Este estudo caracteriza a intoxicação por Trema micrantha em equinos, até então desconhecida nesta espécie. No primeiro artigo (artigo 1), é descrito um surto espontâneo de intoxicação por T. micrantha em equinos que ocorreu em junho de 2007, no Município de São José do Herval, na região da encosta da serra do Rio Grande do Sul. Dois equinos morreram na propriedade, após uma árvore de T. micrantha ter sido derrubada por um temporal e suas folhas terem sido consumidas pelos animais. O quadro clínico patológico apresentado foi característico de insuficiência hepática aguda, com desenvolvimento de encefalopatia hepática. Subsequentemente, para melhor caracterizar a intoxicação por Trema micrantha em equinos, desenvolveu-se um experimento (artigo 2). Quatro pôneis receberam e consumiram espontaneamente folhas de T. micrantha, em doses únicas de 30, 25 e 20g/kg. Um equino recebeu uma dose de 15 e outra de 25g/kg, 30 dias após. Três animais adoeceram e evoluíram para morte. Os principais sinais clínicos apresentados foram apatia, desequilíbrios, dificuldade de deglutição, decúbito esternal, decúbito lateral, movimentos de pedalagem coma e morte. Os três equinos afetados apresentaram elevação na atividade sérica de gama glutamil transferase (GGT), nos níveis séricos de amônia, além de diminuição da glicemia. Os principais achados patológicos foram encontrados no fígado e no encéfalo dos três animais. O fígado apresentava macroscopicamente acentuação do padrão lobular, enquanto que no encéfalo havia áreas amareladas na superfície de corte, mais evidentes na substância branca do cerebelo. Microscopicamente, o fígado apresentava necrose, predominantemente centrolobular e hemorragia. No encéfalo, havia edema perivascular generalizado e astrócitos Alzheimer tipo II na substância cinzenta. Esses astrócitos apresentaram marcação fraca ou negativa na imuno-histoquímica anti-GFAP e marcação positiva do antígeno S-100. A dose letal mínima de folhas de T. micrantha estabelecida nesse experimento foi de 20g/kg. A maior sensibilidade da espécie equina constatada nesse estudo, a ampla distribuição de T. micrantha, bem como sua palatabilidade reforçam a importância da planta em casos acidentais de intoxicação nessa espécie. / This study characterizes Trema micrantha poisoning in horses, previously unknown in this species. The first article (Article 1) describes an outbreak of T. micrantha poisoning in horses. The disease occurred in June 2007, in the Municipality of São José do Herval, Rio Grande do Sul State. Two horses died after consuming the leaves of the branches from a T. micrantha tree, which had been felled by a storm. Clinical pathology presented by the animals was characteristic of an acute liver failure with development of hepatic encephalopathy. To further characterize the Trema micrantha poisoning in horses, an experiment was carried out (Article 2). Four ponies received and spontaneously consumed green leaves of T. micrantha, at the doses of 30, 25, and 20 g/kg. One horse received two doses, 15 and 25 g/kg, 30 days apart. Three animals were affected and died. The main clinical signs were apathy, equilibrium deficit, deglutition difficulty, sternal or lateral recumbency, paddling, coma and death. These tree diseased ponies had also enhanced seric activity of gamma-glutamyl transferase (GGT), seric ammonia apart of diminished glycemia. The main pathological findings were observed in the liver and encephalon. There were enhanced lobular pattern of the livers and yellowish areas in the cut surface of the encephalon, especially visualized in the cerebral white matter. Microscopically, there was hepatic necrosis predominantly centrilobular apart of hemorrhages. Generalized perivascular edema and Alzheimer type II astrocytes were observed in the encephalon. The Alzheimer type II astrocytes showed weak or absent anti-glial fibrillar acid protein immunostaining associated with positive immunostaining for S-100 protein. The minimal lethal dose of Trema micrantha leaves was established at 20 g/kg. The high sensibility of this species to this plant, its wide distribution, and the high palatability of the plant reinforce the importance of Trema micrantha in accidental episodes of intoxication in horses.

This work presents an investigation of the way physiotherapists perform their communication with subjects with chronic non-progressive encephalopathy (CNPE) having restricted or absent speech. For this purpose, we interviewed twelve physiotherapists about non-verbal communication and then we interviewed the five physiotherapists who knew and used the alternative and augmentative communication (AAC) in therapy about the use of this resource. After the initial reading of the narratives, we noticed that all the physiotherapists consider non-verbal communication important and perform it, mainly through reading facial and body expressions. Concerning the use of AAC, the five professionals of the sample emphasized the importance of this resource, although only one of them makes use of it routinely. We conclude that the physiotherapists strive to invest in non-verbal communication and/or AAC with CNPE subjects who present restricted or absent speech and that such an investment improves the hospitalization outcomes and the interaction between the subjects and the professionals who treat them. However, the theoretical and practical learning of non-verbal communication and ACC seems flawed and inadequate in physiotherapy undergraduate course. This fact can be considered one of the causes of the poor use of non-verbal communication as well as one of the causes of the lack of knowledge or of the non-routine use of AAC in therapy. The results suggest the need to overcome the purely biomedical model in the formation of the physiotherapist and to adopt some training that seeks to humanize and promote quality in physical therapy services. / Este trabalho apresenta uma investigação sobre a forma de comunicação que o fisioterapeuta efetua durante a sessão com o sujeito com Encefalopatia Crônica Não Progressiva (ECNP) com oralidade restrita ou ausente. Para tal meta, foram realizadas entrevistas com doze fisioterapeutas sobre a comunicação não verbal e, a seguir, sobre o uso da Comunicação Aumentativa Alternativa (CAA) na terapia com cinco fisioterapeutas que conheciam e utilizaram esse recurso. Após a leitura inicial da coletânea das narrativas, verificou-se que todos os fisioterapeutas consideram importante e realizam a comunicação não verbal, principalmente por meio da leitura de expressões corporais e faciais. Quanto ao uso da CAA, os cinco fisioterapeutas do grupo amostral ressaltaram a importância desse recurso, embora somente um desses o utilize rotineiramente. Conclui-se que os fisioterapeutas procuram investir em uma comunicação não verbal e/ou CAA com o sujeito com ECNP que apresenta oralização restrita ou ausente e que tal investimento produz melhoras na interação e no vínculo com o sujeito em tratamento. Todavia, o aprendizado teórico e prático, tanto da comunicação não verbal quanto da CAA, apresenta-se falho e insuficiente na graduação de Fisioterapia. Esse fato pode ser considerado como uma das causas do investimento precário na comunicação não verbal, assim como do desconhecimento ou do uso não rotineiro da CAA na terapia. Os resultados sugerem a necessidade de ultrapassar o modelo exclusivamente biomédico na formação do fisioterapeuta e de adotar uma formação que busque a humanização e a promoção de qualidade no atendimento fisioterápico.

Este estudo caracteriza a intoxicação por Trema micrantha em equinos, até então desconhecida nesta espécie. No primeiro artigo (artigo 1), é descrito um surto espontâneo de intoxicação por T. micrantha em equinos que ocorreu em junho de 2007, no Município de São José do Herval, na região da encosta da serra do Rio Grande do Sul. Dois equinos morreram na propriedade, após uma árvore de T. micrantha ter sido derrubada por um temporal e suas folhas terem sido consumidas pelos animais. O quadro clínico patológico apresentado foi característico de insuficiência hepática aguda, com desenvolvimento de encefalopatia hepática. Subsequentemente, para melhor caracterizar a intoxicação por Trema micrantha em equinos, desenvolveu-se um experimento (artigo 2). Quatro pôneis receberam e consumiram espontaneamente folhas de T. micrantha, em doses únicas de 30, 25 e 20g/kg. Um equino recebeu uma dose de 15 e outra de 25g/kg, 30 dias após. Três animais adoeceram e evoluíram para morte. Os principais sinais clínicos apresentados foram apatia, desequilíbrios, dificuldade de deglutição, decúbito esternal, decúbito lateral, movimentos de pedalagem coma e morte. Os três equinos afetados apresentaram elevação na atividade sérica de gama glutamil transferase (GGT), nos níveis séricos de amônia, além de diminuição da glicemia. Os principais achados patológicos foram encontrados no fígado e no encéfalo dos três animais. O fígado apresentava macroscopicamente acentuação do padrão lobular, enquanto que no encéfalo havia áreas amareladas na superfície de corte, mais evidentes na substância branca do cerebelo. Microscopicamente, o fígado apresentava necrose, predominantemente centrolobular e hemorragia. No encéfalo, havia edema perivascular generalizado e astrócitos Alzheimer tipo II na substância cinzenta. Esses astrócitos apresentaram marcação fraca ou negativa na imuno-histoquímica anti-GFAP e marcação positiva do antígeno S-100. A dose letal mínima de folhas de T. micrantha estabelecida nesse experimento foi de 20g/kg. A maior sensibilidade da espécie equina constatada nesse estudo, a ampla distribuição de T. micrantha, bem como sua palatabilidade reforçam a importância da planta em casos acidentais de intoxicação nessa espécie. / This study characterizes Trema micrantha poisoning in horses, previously unknown in this species. The first article (Article 1) describes an outbreak of T. micrantha poisoning in horses. The disease occurred in June 2007, in the Municipality of São José do Herval, Rio Grande do Sul State. Two horses died after consuming the leaves of the branches from a T. micrantha tree, which had been felled by a storm. Clinical pathology presented by the animals was characteristic of an acute liver failure with development of hepatic encephalopathy. To further characterize the Trema micrantha poisoning in horses, an experiment was carried out (Article 2). Four ponies received and spontaneously consumed green leaves of T. micrantha, at the doses of 30, 25, and 20 g/kg. One horse received two doses, 15 and 25 g/kg, 30 days apart. Three animals were affected and died. The main clinical signs were apathy, equilibrium deficit, deglutition difficulty, sternal or lateral recumbency, paddling, coma and death. These tree diseased ponies had also enhanced seric activity of gamma-glutamyl transferase (GGT), seric ammonia apart of diminished glycemia. The main pathological findings were observed in the liver and encephalon. There were enhanced lobular pattern of the livers and yellowish areas in the cut surface of the encephalon, especially visualized in the cerebral white matter. Microscopically, there was hepatic necrosis predominantly centrilobular apart of hemorrhages. Generalized perivascular edema and Alzheimer type II astrocytes were observed in the encephalon. The Alzheimer type II astrocytes showed weak or absent anti-glial fibrillar acid protein immunostaining associated with positive immunostaining for S-100 protein. The minimal lethal dose of Trema micrantha leaves was established at 20 g/kg. The high sensibility of this species to this plant, its wide distribution, and the high palatability of the plant reinforce the importance of Trema micrantha in accidental episodes of intoxication in horses.

O diabetes mellitus tipo 1 (DMT1) tem sido associado com complicações a longo prazo no sistema nervoso central, além dos efeitos periféricos comuns relacionados à doença, causando disfunções cognitivas no encéfalo. Por outro lado, o enriquecimento ambiental (EA) induz mecanismos de plasticidade dependentes da experiência, especialmente no hipocampo, melhorando o desempenho dos animais em testes de aprendizado e memória. Assim, nosso objetivo foi avaliar a influência do EA sobre o déficit de memória, a atividade locomotora, os níveis de corticosterona, a imunorreatividade da proteína sinaptofisina, e a densidade e a ativação de astrócitos e microglia no giro denteado (GD) do hipocampo de ratos diabéticos tipo 1. Para isso, ratos Wistar machos com 21 dias de idade, foram expostos ao EA ou mantidos em caixamoradia padrão (controles, C) por 3 meses. Quando adultos, os animais tanto C quanto EA foram randomicamente divididos e induziu-se diabetes através de injeção de estreptozotocina em metade dos animais de cada grupo, sendo mantidas as respectivas condições ambientais para cada um dos grupos. A memória espacial dependente de hipocampo foi avaliada em todos os grupos através do teste de reconhecimento de objeto reposicionado, no 41o dia após a indução do diabetes, bem como a locomoção geral dos animais no campo aberto durante o mesmo teste. Os níveis séricos de corticosterona foram medidos ao final do experimento, a imunorreatividade da sinaptofisina foi avaliada por imunoistoquímica, e a densidade e a ativação de astrócitos e da microglia por imunofluorescência no hilo do GD do hipocampo. Nossos resultados mostraram que o EA foi capaz de prevenir ou atrasar o desenvolvimento do déficit de memória causado pelo diabetes em ratos, porém não reverteu o déficit motor observado nos animais diabéticos. Não houve diferença significativa na imunorreatividade da sinaptofisina entre os grupos. Além disso, embora o EA não tenha modificado a densidade e a ativação dos astrócitos nos animais diabéticos, o enriquecimento atenuou os efeitos prejudiciais da hiperglicemia sobre a ativação microglial, bem como reduziu os níveis séricos de corticosterona nos ratos diabéticos adultos. Assim, o EA ajudou a amenizar as comorbidades cognitivas associadas ao diabetes, possivelmente por atenuar a hiperatividade do eixo HPA e a ativação microglial nos animais diabéticos. / Type 1 diabetes mellitus (T1DM) has been associated with long-term complications in central nervous system, besides peripheral common adverse effects, causing neurocognitive dysfunction in the brain. On the other hand, enriched environment (EE) induces mechanisms of experiencedependent plasticity especially in hippocampus, improving the performance of animals in learning and memory tasks. Thus, our objective was to investigate the influence of the EE on memory deficits, locomotion, corticosterone levels, synaptophysin protein immunoreactivity, and density and activation of astrocytes and microglia in the hippocampal dentate gyrus (DG) of type 1 diabetic rats. For this, male Wistar rats, 21 days old, were exposed to the EE or maintained in standard housing (controls, C) for 3 months. At adulthood, C and EE animals were randomly divided and half of them induced to diabetes by streptozotocin, being maintained the respective environmental conditions for each animal groups. Hippocampus-dependent spatial memory was evaluated in all groups in the novel object-placement recognition task, on 41th day after diabetes induction, as well as the general locomotion in the open field at the same test. Serum corticosterone levels were measured in the end of the experiment, contents of synaptophysin was evaluated by immunohistochemistry, and density and activation of both astrocytes and microglia by immunofluorescence in the hilus of the DG in hippocampus. Our results showed that EE was able to prevent or delay the development of memory deficits caused by diabetes in rats, however did not revert the motor impairment observed in group diabetic. There was no significant difference in synaptophysin immunoreactivity among the groups. Furthermore, although the EE did not modify the density and activation of astrocytes in diabetic animals, it attenuated the injurious effect of hyperglycemia over microglial activation, as well as decreased the serum level of corticosterone in diabetic adult rats. Thus, the EE has helped to ameliorate cognitive comorbidities associated with T1DM, possibly by reducing the hyperactivity of HPA axis and the microglial activation in diabetic animals.

O diabetes mellitus tipo 1 (DMT1) tem sido associado com complicações a longo prazo no sistema nervoso central, além dos efeitos periféricos comuns relacionados à doença, causando disfunções cognitivas no encéfalo. Por outro lado, o enriquecimento ambiental (EA) induz mecanismos de plasticidade dependentes da experiência, especialmente no hipocampo, melhorando o desempenho dos animais em testes de aprendizado e memória. Assim, nosso objetivo foi avaliar a influência do EA sobre o déficit de memória, a atividade locomotora, os níveis de corticosterona, a imunorreatividade da proteína sinaptofisina, e a densidade e a ativação de astrócitos e microglia no giro denteado (GD) do hipocampo de ratos diabéticos tipo 1. Para isso, ratos Wistar machos com 21 dias de idade, foram expostos ao EA ou mantidos em caixamoradia padrão (controles, C) por 3 meses. Quando adultos, os animais tanto C quanto EA foram randomicamente divididos e induziu-se diabetes através de injeção de estreptozotocina em metade dos animais de cada grupo, sendo mantidas as respectivas condições ambientais para cada um dos grupos. A memória espacial dependente de hipocampo foi avaliada em todos os grupos através do teste de reconhecimento de objeto reposicionado, no 41o dia após a indução do diabetes, bem como a locomoção geral dos animais no campo aberto durante o mesmo teste. Os níveis séricos de corticosterona foram medidos ao final do experimento, a imunorreatividade da sinaptofisina foi avaliada por imunoistoquímica, e a densidade e a ativação de astrócitos e da microglia por imunofluorescência no hilo do GD do hipocampo. Nossos resultados mostraram que o EA foi capaz de prevenir ou atrasar o desenvolvimento do déficit de memória causado pelo diabetes em ratos, porém não reverteu o déficit motor observado nos animais diabéticos. Não houve diferença significativa na imunorreatividade da sinaptofisina entre os grupos. Além disso, embora o EA não tenha modificado a densidade e a ativação dos astrócitos nos animais diabéticos, o enriquecimento atenuou os efeitos prejudiciais da hiperglicemia sobre a ativação microglial, bem como reduziu os níveis séricos de corticosterona nos ratos diabéticos adultos. Assim, o EA ajudou a amenizar as comorbidades cognitivas associadas ao diabetes, possivelmente por atenuar a hiperatividade do eixo HPA e a ativação microglial nos animais diabéticos. / Type 1 diabetes mellitus (T1DM) has been associated with long-term complications in central nervous system, besides peripheral common adverse effects, causing neurocognitive dysfunction in the brain. On the other hand, enriched environment (EE) induces mechanisms of experiencedependent plasticity especially in hippocampus, improving the performance of animals in learning and memory tasks. Thus, our objective was to investigate the influence of the EE on memory deficits, locomotion, corticosterone levels, synaptophysin protein immunoreactivity, and density and activation of astrocytes and microglia in the hippocampal dentate gyrus (DG) of type 1 diabetic rats. For this, male Wistar rats, 21 days old, were exposed to the EE or maintained in standard housing (controls, C) for 3 months. At adulthood, C and EE animals were randomly divided and half of them induced to diabetes by streptozotocin, being maintained the respective environmental conditions for each animal groups. Hippocampus-dependent spatial memory was evaluated in all groups in the novel object-placement recognition task, on 41th day after diabetes induction, as well as the general locomotion in the open field at the same test. Serum corticosterone levels were measured in the end of the experiment, contents of synaptophysin was evaluated by immunohistochemistry, and density and activation of both astrocytes and microglia by immunofluorescence in the hilus of the DG in hippocampus. Our results showed that EE was able to prevent or delay the development of memory deficits caused by diabetes in rats, however did not revert the motor impairment observed in group diabetic. There was no significant difference in synaptophysin immunoreactivity among the groups. Furthermore, although the EE did not modify the density and activation of astrocytes in diabetic animals, it attenuated the injurious effect of hyperglycemia over microglial activation, as well as decreased the serum level of corticosterone in diabetic adult rats. Thus, the EE has helped to ameliorate cognitive comorbidities associated with T1DM, possibly by reducing the hyperactivity of HPA axis and the microglial activation in diabetic animals.

O presente estudo avaliou a autorregulação encefálica (ARE) em doentes com insuficiência hepática fulminante (IHF) antes e após transplante hepático. Foram avaliados 25 pacientes com diagnóstico de IHF, 17 foram avaliados antes e após o transplante hepático, sendo seis (24,0%) do sexo masculino e 19 (76,0%) feminino. A média de idade foi de 33,8 anos, que variou de 14 a 56 anos, com desvio padrão de 13,1 anos. A hemodinâmica encefálica foi avaliada pela velocidade de fluxo sanguíneo encefálico (VFSE) nas artérias cerebrais médias e artéria basilar (AB), que usou o ultrassom Doppler transcraniano (DTC), dispositivo de dois canais, com transdutores de 2 mega Hertz (MHz). A autorregulação encefálica foi mensurada pelo índice de autorregulação (IARE) estática que leva em conta os efeitos do aumento da pressão arterial média (PAM) sobre a VFSE. Para isso, promoveu-se o aumento da PAM (20 mmHg a 30 mmHg) com infusão de noradrenalina.. Ao se avaliar o IARE considerando a velocidade de fluxo sanguíneo em quatro momentos (pré-transplante, 1°, 2° e 3° dia após o transplante), observou-se que houve diferença estatística em artéria cerebral média (ACM) à direita (p=0,008), esquerda (p=0,007), máxima (p=0,005), e AB (p=0,006); assim como na análise em cada tempo do IARE, observou-se diferença estatística em ACM à direita (p=0,012), esquerda (p=0,009), máxima (p=0,006), e AB (p=0,011). A análise categórica do IARE na artéria cerebral média e basilar descreveu que a maioria dos doentes reestabeleceu a AR no 2° dia em ACM e 3° na AB (índice > 0,6), enquanto com o índice > 0,8 em ambas as artérias a ARE reestabeleceu no 2° dia. As variáveis sistêmicas como pressão parcial de CO2 e hemoglobina nos tempos da avaliação não apresentaram diferença estatística p=0,100 e p=0,093 respectivamente. Os resultados obtidos apontam para o comprometimento da ARE antes e após transplante hepático, tanto em circulação anterior como posterior, e que tende a ser reestabelecido entre 48 a 72 horas. Os achados deste estudo favorecem o manejo adequado de doentes nestas fases (antes e após transplante) e podem evitar a evolução para complicações neurológicas, como tumefação encefálica e hipertensão intracraniana, que indicam prognóstico ruim para a evolução clínica destes doentes. Estudos futuros necessitam ser realizados para que se consolide o uso da monitoração contínua com métodos não invasivos como o DTC para direcionar o manejo hemodinâmico encefálico na IHF / This study evaluated cerebral autoregulation in patients with fulminant hepatic failure (FHF) before and after liver transplantation. A total of 25 patients comprising six (24.0%) males and 19 (76.0%) females with FHF were evaluated. Seventeen patients were evaluated both before and after liver transplantation. Mean age of the patients was 33.8 years, with a range of 14-56 years and standard deviation of 13.1 years. Brain hemodynamics was assessed by cerebral blood flow velocity in the middle cerebral arteries (MCA) and basilar artery (BA) using transcranial Doppler ultrasound on a two-channel device with 2 MHz transducers. Cerebral autoregulation was measured by static cerebral autoregulation index (SCAI), which accounts for the effects of increase in mean arterial blood pressure (ABP) on cerebral blood flow velocity. An increase in ABP (20 mmHg to 30 mmHg) was induced with norepinephrine infusion. Evaluation of SCAI based on blood flow velocity (BVF) at four timepoints (pre-transplant and on 1st, 2nd and 3rd days post-transplant) revealed a statistical difference in the MCA right (p = 0.008) left (p = 0.007), maximum (p = 0.005) and the BA (p = 0.006). In addition, analysis by timepoint showed a statistical difference in MCA (p = 0.012), left (p = 0.009), maximum (p = 0.006) and in the BA (p = 0.011). Categorical analysis of autoregulation in the MCA and BA showed that most patients reestablished autoregulation in the MCA on the 2nd day post-transplant and in the BA (index > 0.6) on the 3rd day, while autoregulation was reestablished in both arteries (index > 0.8) on the 2nd day. On the assessment by timepoint, the systemic variables CO2 partial pressure and hemoglobin showed no statistically significant differences (p = 0.100 and p = 0.093, respectively). The results reveal impaired SCAI before and after liver transplantation, both in anterior and posterior circulation, with a tendency to reestablish at 48 to72 hours. The findings of this study can help improve management of patients at these stages (pre and post transplantation), preventing neurological complications such as brain swelling and intracranial hypertension, associated with poor prognosis for the clinical course. Future studies should be conducted to consolidate the use of continuous monitoring with noninvasive method (TCD), to provide more accurate information to guide brain hemodynamic management in FHF

L'encéphalopathie hépatique (HE) est un syndrome neuropsychiatrique complexe, une complication majeure de la maladie du foie. L'œdème cytotoxique est une complication grave de l'encéphalopathie hépatique, connu comme étant le résultat d'un gonflement des astrocytes. Les facteurs pathogéniques dérivés du sang tels que l'ammoniaque (NH4+) et le stress oxydatif (SO) sont connus pour être synergiquement impliqués. Les cellules endothéliales (CE) de la barrière hémato-encéphalique (BHE), régulant le passage vers le cerveau, sont les premières cellules à entrer en contact avec les molécules circulantes. L'effet de l'ammoniaque et du SO sur le transport et le métabolisme des CE n'a jamais été complètement exploré. Par conséquent, notre objectif était d'évaluer les effets de NH4+ et des espèces réactives de l'oxygène (ROS) sur les CE de la BHE en utilisant des systèmes de modèles in vivo et in vitro. Il a été démontré que le cotransporteur Na-K-2Cl (NKCC1) était impliqué dans la pathogenèse de l'œdème cérébral dans de nombreuses affections neurologiques. Le NKCC1 peut transporter NH4+ vers le cerveau et est régulé par les ROS. Par conséquent, l'expression de NKCC1 a été évaluée dans des CE primaires soumises à différentes concentrations de ROS et de NH4+ ainsi que dans des microvaisseaux cérébraux (MVC) isolés chez le rat BDL (bile-duct ligated), un modèle d'EH induit par une maladie hépatique chronique. Aucune régulation à la hausse de NKCC n'était présente chez les CE traitées ou les MVC. La glutamine synthétase (GS) est une enzyme qui joue un rôle compensatoire important dans la détoxification du NH4+ au cours de la maladie du foie. La GS est exprimée dans le muscle et le cerveau (astrocytes), mais n'a jamais été totalement explorée dans les CE de la BHE. L'expression et l'activité de la protéine GS ont été trouvées dans les CE de la BHE in vitro (CE primaires) et in vivo (MVC isolés de rats naïfs). Dans le modèle BDL, l'expression de GS dans les MVC n'était pas significativement différente des témoins (SHAM). Par ailleurs, nous avons traité des CE avec du milieu conditionné à partir de plasma de rats BDL et avons trouvé une diminution de l’expression de la protéine GS et de l'activité par rapport aux SHAM. De plus, les CE traitées avec NH4+ augmentaient en activité de GS tandis que les traitements avec SO avec et sans NH4+ diminuent l'activité de GS. Globalement, ces résultats démontrent pour la première fois que la GS est présente dans les CE, à la fois in vivo et in vitro. La GS est régulée à la baisse dans les CE traitées avec du plasma de BDL (mais pas dans les MVC de BDL). Il est intéressant de noter que le NH4+ stimule l'activité de GS dans les CE, alors que le SO inhibe l'activité de GS, ce qui justifie possiblement les résultats de nos études avec les milieux conditionnés. Nous supposons que le SO empêche la régulation à la hausse de GS de la BHE, en diminuant la capacité des CE à détoxifier l'ammoniaque et à limiter l'entrée d'ammoniaque dans le cerveau. Nous envisageons qu'une régulation à la hausse de GS dans les CE de la BHE pourrait devenir une nouvelle cible thérapeutique de l'EH. / Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome, which is a major complication of liver disease. Cytotoxic edema is a serious complication of HE, known to be the result of astrocyte swelling. Blood derived pathogenic factors such as ammonia (NH4+) and oxidative stress’ (OS) are known to be synergistically implicated. Endothelial cells (EC) of the blood brain barrier (BBB) are the first cells regulating passage into the brain and to contact blood-derived molecules. The effect of ammonia and oxidative stress on EC transport and metabolism has never been thoroughly explored. Therefore, our aim was to evaluate the effects of NH4+ and reactive oxygen species (ROS) on EC of the BBB using in vivo and in vitro models systems. The Na–K–2Cl cotransporter (NKCC1) has been demonstrated to be involved in the pathogenesis of brain edema in numerous neurological conditions. NKCC1 can transport NH4+ into the brain and is regulated by ROS. Therefore, the expression of NKCC1 was evaluated in primary EC submitted to different concentrations of ROS and NH4+ as well as in cerebral microvessels (CMV) isolated from the bile-duct ligated (BDL) rat, a model HE induced by chronic liver disease. No upregulation of NKCC1 was present in either the treated EC or CMV. Glutamine synthetase (GS) is an enzyme with an important compensatory role in NH4+ detoxification during liver disease. GS is expressed in muscle and brain (astrocytes) but has never been thoroughly explored in ECs of the BBB. GS protein expression and activity was found in EC of the BBB in vitro (primary EC) and in vivo (CMV isolated from naive rats). In the BDL model, GS expression in CMVs was not significantly different from SHAM-operated controls. In addition, we treated ECs with conditioned medium from plasma of BDL rats and found a decrease in GS protein and activity when compared to SHAM. Furthermore, EC treated with NH4+ increased GS activity while treatments with ROS with and without NH4+ decreased GS activity. Overall these results demonstrate for the first time that GS is present in EC both in vivo and in vitro. GS is downregulated in EC treated with BDL plasma (but not in BDL CMV). Interestingly, NH4+ stimulates GS activity in ECs, while ROS inhibits GS activity, possibly justifying the results found from the conditioned medium studies. We speculate that ROS prevents the upregulation of GS in the BBB, decreasing the capacity of the EC to detoxify ammonia and to limit ammonia entry into the brain. We foresee that upregulating GS in ECs of the BBB could become a new therapeutic target for HE.

L’encéphalopathie spongiforme bovine (ESB) est une maladie neuro-dégénérative fatale affectant les bovins ; elle est également une zoonose à l’origine du variant de la maladie de Creutzfeldt-Jakob. Identifiée pour la première fois au Royaume-Uni en 1986, cette maladie s’est rapidement étendue en Europe, malgré la mise en place de mesures de contrôle. En raison des particularités épidémiologiques de l’ESB (longue période d’incubation, âge précoce à l’infection et diagnostic post-mortem possible uniquement en fin d’incubation), l’évolution temporelle de l’exposition des bovins à l’ESB ne peut être appréhendée qu’à partir de la modélisation. Nous avons utilisé le modèle Age-Période-Cohorte afin de (ré)évaluer, en relation avec les principales mesures de contrôle, l’évolution de l’épizootie d’ESB à la lumière des données de surveillance les plus récente, en France, et dans six autres pays européens : Allemagne, Irlande, Italie, Pays-Bas, Pologne et Royaume-Uni. / Bovine spongiform encephalopathy is a fatal neurodegenerative disease affecting cattle and transmissible to humans as the cause of variant Creutzfeldt-Jakob disease. BSE was first identified in 1986 in United Kingdom, before spreading to European countries despite the implementation of control measures. Due to BSE epidemiological characteristics (long incubation period, early age at infection and post-mortem diagnostic at end stage of incubation period), time trend of BSE cattle exposure can only be estimated by modeling. We used age-period-cohort model in order to (re)evaluate, in relation to the main control measures, the trend of BSE epidemic, using the most recent surveillance data in France and six other European countries: Germany, Ireland, Italy, the Netherlands, Poland and United Kingdom.

Les Encéphalopathies Épileptiques Précoces sont des pathologies rares et sévères caractérisées par des crises fréquentes commençant dans les trois premiers mois de vie accompagnées d’un EEG intercritique altéré et un pronostic très défavorable. Au cours de la caractérisation génétique d’une cohorte de 402 patients, nous avons mis en évidence une délétion de 19,9 kb localisée en Xp11.23 chez un garçon et 34 mutations de novo du gène KCNQ2. La première partie de mon projet a consisté en l’étude de la pathogénicité de la délétion Xp11.23, qui implique trois gènes dont WDR45. Les mutations de WRD45 ont été décrites dans une dégénérescence neuronale avec accumulation de fer et presque exclusivement chez des patients de sexe féminin. Le diagnostic initial, chez ce patient, montre une IRM normale avec un phénotype d'EEP et l'accumulation de fer a été détectée à partir de 5 ans. Ce travail m’a permis de décrire le premier patient atteint d’EEP porteur d’une délétion de WDR45. La deuxième partie de mon projet a concerné le gène KCNQ2. Nos résultats ont montré que les mutations sont impliquées dans deux mécanismes physiopathologiques, une délocalisation subcellulaire et un gain de fonction. Ces résultats ouvrent de nouvelles perspectives en terme de compréhension de la pathologie et de thérapies qui peuvent être proposées. Une dernière partie de ce projet a consisté en l’élaboration de nouveaux modèles in vitro, j’ai mis au point des lignées stables exprimant KCNQ2 qui permettront le criblage de molécules thérapeutiques à haut-débit, ainsi que des progéniteurs neuronaux différenciés à partir de cellules iPS issues de la reprogrammation de fibroblastes de patients. / Early onset epileptic encephalopathies are rare and severe disorders, characterized by frequent motor seizures occurring before three months of age associated with an altered interictal EEG pattern. The prognosis is poor. During the course of the genetic characterization of a cohort of 402 EOEE patients, we identified a de novo deletion located at Xp11.23 in a male patient and 34 KCNQ2 de novo mutations. The first part of my project consisted in the study of the pathogenicity of the Xp11.23 deletion that encompasses three genes including WDR45. Mutations in the WDR45 gene been have recently identified in patients suffering from neurodegeneration with brain iron accumulation. WDR45 mutations have been almost exclusively found in females. Our patient with the Xp11.23 deletion presented a normal MRI and the EOEE phenotype was predominant. Iron accumulation began only at 5 years. My work reveals that deletions of WDR45 are viable in males and can be diagnosed as EOEE. The second part of my project was aimed at the functional study of two KCNQ2 gene mutations. During this work, my results showed that those mutations were involved in new pathological mechanisms, namely a mislocalization or gain of function. Those results provide new perspectives in term of disease knowledge and therapy. The last part of my project consisted in the development of two new in vitro models for the study of KCNQ2 mutations: stable cell lines expressing the Kv7.2 channel for high-throughput screening of drugs and the production of neurons from induced pluripotent stem cells arising from reprogrammed patient fibroblasts.

L’hypoxie-ischémie (HI) et l’inflammation sont les principaux facteurs de risques d’apparition de paralysies cérébrales (PC) chez le nouveau-né prématuré ou à terme. La PC est un ensemble de troubles moteurs et cognitifs nécessitant une prise en charge à vie. Sa prévalence en Europe est de 1,7‰ naissances vivantes, ce qui constitue un problème de santé publique. Les nouveau-nés prématurés et nés à terme montrent des atteintes structurales et des déficits à long terme différents aux plans quantitatif et qualitatif. À ces âges, les interventions thérapeutiques et de prévention sont limitées du fait des interférences probables avec le développement. Afin d’appréhender les mécanismes de ces lésions périnatales et de trouver de potentielles pistes d’intervention précoce, nous avons utilisé un modèle murin d’HI chez la souris de 5 et 10 jours (P5 et P10). À ces stades, le développement cortical chez la Souris mime celui d’enfants prématurés (vers 30 SG) ou à terme. Méthode. Afin d’étudier la réponse différenciée à l’HI entre ces deux stades, nous avons, dans un premier temps, réalisé une étude longitudinale par imagerie IRM suivie d’une étude comportementale des animaux à l’âge adulte, ainsi que des études enzymatiques ciblées en période périnatale. Dans un second temps, nous avons réalisé une étude globale et sans apriori des modifications précoces du transcriptome. Résultats I. Nos résultats renforcent la validité de ce modèle murin pour l’étude des lésions spécifiques correspondant aux lésions : soit de nouveau-nés prématurés soit d’enfants à terme. En effet, nous montrons une atteinte spécifique de la substance blanche (SB) chez les souris à P5, mimant les leucomalacies périventriculaires du grand prématuré. Nous montrons que l’atteinte de la SB est associée à une vulnérabilité vasculaire dépendante de l’âge. L’atteinte vasculaire passe par l’activité de la MMP-9, sous dépendance du tPA. À long terme, nous montrons des atteintes cognitivo-comportementales dépendantes de l’âge, permettant d’associer les lésions de la SB aux déficits d’interaction sociale et à l’hyperactivité, alors que les déficits d’apprentissage sont plus amples chez la souris exposée à l’HI à P10 et sont associés à des lésions de l’hippocampe et du cortex rétrosplénial. Résultats II. L’étude du transcriptome a permis de constituer une base de données utilisable pour des études ultérieures. Elle montre des différences importantes de la réponse induite par l’HI, en fonction de l’âge. Cinq faits parmi les plus marquants sont à retenir : i) si les processus affectés aux deux âges sont les mêmes, soit principalement la régulation de la transcription, l’inflammation, la mort cellulaire et l’angiogenèse, les gènes mis en jeu sont sensiblement différents, ii) une réponse à P10 qui, pour une grande partie, s’oppose à l’évolution ontogénique des niveaux de transcrits, peut être le signe d’un arrêt dans le processus de développement, iii) des cinétiques d’induction et de répression différentes à P5 et P10, la réponse étant retardée à P10 en termes de délai d’induction et de maximum d’amplitude, iv) la réponse transcriptomique à l’HI à P5 semble en voie d’extinction après 24h, alors qu’à ce même délai post-HI, la réponse montre une forte amplification chez les animaux lésés à P10, v) une répression coordonnée, à P5 seulement, de gènes codant des protéines impliquées dans les fonctions synaptiques 12h après l’HI, potentiellement responsable de l’extinction de la réponse à 24h. Conclusion. Ces études, complémentaires, permettent une meilleure compréhension de la pathogenèse des lésions cérébrales néonatales. Elles ouvrent notamment différentes pistes de recherche pour les années à venir, orientées vers : i) la spécificité vasculaire, dépendante de la structure et du stade de développement, ii) la prise en compte du stade de développement pour l’expérimentation et la mise au point de stratégies de neuroprotection spécifiques de l’âge. / Hypoxia-ischemia and inflammation are the major triggers of cerebral palsy (CP) in preterm and term new-born. CP is defined as a group of nonprogressive disorders of movement and posture, associated with cognitive and behavioural disorders. CP prevalence is about 1.7‰ living birth and leads to life-long medical care which altogether makes CP a healthcare issue. Preterm and term new-born exhibit specific structural damages and long-term outcomes. In the perinatal period, therapeutic or preventive strategies are limited due to the risk of interference with the ongoing development. To further explore lesion mechanisms, we used the well described “Rice-Vannucci” model of HI adapted in mice aged 5 or 10 days (P5/P10). At these developmental stages, mouse cortical development mimics those of human preterm and term new-born respectively.Methods. To explore the differentiated response to HI between P5 and P10 mice, we first performed a longitudinal MRI study associated with learning and social behaviour testing at adulthood. We also used targeted enzymatic approaches in perinatal period. In a second time, we performed a global, non-targeted assessment of early HI-induced transcriptome modifications during the first 24h after HI.Results I. Our results validated the HI model for the study of age-dependent lesions corresponding to preterm or term new-born lesions. We confirmed the P5-specific white matter lesions mimicking periventricular leukomalacia of preterm infants (30GW). We showed that these white matter lesions originate from age-dependent vascular vulnerability. This vascular vulnerability involved P5 restricted vascular MMP-9 activity which also depends on tPA activity. We showed age-dependent long-term cognitivo-behavioural outcomes, allowing us to associate white matter damages to social behaviour and hyperactivity, whereas learning deficits were more pronounced in P10 mice and associated with hippocampal and retrosplenial cortex damages.Results II. The transcriptome study has generated a useful database for further research. It also showed very important differences in HI-induced transcriptomic responses. Five highlights emerged: i) identical processes (pathways, GO terms) were affected by HI in both P5 and P10 mice: i.e. regulation of transcription, inflammation, cell death/apoptosis and angiogenesis, but the genes induced or repressed associated to these processes were highly different at the two stages, ii) the HI-induced transcription response at P10 mainly counteracted the development-induced transcription changes, iii) the kinetics of induction/repression were different between P5 and P10 mice; P10 mice exhibiting a global delayed response to HI compared to P5 in terms of delay of induction/repression and maximum amplitude, iv) twenty-four hours after HI, the response at P5 was slowing down, apparently returning to basal state, whereas in P10 mice the changes appeared uncontrolled, v) a P5 specific coordinated repression of genes coding proteins involved in synaptic function was observed 12h post-HI, perhaps at the origin of the global slowing-down of transcription alterations observed 24h post-HI.Conclusion. These complementary studies provide a better understanding of the pathogenesis of neonatal brain injury. They also open routes towards new research areas such as: i) the specific vascular vulnerability, depending on brain structures and developmental stage, ii) the consideration of the maturation stage in the further development and experimentation of new neuroprotective strategies.