologique faible et indirecte, l’analyse du signal français détecté en 1996 qui a révélé une disjonction complète entre les populations cible et rejointe, ainsi que les résultats des analyses de disproportionnalité dans VAERS sont des éléments en faveur d’une possible association entre démyélinisation centrale et vaccin anti-VHB. Cependant, ni la méta-analyse, ni les analyses attendu/observé (bien que leurs conclusions puissent être renversées par un facteur modéré de sous-notification), n’ont fourni de résultat statistiquement significatif. En tout état de cause, si un risque en excès existait, il serait faible et ne concernerait que l’adulte. Les recommandations actuelles qui minimisent la probabilité d’exposition à l’âge adulte, sont donc plus que justifiées. Pour la vaccination anti-HPV, le risque de démyélinisation centrale semble, à ce jour, écarté. Néanmoins, un doute subsiste concernant un possible risque en excès pour le syndrome de Guillain et Barré. Il serait nécessaire de conduire d’autres études, rendues difficiles par la rareté de l’événement, estimée à 1 cas pour 1,000,000 doses vendues. En conclusion, une association forte avec un risque de démyélinisation semble à exclure pour les deux vaccins, rendant la balance bénéfice/risque largement positive pour ces produits, dès lors qu’ils sont utilisés dans leurs populations cibles. Dans ce contexte, une communication scientifique, indépendante et claire est la clé pour promouvoir les programmes de vaccination et créer la confiance et l’adhésion du grand public. Les décisions politiques ont aussi une lourde responsabilité. En effet, les suspensions des campagnes nationales de vaccination peuvent avoir des conséquences délétères à long terme. Le futur de la pharmacovigilance des vaccins pourrait résider dans la mise en place d’un réseau collaboratif entre le patient et son médecin, via l’utilisation de SMS et smartphones, comme cela existe déjà en Australie. En plus de collecter les effets secondaires des vaccins, cela représenterait une opportunité unique de placer le patient au coeur du système de surveillance, lui offrant une voix et contribuant à restaurer sa confiance envers les vaccins, et même envers les décideurs de santé publique. / While vaccines represent a great achievement for public health, the risk of adverse effects is a real threat for vaccine acceptability by both the population and healthcare professionals. France still ranks as the country having the highest vaccine defiance. This often turned into poor vaccination coverages. This origin of this mistrust in vaccines is probably related to the intense polemic around anti-hepatitis B (HB) vaccination and the risk of multiple sclerosis in the 1990’s. The main aim of this thesis was to assess the putative link between vaccination and demyelinating disorders by considering two examples: anti-HB and anti-papillomavirus (HPV) vaccines. For both vaccines, methods adopted a stepwise evidence-based approach. Hypothesis generation was based on evidence regarding the biological plausibility, the published case reports, the disproportionality analyses conducted in the US Vaccine Adverse Event Reporting System (VAERS) and the analysis of signals detected by spontaneous reporting systems, if any. For the research question centered on the anti-HB vaccination, observed-to-expected analyses based on all confirmed cases reported to the French pharmacovigilance in the 1990’s were also conducted. Systematic reviews of all individual studies having assessed the possible association between demyelination and either anti-HB or HPV vaccines were then conducted while meta-analyses brought pooled risk estimates of all evidence published so far. Results were non-conclusive for both vaccines. For anti-HB vaccination, several elements could give credence to an association with central demyelination: a weak and indirect biological plausibility, the analysis of the French signal detected in the 1990’s which revealed a complete disjunction between the target and the joint populations, and the results of the disproportionality analyses in VAERS. Nevertheless, neither the meta-analysis nor the observed-to-expected analyses (although might be easily reversed by a moderate degree of underreporting), provided statistically significant findings. If the excess risk actually existed, it would be weak and would be a concern for adults only. The current recommendations which are minimizing the probability of the French population to be exposed at an adult age, are therefore more than justified. For the anti-HPV vaccination, after reviewing all materials available, the risk of central demyelination seems, at this date, unlikely. Nevertheless, a doubt remains regarding a possible excess risk of Guillain Barré Syndrome (GBS) in the follow of an anti-HPV immunization. More specific studies would be needed, although the rarity of this event renders its evaluation difficult. From the studies already conducted, it was estimated that this excess risk, if any, would be lower than 1 per 1,000,000 doses sold. To conclude, a strong association with a risk of central demyelination can be ruled out for both vaccines, making the benefit and risk balances still largely positive for both products if used in their current target populations. In that context, an independent, clear and scientifically-based communication is the key element to promote vaccination programmes and to generate the confidence and adherence of the general population. Political decisions also carry a heavy responsibility in ensuring trust towards vaccination programmes, as the suspension of national immunization campaigns which could have long-lasting deleterious consequences. The future of vaccine pharmacovigilance could rely on the implementation of a collaborative GP-patient network-based solution using SMS and smartphones, as already experimented in Australia. While collecting potential adverse effects of vaccines, it would also be a unique opportunity to place the patients at the heart of the surveillance system, giving them a voice and potentially contributing to restore their confidence in vaccines and even, in the decision-makers in the field of public health.

An acute demyelinating syndrome (ADS) in a child may be a monophasic illness or may represent the incident attack of multiple sclerosis (MS) – an inflammatory demyelinating neurodegenerative disorder affecting the brain, spinal cord and optic nerves. The central objective of this dissertation was to identify MRI parameters present at ADS that predict MS diagnosis. A scoring tool was first created containing 14 parameters identified from the literature and demonstrating substantial inter-rater agreement (Cohen’s kappa values ≥0.6). Children aged <16 years were enrolled at incident ADS and are currently followed for five years at 23 Canadian centers. Standardized MRI scans were acquired at onset and serially. MS was defined based on the occurrence of a second demyelinating attack or MRI evidence of new lesions in accordance with McDonald criteria for dissemination in time. Multivariable Cox proportional hazards regression models were used to identify MRI parameters that predicted MS diagnosis. Over 1100 MRI scans in 284 children with ADS were evaluated. To date, 57(20%) children have been diagnosed with MS. For those that developed MS, the median (IQR) time from incident attack to diagnosis was 6.2 (4.7-11.1) months. The presence of ≥1 T1-hypointense lesion (HR 20.6, 95% CI 5.5-78.0) and ≥1 T2 periventricular lesion (3.3, 1.3-8.8) were associated with an increased likelihood for MS diagnosis (sensitivity 84%, specificity 93%, PPV 76%, NPV 96%). The predictive parameters were validated in an independent Dutch cohort of 45 children with ADS (n=15, 33% MS): sensitivity 93%, specificity 87%, PPV 78%, NPV 96%. Finally, it was determined that the 2010 McDonald criteria are applicable for diagnosis of pediatric-onset MS diagnosis in older children with non-ADEM presentations. The work embodied herein emphasizes the value of MRI in predicting MS diagnosis in children with incident ADS. Early identification of children with MS is important for planning clinical care and will be valuable in future pediatric MS treatment trials.

Myelin basic protein (MBP) has fascinated researchers and clinicians alike due to its major structural role in myelin and the central nervous system, and its potent auto-immunogenic properties that cause demyelination in animal models. The charge variants of MBP have been of particular interest. The C1 component, the least modified and most cationic of the variants, is the most abundant form of MBP in healthy adult myelin. The C8 component, the most modified and the least cationic variant, has been found in higher proportions in myelin of MS patients and children. Here, an investigation of the structural differences between C1 and C8 components of MBP was conducted. The spectral and hydrodynamic properties of these variants were monitored via a number of biophysical/biochemical techniques. The effect of zinc (Zn2+) on the conformational behaviour of MBP was examined. Zn2+ is an abundant metal in the brain, and had been previously shown to induce hydrodynamic compaction in MBP. Both variants have a loose tertiary arrangement with subtle differences. This arrangement is deficient in secondary structure and undergoes non-cooperative temperature-induced melting. Zn2+ stabilizes a molten globular-like state with enhanced ANS fluorescence, and promotes oligomerization.