Cholesterol is essential for many life processes, including correct development, fluidity of cell membranes, production of steroid hormones and bile acids, and is a major component of myelin. Smith-Lemli-Opitz Syndrome (SLOS) and Niemann-Pick disease type C (NPC) are devastating diseases and both involve dysregulation of cholesterol homeostasis. SLOS is caused by a defect in 7-dehydrocholesterol reductase (DHCR7), resulting in increased levels of 7-dehydrocholesterol (7DHC) and decreased levels of cholesterol. On the other hand, NPC is caused by defects in NPC1 or NPC2. These genes encode two lysosomal proteins that are responsible for the transport of cholesterol and other lipids out of lysosomes. Consequently, defects in these proteins results in accumulation of unesterified cholesterol within late endosomes/lysosomes. The severity ranges of both disorders are broad, and no or limited therapeutic options are available. This thesis aimed to establish the incidence and mechanisms behind SLOS and NPC in order to aid development of novel therapeutic interventions. Using a bioinformatics approach, <b>Chapter 2</b> showed that the estimated incidences of classical SLOS and NPC were similar to clinical reports. However, the analysis suggested that a late onset form of NPC1 could be more prevalent. <b>Chapter 3</b> investigated the behavioural phenotype of the SLOS Dhcr7^{T93M/&Delta;3-5} mouse model and it was found that some parallels could be drawn to the behaviour observed in SLOS patients. It also highlighted some defects in neuro-anatomy that could potentially explain certain cognitive defects. <b>Chapter 4</b> explored the suggestion of oxidative stress in the Dhcr7^{T93M/&Delta;3-5} mouse model. However, this study did not support a role for oxidative stress in this model. Genetic insights were generated via an RNAseq study on SLOS and NPC patient fibroblasts, which suggested that the WNT signalling pathway could play a role in the pathogenesis of SLOS. This pathway was also highlighted when the cells were treated with miglustat, the only approved therapy for NPC. However, the main pathway apparently affected by this drug in both SLOS and NPC was cell proliferation.

Niemann-Pick Type C (NPC) disease is an autosomal recessive disorder that results in accumulation of unesterified cholesterol in late endosomes/lysosomes (LE/Ls), leading to progressive neurodegeneration and premature death. Microglia are resident immune cells of the central nervous system, which upon activation can secrete potentially neurotoxic molecules such as tumor necrosis factor-alpha (TNFα). Inappropriate activation of microglia has been implicated in NPC disease. Primary microglia cultures from the cerebral cortex of Npc1-/- mice have an altered cholesterol distribution characteristic of NPC-deficient cells. Immunocytochemical analysis revealed increased TNFα staining in Npc1-/- microglia. However, Npc1-/- and Npc1+/+ microglia showed similar mRNA levels of pro-inflammatory cytokines and similar levels of TNFα secretion. To determine whether Npc1-/- microglia contribute to neuron death in NPC disease, microglia were co-cultured with cerebellar granule cells. Surprisingly, the extent of neuronal death was the same in neurons cultured with Npc1+/+ or Npc1-/- microglia. Thus, Npc1-/- microglia have an altered phenotype compared to Npc1+/+ microglia, but this does not lead to neuron death in an in vitro co-culture system. Treatment options for NPC disease remain limited. A consequence of cholesterol sequestration in the LE/Ls, is that cholesterol movement to the endoplasmic reticulum, where cholesterol metabolism is regulated, is impaired. Cyclodextrin (CD), a compound that binds cholesterol, has recently been found to delay the onset of neurological symptoms and prolong life of Npc1-/- mice. Since the brain consists of both neurons and glia, it remains unclear if CD acts directly on neurons and/or other cells in the brain. Neurons cultured from the cerebellum and astrocytes cultured from the cortex of Npc1-/- mice were treated with a low dose (0.1mM) of CD. This treatment decreased cholesterol sequestration and decreased the rate of cholesterol synthesis in Npc1-/- neurons and astrocytes. CD also decreased mRNAs encoding proteins involved in cholesterol synthesis in Npc1-/- neurons and increased genes involved in cholesterol efflux in Npc1-/- astrocytes. Moreover, CD increased cholesterol esterification in Npc1-/- astrocytes. These results suggest that cholesterol trapped in LE/Ls in Npc1-/- neurons and astrocytes was released by CD treatment and reached the ER, thereby regulating cholesterol homeostasis. / Experimental Medicine

No description available.

Niemann Pick Type C (NPC) disease is a fatal childhood neurological disease caused by mutations in the NPC-1 protein, resulting in cholesterol buildup in the late endosomes. StarD4 and StarD5 are cholesterol binding proteins that play a role in the intracellular cholesterol transport. In this study we overexpress StarD4 and StarD5 in in vitro and in vivo models, and find evidence of amelioration of the NPC phenotype. This study demonstrates that the overexpression of these proteins has the potential to be a therapeutic treatment for NPC disease.

The Niemann-Pick type C (NPC) disease is a lysosomal lipid storage disorder caused by mutations in one of the two genes NPC1 or NPC2 encoding proteins of the late endosome/lysosome compartment (LE/LY). Defect in these proteins alters vesicular transport and leads to abnormal accumulation of cholesterol (Chol) in LE/LY. There are some lines of evidence suggesting that annexin A6 (AnxA6) participates in vesicular transport of Chol and may interact with membrane domains enriched in Chol and bind Chol. In this work we characterized the membrane microdomains resistant to Triton X-100, i.e., detergent-resistant membranes (DRMs) isolated from NPC patient-derived fibroblasts and from control cells. NPC cells contain a significantly higher amount of DRMs than the control cells that is consistent with the defect in Chol turnover in NPC cells. We also studied the mechanism of AnxA6 involvement in the NPC-induced changes in the membrane organization and showed that in the presence of calcium some AnxA6 molecules associate with the DRMs. This suggests that AnxA6 may play a role in the membrane lateral organization, contributing thus to the etiology of NPC disease. We then focused on the interaction of AnxA6-1 with Chol-rich membranes and on the involvement of its flexible region and VAAEIL sequence in these interactions. For this purpose, kinetics of the interfacial adsorption of human recombinant AnxA6 to Langmuir monolayers containing phosphatidylcholine, Chol and/or cholesteryl acetate were measured. Our data suggest that AnxA6 exhibits the highest affinity to Chol-containing monolayers and that the hydroxyl group of Chol plays a pivotal role in the AnxA6-lipid interactions in vitro.

No description available.

La maladie de Niemann-Pick type C (NP-C) est une maladie autosomal récessive rare neurodégénérative, pan-ethnique et avec variabilité phénotypique. La forme classique se trouve chez les patients juvéniles, mais des patients de tous les âges existent. Les symptômes incluent des signes viscéraux, moteurs et neurologiques. La maladie est causée par une mutation dans le gène NPC1 ou NPC2. La prévalence mondiale se trouve à environ un cas par 100 000 naissances, mais varie beaucoup selon les populations. Pour cette raison, nous avons voulu identifier et classifier des variants qui se trouve dans la population québécoise pour faire une estimation de la prévalence de NP-C au Québec. Nous croyons que cette maladie neurodégénérative est sous-diagnostiquée. Pour identifier le pool génétique de la population québécoise, nous avons utilisé une approche bio-informatique. À l’aide des données de séquençage des 1109 participants sains de la cohorte CARTaGENE, nous avons identifié des variants rares, ayant des fréquences alléliques inférieures à 1%, dans les gènes NPC1 et NPC2. Les données de séquençage de l’ARN et d’exome ont été alignées, les variants ont été détectés et annotés avec différents scores de pathogénicité. Les variants ont ensuite été classifiés à l’aide des lignes directrices de l’ACMG. À l’aide de notre pipeline bio-informatique, nous avons identifié 37 variants rares. Parmi ces variants, un, p.I1061T, a été classifié comme pathogénique comme il l’est dans d’autres bases de données et un, p.P543L, initialement classifié comme potentiellement pathogénique a été classifié comme pathogénique dans notre population. Le variant p.P543L est d’ailleurs possiblement une mutation fondatrice chez les Canadiens-Français. La prévalence mesurée à l’aide des fréquences alléliques de ces deux variants est de 0,61 cas par 100 000 naissances. Cette étude a permis d’identifier deux variants pathogéniques dans une population saine, c’est-à dire sans maladie neurodégénérative connue. Nous avons ensuite pu estimer pour la première fois la prévalence minimale de NP-C au Québec. Les résultats suggèrent que NP-C est sous-diagnostiquée dans notre population. Avec ces informations, les méthodes de diagnostic pourront être ajustées pour accélérer la détection de NP-C au Québec et ainsi aider les patients en donnant accès au traitement disponible pour réduire les symptômes neurologiques. / Niemann-Pick type C disease (NP-C) is a rare autosomal recessive neurodegenerative, pan-ethnic disease with heterogenous symptoms. The classical form mainly affects juvenile patients, but patients of varying ages exist. The main symptoms are visceral, motor and neurological. The disease is caused by mutations in the NPC1 or NPC2 gene. The worldwide prevalence is approximately one case per 100 000 births but varies between populations. Therefore, we wanted to identify and classify rare variants found in Quebec’s population to estimate the prevalence of NP-C in this population. We hypothesized that NP-C is under-diagnosed in Quebec. To determine the genetic pool of NP-C in Quebec’s population, we used a bioinformatics pipeline. With the sequencing data of 1109 healthy individuals of the CARTaGENE cohort, we identified rare variants, with a minor allele frequency inferior to 1%, in the NPC1 and NPC2 genes. The sequencing data from RNA and exome sequencing was aligned and the variants were found and annotated with different pathogenicity scores. The variants were then classified using the ACMG guidelines. Using our bioinformatics pipeline, we identified a total of 37 rare variants. In those variants, one, p.I1061T, was directly classified as pathogenic since it was classified as that in all databases. The other one, p.P543L, was initially classified as likely pathogenic, but we were able to reclassify it as pathogenic in our population. The p.P543L variant is possibly a founder mutation in the French-Canadian population. Next, we estimated the prevalence based on the allelic frequencies of those two variants in our cohort. We found a prevalence of 0,61 case per 100 000 births. This study allowed us to identify two pathogenic variants in a healthy population, without known neurodegenerative disease. We were also able to estimate the first ever minimal prevalence for NP-C in Quebec. Our results suggests that NP-C is underdiagnosed in our population. With the information collected here, we would be able to adjust the diagnostic methods of NP-C in Quebec to then be able to help the patients by giving them access to the available treatment to reduce neurological symptoms.

M. Niemann-Pick Typ C (NPC) ist eine juvenile Demenz mit intrazellulärer Anreicherung von freiem Cholesterin, M. Alzheimer (AD) eine senile Demenz, die mit einem Polymorphismus im Gen des Cholesterintransportproteins Apolipoprotein E (ApoE) assoziiert ist. Bei beiden Erkrankungen treten im Gehirn zahlreiche neurofibrilläre Tangles (NFT), bestehend aus Protein Tau, auf. Es sollte mit einer für freies Cholesterin spezifischen Filipin-Färbung herausgefunden werden, ob sich bei beiden Erkrankungen der Cholesteringehalt Tangle-tragender Neurone von dem Tangle-freier unterscheidet. Zur Verfügung standen diverse Teile aus dem Zentralen Nervensystem von 5 NPC- und Gyri temporales superficiales von 9 AD-Fällen. In Material von 3 NPC-Fällen und 1 AD-Fall fanden sich intraneuronale, mit Tangles assoziierte Cholesterinakkumulationen. In 3 AD-Fällen fanden sich außerdem Cholesterinakkumulationen in Assoziation mit Senilen Plaques. Der Cholesteringehalt Tangle-tragender Neurone war in 6 Regionen der NPC-Fälle und in 3 AD-Fällen erhöht. Für alle Neuronenpaare der AD-Fälle insgesamt ergab sich ein erhöhter Cholesteringehalt des Tangle-tragenden Neurons. Cholesterinspeicherung im NPC-Hirn könnte über oxidativen Stress oder eine Veränderung der cholesterinabhängigen Signaltransduktion zur Tangle-Bildung führen. Argumente für die Unterstützung der Tangle-Bildung durch Cholesterin über oxidativen Stress und veränderte Signaltransduktion in AD werden angeführt. Diese Untersuchung erlaubt, neue Hypothesen zu gemeinsamen Mechanismen der Tangle-Entstehung in AD und NPC zu formulieren. / Niemann-Pick type C disease (NPC) is a juvenile dementia with intracellular accumulation of free cholesterol, whereas Alzheimer s disease (AD) is a senile dementia associated with a gene polymorphism of a cholesterol transport protein, apolipoprotein E (apoE). In both conditions, there are abundant neurofibrillary tangles (NFT) in brain, consisting of protein tau. This study addresses the issue whether cholesterol content of tangle-bearing neurons is the same compared to tangle-free neurons, in both diseases. For this purpose, staining with the free cholesterol-specific fluorochrome filipin was used. Several CNS tissue specimen of 5 NPC cases and superior temporal gyri of 9 AD cases were available. In 3 NPC cases and 1 AD case, intraneuronal cholesterol accumulation were found associated with neurofibrillary tangles. Furthermore, cholesterol accumulations were found associated with senile plaques in 3 AD cases. Cholesterol content of tangle-bearing neurons was increased in 6 regions of the NPC cases and in 3 AD cases. For all neurons analysed in AD, the tangle-bearing neuron showed more cholesterol than the adjacent tangle-free neuron. Cholesterol storage in NPC brain could lead to neurofibrillary degeneration by enhancing oxidative stress or by alterating cholesterol-dependent signal transduction. Cholesterol accumulation in AD neurons could lead to neurofibrillary degeneration by the same mechanisms. This study allows the creation of new hypotheses concerning common mechanisms of neurofibrillary degeneration in both Niemann-Pick type C and Alzheimer s diseases.

Niemann-Pick tipo C (NPC) é uma doença de depósito lisossomal, ocasionada por alterações no tráfico de colesterol não esterificado, decorrente de alterações bialélicas nos genes NPC1 ou NPC2, ambos definindo uma doença autossômica recessiva, progressiva e irreversível, caracterizada por manifestações viscerais, neurológicas e psiquiátricas, não necessariamente combinadas. Com o propósito de descrever as características fenotípicas e genotípicas de pacientes com NPC, objetivou-se relatar dados demográficos, formas clínicas classificadas por idade, sinais e sintomas neurológicos e psiquiátricos, achados de ressonância magnética (RM) de encéfalo e ultrassonografia de abdome, assim como teste de filipin, mutações observadas e o tratamento com N-butyldeoxynojirimycin (Miglustat). De uma casuística de 12 pacientes atendidos entre 2000-2014, por revisão de prontuários, no Ambulatório de Neurogenética do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, havia 7 mulheres e 5 homens, idade média de 20 anos (entre 2 e 42), sendo dez pacientes da etnia branca e dois mulatos, procedentes de 3 estados brasileiros: São Paulo, Mato Grosso do Sul e Minas Gerais. As formas clínicas identificadas foram infantil, juvenil e adulto. A idade do primeiro sintoma neurológico ocorreu entre 1 e 27 anos (media 9,5). Dentre os achados viscerais, dois pacientes encontravam-se assintomáticos, os demais apresentaram icterícia prolongada/colestase, hepatomegalia e esplenomegalia. Todos os pacientes apresentaram em diferentes momentos da evolução manifestações neuropsiquiátricas, tais como: paralisia do olhar vertical, ataxia/quedas, epilepsia, mioclonias, distonia, disartria, disfagia, fraqueza muscular, espasticidade, declínio cognitivo/demência, sintomas psicóticos, atraso escolar, distúrbio de comportamento, cataplexia gelástica e hipotonia neonatal. A idade de diagnóstico variou de 0 a 41 anos, com uma média de 14,5 anos. O tempo entre a idade do primeiro sintoma neurológico e o diagnóstico da doença variou de 0 a 14 anos, tempo médio de 5,3 anos. O teste de Filipin demonstrou seis resultados positivos e seis variantes. A RM de encéfalo apresentou três diferentes tipos de alteração: atrofia cerebral em 6 casos, atrofia cerebelar e desmielinização em 7. A ultrassonografia de Abdome resultou em três alterações: hepatomegalia em 8, esplenomegalia em 10 e hepatoesplenomegalia em 8. O resultado do teste genético molecular em 11 pacientes evidenciou alterações no gene NPC1 e uma paciente não possuía o resultado. A mutação c.3104C>T foi a mais frequente, em oito pacientes; c.3548G>A, de significado incerto, em um paciente, e, as demais mutações encontradas: c.3493G>A, c.3019C>G. O tratamento com N-butyl deoxynojirimycin (Miglustat) foi realizado por todos os pacientes, o tempo entre o diagnóstico e o início da medicação variou de 0 a 9 anos, média de 2,9 anos. Concluímos que o registro da doença NPC deve ser feito através de uma coleta de dados detalhada e contínua, pois sua heterogeneidade fenotípica e genotípica sugerem um número subestimado de casos, não só por sua raridade, mas também pelo desconhecimento da doença, já que há poucos grupos estudados e publicados. O seu reconhecimento precoce, associado ao adequado manejo clínico, podem retardar a progressão implacável da doença e aumentar a expectativa de vida dos pacientes. / Niemann-Pick type C (NPC) is a lysosomal storage disease caused by abnormal unesterified cholesterol trafficking, resulting from biallelic changes in NPC1 or NPC2 genes, both defining an autosomal recessive progressive and irreversible disease characterized by visceral, neurological and psychiatric manifestations, not necessarily combined. In order to describe the phenotypic and genotypic characteristics of patients with NPC, this work aimed to report demographic data, clinical forms classified by age, neurological and psychiatric signs and symptoms, brain magnetic resonance imaging (MRI) and abdominal ultrasound findings, Filipin test, the gene mutations, and the treatment with N-butyldeoxynojirimycin (Miglustat). A series of 12 patients were studied, treated between 2000-2014, by review of medical records of the Neurogenetics Clinic at the Hospital of Clinics, Ribeirão Preto Medical School, Brazil. There were 7 women and 5 men, mean age 20 years (from 2 to 42); 10 caucasian and 2 mulattos, coming from three Brazilian states: São Paulo, Mato Grosso do Sul and Minas Gerais. Infantile, Juvenile and adult clinical forms were identified. The age of the first neurological or psichiatric symptoms occurred between 1 and 27 years (mean 9.5). Among the visceral findings, two patients were asymptomatic, and the others had prolonged jaundice / cholestasis, hepatomegaly and splenomegaly. All patients had at different times of evolution symptoms, such as paralysis of vertical gaze, ataxia/falls, epilepsy, myoclonus, dystonia, dysarthria, dysphagia, muscle weakness, spasticity, cognitive decline/dementia, psychotic symptoms, school delay, disorders behavior, gelastic cataplexy and neonatal hypotonia. Age at diagnosis ranged from 0 to 41 years, with a mean of 14.5 years. The interval between the first signs of the disease and the onset of treatment ranged from zero to 14 years, with an average of 5.3 years. Filipin test resulted six positive and six variant form. The MRI scans showed three different types of changes: brain atrophy in 6 cases, cerebellar atrophy in 7 and demyelination in 7. Abdominal ultrasound revealed 8 patients with hepatomegaly, 10 with splenomegaly and 8 hepatosplenomegaly. The results of the molecular genetic testing on 11 patients showed changes in NPC1 gene and a patient did not have the result. Mutation c.3104C>T was more frequent in eight patients; c.3548G>A, of uncertain significance in a patient, and other mutations found: c.3493G>A and c.3019C>G. Treatment with N-butyl deoxynojirimycin (Miglustat) was carried by all patients; the time between diagnosis and beginning of the treatment ranged from 0 to 9, with an average of 2.9 years. We conclude that NPC disease registry should be done through a collection of detailed and continuous data because their phenotypic and genotypic heterogeneity suggest an underestimated number of cases, not only for its rarity but also by unawareness about the disease, and the fact that there are few published studies. The early recognition, coupled with appropriate clinical management, may slow the progression of the disease and increase life expectancy of patients.

La maladie de Niemann-Pick de type C (NPC) est une lipidose lysosomale complexe due à une mutation d’un des gènes NPC1 ou NPC2, qui codent pour ces protéines localisées dans les compartiments endo-lysosomaux (LE/LY). Leur absence altère le trafic intracellulaire et induit l’accumulation du cholestérol (Chol) dans les LE/LY. De plus, l’AnxA6 semble participer au transport vésiculaire du Chol en interagissant avec les microdomaines membranaires enrichis en Chol, ou avec le Chol lui-même. Dans ce travail, nous avons isolé des microdomaines membranaires résistant au Triton X-100 (également appelés DRMs pour detergent resistant membranes) à partir de lignée cellulaire NPC L1 ou de cellules saines. Les fibroblastes NPC contiennent plus de DRMs que les fibroblastes sains. Ceci semble être corrélé aux problèmes de transport du Chol dans les cellules NPC. Nous avons aussi montré qu’en présence de calcium, une partie de l’AnxA6 est associé aux DRMs, suggérant que l’AnxA6 participe à l’organisation de la membrane et par ce bias à l’étiologie de la maladie de NPC. Nous avons alors analysé les interactions de l’AnxA6-1 avec les microdomaines riches en Chol ainsi que l’implication de sa région flexible et de la séquence VAAEIL dans ces interactions. Leurs interactions avec des monocouches de Langmuir constituées de phosphatidylcholine, Chol et/ou d’acétate de cholestéryle. Nos résultats montrent que l’AnxA6 a la plus grande affinité pour les monocouches contenant du Chol ainsi que l’implication du groupement hydroxyle du Chol lors de ces interactions. / The Niemann-Pick type C (NPC) disease is a lysosomal lipid storage disorder caused by mutations in one of the two genes NPC1 or NPC2 encoding proteins of the late endosome/lysosome compartment (LE/LY). Defect in these proteins alters vesicular transport and leads to abnormal accumulation of cholesterol (Chol) in LE/LY. There are some lines of evidence suggesting that annexin A6 (AnxA6) participates in vesicular transport of Chol and may interact with membrane domains enriched in Chol and bind Chol. In this work we characterized the membrane microdomains resistant to Triton X-100, i.e., detergent-resistant membranes (DRMs) isolated from NPC patient-derived fibroblasts and from control cells. NPC cells contain a significantly higher amount of DRMs than the control cells that is consistent with the defect in Chol turnover in NPC cells. We also studied the mechanism of AnxA6 involvement in the NPC-induced changes in the membrane organization and showed that in the presence of calcium some AnxA6 molecules associate with the DRMs. This suggests that AnxA6 may play a role in the membrane lateral organization, contributing thus to the etiology of NPC disease. We then focused on the interaction of AnxA6-1 with Chol-rich membranes and on the involvement of its flexible region and VAAEIL sequence in these interactions. For this purpose, kinetics of the interfacial adsorption of human recombinant AnxA6 to Langmuir monolayers containing phosphatidylcholine, Chol and/or cholesteryl acetate were measured. Our data suggest that AnxA6 exhibits the highest affinity to Chol-containing monolayers and that the hydroxyl group of Chol plays a pivotal role in the AnxA6-lipid interactions in vitro.