The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of chronic muscle diseases with frequent extramuscular organ involvement that contributes to serious prognosis. The presence of autoantibodies and composition of muscle infiltrates both support autoimmune nature of the disease and pathogenic role of B lymphocytes. Besides the traditional diagnostic subgroups, autoantibody characterised phenotype subsets have been identified with presumed similar pathogenic mechanisms. The best known is the antisynthetase syndrome which is characterised by presence of myositis, antisynthetase autoantibodies (with anti-Jo-1 being the most frequent), interstitial lung disease and other extramuscular manifestations. BAFF (B cell-Activating Factor of the TNF Family) is a key factor in B cell homeostasis modulation. In high levels, it allows survival of autoreactive B cell clones and thus participates in the pathogenesis of autoimmune diseases. Its expression is induced by type I interferons (IFN-1). The aim of the PhD thesis was to explore the role of BAFF in pathogenesis of IIMs by analysis of its serum levels, the receptors for BAFF in muscle tissue, their associations to IFN-1 and expression of BAFF gene mRNA transcription variants in peripheral blood cells. Further aspect was to study a possible...

La contraction des muscles striés est sous la dépendance du Complexe de Relâchement du Calcium (CRC). Ce complexe protéique est constitué principalement de deux canaux calciques, le récepteur des dihydropyridines, un canal sensible au voltage localisé dans la membrane des tubules-T et le récepteur de la ryanodine (RyR) situé dans la membrane du RS. Le CRC comprend également de nombreuses protéines régulatrices comme la triadine, la calséquestrine, la junctine et FKBP. Des mutations dans les gènes codant les protéines du CRC conduisent à des pathologies rares et souvent sévères. Cette thèse porte sur l'étude des mécanismes physiopathologiques induits par quelques unes de ces mutations pour décrypter les mécanismes pathologiques mis en œuvre mais également pour comprendre le fonctionnement global du CRC dans les muscles squelettique et cardiaque. La première partie de cette étude concerne RYR1, le gène codant l'isoforme squelettique du RyR qui est une cible importante de mutations chez des patients atteints de myopathies congénitales à cores. L'effet fonctionnel de ces mutations, réparties sur toute la séquence de RYR1, est peu connu. Ces mutations pourraient modifier la fonction canal de RyR1 mais également son adressage à la triade ou sa régulation par d'autres protéines du CRC. Parmi ces hypothèses, la modification de la localisation de RyR1 et sa régulation par une protéine régulatrice (la cavéoline-3) ont été révélées par l'étude de deux mutations de RyR1. La deuxième partie de cette étude concerne la tachycardie ventriculaire polymorphe catécholaminergique (TVPC), une pathologie liée à des défauts du CRC cardiaque, pour laquelle des recherches de mutations sont effectuées sur l'isoforme cardiaque du RyR, RYR2, puis dans les autres protéines du complexe. Nous avons identifié au laboratoire les premières mutations dans le gène de la triadine chez un de ces patients. L'impact d'une de ces mutations sur le fonctionnement du complexe a été étudié et nous avons pu caractériser le mécanisme physiopathologique mis en œuvre et conduisant à la TVPC chez ces patients. / The calcium release complex (CRC) plays a central role in both skeletal and cardiac muscle contraction. The composition of the complex is quite similar in both tissues, and differs only by tissue specific isoforms. The core of the complex is composed of the dihydropyridines receptor, a voltage sensor channel of the T-tubule and the ryanodine receptor, the sarcoplasmic reticulum calcium channel. A number of proteins are associated to this calcium channel like calsequestrin, triadin, junction and FKBP. Mutations in the skeletal CRC are responsible for rare and often severe diseases. This thesis work focuses on the study of physiopathological mechanisms induced by some of these mutations to decipher pathological mecanisms but also to understand the overall CRC functioning in skeletal and cardiac muscles. The first part of this study concerns RYR1, the skeletal RyR isoform coding gene. This gene is mostly the target of mutations resulting in core myopathies. The functional effect of these mutations spred on the entire RYR1 sequence is little known. These mutations could directly alter the calcium channel function but also its targeting to the triad or its regulation by other CRC proteins. Among these hypotheses, the modification of RyR1 localisation and regulation by a protein, Caveolin-3, have been highlighted with the study of two RyR1 mutations. The second part of this study concerns the catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare fatal arrhythmia caused in part by mutations in RYR2 and CASQ2, both belonging to the cardiac CRC,. Recently, we have identified the first mutations in the human triadin gene, TRDN, in a CPVT patient. The goal of this project was to study the molecular and physiological consequences of one of these TRDN mutations allowing the analysis of the pathological mechanisms of this disease, but also a better understanding of the normal function of the cardiac CRC.

Muscle contraction is a highly fine-tuned process that requires the precise and timely construction of large protein sub-assemblies to form sarcomeres, the individual contractile units. Mutations in many of the genes encoding constituent proteins of this macromolecular machine result in defective functioning of the muscle tissue, and in humans, often lead to myopathic conditions like cardiomyopathies and muscular dystrophies, which affect a considerable number of people the world over. As more information regarding causative mutations becomes available, it becomes imperative to explore mechanisms of muscle development, maintenance and pathology. In striated muscles, contraction is regulated by the thin filament-specific tropomyosin (Tm) – troponin (Tn) complex (Ca2+-binding troponin-C, inhibitory troponin-I and tropomyosin-binding troponin-T). These troponin subunits are present in 1:1:1 ratio on thin filaments, with 1 Tm-Tn complex present on every 7th actin molecule. This stoichiometry is tightly regulated, and disturbances have been associated with functional defects. Each of these proteins has multiple isoforms, whose expression is controlled both spatially and temporally. The expression of specific combination of isoforms confers specific contractile properties to each muscle subtype. Drosophila melanogaster has been a preferred model of choice to study various aspects of muscle development for decades. In this study, the Indirect Flight Muscles (IFMs) of Drosophila have been used to investigate developmental and functional roles of two temporally regulated isoforms of a vital structural and regulatory component of the sarcomere – Troponin T (TnT). On a larger scale, whole genome expression profiles of mutants that are null for major myofbrillar proteins have also been discussed. IFMs serve as an excellent model system to address these questions, owing to the extreme ease of genetic manipulability in this system, and high degree of homology between mammalian and Dipteran cytoskeletal proteins. Chapter 1 covers basics of muscle biology, and the role of TnT in muscle contraction. Phenomena responsible for generating diversity in genes encoding muscle proteins – alternative splicing and isoform switching – have also been discussed. These mechanisms are highly conserved, as are patterns of TnT splicing and isoform expression across phyla. Mutations leading to altered splicing patterns lead to myopathic conditions, and the importance of model systems to study muscle biology has been emphasized. The advantages of studying Drosophila IFMs and a comprehensive overview of IFM development has been covered. The resources and experimental tools used have been described in Chapter 2. Two isoforms of TnT are alternatively spliced in the Drosophila thorax – one containing alternative exon 10a (expressed in adult IFMs and jump muscle); and one containing alternative exon 10b (expressed in pupae and newly eclosed flies). These exons are spliced in a mutually exclusive manner, and defects in splicing have been reported to cause uncontrolled, auto-destructive contractions. In Chapter 3, a splice mutant of TnT, up1, has been discussed, with respect to its developmental profile. Transgenic rescue experiments with two separate isoforms demonstrate rescue at the structural as well as functional level. Transgenic over-expression, however, leads to functional abnormalities, highlighting the importance of stoichiometry in multi-protein complexes. In Chapter 4, molecular signals that bring about the developmentally regulated TnT isoform switch are discussed. A splicing factor, Muscleblind, has been transgenically knocked down in normal and mutant IFMs to study effects on muscle function. Chapter 5 looks at whole genome transcriptional alterations in muscles null for either actin or myosin. All significant expression changes have been classified into categories based on different biological processes, and an attempt to differentiate generic muscle responses from filament-specific responses has been made. In conclusion, the studies have highlighted the importance of TnT isoform switching, and that extended expression of a pupal stage-specific isoform can partially compensate for loss of the adult isoform. Also, in the absence of major myofibrillar proteins, stress response pathways like heat shock response and protein degradation pathways are activated, along with a subset of metabolic responses that are unique to the thin or thick filament systems.

Title: Sexual Dysfunction and Pelvic Floor Dysfunction in Patients with Systemic Rheumatic Diseases Objectives: To assess sexual functions, quality of life and pelvic floor function in female patients with Systemic Sclerosis (SSc) and Idiopathic Inflammatory Myopathies (IIM) compared to age-/sex-matched healthy controls (HC). Methods: In total, 41 women with SSc (mean age: 50.9, disease duration: 5.8 years), who fulfilled the ACR/EULAR 2013 classification criteria for SSc, 41 healthy controls (mean age: 50.9) without rheumatic diseases, 22 women with IIM [mean age: 55.1, disease duration: 7.9 years, dermatomyositis (DM, 8)/ polymyositis (PM, 10)/ necrotizing myopathy (IMNM, 3)/ inclusion body myositis (IBM, 1)], who fulfilled the Bohan/Peter 1975 diagnostic criteria for DM/PM, and 22 healthy controls (mean age: 55.1 years) filled in 12 well-established and validated questionnaires assessing sexual function/quality of life, pelvic floor function, fatigue, physical activity and depression. Results: Compared to HC, patients with SSc and IIM had significantly higher prevalence and greater severity of sexual dysfunction (FSFI, BISF-W: in all subscales as well as total scores), dysfunction of pelvic floor (PISQ-12), and worse sexual quality of life (SQoL-F). Worse scores in SSc patients were associated...

Sabe-se que a cada ano cerca de dois bilhões de pessoas consomem bebidas alcoólicas, e no Brasil há uma estimativa de que aproximadamente 11,2% da população é dependente de álcool, o que representa mais de cinco milhões de pessoas. Básicamente se pode dizer que todos os órgãos são afetados pela exposição crônica e aguda, mas as miopatias alcoólicas atingem de 1/3 a 2/3 dos alcoólatras e são as das doenças musculares mais frequentes. A literatura apresenta vários suplementos nutricionais que prometem melhora na performance de atividade físicas promovendo conservação ou hipertrofia das fibras musculares, mas estudos mais profundos tem demonstrado que apenas as suplementações de creatina e β- hidroxi-β-metilbutirato (HMB) demonstraram efeitos sobre a otimização dos ganhos de força e massa muscular, Os trabalhos com HMB afirmam que esta substância diminui a degradação proteica muscular e estimula a síntese proteica, entre outras atividades. Considerando os prejuízos causados pelo álcool no tecido muscular e os benefícios produzidos pelo HMB no mesmo tecido pensou-se na realização de um trabalho associando as duas substâncias para responder as seguintes perguntas: a-) o álcool e o HMB alteram do peso dos animais, atuando individualmente e em conjunto? b-) o álcool e o HMB alteram a área das fibras musculares do EDL e do sóleo, atuando individualmente e em conjunto? c-) se as alterações ocorrerem elas são semelhantes nos músculos EDL e sóleo? Para isso foram utilizados 25 ratos (Rattus novergicus), machos, adultos (com aproximadamente 90 dias de idade (407g) divididos em 4 grupos: Grupo Controle Placebo, Grupo Experimental Álcool (25%), Grupo β-Hidroxi β-Metilbutirato (0,3g/Kg) e Grupo Álcool + β-Hidroxi β- Metilbutirato. Foram retiradas amostras dos músculos sóleo e extensor longo dos dedos e submetidas a coloração de HE. Foi realizado a morfometria de duzentas fibras de cada músculo de cada animal. Estas fibras tiveram as suas áreas calculadas. Os dados obtidos foram submetidos ao tratamento estatístico. Os dados encontrados nesta pesquisa permitiram concluir que: : a-) o álcool alterou, de maneira negativa o peso dos animais, mas o HMB não, mesmo quando atuou em conjunto com o álcool, ou seja, o HMB não conseguiu anular o efeito negativo do álcool; b-) o álcool alterou, de maneira negativa a área das fibras dos músculos EDL e sóleo, e o HMB não, mas quando ele atuou em conjunto, conseguiu anular o efeito negativo do álcool; c-) as alterações produzidas pela ação do álcool e HMB, individualmente ou em conjunto foram semelhantes nos músculos EDL e sóleo. / It is known that every year about two billion people consume alcoholic beverages, and in Brazil there is an estimate that approximately 11.2% of the population is dependent on alcohol, which is more than five million people. Basically you can say that all organs are affected by chronic and acute exposure, but alcoholic myopathy reach 1/3 to 2/3 of alcoholics, and are the most frequent muscular diseases. The literature contains several nutritional supplements that promise improvement in physical activity performance promoting conservation or hypertrophy of muscle fibers, but further study has shown that only creatine supplementation and β-hydroxy-β-methylbutyrate (HMB) have shown effects on optimization the strength gains and muscle mass, works with HMB claim that this substance decreases muscle protein degradation and stimulates protein synthesis, among other activities. Considering the damage caused by alcohol in muscle tissue and the benefits produced by the HMB in the same fabric was thought in achieving a work combining the two substances to answer the following questions: a-) alcohol and HMB alter the weight of the animals, acting individually and together? b-) alcohol and HMB alter the area of the muscle fibers of the soleus and EDL individually and jointly acting? c) if changes occur they are similar in EDL and soleus muscles? For this we used 25 rats (Rattus norvegicus), adult male (approximately 90 days old (407 g) divided in 4 groups: Control Group Placebo Experiment Group Alcohol (25%), Group β-hydroxy β-methylbutyrate (0.3g / kg), and Group Alcohol + β-hydroxy β-methylbutyrate. soleus and samples were taken long extensor muscles of the fingers and subjected to HE staining. morphometry was performed two hundred fibers of each muscle of each animal. These fibers had calculated their areas the data were subjected to statistical analysis the data found in this study showed that: a-) alcohol changed in a negative way the weight of the animals, but the HMB not even when he served in together with the alcohol, i.e., HMB could not nullify the negative effects of alcohol; b) alcohol changed in a negative way the area of the fibers of the EDL and soleus muscles, and HMB not, but when he acted together, could nullify the negative effect of alcohol; c) the changes produced by the action of alcohol and HMB, individually or together were similar in EDL and soleus muscles.

Introdução: A miopatia centronuclear é uma doença muscular congênita com apresentação clínica heterogênea, caracterizada histologicamente pela proeminência de fibras musculares com núcleos centralizados. Três formas são reconhecidas: neonatal grave, com herança ligada ao X e envolvimento do gene MTM1; autossômica dominante, com início geralmente tardio e curso mais leve, associada a mutações no gene DNM2; e autossômica recessiva, com gravidade intermediária entre as outras formas e envolvimento dos genes BIN1, RYR1 ou TTN. Apesar da identificação dos principais genes responsáveis pela doença, os métodos usuais de diagnóstico genético não encontram mutações em cerca da metade dos casos. Objetivo: O objetivo deste estudo foi a caracterização clínica, histológica e molecular de pacientes brasileiros portadores de miopatia centronuclear. Métodos: Laudos de dois bancos de biópsia muscular foram usados para identificar pacientes com diagnóstico de miopatia centronuclear nos últimos dez anos. As lâminas das biópsias foram revisadas e analisadas, e as famílias correspondentes convocadas para aplicação de protocolo clínico e coleta de sangue periférico para extração de DNA genômico. As famílias foram estudadas para os genes conhecidos por sequenciamento Sanger, MLPA, painel de genes implicados em doenças neuromusculares ou sequenciamento de exoma. Resultados: Foram convocados 24 pacientes provenientes de 21 famílias, em 16 das quais foi possível estabelecer o diagnóstico molecular. As 7 famílias com a forma neonatal grave constituíam um grupo homogêneo clínica e histologicamente, e mutações novas e conhecidas foram encontradas no gene MTM1 em 6 destas. Dois meninos deste grupo, com evolução estável, tiveram óbito súbito por choque hipovolêmico subsequente a rompimento de cisto hepático. O gene MTM1 também foi implicado em uma menina portadora manifestante, com quadro mais leve, na forma de uma macrodeleção em heterozigose, detectada por MPLA. Duas famílias em cuja histologia foram encontradas fibras com aspecto em \"roda de carroça\" apresentaram mutações no gene DNM2, uma das quais, p.Phe372Cys, nunca havia sido descrita. Em 7 famílias, o gene RYR1 foi o responsável, em todas sob a forma de heterozigose composta, com 14 mutações, das quais 13 novas, encontradas ao longo de todo o gene. Este grupo, apesar de heterogêneo clinicamente, apresentou em comum a presença de falhas focais na atividade oxidativa das fibras musculares na maioria dos indivíduos. O gene TTN está provavelmente implicado em uma família com um único afetado, no qual o sequenciamento de exoma mostrou mutação nula em heterozigose composta. Nesta coorte de pacientes brasileiros, não houve famílias com alterações no gene BIN1, e três famílias seguem sem diagnóstico molecular, com prováveis novos genes implicados. Conclusões: Os achados clínicos e histológicos de pacientes brasileiros com miopatia centronuclear seguem os padrões descritos na literatura, e em conjunto podem direcionar o estudo molecular adequado. Nesta coorte de pacientes, o gene RYR1, estudado por sequenciamento de alto débito de exoma, foi o mais frequentemente acometido, sugerindo que sua implicação na miopatia centronuclear vem sendo subestimada. Novas mutações encontradas nos genes MTM1, DNM2 e RYR1 contribuíram para confirmar regiões de patogenicidade e ampliar o espectro de alterações nestes genes / Introduction: Centronuclear myopathy is a heterogeneous congenital muscle disease, characterized by the prominence of centralized nuclei in muscle fibers. Three disease forms are recognized: a severe neonatal, X-linked form caused by mutations in the MTM1 gene; an autosomal dominant, late-onset milder form, associated to the DNM2 gene; and an autosomal recessive form, with intermediate severity, so far with the BIN1, RYR1 or TTN genes implicated. In spite of the identification of these genes, usual molecular diagnostic methods don\'t yield a molecular diagnosis in about half of cases. Objetives: The aim of this work was to study clinical, histological, and molecular aspects of centronuclear myopathy Brazilian patients. Methods: Reports taken from two muscle biopsy banks were used to identify centronuclear myopathy patients in the last ten years. Biopsy slides were reviewed and analyzed, and corresponding families recruited to apply a clinical protocol and to draw peripheral blood to extract genomic DNA. Families were studied for known genes via Sanger sequencing, MLPA, panel of genes implicated in neuromuscular diseases, or exome sequencing. Results: Twentyfour patients out of 21 families were recruited, and in 16 families molecular diagnosis was established. The 7 families with the severe neonatal form amounted to a clinically and histologically homogeneous group, and mutations, both known and novel, were found in the MTM1 gene in 6 of these. Two boys of this group, with a stable course, died suddenly of hypovolemic shock due to a hepatic cyst rupture. The MTM1 gene was also implicated in the case of a mild manifesting carrier girl with a heterozygous macrodeletion detected via MLPA. Two families whose histology contained fibers with a \"spoke of wheels\" aspect had mutations in the DNM2 gene, one of which, p.Phe372Cys, had never been described. In 7 families, the RYR1 gene was the culprit, in all of them in a compound heterozygous state, with 14 mutations, 13 of which novel, found throughout the length of the gene. This group, despite clinically heterogeneous, had in common the presence of focal disruptions in the oxidative activity of muscle fibers in the majority of individuals. The TTN gene is probably implicated in a family with a single affected, whose exome sequencing showed compound heterozygous null mutations. In this cohort of Brazilian patients, no family was found to have alterations in the BIN1 gene, and three families remain without molecular diagnosis, with probable new implicated genes. Conclusions: Clinical and histological findings of Brazilian patients with centronuclear myopathy follow patterns already described in the literature, and taken as a whole can direct the adequate molecular study. In this patient cohort, the RYR1 gene, sequenced though hight-throughput techniques, was the most frequently involved, suggesting that its implication in centronuclear myopathy is underestimated. Novel mutations found in the MTM1, DNM2 and RYR1 genes contributed to confirm pathogenic regions and expand the spectrum of alterations in these genes

Made available in DSpace on 2016-01-26T12:51:20Z (GMT). No. of bitstreams: 1 marilitafalangolaaccioly_tese.pdf: 2076302 bytes, checksum: 922e6d60d30a7543a522073d3b9c0607 (MD5) Previous issue date: 2007-10-25 / Statins are used to treat dislipidemias with great tolerance, however, several side effects can occur, specially myopathies. The regular practice of physical exercise (PE) produce beneficial alteration in the lipidic profile, however can generate muscle injuries. OBJECTIVE -To evaluate the effect of PE in the lipidic profile; the efficacy of the assocciation between PE and statins in the control of the lipidic profile and evaluate the effect of the association between PE and statins in the muscular function through histological analysis. MATERIAL/METHOD- It was used 80 male Wistar rats , distributed in 8 groups, including animals submitted to a hypercholesterolemic diet (HD), simvastatin with (G1) and without (G2) PE; HD and fluvastatin with (G3) and without PE (G4); fed with comercial ration (CR) in presence (G5) and absence (G6) of PE; HD submitted (G7) or not to PE (G8). The HD was administered for 90 days, statins and practice of PE in the treadmill for 8 weeks. It was measured in the beginning (T0) and at the end (T2) of the experiment the level of total cholesterol (TC) , the fraction of cholesterol of high density lipoprotein (HDLc), triglycerides (TG), piruvic glutamic transaminase (TGP) and the fraction of the cholesterol non-HDLc (non-HDLc) was calculated. The animals were sacrificed, the soleus muscle removed for histological analysis. The paired t test and multivaried analysis were applied with a significance level of p<0,05. RESULTS â The analysis of the groups, at the T2, showed reduction in the TC level when compared G3 with groups G1 (p=0,0414), G6 (p=0,0021) and G8 (p=0,0099) and G7 with group G8 (p<0,0001). However, G1 presented elevated levels in relation to G5 (p=0,0286), G7 (p=0,0192) and G8 (p=0,0196), as well as the G2 in comparison to G7 (p=0,0115). The PE associated with fluvastatin (G3) or simvastatin (G1) has not induced a significant increase in the levels of HDLc, when compared to G4 and G2 (p>0,05). The CR, even with sedentarism (G6) kept the levels of HDLc elevated when compared to the groups remaining. Fluvastatin, independently of the presence of PE (G3 and G4) reduced the fraction of non-HDLc in comparison to G6 (p=0,0201; p=0,0315) and G1 (p=0,0271; p=0,0390, respectively). For the triglycerides levels G1 showed elevated values compared to G3 (p=0,0278), as well as TGP (p=0,0151). The main histological alteration found were fibers of different diameter, atrophics, in degeneration, splitting, edema, inflammatory infiltrate. These alterations were observed in 90% of the animals of G1, 80% of G2, 70% of G3, 30% of G4, 40% of G5 and 30% of G7. In G6 and G8 muscular fibers with preserved morphology were identified. CONCLUSION â PE influenciates in the reduction of TC levels even with DH, becoming the differential in the reduction of TC, non-HDLc and TG with the use of fluvastatin compared to simvastatin, whilst levels of HDLc resist to increase. Conversely, the increase in TGP levels are associated with HD and the use of statins, preferably simvastatin and PE practice. Moreover, PE seems to potentialize muscle injury induced by statins. / As estatinas são utilizadas no tratamento das dislipidemias, com grande tolerância, no entanto, vários efeitos colaterais podem surgir, destacando-se miopatia. A prática regular do exercício físico (EF) produz modificações favoráveis no perfil lipídico, entretanto, pode gerar lesões musculares. OBJETIVO - Avaliar a influência do EF no perfil lipídico; a eficácia da associação entre EF e estatinas no controle do perfil lipídico e avaliar o efeito da associação entre EF e estatinas na função muscular pela análise histológica. MATERIAL e Mà TODO - Foram utilizados 80 ratos machos Wistar, distribuídos em 8 grupos, incluindo animais submetidos à dieta hipercolesterolêmica (DH), simvastatina com (G1) e sem (G2) EF; DH e fluvastatina, com (G3) e sem EF (G4); alimentados com ração comercial (RC) na presença (G5) e ausência de (G6) EF; DH submetidos (G7) ou não (G8) a EF. A DH foi administrada por 90 dias, as estatinas e prática de EF em esteira rolante por 8 semanas. Foram dosados, no início (T0) e ao final (T2) dos experimentos, os níveis de colesterol total (CT), fração de colesterol da lipoproteína de alta densidade (HDLc), triglicérides (TG), transaminase glutâmico pirúvico (TGP) e calculada a fração de colesterol não-HDLc (não-HDLc). Os animais foram sacrificados, e o músculo sóleo retirado para análise histológica. Aplicaram-se os testes t-teste pareado e análise multivariada, com nível significante para p<0,05. RESULTADOS â A análise entre os grupos, no T2, mostrou redução dos níveis de CT quando comparado G3 aos grupos G1 (p=0,0414), G6 (p=0,0021) e G8 (p=0,0099) e G7 ao grupo G8 (p<0,0001). Entretanto, G1 apresentou níveis aumentados em relação a G5 (p=0,0286), G7 (p=0,0192) e G8 (p=0,0196), assim como, o G2 em comparação ao G7 (p=0,0115). O EF associado à fluvastatina (G3) ou a simvastatina. (G1) não induziu aumento significante nos níveis de HDLc, quando comparado a G4 e G2 (p>0,05). A RC mesmo com o sedentarismo (G6) manteve os níveis de HDLc elevados quando comparados aos demais grupos. A fluvastatina independente da presença de EF (G3 e G4) reduziu a fração não-HDLc em comparação a G6 (p=0,0201; p=0,0315) e a G1 (p=0,0271; p=0,0390, respectivamente). Para os níveis de TG destacou-se G1 com valores elevados em comparação a G3 (p=0,0278), assim como para TGP (p=0,0151). As principais alterações histológicas encontradas foram fibras de diferentes diâmetros, atróficas, em degeneração, splitting, edema, infiltrado inflamatório. Essas alterações foram observadas em 90% dos animais do grupo G1, 80% de G2, 70% de G3, 30% de G4, 40% de G5 e 30% de G7. Nos grupos G6 e G8 identificaram-se fibras musculares com morfologia preservada. CONCLUSà ES â EF influencia na redução dos níveis de CT mesmo com DH, tornando-se o diferencial na diminuição dos níveis de CT, não-HDLc e TG no uso de fluvastatina comparado a simvastatina, enquanto os níveis de HDLc são resistentes a elevação. Por outro lado, o aumento nos níveis de TGP associa-se com DH e uso de estatinas, preferencialmente simvastatina e prática de EF. Além disso, o EF parece potencializar a lesão muscular induzida pelas estatinas.

Sabe-se que a cada ano cerca de dois bilhões de pessoas consomem bebidas alcoólicas, e no Brasil há uma estimativa de que aproximadamente 11,2% da população é dependente de álcool, o que representa mais de cinco milhões de pessoas. Básicamente se pode dizer que todos os órgãos são afetados pela exposição crônica e aguda, mas as miopatias alcoólicas atingem de 1/3 a 2/3 dos alcoólatras e são as das doenças musculares mais frequentes. A literatura apresenta vários suplementos nutricionais que prometem melhora na performance de atividade físicas promovendo conservação ou hipertrofia das fibras musculares, mas estudos mais profundos tem demonstrado que apenas as suplementações de creatina e &#x3B2;- hidroxi-&#x3B2;-metilbutirato (HMB) demonstraram efeitos sobre a otimização dos ganhos de força e massa muscular, Os trabalhos com HMB afirmam que esta substância diminui a degradação proteica muscular e estimula a síntese proteica, entre outras atividades. Considerando os prejuízos causados pelo álcool no tecido muscular e os benefícios produzidos pelo HMB no mesmo tecido pensou-se na realização de um trabalho associando as duas substâncias para responder as seguintes perguntas: a-) o álcool e o HMB alteram do peso dos animais, atuando individualmente e em conjunto? b-) o álcool e o HMB alteram a área das fibras musculares do EDL e do sóleo, atuando individualmente e em conjunto? c-) se as alterações ocorrerem elas são semelhantes nos músculos EDL e sóleo? Para isso foram utilizados 25 ratos (Rattus novergicus), machos, adultos (com aproximadamente 90 dias de idade (407g) divididos em 4 grupos: Grupo Controle Placebo, Grupo Experimental Álcool (25%), Grupo &#x3B2;-Hidroxi &#x3B2;-Metilbutirato (0,3g/Kg) e Grupo Álcool + &#x3B2;-Hidroxi &#x3B2;- Metilbutirato. Foram retiradas amostras dos músculos sóleo e extensor longo dos dedos e submetidas a coloração de HE. Foi realizado a morfometria de duzentas fibras de cada músculo de cada animal. Estas fibras tiveram as suas áreas calculadas. Os dados obtidos foram submetidos ao tratamento estatístico. Os dados encontrados nesta pesquisa permitiram concluir que: : a-) o álcool alterou, de maneira negativa o peso dos animais, mas o HMB não, mesmo quando atuou em conjunto com o álcool, ou seja, o HMB não conseguiu anular o efeito negativo do álcool; b-) o álcool alterou, de maneira negativa a área das fibras dos músculos EDL e sóleo, e o HMB não, mas quando ele atuou em conjunto, conseguiu anular o efeito negativo do álcool; c-) as alterações produzidas pela ação do álcool e HMB, individualmente ou em conjunto foram semelhantes nos músculos EDL e sóleo. / It is known that every year about two billion people consume alcoholic beverages, and in Brazil there is an estimate that approximately 11.2% of the population is dependent on alcohol, which is more than five million people. Basically you can say that all organs are affected by chronic and acute exposure, but alcoholic myopathy reach 1/3 to 2/3 of alcoholics, and are the most frequent muscular diseases. The literature contains several nutritional supplements that promise improvement in physical activity performance promoting conservation or hypertrophy of muscle fibers, but further study has shown that only creatine supplementation and &#x3B2;-hydroxy-&#x3B2;-methylbutyrate (HMB) have shown effects on optimization the strength gains and muscle mass, works with HMB claim that this substance decreases muscle protein degradation and stimulates protein synthesis, among other activities. Considering the damage caused by alcohol in muscle tissue and the benefits produced by the HMB in the same fabric was thought in achieving a work combining the two substances to answer the following questions: a-) alcohol and HMB alter the weight of the animals, acting individually and together? b-) alcohol and HMB alter the area of the muscle fibers of the soleus and EDL individually and jointly acting? c) if changes occur they are similar in EDL and soleus muscles? For this we used 25 rats (Rattus norvegicus), adult male (approximately 90 days old (407 g) divided in 4 groups: Control Group Placebo Experiment Group Alcohol (25%), Group &#x3B2;-hydroxy &#x3B2;-methylbutyrate (0.3g / kg), and Group Alcohol + &#x3B2;-hydroxy &#x3B2;-methylbutyrate. soleus and samples were taken long extensor muscles of the fingers and subjected to HE staining. morphometry was performed two hundred fibers of each muscle of each animal. These fibers had calculated their areas the data were subjected to statistical analysis the data found in this study showed that: a-) alcohol changed in a negative way the weight of the animals, but the HMB not even when he served in together with the alcohol, i.e., HMB could not nullify the negative effects of alcohol; b) alcohol changed in a negative way the area of the fibers of the EDL and soleus muscles, and HMB not, but when he acted together, could nullify the negative effect of alcohol; c) the changes produced by the action of alcohol and HMB, individually or together were similar in EDL and soleus muscles.

Introdução: A miopatia centronuclear é uma doença muscular congênita com apresentação clínica heterogênea, caracterizada histologicamente pela proeminência de fibras musculares com núcleos centralizados. Três formas são reconhecidas: neonatal grave, com herança ligada ao X e envolvimento do gene MTM1; autossômica dominante, com início geralmente tardio e curso mais leve, associada a mutações no gene DNM2; e autossômica recessiva, com gravidade intermediária entre as outras formas e envolvimento dos genes BIN1, RYR1 ou TTN. Apesar da identificação dos principais genes responsáveis pela doença, os métodos usuais de diagnóstico genético não encontram mutações em cerca da metade dos casos. Objetivo: O objetivo deste estudo foi a caracterização clínica, histológica e molecular de pacientes brasileiros portadores de miopatia centronuclear. Métodos: Laudos de dois bancos de biópsia muscular foram usados para identificar pacientes com diagnóstico de miopatia centronuclear nos últimos dez anos. As lâminas das biópsias foram revisadas e analisadas, e as famílias correspondentes convocadas para aplicação de protocolo clínico e coleta de sangue periférico para extração de DNA genômico. As famílias foram estudadas para os genes conhecidos por sequenciamento Sanger, MLPA, painel de genes implicados em doenças neuromusculares ou sequenciamento de exoma. Resultados: Foram convocados 24 pacientes provenientes de 21 famílias, em 16 das quais foi possível estabelecer o diagnóstico molecular. As 7 famílias com a forma neonatal grave constituíam um grupo homogêneo clínica e histologicamente, e mutações novas e conhecidas foram encontradas no gene MTM1 em 6 destas. Dois meninos deste grupo, com evolução estável, tiveram óbito súbito por choque hipovolêmico subsequente a rompimento de cisto hepático. O gene MTM1 também foi implicado em uma menina portadora manifestante, com quadro mais leve, na forma de uma macrodeleção em heterozigose, detectada por MPLA. Duas famílias em cuja histologia foram encontradas fibras com aspecto em \"roda de carroça\" apresentaram mutações no gene DNM2, uma das quais, p.Phe372Cys, nunca havia sido descrita. Em 7 famílias, o gene RYR1 foi o responsável, em todas sob a forma de heterozigose composta, com 14 mutações, das quais 13 novas, encontradas ao longo de todo o gene. Este grupo, apesar de heterogêneo clinicamente, apresentou em comum a presença de falhas focais na atividade oxidativa das fibras musculares na maioria dos indivíduos. O gene TTN está provavelmente implicado em uma família com um único afetado, no qual o sequenciamento de exoma mostrou mutação nula em heterozigose composta. Nesta coorte de pacientes brasileiros, não houve famílias com alterações no gene BIN1, e três famílias seguem sem diagnóstico molecular, com prováveis novos genes implicados. Conclusões: Os achados clínicos e histológicos de pacientes brasileiros com miopatia centronuclear seguem os padrões descritos na literatura, e em conjunto podem direcionar o estudo molecular adequado. Nesta coorte de pacientes, o gene RYR1, estudado por sequenciamento de alto débito de exoma, foi o mais frequentemente acometido, sugerindo que sua implicação na miopatia centronuclear vem sendo subestimada. Novas mutações encontradas nos genes MTM1, DNM2 e RYR1 contribuíram para confirmar regiões de patogenicidade e ampliar o espectro de alterações nestes genes / Introduction: Centronuclear myopathy is a heterogeneous congenital muscle disease, characterized by the prominence of centralized nuclei in muscle fibers. Three disease forms are recognized: a severe neonatal, X-linked form caused by mutations in the MTM1 gene; an autosomal dominant, late-onset milder form, associated to the DNM2 gene; and an autosomal recessive form, with intermediate severity, so far with the BIN1, RYR1 or TTN genes implicated. In spite of the identification of these genes, usual molecular diagnostic methods don\'t yield a molecular diagnosis in about half of cases. Objetives: The aim of this work was to study clinical, histological, and molecular aspects of centronuclear myopathy Brazilian patients. Methods: Reports taken from two muscle biopsy banks were used to identify centronuclear myopathy patients in the last ten years. Biopsy slides were reviewed and analyzed, and corresponding families recruited to apply a clinical protocol and to draw peripheral blood to extract genomic DNA. Families were studied for known genes via Sanger sequencing, MLPA, panel of genes implicated in neuromuscular diseases, or exome sequencing. Results: Twentyfour patients out of 21 families were recruited, and in 16 families molecular diagnosis was established. The 7 families with the severe neonatal form amounted to a clinically and histologically homogeneous group, and mutations, both known and novel, were found in the MTM1 gene in 6 of these. Two boys of this group, with a stable course, died suddenly of hypovolemic shock due to a hepatic cyst rupture. The MTM1 gene was also implicated in the case of a mild manifesting carrier girl with a heterozygous macrodeletion detected via MLPA. Two families whose histology contained fibers with a \"spoke of wheels\" aspect had mutations in the DNM2 gene, one of which, p.Phe372Cys, had never been described. In 7 families, the RYR1 gene was the culprit, in all of them in a compound heterozygous state, with 14 mutations, 13 of which novel, found throughout the length of the gene. This group, despite clinically heterogeneous, had in common the presence of focal disruptions in the oxidative activity of muscle fibers in the majority of individuals. The TTN gene is probably implicated in a family with a single affected, whose exome sequencing showed compound heterozygous null mutations. In this cohort of Brazilian patients, no family was found to have alterations in the BIN1 gene, and three families remain without molecular diagnosis, with probable new implicated genes. Conclusions: Clinical and histological findings of Brazilian patients with centronuclear myopathy follow patterns already described in the literature, and taken as a whole can direct the adequate molecular study. In this patient cohort, the RYR1 gene, sequenced though hight-throughput techniques, was the most frequently involved, suggesting that its implication in centronuclear myopathy is underestimated. Novel mutations found in the MTM1, DNM2 and RYR1 genes contributed to confirm pathogenic regions and expand the spectrum of alterations in these genes

« Myopathie héréditaire » est un terme générique pour les maladies génétiques rares caractérisées par une faiblesse musculaire et une hypotonie avec ou sans atrophie musculaire. Les personnes atteintes d'une forme légère peuvent présenter des contractures, une scoliose, une hyporéflexie ou des caractéristiques dysmorphiques, et les plus sévères peuvent être accompagnées de symptômes cardiaques ou respiratoires pouvant s'avérer mortel. Alors que les méthodes de séquençage de nouvelle génération basées sur l'ADN ont considérablement accéléré la découverte de gènes responsables de maladies rares, de nombreux patients demeurent sans diagnostiques génétiques. L'une des principales raisons de ce problème est le grand nombre de variants de signification inconnue identifiés, où l’impact biologique est peu ou pas connu. Ce mémoire de maîtrise contient trois projets distincts dont l'objectif global est d'augmenter le rendement diagnostique pour les patients atteints de myopathies héréditaires rares. La première étude porte sur trois frères et soeurs atteints d'une dystrophie musculaire non diagnostiquée. Une combinaison de techniques « omic » a été utilisée pour identifier un variant faux-sens dans le gène IARS accompagné d’un déséquilibre allélique spécifique aux tissus musculaires. L’inhibition de iars-1 chez le C. elegans a entraîné une désorganisation progressive du muscle de la paroi corporelle, mais sans perte significative de la motilité. Ainsi, nous avons conclu que iars-1 joue clairement un rôle dans l'organisation des myotubes. La pathogénicité du variant, cependant, nécessite une enquête plus approfondie. La deuxième étude porte sur une femme présentant une myopathie statique congénitale se manifestant par une faiblesse proximale et distale. En utilisant le séquençage de l’ARN, nous avons identifié pour la première fois un profil d'expression génique compatible avec une prédominance des fibres musculaires de type I, focussant l’intérêt sur un variant dans le gène RYR1. La troisième étude englobe une cohorte de vingt-huit patients porteurs de la même mutation RYR1, mais présentant une hétérogénéité clinique significative. Des modèles « knock-in » de C. elegans pour les études deux et trois ont démontrés des changements en transmission synaptique, la durée de vie, la taille corporelle et la locomotion. Ainsi, nous avons conclu que les deux variants identifiés dans RYR1 ont probablement également des conséquences cliniques chez les porteurs humains. En fin de compte, ces études mettent en évidence l'utilité du séquençage de l’ARN en tant qu'outil de diagnostic complémentaire, capable de restreindre la liste de candidats potentiellement pathogéniques, ainsi que le pouvoir du C. elegans en tant que modèles pour des tests rapides et coordonnés de variants candidats. / “Hereditary myopathies” is an umbrella term for rare inherited diseases characterized by muscle weakness and hypotonia with or without muscle atrophy. Individuals with a mild affliction may present with contractures, scoliosis, hyporeflexia or dysmorphic features, while those more severely affected may present cardiac or respiratory involvement that could prove deadly. While traditional DNA-based next-generation sequencing techniques have greatly accelerated discovery of genes causing rare diseases, many patients remain without a known genetic cause. The main reason for this diagnostic shortfall is the vast number of variants of unknown significance identified whose biological functions are unknown. This master’s thesis contains three separate projects with an overarching goal to increase the diagnostic yield of patients with rare hereditary myopathies. The first study focuses on three siblings with an undiagnosed muscular dystrophy. A combination of “omic” techniques were used to identify a missense variant as well as a muscle-specific allelic imbalance in the gene IARS leading to the exclusive expression of the mutant allele. Iars-1 knock-down in C. elegans resulted in progressive disorganization of the body wall muscle but with no significant loss of motility. Thus, we concluded that iars-1 likely plays a role in the organization of myotubes. The pathogenicity of the variant, however, requires further investigation. The second study involves a woman with a congenital static myopathy exhibited as proximal and distal weakness. Using RNA-sequencing, we identified for the first time a gene expression profile consistent with type I fiber predominance in the proband which guided the search for the causative RYR1 variant. The third study encompasses a cohort of twenty-eight patients who carry the same RYR1 mutation but display significant clinical heterogeneity. Knock-in models of C. elegans for both studies demonstrated altered synaptic transmission, lifespan, body size and locomotion. Thus, we concluded that both variants identified in RYR1 likely have consequences for human carriers as well. Ultimately, these studies highlight the utility of RNA-seq as a complimentary diagnostic tool capable of narrowing the search for novel pathogenic mutations as well as the value of C. elegans as models for rapid and coordinated testing of candidate variants.