Base teórica: A qualidade de vida é uma variável amplamente estudada nas ciências da saúde e tem se tornado, cada vez mais, um indicativo importante na avaliação dos estados e desfechos de saúde. As doenças crônicas se caracterizam por curso prolongado, por vezes acompanhando o portador por toda sua vida, o que pode influenciar a percepção que o indivíduo tem de si mesmo e de sua vida. A Neurofibromatose tipo 1 (NF1) é uma doença crônica, genética, que atinge cerca de 1:3500 nascimentos. Além de ser uma doença que acarreta uma maior predisposição ao desenvolvimento de tumores, a NF1 possui sintomas físicos de fácil identificação. Objetivo: O presente estudo visa estudar a qualidade de vida e algumas variáveis emocionais de pessoas com neurofibromatose tipo 1. Método: Trata-se de um estudo transversal. Foram avaliadas as variáveis de qualidade de vida genérica (WHOQOL-bref e SF-36), qualidade de vida específica para pessoas com problemas de pele (DLQI-bra), sintomas depressivos (BDI), sintomas de ansiedade(BAI), percepção de suporte familiar (IPSF) e estratégias de enfrentamento (Inventário de Estratégias de Coping de Folkman e Lazarus). Os participantes deste estudo também foram avaliados quanto à gravidade (Escala de Riccardi) e visibilidade dos sintomas da doença (Ablon). Resultados: Foram coletados dados de 71 pacientes adultos com NF1. Do total 60,0% da amostra foram pessoas do sexo feminino, a média de idade foi de ± 40,36 anos. Dos 52 pacientes avaliados pela escala de Riccardi, 11,3% apresentou gravidade leve, 40,4% gravidade moderada, 42% sintomas graves de gravidade e 6,5% sintomas muito graves da doença. Com relação a visibilidade dos sintomas medidos pela escala de Ablon, 36,5% apresentam visibilidade leve de sintomas, 30,8% visibilidade moderada e 32.7% visibilidade severa dos sintomas. Conclusão: Os resultados da avaliação de qualidade de vida de pessoas com NF1, ao serem comparados com os dados normativos para amostra, não apresentou diferença estatisticamente significativa. A análise dos sintomas depressivos indicou que grande parte dos entrevistados apresentam sintomas leves de depressão e os dados da escala BAI referente aos sintomas de ansiedade constatou que a média dos entrevistados apresentam sintomas graves de ansiedade, podendo sugerir que a ansiedade seja uma característica importante dessa população. As estratégias de enfrentamento mais utilizadas por esta população foram a reavaliação e o suporte social. Com relação aos resultados da percepção de suporte familiar, podemos perceber que os dados da amostra não apresentaram diferença significativa ao serem comparados com os dados normativos da escala. / Theoretical basis: Quality of life is an important studied variable in health sciences and has become an important indicator in assessing states and health outcome. Chronic diseases are characterized by a prolonged course, sometimes accompanying the carrier all his life, which can influence the perception that the individual has of himself and of his life. The neurofibromatosis type 1 (NF1) is a chronic and genetics condition that affects about 1: 3500 births. Besides being a disease that leads to a greater predisposition to develop tumors, NF1 has physical symptoms of easy identification. Objective: This project aims to study the quality of life and emotional variables of people with neurofibromatosis type 1. Method: This is an observational study. The overall quality of life variables were evaluated (WHOQOL-bref and SF-36), specific quality of life for people with skin problems (DLQI-bra), depressive symptoms (BDI), anxiety symptoms (BAI), perception of family supports (IPSF) and coping strategies (coping strategies Inventory of Folkman and Lazarus). The participants were also evaluated for the severity (Riccardi Scale) and visibility of disease symptoms (Ablon). Results: Were collected data from 71 adults patients with NF1. From all sample 60% were female. The mean age was ± 40.36 years . Of the 52 patients evaluated for Riccardi scale , 11.3 % had mild severity , 40.4 % moderate severity , 42% Severity of symptoms and 6.5 % symptoms very severe. The data of the visibility of the symptoms were measure by Ablon scale , 36.5 % have mild symptoms visibility , 30.8 % moderate and 32.7 % severe visibility of symptoms. Conclusion: The results of the quality of life of people with NF1, when compared with the normative data for sample, indicate no statistically significant difference. The analysis of depressive symptoms indicated that the majority of respondents have mild symptoms of depression and the BAI scale data related to symptoms of anxiety found that the average of respondents have severe anxiety symptoms and may suggest that anxiety can be an important feature of this population. Coping strategies most used by this population were the re-evaluation and social support. Regarding the results of the perception of family support, we can see that the sample data showed no significant difference when compared with the normative data range.

Base teórica: A qualidade de vida é uma variável amplamente estudada nas ciências da saúde e tem se tornado, cada vez mais, um indicativo importante na avaliação dos estados e desfechos de saúde. As doenças crônicas se caracterizam por curso prolongado, por vezes acompanhando o portador por toda sua vida, o que pode influenciar a percepção que o indivíduo tem de si mesmo e de sua vida. A Neurofibromatose tipo 1 (NF1) é uma doença crônica, genética, que atinge cerca de 1:3500 nascimentos. Além de ser uma doença que acarreta uma maior predisposição ao desenvolvimento de tumores, a NF1 possui sintomas físicos de fácil identificação. Objetivo: O presente estudo visa estudar a qualidade de vida e algumas variáveis emocionais de pessoas com neurofibromatose tipo 1. Método: Trata-se de um estudo transversal. Foram avaliadas as variáveis de qualidade de vida genérica (WHOQOL-bref e SF-36), qualidade de vida específica para pessoas com problemas de pele (DLQI-bra), sintomas depressivos (BDI), sintomas de ansiedade(BAI), percepção de suporte familiar (IPSF) e estratégias de enfrentamento (Inventário de Estratégias de Coping de Folkman e Lazarus). Os participantes deste estudo também foram avaliados quanto à gravidade (Escala de Riccardi) e visibilidade dos sintomas da doença (Ablon). Resultados: Foram coletados dados de 71 pacientes adultos com NF1. Do total 60,0% da amostra foram pessoas do sexo feminino, a média de idade foi de ± 40,36 anos. Dos 52 pacientes avaliados pela escala de Riccardi, 11,3% apresentou gravidade leve, 40,4% gravidade moderada, 42% sintomas graves de gravidade e 6,5% sintomas muito graves da doença. Com relação a visibilidade dos sintomas medidos pela escala de Ablon, 36,5% apresentam visibilidade leve de sintomas, 30,8% visibilidade moderada e 32.7% visibilidade severa dos sintomas. Conclusão: Os resultados da avaliação de qualidade de vida de pessoas com NF1, ao serem comparados com os dados normativos para amostra, não apresentou diferença estatisticamente significativa. A análise dos sintomas depressivos indicou que grande parte dos entrevistados apresentam sintomas leves de depressão e os dados da escala BAI referente aos sintomas de ansiedade constatou que a média dos entrevistados apresentam sintomas graves de ansiedade, podendo sugerir que a ansiedade seja uma característica importante dessa população. As estratégias de enfrentamento mais utilizadas por esta população foram a reavaliação e o suporte social. Com relação aos resultados da percepção de suporte familiar, podemos perceber que os dados da amostra não apresentaram diferença significativa ao serem comparados com os dados normativos da escala. / Theoretical basis: Quality of life is an important studied variable in health sciences and has become an important indicator in assessing states and health outcome. Chronic diseases are characterized by a prolonged course, sometimes accompanying the carrier all his life, which can influence the perception that the individual has of himself and of his life. The neurofibromatosis type 1 (NF1) is a chronic and genetics condition that affects about 1: 3500 births. Besides being a disease that leads to a greater predisposition to develop tumors, NF1 has physical symptoms of easy identification. Objective: This project aims to study the quality of life and emotional variables of people with neurofibromatosis type 1. Method: This is an observational study. The overall quality of life variables were evaluated (WHOQOL-bref and SF-36), specific quality of life for people with skin problems (DLQI-bra), depressive symptoms (BDI), anxiety symptoms (BAI), perception of family supports (IPSF) and coping strategies (coping strategies Inventory of Folkman and Lazarus). The participants were also evaluated for the severity (Riccardi Scale) and visibility of disease symptoms (Ablon). Results: Were collected data from 71 adults patients with NF1. From all sample 60% were female. The mean age was ± 40.36 years . Of the 52 patients evaluated for Riccardi scale , 11.3 % had mild severity , 40.4 % moderate severity , 42% Severity of symptoms and 6.5 % symptoms very severe. The data of the visibility of the symptoms were measure by Ablon scale , 36.5 % have mild symptoms visibility , 30.8 % moderate and 32.7 % severe visibility of symptoms. Conclusion: The results of the quality of life of people with NF1, when compared with the normative data for sample, indicate no statistically significant difference. The analysis of depressive symptoms indicated that the majority of respondents have mild symptoms of depression and the BAI scale data related to symptoms of anxiety found that the average of respondents have severe anxiety symptoms and may suggest that anxiety can be an important feature of this population. Coping strategies most used by this population were the re-evaluation and social support. Regarding the results of the perception of family support, we can see that the sample data showed no significant difference when compared with the normative data range.

Les données de la littérature concernant les difficultés cognitives et comportementales dans la Neurofibromatose de type 1 (NF1) sont nombreuses avec des résultats parfois contradictoires. Après une revue de la littérature, ce travail de recherche : (i) décrit les difficultés comportementales, cognitives et motrices chez 78 patients atteints de NF1, âgés de 5 à 18 ans, au moyen de questionnaires aux parents (qualité de vie, impact de la maladie, difficultés des parents eux-mêmes, Conners, BRIEF, CBCL), et d'une évaluation de l'efficience intellectuelle et neuropsychologique détaillée ; (ii) analyse les relations entre les aspects cliniques, comportementaux, neuropsychologiques et l'imagerie (présence ou non d'« Objets Brillants Non Identifiés » caractéristiques de la NF1). Les difficultés d'apprentissage, malgré une qualité de vie plutôt bonne et un faible impact de la maladie, les troubles attentionnels et l'anxiété de l'enfant constituaient les principales sources d'inquiétude des parents. Les questionnaires étaient corrélés entre eux, mais ils étaient peu liés aux tests neuropsychologiques. La présence de difficultés cognitives spécifiques, en particulier visuo-spatiales et en motricité fine, a été confirmée. Aucune relation n'a pu être établie entre la neuropsychologie et l'imagerie. Les difficultés neuropsychologiques étaient plus sévères dans les formes familiales que sporadiques. / Cognitive and behavioral difficulties are common in children with Neurofibromatosis type 1 (NF1), however findings concerning the specific neuropsychological and behavioral profile as well as the association of these difficulties with clinical manifestations and brain imagery abnormalities are often contradictory. After a literature review, the present study: (i) describes behavioral, cognitive, and motor difficulties in 78 patients with NF1, aged 5 to 18 years, using parental questionnaires (quality of life, impact of illness, parental difficulties, Conners, BRIEF, CBCL), and tests of intellectual efficiency and specific neuropsychological functions; (ii) examines the relationships between clinical, behavioral, neuropsychological and imaging findings (presence or absence of "Unidentified Bright Objects" UBOs, characteristic feature of NF1). Learning disabilities, despite relatively good report of quality of life, attention disorders and child anxiety were the main parental concerns. All parental questionnaires were strongly inter-correlated, and associated with an overall positive or negative parental attitude during the interview with the psychologist. Parental concerns were only weakly related to neuropsychological tests. The presence of specific cognitive difficulties, particularly in visuospatial and fine motor skills, was confirmed. Imaging data were not associated with neuropsychological scores. Cognitive difficulties were more important in familial than sporadic forms.

No description available.

La neurofibromatose de type 1 (NF1) est une condition génétique entraînant des répercussions dans différents systèmes, y compris le système nerveux. Les enfants atteints de la NF1 sont à risque de rencontrer différents défis sur le plan cognitif et comportemental. Un chevauchement avec les symptômes associés à d’autres troubles neurodéveloppementaux, notamment le trouble déficitaire de l’attention avec ou sans hyperactivité (TDAH) et le trouble du spectre de l’autisme (TSA), est d’ailleurs présent dans cette condition génétique. Les études réalisées avec des modèles animaux de NF1 ont permis d’identifier des déséquilibres dans la neurotransmission qui pourraient sous-tendre les déficits cognitifs. Comment ces déséquilibres se traduisent sur le plan de l’activité cérébrale chez l’humain ayant la NF1 demeure peu compris à ce jour. L’objectif général de cette thèse est donc d’étudier, à l’aide de l’électroencéphalographie (EEG), les réponses neuronales lors du traitement sensoriel chez les enfants ayant la NF1 ainsi que les associations avec le fonctionnement cognitif et comportemental. Dans le premier article, nous avons étudié l’intégrité de la réponse de synchronisation neuronale lors de stimulations visuelles rythmiques à différentes fréquences. Considérant l’importance des déficits visuo-perceptifs ainsi que les indices de perturbations de la transmission GABAergique au niveau du cortex occipital dans la NF1, nous avons émis l’hypothèse d’une réduction de la synchronisation neuronale dans le groupe NF1 par rapport au groupe d’enfants neurotypiques. Une puissance réduite de la synchronisation neuronale a effectivement été trouvée dans la NF1, particulièrement en réponse à la plus haute fréquence de stimulation. Cette réponse neuronale affaiblie a été corrélée à une plus grande sévérité des symptômes comportementaux du TDAH. Cela soulève la possibilité d’une modulation de la réponse sensorielle par les réseaux attentionnels et soulève également des questions en lien avec l’impact du diagnostic de TDAH en comorbidité avec la NF1. L’impact de la médication psychostimulante, testé avec un sous-groupe de l’échantillon NF1, s’est d’ailleurs révélé par une amélioration de la réponse de synchronisation neuronale à la plus faible fréquence de stimulation. La réponse de synchronisation neuronale apparait donc comme un marqueur à investiguer davantage pour comprendre les mécanismes qui sous-tendent les déficits cognitifs dans la NF1 et pour évaluer l’impact de traitements. Dans le deuxième article, nous avons étudié les oscillations cérébrales dans la réponse de suppression neuronale et de détection du changement, toujours en comparant un groupe d’enfants ayant la NF1 à un groupe d’enfants neurotypiques. Une modulation atypique des oscillations cérébrales était attendue dans la NF1 en réponse à la répétition et au changement dans la séquence de stimuli audio-visuels. Les résultats ont démontré une réponse de suppression neuronale préservée dans le groupe NF1, mais une puissance accrue des oscillation thêta dans la condition de détection du changement. Les symptômes comportementaux du TDAH ont été associés à une réduction de la puissance des oscillations dans la réponse de détection du changement et ne contribueraient donc pas à la réponse accrue identifiée dans le groupe NF1. En somme, les résultats de la thèse ont permis d’identifier des particularités dans les réponses électrophysiologiques du traitement sensoriel chez les enfants ayant la NF1 et de mettre de l’avant des mesures dont le potentiel translationnel pourrait faciliter le transfert des connaissances accumulées dans les modèles animaux de NF1. Les résultats soulignent la complexité d’établir les bases neuronales des déficits cognitifs dans la NF1 compte tenu de l’hétérogénéité du profil cognitif. Cela dit, les associations établies entre les réponses neuronales et les symptômes comportementaux du TDAH suggèrent la possibilité de considérer le profil électrophysiologique pour guider le développement de traitements et interventions visant à améliorer le fonctionnement cognitif chez les enfants ayant la NF1. / Neurofibromatosis type 1 (NF1) is a genetic condition that has implications across different systems, including the nervous system. Children with NF1 are at risk of facing various cognitive and behavioral challenges. An overlap with symptoms associated with other neurodevelopmental disorders, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), is also present in this genetic condition. Studies conducted using animal models of NF1 have identified imbalances in neurotransmission that may underlie cognitive deficits. However, how these imbalances translate into human brain activity in individuals with NF1 remains poorly understood to date. The overall objective of this thesis is to investigate, using electroencephalography (EEG), neural responses during sensory processing in children with NF1 and their associations with cognitive and behavioral functioning. In the first article, we studied the integrity of the neural synchronization response during rhythmic visual stimulation at different frequencies. Given the significance of visuo-perceptual deficits as well as indications of disrupted GABAergic transmission in the occipital cortex of individuals with NF1, we hypothesized a reduction in neural synchronization in the NF1 group compared to neurotypical children. Reduced power of neural synchronization was indeed found in NF1, particularly in response to the highest stimulation frequency. This weakened neural response was correlated with greater severity of ADHD behavioral symptoms. These results suggest a possible modulation of this sensory response by attentional networks and raise questions regarding the impact of comorbid ADHD diagnosis on neural activity in NF1. The intake of psychostimulant medication, in a subgroup of the NF1 sample, resulted in an increased neural synchronization at the lowest stimulation frequency. Neural synchronization should be further investigated as a potential biomarker in NF1 and could help understand the underlying mechanisms of cognitive deficits and assess the impact of treatments. In the second article, we studied brain oscillations in the repetition suppression and change detection response, again comparing a group of children with NF1 to a group of neurotypical children. Atypical modulation of brain oscillations was expected in NF1 in response to repetition and change in the audio-visual stimuli sequence. Results showed preserved repetition suppression response in the NF1 group, but increased power of theta oscillations in the change detection condition. Behavioral symptoms of ADHD were associated with reduced oscillatory power in the change detection response, which suggest that the ADHD comorbidity did not contribute to the increased response identified in the NF1 group. In summary, results of this thesis have demonstrated distinct electrophysiological responses during sensory processing in children with NF1 and have highlighted measures with translational potential that could facilitate the transfer of knowledge gained from animal models of NF1. The results emphasize the complexity of establishing the neural basis of cognitive deficits in NF1, given the heterogeneity of the cognitive profile. However, the associations established between neural responses and ADHD behavioral symptoms suggest the possibility of considering the electrophysiological profile to guide the development of treatments and interventions aimed at improving cognitive functioning in children with NF1.

Einleitung: Die Entdeckung somatischer homoplasmischer Mutationen der mitochondrialen DNA (mtDNA) in Tumoren gab Anlass zu der Frage, ob Mutationen der mtDNA einen Einfluss auf Entstehung und Wachstum von Tumoren haben könnten. Die Neurofibromatose Typ 1 (NF1, von Recklinghausen) ist eine der häufigsten erblichen Tumorerkrankungen mit einer Penetranz von 100%, aber hoher phänotypischer Variabilität. Selbst eineiige Zwillinge können sich erheblich in ihrem Phänotyp unterscheiden. Durch die ungleiche Verteilung der Mitochondriengenome auf die Embryonen könnten heteroplasmische mtDNA-Polymorphismen den Phänotyp der Neurofibromatose Typ 1 unterschiedlich beeinflussen. Ziel dieser Arbeit war es herauszufinden, ob es interindividuelle Unterschiede in der mtDNA-Sequenz monozygoter Zwillinge gibt, die an Neurofibromatose Typ 1 erkrankt sind, sich jedoch im Phänotyp unterscheiden. Des Weiteren habe ich nach intraindividuellen Unterschieden der mtDNA-Sequenz zwischen Blut und Tumorgewebe gesucht. Die Frage war, ob es somatische mtDNA-Mutationen gibt, die einen Einfluss auf das Entstehen der Tumore haben könnten. Innerhalb der mtDNA gibt es hypervariable Regionen (HVR), von denen der oft in heteroplamischer Form vorkommende D310-Trakt im D-loop als Marker für klonales Wachstum in Tumoren empfohlen wurde. Ich habe versucht, durch Analyse des D-loops der mtDNA aus Neurofibromen klonales Wachstum nachzuweisen. Methoden: Ich habe die mitochondriale DNA vier monozygoter Zwillingspaare untersucht. Die DNA wurde sowohl aus Blutleukozyten als auch aus Neurofibromen extrahiert. Ich habe zunächst mit mtDNA-spezifischen Primern eine Long-range PCR durchgeführt. Mit dem Long-range PCR-Produkt als Matrize habe ich in 17 verschachtelten PCR Reaktionen Fragmente generiert und diese sequenziert. Den relativen Anteil heteroplasmischer Längenvarianten des D310-Traktes ermittelte ich mittels Genotypisierung. Ergebnisse: Beim Vergleich der mtDNA-Sequenzen mit der mtDNA Standardsequenz (Genbank, NC_001807) habe ich insgesamt 88 Abweichungen gefunden. Die meisten waren in der Datenbank Mitomap verzeichnet. Es fanden sich keine interindividuellen Unterschiede innerhalb der einzelnen Paare. Beim Vergleich der mtDNA-Sequenzen aus Blut- mit denen aus Tumorzellen eines Zwillingspaares fand ich keinen intraindividuellen Unterschied. Der D310-Trakt innerhalb der HVR2 kam bei allen Zwillingspaaren in heteroplasmischer Form vor. Bei den Zwillingen A1 und A2 sowie deren Mutter MA konnte ich annähernd die gleiche Verteilung der Löngenvarianten in Blutzellen sowie in Neurofibromen von A1 und A2 zeigen. Schlussfolgerungen: Ich konnte keinen Hinweis dafür finden, dass Veränderungen in der mtDNA die phänotypische Ausprägung der NF1 beeinflussen. In Neurofibromen konnte ich durch Untersuchung des D310-Traktes keinen Hinweis auf klonales Wachstum finden. / Introduction: The discovery of homoplasmic somatic mutations of the mitochondrial DNA (mtDNA) led to the question whether mutations of mtDNA could influence tumor development and growth. Neurofibromatosis Type 1 (NF1) is one of the most common inherited disorders. Penetrance of the disease is 100%, but phenotypic variability is high, even amongst identical twins. I wanted to test the hypothesis, whether the unequal distribution of heteroplasmic mtDNA variants between the embryos might influence NF1 phenotype. The aim of this study was to look for interindividual differences of the mtDNA sequence between identical twins. In order to detect somatic mutation that could possibly influence tumor development I searched for intraindividual differences between blood- and tumor-mtDNA. The hypervariable D310-tract within the D-loop is heteroplasmic in most individuals, but shows a tendency towards homoplasmy in tumors. Therefore, it has been proposed as marker for clonal tumor growth. I tried to identify clonal growth in cutaneous neurofibromas by examination of the D310-tract. Methods: I examined the mtDNA from four pairs of identical twins. MtDNA was extracted from blood-leucocytes as well as from neurofibromas. With DNA-specific primers I first performed a long-range PCR. The product was then reamplified as 17 nested PCR fragments and sequenced afterwards. The relative amount of heteroplasmic D310-tract length variants was analyzed by genotyping. Results: Taken together, I identified 88 deviations from the mtDNA standard sequence (Genbank NC_001807). Most of these variants were already known as polymorphisms in the database MITOMAP. I could neither find any interindividual differences between the individuals of a twin pair nor intraindividual differences between blood- and tumor-mtDNA. The D310-tract was heteroplasmic in all twin pairs. Twins A1 and A2 as well as their mother showed almost the same distribution of length variants in blood and tumor. Conclusion: I could not show that mtDNA polymorphisms play a role in phenotypic variability of NF1. Examination of the D310 tract in cutaneous neurofibromas did not show signs of clonal growth.

Made available in DSpace on 2016-01-26T12:51:47Z (GMT). No. of bitstreams: 1 fabianomoraisnogueira_dissert.pdf: 1824799 bytes, checksum: 73140945d3aa23f7080cfee361148ad6 (MD5) Previous issue date: 2013-07-11 / Introduction: Neurofibromatosis type 1 (NF1) is among the most common genetic disorders caused by mutations on chromosome 17 and characterized by a broad spectrum of clinical manifestations. Scoliosis is one of the most frequently musculoskeletal alterations and may be accompanied by dystrophic changes and tumor-related spine. Objective: To identify the prevalence of tumors and dystrophic changes in the spine of children and adolescents with neurofibromatosis type 1 assessed by magnetic resonance imaging and to analyze possible correlations between these findings and the presence of spinal deformities. Methods: Twenty-two patients with NF1, less than 21 years, underwent clinical and magnetic resonance imaging of the spine between September 2009 and July 2011. The group had 13 girls and 9 boys, with a mean age of 13.04 years (range 4-20 years). Only patients with clinical evidence of scoliosis were subjected to x-ray total spine for measuring the Cobb angle. Statistical analysis was performed using the Statistical Analysis Systems. The level of significance for all tests was 5%. Results: Scoliosis was diagnosed in 13 patients at the apex of the curve in the thoracic region predominantly represented by nine patients (69.23%). Excluding 3 patients did not undergo X-ray, 4 patients presented with dystrophic scoliosis mean Cobb angle of 57.75 degrees and 6 patients with non-dystrophic scoliosis and average Cobb angle of 15.33 degrees (p=0.0017). Neurofibromas associated to the spine were present in 9 patients (40.91%) and predominated in children older than 12 years (77.7%) but without statistical significance (p=0.2031). Among the patients with neurofibromas, 6 patients (66.7%) had associated with scoliosis (p=0.674). The dystrophic changes were found in 5 patients (22.72%), all with scoliosis. The vertebral erosion was the most frequent finding dystrophic, with 31 lesions in 25 vertebrae, mostly located in the posterior region of the vertebra and thoracic spine (54.84%). The vertebral erosions were associated with scoliotic curve in 96.7% of cases, dural ectasia in 87.5% of cases and patients with the greatest number of these lesions had a higher magnitude of their curves (Pearson=0.8275; p=0.0838). One patient had multiple meningoceles and one patient had two ribs intracanal, both associated with dystrophic curves. Conclusion: The evaluation with magnetic resonance imaging of the spine was able to identify the main tumor and dystrophic changes, correlate with the presence of vertebral deformities and analyze their distribution area of the curve. The vertebral erosion was the most common finding in dystrophic scoliosis curve and showed a tendency of correlation between the curves more severe and patients with higher number of vertebrae eroded. Neurofibromas that were associated with the spine were mainly found in the older children and tended to occur more frequently in the patients with scoliosis. In both cases, studies with larger samples are needed to assess whether these trends are evident. / Introdução: A neurofibromatose tipo 1 (NF1) está entre as desordens genéticas mais comuns causada por mutações no cromossomo 17 e caracterizada por um amplo espectro de manifestações clínicas. A escoliose é uma das alterações musculoesqueléticas mais frequentes, podendo estar acompanhada por lesões distróficas e tumorais associadas a coluna. Objetivo: Identificar a prevalência das alterações distróficas e tumorais presentes na coluna vertebral de crianças e adolescentes portadores de NF1 avaliados por imagens de ressonância magnética, bem como analisar possíveis correlações entre esses achados e a presença de deformidades espinhais. Casuística e Métodos: Vinte e dois pacientes portadores de NF1, menores de 21 anos, foram submetidos a exames clínicos e de ressonância magnética da coluna vertebral entre setembro de 2009 e julho de 2011. O grupo apresentava 13 meninas e 9 meninos, com idade média de 13,04 anos (variação de 4 a 20 anos). Apenas os pacientes com evidências clínicas de escoliose foram submetidos ao raio x de coluna total para medição do ângulo de Cobb. A análise estatística foi realizada no programa Statistical Analysis Systems. O nível de significância adotado foi de 5%. Resultados: A escoliose foi diagnosticada em 13 pacientes com ápice da curva predominando na região torácica (69,23%). Excluindo-se 3 pacientes não submetidos ao raio X de coluna total, 4 pacientes apresentavam escoliose distrófica com ângulo de Cobb médio de 57,75 graus e 6 pacientes com escoliose não distrófica e ângulo de Cobb médio de 15,33 graus (p=0,0017). Os neurofibromas associados à coluna vertebral estavam presentes em 9 pacientes e predominavam nas crianças maiores de 12 anos (77,7%) porém sem significância estatística (p=0,2031). Entre os portadores de neurofibromas, 6 pacientes (66,7%) apresentavam associação com escoliose (p=0,674). As alterações distróficas foram encontradas em 5 pacientes (22,72%), todos com escoliose. A erosão vertebral foi o achado distrófico mais frequente, sendo 31 lesões distribuídas em 25 vértebras, a maioria localizada concomitantemente na região posterior da vértebra e no segmento torácico da coluna (54,84%). As erosões vertebrais estavam associadas à curva escoliótica em 96,7% dos casos, a ectasias durais em 87,5 % dos casos e pacientes com maior número dessas lesões apresentavam maior magnitude de suas curvas (Pearson=0,8275; p=0,0838). Um paciente apresentou múltiplas meningoceles e um paciente apresentou duas costelas intracanal, ambos associados a curvas distróficas. Conclusão: A avaliação das imagens de ressonância magnética da coluna vertebral, foram capazes de identificar as principais alterações distróficas e tumorais, correlacionar com a presença de deformidades vertebrais e analisar sua distribuição em relação à área da curva. A erosão vertebral foi o achado mais frequente nas escolioses distróficas com uma tendência de correlação entre as curvas mais graves e maior número de vértebras erodidas. Neurofibromas associados a coluna predominaram nas crianças mais velhas e tenderam a ocorrer mais frequentemente em pacientes com escoliose. Em ambos os casos, estudos com maior casuística são necessários para que essas tendências sejam evidenciadas.

<p>Microarray-based comparative genomic hybridization (array-CGH) has emerged as a versatile platform with a wide range of applications in molecular genetics. This thesis focuses on the development of array-CGH with a specific aim to approach disease-related questions through improved strategies in array construction and enhanced resolution of analysis. In <b>paper I</b>, we applied an array covering 11 Mb of 22q, encompassing the <i>NF2</i> locus, for deletion detection in sporadic schwannoma. Hemizygous deletions and tumor heterogeneity were identified. Array-CGH was established as a reliable platform for detection of DNA dosage alterations. <b>Paper II</b> described the construction of the<i> NF2</i> gene-specific microarray for high-resolution scanning of deletions in the <i>NF2</i> locus. We report a novel PCR-based non-redundant strategy for microarray fabrication, which considerably improved the sensitivity and reliability of deletion detection. <b>Paper III</b> reported the first tiling-path array comprehensively covering a human chromosome. The usefulness of the 22q-array was demonstrated by applying it to detect DNA dosage-alterations in 22q-associated disorders. In <b>paper IV</b>, we optimized array-CGH protocols for deletion detection in 22q11 deletion-syndrome. We showed that genomic and cDNA clones are not optimal for analysis of 22q11 locus and that PCR-based non-redundant strategy is reliable for deletion detection in such regions. In <b>paper V</b>, we utilized the 22q-array for understanding the genetic basis of schwannomatosis. Two commonly deleted regions were identified within the <i>IGL</i> and the <i>GSTT1/CABIN1</i> loci. Further investigations using high-resolution arrays, bioinformatic analysis and mutational screening were performed. Missense mutations, specific to the schwannomatosis- and NF2 samples, were identified in the <i>CABIN1 </i>gene. <b>Paper VI</b> described the first array-CGH study for comprehensive and high-resolution profiling of deletions spanning the 17q11 locus. Both typical and atypical deletions were identified in NF1 samples. Bioinformatic analysis revealed novel segmental duplications, which can potentially mediate 17q11 deletions.</p>

Microarray-based comparative genomic hybridization (array-CGH) has emerged as a versatile platform with a wide range of applications in molecular genetics. This thesis focuses on the development of array-CGH with a specific aim to approach disease-related questions through improved strategies in array construction and enhanced resolution of analysis. In <b>paper I</b>, we applied an array covering 11 Mb of 22q, encompassing the NF2 locus, for deletion detection in sporadic schwannoma. Hemizygous deletions and tumor heterogeneity were identified. Array-CGH was established as a reliable platform for detection of DNA dosage alterations. <b>Paper II</b> described the construction of the NF2 gene-specific microarray for high-resolution scanning of deletions in the NF2 locus. We report a novel PCR-based non-redundant strategy for microarray fabrication, which considerably improved the sensitivity and reliability of deletion detection. <b>Paper III</b> reported the first tiling-path array comprehensively covering a human chromosome. The usefulness of the 22q-array was demonstrated by applying it to detect DNA dosage-alterations in 22q-associated disorders. In <b>paper IV</b>, we optimized array-CGH protocols for deletion detection in 22q11 deletion-syndrome. We showed that genomic and cDNA clones are not optimal for analysis of 22q11 locus and that PCR-based non-redundant strategy is reliable for deletion detection in such regions. In <b>paper V</b>, we utilized the 22q-array for understanding the genetic basis of schwannomatosis. Two commonly deleted regions were identified within the IGL and the GSTT1/CABIN1 loci. Further investigations using high-resolution arrays, bioinformatic analysis and mutational screening were performed. Missense mutations, specific to the schwannomatosis- and NF2 samples, were identified in the CABIN1 gene. <b>Paper VI</b> described the first array-CGH study for comprehensive and high-resolution profiling of deletions spanning the 17q11 locus. Both typical and atypical deletions were identified in NF1 samples. Bioinformatic analysis revealed novel segmental duplications, which can potentially mediate 17q11 deletions.

Introdução: A Neurofibromatose tipo 1 (NF1) é uma doença genética autossômica dominante causada por mutação no gene NF1 (17q11.2; proteína neurofibromina). A incidência é de aproximadamente 1:3500 recém-nascidos e o diagnóstico clínico é possível na maioria dos casos. Alguns estudos sugeriram que pacientes com NF1 são mais suscetíveis a apresentar deficiência de vitamina D quando comparados à população geral. Objetivo: Determinar os níveis de 25(OH)D em indivíduos com NF1 e em controles saudáveis. Nos pacientes com NF1 nos também avaliamos o fenótipo clínico e analisamos polimorfismos comuns do gene VDR (BsmI e FokI) para avaliar se estavam correlacionados com os níveis de 25(OH)D. Métodos: Estudo de caso-controle que incluiu 45 pacientes com NF1 do Sul do Brasil e 45 controles saudáveis pareados por idade, sexo e tipo de pele de acordo com a classificação de Fitzpatrick. Resultados e Conclusões: Setenta e sete vírgula oito por cento dos 90 sujeitos de pesquisa apresentaram níveis de 25(OH)D abaixo de 30ng/ml. Deficiência de 25(OH)D (<20ng/mL) foi observada em 28 (31,1%) e insuficiência (de 20 a 30ng/mL) em 42 (46,6%). Deficiência ou insuficiência de 25(OH)D não foi mais frequente em pacientes com NF1 do que em controles (p=0,074). Nos não observamos qualquer associação entre os polimorfismos do gene VDR e os níveis de vitamina D sugerindo que o fenótipo da insuficiência ou deficiência bioquímica de 25(OH)D nos pacientes estudados não está associado com essas variantes genéticas. / Introduction: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder caused by mutations in the NF1 gene (17q11.2, neurofibromin). The estimated incidence is approximately 1:3500 newborns and clinical diagnosis is possible in the majority cases. A few studies suggest that patients with NF1 are more likely to have vitamin D deficiency when compared to the general population. Objectives: The goal of the study was to determine the levels of 25-OH-vitamin D [25(OH)D] in individuals with NF1 and disease-unaffected controls. In NF1 patients we also assessed clinical phenotype and analyzed common VDR gene polymorphisms (BsmI and FokI) to verify whether they were associated with lower vitamin D levels. Methods: Case-control study that included 45 NF1 patients from Southern Brazil and 45 healthy controls matched by sex, skin type and age to the cases. Results and conclusions: Overall, 70 (77.8%) of the individuals studied had levels of 25(OH)D below 30ng/ml: vitamin D deficiency was observed in 28 (31.1%) and vitamin D insufficiency in 42 (46.6%) subjects. 25(OH)D deficiency or insufficiency were not more frequent in NF1 patients than in controls (p=0,074). We did not observe an association of VDR gene polymorphisms and vitamin D levels suggesting that the insufficient or deficient biochemical phenotypes in the patients studied here are not associated with these genetic variants.