Neural tube defects (NTDs) are malformations affecting about 2.6/1000 births worldwide, and 1/1000 in the United States. Their etiology remains unknown, and is likely due to interaction of genetic susceptibility factors with environmental exposure. Of the many environmental agents considered to potentially contribute to NTD risk, arsenic is one that is surrounded in controversy. We have developed a model system utilizing maternal intraperitoneal (I.P.) exposure on E7.5 and E8.5 to As 9.6 mg/kg (as sodium arsenate) in a normal inbred mouse strain, LM/Bc/Fnn, that is sensitive to arsenate-induced exencephaly. We investigated arsenate induced gene expression changes using DNA microarrays of embryonic anterior neural tube tissue, as well as monitoring of metabolic function in conjunction with the administration of select compounds to rescue the normal phenotype. Finally, to address questions concerning the importance of route of administration and potential maternal toxicity, a teratology study was performed using three arsenate doses administered orally. Regarding the gene expression study, we identified several candidate genes and ontology groups that may be responsible for arsenate’s teratogenicity. Genes include: engrailed 1 (En-1), platelet derived growth factor receptor alpha (Pdgfrα) and ephrinA7 (EphA7). Gene ontology groups identified include oxidative phosphorylation, redox response, and regulation of I-kappaB kinase/NF-kappaB cascade. Acute arsenate exposure induced disruption of mitochondrial function and dependent glucose homeostasis: subsequent hyperglycemia was teratogenic. Maternal treatment with insulin or n-acetyl cysteine, an antioxidant and precursor of glutathione synthesis, proved highly successful in rescuing both the normal phenotype, and to differing degree, the maternal hyperglycemia. Maternal oral arsenate administration also resulted in exencephaly, with exposed embryos exhibiting a positive linear trend with arsenate dosage. There were also linear trends in the relationships between arsenate dose and anomalies involving several components of the axial skeleton: the vertebrae and calvarium. There was no evidence of maternal toxicity as shown by lack of differences in maternal body weight gain, liver, and kidney weights. In conclusion, maternal arsenate exposure (regardless of exposure route) was teratogenic in our model, primarily causing NTDs. Responsible mechanisms may involve disruption of redox and glucose homeostasis as well as expression of established NTD candidate genes.

Neural tube defects (NTDs) are malformations affecting about 2.6/1000 births worldwide, and 1/1000 in the United States. Their etiology remains unknown, and is likely due to interaction of genetic susceptibility factors with environmental exposure. Of the many environmental agents considered to potentially contribute to NTD risk, arsenic is one that is surrounded in controversy. We have developed a model system utilizing maternal intraperitoneal (I.P.) exposure on E7.5 and E8.5 to As 9.6 mg/kg (as sodium arsenate) in a normal inbred mouse strain, LM/Bc/Fnn, that is sensitive to arsenate-induced exencephaly. We investigated arsenate induced gene expression changes using DNA microarrays of embryonic anterior neural tube tissue, as well as monitoring of metabolic function in conjunction with the administration of select compounds to rescue the normal phenotype. Finally, to address questions concerning the importance of route of administration and potential maternal toxicity, a teratology study was performed using three arsenate doses administered orally. Regarding the gene expression study, we identified several candidate genes and ontology groups that may be responsible for arsenate’s teratogenicity. Genes include: engrailed 1 (En-1), platelet derived growth factor receptor alpha (Pdgfrα) and ephrinA7 (EphA7). Gene ontology groups identified include oxidative phosphorylation, redox response, and regulation of I-kappaB kinase/NF-kappaB cascade. Acute arsenate exposure induced disruption of mitochondrial function and dependent glucose homeostasis: subsequent hyperglycemia was teratogenic. Maternal treatment with insulin or n-acetyl cysteine, an antioxidant and precursor of glutathione synthesis, proved highly successful in rescuing both the normal phenotype, and to differing degree, the maternal hyperglycemia. Maternal oral arsenate administration also resulted in exencephaly, with exposed embryos exhibiting a positive linear trend with arsenate dosage. There were also linear trends in the relationships between arsenate dose and anomalies involving several components of the axial skeleton: the vertebrae and calvarium. There was no evidence of maternal toxicity as shown by lack of differences in maternal body weight gain, liver, and kidney weights. In conclusion, maternal arsenate exposure (regardless of exposure route) was teratogenic in our model, primarily causing NTDs. Responsible mechanisms may involve disruption of redox and glucose homeostasis as well as expression of established NTD candidate genes.

The inclusion of human fetal skeletons in the archaeological record can reveal much about past cultures' perception of life and death. The preservation of fetal remains in the archaeological record is a rarity, and the discovery of pathological skeletons is even rarer. A fetal skeleton from a Roman period cemetery (c. 31BC - 303AD) in the Dakhleh Oasis, Egypt, displays what are thought to be classic skeletal indicators of the neural tube defect, anencephaly. The published literature concerning the skeletal diagnosis of anencephaly is scant so in order to diagnose this individual it is pertinent to create a diagnostic standard. The purpose of this thesis is twofold - first to create a quantitative standard from which researchers can determine the presence of anencephaly in the archaeological record, thus ruling out trauma or taphonomic processes as reasons for missing cranial elements. The second objective of this research is to conduct a qualitative comparison in order to diagnose the individual from the Dakhleh Oasis. A comparative analysis of nine documented anencephalic skeletal remains housed at the Smithsonian Institute was conducted to create a diagnostic standard for the skeletal characteristics of anencephaly. The comparative analysis of the Dakhleh specimen supports the diagnosis of anencephaly.

Made available in DSpace on 2014-08-06T17:29:38Z (GMT). No. of bitstreams: 2 Aline Costa.pdf: 2324687 bytes, checksum: 04115292021785e54c4bf64f9a7bc8fd (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / O objetivo desse trabalho foi discutir o aconselhamento genético (AG) como prática clínica, focalizando a anencefalia que é um defeito de fechamento de tubo neural (DFTN) aberto, acometendo 1:1000 nascimentos, e sua associação com outras malformações maiores. Para tanto foi empreendido o levantamento de laudos de necropsias realizadas no Departamento de Anatomia Patológica do Instituto Fernandes Figueira/FIOCRUZ, entre 2000 e 2008, e dos respectivos prontuários das gestantes dos quais constava o resultado dos achados da ultrasonografia gestacional (USG). A análise dos dados foi feita utilizando o Epi-Info/ANOVA. Os resultados apontaram: a) 74 necropsias realizadas no período, das quais 56,7% indicaram anencefalia isola, 14,9% mostraram outro DFTN e 28,4% associada com outras malformações; b) as malformações mais frequentemente associadas com a anencefalia foram: raquisquise, fenda labial ou e palatina, onfalocele, hérnia diafragmática e baço acessório; c) o diagnóstico da USG mostrou anencefalia isolada em 87,4% dos casos; associada com outro DFNT em 2,8% e múltiplas malformações em 9,8%, das quais as mais frequentes foram: raquisquise, onfalocele, defeito de parede tóraco-abdominal com ectopia cordis; d) a maioria das gestantes tinha segundo grau completo, eram primigestas, com história familiar de DFTN em 9,4% dos casos, sendo que em 6,7% deles houve exposição a teratogênos e 20% tiveram complicações gestacionais, sendo a polidraminia a mais frequente; e) em nenhum dos casos achou-se referência ao uso de ácido fólico pré e periconcepcional; f) após a confirmação diagnóstica, 49,3% gestantes decidiram pela interrupção judicial da gravidez e 50,7% evoluiram para o parto (36% natimortos e 64% nativivos) e, por fim, g) 42% das gestantes realizou consulta no ambulatório de AG pósnatal, depois do desfecho da gestação. Concluiu-se que diante do diagnóstico de anomalia tão grave e incompatível com a vida extra-uterina, as demais malformações perdem significado no momento da USG, o tem repercussões para o direcionamento do AG relacionado às opções reprodutivas futuras. Por outro lado reiterou-se a importância da suplementação oral de ácido fólico no período pré e periconcepcional como medida de prevenção primária e de promoção da saúde. / The aim of this investigation was to discuss genetic counseling as a clinical practice, focusing on anencephaly, which is an open neural tube defect that affects 1:1000 births, and its relation to other major malformations. For this purpose, we undertook a survey of autopsy reports, performed at the pathology department of Instituto Fernandes Figueira/FIOCRUZ between 2000-2008, and medical charts of the related mothers, where data on the obstetric ultrasound was registered. Data analysis was performed with Epi-Info/ANOVA. The results point to: a) 74 autopsies were executed during this period; 56,7% revealed isolated anencephaly, 14,9% were associated to other neural tube defects, and 28,4% were associated to other malformations; b) malformations most frequently associated were: rachischisis, cleft lip and/or palate, omphalocele, diaphragmatic hernia, and accessory spleen; c) obstetric ultrasound showed isolated anencephaly in 87,4% of the cases; association to other neural tube defects in 2,8%, and multiple malformations in 9,8%, the most frequent being rachischisis, omphalocele, thoraco-abdominal wall defect, and ectopia cordis; d) the majority of pregnant woman had completed high school and were pregnant for the first time; family history for neural tube defect was positive in 9,4% of the cases, of which 6,7% were associated to teratogen exposure, and 20% presented with pregnancy complications, mostly polyhydramnios; e) we found no record of folic acid use before or peri-conception; f) after diagnosis, 49,3% of pregnant women decided for pregnancy interruption, and 50,3% delivered their babies (36% stillbirths, 64% newborns), and g) genetic counseling was given to 42% of women. We come to the conclusion that facing such a serious, and deadly anomaly, all other malformations loose their value, what reflects upon genetic counseling and reproductive choices. Besides, we emphasize the need of folic acid use before and peri-conception as a primary prevention and health promotion measure.

Les folates sont des vitamines importantes dans le développement neurologique d’un enfant puisqu’elles sont impliquées dans deux pathologies : l’autisme et les anomalies de fermeture du tube neural (AFTN). Une carence en vitamine B9 et la présence de certains polymorphismes des gènes du métabolisme des monocarbones sont associées à un risque augmenté d’anomalies de fermeture du tube neural. A l’inverse, une supplémentation périconceptionnelle en vitamine B9 a permis de réduire l’incidence de ces malformations. Dans le cadre de l’autisme, la présence d’anticorps dirigés contre le récépteur aux folates FR aplha au niveau cérébral entraînant une carence en folate cérébral a été décrite avec une fréquence importante chez les enfants autistes. Un traitement par acide folinique permettrait une amélioration des symptômes en corrigeant la carence en folates grâce à un passage médié par le RFC (récépteur non bloqué par les anticorps). La première partie est une étude clinique randomisée versus placebo réalisée au CHU de Nancy dont le but est d’évaluer l’éfficacité d’un traitement par acide folinique pendant 12 semaines sur la réduction des troubles autistiques. 19 enfants ont été inclus dans l’étude.Une amélioration significative des symptômes autistiques est observée pour le score ADOS dans le groupe traité (p= 0,02), plus particulièrement pour les interactions sociales réciproques (p=0,019). La fréquence des Anticorps anti FR alpha au sein du groupe est de 58 %. Il n’y a pas de corrélation observée entre le taux d’anticorps et l’importance de la réponse au traitement. Aucun effet secondaire grave n’a été observé au cours de l’étude. La seconde partie est une étude par séquençage haut débit d’un large panel de gènes chez des patients présentant des anomalies de fermeture du tube neural (SureSelect Focused Exome Plus (Agilent®)). Le séquençage a été complété par une analyse de méthylation pan-génomique (Infinium HumanMethylation Beadchip (Illumina®)). 23 patients ont été inclus dans l’étude. Plusieurs variants rares ont été identifiés comme associés au risque de AFTN dont des variants de gènes du métabolisme des monocarbones : LRP2, rs137983840, p=0,005; MMAA, rs148142853, p= 0,005 ;TCN2, rs35838082, p=0,044, FPGS, rs41306702, p=0,0012, BHMT, rs763726268, p= 0,011 et de la voie Sonic Hedgehog (SHH) (GLI3, rs35364414, p=0,012). Une différence de méthylation significative a été mise en évidence au niveau du gène CFAP46 (hémiméthylation versus absence de méthylation chez les contrôles) chez un patient porteur des 4 variants à risque identifiés (LRP2, MMAA, BHMT et GLI3). Ces résultats renforcent l’implication des folates dans ces deux pathologies du neurodéveloppement que sont l’autisme et les anomalies de fermeture du tube neural. Une recherche des anticorps anti-FRalpha plus systématique chez les enfants autistes pourrait permettre de proposer un traitement par acide folinique ciblé. Dans le cadre des AFTN, notre étude a mis en évidence l’influence de gènes impliqués dans le métabolisme de la vitamine B12 et monocarbone sur le risque de AFTN. Un nouveau gène candidat (GLI3) est identifié ainsi qu’une signature de méthylation mettant en évidence l’influence de la voie SHH / Folates are essentials vitamins in children neurodevelopment with an implication in two pathologies : autism and neural tube defects (NTD). Folates deficiency and some polymorphisms of genes involved in one carbon metabolism (OCM) are associated with NTD. Contrary, periconceptional folate supplementation is associated with decreased NTD frequency.In autism, higher frequency of antibodies against Folate Receptor Alpha (FR alpha) is rapported and associated with folates cerebral deficiency. Folinic acid treatment could improve autistic symptoms by correcting cerebral folate deficiency (cerebral transport mediated by RFC, an other receptor which not blocked by antibodies anti-FR alpha). First part is a randomized controlled trial versus placebo realized in CHU of Nancy in order to evaluate efficiency of folinic acid treatment during 12 weeks on autistic symptoms. 19 children have been included in the study. A significative improvement of autistic symptoms is observed by ADOS score in folinic acid group (p= 0.02) and particularly for mutual social interactions (p=0.012). FRalpha antibodies are present in 58 % of the group. We didn’t observed correlation between antibodies titers and folinic acid response. No serious adverse effects have been observed during the study. Second part is hight throughput next generation sequencing of DNA from patients with NTD using SureSelect Focused Exome Plus (Agilent®). Sequencing has been completed with DNA methylation analysis (Infinium HumanMethylation Beadchip (Illumina®)). 23 patients were included in the study. Six variants have been associated with NTD: from genes of B12 metabolism LRP2, rs137983840, p=0.005; MMAA, rs148142853, p= 0.005 and TCN2, rs35838082, p=0.044), folate cellular metabolism (FPGS, rs41306702, p=0.0012; choline metabolism, BHMT, rs763726268, p= 0.011) and Sonic Hedgehog pathway(SHH) (GLI3, rs35364414, p=0.012). A significative difference of methylation is identified in the vicinity of CFAP46 gene (hemimethylation versus no methylation in pseudo-controls) in one patient exhibited variants of BHMT, LRP2etMMAA. These results highlight implication of folates in these two pathologies of neurodevelopment, wich are autism and NTD. Anti-FRalpha should be routinely evaluated in case of autism in order to propose folinic acid treatment if they are positives. In the NTD study, we identified new variants from gene from one carbon metabolism probably implicated. A new candidate gene is identified (GLI3) and a methylation signature in association with B12 metabolism and OCM gene variants

The present study evaluates two fetal individuals (B532 and B625) from the Kellis 2 cemetery (Roman period circa A.D. 50 A.D. 450), Dakhleh Oasis, Egypt, that display skeletal anomalies that may explain their death. Both individuals exhibit bowing of the long bones in addition to other skeletal deformities unique to each individual. To assess these pathologies a differential diagnosis based on the congenital occurrence of long bone bowing is developed. Long bone bowing is selected because it is the more prevalent abnormality in the paleopathological literature and the other abnormalities are not as easily identifiable in the literature. For the purposes of this study, the differential diagnosis is defined as a process of comparing the characteristics of known diseases with those shared by an archaeological specimen, in the anticipation of diagnosing the possible condition. It is expected that the differential diagnosis will assist in providing a thorough assessment of each skeleton and yield a possible diagnosis for the condition(s). Macroscopic and radiographic analyses are used to document and examine the bone abnormalities for each individual and compare the results with the developed differential diagnosis. Results suggest that the bent long bones of B532 were caused by osteogenesis imperfecta whereas the cause of the bent long bones of B625 is not clear. Further analyses of B625, including the pathologic abnormalities of its skull, suggest that the neural tube defect iniencephaly with associated encephalocele was the likely cause of the observed skeletal abnormalities. The abnormalities of the long bones complicate estimations of the age-at-death of these two individuals, thus the pars basilaris bone was used to assess age estimation. A population sample of 37 Kellis 2 fetal individuals allowed for the development of linear regression formulae of the pars basilaris measurements for long bone length estimates and a comparison of which would provide the most accurate age estimate. Finally, the diagnoses of the fetal specimens are considered in relation to the cultural aspects and disease pattern of the Kellis 2 cemetery

Résumé : Le métabolisme monocarboné ou métabolisme 1-C désigne l’ensemble des voies métaboliques permettant la synthèse et / ou le recyclage de molécules donneur de groupement monocarboné au cours des réactions de méthylation. L’objectif de ce travail était d’évaluer l’implication des métabolismes de la choline, de la phosphatidylcholine (PC) et de la bétaïne dans la physiopathologie des désordres impliquant le métabolisme 1-C en période prénatale et postnatale. Nous avons montré une augmentation progressive de l’expression de la majorité des gènes impliqués dans le métabolisme 1-C au cours de l’ontogénèse hépatique murine, tandis que les leur expression était plus faible avec des profils plus variable au niveau cérébral. Chez l’homme, les valeurs normales des concentrations des intermédiaires du métabolisme 1-C dans le liquide amniotique (LA) en fonction du terme gestationnel ont été déterminées pour tous les paramètres et les concentrations de S-adénosyl-homocystéine et de méthionine étaient augmentées dans les LA du groupe affecté par des défauts de fermeture du tube neural (DFTN) suggérant que certains cas de DFTN pourraient être associés à des déséquilibres du métabolisme 1-C. En post natal, nous avons montré à la fois chez l’homme et l’animal, que les hyperhomocystéinémie d’origine nutritionnelles ou génétiques induisaient une déplétion en bétaïne, épargnant uniquement le rein où elle est un osmolyte majeur. Dans un modèle murin de déficit en cystathionine–beta synthase induisant une hyperhomocystéinémie, une technique de lipidomique ciblée a montré au niveau hépatique des modifications qualitatives des phospholipides (PLs) avec une diminution des PC contenant des acides gras insaturés et des phosphatidyléthanolmines contenant de l’acide arachidonique. Ces modifications des PLs pourraient jouer un rôle dans la constitution de la stéatose hépatique observée dans l’histoire naturelle de cette maladie. En conclusion, ce travail a permis de montrer que la choline, la bétaïne et les PC sont des acteurs indissociables du métabolisme 1-C qui pourraient être impliqués dans la physiopathologie des DFTN et dans les hyperhomocystéinémies. Ils pourraient également être impliqués dans la physiopathologie des stéatoses hépatiques non alcooliques ou des déficits cognitifs, dans lesquels des désordres du métabolisme 1-C ont été observés. / Abstract: One carbon metabolism or 1C metabolism includes all metabolic pathways for the synthesis and / or recycling of molecules involved in methylation reactions. The objective of this study was to evaluate the involvement of choline, phosphatidylcholine (PC) and betaine metabolisms in the pathophysiology of diseases with impaired 1-C metabolism in prenatal and postnatal period. We showed a progressive increase of the expression of the majority of genes involved in 1-C metabolism during the mouse liver ontogeny while their gene expression was at lower levels and with more variable patterns during brain ontogeny. In humans, amniotic fluid concentrations of all intermediates of 1-C metabolism according to gestational term were determined and we observed increased concentrations of S-adenosyl-homocysteine and methionine in pregnancies affected by neural tube defects (NTD) suggesting that some NTDs cases could be associated with an imbalance in 1-C metabolism. In the postnatal period we showed that both in animal and humans and both in nutritional and genetic hyperhomocysteinemia, that betaine pools were decreased, only sparing the kidney betaine concentrations, where betaine acts as an essential osmolyte. In a mouse model of cystathionine-beta synthase deficiency inducing hyperhomocysteinemia, a technic of targeted lipidomic revealed qualitative changes in the liver phospholipids composition, in particular a decrease of PC containing unsaturated fatty acids and of phosphatidylethanolamine containing arachidonic acid and an increase of phosphatidylethanolamine containing docosohaexaenoic acid. This phospholipids remodelage may participate in the development of the steatosis observed in the natural history of this disease. In conclusion, this study has shown that choline, betaine and phosphatidylcholine are essential actors of 1-C metabolism that could be involved in the pathogenesis of NTD and hyperhomocystéinemia. They could also be involved in the pathophgysiology of non alcoholic fatty liver disease or cognitive decline, in which disorders of 1-C metabolism were observed.