Hong, Sijia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 197-234). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

De nombreux tests de dépistage des troubles cognitifs légers ont été élaborés ces dernières années afin d'identifier des personnes plus à risque de développer une maladie neurodégénérative telle que la maladie d'Alzheimer. Plusieurs indices (sensibilité, spécificité, valeurs de prédiction et rapports de vraisemblance) permettent d'évaluer la performance et l'utilité d'un test en pratique. L'objectif de cette thèse était d'évaluer le degré de variation de la performance d'un outil de dépistage des troubles cognitifs légers et ses conséquences sur la prise de décision clinique. Nos résultats montrent une variation importante de la performance de l'outil étudié en fonction des caractéristiques démographiques des individus, de la nature et la sévérité du trouble cognitif La performance globale d'un test ne serait donc pas constante et exposerait à un risque de sous-estimer ou de surestimer la présence de troubles cognitifs dans certains sous-groupes de l'échantillon d'étude. La mesure de ce phénomène de variation (ou effet de spectre) devrait faire partie des étapes obligatoires de la validation d'un test de dépistage des troubles cognitifs. Elle implique l'analyse de grands échantillons permettant de rendre compte de la complexité de l'interprétation d'un test et son application au niveau pratique. L'utilisation de valeurs seuils ajustées selon l'âge et le niveau scolaire, est proposée afin d'améliorer la prise de décision clinique. Nous discutons également de l'intérêt d'utiliser le concept épidémiologique de dépistage dans la recherche et l'identification de troubles cognitifs et proposons le terme plus approprié de repérage qui ne préjuge pas de leur étiologie. / In recent years, numerous tests have been proposed to screen Mild Cognitive Impairment (MCI) in order to identify individuals who are at risk for developing a neurodegenerative pathology such as Alzheimer's disease. Severa! indices (sensitivity, specificity, predictive values and likelihood ratios) enable to assess the performance and the utility of a test in clinical practice. The main objective of this thesis was to determine the degree of variation of an MCI screening test performance and its impact on clinical decision. Our results showed that performance indices of the study test may vary depending on the demographic characteristics of the individuals, the type and the degree of cognitive impairment. They also highlight that the overall performance of a screening test is not fixed and may result in failure to identify cognitive impairment in true cases and misclassified non cases as cognitively impaired in some subgroups of the study sample. These findings support the perspective that this subgroup variation ( or spectrum effect) should routinely be taken into account to assess the quality of a cognitive screening test. One way to minimize the impact of this phenomena would be to focus the assessment on broad and well defined subgroups of patients. The use of adjusted eut-offs values could help clinicians to increase their level of certainty regarding whether a cognitive impairment is present. We also discuss the interest of using the epidemiological concept of screening in the identification of cognitive impairments and propose a more appropriate term of cognitive impairment detection without prejudging its aetiology

A esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa que afeta os neurônios motores levando a atrofia muscular e morte por insuficiência respiratória. Esta patologia se manifesta de forma esporádica ou familiar, que são indistinguíveis clinicamente. Mutações na enzima antioxidante superóxido dismutase 1 (hSod1) respondem por aproximadamente 20% dos casos familiares de ELA. Além disso, o caráter autossômico dominante destas mutações revela que a hSod1 adquire propriedades tóxicas aos neurônios motores. Atualmente, duas hipóteses não mutuamente excludentes existem para explicar o caráter tóxico das mutantes da hSod1 relacionadas à ELA. A primeira refere-se à produção de oxidantes pela atividade peroxidásica exacerbada das mutantes contribuindo para o estresse oxidativo observado em ELA. A segunda refere-se à agregação de proteínas como ocorre em outras doenças neurodegenerativas. Digno de nota, o radical carbonato produzido na atividade peroxidásica da hSod1 causa a formação de um dímero covalente da proteína análogo a uma espécie de hSod1 frequentemente detectada em modelos experimentais e pacientes da doença e associada à propriedade tóxica das mutantes. Desta forma, o presente trabalho buscou esclarecer o mecanismo de produção do radical carbonato pela hSod1, bem como caracterizar o dímero covalente da proteína para posterior estudo de sua formação em um modelo de ELA em ratos que superexpressam a mutante G93A da hSod1. Os estudos cinéticos da variação do pH sobre os efeitos de bicarbonato/CO2, nitrito e formato na atividade peroxidásica da hSod1, medidos pelo consumo de peróxido de hidrogênio e produção de radical, permitiram excluir o mecanismo de Fenton para explicar o ciclo peroxidativo da enzima em tampão bicarbonato em favor de outros intermediários reativos. Já, os experimentos de 13C RMN, modelagem molecular e cinética de fluxo interrompido com mistura assimétrica demonstraram que o ânion peroxomonocarbonato constitui o precursor do radical carbonato produzido pela hSod1. A caracterização do dímero covalente da hSod1 por proteólise com tripsina seguida de análise por HPLC/UV-vis e HPLC/ESI-MS identificou um peptídeo característico do dímero covalente da hSod1. A digestão enzimática em H2 18O demonstrou de forma inequívoca a natureza dímerica deste peptídeo pela marcação da extremidade C-terminal. Ainda, o sequenciamento do peptídeo dimérico por MS/MS revelou a estrutura primária ESNGPVKVW(ESNGPVKVWGSIK)GSIK, na qual as cadeias polipeptídicas estão ligadas através de um aduto de ditriptofano composto por resíduos Trp32 da proteína. Por fim, este peptídeo dimérico pode ser empregado como marcador bioquímico específico para o estudo do dímero covalente da hSod1 in vivo. A análise do extrato de proteínas das medulas dos ratos modelo de ELA identificou quinze candidatos a dímero covalente da hSod1 por Western-blot, sendo que dois deles foram excluídos por espectrometria de massa, pois tiveram o resíduo Trp32 identificado. O peptídeo ESNGPVKVW(ESNGPVKVWGSIK)GSIK não foi observado, porém as treze espécies restantes permanecem candidatas e deverão ser reexaminadas em trabalhos que darão sequência a esta tese de doutorado. Em suma, o peroxomonocarbonato constitui o intermediário na produção do radical carbonato pela hSod1 e o peptídeo ESNGPVKVW(ESNGPVKVWGSIK)GSIK uma ferramenta importante no estudo da agregação covalente da hSod1 em ELA. / Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of motors neurons that causes muscle atrophy, weakness, and death by respiratory failure. This pathology occurs in both sporadic and familiar forms that are clinically indistinguishable. Mutations in the antioxidant enzyme superoxide dismutase 1 (hSod1) respond to about 20% of the familiar cases of ALS. Besides, the autosomal dominant nature of these hSod1-associated ALS suggests that the mutants gain toxic properties to motor neurons. Currently, two hypotheses exist to explain the toxicity of hSod1 mutants but they do not exclude each other. The first one is related to the production of oxidants by the increased peroxidase activity of the ALS-linked mutants that could contribute to the oxidative stress reported in ALS. The second refers to protein aggregation as proposed in other neurodegenerative diseases. Noteworthy, the carbonate radical produced during hSod1 peroxidase activity leads to the formation of a covalent dimer of the protein similar to a hSod1 species often detected in experimental models and patients of the disease and implicated in the toxic properties of hSod1 mutants. Thus, the present work aimed to determine the mechanism of carbonate radical production by hSod1 and to characterize the covalent dimer of the protein in vitro followed by the study of covalent aggregates of hSod1 in a rat model of ALS that overexpresses the G93A mutant of the protein. The kinetic studies of the effect of bicarbonate/CO2, nitrite and formate in the peroxidase activity of hSod1 at various pH, measured by hydrogen peroxide consumption and radical production, permitted to exclude the Fenton mechanism to explain the enzyme peroxidative cycle in bicarbonate buffer in favor of other reactive intermediates. Furthermore, 13C NMR, molecular docking and stopped-flow experiments with asymmetric mixing demonstrated that the anion peroxomonocarbonate is the precursor of the carbonate radical produced by hSod1. The characterization of hSod1 covalent dimer by proteolysis with trypsin followed by HPLC/UV-vis and HPLC/ESI-MS analysis identified a peptide characteristic of the covalent dimer of the protein. The enzymatic digestion in H2 18 O irrefutably demonstrated the dimeric nature of this peptide because of the C-terminal labeling with oxygen-18 isotopes. In addition, sequencing of the dimeric peptide by MS/MS determined the primary structure ESNGPVKVW(ESNGPVKVWGSIK)GSIK, in which the polipeptide chains are crosslinked through a ditryptophan adduct formed by a covalent bond between the Trp32 residues of each subunit. So, this dimeric peptide can be employed as a biochemical marker for studying the hSod1 covalent dimer in vivo. The analysis of protein extracts from the spinal cord of the rat model of ALS by Western-blot identified fifteen candidates to hSod1 covalent dimer, but two of them were excluded by mass spectrometry analysis that identified unmodified Trp32 residues. Moreover, neither the dimeric peptide nor the Trp32 residue were observed in the remaining species. Therefore, these thirteen candidates must be reexamined in subsequent studies. In conclusion, the anion peroxomonocarbonate is the key intermediate in the production of the carbonate radical by hSod1 and the dimeric peptide constitutes a specific tool to study hSod1 covalent aggregation in ALS

Trinucleotide repeat (TNR) instability including repeat expansions and repeat deletions is the cause of more than 40 inherited incurable neurodegenerative diseases and cancer. TNR instability is associated with DNA damage and base excision repair (BER). In this dissertation research, we explored the mechanisms of BER-mediated TNR instability via biochemical analysis of the BER protein activities, DNA structures, protein-protein interaction, and protein-DNA interaction by reconstructing BER in vitro using synthesized oligonucleotide TNR substrates and purified human proteins. First, we evaluated a germline DNA polymerase β (pol β) polymorphic variant, pol βR137Q, in leading TNR instability-mediated cancers or neurodegenerative diseases. We find that the pol βR137Q has slightly weaker DNA synthesis activity compared to that of wild-type (WT) pol β. Because of the similar abilities between pol βR137Q and WT pol β in bypassing a template loop structure, both pol βR137Q and WT pol β induces similar amount of repeat deletion. We conclude that the slightly weaker DNA synthesis activity of pol βR137Q does not alter the TNR instability compared to that of WT pol β, suggesting that the pol βR137Q carriers do not have an altered risk in developing TNR instability-mediated human diseases. We then investigated the role of DNA synthesis activities of DNA polymerases in modulating TNR instability. We find that pol βY265C and pol ν with very weak DNA synthesis activities predominantly promote TNR deletions. We identify that the sequences of TNRs may also affect DNA synthesis and alter the outcomes of TNR instability. By inhibiting the DNA synthesis activity of pol β using a pol β inhibitor, we find that the outcome of TNR instability is shifted toward repeat deletions. The results provide the direct evidence that DNA synthesis activity of DNA polymerases can be utilized as a potential therapeutic target for treating TNR expansion diseases. Finally, we explored the role of post-translational modification (PTM) of proliferating cell nuclear antigen (PCNA) on TNR instability. We find that ubiquitinated PCNA (ub-PCNA) stimulates Fanconi associated nuclease 1 (FAN1) 5’-3’ exonucleolytic activities directly on hairpin structures, coordinating flap endonuclease 1 (FEN1) in removing difficult secondary structures, thereby suppressing TNR expansions. The results suggest a role of mono-ubiquitination of PCNA in maintaining TNR stability by regulating nucleases switching. Our results suggest enzymatic activities of DNA polymerases and nucleases and the regulation of the activities by PTM play important roles in BER-mediated TNR instability. This research provides the molecular basis for future development of new therapeutic strategies for prevention and treatment of TNR-mediated neurodegenerative diseases.

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This study investigates the characteristics of and the interrelationships between disease, disability, service use and social support in a random sample of 647 community dwellers aged 75 years and over. The two broad objectives of the study are: to examine the physical aspects and manifestations of health by investigating disease and disability and the interrelationships between these two factors, and; to examine the social aspects of health by investigating service use and social support and the interrelationships between these two factors. Given the dramatic population ageing in Australia, particularly in the very old age groups, the health, well-being and quality of life of older Australians are of paramount importance and will be well into the future. The proportion of the population with diseases and disabilities increases significantly with age. As the physical aspects of health are manifested with increasing age the social aspects of health also become increasingly important. Older adults, particularly those in advanced old age, are disproportionately high users of health and community services. Despite the high use of services in this age group, far more older adults living in the community rely on their families, friends and neighbours for social support and many older adults use a combination of formal services and informal social support. Little is known about people aged 75 years and over living in the community in Australia. In particular, significant knowledge gaps exist with regard to the relationship between disease and disability and that between service use and social support. The characteristics of social support in this group of older adults are also largely unknown. The papers presented in this thesis are based on data collected in The Sydney Older Persons Study (SOPS). This is a large longitudinal multidisciplinary project which began in 1991 in order to investigate the health and service use patterns of people aged 75 years and over living in the community in the Central Sydney Health Area. The initial sample consisted of two groups: first, the Australian Bureau of Statistics (ABS) selected census districts with probability proportional to size and 9271 households were door-knocked to obtain a random sub-sample of the general community (n=320, response rate 73%); second, community-living veterans and war widows residing in the Central Sydney Health Area were selected at random from a list provided by the Department of Veterans Affairs to obtain a veteran/war widow sub-sample (n=327, response rate 82%). Respondents participated in both an interview conducted by a social scientist and a medical assessment performed by a medical practitioner with experience in geriatric medicine. An informant was sought for each respondent and this informant participated in a phone interview conducted by a social scientist. The first paper in this thesis investigates the characteristics of diseases (neurodegenerative, systemic and psychiatric) including their prevalence and association with age. The second paper extends the first by examining the nature of the relationship between disease and disability and in particular which individual diseases and groups of diseases have the greatest impact on disability. The third paper expands the analysis in the second paper by focusing in greater detail on the relationship between disease and disability. The contribution of clinically-diagnosed individual diseases and groups of diseases to three different measures of disability (clinician-rated, informant-rated or proxy and self-report) is investigated here. The fourth paper examines the possibility of disease and disability being the major predictors of service use and social support. It focuses on the determinants of service use and social support using Andersen's behavioral model. The fifth paper investigates the characteristics of social support, in particular gender differences and the socio-demographic variables associated with social support. This is an important research area because lower levels of social support have been found to predict mortality, disease and lower levels of well-being. Finally, the sixth paper links the major themes of the fourth and fifth papers by investigating the relationship between service use and social support. This paper tests Cantor's 'hierarchical-compensatory' mechanism, which predicts a negative association between service use and social support, and the 'bridging' mechanism which predicts a positive association between these two factors. Thus it assesses the extent to which demands for service use and for social support are made together or in a compensatory fashion for respondents of equal disease and disability. The presented work demonstrates that neurodegenerative diseases [dementia, cognitive impairment, parkinsonism, instability (gait ataxia), immobility (gait slowing) and motivation loss/behaviour change] have the largest and most significant increases with age of all disease groups. Therefore the hypothesis made in paper one that neurodegenerative diseases will come to dominate the health care needs of older adults, particularly when combined with population ageing, is supported. Further, results of papers two and three indicate that neurodegenerative diseases result in greater levels of disability, lending credence to the finding that it is these neurodegenerative diseases that are of central importance to the future of the health care needs of older adults of advanced age. While systemic diseases play an important role in disability, the neurodegenerative diseases are under-recognised by self-report and yet are most strongly associated with severe disability. A major recommendation of this study is that assessments and diagnosis of neurodegenerative diseases be included in disability assessments. With regard to the social aspects of health, the fourth paper finds that disease and disability are the main predictors of service use and social support. The fifth paper highlights important gender differences in social support and also finds that lower levels of social support are associated with increased age, male gender, single marital status and lower socioeconomic status. Because it is widely accepted that social support is protective against adverse health outcomes and low levels of wellbeing, these groups of older adults are at risk of poorer health and wellbeing. Finally the sixth paper fills some knowledge gaps with regard to the relationship between service use and social support. It shows that with regard to IADL (instrumental activities of daily living) services and IADL social support, Cantor's 'hierarchical-compensatory' mechanism (negative correlation) applies but with regard to medical services and both ADL (activities of daily living) and IADL social support the 'bridging' mechanism (positive correlation) is supported. These complex interrelationships between disease, disability, service use and social support are summarised schematically in a model. In light of significant population ageing, substantial resources in the form of medical and community services and social support from carers, family, friends and neighbours will need to be devoted to older adults with diseases, in particular neurodegenerative diseases, and to those with disabilities. Given the increasing importance of disease, disability, service use and social support in very old age, it is crucial that knowledge and understanding of these factors and their interrelationships be advanced in order to better allocate and sustain resources and to ultimately improve the health, well-being and quality of life of very old adults.

Submitted by Natasha Brizolla (natbrizolla@gmail.com) on 2018-01-13T16:13:41Z No. of bitstreams: 1 ThesisMPGI_Natasha_20180112.pdf: 9803841 bytes, checksum: 1bbf6c1cc55b2b5be7fc619e672545e5 (MD5) / Approved for entry into archive by Vera Lúcia Mourão (vera.mourao@fgv.br) on 2018-01-15T13:45:37Z (GMT) No. of bitstreams: 1 ThesisMPGI_Natasha_20180112.pdf: 9803841 bytes, checksum: 1bbf6c1cc55b2b5be7fc619e672545e5 (MD5) / Made available in DSpace on 2018-01-15T14:33:46Z (GMT). No. of bitstreams: 1 ThesisMPGI_Natasha_20180112.pdf: 9803841 bytes, checksum: 1bbf6c1cc55b2b5be7fc619e672545e5 (MD5) Previous issue date: 2017-12-13 / Under the shifting dynamics of pharmaceutical industries, companies must be responsive to adjust their strategies to the constantly evolving environment as well as predict future changes to be able to prepare and position their brands in the market to foster a privileged place. The goal of this study is to examine brand positioning strategies of age-related neurodegenerative drugs through content analysis in order to provide an overview of the pharmaceutical industry strategic approach regarding marketing and communication initiatives. This research adopted a descriptive qualitative methodology and begun by exploring concepts and theories regarding brand positioning and its application in the industry at hand. Then data was collected and examined under the Costumer-Driven Positioning framework from Vanderveer & Pines (2007) that focuses on physicians and message construction according to five rubrics: problem statement, functional benefits, main theme, emotional benefits, and reasons to believe. This research assessed each rubric of the CDP model and applied them for the eight brands embracing three major disease groups: Alzheimer, Parkinson, and Amyotropic Lateral Sclerosis. Suggestions of additional elements to be incorporated as well as limitations to be further investigated were discussed at last. / Para alinharem-se às mudanças de dinâmica das indústrias farmacêuticas, as empresas precisam ser ágeis para ajustar suas estratégias ao ambiente constantemente em desenvolvimento assim como prever mudanças que estão por vir para posicionar suas marcas no mercado adequadamente a fim de alcançarem uma posição privilegiada. O objetivo deste trabalho é propor uma análise das estratégias de posicionamento de marca para doenças neurodegenerativas advindas do envelhecimento através de análise de conteúdo a fim de proporcionar uma visão geral da abordagem estratégica da indústria farmacêutica em relação às iniciativas de comunicação e marketing. Essa pesquisa adotou uma metodologia qualitativa e descritiva começando por explorar conceitos e teorias a respeito de posicionamento de marca e suas aplicações na indústria em questão. Em seguida, os dados foram coletados e analisados sob o prisma da abordagem de posicionamento de Vanderveer & Pines (2007) (Costumer-Driven Positioning) centrado no público médico e na construção da mensagem de acordo com cinco rubricas: descrição do problema, benefícios funcionais, tema principal, benefícios emocionais e motivos para acreditar. Esse estudo considerou cada rubrica do modelo de posicionamento (CDP) e as aplicou para oito marcas abarcadas nos três grupos de doenças: Alzheimer, Parkinson e Esclerose Lateral Amiotrófica. Por fim foram discutidas sugestões para incorporar elementos adicionais assim como limitações para serem aprofundadas em pesquisas futuras.

As septinas fazem parte de uma família de proteínas de ligação ao nucleotídeo guanina. As septinas têm mostrado ter um papel importante na citocinese e outros processos celulares, incluindo a determinação da polaridade celular e reorganização do citoesqueleto. Todos os membros da família de septinas são compostos por três domínios: um N-terminal variável, um domínio central GTPase e uma região C-terminal que inclui sequências de coiled-coil. Septinas possuem uma característica de polimerizarem para formar complexos hetero-oligoméricos altamente organizados, in vivo e in vitro. Estruturas homo-oligoméricas também foram observadas, embora sua função ainda não esteja bem estabelecida. A Septina 2 humana (SEPT2) se acumula no sulco de clivagem de células em divisão, desde a anáfase até a telófase, além de interagir com a actina, e também está envolvida em doenças neurodegenerativas, como mal de Azheimer. Nesse estudo, a ORF que codifica SEPT2, bem como os fragmentos que codificam seus domínios, foram clonados, expressos em E.coli e purificados por cromatografia de afinidade e cromatografia de exclusão molecular. Os produtos foram analisados por espectroscopia de dicroísmo circular, espalhamento de luz a ângulo fixo e espectroscopia de fluorescência extrínseca, usando Tioflavina-T, que é um marcador clássico para fibras amilóides. Em todos os casos, os produtos formaram homodímeros in vitro, e também agregaram em temperaturas fisiológicas. O desenovelamento térmico das proteínas recombinantes revelou a presença de uma população intermediária de desenovelamento, rica em folhas-β, e que ligam Tioflavina-T, sugerindo uma estrutura amiloidogênica para essa proteína, confirmada pelos programas de predição TANGO e WALTZ. Imagens dessas fibras foram obtidas usando Microscopia eletrônica de Transmissão, evidenciando uma agregação organizada das proteínas. Além disso, usando monocamadas de Langmuir, foi possível confirmar a ligação específica de SEPT2 ao fosfolipídeo fosfatidilinositol 4,5-bifosfato (PtdIns(4,5)P2). Essa ligação específica mantém a estrutura secundária de SEPT2, observada pela técnica PM-IRRAS, algo que não ocorre caso o lipídio seja inespecífico, sugerindo uma associação de SEPT2 com a membrana plasmática e podendo ter um papel na regulação das septinas. Por meio da técnica de duplo híbrido em levedura, identificamos proteínas que interagem com a SEPT2, como a MPBI e a DCTN2, auxiliando na elucidação de processos em que a SEPT2 possa participar. O conjunto dos resultados sobre a estabilidade, os processos de agregação de SEPT2 e a identificação de novos parceiros protéicos de interação, obtidos nesse trabalho, contribuíram para o melhor entendimento da função da SEPT2 e de seu envolvimento em desordens neurodegerenativas. / Septins are members of a conserved group of GTP-binding and filament-forming proteins. They are involved in a variety of cellular processes, such as microtubule regulation, vesicle trafficking, the formation of scaffolding platforms and actin dynamics. Human Septin 2 (SEPT2) has an N-terminal polybasic region responsible for lipid binding, a GTPase domain, and a C-terminal domain. SEPT2 is essential for cytokinesis and it is found in many tissues, mainly in the brain. Together with SEPT1 and SEPT4, it is accumulated in deposits known as neurofibrillary tangles in Alzheimers disease, which is evidence that SEPT2 may be involved in this process. In this study, the human SEPT2, and its domains, were cloned, expressed in E.coli and purified by affinity and size-exclusion chromatographies. The proteins form homodimers in vitro, suggesting that the GTPase domain is enough to promote the oligomerization. Thermal unfolding revealed the formation of aggregates under physiological conditions, which have the ability to bind a specific amyloid dye, Thioflavin-T, suggesting them to be an amyloidal fiber. Besides, in silico prediction programs, TANGO and WALTZ, corroborate that SEPT2 contain regions with high probability of aggregation and amyloidogenic formation, respectively. Moreover, we observed 20-50 nm thick filamentous structures by electron microscopy of negatively stained. Using Langmuir monolayers at the cell membrane lipid packing, SEPT2 and SEPT2NG bound to the phospholipid phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P2). Results from in situ PM-IRRAS experiments indicated that the secondary structure of SEPT2 is preserved upon interacting with PtdIns(4,5)P2, but not when interacting with DPPC - which is not specific for SEPT2 - at the air/water interface suggesting an association with the plasma membrane and a role in septin regulation. Furthermore, we also identified protein partners of SEPT2, from both human leukocyte and brain fetal cDNA libraries, using the yeast two-hybrid system. SEPT2 was shown to interact with: septins 6 and 4; a serine-protease and a MAP inhibitory protein; an ubiquitin-conjugating enzyme; and proteins related to cellular division. Thus, taken together this study contributed for the knowledgment of the stability and the aggregation kinetic of the SEPT2, leading to a better understanding of this protein and their role in neurodegenerative disorders.

Introducão: o comprometimento cognitivo leve (CCL) é reconhecido como um estágio transicional sintomático entre o envelhecimento normal e a demência, particularmente a doença de Alzheimer (DA). Apresenta como subtipos principais o amnéstico (CCLa), com comprometimento de memória, e o não amnéstico (CCLna), que apresenta perda de outras funções, principalmente executivas, de atenção, de linguagem e visuoespaciais. Aparentemente o CCLna tem menor taxa de conversão para demências ao longo do tempo que o subtipo amnéstico, particularmente para a DA. Dessa forma, o CCLna poderia apresentar um perfil de biomarcadores diferente do CCLa no momento do diagnóstico. Estudos na literatura investigando o padrão de biomarcadores no CCLna como grupo independente são raros, alguns destes indicando perfil menos relacionado à DA no CCLna que o visto no CCLa. Segundo nosso conhecimento, não há estudos investigando concomitantemente volume e metabolismo cerebrais, além de biomarcadores no LCR de uma mesma amostra de CCLna, em comparação com CCLa e um grupo de idosos cognitivamente normais. Objetivo: investigar as alterações de volume e metabolismo cerebral em grupos de indivíduos com os subtipos amnéstico e não amnésico de CCL, comparativamente a voluntários idosos sem comprometimento cognitivo, com o intuito de avaliar se há concordância entre estas alterações. Avaliou-se ainda possíveis associações entre os perfis dos estudos de imagem com padrões classicamente descritos na para CCL em risco de evolução para DA, investigando ainda a existência de correlações entre destes achados com o dos diferentes biomarcadores no LCR e com dados clínicos. Métodos: cento e quatorze voluntários foram incluídos em três diferentes grupos: gCCLna (N = 38), gCCLa (N = 46) e GC (N = 30). Após entrevista clínica, exame neurológico e classificação por uma bateria de testes neuropsicológicos, estes foram submetidos a exames de RM cerebral (para excluir outras causas de comprometimento cognitivo e para análise de morfometria baseada em voxels - VBM) e de PET-18FDG cerebral. Analisou-se ainda os valores de biomarcadores no LCR (A?, tau e p-tau) de uma subamostra de pacientes (CCLna = 33, CCLa = 38). Resultados: os três grupos não apresentaram diferenças em relação às variáveis idade, escolaridade, sexo, fatores de risco cardiovascular (exceto por maior prevalência de dislipidemia no gCCLa) e hiperintensidades de substância branca na RM. Menores valores de mini-exame do estado mental foram observado nos grupos CCLa e CCLna em relação ao GC. O subgrupo amnéstico apresentou redução de volume em porções mediais e polares de ambos os lobos temporais em comparação com GC e gCCLna, além de áreas de redução do metabolismo no giro do cíngulo posterior e pré-cúneo direitos e giro temporal médio esquerdo em relação ao GC. Esse padrão de redução volumétrica e metabólica não foi visto no gCCLna, que demonstrou discreta redução volumétrica nos giros temporal inferior esquerdo e frontal médio direito em comparação com o GC. Nenhuma alteração metabólica persistiu no subgrupo não amnéstico após correção para efeito de volume parcial em comparação com o GC, havendo redução metabólica bilateral no giro frontal médio em comparação com o gCCLa. Não houve diferenças significativas nos biomarcadores de LCR entre os grupos CCLa e CCLna. Houve, porém, tendência de menores valores de peptídeo A? no gCCLa. Observou-se correlação positiva entre metabolismo no giro temporal médio esquerdo e rendimento em testes de memória; correlação negativa também foi observada entre os valores de A? e os de tau e p-tau no LCR. Conclusão: os grupos CCLa e CCLna apresentaram alterações de volume e metabolismo diferentes em comparação com o grupo controle, e estas alterações não apresentaram concordância entre si. Também não foram encontradas correlações entre os diferentes biomarcadores de imagem e no LCR, notando-se apenas correlação positiva entre metabolismo temporal e desempenho em testes de memória. O gCCLa apresentou padrões de metabolismo e volume cerebrais classicamente relacionados a risco de evolução para DA. Por outro lado, o grupo CCLna apresentou um padrão diferente de alterações metabólicas e volumétricas, com áreas menores de redução de volume e padrão mais heterogêneo de alterações metabólicas em relação ao grupo controle. O conjunto de achados de biomarcadores no gCCLna não é indicativo de nenhum perfil específico de evolução para demências / Introduction: Mild cognitive impairment (MCI) is presumably a transitional stage between normal aging and dementia, particularly Alzheimer\'s disease (AD). Non-amnestic subtypes (naMCI) present with executive, attention, visuospatial and language dysfunctions. They have a lower conversion rate to dementia compared to amnestic subtypes (aMCI). Investigations regarding biomarker profiles of naMCI as an independent group are scarce. To our knowledge there is no study investigating the brain volumetric and metabolic features, as well as the profile of cerebrospinal fluid (CSF) biomarkers of naMCI patients as a single group in comparison to aMCI and cognitively normal elderly patients (control group - CG). Objective: to investigate the brain volumetric and metabolic changes in individuals presenting amnestic and non-amnestic MCI subtypes in comparison to elderly volunteers without cognitive impairment, aiming to verify if there are agreements between these changes. Possible associations between the imaging profile of these groups and classical patterns of high risk for developing AD were also evaluated, as well as possible correlations between imaging biomarkers, CSF biomarkers and clinical data. Methods: a hundred and fourteen (114) patients were included in three different groups: naMCIg (N = 38), aMCIg (N = 46) and CG (N = 30). Patients underwent brain MRI (in order to exclude other causes of the cognitive impairment but also for VBM analysis) and [18F]FDG-PET. A subsample (naMCIg = 33, aMCIg = 38) also underwent a lumbar puncture in order to assess the profile of amyloid-ß peptide, tau and phosphorylated tau protein levels in the CSF. Results: There was no difference in CSF biomarkers, education years, age, gender and cardiovascular risk factors between the naMCI and aMCI groups, except for a higher prevalence of dyslipidemia in aMCI. The amnestic MCI group had lower rBGM in relation to control group in the precuneus, posterior cingulate and left medium temporal gyrus. Compared to aMCIg, naMCIg presented with bilateral prefrontal cortex hypometabolism, but without metabolic changes in relation to CG after correction for partial volume effect. Amnestic MCI group had bilateral temporal lobe volume reduction in comparison to naMCI and CG, particularly in the polar and mesial parts of the temporal lobe. Non-amnestic MCI presented with discrete volumetric reductions in comparison to CG, Conclusion: Volumetric and metabolic alterations were different and essentially discordant between aMCI and naMCI groups in comparison to CG. Amnestic MCI showed metabolic and volumetric profiles classically related to MCI due to AD, while naMCI group presented with less-significant areas of volumetric and metabolic reductions in relation to control group. Our non-amnestic MCI group probably represents a heterogeneous group with a different pattern of neurodegeneration than the classical MCI due to AD