La dystrophie musculaire de Duchenne (DMD) est la maladie neuromusculaire la plus fréquente de l'enfant. Son évolution progressive inexorable conduit habituellement au décès dans la troisième décade. La DMD constitue cependant une affection hétérogène pour la sévérité de l'atteinte musculaire, cognitive et cardiaque, et cette hétérogénéité n'est pas totalement expliquée par la localisation des mutations dans le gène de la dystrophine. Ma thèse comporte trois volets: (1) une analyse clinique multivariée d'une cohorte de DMD suivie à long terme qui nous a permis de définir 4 phénotypes distincts de DMD; (2) une étude de corrélation clinico-pathologique qui a identifié la fibrose endomysiale précoce comme seul facteur histologique prédictif de sévérité motrice; (3) la mise au point d'un modèle murin original de myofibrose dystrophique chez la souris mdx déficiente en dystrophine. 1- Étude multiparamétrique clinique. La saisie par la même équipe des données fonctionnelles musculaires, cardiaques, respiratoires et cognitives de 75 patients atteints de DMD (tous génotypés et présentant une absence complète de dystrophine musculaire), suivis pendant &gt;10 ans, a permis d'établir un modèle multiparamétrique satisfaisant à deux dimensions principales, cognitive et motrice, et de définir 4 clusters phénotypiques : (i) DMD cognitive et motrice congénitale (20%), (ii) DMD classique (28%), (iii) DMD motrice pure modérée (22%), (iv) DMD motrice pure sévère (30%). La corrélation génotypephénotype était restreinte à la seule atteinte cognitive. Des indicateurs pronostics précoce ont été identifiés et validés sur une 2ème série de 34 patients. 2- Étude histopathologique. Les variations de sévérité de l'atteinte musculaire n'étant pas expliquées par la génétique moléculaire, nous avons cherché à corréler les paramètres moteurs et la biopsie musculaire prélevée dans le quadriceps à un stade précoce (3-7 ans) chez 25 patients (analyse stéréologique des images numérisées pour les paramètres élémentaires: nécrose/régénération, fibres hypercontractées, adipocytes, fibrose endomysiale et périmysiale). Seule la fibrose endomysiale était associée à un pronostic moteur défavorable (p&lt;0.002) attesté par l'âge de perte de marche, la force du quadriceps et le testing musculaire global à 10 ans. Cette fibrose endomysiale dissociait les capillaires des myofibres (écartement x 2.5), et s'accompagnait d'une augmentation sélective des macrophages CD206+ activés dans la voie alterne (M2) et d'une diminution relative des cellules satellites musculaires (p&lt;0.0001). Ces données suggèrent un rôle clé de la fibrose endomysiale (et des macrophages M2 profibrosant) et dans la sévérité clinique de la DMD. 3- Étude expérimentale. Ces éléments rendent nécessaire la mise au point d'un modèle expérimental de myofibrose dystrophique, la souris mdx présentant peu de fibrose et un déficit moteur modéré et tardif. Nous avons mis au point une nouvelle méthode de lésion musculaire focale profibrosante du tibialis antérieur chez la souris mdx (piqûres multiples quotidiennes pendant 15 jours). Une fibrose endomysiale attestée par un fort immunomarquage du collagène I (à 8, 30, 60 et 90 jours) a été quantifiée et corrélée à la perte de la force musculaire dans la patte lésée (comparée au muscle contralatéral). Ces résultats légitiment et préparent les futures stratégies thérapeutiques "anti-fibrosantes" dans la DMD</abstract> / The clinical heterogeneity of Duchenne muscular dystrophy (DMD) may prove a major obstacle to the interpretation of therapeutic trials but has not been subjected to systematic analysis. In a first part, we present a statistical analysis on two series of steroid-free patients with complete lack of dystrophin determined by Western blot. Series 1 consisting of 75 patients longitudinally evaluated for motor, respiratory, cardiac and cognitive functions by the same team (median follow-up: 10.5yrs) was subjected to exploratory data analysis whose main conclusion were confirmed by exploration of data obtained from 34 routinely evaluated patients (series 2). Main outcome measures were age at loss of ambulation and of onset of contractures, manual muscle testing (MMT), cardiac and respiratory functional tests, general intelligence assessment (IQ), educational level. Multivariate exploratory analysis of series 1 classified 70/75 patients into 4 clusters with distinctive intellectual and motor outcomes: A (congenital DMD, 20%): markedly poor intellectual and motor outcome; B (classical DMD, 28%): intermediate intellectual and poor motor outcome; C (moderate pure motor DMD, 22%): normal intelligence and delayed motor impairment; and D (severe pure motor DMD, 30%): normal intelligence and poor motor outcome. Group A patients had the most severe respiratory and cardiac involvement. Frequency of mutations upstream to exon 30 increased from group A to D, but genotype/phenotype correlations were restricted to cognition. Diagnostic accuracy tests showed that combination of "clinical onset &lt;2yrs" with "mental retardation" reliably assigned patients to group A (sensitivity 0.93, specificity 0.98). Combination of "lower limb MMT score&gt;6 at 8yrs" with "normal or borderline mental status" reliably assigned patients to group C (sensitivity: 1, specificity: 0.94). These early criteria were also predictive of "congenital DMD" and "moderate pure motor DMD" in series 2. In a second part, we included 25 steroid-free DMD patients in a multiparametric analysis plotting initial histological alterations in quadriceps muscle with 13 relevant clinical data collected by the same team over a long-term follow-up (mean&gt;10yrs). Elementary histological parameters (fiber size, hypercontracted fibers, necrotic/basophilic fibers, edema, endomysial and perimysial fibrosis, and fatty degeneration) were assessed by morphometry. Endomysial fibrosis was the sole myopathological parameter significantly correlated with poor motor outcome, assessed by quadriceps muscle strength, manual muscle testing of upper and lower limbs at 10yrs, and age at ambulation loss (all p&lt;0.002). Motor outcome and fibrosis were not correlated with genotype. Myofibers exhibited oxidative stress-induced protein alterations and became separated from capillaries by fibrosis, which was associated with both increase of CD206+ alternatively activated macrophages and relative decrease of CD56+ satellite cells (both p&lt;0.0001). This study provides firm basis for antifibrotic therapeutic strategies in DMD, and supports the view that alternatively activated macrophages, known to inhibit myogenesis while promoting collagen-producing cell formation, play a key role in myofibrosis. In the third experimental part, experiments were conducted on mdx mice at 6-8 weeks of age. Fifteen micropunctures were made daily in the right tibialis anterior (TA) muscle with micropins used for entomology (150 µm diameter) during 2 weeks. Our data suggest that repeated microinjuries of muscle deficient in dystrophin protein triggers a endomysial fibrotic process that stabilizes with time well associated with muscle strenght decrease. Endomysial fibrosis seems to be one of the target of therapy in DMD. This satisfactory model will be usefull to study the mechanisms of fibrosis process in dystrophin deficient muscle and to evaluate antifibrotic treatment

Orientador: Maria Julia Marques / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-09-11T21:17:52Z (GMT). No. of bitstreams: 1 Taniguti_AnaPaulaTiemi_D.pdf: 2092152 bytes, checksum: 12213bebdeb4e5920c800ccf1d164d9a (MD5) Previous issue date: 2011 / Resumo: O camundongo mdx é o animal mais utilizado como modelo da distrofia muscular de Duchenne (DMD), diferindo dos humanos doentes por apresentar ciclos de regeneração muscular e reduzida fibrose. Este trabalho tem como objetivos: 1. desenvolver protocolo experimental para promover fibrose muscular através de exercício de corrida em esteira e 2. verificar se a suramina inibe a fibrose induzida experimentalmente. A suramina tem efeito anti-fibrótico, sendo um potencial agente farmacológico para tratamento da DMD visando sucesso de terapias celulares. Foram utilizados camundongos mdx (n=42) e C57BL/10 (n=11) com seis meses de idade. Os camundongos mdx foram divididos em quatro grupos experimentais: grupo sedentário e tratado com salina (n=11), grupo sedentário e tratado com suramina (n=11), grupo exercitado e tratado com salina (n=10) e grupo exercitado e tratado com suramina (n=10). Os animais foram submetidos à corrida em esteira diariamente e o tratamento com suramina (60mg/kg) foi realizado em dias alternados, via intra-peritoneal. Após sete semanas, os animais foram sacrificados e o músculo tibial anterior, bíceps braquial, diafragma e coração coletados e congelados para análise histológica e protéica por western blot. O plasma sanguíneo foi submetido à análise de creatina-quinase. A força de tração dos membros anteriores foi medida no início e no final do protocolo experimental utilizando-se Grip Strength Meter e o músculo diafragma submetido ao estudo in vitro para verificar a força de contração. Verificamos que o protocolo de corrida em esteira foi adequado para induzir a fibrose e inibir a regeneração nos músculos da pata dos camundongos mdx. O aumento da área de fibrose foi acompanhado pelo aumento dos níveis de TGF-?1, aumento de creatina-quinase e diminuição da força de tração. O tratamento com suramina diminuiu a fibrose nos músculos exercitados e acelerou o processo de regeneração. Adicionalmente, observamos que a suramina reduziu o número de fibras marcadas com azul de Evans, diminuiu os níveis da CK e impediu a perda da força de tração bem como a força de contração do músculo diafragma. Concluímos que o protocolo de corrida em esteira foi eficaz na indução de fibrose nos músculos tibial anterior e bíceps braquial. O efeito anti-fibrótico da suramina torna-a droga potencialmente útil para a terapia farmacológica da DMD / Abstract: The mdx mouse is commonly used as a model to study Duchenne muscular dystrophy (DMD) however shows cycles of muscle regeneration and reduced fibrosis. The purposes of this study were (1) to induce muscle fibrosis through eccentric running exercise in mdx mice and (2) to verify the effects of suramin on muscle fibrosis. Six-month-old mdx (n=42) and control (C57BL/10, n=11) mice were used. Mdx mice were divided in four groups: sedentary and saline-treated (n=11); sedentary and suramintreated (n=11); exercised and saline-treated (n=10) and exercised and suramin-treated (n=10). The mdx mice belonging to the exercised groups were placed on treadmill to run daily, for seven weeks. Suramin was injected at a dose of 60mg/kg i.p. on alternate days. At the end of the experimental protocol, the mice were sacrificed and the tibialis anterior, biceps brachii, diaphragm and heart muscles were dissected, frozen in liquid nitrogen and used to histological and western blot analysis. Blood was obtained to determine creatine-kinase (CK) levels. The forelimb force was measured by an adapted Grip Strength Meter. Force of contraction of diaphragm in vitro was verified. Our results showed that the experimental protocol was adequate to induce muscle fibrosis in mdx mice. The occurrence of fibrosis was accompanied by elevated levels of TGF- ?1 and serum CK and decreased forelimb force. Suramin reduced muscle fibrosis, decreased the number of muscle fibers stained with Evans blue, reduced serum CK levels and prevented the loss of muscle force in exercised mdx and diaphragm strips in vitro. We concluded that the downhill running protocol was effective for inducing fibrosis in tibialis anterior and biceps brachii muscles of mdx mice. Suramin seems to be a potential useful therapeutic alternative for DMD treatment / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural