Orientador: Alexandre Leite Rodrigues de Oliveira / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-21T17:19:57Z (GMT). No. of bitstreams: 1 Simoes_GustavoFerreira_D.pdf: 65115196 bytes, checksum: 18f51cababf3e248cceb806b8faef631 (MD5) Previous issue date: 2012 / Resumo: Atualmente, muito se sabe sobre o acometimento muscular na DMD, mas poucos estudos estão voltados para os efeitos no Sistema Nervoso Central (SNC), mais especificamente no microambiente do motoneurônio medular. Sabe-se que durante a evolução da doença, o terminal axonal, na junção neuromuscular, entra em um ciclo de denervação (retração) e reinervação (brotamento). A possibilidade de modulação do MHC I se apresenta como uma nova estratégia de influenciar positivamente o processo de plasticidade sináptica após lesões do Sistema Nervoso Periférico (SNP) e SNC. Tal modulação pode ser realizada através da utilização ou desenvolvimento de drogas específicas. O fator estimulador de colônias glanulocitárias (G-CSF) é uma glicoproteína que foi descrita há mais de vinte anos, possui aprovação do ANVISA (Agência Nacional de Vigilância Sanitária) e é comumente utilizada para tratar neutropenia, ou para transplantes de medula óssea. O GCSF possui um efeito neuroprotetor aparentemente multimodal, incluindo-se a atividade anti-apoptóptica em neurônios, regeneração da vascularização, efeito antiinflamatório e estimulação de neurogênese endógena, sendo capaz de atuar efetivamente no processo de regeneração do sistema nervoso. No presente trabalho, foram utilizados camundongos MDX. Os camundongos foram distribuídos em 4 grupos (axotomia + G-CSF; Axotomia; Controle + G-CSF e Controle), com n=10. Incluiu-se para imunoistoquímica o grupo placebo, onde os animais receberam uma dose diária de 200?m, via subcutânea, de glicose a 25%. Nossos resultados indicam que redução de sinapses nos motoneurônios alfamedulares e aumento da astrogliose circunjacente aos neurônios alfa-medulares, seja decorrente da desconexão parcial entre o orgão alvo e o corpo neuronal durante o período de ciclos de degeneração/regeneração muscular que ocorrem a partir das primeiras semanas de vida nos camundongos MDX. Estes ciclos podem repercutir retrogradamente nos corpos celulares dos motoneurônios alfa-medulares, provocando uma série de alterações denominadas cromatólise. A axotomia do nervo isquiático resulta num aumento significativo da expressão de MHC I nas duas linhagens estudadas. Contudo, nos animais MDX, este aumento é menor, comparativamente à linhagem C57BL/10. Quando tratados com G-CSF a expressão de MCH I ficou maior em relação aos grupos não tratados e, isso pode indicar um papel ativo da droga no potencial regenerativo após a lesão. Também podemos sugerir que, apesar dos animais MDX apresentarem uma menor função motora em relação aos animais controle, os resultados indicam que o tratamento com G-CSF é capaz de reduzir os efeitos inflamatórios e atuar positivamente no processo de regeneração nervosa periférica após esmagamento do nervo isquiático / Abstract: Currently, much is known about the muscular involvement in DMD, but few studies have focused on the effects on the central nervous system (CNS), specifically in the microenvironment of spinal motor neurons. It is known that during the course of the disease, the axon terminal at the neuromuscular junction, enters a cycle of denervation (retraction) and reinnervation (sprouting). The possibility of modulation of MHC I presents itself as a new strategy to positively influence the process of synaptic plasticity after injury Peripheral Nervous System (PNS) and CNS. Such modulation may be accomplished through the use or development of special drugs. The granulocyte colony-stimulating factor (G-CSF) is a glycoprotein which was first described more than twenty years, has approval from ANVISA (Agência Nacional de Vigilância Sanitária) and is commonly used to treat neutropenia, or bone marrow transplants. The G-CSF has a multimodal neuroprotective effect l, including the anti-apoptotic activity in neurons, regeneration of vascularization, anti-inflammatory effect and stimulation of endogenous neurogenesis, being able to act effectively in the process of regeneration of the nervous system. In this study, we used MDX mice. The mice were divided into 4 groups (axotomy + G-CSF; axotomy, Control + G-CSF and Control), with n = 10. Included immunohistochemistry to the placebo group, where the animals received a daily dose of 200?m, subcutaneously, glucose 25%. Our results indicate that reduction of synapses in the alpha motoneurosn and increased astrogliosis , either due to partial disconnection between the target organ and the neuronal body during the cycles of degeneration /regeneration muscle that occur from first weeks of life in MDX mice. These cycles can pass retrogradely in alpha motoneurons cell bodies, causing a series of changes called chromatolysis. The sciatic nerve axotomy results in a significant increase of MHC I expression in both strains studied. However, in MDX strain, this increase is smaller, compared to C57BL/10. After treatment with G-CSF the expression of MCH I got bigger compared to untreated groups, and this may indicate an active role in the regenerative potential of the drug after injury. Also we suggest that while the animals present MDX a smaller motor function compared to control animals, the results indicate that treatment with G-CSF is capable of reducing the inflammatory effects and act positively on peripheral nerve regeneration process after nerve crush sciatic. Also our results indicate that treatment with G-CSF is able to reduce the inflammatory effects and act positively on peripheral nerve regeneration process after nerve crush sciatic / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural

Cette thèse interdisciplinaire a été dédiée à la caractérisation des propriétés mécaniques de myoblastes (murins et humains) et de myotubes (murins) à l'aide de la microscopie à force atomique (AFM). En modifiant ou en inhibant la dynamique du cytosquelette (CSK) d’actine de ces cellules, nous avons pu montrer que ces propriétés mécaniques variaient. L’enregistrement de courbes de force indentation nous a permis de montrer que la présence de cellules adhérentes introduisait sur les leviers d’AFM un amortissement visqueux supplémentaire à celui d’une paroi solide, et que cet amortissement visqueux dépendait de sa vitesse d’approche et que celui-ci restait non négligeable pour les plus faibles vitesses (1μm/s). Nous avons observé que les propriétés mécaniques des précurseurs de muscles devenaient non linéaires (comportement plastiques) pour des grandes déformations (>1μm) et qu’elles dépendaient de l’état, du type de cellule et de leur environnement. En combinant des expériences d’AFM, des modèles visco-élastiques et des méthodes d'analyse multi-échelle basées sur la transformation en ondelettes, nous avons illustré la variabilité des réponses mécaniques de ces cellules (de visco-élastiques à visco-plastiques). À l'aide de courbes de force-indentation, de l’imagerie morpho-structurale (DIC, microscopie à fluorescence) et de traitements pharmacologiques, nous avons éclairé le rôle essentiel des processus actifs (dépendants de l’ATP) dans la mécanique de myoblastes, en discutant tout particulièrement ceux des moteurs moléculaires (myosine II) couplés aux filaments d’actine. En particulier, nous avons montré que les fibres de stress du cytosquelette d’actine situées autour du noyau pouvaient présenter des évènements de remodelage soudains (ruptures) et que ces ruptures étaient une mesure indirecte de l’aptitude de ces cellules à tendre leur CSK. Nous avons enfin montré qu’il était possible de généraliser cette approche à des cas cliniques humains, en l’occurrence des myoblastes primaires de porteurs sains et de patients atteints de dystrophie musculaire de Duchenne, ouvrant la voie à des études plus larges sur d’autres types cellulaires et pathologies. / This interdisciplinary thesis was dedicated to the atomic force microscopy (AFM) characterization of the mechanical properties of myoblasts (murine and human) and myotubes (murine). We reported that the mechanical properties of these cells were modified when their actin cytoskeleton (CSK) dynamics was inhibited or altered. Recording single AFM force indentation curves, we showed that adherent layers of myoblasts and myotubes introduced on the AFM cantilever an extra hydrodynamic drag as compared to a solid wall. This phenomenon was dependent on the cantilever scan speed and not negligible even at low scan velocities (1μm/s). We observed that the mechanical properties of the muscle precursor cells became non-linear (plastic behaviour) for large local deformations (>1μm) and that they varied depending on the state, type and environment of the cells. Combining AFM experiments, viscoelastic modeling and multi-scale analyzing methods based on the wavelet transform, we illustrated the variability of the mechanical responses of these cells (from viscoelastic to viscoplastic). Through AFM force indentation curves analysis, morpho-structural imaging (DIC, fluorescence microscopy) and pharmacological treatments, we enlightened the important role of active (ATP-dependent) processes in myoblast mechanics, focusing especially on those related to the molecular motors (myosin II) coupled to the actin filaments. In particular, we showed that the perinuclear actin stress fibers could exhibit some abrupt remodelling events (ruptures), which are characteristic of the ability of these cells to tense their CSK. Finally, we showed that this approach can be generalized to some human clinical cases, namely primary human myoblasts from healthy donors and patients affected by Duchenne muscular dystrophy, paving the way for broader studies on different cell types and diseases.

Les dystrpohies musculaires sont des maladies génétiques rares qui se caractérisent par une dégénérescence musculaire progressive. la Dystrophie Musculaire de Duchenne (DMD) qui est la plus sévère d'entre elles est due à des mutations dans le gène de la dystrophine. Les mécanismes cellulaires impliqués dans le processus de dégénérescence des muscles restent peu compris et aucun traitement efficace n'existe à ce jour. Notre équipe a développé un modèle de la DMD chez le nématode C. elegans qui présente une dégénérescence musculaire progressive. Pendant ma thèse, j'ai caractérisé le processus de dégénérescence musculaire chez ce modèle par microscopie électronique. J'ai également contribué à une étude du rôle des mitochondries dans la dégénérescence musculaire dystrophine-dépendante chez le nématode. Par ailleurs, j'ai étudié l'effet de suppresseurs pharmacologique et génétiques de la dégénérescence musculaire dystrophine-dépendante. Enfin, j'ai pu mettre en évidence que la force exercée par le muscle influence le taux de dégénérescence musculaire. L'ensemble des résultats obtenus au cours de ma thèse, suggèrent que la perte de fonctions de la dystrophine affecte chez le nématode l'intégrité du sarcolemme et des structures d'ancrage des sarcomères et déclenche ainsi une cascade d'événements intracellulaires conduisant in fin à la mort de la cellule musculaire. Ainsi mes travaux dethèse mettent en évidence de nouveau mécanismes cellulaires impliqués dans la dégénérescence musculaire et ouvrent de nouvelles perspectives pour le développement de thérapie visant à cibler les défauts primaires ou secondaires induits par la perte de fonction de la dystrophine / Muscle dystrophies are genetic diseases caraterized by progressive muscle degeneration. Duchenne Muscular Dystrophy (DMD) is the most severe and is due to a mutation in the gene coding the dystrophin protein. The cellular mechanisms implicated in the degenerating process arte not understood yet and there is still no efficient treatment to cure the disease. Our group decvelopped a DMD model in C. elegans that presents progressive muscle degeneration. During my PhD thesis, I characterized the process of muscle degeneration in this model by electron microscopy. I also contribued to an investigation of the role of mitochondira in dystophin-dependant muscle degeneration. I also studied the effect of pharmacological and genetic suppressors of muscle degeneration. Finally, I showed that the force developped by the worm to move influences the level of muscle degeneration. Altogether, the results I obtained during my PhD thesis, suggest that the loss of funciotnof the dystrophin protein affects the integrity of the muscle plasma membrane and the sarcomeres anchoring structures triggering a cascade of intracellular events leading to the muscle cell death in C. elegans. Therefore, my results highlight new cellular mechanisms implicated in the phenomenon of muscle degeneration and open new perspectives for the development of therapies targeting primary and secondary defects induced by the dystrophin loss of function.

Objetivo: Determinar a responsividade do domínio subir e descer escada da escala de avaliação funcional em distrofia muscular de Duchenne (DMD), no período de um ano. Método: Participaram do estudo 26 pacientes com DMD. A análise utilizou o Tamanho do Efeito (ES) e a Média Padronizada de Resposta (SRM). Resultados: Atividade de subir escada: o ES mostrou responsividade baixa nos intervalos de avaliação de 3 meses (0,26; 0,35; 0,13; 0,17), baixa a moderada em 6 meses (0,58, 0,48; 0,33), moderada em 9 meses (0,70; 0,68) e alta em 1 ano (0,88). A análise com SRM mostrou responsividade baixa nos intervalos de avaliação de 3 meses (0,29; 0,38; 0,18 e 0,19), baixa a moderada em intervalos de 6 meses (0,59 e 0,51, 0,36), moderada em 9 meses (0,74 e 0,70) e alta em 1 ano (0,89). Atividade de descer escada: O ES apresentou responsividade baixa nos intervalos de avaliação de 3 meses (0,16; 0,25; 0,09; 0,08) e 6 meses (0,48; 0,35; 0,18), baixa a moderada em 9 meses (0,59, 0,44) e moderada em 1 ano (0,71). Análise com SRM mostrou responsividade baixa nos intervalos de 3 meses (0,25; 0,35; 0,12 e 0,09) e 6 meses (0,47; 0,38 e 0,21), moderada a baixa em 9 meses (0,62, 0,49) e moderada em 1 ano (0,74). Conclusão: A avaliação da atividade de subir escada, por meio da FES-DMD-D3, deve ser realizada em intervalos a partir de 9 meses, pois a responsividade é de moderada a alta. A avaliação do descer escadas deve ser realizada anualmente, pois houve responsividade moderada somente a partir de 12 meses / Objective: To determine the responsiveness of the domain up and down stair Functional Evaluation Scale for Duchenne Muscular Dystrophy (DMD) in one year follow-up. Method: The study included 26 patients with DMD. The analysis used the Effect Size (ES) and Standardized Response Mean (SRM) tests. Results: Climbing stairs activity: the ES test showed low responsiveness in the 3-month evaluation intervals (0.26; 0.35; 0.13; 0.17), low to moderate at 6 months (0.58, 0 48; 0.33), moderate in 9 months (0.70, 0.68) and high in one year (0.88). The SRM analysis showed low response in the 3 month evaluation interval (0.29, 0.38, 0.18 and 0.19), moderate to low every 6 months (0.59 and 51, 0, 36), moderate in 9 months (0.74 and 0.70) and high in one year (0.89). Down stairs activity: The ES test showed low responsiveness in the 3 month evaluation intervals (0.16; 0.25; 0.09; 0.08) and 6 months (0.48, 0.35, 0, 18), low to moderate at 9 months (0.59, 0.44) and moderate in 1 year (0.71). SRM Analysis showed low response at intervals of 3 months (0.25; 0.35; 0.12 and 0.09) and 6 months (0.47, 0.38 and 0.21), low to moderate 9 months (0.62, 0.49) and moderate in 1 year (0.74). Conclusion: The assessment of stair climbing up should be performed in 9 months or longer intervals, when responsiveness is moderate to high. Going down stairs assessment should be performed annually, because moderate responsiveness was observed in 1 year interval

O nosso objetivo foi de avaliar evolutivamente a perda da força muscular e das habilidades motoras, bem como a progressão da distribuição da fraqueza muscular nos diferentes segmentos dos membros superiores em pacientes com distrofia muscular de Duchenne em corticoterapia. Selecionamos seguintes testes de fácil aplicação: Teste de força Manual Muscular Escala Medical Research Council; Teste ABC provas de coordenação visual-motora e fatigabilidade provas n° 1, 3, 7 e 8; Grau funcional de Brooke; Índice de Barthel. Os testes foram aplicados em 40 pacientes com idades entre 5 e 15 anos, deambulantes e não deambulantes, os quais foram avaliados três vezes, com intervalos de seis meses entre cada avaliação. Os resultados mostraram que a progressão da distribuição da força muscular nos membros superiores ocorreu dos segmentos proximais para os distais em todos os pacientes e foi maior nos pacientes não deambulantes e com maior idade. O ato de escrever (pegada no lápis e/ou caneta) não foi influenciado pela progressão; no entanto, o aumento da fatigabilidade foi um fator limitante contribuindo para a redução do ritmo e da qualidade da escrita. O grau funcional de Brooke confirmou a variação das medidas de força muscular e nas atividades de vida diária o nível de dependência foi maior nos pacientes com maior idade, acontecendo nestes compensações funcionais importantes que lhes permitiram realizar a atividade de forma adaptada. / Our aim was to analyze the progression of the involvement of muscle strength and functional motor hability as well as the progression of the weakness pattern in the upper limbs of children with Duchenne muscular dystrophy who were receiving steroid therapy. We evaluated 40 patients with DMD, aged 5-15 years, by using the following simple tests: MRC score based on the upper limbs muscles; ABC tests number 1, 3, 7 and 8 for assessing visual motor coordination and fatigability; Brooke functional ability scale and modified Barthel index. All boys were evaluated every 6 months along a period of 18 months. The loss of muscular strength showed a proximal to distal progression and was greater in non- ambulant and in older patients. The act of writing (to hold pencil or pen) was not influenced by the progression; however, the fatigability increased and was a limiting factor for the speed and the quality of the hand writing. The Brooke functional ability scale confirmed the changes in the muscular strength. The performance in daily activities showed a greater dependence in the older patients who adopted functional compensations for performing the activities in an adapted way.

Hintergrund und Zielsetzung: DMD ist die häufigste Form der Muskeldystrophie im Kindesalter und bis heute unheilbar. Sie wird durch das Fehlen des Proteins Dystrophin verursacht, welches verschiedene Signaltransduktionswege beeinflusst. Das Anliegen der Arbeit ist die Untersuchung und Modulation von Signaltransduktionswegen, die als alternative Therapiestrategie den Verlust von Dystrophin kompensieren könnten. Experimentelle Strategie: Für die Charakterisierung von Dystrophin nachgeschalteten Prozessen wurden mRNA-Expressionsanalysen in Muskelgeweben von DMD-Patienten und einem DMD-Brüderpaar mit einem infrafamiliär unterschiedlichen Verlauf der DMD durchgeführt. Aus diesen Expressionsdaten wurde erstmalig ein Petri-Netz entwickelt, welches Dystrophin mit in diesem Zusammenhang bisher unbekannten Signaltransduktionswegen verknüpft. Das Petri-Netz wurde auf Netzwerkintegrität und –verhalten mittels Invarianten- (INA) und theoretischen Knockout- (Mauritius Maps) Analysen untersucht. Durch beide Methoden läßt sich der maßgebliche Teilsignalweg bestimmen. In diesem Signalweg wurden die Proteinaktivität und die Genexpression durch siRNA, Vektor-DNA und chemische Substanzen in humanen SkMCs moduliert. Anschließend wurden die Proliferation und die Vitalität der Zellen sowie auch die Expression auf mRNA- und Protein-Niveau untersucht. Ergebnisse: RAP2B und CSNK1A1 waren in dem DMD-Brüderpaar differentiell exprimiert und konnten erstmalig in einem neuen, komplexen Signalweg in Zusammenhang mit Dystrophin nachgeschalteten Prozessen dargestellt werden. Mittelpunkt dieses Signalweges ist die De- und Aktivierung des Transkriptionsfaktors NFATc. Seine Zielgene umfassen neben anderen den negativen Proliferationsfaktor p21, das Dystrophin homologe UTRN und den Differenzierungsfaktor MYF5. Folglich würde ein Anstieg von UTRN eine unerwünschte Reduktion der Proliferationsrate von Myoblasten implizieren. Letzteres konnte bereits nachgewiesen werden und stellte das Motiv für weitere Studien dar. Jedoch zeigten siRNA- und Vektor-DNA-Experimente, daß NFATc nicht der ausschlaggebende Faktor für diese Zielgene ist. Die Substanzen Deflazacort (DFZ) und Cyclosporin A (CsA) wurden dagegen beschrieben, die Aktivierung von NFATc zu beeinflussen. Die Ergebnisse zeigten, daß beide Substanzen die Proliferation von Myoblasten erhöhen können. Die gleichzeitige Applikation von DFZ und CsA führte zu einem Anstieg der UTRN-Expression. Schlußfolgerung: Die Modulation der Proliferation und UTRN-Expression ist unabhängig von einander möglich. Entsprechend der Grundidee der Arbeit zeichnet sich eine neue Therapiestrategie ab, welche Dystrophin nachgeschaltete Prozesse einbezieht. / Background and aim: DMD is the most common muscular dystrophy in childhood and incurable to date. It is caused by the absence of dystrophin, what influences several signal transduction pathways. The thesis is interested in the investigation and modulation of signal transduction pathways that may compensate the lack of dystrophin as an alternative therapy strategy. Experimental strategy: To study Dystrophin downstream pathways the mRNA expression of DMD patients and two DMD siblings with an intra-familially different course of DMD were analysed in muscle tissue. On the basis of these expression data a Petri net was first developed implicating signal transduction pathways and Dystrophin downstream cascades. Invariant (INA) and theoretical knockout (Mauritius Maps) analyses were applied for studying network integrity and behaviour. Both methods provide information about the most relevant part of the network. In this part modulation of protein activity and of gene expression using siRNA, vector-DNA, and chemical substances were performed on human SkMCs. Subsequently, the cells were studied by proliferation and vitality tests as well as expression analyses at mRNA and protein level. Results: RAP2B and CSNK1A1 were differently expressed in two DMD siblings, and first are part of a signal transduction pathway implicating Dystrophin downstream processes. The central point of this pathway is the de- and activation of the transcription factor NFATc. Its target genes are, among others, the negative proliferation factor p21, the Dystrophin homologue UTRN, and the differentiation factor MYF5. Consequently, an increase in UTRN implicates an undesirably reduced myoblast proliferation rate. Latter was found in DMD patients and was target for further studies. But, siRNA and vector DNA experiments showed that NFATc is not the decisive factor for the target genes. Deflazacort and cyclosporin A are known to influence the activation of NFATc. The results first showed that both substances do induce myoblast proliferation. The use of deflazacort in combination with cyclosporin A resulted in an increase of UTRN expression. Conclusion: The modulation of proliferation and UTRN-expression independently of each other is possible. According to the basic idea of this study, a new therapeutic strategy becomes apparent, which considers Dystrophin downstream processes.

O nosso objetivo foi de avaliar evolutivamente a perda da força muscular e das habilidades motoras, bem como a progressão da distribuição da fraqueza muscular nos diferentes segmentos dos membros superiores em pacientes com distrofia muscular de Duchenne em corticoterapia. Selecionamos seguintes testes de fácil aplicação: Teste de força Manual Muscular Escala Medical Research Council; Teste ABC provas de coordenação visual-motora e fatigabilidade provas n° 1, 3, 7 e 8; Grau funcional de Brooke; Índice de Barthel. Os testes foram aplicados em 40 pacientes com idades entre 5 e 15 anos, deambulantes e não deambulantes, os quais foram avaliados três vezes, com intervalos de seis meses entre cada avaliação. Os resultados mostraram que a progressão da distribuição da força muscular nos membros superiores ocorreu dos segmentos proximais para os distais em todos os pacientes e foi maior nos pacientes não deambulantes e com maior idade. O ato de escrever (pegada no lápis e/ou caneta) não foi influenciado pela progressão; no entanto, o aumento da fatigabilidade foi um fator limitante contribuindo para a redução do ritmo e da qualidade da escrita. O grau funcional de Brooke confirmou a variação das medidas de força muscular e nas atividades de vida diária o nível de dependência foi maior nos pacientes com maior idade, acontecendo nestes compensações funcionais importantes que lhes permitiram realizar a atividade de forma adaptada. / Our aim was to analyze the progression of the involvement of muscle strength and functional motor hability as well as the progression of the weakness pattern in the upper limbs of children with Duchenne muscular dystrophy who were receiving steroid therapy. We evaluated 40 patients with DMD, aged 5-15 years, by using the following simple tests: MRC score based on the upper limbs muscles; ABC tests number 1, 3, 7 and 8 for assessing visual motor coordination and fatigability; Brooke functional ability scale and modified Barthel index. All boys were evaluated every 6 months along a period of 18 months. The loss of muscular strength showed a proximal to distal progression and was greater in non- ambulant and in older patients. The act of writing (to hold pencil or pen) was not influenced by the progression; however, the fatigability increased and was a limiting factor for the speed and the quality of the hand writing. The Brooke functional ability scale confirmed the changes in the muscular strength. The performance in daily activities showed a greater dependence in the older patients who adopted functional compensations for performing the activities in an adapted way.

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