Le syndrome de Kallmann de Morsier (KS) est défini par l’association d’un hypogonadisme hypogonadotrope (HH) et d’une altération de l’odorat, hyposmie ou anosmie.L’association d’anomalies du système olfactif avec un hypogonadisme a été observée la première fois par Maestre de San Juan en 1956, un anatomopathologiste espagnol qui a décrit un sujet ayant des testicules de petite taille et l’absence de bulbes olfactifs (Maestre de San Juan 1856). En 1944, le psychiatre et généticien américain Franz Josef Kallmann individualisa le syndrome au sein de 3 familles et fit l’hypothèse de son caractère héréditaire (Kallmann et al. 1944). Dans les années 50, l’anatomopathologiste suisse de Morsier approfondit la connaissance du syndrome en décrivant plusieurs cas d’absence complète ou partielle des bulbes et du tractus olfactif chez des patients masculins atteints d’hypogonadisme et d’anomalie anatomique de la ligne médiane (de Morsier 1954; de Morsier 1962; de Morsier and Gauthier 1963). Il appela ce syndrome « dysplasie olfactogénitale » et il fut le premier à suggérer l’origine hypothalamique de l’hypogonadisme. Enfin, en 1971, l’origine hypothalamique de l’hypogonadisme fut démontré, secondaire à un déficit en gonadolibérine (GnRH) (Naftolin et al. 1971). / Kallmann syndrome (KS) : study of phenotype / genotype correlation and modes of transmission of mutations and PROK2 PROKR2 : characterization of a novel gene responsible for KS, alpha dystrobrevin

A Síndrome de Kallmann (SK), associação entre hipogonadismo hipogonadotrófico e distúrbio olfatório (hiposmia ou anosmia), é causada por uma deficiência da migração neuronal que envolve as células produtoras do hormônio liberador de gonadotrofinas e os neurônios olfatórios, com origem embriológica comum. O primeiro gene descrito, KAL1, codifica uma proteína chamada anosmina, que possui homologia com moléculas de adesão axonal envolvidas na migração neuronal. Dentre as anormalidades fenotípicas descritas na SK, destacam-se a malformação das estruturas do rinencéfalo (bulbos e sulcos olfatórios) e a presença, em parte dos pacientes, de uma alteração neurológica específica, os movimentos em espelho (ME). No presente trabalho estudamos 21 pacientes com SK, comparando com um grupo controle (n=16), utilizando técnicas qualitativas e quantitativas de imagem por Ressonância Magnética (RM), com os objetivos de (I) correlacionar as diferentes alterações radiológicas do encéfalo com os achados clínicos, laboratoriais e a presença de mutações gênicas; (II) caracterizar qualitativa e quantitativamente as alterações do rinencéfalo; e (III) investigar possíveis alterações associadas aos ME, dando atenção às duas principais hipóteses para sua causa, desenvolvimento anormal do trato corticoespinhal e deficiência do mecanismo inibitório contra-lateral via corpo caloso. Para estudo do rinencéfalo utilizamos especialmente imagens coronais ponderadas em T2 com cortes finos, avaliando subjetivamente e posteriormente medindo o volume dos bulbos olfatórios, comprimento e profundidade dos sulcos. Para estudo dos ME utilizamos a técnica de morfometria baseada em voxel (VBM), procurando alterações volumétricas da substancia branca (SB) e cinzenta (SC), seguida da avaliação de alterações da SB com as técnicas de relaxometria (RL) e cálculo da taxa de transferência de magnetização (TTM). Dezoito (85%) pacientes apresentaram graus variáveis de acometimento das estruturas olfatórias. Demonstramos que a aplasia dos bulbos e/ou sulcos olfatórios foi o achado mais comum na SK, e a presença de aplasia de bulbo olfatório teve excelente concordância com a presença de anosmia no teste olfativo. O VBM otimizado mostrou áreas alteradas da SC envolvendo o córtex motor de maneira diferente nos pacientes com e sem ME, compatíveis com uma resposta cortical hipertrófica à uma decussação deficiente do trato corticoespinhal nos pacientes com SK e ME. Ainda, as alterações da SC nos pacientes sem ME podem representar mecanismos mais complexos determinando a presença ou não do sinal. Apesar do nosso estudo de VBM não mostrar alteração significativa de volume da SB, as avaliações com RL e TTM mostraram áreas de alteração de sinal, demonstrando a presença de desmielinização e/ou desorganização axonal na SB dos pacientes com SK, envolvendo diferentemente o sistema motor dos pacientes com e sem ME, sendo compatível com os estudos prévios que sugerem a associação entre uma anomalia do trato corticoespinhal e uma deficiência no mecanismo inibitório inter-hemisférico como responsáveis pela persistência patológica dos ME. A análise da TTM demonstrou ainda alteração em topografia da decussação das pirâmides bulbares que pode representar o desarranjo primário desta região, com as alterações das fibras a montante, superiormente (evidenciadas na RL e TTM), e do córtex motor (evidenciadas no VBM), possivelmente sendo secundárias e acometendo diferentemente os pacientes com e sem ME. / Kallmann syndrome (KS) is defined by the association of hypogonadotropic hypogonadism with olfaction disturbance (hyposmia or anosmia). It is caused by a neuronal migration arrest that involves both the gonadotropin releasing hormone (GnRH) and the olfactory neurons, which have a common embryonic origin. The first gene described, KAL1, encodes a protein named anosmin, which shows a strong homology to axonal adhesion molecules involved in neuronal migration and axonal pathfinding. Various phenotypic abnormalities have been described in KS, including olfactory bulbs and sulci aplasia or hypoplasia and specific neurologic disorders, such as mirror movements (MM). In this study we evaluated 21 patients with KS, comparing with a control group (n=16), using qualitative and quantitative techniques with Magnetic Resonance Imaging (MRI), with the following purposes: (I) correlate the brains radiologic alterations with the clinical, laboratorial and genetic findings; (II) characterize the rhinencephalon alterations; and (III) investigate MM etiology, addressing the two main hypotheses concerning its cause, abnormal development of the primary motor system, involving the ipsilateral corticospinal tract, and lack of contralateral motor cortex inhibitory mechanisms, mainly through the corpus callosum. For rhinencephalon evaluation, we specially used thin-section coronal T2-weighed images, which were reviewed and then objectively evaluated with the measurements of the olfactory bulbs and sulci. To study MM we used the voxel-based morphometry (VBM), to determine white (WM) and gray matter (GM) volume changes, and T2 relaxometry (T2R) and magnetization transfer ratio (MTR), searching for signal intensity changes in the WM. Eighteen (85%) patients presented different degrees of olfactory structures abnormalities, with the bulbs and/or sulci aplasia being the most common finding, and presence olfactory bulb aplasia showed excellent agreement with anosmia as determined by the smell identification clinical test. The optimized VBM study did not show significant white matter changes in patients with KS but showed gray matter alterations in keeping with a hypertrophic response to a deficient pyramidal decussation in patients with MM. In addition, gray matter alterations were observed in patients without MM, which can represent more complex mechanisms determining the presence or absence of this symptom. Even if the VBM did not show significant volume changes in WM, the evaluation with the T2R and MTR showed WM signal intensity alterations, differently involving patients with and without MM, in keeping with demyelinization and/or axonal disorder, in accordance with the involvement of a corticospinal tract anomaly and a deficient inhibitory interhemispheric mechanism in the etiology of MM. The MTR analysis also showed a different alteration in the pyramidal decussation, which can represent a primary disorder in this region, with all other alterations in the superior WM fibers and motor cortex possibly being secondary to this disarrangement, and involving patients with and without MM in a different manner.

Es werden die Entdeckung der organischen Szintillatoren durch Hartmut Kallmann und seine anderen Arbeiten, insbesondere die Entwicklung der flüssigen Szillitatoren beschrieben. / The discovery of organic scintillators by Hartmut Kallmann and his further work, especially the development of liquid scintillators are described.

A Síndrome de Kallmann (SK), associação entre hipogonadismo hipogonadotrófico e distúrbio olfatório (hiposmia ou anosmia), é causada por uma deficiência da migração neuronal que envolve as células produtoras do hormônio liberador de gonadotrofinas e os neurônios olfatórios, com origem embriológica comum. O primeiro gene descrito, KAL1, codifica uma proteína chamada anosmina, que possui homologia com moléculas de adesão axonal envolvidas na migração neuronal. Dentre as anormalidades fenotípicas descritas na SK, destacam-se a malformação das estruturas do rinencéfalo (bulbos e sulcos olfatórios) e a presença, em parte dos pacientes, de uma alteração neurológica específica, os movimentos em espelho (ME). No presente trabalho estudamos 21 pacientes com SK, comparando com um grupo controle (n=16), utilizando técnicas qualitativas e quantitativas de imagem por Ressonância Magnética (RM), com os objetivos de (I) correlacionar as diferentes alterações radiológicas do encéfalo com os achados clínicos, laboratoriais e a presença de mutações gênicas; (II) caracterizar qualitativa e quantitativamente as alterações do rinencéfalo; e (III) investigar possíveis alterações associadas aos ME, dando atenção às duas principais hipóteses para sua causa, desenvolvimento anormal do trato corticoespinhal e deficiência do mecanismo inibitório contra-lateral via corpo caloso. Para estudo do rinencéfalo utilizamos especialmente imagens coronais ponderadas em T2 com cortes finos, avaliando subjetivamente e posteriormente medindo o volume dos bulbos olfatórios, comprimento e profundidade dos sulcos. Para estudo dos ME utilizamos a técnica de morfometria baseada em voxel (VBM), procurando alterações volumétricas da substancia branca (SB) e cinzenta (SC), seguida da avaliação de alterações da SB com as técnicas de relaxometria (RL) e cálculo da taxa de transferência de magnetização (TTM). Dezoito (85%) pacientes apresentaram graus variáveis de acometimento das estruturas olfatórias. Demonstramos que a aplasia dos bulbos e/ou sulcos olfatórios foi o achado mais comum na SK, e a presença de aplasia de bulbo olfatório teve excelente concordância com a presença de anosmia no teste olfativo. O VBM otimizado mostrou áreas alteradas da SC envolvendo o córtex motor de maneira diferente nos pacientes com e sem ME, compatíveis com uma resposta cortical hipertrófica à uma decussação deficiente do trato corticoespinhal nos pacientes com SK e ME. Ainda, as alterações da SC nos pacientes sem ME podem representar mecanismos mais complexos determinando a presença ou não do sinal. Apesar do nosso estudo de VBM não mostrar alteração significativa de volume da SB, as avaliações com RL e TTM mostraram áreas de alteração de sinal, demonstrando a presença de desmielinização e/ou desorganização axonal na SB dos pacientes com SK, envolvendo diferentemente o sistema motor dos pacientes com e sem ME, sendo compatível com os estudos prévios que sugerem a associação entre uma anomalia do trato corticoespinhal e uma deficiência no mecanismo inibitório inter-hemisférico como responsáveis pela persistência patológica dos ME. A análise da TTM demonstrou ainda alteração em topografia da decussação das pirâmides bulbares que pode representar o desarranjo primário desta região, com as alterações das fibras a montante, superiormente (evidenciadas na RL e TTM), e do córtex motor (evidenciadas no VBM), possivelmente sendo secundárias e acometendo diferentemente os pacientes com e sem ME. / Kallmann syndrome (KS) is defined by the association of hypogonadotropic hypogonadism with olfaction disturbance (hyposmia or anosmia). It is caused by a neuronal migration arrest that involves both the gonadotropin releasing hormone (GnRH) and the olfactory neurons, which have a common embryonic origin. The first gene described, KAL1, encodes a protein named anosmin, which shows a strong homology to axonal adhesion molecules involved in neuronal migration and axonal pathfinding. Various phenotypic abnormalities have been described in KS, including olfactory bulbs and sulci aplasia or hypoplasia and specific neurologic disorders, such as mirror movements (MM). In this study we evaluated 21 patients with KS, comparing with a control group (n=16), using qualitative and quantitative techniques with Magnetic Resonance Imaging (MRI), with the following purposes: (I) correlate the brains radiologic alterations with the clinical, laboratorial and genetic findings; (II) characterize the rhinencephalon alterations; and (III) investigate MM etiology, addressing the two main hypotheses concerning its cause, abnormal development of the primary motor system, involving the ipsilateral corticospinal tract, and lack of contralateral motor cortex inhibitory mechanisms, mainly through the corpus callosum. For rhinencephalon evaluation, we specially used thin-section coronal T2-weighed images, which were reviewed and then objectively evaluated with the measurements of the olfactory bulbs and sulci. To study MM we used the voxel-based morphometry (VBM), to determine white (WM) and gray matter (GM) volume changes, and T2 relaxometry (T2R) and magnetization transfer ratio (MTR), searching for signal intensity changes in the WM. Eighteen (85%) patients presented different degrees of olfactory structures abnormalities, with the bulbs and/or sulci aplasia being the most common finding, and presence olfactory bulb aplasia showed excellent agreement with anosmia as determined by the smell identification clinical test. The optimized VBM study did not show significant white matter changes in patients with KS but showed gray matter alterations in keeping with a hypertrophic response to a deficient pyramidal decussation in patients with MM. In addition, gray matter alterations were observed in patients without MM, which can represent more complex mechanisms determining the presence or absence of this symptom. Even if the VBM did not show significant volume changes in WM, the evaluation with the T2R and MTR showed WM signal intensity alterations, differently involving patients with and without MM, in keeping with demyelinization and/or axonal disorder, in accordance with the involvement of a corticospinal tract anomaly and a deficient inhibitory interhemispheric mechanism in the etiology of MM. The MTR analysis also showed a different alteration in the pyramidal decussation, which can represent a primary disorder in this region, with all other alterations in the superior WM fibers and motor cortex possibly being secondary to this disarrangement, and involving patients with and without MM in a different manner.

Les hypogonadismes hypogonadotropes congénitaux (CHH) sont des maladies héréditaires caractérisées par un déficit de sécrétion des gonadotrophines par l’hypophyse, à l’origine d’une infertilité ou d’une absence complète de puberté. On distingue les formes isolées avec olfaction normale (nCHH) et les formes syndromiques associant au déficit gonadotrope d’autres signes, tel qu’un défaut d’olfaction dans le cas du syndrome de Kallmann (SK), la forme plus fréquente de CHH. Les gènes identifiés dans le SK participent au développement embryonnaire et les gènes des nCHH sont impliqués dans la régulation de la sécrétion de la GnRH ou de son action. A ce stade, deux populations de neurones hypothalamiques gonadotropes sont connues, le neurone à GnRH et le neurone KNDy, sécrétant les Kisspeptines et la Neurokinine B. On estimait que l’ensemble des gènes identifiés couvraient moins de 20% des étiologies génétiques. L’objectif de ce doctorat était d’étudier prévalences et mécanismes physiopathologiques des gènes connus et d’identifier de nouvelles étiologies génétiques de CHH. Dans la première partie, nous avons caractérisé la fonctionnalité de tous les variants identifiés sur les gènes KISS1R, TACR3 et TAC3. Cela a permis de préciser les prévalences chez 600 patients, d’identifier un profil neuroendocrinien propre à l’altération de la signalisation Neurokinine B et de démontrer l’implication des Kisspeptines au cours de la vie embryonnaire. Enfin, nous proposons un modèle d’interaction entre le neurone à GnRH et le neurone KNDy. Dans la seconde partie, nous avons identifié deux nouveaux gènes, SEMA3A dans une forme familiale de SK et PNPLA6 dans une forme familiale rare de CHH syndromique. En conclusion, notre connaissance accrue des formes génétiques de CHH, a permis de développer un panel d’exome ciblé dédié au diagnostic par séquençage nouvelle génération permettant l’analyse simultanée de gènes candidats et de gènes connus. / Congenital hypogonadotropic hypogonadism (CHH) is characterized by deficient or absent pubertal development due to deficient or absent secretion of the pituitary gonadotropins. The many known genetic causes are generally classified into distinct nosological groups. One comprises abnormalities that affect the pre-natal development or migration of GnRH neurons, the paradigm of which is Kallmann syndrome. The other encompasses molecular abnormalities that only affect hypothalamic GnRH synthesis, GnRH release or GnRH signaling at pituitary level. At this stage, two populations of hypothalamic neurons implicated in a gonadotrop function are identified, GnRH neurons and KNDy neurons secreting kisspeptins and neurokinin B. All of the identified genes would represent less than 20% of genetic etiologies.The aim of this PhD was to study the prevalence and pathophysiology mechanisms of known genes and to identify new genetic etiologies of CHH.In the first part, we characterized the function of all molecular events identified on KISS1R, TACR3 and TAC3 genes. Prevalences were estimated in 600 patients. A particular neuroendocrine profile was identified in patients presenting an alteration of neurokinin B signaling. Importance of Kisspeptins during embryonic life was validated. According to these data, a model of interaction between GnRH and KNDy neurons was proposed.In the second part, we identified two new CHH genes using various molecular genetics approaches. SEMA3A was identified in a familial form of Kallmann syndrome and PNPLA6 in a rare familial form of CHH.Finally, our increased knowledge of the various genetic forms of CHH allows proposing a new genetic approach based on next generation sequencing to test together all known and several candidate genes.

A síndrome de Kallmann (SK) é um distúrbio raro, caracterizado pela presença do Hipogonadismo Hipogonadotrófico Idiopático (HHI) associado à anosmia ou hiposmia (ausência ou déficit no sentido do olfato, respectivamente). O HHI tem como principal causa a deficiência do hormônio liberador de gonadotrofina (GnRH), com heterogeneidade genética significativa. Clinicamente é caracterizada por níveis plasmáticos baixos dos hormônios luteinizante (LH) e folículo-estimulante (FSH) associados com baixas concentrações de esteroides sexuais. O estabelecimento de um fenótipo cognitivo claro da SK pode ajudar na compreensão sobre o desenvolvimento das funções cognitivas humanas e a informar para um melhor manejo do paciente, com um acompanhamento mais apropriado. Neste estudo foi realizada uma bateria de avaliação neuropsicológica, caracterizando aspectos referentes aos quocientes intelectuais, atenção, funções executivas, memória, linguagem e habilidades visuoespaciais. Como resultados, o grupo de participantes diagnosticado de SK apresentou desempenho inferior em todas as áreas avaliadas, quando comparado ao grupo controle. Todavia, seu desempenho de maneira geral esteve dentro das faixas média e média-inferior, caracterizando assim um déficit leve das funções neuropsicológicas avaliadas. A memória declarativa de longa duração, no entanto, no grupo clínico esteve bastante prejudicada, com classificação dentro do espectro deficitário. Este resultado, aliado ao desempenho inferior em atividades que exigiam um julgamento de origem temporal e ao comprometimento da aprendizagem de associações condicionais arbitrárias (entre estímulos e respostas), sugere que a maior característica cognitiva presente no grupo clínico está na dificuldade de reter e selecionar informações apropriadas dentre os diversos estímulos e não apenas na recuperação destas informações. / The Kallmann syndrome (KS) is a rare disorder characterized by the presence of hypogonadotropic hypogonadism Idiopathic (IHH) associated with anosmia or hyposmia (absence or deficit in the sense of smell, respectively). The HHI\'s main causes deficiency of gonadotropin-releasing hormone (GnRH), with significant genetic heterogeneity. Clinically, it is characterized by low plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) associated with low concentrations of sex steroids. The establishment of a clear cognitive phenotype of SK can help in understanding the development of human cognitive functions and to report to a better management of the patient with a more appropriate accompaniment. In this study a battery of neuropsychological evaluation was performed, featuring aspects of intellectual quotients, attention, executive functions, memory, language and visuospatial skills. As a result, the diagnosed group of participants of KS showed lower performance in all areas evaluated, when compared to the control group. However, its performance in general was in the middle and lower-middle ranges, characterizing a slight deficit of assessed neuropsychological functions. The declarative memory of long term, however, in the clinical group was significantly impaired classified within the spectrum deficit. This result, coupled with lower performance in activities requiring a judgment of temporal origin and impairment of learning arbitrary conditional associations (between stimuli and responses), suggests that higher cognitive feature present in the clinical group is the difficulty of retaining and select information appropriate from the various stimuli, not just the recovery of this information.

A síndrome de Kallmann (SK) é um distúrbio raro, caracterizado pela presença do Hipogonadismo Hipogonadotrófico Idiopático (HHI) associado à anosmia ou hiposmia (ausência ou déficit no sentido do olfato, respectivamente). O HHI tem como principal causa a deficiência do hormônio liberador de gonadotrofina (GnRH), com heterogeneidade genética significativa. Clinicamente é caracterizada por níveis plasmáticos baixos dos hormônios luteinizante (LH) e folículo-estimulante (FSH) associados com baixas concentrações de esteroides sexuais. O estabelecimento de um fenótipo cognitivo claro da SK pode ajudar na compreensão sobre o desenvolvimento das funções cognitivas humanas e a informar para um melhor manejo do paciente, com um acompanhamento mais apropriado. Neste estudo foi realizada uma bateria de avaliação neuropsicológica, caracterizando aspectos referentes aos quocientes intelectuais, atenção, funções executivas, memória, linguagem e habilidades visuoespaciais. Como resultados, o grupo de participantes diagnosticado de SK apresentou desempenho inferior em todas as áreas avaliadas, quando comparado ao grupo controle. Todavia, seu desempenho de maneira geral esteve dentro das faixas média e média-inferior, caracterizando assim um déficit leve das funções neuropsicológicas avaliadas. A memória declarativa de longa duração, no entanto, no grupo clínico esteve bastante prejudicada, com classificação dentro do espectro deficitário. Este resultado, aliado ao desempenho inferior em atividades que exigiam um julgamento de origem temporal e ao comprometimento da aprendizagem de associações condicionais arbitrárias (entre estímulos e respostas), sugere que a maior característica cognitiva presente no grupo clínico está na dificuldade de reter e selecionar informações apropriadas dentre os diversos estímulos e não apenas na recuperação destas informações. / The Kallmann syndrome (KS) is a rare disorder characterized by the presence of hypogonadotropic hypogonadism Idiopathic (IHH) associated with anosmia or hyposmia (absence or deficit in the sense of smell, respectively). The HHI\'s main causes deficiency of gonadotropin-releasing hormone (GnRH), with significant genetic heterogeneity. Clinically, it is characterized by low plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) associated with low concentrations of sex steroids. The establishment of a clear cognitive phenotype of SK can help in understanding the development of human cognitive functions and to report to a better management of the patient with a more appropriate accompaniment. In this study a battery of neuropsychological evaluation was performed, featuring aspects of intellectual quotients, attention, executive functions, memory, language and visuospatial skills. As a result, the diagnosed group of participants of KS showed lower performance in all areas evaluated, when compared to the control group. However, its performance in general was in the middle and lower-middle ranges, characterizing a slight deficit of assessed neuropsychological functions. The declarative memory of long term, however, in the clinical group was significantly impaired classified within the spectrum deficit. This result, coupled with lower performance in activities requiring a judgment of temporal origin and impairment of learning arbitrary conditional associations (between stimuli and responses), suggests that higher cognitive feature present in the clinical group is the difficulty of retaining and select information appropriate from the various stimuli, not just the recovery of this information.

L’acquisition de la fertilité chez les mammifères est le résultat d’un long processus de développement et de maturation de l’axe gonadotrope. Cette fonction cruciale à la survie des espèces est orchestrée par une poignée de cellules localisées au niveau de l’aire préoptique hypothalamique chez le rongeur, sécrétant la gonadotropin-releasing hormon (GnRH). La GnRH stimule la sécrétion de LH et de FSH par l’adénohypophyse, qui stimulent à leur tour les gonades. Les cellules à GnRH naissent dans l’épithélium voméronasal pendant le développement embryonnaire et migrent le long des axones voméronasaux pour atteindre l’hypothalamus. A la naissance le système est entièrement en place, toutefois il subira une phase de maturation avant d’atteindre la puberté, signant le début de la fertilité. Chez l’homme, un défaut de sécrétion de GnRH peut conduire à un hypogonadisme hypogonadotrope idiopathique (IHH) caractérisé par une subfertilité et une puberté retardée voire absente, ou même à un syndrome de Kallmann. Dans une grande partie des cas ce défaut de sécrétion est lié à un défaut de développement prénatal et à une diminution du nombre de neurones à GnRH dans dans l’hypothalamus. Depuis peu, la grande famille des semaphorines, déjà connues pour leurs effets chimiotactiques dans certains types cellulaires, et en particulier la semaphorine3A (Sema3A) via son récepteur la Neuropilin-1 (Nrp1), a été décrite comme un facteur indispensable au développement du système à GnRH et décrit comme un « gène Kallmann ». Toutefois son rôle spécifique dans les cellules à GnRH reste à élucider. Le premier objectif de ma thèse a donc été de déterminer le rôle de l’expression du récepteur Nrp1 dans les neurones à GnRH. Le suivi de la maturation sexuelle des animaux Gnrh::cre, Nrp1loxp/loxp (qui n’expriment pas la Nrp1 exclusivement dans les neurones à GnRH) a révélé l’apparition d’une puberté précoce et d’un phénotype de surpoids en comparaison aux animaux contrôles, corrélé à une accumulation des cellules à GnRH dans l’aire préoptique. L’étude de l’embryogenèse du système à GnRH chez ces animaux a démontré une augmentation du nombre de cellules à GnRH pendant leur migration. Nos résultats obtenus in vivo et in vitro suggèrent que la signalisation Nrp1 a un impact sur la survie des neurones à GnRH, et qu’elle module la motilité des cellules en migration et influe leur positionnement dans le cerveau. Le deuxième objectif de ma thèse a été d’étudier le rôle de l’exocytose dépendante du calcium et donc de la neurosécrétion dans les neurones à GnRH sur leur développement. Le suivi de la physiologie d’animaux Gnrh::cre; iBot, dont l’exocytose dépendante du calcium est abolit par clivage de protéine VAMP2/synaptobrevin 2 dans le neurone à GnRH, a révélé l’apparition de deux phénotypes distincts selon la pénétrance du transgène : un groupe ayant une puberté normale et un poids comparable aux animaux contrôles, et un groupe ayant une puberté retardée voire inexistante associé à un surpoids. Ces derniers présentent un IHH, une augmentation du tissu adipeux périgonadique et une hyperleptinémie, alors que la distribution des neurones à GnRH dans le cerveau n’est pas altérée. Ces données mettent en évidence le fait que l’activité de neurosécrétion dans les neurones à GnRH ne serait pas nécessaire pour leur développement embryonnaire, mais qu’elle pourrait jouer un rôle dans le maintien de l’homéostasie énergétique.Ces deux études mettent en avant un lien étroit entre axe gonadotrope et métabolisme énergétique chez les mammifères et ont dévoilés de nouveaux mécanismes qui pourraient être impliqués dans la physiopathologie de la reproduction chez l’homme. / Fertility in mammals is the result of a long development and maturation process of the hypothalamic-pituitary-gonadal axis. The reproductive function is orchestrated by a small population of neurons, located in preoptic area of hypothalamus in rodents, and releasing in a pulsatile manner Gonadotropin-releasing hormon (GnRH) in the portal blood vessels, where it is transported to the anterior pituitary gland. GnRH neuropeptide triggers synthesis and release of the gonadotropins LH and FSH, which in turn stimulates development and function of the gonads. GnRH neurons differenciate extracerebraly in the nasal placode and migrate from the vomeronasal organ to the forebrain along olfactory/vomeronasal nerves. At birth, the system is ready, however it will undergo a maturation phase before reaching puberty, signing the beginning of fertility. Deficiency in GnRH release can lead to idiopathic hypogonadotropic hypogonadism (IHH), characterized by a defect in sexual maturation and delayed or no puberty, or even to Kallmann syndrome when the IHH is associated with a deficit in the sens of smell. These phenotypes could be linked to a defect during GnRH neuron migration period and a decrease of GnRH cells located in hypothalamus after birth. Numerous studies have described the influence of different molecules on the migration of GnRH neurons. Recently, the semaphorin family, well known for its chemotactic effects in some cell types, and particularly the semaphorin3A (Sema3A), has been described by our laboratory as an essential factor for the guidance of GnRH neurons during embryogenesis, and characterized as a « Kallmann gene ». However, the role of Sema3A, and its specific receptor Neuropilin-1 (Nrp1) in GnRH neurons remains to be elucidated. The first objective of my thesis was to determine the role of the expression of Nrp1 in GnRH neurons. The analysis of sexual maturation in mice in which Nrp1 expression was selectively knocked out in GnRH neurons revealed a precocious onset of puberty and overweight compared to control littermates, correlated with an accumulation of GnRH neurons in preoptic area. The study of the development of the GnRH system during embryogenesis has shown an increased number of cells during migration. In vivo and in vitro data suggested the involvement of Nrp1 signaling pathway in the survival of GnRH neurons, the control of their motility during migration, and their final positioning in the brain.The second objective of my thesis was to study the role of Calcium-dependent exocytosis, and thus neurosecretion, in GnRH neurons on their development. The monitoring of Gnrh::cre; iBot animals, in which calcium-dependent exocytosis is abolished by cleavage of VAMP2/synaptobrevin2 protein in GnRH neurons, showed the distinction of two different phenotypes. A subpopulation of mice underwent normal puberty onset, with a similar bodyweight than control littermates, and the other one never reached puberty and developed overweight. The later animals exihibited IHH, increase of the volume of perigonadic fat tissue, and hyperleptinemia, with no alteration of GnRH neuron number and distribution. This data established that neurosecretion in GnRH neurons is not a prerequisite for their migration during embryonic development but revealed that it could play an important role in metabolic homeostasis.Together these two studies highlight an intriguing direct connection between GnRH neurons and energy metabolism in mammals as well as new mechanisms that could be implicated in reproductive physiopathology in human.

Es werden die Entdeckung der organischen Szintillatoren durch Hartmut Kallmann und seine anderen Arbeiten, insbesondere die Entwicklung der flüssigen Szillitatoren beschrieben. / The discovery of organic scintillators by Hartmut Kallmann and his further work, especially the development of liquid scintillators are described.

O sistema da procineticina desempenha um papel importante na migração dos neurônios secretores de GnRH e na neurogênese do bulbo olfatório. Camundongos com ablação dos genes que codificam a procineticina 2 (PROK2) e seu receptor (PROKR2) apresentaram fenótipos semelhantes ao da síndrome de Kallmann descrita em humanos. Mutações inativadoras nos genes PROK2 e PROKR2 foram identificadas em pacientes com hipogonadismo hipogonadotrófico isolado. Com base nestes achados, investigamos a presença de alterações estruturais nos genes PROK2 e PROKR2 em 107 pacientes brasileiros (63 com síndrome de Kallmann e 47 com hipogonadismo hipogonadotrófico isolado normósmico). Cem indivíduos brasileiros que relataram desenvolvimento puberal normal foram utilizados como grupo controle. As regiões codificadoras dos genes PROK2 e PROKR2 foram amplificadas utilizando-se oligonucleotídeos intrônicos específicos, seguida de purificação enzimática e sequenciamento automático. Duas mutações no gene PROK2 foram identificadas: a mutação p.G100fsX121 em homozigose presente em dois irmãos com síndrome de Kallmann; e a mutação p.I55fsX56 em heterozigose identiificada em um paciente com HHIn. Quatro mutações foram identificadas no gene PROKR2 (p.R80C, p.Y140X, p.L173R e p.R268C) em cinco pacientes com síndrome de Kallmann e um paciente com HHIn. Essas mutações não foram encontradas no grupo controle. As mutações do tipo missense, p.R80C, p.L173R e p.R268C foram identificadas em heterozigose. Mutações nos genes FGFR1, GnRHR, KiSS-1 e GPR54 foram excluídas nesses pacientes. O paciente portador da mutação p.R268C do PROKR2 apresentou deleção dos exons 1 e 2 do gene KAL1. Adicionalmente, as mutações p.R80C e p.R268C foram identificadas em heterozigose em parentes de primeiro grau assintomáticos dos casos índices. A nova mutação p.Y140X do PROKR2, única alteração em homozigose, foi identificada em um paciente com micropênis, criptorquidia bilateral, anosmia e palato ogival. Os pais deste paciente eram portadores da mutação p.Y140X em heterozigose e relataram desenvolvimento puberal normal e ausência de anormalidades olfatórias. Estudos in vitro da nova mutação p.R80C localizada na primeira alça intracelular demonstraram que o acúmulo de fofatidil-inositol (IP), assim como a ativação da via da MAPK foram significativamente afetadas em células transfectadas com o receptor mutado em relação ao receptor selvagem, indicando que a mutação p.R80C determina uma menor atividade do receptor. Avaliação da expressão por Western blot mostrou uma diminuição na expressão do receptor mutado R80C e uma maior expressão de receptores imaturos. Esses achados sugeriram o papel crítico da arginina localizada na posição 80 na atividade normal do receptor. Em conclusão, expandimos o repertório de mutações deletérias nos genes PROK2 e PROKR2 em pacientes com hipogonadismo hipogonadotrófico isolado. A haploinsuficiência do PROKR2 não foi suficiente para causar síndrome de Kallmann ou HHIn, entretanto mutações inativadoras em homozigose nos genes PROK2 e PROKR2 foram responsáveis pelo fenótipo reprodutivo e olfatório anormal, em concordância com os estudos prévios de ablação gênica em modelos animais. Arginina localizada na posição 80 do PROKR2 desempenha um papel crucial na adequada maturação do receptor / Physiological activation of the prokineticin pathway has a critical role in olfactory bulb morphogenesis and GnRH secretion. Knock-out mice for genes that encode prokineticin 2 (PROK2) and the prokineticin receptor 2 (PROKR2) exhibited a phenotype similar to the Kallmann syndrome (KS). Inactivating mutations in PROK2 and PROKR2 have been identified in patients with isolated hypogonadotropic hypogonadism. Based on these findings, we investigated the presence of inactivating mutations of the genes PROK2 and PROKR2 in Brazilian patients with isolated hypogonadotropic hypogonadism associated or not with olfactory abnormalities and performed in vitro studies of the new identified mutations. We studied 107 patients with HH (63 with Kallmann syndrome and 44 with normosmic HH) and 100 control individuals. The coding regions of PROK2 and PROKR2 were amplified by polymerase chain reaction followed by enzymatic purification and direct automatic sequencing. In PROK2, two known frameshift mutations were identified. Two brothers with Kallmann syndrome harbored the homozygous p.G100fsX121 mutation, whereas one male with normosmic HH harbored the heterozygous p.I55fsX56 mutation. In PROKR2, four distinct mutations (p.R80C, p.Y140X, p.L173R and p.R268C) were identified in five patients with Kallmann syndrome and in one patient with normosmic HH. These mutations were not found in the control group. The p.R80C and p.R268C missense mutations were identified in heterozygous state in the HH patients and in their asymptomatic first-degree relatives. The p.L173R was also identified in heterozygous state. In addition, no mutations of FGFR1, GnRHR, KiSS-1 or GPR54 were identified in these patients. The patient with the PROKR2 mutation p.R268C also has a deletion of the exon 1 and 2 in the gene KAL1. Notably, the new nonsense mutation (p.Y140X) was identified in homozygous state in an anosmic boy with micropenis, bilateral cryptorchidism and high-arched palate. His asymptomatic parents were heterozygous for this severe defect. In vitro studies of the new mutation, p.R80C, were performed in order to access the mechanism by which this mutation could affect the activity of the PROKR2. In vitro studies showed that the amount of fofatidil-inositol (PI) and the activation of MAPK were significantly lower in cells transfected with the R80C mutant receptor than in cells transfected with the wild receptor, indicating that this variant is a loss-of-function mutation. Binding studies and Western blot showed a reduction in the expression levels of the receptor in the plasma membrane and in whole cell, respectively. Additionally, Western blot analysis of R80C PROKR2 revealed an additional smaller molecular weight band that represents the presence of immature unglycosylated receptors. The arginine 80 in ICL1 is important for post-translational processing of PROKR2. In conclusion, we expanded the repertoire of PROK2 and PROKR2 mutations in patients with HH and showed that PROKR2 haploinsufficiency is not sufficient to cause Kallmann syndrome or normosmic HH, whereas homozygous loss-of-function mutations either in PROK2 or PROKR2 are sufficient to cause disease phenotype, in accordance with the Prokr2 and Prok2 knockout mouse models. In vitro studies suggested that the arginine located at position 80 of the receptor seems to play an important role in the receptor function