Les travaux de cette thèse ont porté sur le contrôle des neurones à GHRH dans des conditions physiologiques et pathologiques. Le but étant de caractériser les mécanismes cellulaires et moléculaires impliqués dans le fonctionnement ou dérégulations du réseau de neurones à GHRH. Ces neurones sont les principaux stimulateurs de la libération de l’hormone de croissance (GH). Nous avons d’abord montré que l’axe de la croissance et de l’appétit peuvent être régulés indépendamment au niveau de l’hypothamus. En effet, la ghréline, seule hormone produite par le tractus gastro-intestinal et connue pour stimuler la libération de GH en agissant principalement sur les neurones GHRH, stimule ces derniers de manière uniquement directe. Ces effets sont indépendants de ceux qu’elle exerce sur les neurones voisins à NPY, orexigéniques. De plus, la ghréline et les GHS (agonistes sélectifs du récepteur de la ghréline) ne changent pas le mode de décharge électrique des neurones à GHRH ni ne les synchronise. Enfin, ces effets ne présentent pas de dimorphisme sexuel. Dans un second temps, la somatostatine, principal inhibiteur de l’axe GH, induit un rythme d’activité électrique des neurones à GHRH médié par les récepteurs de sous-type SST1 et SST2. Ces effets sont donc temps-dépendants, et aussi sexuellement dimorphiques. Ils sont probablement impliqués dans la modulation de la pulsatilité ultradienne de la libération de GH. Enfin, après un traumatisme crânien, nous observons un déficit de la libération de GH qui apparaît tôt et est soutenu, comme ceux observés chez l’humain. Aucune inflammation ni changement histologique n’a été observe dans l’hypophyse. Cependant, l’inflammation, impliquant une réaction tanycytaire, microgliale, astrocytaire, est présente dans le noyau arqué et l’éminence médiane (EM), ou sont respectivement présents les corps cellulaires et terminaisons des neurones à GHRH. Ceci est lié à des changements morpho-fonctionnels de l’EM (augmentation perméabilité, rupture des barrières tanycytaires). Aucun changement n’a été observé dans le noyau périventriculaire, où sont localisés les neurones à somatostatine. Enfin, les propriétés électriques passives des neurones à GHRH ne sont pas modifiées. En conclusion, une dérégulation de leur activité au niveau des terminaisons nerveuses doit expliquer les défauts posttraumatiques de libération de GH. / The works of this thesis were interested in the control of the hypothalamic GHRH neurons in physiological and pathological conditions. The goal was to clarify the molecular and cellular mechanisms involved in the control or impairments of GHR neuronal network functions. These neurons are the main stimulators of the GH release. We first showed that the hypothalamic growth axis could be regulated independently from the feeding network. Indeed, GHRH neurons are directly stimulated by ghrelin, which is the only hormone produced by the gastrointestinal tract known to stimulate the GH release through acting mainly on GHRH neurons. These effects are independent from its orexigenic effects exerted on the neighbourings NPY neurons. In addition, ghrelin and GHS (synthetic ghrelin receptor agonists) don’t change neither the firing rate of GHRH neurons, nor synchronize them. These effects are not gender-dependant; by contrast, Somatostatin, the major GH axis inhibitor, generates a sexual dimorphic and rhythmic inhibition of the GHRH neurons electrical activity mediated by its SST1 and SST2 receptors subtypes. These effects are so time-dependant direct and indirect effects and can probably be involved in the generation of the ultradian rhythm of the GH release. After a traumatic brain injury, we found an early and sustained deficiency of the GH release, like those observed in human. No pathological changes are visible in the pituitary gland. Inflammation occurs at the arcuate nucleus, and mainly at the median eminence levels; it involves a strong astrocyte reaction, tanycytes, and microglial and (or) infiltrated immune cells activations. These changes elicit morpho-functional impairments of the median eminence, permeability and leakage of the tanycyte barrier between the blood, CSF and Arc; at the opposite, nothing occur at the periventricular level, where are located SST neurons. Neither the number of GHRH neurons, neither their passive electrophysiological properties changed. Impairments of the activities of the GHRH nerve terminals, maybe associated to impairments of their regulated activity, must explain a GH deficiency.

In a HEK 293 cell line stably expressing seabream GHS-R1a (sbGHS-R1a), we found that a synthetic growth hormone secretagogue (GHS) increased [ 3H]-inositol phosphate production, clearly indicating coupling of this receptor to Gq/11-proteins. Using Western blotting, we found that GHS could also stimulate extracellular signal-regulated kinases 1 and 2 (ERK1/2), and that this response was inhibited by the MEK inhibitor U0126. For both the [3H]-inositol phosphate and ERK1/2 assays, the presence of the GHS-R antagonist D-Lys(3)-GHRP-6 significantly inhibited the GHS-stimulated activities, and in addition inhibited basal activities by 50% and 40%, respectively. These results showed that sbGHS-R1a is a constitutively active receptor and the antagonist D-Lys(3)-GHRP-6 is an inverse agonist. We also proposed that the expression of sbGHS-Rs was involved in the regulation of cell apoptosis. / Oligomerization of the human GHS-Rs (hGHS-Rs) was explored by transient transfection of the hGHS-Rs in HEK 293 cells followed by co-immunoprecipitation of differentially epitope-tagged forms of the receptors and bioluminescence resonance energy transfer 2 (BRET2) studies. (Abstract shortened by UMI.) / The concept that G protein-coupled receptors (GPCRs) exist and potentially function as dimers and/or higher oligomers has progressed from hypothesis to being widely accepted recently. Oligomerization of GPCRs has been increasingly noted in the regulation of the biological activity of the receptors. The growth hormone secretagogue receptor 1a (GHS-R1a) is a GPCR which principally regulates the pulsatile release of growth hormone from the pituitary gland. The GHS-R exists in two forms: GHS-R1a being a constitutively-active GPCR with 7 transmembrane (TM) domains, and GHS-R1b being a truncated version of type 1a but having only 5 TM domains. The endogenous agonist for GHS-R1a is ghrelin which exerts a wide range of physiological actions, but the function of GHS-R1b is still unclear. Since the tissue distribution patterns of the two isoforms of GHS-R are different, the objective of the present study is to explore the mechanisms of cell signalling of GHS-R1a and to determine the extent and importance of interactions between these two receptor isoforms. / Leung Po Ki. / "July 2005." / Adviser: Helen Wise. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3728. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 189-210). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13362号 / 論医博第2204号 / 新制||医||1045(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 稲垣 暢也, 教授 渡邉 大, 教授 影山 龍一郎 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Dans les cellules somatotropes, la liaison du facteur de libération de l’hormone de croissance (GHRH) à son récepteur (GHRH-R) stimule la synthèse et la sécrétion de l’hormone de croissance (GH) ainsi que la prolifération cellulaire. Chez les mammifères, le vieillissement est caractérisé par une diminution de la sécrétion de GH, liée à une perte de sensibilité des somatotropes au GHRH. Chez le rat âgé, des modifications de niveaux d'ARNm du GHRH-R et une diminution d'affinité et de capacité de liaison du GHRH sont rapportés. Au cours du vieillissement, une augmentation des niveaux de glucose et d’acides gras libres sérique suggère qu’une gluco- ou lipotoxicité puisse contribuer au dysfonctionnement de la fonction somatotrope. À ce jour, la restriction calorique modérée de longue durée (RCMLD) constitue l’intervention la plus efficace pour prévenir ou retarder les détériorations liées à l’âge. Des études ont montré des effets bénéfiques de la RCMLD sur l’axe somatotrope au cours du vieillissement via un maintien des paramètres de liaison du GHRH-R. Compte tenu de l’importance de cet axe, la compréhension des mécanismes menant à la somatopause ainsi que ceux associés aux effets bénéfiques de la RCMLD s’avère importante. Les objectifs principaux de la présente thèse étaient : 1) de déterminer les effets de la RCMLD chez le rat, sur le GHRH-R hypophysaire et la sensibilité des somatotropes au GHRH, 2) d’identifier les mécanismes associés à la somatopause et aux effets bénéfiques de la RCMLD, et 3) de préciser les effets d’une gluco-ou lipotoxicité sur l’axe somatotrope de rats et leur implication dans la somatopause. Des rats de 8 mois ont été soumis à une restriction calorique de 40% jusqu’à l’âge de 18-20 mois et ont été comparés à des rats jeunes et âgés nourris ad libitum. Cette étude a permis de mettre en évidence des effets bénéfiques de la RCMLD sur la régulation et la fonctionnalité du GHRH-R et de proposer que le glucose et les acides gras libres (AGL) circulants soient impliqués dans le vieillissement de la somatotrope. Une étude de micro-puce à ADN à permis d’identifier des gènes associés à des mécanismes de protection et de réparation des dommages cellulaires mis en place dans l’hypophyse antérieure au cours du vieillissement et par la RCMLD. Finalement, les effets d’un stress gluco- ou lipotoxique sur la fonction somatotrope ont été étudiés chez des rats de 2 et 6 mois, infusés 72 h avec une solution de glucose ou d’Intralipides, mimant les niveaux circulants de glucose et d’AGL retrouvés chez le rat âgé. Les résultats obtenus montrent que la glucotoxicité affecte la régulation de certains gènes de la somatotrope, dont le GHRH-R, et suggèrent que la capacité de réponse à ce type de stress est altérée. Les mécanismes par lesquels la glucotoxicité exerce ces effets pourraient inclure la génération de stress oxydant. L’ensemble de ces résultats proposent de nouvelles pistes mécanistiques qui pourraient contribuer au retardement de la somatopause et, ultimement, à l’élaboration de nouvelles stratégies d’intervention nutritionnelles ou pharmacologiques ciblant les mêmes voies que la RCMLD, avec une efficacité similaire ou supérieure. / In somatotroph cells, growth hormone-releasing hormone (GHRH) binding to its receptor (GHRH-R) stimulates growth hormone (GH) secretion and cell proliferation. In mammals, aging is characterized by a decrease of GH, associated with a decline of GHRH somatotroph sensitivity. In the aged rat, changes in GHRH-R mRNA levels and decrease of GHRH affinity and capacity were reported. In the course of aging, significant increase of glucose and free fatty acid (FFA) serum levels are observed, suggesting that gluco- or lipotoxicity could contribute to somatotroph dysfunction. Up to now, long-term moderate caloric restriction (LTMCR) has been the most efficient intervention to prevent or delay age-related deteriorations. Studies have shown beneficial effects of LTMCR on somatotroph axis during aging, through the maintenance of GHRH-R binding parameters. Knowing the importance of this axis, an understanding of the mechanisms associated with the effects of somatopause and benefits of LTMCR is important. Therefore, the main objectives of this thesis were: 1) to determine the effects of LTMCR on rat pituitary GHRH-R and somatotroph sensitivity to GHRH, 2) to identify the mechanisms associated to somatopause and the beneficial effects of LTMCR and 3) to specify the effect of gluco- or lipotoxicity on the rat somatotroph axis and their implications in somatopause. Eight-month-old rats were submitted to a 40% LTMCR until the age of 18 to 20-months and where compared to young and old rats fed ad libitum (AL). This study highlighted beneficial effects of LTMCR on GHRH-R regulation and functionality and suggested that high circulating levels of glucose and FFA could be involved in somatotroph aging. A microarray study was also performed, allowing the identification of genes associated to cellular protection and damage repair mechanisms regulated by aging and LTMCR in the anterior pituitary. Finally, effects of a gluco- or lipotoxic stress on the somatotroph function was assessed in 2- and 6-month-old rats submitted to a 72-h glucose and/or Intralipid infusion, to mimic the levels of glucose and FFA found in aged rats. The results showed that glucotoxicity affects the regulation of specific genes in the somatotroph, such as the GHRH-R gene, and suggest that the response capacity against this type of stress is altered with age very early on. Mechanisms by which glucotoxicity exerts these effects might include oxidative stress production. Altogether, these results proposed novel mechanisms that could contribute to delay somatopause and, ultimately, to the development of new nutritional or pharmacologic interventions targeting the same pathways as LTMCR, with a similar or greater efficiency.

Περιγράψαμε την Διαταραχή Μεταγωγής Σήματος Αυξητικής Ορμόνης (GHTD), σε παιδιά με σοβαρή καθυστέρηση ανάπτυξης, φυσιολογική έκκριση αυξητικής ορμόνης (GH), χαμηλό IGF-I αλλά φυσιολογική ανταπόκριση IGF-I σε χορήγηση hGH, που παρουσιάζουν ελαττωματική φωσφορυλίωση του STAT3. Η διαταραχή θεραπεύεται με hGH. Οι CIS πρωτεΐνες είναι αρνητικοί ρυθμιστές του σηματοδοτικου μονοπατιού της GH που ανταγωνίζονται STATs για θέση πρόσδεσης με τον υποδοχέα GHR ή συμμετέχουν στην αποδόμηση του JAK2/GHR μέσω ουβυκουιτίνης/προτεασώματος. Η αδυναμία φωσφορυλίωσης του STAT3 και JAK2 φαινεται να προσπερνάται με χρήση εναλακτικής οδου. Με ‘διασυνομιλία’ της GH με το μονοπάτι του EGF. Συγκεκριμένα η GH φωσφωρυλιώνει το EGFR μέσω φωσφορυλίωσης JAK2. Τέλος, η φωσφορυλίωση STAT3 προκαλείται και από την 17β-οιστραδιόλη. Υπάρχει μία κλινική οντότητα της “καθυστέρησης της ήβης και ανάπτυξης” όπου γίνεται σημαντική επιτάχυνση στην ανάπτυξη μετά την εφηβεία όπου υπάρχει φυσιολογικό τελικό ανάστημα που ταιριάζει με την πορεία ενός ασθενή. Σκοπός: Μελετήθηκε η αρνητική ρύθμιση της GH σε ινοβλάστες παιδιών με GHTD και φυσιολογικών. Στη συνέχεια, η πιθανή συσχέτιση του σηματοδοτικού μονοπατιού της GH και EGF στα παιδιά και τέλος η πιθανή συσχέτιση των στερεοειδών του φύλου με το GH άξονα σε ένα GHTDπαιδί . Yλικά/μέθοδοι: Σε πρωτογενείς καλλιέργειες ινοβλαστών ούλων μαρτύρων και GHTD παιδιών μελετήσαμε την έκφραση και ενεργοποίηση της CIS και JAK2, με επαγωγή με hGH, με Western blot. Στη συνέχεια μελετήθηκε η έκφραση του EGF και pEGF στα κύτταρα των παιδιών και μαρτύρων με επαγωγή των κυττάρων με GH και EGF έλεγχος με Western blot και coimmunoprecipitation. Τέλος μελετήθηκε η φωσφoρυλίωση STAT3 και JAK2 σε ινοβλαστες (προεφηβικούς και εφηβικούς) του ασθενή με GH και 17-β οιστραδιόλη με Western immunoblotting. Αποτελέσματα: Η έκφραση του CIS με 200 ng/ml hGH έδειξε μόνο στους ασθενείς αύξηση της συνολικής CIS και της ουβικουτινυλιομενής μορφής της. Η έκφραση και ενεργοποίηση τoυ JAK2 μόνο στους ασθενείς με επαγωγή με hGΗ δείχνει καθυστερημένη ενεργοποίηση του. Το STAT3 φωσφωρυλιώνεται φυσιολογικά με επαγωγή των κυττάρων των ασθενών με EGF όχι με GH. Οι pEGFRs φωσφωρυλιώνουν φυσιολογικά το JAK2 στους ασθενείς, ενώ όχι στους μάρτυρες. Ο ένας ασθενής προεφηβικά δε φωσφωρυλιώνει το STΑT3 με GH. Εμφανίζει την ουβικουτινιλιωμένη μορφή του CIS. Δεν φωσφωρυλιώνει το STAT3 με 17β-οιστραδιόλη προ-εφηβικά, και εμφανίζει την ουβικουτινιλιωμένη μορφή του CIS. Ενώ εφηβικά φωσφορυλιώνει το STAT3 με 17β-οιστραδιόλη και δεν εμφανίζει την ουβικουτινιλιωμένη μορφή του CIS. Συμπεράσματα: Βρέθηκε καθυστερημένη ενεργοποίηση του GH άξονα σε 2 ασθενής με GHTD μαζί με υπερέκφραση της CIS και ουβικουτινυλιομενής CIS. Η σηματοδότηση της GH γίνεται φυσιολογικά στους μάρτυρες άρα δεν υπάρχει λόγος εναλλακτικής οδού, σε αντίθεση με ασθενείς που χρειάζεται να χρησιμοποιήσουν το μονοπάτι του EGF. Ο ένας ασθενής ξεπέρασε την αδυναμία να φωσφορυλιώσει το STAT3 χωρίς hGH αλλά με την έναρξη της εφηβείας. Ένας λόγος που το παιδί αυτό έδειξε σημαντική επιτάχυνση στην ανάπτυξη είναι ότι μετά την εφηβεία δεν υπήρχε υπερλειτουργία του ανασταλτικού μηχανισμού της GH, διαμέσου του Ub CIS. / We have previously described a new disorder (GHTD) in 4 children with growth delay, normal provoked and spontaneous GH secretion, and low IGF-I concentrations but normal IGF-I generation test results who have a defect in the phosphorylation of the signal transducer and activator of transcription STAT-3. These children respond with a significant increase in their growth velocity after administration of hGH. CIS proteins are inhibitors of the GH signal transduction pathway, by distinct mechanisms: by competition with STATs for common tyrosine-binding sites on the cytoplasmic tail of GHR or by a proteasome-dependent mechanism. Monoubiquitinated form of CIS protein was observed in 2 GHTD patients.Also STAT3 phosphorylation defect could be overcomed by using an alternative pathway the one of Epidermal Growth factor (EGF). Also in one patient its STAT3 defect was overcomed when he entered puberty, sex steroids may enhanced his growth. Objective: The purpose of the study was the characterization of the molecular mechanisms involved in GH signal transduction pathway in GHTD patients, as a possible cause of an increased expression of its inhibitors. Also to search if there is a possible crosstalk between GH and EGF growth transduction pathways. And finally the role of sex steroids in GH signalling in one GHTD patient. Patients/Material and Methods: In primary fibroblast cell cultures from gingival biopsies of the GHTD patients and age-matched normal children we studied: expression analysis, in cells inducted with GH, of CIS and JAK2 phosphorylationby western immunoblotting and RT-PCR. Also the cells of the same children and controls were inducted with EGF and STAT3 phosphorylation was studied. Finally the cells of one of the patients were inducted with GH and 17β-estradiole before and after puberty and its STAT3 phosphorylation and CIS expression were studied. Results: Expression analysis in the childrens’ fibroblasts showed an overexpression of CIS in 2 patients as compared to normal children. STAT3 defect was not present in the patients fibroblasts that were inducted with EGF. Also one GHTD patient that he couldn't phosphorylate in his inducted fibroblast with GH and 17-b estardiole STAT3 and ubiquitinated CIS was present to his cells before puberty this defect was overcomed after he entered puberty. Conclusions: The overexpression of CIS may inhibit the activation of STAT3 and may be involved in the pathogenesis of the severe short stature of the GHTD children. Also GH signalling pathway has no defect in control patients so there is no need of using an alternative pathway such as the one of EGF that occurs in GHTD patients. Also one GHTD patient that showed a STAT3 defect before puberty was overcomed after he entered puberty and without GH treatment. There is a clinical status that is called 'growth dealy' that matches this patients profile, that shows rapid growth after puberty. A probable cause could be that ubiquitinated form of CIS was not present after he entered puberty.

No description available.

Introdução: Alterações em genes relacionados com a secreção de GH ou a organogênese hipofisária foram identificadas em pacientes com deficiência de hormônio do crescimento (DGH) congênita. Entretanto, poucos casos de DGH têm sua etiologia esclarecida. O GHRH é um candidato óbvio para explicar a deficiência isolada de GH (DIGH). Na literatura, os estudos de análise do GHRH não conseguiram identificar mutações, porém são antigos e utilizaram uma metodologia com limitações. A maioria dos pacientes com deficiência hipotálamo-hipofisária múltipla (DHHM) apresenta neuroipófise ectópica sugerindo a importância do estudo de genes que atuam no início do desenvolvimento hipofisário, com expressão inclusive no infundíbulo. O GLI2 é um fator de transcrição na sinalização Sonic Hedgehog, envolvido com o início da embriogênese hipofisária, expresso na bolsa de Rathke primordial e no diencéfalo ventral. Previamente, mutações no GLI2 foram encontradas em pacientes com holoprosencefalia, e também alterações hipofisárias. Objetivos: Analisar o GHRH em 151 pacientes com DIGH (42 brasileiros e 109 encaminhados de centros internacionais) e analisar o GLI2 em 180 pacientes brasileiros com DIGH ou DHHM por PCR e sequenciamento automático dos genes; e descrever o fenótipo dos pacientes com mutações identificadas. Resultados: No GHRH foram identificadas seis variantes em heterozigose com previsão benigna pelas análises in silico. A análise do GLI2 identificou três mutações novas em heterozigose com códon de parada prematuro (p.L788fsX794, p.L694fsX722 e p.E380X), e geração de proteínas truncadas, com perda do domínio responsável pela ativação transcricional. A mutação p.L788fsX794 foi identificada numa paciente com baixa estatura, polidactilia, epilepsia e hipoglicemias. Apresentava deficiência de GH, TSH, ACTH, prolactina, LH e FSH. Na investigação familiar foi diagnosticada DIGH em dois tios e DHHM numa prima. Estes familiares, além de sua mãe e outros parentes maternos também apresentaram a mutação e polidactilia. A mutação p.L694fsX722 foi identificada num menino com baixa estatura por deficiência de GH, além de lábio leporino e fenda palatina. Seu pai, embora saudável, também apresentou a mutação. A mutação p.E380X foi identificada numa lactente com retardo no desenvolvimento, hipoglicemias, poliúria e polidipsia. Apresentava deficiência de GH, ACTH, TSH e ADH. Sua mãe aparentemente normal também apresentou a mutação. Todos os pacientes com DGH e mutação no GLI2 apresentaram neuroipófise ectópica (não visualizada na paciente com p.E380X), adenoipófise hipoplásica e ausência de holoprosencefalia na ressonância magnética. Dezoito variantes não-sinônimas também foram identificadas no GLI2 em 24 pacientes. Dezesseis dessas variantes foram consideradas deletérias em pelo menos um programa de predição in silico e dez delas não foram encontradas em população controle. O fenótipo dos pacientes foi predominante de DHHM e com neuroipófise ectópica e sem holoprosencefalia. Variantes silenciosas, intrônicas e polimorfismos foram identificados no GLI2, mas aparentemente sem alteração funcional. Conclusão: Não identificamos mutação no GHRH e se realmente existe mutação neste gene como causa de DGH, deve ser muito rara. Variantes no GLI2 são frequentes (15%), indicando seu importante papel na etiologia da DGH congênita. Além disso, ampliamos o espectro fenotípico dos pacientes com mutações no GLI2, que foi caracterizado por DIGH ou DHHM, inclusive com diabetes insipidus, neuroipófise ectópica (maioria) e ausência de holoprosencefalia. Outras características observadas foram polidactilia, defeito de linha média facial e herança autossômica dominante com penetrância incompleta / Introduction: Alterations in genes related to GH secretion and pituitary organogenesis have been identified in patients with congenital GH deficiency (GHD). However, in only few cases of GHD the etiology has been established. GH-releasing hormone (GHRH) is an obvious candidate to explain isolated GH deficiency (IGHD). Previous reports in the literature did not identify mutations in GHRH, however, the methodology used was limited. Most patients with combined pituitary hormone deficiency (CPHD) have an ectopic posterior pituitary lobe (EPP) suggesting the study of genes involved in early pituitary development and also expressed in the infundibulum. GLI2 is a transcription factor in Sonic hedgehog signaling expressed in the primordial Rathkes pouch and ventral diencephalon during early pituitary development. Previously, GLI2 mutations were found in patients with holoprosencephaly and pituitary abnormalities. Aim: Analyse GHRH in 151 patients with IGHD (42 Brazilian and 101 from international centers) and GLI2 in 180 Brazilian patients with IGHD or CPHD by PCR and automatic sequencing, and describe the phenotype of patients with mutations. Results: In GHRH, six heterozygous variants that are benign according to in silico analysis were identified. GLI2 study revealed three novel heterozygous mutations leading to premature stop codons (p.L788fsX794, p.L694fsX722 e p.E380X) and truncated proteins, without the transcriptional activator domain. p.L788fsX794 was identified in a girl with short stature, polydactyly, epilepsy and hypoglycemia. She had GH, TSH, ACTH, prolactina, LH and FSH deficiencies. Two uncles had IGHD and one cousin CPHD. These relatives, the mother and other maternal relatives had polydactyly and carried the mutation. p.L694fsX722 was identified in a boy with short stature due to GHD who also had cleft lip and palate. His healthy father also carried the mutation. p.E380X was identified in an infant with delayed development, hypoglycemia, polyuria and polydipsia. She had GH, ACTH, TSH and ADH deficiencies. Her apparently normal mother also carried the mutation. All patients with GHD and GLI2 mutations had an EPP (not visualized in the patient with p.E380X), hypoplastic anterior pituitary lobe and absence of holoprosencephaly on MRI. Eighteen non-synonymous variants in GLI2 were identified in 24 patients. Sixteen of these were considered deleterious in at least one in silico prediction program and ten of these were not found in the control population. The phenotype was mainly of CPHD and EPP without holoprosencephaly. Several synonymous and intronic GLI2 variants and polymorphisms apparently without functional consequences were identified. Conclusions: No mutations in GHRH were identified and if mutations in this gene exist as a cause of IGHD, they must be very rare. Variants in GLI2 are frequent (15%) indicating its important role in the etiology of GHD. Furthermore, we expanded the clinical spectrum of patients with GLI2 mutations characterized by IGHD or CPHD including diabetes insipidus, ectopic posterior pituitary lobe (in most patients) and absence of holoprosencephaly. Additional features were polydactyly and midline facial defects and the inheritance was autosomal dominant with incomplete penetrance

Introdução: Alterações em genes relacionados com a secreção de GH ou a organogênese hipofisária foram identificadas em pacientes com deficiência de hormônio do crescimento (DGH) congênita. Entretanto, poucos casos de DGH têm sua etiologia esclarecida. O GHRH é um candidato óbvio para explicar a deficiência isolada de GH (DIGH). Na literatura, os estudos de análise do GHRH não conseguiram identificar mutações, porém são antigos e utilizaram uma metodologia com limitações. A maioria dos pacientes com deficiência hipotálamo-hipofisária múltipla (DHHM) apresenta neuroipófise ectópica sugerindo a importância do estudo de genes que atuam no início do desenvolvimento hipofisário, com expressão inclusive no infundíbulo. O GLI2 é um fator de transcrição na sinalização Sonic Hedgehog, envolvido com o início da embriogênese hipofisária, expresso na bolsa de Rathke primordial e no diencéfalo ventral. Previamente, mutações no GLI2 foram encontradas em pacientes com holoprosencefalia, e também alterações hipofisárias. Objetivos: Analisar o GHRH em 151 pacientes com DIGH (42 brasileiros e 109 encaminhados de centros internacionais) e analisar o GLI2 em 180 pacientes brasileiros com DIGH ou DHHM por PCR e sequenciamento automático dos genes; e descrever o fenótipo dos pacientes com mutações identificadas. Resultados: No GHRH foram identificadas seis variantes em heterozigose com previsão benigna pelas análises in silico. A análise do GLI2 identificou três mutações novas em heterozigose com códon de parada prematuro (p.L788fsX794, p.L694fsX722 e p.E380X), e geração de proteínas truncadas, com perda do domínio responsável pela ativação transcricional. A mutação p.L788fsX794 foi identificada numa paciente com baixa estatura, polidactilia, epilepsia e hipoglicemias. Apresentava deficiência de GH, TSH, ACTH, prolactina, LH e FSH. Na investigação familiar foi diagnosticada DIGH em dois tios e DHHM numa prima. Estes familiares, além de sua mãe e outros parentes maternos também apresentaram a mutação e polidactilia. A mutação p.L694fsX722 foi identificada num menino com baixa estatura por deficiência de GH, além de lábio leporino e fenda palatina. Seu pai, embora saudável, também apresentou a mutação. A mutação p.E380X foi identificada numa lactente com retardo no desenvolvimento, hipoglicemias, poliúria e polidipsia. Apresentava deficiência de GH, ACTH, TSH e ADH. Sua mãe aparentemente normal também apresentou a mutação. Todos os pacientes com DGH e mutação no GLI2 apresentaram neuroipófise ectópica (não visualizada na paciente com p.E380X), adenoipófise hipoplásica e ausência de holoprosencefalia na ressonância magnética. Dezoito variantes não-sinônimas também foram identificadas no GLI2 em 24 pacientes. Dezesseis dessas variantes foram consideradas deletérias em pelo menos um programa de predição in silico e dez delas não foram encontradas em população controle. O fenótipo dos pacientes foi predominante de DHHM e com neuroipófise ectópica e sem holoprosencefalia. Variantes silenciosas, intrônicas e polimorfismos foram identificados no GLI2, mas aparentemente sem alteração funcional. Conclusão: Não identificamos mutação no GHRH e se realmente existe mutação neste gene como causa de DGH, deve ser muito rara. Variantes no GLI2 são frequentes (15%), indicando seu importante papel na etiologia da DGH congênita. Além disso, ampliamos o espectro fenotípico dos pacientes com mutações no GLI2, que foi caracterizado por DIGH ou DHHM, inclusive com diabetes insipidus, neuroipófise ectópica (maioria) e ausência de holoprosencefalia. Outras características observadas foram polidactilia, defeito de linha média facial e herança autossômica dominante com penetrância incompleta / Introduction: Alterations in genes related to GH secretion and pituitary organogenesis have been identified in patients with congenital GH deficiency (GHD). However, in only few cases of GHD the etiology has been established. GH-releasing hormone (GHRH) is an obvious candidate to explain isolated GH deficiency (IGHD). Previous reports in the literature did not identify mutations in GHRH, however, the methodology used was limited. Most patients with combined pituitary hormone deficiency (CPHD) have an ectopic posterior pituitary lobe (EPP) suggesting the study of genes involved in early pituitary development and also expressed in the infundibulum. GLI2 is a transcription factor in Sonic hedgehog signaling expressed in the primordial Rathkes pouch and ventral diencephalon during early pituitary development. Previously, GLI2 mutations were found in patients with holoprosencephaly and pituitary abnormalities. Aim: Analyse GHRH in 151 patients with IGHD (42 Brazilian and 101 from international centers) and GLI2 in 180 Brazilian patients with IGHD or CPHD by PCR and automatic sequencing, and describe the phenotype of patients with mutations. Results: In GHRH, six heterozygous variants that are benign according to in silico analysis were identified. GLI2 study revealed three novel heterozygous mutations leading to premature stop codons (p.L788fsX794, p.L694fsX722 e p.E380X) and truncated proteins, without the transcriptional activator domain. p.L788fsX794 was identified in a girl with short stature, polydactyly, epilepsy and hypoglycemia. She had GH, TSH, ACTH, prolactina, LH and FSH deficiencies. Two uncles had IGHD and one cousin CPHD. These relatives, the mother and other maternal relatives had polydactyly and carried the mutation. p.L694fsX722 was identified in a boy with short stature due to GHD who also had cleft lip and palate. His healthy father also carried the mutation. p.E380X was identified in an infant with delayed development, hypoglycemia, polyuria and polydipsia. She had GH, ACTH, TSH and ADH deficiencies. Her apparently normal mother also carried the mutation. All patients with GHD and GLI2 mutations had an EPP (not visualized in the patient with p.E380X), hypoplastic anterior pituitary lobe and absence of holoprosencephaly on MRI. Eighteen non-synonymous variants in GLI2 were identified in 24 patients. Sixteen of these were considered deleterious in at least one in silico prediction program and ten of these were not found in the control population. The phenotype was mainly of CPHD and EPP without holoprosencephaly. Several synonymous and intronic GLI2 variants and polymorphisms apparently without functional consequences were identified. Conclusions: No mutations in GHRH were identified and if mutations in this gene exist as a cause of IGHD, they must be very rare. Variants in GLI2 are frequent (15%) indicating its important role in the etiology of GHD. Furthermore, we expanded the clinical spectrum of patients with GLI2 mutations characterized by IGHD or CPHD including diabetes insipidus, ectopic posterior pituitary lobe (in most patients) and absence of holoprosencephaly. Additional features were polydactyly and midline facial defects and the inheritance was autosomal dominant with incomplete penetrance

Le récepteur du facteur de libération de l’hormone de croissance (GHRHR) est un récepteur de la famille des récepteurs couplés aux protéines G. Il est fortement exprimé dans les cellules somatotropes de l’hypophyse antérieure de plusieurs mammifères. Ce récepteur exerce un rôle primordial dans la stimulation de la synthèse et de la sécrétion de l’hormone de croissance ainsi que dans la prolifération des somatotropes. Au niveau extrahypophysaire, les niveaux les plus élevés d’ARNm du GHRHR se retrouvent dans le rein. Toutefois, aucune analyse immunohistochimique n’existe encore sur la localisation précise et la quantification sur les niveaux de GHRHR dans les différents segments du rein de rat et sa dynamique d’expression en situation normale et pathologique telle que l’ischémie. De plus, dans le rein humain normal, aucune information n’est présentement disponible. Le premier article de ce mémoire a pour objectif d’identifier, par immunofluorescence directe, la localisation du GHRHR à travers le système tubulaire rénal, chez le rat jeune en bonne santé. Nos résultats mettent en évidence que dans le rein de rat sain, le GHRHR est exprimé dans les cellules du tubule proximal contourné et droit, de l’anse de Henlé ascendante épaisse corticale et médullaire et de l’anse de Henlé ascendante mince. Le cortex et la bande externe de la médulla externe seraient les deux régions où l’expression est la plus élevée. À la suite d’une insulte rénale comme l’ischémie-reperfusion (IR) chaude, nos résultats démontrent que l’expression du GHRHR est régulée à la baisse dans ces mêmes régions. De plus, une augmentation de certains marqueurs de détérioration cellulaire est présente comme l’enzyme initiatrice, la caspase-9 clivée et effectrice (caspase-3 clivée), des fragments d’ADN et la surexpression d’indication d’injure tissulaire comme la protéine Kidney Injury Molecule 1 (KIM-1). L’ensemble de ces résultats ouvre plusieurs pistes d’études concernant l’importance du GHRHR en rénoprotection. Le deuxième article de ce mémoire a pour objectif d’identifier, par immunofluorescence directe, la localisation du GHRHR à travers le système tubulaire rénal humain. Nos résultats suggèrent que dans le rein humain sain, le GHRHR est davantage exprimé dans le cortex, plus précisément, au niveau du tubule proximal droit et contourné et l’anse de Henlé corticale ascendante épaisse. L’expression du GHRHR est aussi notable au niveau de la région médullaire, pour être plus spécifique, au niveau de l’anse de Henlé médullaire ascendante épaisse et de la médulla. Ainsi, comme chez le rat, l’expression du GHRHR rénal est régio-spécifique. Finalement, le troisième article de ce mémoire est une revue de la littérature ayant pour but d’établir un lien entre les mécanismes connus du stress oxydant dans un contexte d’IR rénale et son impact spécifique dans la médulla. Cet article met en évidence que les différents segments du rein réagissent différemment à une agression oxydante et que la médulla est la région la plus vulnérable. De plus, cette revue de la littérature souligne que les différents types de mécanismes connus du stress oxydant dans un contexte d’IR rénale, tel que la production de dérivés réactifs de l’oxygène, ciblent principalement deux structures du néphron : le tubule proximal et l’anse de Henlé ascendante épaisse médullaire. Les principales répercussions de ces mécanismes observables sont l’inflammation, l’apoptose cellulaire et la diminution des fonctions rénales. Ces mécanismes peuvent aussi être utilisés comme un outil de diagnostic ou de détermination de la santé de l’organe. / The growth hormone-releasing factor receptor (GHRHR) is a receptor of the family of G- protein-coupled receptors. It is highly expressed in the somatotropic cells of the anterior pituitary of several mammals. This receptor plays an essential role in the stimulation of the synthesis and secretion of growth hormone as well as in the proliferation of somatotrophs. At the extra- pituitary level, the highest levels of GHRHR mRNA are found in the kidney. However, no immunohistochemical analysis yet exists on precise localization and quantification of GHRHR levels in the different segments of the rat kidney and its expression dynamics in normal and pathological situations such as ischemia. Additionally, in the normal human kidney, no information is currently available. The first article of this thesis aims to identify, by direct immunofluorescence, the localization of the GHRHR through the renal tubular system, in young healthy rats. Our results show that in the healthy rat kidney, GHRHR is expressed in the cells of the convoluted and right proximal tubule, of the cortical and medullary thick ascending loop of Henle and of the thin ascending loop of Henle. The cortex and the outer band of the outer medulla would be the two regions where the expression is the highest. Following a renal insult such as warm ischemia-reperfusion (RI), our results demonstrate that GHRHR expression is down-regulated in these same regions. In addition, an increase in certain markers of cellular damage is present including initiating enzymes, cleaved and effector caspase-9 (cleaved caspase-3), DNA fragments and overexpression indicative of tissue injury such as protein Kidney Injury Molecule 1 (KIM-1). All these results open up several avenues of study concerning the importance of GHRHR in renoprotection. The second article of this thesis aims to identify, by direct immunofluorescence, the localization of the GHRHR through the human renal tubular system. Our results suggest that in the healthy human kidney, the GHRHR is more expressed in the cortex, more precisely at the level of the right, convoluted proximal tubule and the thick ascending cortical loop of Henle. The expression of GHRHR is also appreciable at the level of the medullary region, more precisely at the level of the thick ascending medullary loop of Henle, and the medulla. Thus, as in rats, the expression of renal GHRHR is region specific. Finally, the third article of this thesis is a review of the literature aimed at establishing a link between the known mechanisms of oxidative stress in the context of renal IR and its specific impact in the medulla. This article highlights that the different segments of the kidney react differently to an oxidative attack and that the medulla is the most vulnerable region. In addition, this review of the literature underlines that the different types of known mechanisms of oxidative stress in a context of renal IR, such as the production of reactive oxygen species, mainly target two structures of the nephron: the proximal tubule and the thick ascending loop of Henle. The main repercussions of these observable mechanisms are inflammation, cellular apoptosis and reduced renal function. These mechanisms can also be used as a diagnostic tool or to determine the health of the organ.