Em 32 pacientes com Distrofia Muscular de Duchenne, em corticoterapia, avaliou-se a evolução da força muscular, ao longo de 14 meses, mensalmente no primeiro semestre e a cada dois meses no segundo e terceiro semestre. Testes empregados: escala "Medical Research Council", Hammersmith "motor ability score", levantamento de peso cronometragem do tempo para manobra de Gowers e para percorrer 9 metros. O estudo revelou tendência de estabilidade da força muscular durante o acompanhamento e que para avaliar objetivamente a força muscular são suficientes intervalos de três meses no primeiro semestre de corticoterapia e, posteriormente, de seis meses enquanto durar o tratamento / In 32 patients with Duchenne muscular dystrophy and receiving steroid therapy we assessed muscle strength along a follow-up of 14 months using Medical Research Council scale, Hammersmith functional motor scale, timed testing for rising from the floor and walking 9 meters, as well as rising weights. The tests were repeated monthly along the first 6 months and every two months by the rest of the follow-up. The study revealed a trend to functional stability and that the muscle strength can be evaluated at 3 and 6 months of treatment and then every 6 months while the steroid therapy is maintained

A evolução da Distrofia Muscular de Duchenne (DMD) culmina na morte dos pacientes por problemas respiratórios, que aparentemente estão relacionados com a fraqueza de sua musculatura. O propósito deste estudo foi avaliar o efeito de três exercícios respiratórios de ioga na função respiratória em pacientes com DMD. A escolha dos exercícios foi motivada pelo fato de não se encontrar similares nos procedimentos fisioterápicos atuais no ocidente e por poderem ser praticados sem a necessidade de aparatos ou ajuda externa, facilitando sua execução diária. Os exercícios foram ensinados individualmente no ambulatório do Hospital das Clínicas da Universidade de São Paulo em dias regulares de consultas dos pacientes. As séries, bem como a sua progressão, levaram em consideração as limitações individuais. Foi realizada uma avaliação inicial das condições respiratórias (função pulmonar e pressões respiratórias) em 85 pacientes com idade entre 6 e 14 anos. Estas avaliações foram repetidas a cada 5 meses (em média) ao longo do treinamento. Os dados foram analisados de diferentes maneiras: pacientes que fizeram todas as avaliações ao longo de 10 meses (N=39); ao longo de 20 meses (N=18) e com os resultados dos pacientes que fizeram pelo menos uma avaliação além da inicial ao longo de 10 meses (N=70). Os grupos foram divididos por faixa etária em dois subgrupos (6 a 9 anos e 10 a 14 anos de idade). Constatou-se na análise com N=39 e N=70 que os pacientes mais novos que executaram os exercícios aplicados, apresentaram depois de 10 meses de treinamento, elevação nos valores absolutos e relativos da capacidade vital forçada (CVF), volume expiratório forçado em 1 segundo (VEF1) e pressão expiratória máxima (PEmax) e que os pacientes mais velhos, depois de 10 meses de treinamento, apresentaram melhora nos índices de pressão expiratória máxima (PEmax) em valores absolutos e relativos. Na análise com N=18 observou-se que os pacientes obtiveram melhora nos valores absolutos da função pulmonar (CVF e VEF1) até os 20 meses de treinamento quando comparamos com os valores do início e para a PEmax em valores absolutos, os resultados aumentam até 10 meses de treinamento e depois se mantém estáveis. Observou-se diminuição no declínio dos índices de função pulmonar dos pacientes quando comparados com crianças normais (porcentagem do predito). Constatou-se na análise determinada pela curva dos resultados da PEmax por faixa etária em valores relativos, que após 10 meses de prática dos exercícios de ioga, o declínio de seus valores foi retardado. O grande fator de melhora destes pacientes foi o aumento da força muscular expiratória forçada conseguido especialmente com a prática da técnica denominada kapalabhati. Recomendamos que estes exercícios sejam incorporados à prática clínica dos pacientes com DMD com a intenção de minimizar os danos causados pela perda da capacidade respiratória. / Duchenne Muscular Dystrophy (DMD) has a progression that culminates in the death of the patients for respiratory problems, which are apparently related to the weakness of the respiratory muscles. The objective of this study was to investigate the effects of three respiratory techniques of yoga in the respiratory function of patients with DMD. The selection of the exercises was conducted taking into account that there are no similar ones in the actual western physiotherapeutic procedures, and due to the fact that all of them may be practiced without the need of any apparatus or external help, making their daily practice easy. The exercises were taught individually in the Ambulatory of the General Hospital of the University of São Paulo during the regular appointments of the patients. The series of exercises, as well as their progressions, took into consideration the individual limitations. In order to establish the respiratory conditions (FVC, FEV1, PImax, and PEmax) of the group, an initial evaluation was conducted with 85 patients between 6 and 14 years old. The follow-up evaluations were carried out on an average 5-month interval, during the training period. Data were analyzed in different ways: subjects which had all the evaluations during 10 months of training (N=39); during 20 months of training (N=18) and with the results of patients that had at lest one evaluation besides the initial in the first 10 months (N=70). Furthermore, the total group was divided by age into 2 subgroups: (from 6 to 9 years old, and from 10 to 14 years old). The analysis of the groups with N=39, and N=70 revealed that, after 10 months of training, the younger subjects had increased their absolute and relative values of forced vital capacity (FVC), expiratory forced volume in 1 sec (FEV1), and maximal expiratory pressure (PEmax) , and that the older subjects, after the same period, had their absolute and relative PEmax also increased. In the analysis of the subgroup with N=18, there was an increase in the absolute values for pulmonary function (FVC and FEV1) until 20 months of training, while for PEmax this increase was seen only until 10 months, and afterwards there was a maintenance of its values. There was a reduction in the decline of the pulmonary function indexes of the patients when compared with healthy subjects (percentage of the predicted). The curve results of relative PEmax according to age revealed that after 10 months of practicing the prescribed exercises, the decline of its values was postponed. The greatest improvement in these children was found in the expiratory muscle power, attained through the practice of the technique called kapalabhati. We recommend the inclusion of these exercises to the clinical treatment of the DMD patients with the intention of minimizing the damage caused by the loss of respiratory capacity.

Orientador: Elaine Minatel / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-24T19:48:05Z (GMT). No. of bitstreams: 1 Moraes_LuisHenriqueRapucci_D.pdf: 3874036 bytes, checksum: 7d72faf59790ed5f085eb2edd9aba075 (MD5) Previous issue date: 2014 / Resumo: Devido ao fato dos camundongos mdx, modelo experimental da distrofia muscular de Duchenne, apresentarem peroxidação lipídica da membrana causada pelo aumento da produção espécies reativas de oxigênio (EROs) no período que antecede o início da degeneração das fibras musculares, sugere-se que o estresse oxidativo pode ser um dos mecanismos primários da degeneração muscular distrófica, ao invés de ser um efeito secundário deste processo. Camundongos mdx tratados com o antioxidante N-acetilcisteína (NAC) apresentaram diminuição da degeneração muscular. De acordo com a literatura a associação de NAC com Deferoxamina (DFX) produz resultado mais efetivo contra o estresse oxidativo do que a administração de NAC isoladamente. Desta forma, o objetivo do presente estudo foi de verificar, através de análises morfológica, celular e bioquímica, se o tratamento in vivo e in vitro com a associação de NAC e DFX diminui a produção das EROs. Para os estudos in vivo foram utilizados camundongos C57BL/10 (grupo controle) e camundongos mdx, com 14 dias de vida pós-natal. Os camundongos mdx e C57BL/10 foram divididos em 4 grupos experimentais: tratados com salina, tratados com NAC+DFX, tratados com DFX e tratados com NAC (150 mg/kg) por 14 dias. Todos os animais foram submetidos à análise de medida de força. Os músculos Esternomastóideo (STN), Diafragma (DIA) e Tibial Anterior (TA) foram retirados e submetidos às técnicas histológicas (HE, azul de Evans e reação de DHE), Western Blotting (TNF-?, NF-?B, MyoD, MAFbx e 4-HNE). Plasma sanguíneo foram utilizadas para determinação de creatina quinase (CK) e de citocinas inflamatórias. Nos experimentos in vitro foram utilizados os músculos do membro pélvico de camundongos C57BL/10 e mdx com 14 dias de vida. As culturas de células musculares foram utilizadas para análises de viabilidade celular (Trypan blue, MTT e vermelho neutro), análise de cálcio e Western Blotting após serem tratadas ou não com NAC e DFX. O tratamento com NAC, DFX e NAC+DFX apresentou efeito benéficos sobre as fibras musculares distróficas, tanto nos experimentos in vivo quanto in vitro, reduzindo a degeneração muscular, a inflamação exacerbada, a peroxidação lipídica e a produção de EROs. Tanto o tratamento isolado dos medicamentos quanto a associação apresentou potencial efeito, entretanto em alguns experimentos a associação mostrou-se mais eficaz contra os danos provocados pela distrofia / Abstract: Due the fact of mdx mice, an experimental model of Duchenne muscular dystrophy, presenting the lipid peroxidation of membrane caused by increased production of reactive oxygen species (ROS) in the period that preced the onset of muscle fibers degeneration, it is suggested that stress oxidative may be one of the primary mechanisms of dystrophic muscle degeneration, rather than a side effect of this process. Mdx mice treated with the antioxidant N-acetylcysteine (NAC) showed a decrease in muscle degeneration. According to the literature the association of NAC with Deferoxamine (DFX) produces more effective results against oxidative stress than NAC alone. Thus, the aim of this study was to verify, through morphological analysis, cellular and biochemistry, if the in vivo and in vitro treatment with the combination of NAC and DFX decreases the ROS production. For in vivo studies were used C57BL/10 mice (control group) and mdx mice, with 14 days postnatal. The mdx and C57BL/10 mice were divided into 4 experimental groups: treated with saline, treated with NAC + DFX, treated with DFX and treated with NAC (150 mg/kg) for 14 days. All animals were subjected to strength measurement analysis. The Sternomastoid (STN), Diaphragm (DIA) and Tibialis anterior (TA) muscles were removed and submitted to histological techniques (HE, Evans blue dye and DHE reaction), Western Blotting (TNF-?, NF-kB, MyoD, MAFbx and 4-HNE). Blood plasma was used for determination of Creatine kinase (CK) and inflammatory cytokines. In the in vitro experiments, the muscles of the pelvic limb of C57BL/10 and mdx mice with 14 days postnatal were used. The muscles culture cells were used for cell viability analysis (Trypan blue, MTT and Neutral red), calcium analysis and Western blotting after being treated or not with NAC and DFX. Treatment with NAC , DFX and NAC + DFX showed benefic effect on dystrophic muscle fibers, both in vivo and in vitro experiments, reducing muscle degeneration, exacerbated inflammation, lipid peroxidation, and ROS production. Either the isolated or the combination treatment of medication showed a potential effect, however in some experiments the combination was more effective against the damage caused by the disease / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural

Orientadores: José Dirceu Ribeiro, Anamarli Nucci / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T06:16:29Z (GMT). No. of bitstreams: 1 Luiz_LiviaCocato_M.pdf: 3785934 bytes, checksum: 1710c66693a6b2ad73359d8f3b987905 (MD5) Previous issue date: 2014 / Resumo: Contextualização: A distrofia muscular de Duchenne (DMD) é a miopatia infantil mais comum, e sua progressão é causada pela perda de massa e força muscular. Os cuidados paliativos são extremamente influenciados pelas disfunções motoras e respiratórias. O objetivo do presente estudo foi caracterizar simultaneamente as disfunções motora e respiratória em pacientes com DMD. Métodos: Estudo transversal realizado em um hospital universitário terciário em uma população de 34 pacientes com DMD: 19 foram avaliados simultaneamente para disfunção motora [Medida da Função Motora (MFM) e Teste de Caminhada de 6 Minutos (TC6¿)] e respiratória [força muscular respiratória, pico de fluxo da tosse (PFT), espirometria e capnografia volumétrica (CapV)]. Resultados: Foi encontrada diferença estatística (p<0,05) na MFM para DMD deambuladores e não- deambuladores; no TC6¿ [DMD mostrou menor distância percorrida; maior frequência respiratória no repouso, frequência cardíaca (FC) no repouso e FC após 9 minutos em relação aos controles]; na espirometria [DMD mostrou menor capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo, fluxo expiratório forçado entre 25-75% da CVF, fluxo expiratório forçado máximo e maior índice de Tiffeneau que os controles]; e na CapV [DMD mostrou menor volume minuto alveolar, volume minuto, volume corrente alveolar, volume corrente total, volume espaço morto, volume de dióxido de carbono e volume expiratório que controles menores de 11 anos e também DMD mostrou maior FC que controles maiores de 11 anos]. Conclusões: Pacientes com DMD mostraram deterioração motora e respiratória independentemente da progressão da doença ou da condição da marcha. A MFM e o TC6¿ puderam demonstrar a variabilidade da disfunção motora. Entre as ferramentas para avaliação respiratória, a espirometria mostrou o comprometimento mais evidente, seguida do PFT. No entanto, não houve correlação entre a gravidade motora e respiratória nesta série / Abstract: Background: Duchenne muscular dystrophy (DMD) is the most common child myopathy, and its progression is caused by loss of muscle mass and strength. The palliative management is greatly influenced by motor and respiratory dysfunctions. The aim of the present study was to simultaneously characterize motor and respiratory dysfunctions in DMD. Methods: A cross-sectional study was performed in a tertiary university hospital in a cohort of 34 DMD patients¿; 19 were simultaneously evaluated for motor [Motor Function Measure (MFM) and 6-minute walk test (6MWT)] and respiratory evaluation [respiratory muscle strength, cough peak flow (CPF), spirometry and volumetric capnography (VCap)]. Results: Statistical difference (p<0.05) was found in MFM for ambulatory and non- ambulatory DMD; in 6MWT [DMD showed lower walked distance, higher rest respiratory rate, rest heart rate (HR) and HR after 9minutes than controls]; in spirometry [DMD showed lower vital forced capacity (VFC), forced expiratory volume in one second, forced expiratory flow between 25-75%VFC, maximum forced expiratory flow and higher Tiffeneau index than controls]; and in VCap [DMD showed lower alveolar ventilation per minute, ventilation per minute, tidal alveolar volume, tidal volume, airway dead space, carbon dioxide production and expiratory volume than controls younger than 11 years; and also DMD showed higher HR when compared to controls older than 11 years]. Conclusions: Patients with DMD showed motor and respiratory deterioration regardless disease progression or ambulatory status. The MFM and 6MWT could demonstrate the motor impairment variability. Among the respiratory tools used, the spirometry showed more evident compromise, followed by the CPF. Nevertheless, motor and respiratory severity did not correlate in this series / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Orientador: Maria Julia Marques / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-19T19:42:06Z (GMT). No. of bitstreams: 1 Machado_RafaelVentura_D.pdf: 18399994 bytes, checksum: 2db06c9364e5b215f2cf4f91753c4d19 (MD5) Previous issue date: 2011 / Resumo: Na distrofia muscular de Duchenne e no camundongo mdx a proteína distrofina está ausente ou é expressa de forma não funcional. Com isso, o complexo distrofina-glicoproteínas se desorganiza, a fibra muscular se torna frágil durante os ciclos de contração e relaxamento muscular, as concentrações intracelulares de cálcio e radicais livres se elevam, resultando em necrose da célula. A inflamação mediada por células do sistema imunológico e citocinas pró-inflamatórias, como o TNF-alfa, é um evento importante diretamente relacionado com a progressão da doença. O ácido eicosapentaenóico (EPA) é um ácido graxo poli-insaturado ômega-3 que promove benefícios em doenças inflamatórias em humanos. No presente trabalho analisamos os efeitos do EPA no estágio inicial da distrofinopatia do camundongo mdx. Camundongos mdx com 14 dias de idade receberam 300 mg/kg/dia de EPA por 16 dias. Os grupos controle mdx e C57BL10 receberam óleo mineral. EPA diminuiu a mionecrose, os níveis séricos da enzima creatinoquinase e o TNF-alfa em músculos esqueléticos distróficos. Sugere-se que o EPA tenha utilidade terapêutica nas distrofinopatias / Abstract: In Duchenne muscular dystrophy (DMD) and in the mdx murine model of DMD, lack of dystrophin leads to myonecrosis and cardiorespiratory failure. The intense inflammatory reaction, mediated by immune cells and TNF-alpha, contributes to the progressive myonecrosis. The eicosapentaenoic acid (EPA) is an omega-3 fatty acid that shows beneficial effects in inflammatory diseases. In the present study, we examined the effects of EPA on the early stages of dystrophy in mdx mice. Mdx mice (14 days old) received EPA at 300 mg/kg EPA for 16 days, while the control mdx mice and C57BL10 received vehicle. EPA treatment decreased creatine kinase and TNF-alpha levels and reduced myonecrosis. The present results support further studies with EPA as a potential therapy for dystrophinopathies / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural

Orientador: Maria Julia Marques / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-20T01:04:16Z (GMT). No. of bitstreams: 1 Mauricio_AdrianaFogagnolo_M.pdf: 1763243 bytes, checksum: bb94a0eae96254b7325735da6a1f32c7 (MD5) Previous issue date: 2012 / Resumo: Na Distrofia Muscular de Duchenne (DMD) e no camundongo mdx, modelo experimental da DMD, a ausência de distrofina promove instabilidade do sarcolema e degeneração muscular progressiva. O processo inflamatório que se instala contribui de forma significativa para a fisiopatologia da doença, sendo que antiinflamatórios esteroides são amplamente utilizados para a terapia da DMD. Entretanto, em decorrência da sua ação pouco efetiva e dos efeitos colaterais outras drogas são investigadas com o objetivo de substituir o uso dos corticoides. Em estudo prévio, demonstramos que o ácido eicosapentaenoico, em uma forma altamente purificada, atenuou a mionecrose em músculos esqueléticos de camundongos mdx durante os estágios iniciais da doença. No presente trabalho, verificamos se diferentes formas de ácidos graxos disponíveis comercialmente para o consumo humano (cápsulas de ômega-3 e sementes de linhaça) também teriam efeito protetor nos músculos distróficos, principalmente nos estágios tardios da doença, em que há comprometimento do músculo cardíaco. Animais mdx jovens (14 dias de idade) receberam ômega-3 diariamente, durante 16 dias, via gavagem. Animais mdx idosos (8 meses de idade) receberam sementes de linhaça durante 5 meses. Animais controle mdx, jovens e idosos, receberam óleo mineral e nenhum complemento alimentar, respectivamente. Nos animais jovens, o ômega-3 melhorou a distrofinopatia, reduzindo a mionecrose e o processo inflamatório no músculo mais afetado, o diafragma. Nos animais idosos, a linhaça resultou em melhora da distrofinopatia no diafragma. Entretanto, a fibrose cardíaca, que caracteriza morfologicamente a cardiomiopatia dos animais idosos mdx, não foi alterada pela linhaça, provavelmente devido a diferenças de metabolismo de ácidos graxos entre os músculos esquelético e cardíaco. Sugere-se que ácidos graxos ômega-3, em formulações disponibilizadas comercialmente para uso humano, são potencialmente úteis para o tratamento das distrofinopatias dos músculos estriados esqueléticos, nos estágios inicial e tardio da doença / Abstract: In Duchenne muscular dystrophy (DMD) and in the mdx mice model of DMD, absence of dystrophin promotes instability of the sarcolemma and progressive muscle degeneration. The inflammatory process contributes significantly to the pathophysiology of the disease. Anti-inflammatory steroids are widely used for DMD therapy. However, due to its ineffective action and their side effects, other drugs are investigated in order to replace the use of corticosteroids. Previously, we have demonstrated that eicosapentaenoic acid in a highly purified form inhibit myonecrosis in skeletal muscles of mdx mice during the early stages of the disease. In the present study, we have verified whether different forms of commercially available fatty acids for human (capsules of omega-3 and flaxseed) would also have a protective effect in dystrophic muscles, especially in the later stages of the disease, when cardiac muscle is also affected. Young mdx mice (14 days old) received omega-3 daily for 16 days via gavage. Older mdx mice (8 months old) received flaxseed for 5 months. mdx control group, young and old, received mineral oil and no food supplement, respectively. In young mice, omega-3 inhibits the dystrophinopathy, reducing myonecrosis and inflammatory process in the most affected muscle, the diaphragm. In aged animals, flaxseed resulted in improvement of dystrophinopathy only in the diaphragm. In the dystrophic heart, flaxseed did not inhibit fibrosis, which is a feature of cardiomyopathy in older mdx mice. Possibly, differences in fatty acid metabolism between skeletal and cardiac muscles may explain these differential results. It is concluded that omega-3 fatty acids commercially available for human use are potentially useful for the treatment of skeletal muscle dystrophinopathy, during early and late stages of the disease / Mestrado / Anatomia / Mestre em Biologia Celular e Estrutural

La dystrophie musculaire de Duchenne (DMD) est la conséquence de la perte de la dystrophine, protéine sous membranaire indispensable au maintien mécanique et fonctionnel du sarcolemme. Cette déficience augmenterait les influx cationiques par des microruptures de la membrane ou par la dérégulation de canaux tels que les canaux activés par l'étirement (SACs: Stretch-activated channel). Dans ce travail, les effets d'une stimulation mécanique ont été explorés sur des cardiomyocytes dans le contexte pathologique de la cardiomyopathie dilatée associée à la DMD. L'utilisation de fibres de carbone a permis de réaliser un étirement axial similaire aux conditions physiologiques de remplissage ventriculaire. Dans ces conditions, l'exploration de la topographie membranaire par la microscopie de conductance ionique à balayage n'a montré aucune évolution de la surface ni de lésion du sarcolemmel dans les conditions d'étirement. L'étude s'est donc focalisée sur l'activité de candidats moléculaires des SACs et plus particulièrement ceux appartenant à la famille des TRPs (Transient Receptor Potential) dans le dérèglement de l'homéostasie calcique induite par l'étirement. Les influx cationiques évalués par la technique d'extinction de fluorescence et l'étude de la concentration intracellulaire de Ca2+ ([Ca2+]i) grâce à la sonde Fluo8 montrent une implication des canaux TRPV2 et TRPCs. Les premiers semblent responsables d'une entrée cationique et d'une augmentation de [Ca2+]i importante dans les cardiomyocytes mdx. Les seconds, bien que responsables d'un influx, ne participeraient pas à l'augmentation de [Ca2+]i. Ces résultats révèlent que les canaux TRPV2 pourraient jouer un rôle important dans la dérégulation calcique observée dans les cardiomyocytes déficients en dystrophine. / Duchenne muscular dystrophy (DMD) is the consequence of the loss of dystrophin, a subsarcolemmal protein essential for mechanical and functional maintenances of the sarcolemma. This deficiency could increase cationic influxes by membrane microruptures or by dysregulation of channels such as stretch-activated channels (SACs). In this work, the effects of a mechanical stretch were explored on cardiomyocytes in the pathological context of dilated cardiomyopathy associated with DMD. Using carbon fibers, an homogenous axial stretch was performed to mimic physiological conditions of ventricular filling. In these conditions, exploration of membrane topography using the scanning ion conductance microscopy did not show any surface evolution or sarcolemma disruption in stretch condition. The study was thus focused on activity and identification of molecular candidates for SACs, especially the TRPs (Transient Receptor Potential) channels in the stretch-induced. Ca2+ homeostasis dysregulation. Cationic influxes assessed by Mn2+-quenching and assessment of the intracellular Ca2+ concentration ([Ca2+]i) using fluo-8 fluorescence demonstrated an involvement of TRPV2 and TRPCs channels. The first ones seem to be responsible for cationic entry and [Ca2+]i increase in mdx cardiomyocytes. The latter, though responsible for an influx, do not contribute to [Ca2+]i increase. These findings reveal that TRPV2 channels could play an important role in calcium dysregulation observed in dystrophin-deficient cardiomyocytes.

La thérapie cellulaire est une envisagée pour traiter des pathologies cardiaques ou squelettiques basée sur la médecine régénérative. Les progéniteurs cellulaires classiquement utilisés (myoblastes ou cellules mésenchymateuses) n'ont démontré qu'une efficacité limitée. Dans ce contexte, notre laboratoire a identifié une nouvelle catégorie de progéniteurs, sur la base de leur activité enzymatique aldéhyde déshydrogénase (ALDH) mise en évidence par un substrat fluorescent, l'Aldéfluor, et en association avec le marqueur CD34. Les ALDH sont impliquées dans le métabolisme et la détoxification des aldéhydes, et constituent un nouveau marqueur des cellules souches. Ce travail de thèse a permis de mieux caractériser les progéniteurs myogéniques (ALDH+/CD34-) et non myogéniques (ALDH+/CD34+), dans différents contextes physiopathologiques. Leur présence dans différents muscles de primates humains ou non humains, leur persistance au cours du vieillissement naturel ou lors d'atteinte par la dystrophie musculaire de Duchenne (DMD) chez l'Homme et dans des modèles animaux, suggèrent une utilisation possible des cellules ALDH+/CD34- pour des développements thérapeutiques ultérieurs. L'étude phénotypique révèle que des marqueurs transmembranaires sont associés à des sous-populations de cellules ALDH myogéniques ou non myogéniques dont la comparaison permettra de proposer de meilleurs candidats de thérapie cellulaire. En parallèle, les caractérisations histologiques et cytologiques ont identifié des sous-populations exprimant des isoenzymes et les analyses d'expressiongénique réalisées ex vivo et en culture suggèrent que certaines sont impliquées dans l'homéostasie musculaires. / Cell therapy is a regenerative medicine strategy considered for the treatment of cardiac or skeletal muscle diseases. The cellular progenitors used to date (myoblasts or mesenchymal stem cells) provided mitigated success, thus mandating the identification and characterization of new categories of progenitors. Our laboratory has identified new populations of progenitors, based on their Aldehyde Deshydrogenase activity (ALDH) detectable using the fluorescent substrate Aldefluor, associated with the expression of the CD34 marker. ALDH are involved in metabolism and detoxification of aldehydes, they play important roles in cell survival and differentiation and are considered a new marker of stem cells. The present project allowed characterizing extensively the myogenic (ALDH+/CD34-) and non myogenic (ALDH+/CD34+) progenitors, in several physiopathological contexts and animal models. The presence of ALDH+/CD34- cells in distinct muscle groups in Human and non-human Primates, their persistence through natural ageing and despite the ongoing degenerative process observed in Duchenne muscular dystrophy in Human patients and animal models suggest their future use for therapeutic applications. The phenotypic characterization indicated that membrane markers are associated to myogenic or non myogenic sub-populations of ALDH cells. The comparison on their efficacies in vito and in vivo will allow proposing new candidates for cell therapy. In parallele, histological and cytological analysis identified cell populations expressing isoenzymes The analysis of gene expressions suggested that, at least, some of them are involved in muscle homeostasis in situ or in vitro.

La Dystrophie Musculaire de Duchenne (DMD) est la plus fréquente et la plus sévère des maladies dégénératives du muscle. Elle se caractérise par une dégénérescence progressive des fibres musculaires due à l’absence de dystrophine fonctionnelle dans les muscles. Actuellement, le rôle physiologique de la dystrophine n’est pas clairement établi et il n’existe pas encore de traitement curatif pour cette maladie. La difficulté de mettre en évidence la fonction de la dystrophine et la physiopathologie de la DMD est en partie expliquée par la complexité moléculaire et cellulaire du muscle des modèles vertébrés utilisés dans les études actuelles. Notre équipe de recherche a développé un modèle de DMD chez le nématode Caenorhabditis elegans. Dans ce modèle, la mutation du gène de la dystrophine, provoque une dégénérescence progressive des muscles conduisant à une paralysie des animaux adultes. Nous utilisons ce modèle afin d’étudier la fonction de la dystrophine et les mécanismes impliqués dans la dégénérescence musculaire chez le nématode. Ce travail de thèse porte sur deux nouveaux acteurs de la dégénérescence musculaire dépendante de la dystrophine : la protéine DYC‐1 et son principal partenaire ZYX‐1. Ce travail présente la caractérisation de ces deux protéines et étudie leurs fonctions dans le muscle. Par ailleurs, ce travail de thèse présente les premiers résultats d’un projet de microscopie électronique ayant pour but de caractériser en détail les évènements subcellulaires du processus dégénératif au cours du cycle de vie du nématode dystrophique. À plus long terme, les études chez le nématode permettront de proposer de nouvelles hypothèses quant aux mécanismes moléculaires et cellulaires de la dégénérescence musculaire / Duchenne Muscular Dystrophy (DMD) is the most prevalent and one of the most severe muscular dystrophy. DMD is due to the absence of functional dystrophin in cardiac and skeletal muscle cells, this lack leads to a progressive muscle degeneration of contractile fibres. Currently, the physiological role of dystrophin is not yet clearly established and curative treatments for DMD are not yet available. The lack of knowledge about dystrophin function and DMD physiopathology can be partly attributed to the complexity of vertebrate muscle, and the absence of a simple model that emulates the human pathology. Our research team developed a model of muscle degeneration in the nematode Caenorhabditis elegans. In this model, the mutation of the dystrophin gene produces a progressive muscle degeneration leading to the paralysis of the adult worms. We use this model for investigating the role of dystrophin and the mechanisms of muscle degeneration in C. elegans. This PhD work concerns two new actors of dystrophin‐dependant muscle degeneration: The DYC‐1 protein and its main interactor ZYX‐1. This study aims to characterise these proteins and to study their muscle functions. Moreover, this PhD work presents preliminary results of an in depth characterisation of subcellular processes of muscle degeneration in dystrophic worms by electron microscopy. Our aim is to visualise first events and to observe the progression of degeneration until the death of muscle cell. These molecular and cellular approaches aims to get new insights in the mechanisms underlying muscle degeneration in order to propose new hypotheses for the understanding of DMD

L'objectif de ce travail est de développer la partie clinique de la banque de données du gène DMD, afin d'étudier l'histoire naturelle des dystrophinopathies et les corrélations génotype–phénotype, et de faciliter la sélection des patients pour les futurs essais thérapeutiques. La méthodologie créée pour le gène DMD peut être généralisée et utilisée pour d'autres banques de données dédiées à des maladies génétiques. La collecte de 70 000 données cliniques chez 600 patients avec un suivi longitudinal moyen de 12 ans permet de décrire l'histoire naturelle des dystrophies musculaires de Duchenne et de Becker et des formes symptomatiques chez les femmes. Nous avons pu préciser l'hétérogénéité phénotypique sur le plan moteur, orthopédique et respiratoire (forme sévère et forme intermédiaire de la dystrophie musculaire de Duchenne), sur le plan cardiaque (absence de corrélation entre les atteintes motrice et cardiaque, variabilité de l'atteinte cardiaque), et sur le plan cérébral (atteinte intellectuelle chez les patients avec dystrophie musculaire de Becker, troubles psychologiques des dystrophinopathies). L'utilisation de cet outil par les cliniciens et les généticiens devrait faciliter le travail de recherche clinique et la réalisation des futurs essais cliniques. Ceci nécessite maintenant de développer l'accessibilité de la banque de données et d'envisager sa pérennisation. / The objective of this work is to develop the clinical part of the French dystrophinopathy data-base, in order to study the natural history and the genotype-phenotype correlations, and to facilitate the selection of the patients for the future therapeutic trials. The methodology developed for the DMD gene can be generalized and used for the other databases dedicated to genetic diseases. The collection of 70 000 clinical data for 600 patients with an average lon-gitudinal follow-up of 12 years allows to clarify the natural history of the muscular dystrophies of Duchenne and Becker and in symptomatic females. We were able to specify the pheno-typic heterogeneity of the motor, orthopaedic and respiratory involvements (severe form and intermediary form of the Duchenne muscular dystrophy), of the cardiac disorder (absence of correlation between motor and cardiac involvements, variability of the cardiomyopathy), and of the brain function (mental deficiency in the patients with Becker muscular dystrophy, psychological disorders in dystrophinopathies). The use of this tool by the clinicians and the ge-neticists should facilitate their clinical research work and the realization of the future clinical trials. This requires now to develop the accessibility of the database and to ensure its continued existence.