Au cours de ma thèse, mes projets de recherche ont visé à mieux comprendre les mécanismes moléculaires contrôlant la prolifération et la spécification des cellules progénitrices dans la rétine du xénope à travers trois projets principaux. Le réseau de régulation qui contrôle la spécification des cellules progénitrices vers les sous-types neuronaux est à ce jour très peu connu. C’est dans ce contexte que j’ai étudié le rôle du facteur de transcription à domaine bHLH, Ascl1, dans la détermination des sous-types rétiniens au cours du développement. Par des approches in vivo de gain et perte de fonction d’Ascl1, des expériences d’épistasie et la recherche de ses cibles transcriptionnelles, j’ai pu mettre en évidence qu’Ascl1 (i) est impliqué dans la genèse des neurones GABAergiques rétiniens, (ii) qu’il est épistatique sur des facteurs glutamatergiques tels que Neurog2, NeuroD1 ou Atoh7, (iii) que son activité GABAergique est conférée par son domaine basique de liaison à l’ADN et (iv) que cette activité implique la régulation directe du facteur de transcription Ptf1a. Ces données ajoutent donc une nouvelle pièce au réseau transcriptionnel gouvernant la spécification des sous-types GABAergiques au cours du développement de la rétine. La mise en place correcte des types et sous-types cellulaires de la rétine nécessite une coordination avec le moment de sortie du cycle cellulaire des progéniteurs rétiniens. Dans ce contexte, j’ai contribué à l’avancée d’un projet visant à étudier le réseau de signalisation contrôlant la prolifération des précurseurs de la rétine. Par des approches in vivo, génétiques et pharmacologiques, cette étude a montré que les voies Wnt et Hedgehog s’antagonisent pour réguler l’activité proliférative des cellules souches et progénitrices rétiniennes. Nos données préliminaires suggèrent que ces voies agissent de façon opposée à la fois sur la sortie et sur la cinétique du cycle cellulaire. Ce travail nous a conduit à proposer un modèle selon lequel ces voies Wnt et Hedgehog réguleraient la balance entre prolifération et différenciation dans la rétine post-embryonnaire. Enfin, dans le but d’élargir nos connaissances sur les réseaux de signalisation et les réseaux transcriptionnels impliqués dans le contrôle de la prolifération et de la détermination cellulaire dans la rétine, j’ai également contribué à la recherche de nouveaux marqueurs spécifiques des différentes populations cellulaires rétiniennes au travers d’un crible à grande échelle par hybridation in situ. De nombreux gènes spécifiquement exprimés dans les cellules souches ou les cellules progénitrices constituent des gènes candidats pour de futures approches fonctionnelles. / My thesis research work aimed to better understand the molecular mechanisms underlying proliferation and specification of retinal progenitors in Xenopus through three main projects. As the mechanisms governing specification of retinal progenitors towards the different neuronal subtypes are still poorly understood, I focused my work on the role of Ascl1, a bHLH transcription factor, in cell-subtype determination during retinogenesis. Using in vivo gain- and loss-of-function experiments, I have investigated Ascl1’s epistatic relationships with other bHLH factors and identified its transcriptional targets. My results indicate that Ascl1 (i) is implicated in the genesis of retinal GABAergic neurons (ii) is epistatic to glutamatergic factors such as Neurog2, NeuroD1 and Atoh7 (iii) that its basic DNA-biding domain is sufficient for its GABAergic-inducing activity (iv) and that this activity involves a direct regulation of the Ptf1a transcription factor. The correct order of neural cell types and subtypes formation is tightly coordinated with the timing of cell-cycle exit of retinal progenitors. Ongoing work in the laboratory, to which I have contributed, was therefore investigating the role of signaling pathways controlling retinal precursor proliferation in this process. Using in vivo genetic and pharmacological tools, we have shown that an antagonistic cross-regulation between Wnt and Hedgehog signaling governs stem cell and progenitor proliferation in post-embryonic retina. Preliminary data shows that Wnt and Hedgehog have opposite effects on both cell cycle exit and kinetics and may therefore regulate the proliferation/differentiation balance in the post-embryonic retina. Lastly, in order to broaden our knowledge on the transcriptional and signaling networks which govern proliferation and cell fate determination in the retina, I have participated in a large scale screen by in situ hybridization aiming to identify new molecular markers of different retinal cell population. Many genes that are exclusively expressed in retinal stem cells or progenitors are promising candidates for future functional studies.

楞嚴經中的身心關係, 簡單地說來, 是以空性為基礎而達至 '身心一體' 的結論, 實際理論分析的過程, 則可用 '不即不離本一體, 非因非自體空寂' 二句話概括. '不即' 是指因先揀擇真妄 (心真身妄) 而顯現出心與身之不一, '不離' 則是說明此虛妄之身與心之不異, 而不一不異的可能性在於二者 '本一體'; 然此體非一實在之自體, 其性空寂, 雙遣因緣和自然, 展現出離一切戲論言說之妙真如性, 後者即一般所謂的 '空如來藏'. 在論文的第二章第二節 '視覺分析與光影成像' 中,我們藉一般的常識說明普通人 的觀念----書在眼外, 心在身內----是錯 誤的, 文中名之為 '視網膜弔詭', 這是理解本論文的重要方法.

La débitmétrie au laser à effet Doppler (LDF) constitue une méthode prometteuse et non-invasive pour l'étude du débit sanguin local dans l'œil. Cette technique est basée sur un changement de fréquence subi par la lumière lors du mouvement des globules rouges dans les vaisseaux. Une nouvelle sonde LDF a été testée pour sa sensibilité à évaluer la circulation rétinienne/choroïdienne sous des conditions hypercapniques et en présence de diverses substances vasoactives ou suivant la photocoagulation des artères rétiniennes chez le rat. Après dilatation pupillaire, la sonde LDF a été placée en contact avec la cornée de rats anesthésiés et parallèle à l'axe optique. L'hypercapnie a été provoquée par inhalation de CO2 (8% dans de l'air médical), alors que les agents pharmacologiques ont été injectés de façon intravitréenne. La contribution relative à la circulation choroïdienne a été évaluée à la suite de la photocoagulation des artères rétiniennes. Le débit sanguin s'est trouvé significativement augmenté à la suite de l'hypercanie (19%), de l'adénosine (14%) ou du nitroprusside de sodium (16%) comparativement au niveau de base, alors que l'endothéline-1 a provoqué une baisse du débit sanguin (11%). La photocoagulation des artères rétiniennes a significativement diminué le débit sanguin (33%). Des mesures en conditions pathologiques ont ensuite été obtenues après l'injection intravitréenne d'un agoniste sélectif du récepteur B1 (RB1). Ce récepteur des kinines est surexprimé dans la rétine des rats rendus diabétiques avec la streptozotocine (STZ) en réponse à l'hyperglycémie et au stress oxydatif. Les résultats ont montré que le RB1 est surexprimé dans la rétine chez les rats diabétiques-STZ à 4 jours et 6 semaines. À ces moments, le débit sanguin rétinien/choroïdien a été significativement augmenté (15 et 18 %) après l'injection de l'agoniste, suggérant un effet vasodilatateur des RB1 dans l'œil diabétique. Bien que la circulation choroïdienne contribue probablement au signal LDF, les résultats démontrent que le LDF représente une technique efficace et non-invasive pour l'étude de la microcirculation rétinienne in-vivo en continu. Cette méthode peut donc être utilisée pour évaluer de façon répétée les réponses du débit sanguin pendant des modifications métaboliques ou pharmacologiques dans des modèles animaux de maladies oculaires. / Laser Doppler Flowmetry (LDF) is a promising, non-invasive technique to assess local ocular blood flow. This technique is based on a Doppler frequency shift of the backscattered light due to the movement of the red blood cells in the vessels. A new LDF probe was tested for its sensitivity to assess the retinal/choroidal blood flow variations in response to hypercapnia, diverse vasoactive agents and following retinal arteries photocoagulation in the rat. After pupil dilation, a LDF probe was placed in contact to the cornea of anesthetised rats in the optic axis. Hypercapnia was induced by inhalation of CO2 (8% in medical air) while pharmacological agents were injected intravitreously. The relative contribution of the choroidal circulation to the LDF signal was determined after retinal artery occlusion by photocoagulation. Blood flow was significantly increased by hypercapnia (19%), adenosine (14%) and sodium nitroprusside (16%) as compared to baseline values while endothelin-1 decreased blood flow (11%). Photocoagulation of retinal arteries significantly decreased blood flow level (33%). Measurements in pathological conditions were then obtained after intravitreal injections of a B1R agonist. This kinin receptor is overexpressed in the retina of streptozotocin (STZ) diabetic rats in response to hyperglycaemia and oxidative stress. Data showed that B1R was upregulated in the STZ-diabetic retina at 4 days and 6 weeks. At these time points, retinal/choroidal blood flow was significantly increased (15 and 18 %) upon injection of the agonist, suggesting a vasodilatory effect of B1R in the diabetic eye. Although choroidal circulation most likely contributes to the LDF signal in this setting, the results demonstrate that LDF represents a suitable in vivo non-invasive technique to monitor online relative changes of retinal microcirculation. This technique could be used for repeatedly assessing blood flow reactivity to metabolic or pharmacologic challenges in rodent models of ocular diseases.

La leucine zipper de la rétine neurale (Nrl) joue un rôle central dans le développement et l'homéostasie des bâtonnets en activant I'expression de gènes tels que le photopigment Rhodopsine. Nrl est aussi associé à la Rétinite Pigmentaire, faisant ainsi de ce gène un modèle intéressant pour la compréhension des programmes contrôlant le développement et I'homéostasie des photorécepteurs.Ce travail de thèse vise à caractériser les mécanismes régulateurs de I'expression de Nr/ au cours du développement rétinien. L'électroporation in vivo de vecteurs rapporteurs dans des rétines de souris en développement, a révélé des séquences minimales de promoteur Nr/ nécessaires à une expression spécifique dans les photorécepteurs. Nous avons identifié RORI3 comme facteur requis pour cette expression, et montré que les facteurs OTX2, CRX et CREB s'accrochent aussi directement à des régions régulatrices particulières du promoteur. Nous avons construit un virus adéno-associé (AAV) contenant un promoteur minimal Nrl de 0.3 kb, et montré qu'il est adapté à la délivrance de gène spécifiquement dans les photorécepteurs.Nous avons montré que NRL, CRX et NR2E3, les régulateurs principaux de la Rhodopsine, ont une expression rythmique au cours de 24 h, et que l'expression cyclique de Nr/ peut être due à l'activation par RORp, un composant l'horloge circadienne. Enfin, nous avons identifié un nouveau facteur de transcription, NonO, au niveau de la région du promoteur proximal de la Rhodopsine, qui en combinaison avec NRL et CRX, active le promoteur de la Rhodopsine. L'invalidation de NonO au cours du développement rétinien a prouvé son implication pour le développement et I'homéostasie des bâtonnets.

La rétinopathie diabétique est associée à plusieurs changements pathologiques du lit vasculaire rétinien, incluant l’ouverture de la barrière hémato-rétinienne, l’inflammation vasculaire et la modification du débit sanguin. Récemment, il a été proposé que le récepteur B1 des kinines, qui est surexprimé dans la rétine diabétique, puisse être impliqué dans le développement de ces altérations vasculaires. Ainsi, cette thèse présente les effets de traitements pharmacologiques avec des antagonistes du récepteur B1 sur la perfusion rétinienne, la perméabilité vasculaire, l’infiltration des leucocytes (leucostasie), l’expression de médiateurs de l’inflammation et la production d’anion superoxyde dans la rétine du rat rendu diabétique avec la streptozotocine (STZ). Les résultats obtenus montrent que l’application oculaire (10 µl d’une solution à 1%, deux fois par jour pendant 7 jours) de LF22-0542, un antagoniste hydrosoluble du récepteur B1, bloque significativement l’hyperperméabilité vasculaire, la leucostasie, le stress oxydatif et l’expression génique de médiateurs de l’inflammation (B1R, iNOS, COX-2, VEGF-R2, IL-1β et HIF-1α) dans la rétine chez le rat à 2 semaines de diabète. L’administration orale (3 mg/kg) d’un antagoniste non-peptidique et sélectif pour le récepteur B1, le SSR240612, entraîne une diminution du débit sanguin rétinien 4 jours après l’induction du diabète mais n’a aucun effet sur la réduction de la perfusion rétinienne à 6 semaines. Le récepteur B1 joue donc un rôle protecteur au tout début du diabète en assurant le maintien d’un débit sanguin normal dans la rétine; un effet qui n’est toutefois pas maintenu pendant la progression du diabète. Ces données présentent ainsi la dualité du récepteur B1 avec des effets à la fois protecteurs et délétères. Elles suggèrent aussi un rôle important pour le récepteur B1 dans l’inflammation rétinienne et le développement des altérations vasculaires. Le récepteur B1 pourrait donc représenter une nouvelle cible thérapeutique pour le traitement de la rétinopathie diabétique. / Diabetic retinopathy is associated with retinal vascular changes, including blood retinal barrier breakdown, vascular inflammation and blood flow alterations. It has been proposed that kinin B1 receptor, which is upregulated in the diabetic retina, could be involved in the development of these pathological features of diabetic retinopathy. In a rat model of diabetes induced by Streptozotocin (STZ), the effects of kinin B1 receptor antagonists on retinal perfusion, vascular permeability, leukostasis, gene expression of inflammatory mediators and production of superoxide anion in the retina were evaluated. The results show that in 2-week diabetic rats, topical ocular application of the water soluble kinin B1 receptor antagonist LF22-0542 (10 µl of 1% solution, twice per day) for a 7-day period reverses vascular hyperpermeability, leukostasis, oxidative stress and gene expression of inflammatory mediators (B1R, iNOS, COX-2, VEGF-R2, IL-1β and HIF-1α) in the retina. Single oral administration (3 mg/kg) of SSR240612, a selective non-peptide B1 receptor antagonist, induces a decrease of retinal blood flow in 4-day diabetic rats but has no effect on retinal blood flow reduction present at 6 weeks of diabetes. Therefore, B1 receptor has a protective role in early diabetes by preserving a normal blood flow in the retina. These data suggest that B1 receptor exerts protective and adverse effects in the diabetic retina. They also support a key role for B1 receptor in retinal inflammation and the development of vascular alterations. B1 receptor could therefore represent a promising therapeutic target for the treatment of diabetic retinopathy.

Melanopsin (Opn4) is the opsin photopigment of intrinsically photosensitive retinal ganglion cells (ipRGCs). It has a conserved opsin structure and activation mechanism, yet demonstrates unusual functional properties that suggest it will possess unique structure-function relationships. The aim of this thesis was to characterise key OPN4 residues by examining the impact of non-synonymous mutations on melanopsin function. A genotype-driven screen of a chemically-mutagenized mouse archive led to the identification of a novel Opn4 mutant, S310A, located at a known opsin spectral tuning site. Action spectra from ipRGC and pupil light responses (PLR) of Opn4^S310A mice revealed no change in wavelength of peak sensitivity. However, Opn4^S310A PLR was significantly less sensitive at longer wavelengths, consistent with a short-wavelength shift in spectral sensitivity. This suggests S310A acts as a spectral tuning site in melanopsin. Next, the impact of naturally-occurring missense variants in human melanopsin (hOPN4) was examined in vitro. Fluorescent calcium imaging of 16 hOPN4 variants expressed in HEK293 cells revealed four hOPN4 variants abolished or attenuated responses to light (Y146C, R168C, G208S and S308F). These variants were located in conserved opsin motifs for chromophore binding or hydrogen-bond networks, functional roles apparently shared by melanopsin. Finally, two hOPN4 single nucleotide polymorphisms (SNPs) P10L and T394I, associated with abnormal non-image forming behaviour in humans, were explored in vivo. Using targeted viral-delivery of hOPN4 SNPs to mouse ipRGCs, a range of OPN4-driven behaviours, such as circadian photoentrainment and pupil light responses, were found to be comparable with hOPN4 WT control. Multi-electrode array recordings of ipRGCs transduced with hOPN4 T394I virus had significantly attenuated sensitivity and faster response offset, indicating this site may be functionally important for melanopsin activity but compensatory rod and cone input limits changes to non-image forming behaviour.

Le syndrome d’apnées obstructives du sommeil (SAOS) est associé à la survenue de neuropathies optiques, en particulier la neuropathie optique ischémique antérieure aigue non artéritique (NOIAA-NA). Parmi les mécanismes d’apparition de cette neuropathie et potentiellement associés au SAOS, la dysrégulation et l’inflammation vasculaires pourraient jouer un rôle. Il n’existe aucune donnée dans la littérature sur l’effet de l’hypoxie intermittente (HI) chronique sur la fonction vasculaire de l’œil.Le but de ce travail était de développer des techniques d’évaluation de la fonction vasculaire oculaire chez le rat et de les appliquer à l’étude des conséquences vasculaires oculaires de l’HI. Ainsi, deux approches complémentaires ont été développées : 1) un prototype de fluxmètre laser Doppler (LDF) adapté au rongeur pour l’évaluation in vivo de la perfusion sanguine rétinienne et de la tête du nerf optique (TNO) et 2) le modèle d’étude de l’artère ophtalmique (AO) du rat par myographie vasculaire, in vitro.La mise au point du LDF chez le rat sain a permis de valider la pertinence du signal provenant des artères rétiniennes. A l’inverse, nos données invalident l’intérêt de la mesure au niveau de la TNO. En réponse à l’inhalation d’oxygène pur, nous observons une diminution de 17,0 ± 13,7 % de la vélocité artérielle rétinienne (VelART). Nous n’observons pas de variation significative de VelART lors d’injection intra-carotidienne d’endothéline 1 (ET-1) malgré une forte vasoconstriction des vaisseaux rétiniens. Les perspectives consistent à associer une caméra de haute résolution à un système bidirectionnel de LDF. L’étude de la réactivité de l’AO par myographie chez le rat soumis à 14 jours d’HI a mis en évidence une augmentation de la contraction à l’ET-1, associée à une augmentation de la réponse médiée par les récepteurs de type A (ETRA)et à une surexpression des ETRA au sein de l’AO. La relaxation NO-dépendante était diminuée chez le rat HI, et associée à un effet prédominant des produits vasoconstricteurs du cytochrome P450. Ces réponses étaient associées à une augmentation de la présence d’anions superoxyde dans la paroi de l’AO. Des études complémentaires sont nécessaires pour explorer les mécanismes à l’origine des ces altérations vasculaires, en particulier le rôle du stress oxydant. / Obstructive sleep apnea (OSA) has recently been associated with the occurrence of optic neuropathies, especially acute non-arteritic anterior ischemic optic neuropathy (NAION). Among the mechanisms of NAION onset potentially associated with OSA, vascular dysregulation and inflammation may play a role. There is still no data on the effect of chronic intermittent hypoxia (IH) on vascular function of the eye. The purpose of this work was to develop techniques for assessing rat ocular vascular function and apply them to the study of the ocular vascular consequences of IH. Thus, two complementary models have been developed: 1) a laser Doppler flowmeter (LDF) prototype adapted for rodents, to evaluate in vivo retinal and optic nerve head (ONH) blood perfusion and 2) in vitro model of rat ophthalmic artery (OA) study by myography. Preliminary work on healthy rat enabled us to validate the relevance of retinal arteries LDF signal, but not that of the ONH. Retinal blood velocity (VelART) dropped by 17.0 ± 13.7% in response to pure oxygen inhalation. We did not observe any significant change in VelART signal after intracarotidian endothelin 1 (ET -1) injection, despite strong vasoconstriction of retinal vessels. OA reactivity study by myography in rats exposed to a 14-day IH showed increased contraction to ET-1, associated with an increased endothelin receptor A-mediated (ETRA) response and ETRA overexpression within the AO. NO-dependent relaxation is reduced in IH rats, and associated with a shift towards vasoconstrictive effects of cytochrome P450 products. These responses were associated with an increase in superoxide anions in the OA wall. Further studies are needed to explore the underlying mechanisms of these vascular changes, particularly the role of oxidative stress. Understanding of the LDF signal is partial and should be further explored to permit application to the study of IH rat.

Diabetes mellitus currently affects over 422 million people globally and over 80% of patients with diabetes will develop diabetic retinopathy. Patients with diabetic retinopathy initially develop background retinopathy, which does not cause significant deterioration of visual function; however, background retinopathy may progress and lead to proliferative diabetic retinopathy and diabetic macular oedema, both of which cause severe visual dysfunction if left untreated. Current therapies for diabetic retinopathy include invasive intravitreal injections and laser photocoagulation; however these treatments only attenuate the progression of proliferative diabetic retinopathy and diabetic macular oedema. Aside from prevention by maintaining good blood glucose and blood pressure control, there are currently no treatments to prevent progression to late-stage diabetic retinopathy and new innovations in the field have not significantly progressed. For this reason, we have used untargeted –omics approaches to identify previously unknown pathological pathways in diabetes. In this thesis, I have analysed a range of trace metals in donor retinas and found that total copper was increased in diabetic retinas compared with non-diabetic. This result was replicated in streptozotocin-induced diabetic rat retinas and further evidenced by upregulation of metallothioneins and caeruloplasmin in diabetic rat retinas compared with non-diabetic. Treatment with the copper chelator triethylenetetramine modulated these changes, the downstream effects of which require further study. This is the first description, to our knowledge, of dysregulated copper homeostasis in the diabetic retina. I have also mapped metabolic changes in streptozotocin-induced diabetic rat retinas and found previously undescribed metabolite changes such as diabetes-induced downregulation of scyllo inositol. This coincided with substantial changes to retinal lipids during diabetes and changes to individual lipids were consistent within their respective class. I have also found a pattern whereby regardless of the extent of change to a lipid class in diabetes, lipids containing docosahexaenoic acid (22:6 carbon chain) were consistently downregulated. This is thought to be the first study to describe this range of metabolite changes in the diabetic retina but also the first study to describe this range of metabolite analysis concomitantly within the same tissue sample. The data from this study provides new insights into metallomic and metabolic dysfunction in diabetic retinopathy and shown that these data are reproducible. We suggest that there is plenty of scope for further research to investigate mechanisms behind copper dysregulation, how this affects pathogenesis of diabetic retinopathy along with new insights into dysregulated metabolic pathways.

Introdução: a ataxia espinocerebelar tipo 7 (SCA7) é um distúrbio neurodegenerativo autossômico dominante causado por uma repetição CAG expandida (CAGexp) no gene ATXN7, resultando na inserção de uma poliglutamina (poliQ) alongada na proteína ataxina-7. Em consequência, pacientes com SCA7 desenvolvem ataxia, espasticidade e outros sintomas neurológicos. A SCA 7 se destaca de outras SCAs por se associar à distrofia retiniana, causando deficiências visuais que podem levar à cegueira. Sendo uma das mais raras SCAs, pequenas séries de casos têm aparecido na literatura. Poucas delas buscaram correlacionar os achados neurológicos com os oftalmológicos; e a fase pré-clínica jamais foi sistematicamente investigada. Objetivo: descrever os achados neurológicos e oftalmológicos de uma coorte de casos de SCA 7, comparando as manifestações encontradas em sujeitos sintomáticos com as encontradas em portadores assintomáticos e em parentes não portadores, em uma abordagem exploratória que buscou levantar potenciais biomarcadores de progressão da doença. Métodos: trata-se de um estudo transversal onde pacientes com diagnóstico molecular de SCA7 realizado na nossa instituição foram identificados em nossos arquivos protegidos. Tanto eles como seus parentes foram convidados a participar da presente investigação. Sujeitos em risco de 50% foram incluídos se tivessem mais de 18 anos. Após o consentimento, dados clínicos e demográficos foram coletados entre junho de 2016 e setembro de 2017. A seguir, todos os participantes realizaram uma bateria de escalas clínicas voltadas à medida da ataxia (SARA, CCFS, PATA e 8 MW) e das manifestações neurológicas (NESSCA e INAS); um questionário de qualidade de vida relacionada à visão (NEI-VFQ 25); avaliação da acuidade visual melhor corrigida (AVMC), desvio médio em campimetria computadorizada (MD) e espessuras da mácula e da camada de células ganglionares na tomografia de coerência óptica (OCT). A escala SARA e a AVMC foram escolhidas como as variáveis de referência para a gravidade dos quadros. A análise molecular do ATXN7 foi feita, mas participantes do estudo e avaliadores foram mantidos cegos para seus resultados; os indivíduos em risco interessados em receber seus resultados foram enviados para o programa de testes pré-sintomáticos. Como não houve critérios a priori para estimar tamanhos de efeito e como a SCA7 é uma condição rara, não houve como decidir um tamanho de amostra. O estudo foi exploratório e por isso não foram feitas correções para múltiplas testagens. Um p de 0,05 foi eleito para definir significância, e testes estatísticos foram aplicados de acordo com as características das variáveis em estudo. Resultados: 12 portadores sintomáticos (grupo 2) e 8 indivíduos em risco (3 portadores - grupo 1 - e 5 não-portadores - grupo 0) foram incluídos neste estudo. Todas as variáveis contínuas à exceção da CAGexp tiveram distribuição 4 normal. A AVMC estava reduzida em todos os participantes sintomáticos e claramente diferente entre estes e os outros dois grupos (p <0,0001, ANOVA), enquanto os portadores assintomáticos e os não portadores tiveram resultados semelhantes. A AVMC média foi 20/143, 20/18 e 20/20 nos grupos 2, 1 e 0, respectivamente. Não surpreendentemente, o NEI-VFQ 25 também demonstrou uma diferença estatisticamente significativa, mas o que foi inesperado foi a forma progressivamente diferente entre os 3 grupos (grupo 0 = 92,76 ± 6,7; grupo 1 = 74,9 ± 55,5; grupo 2 = 58,0 ± 21,3) (p= 0,012, ANOVA com Tukey) O MD mostrou um padrão linear estatisticamente significativo para piorar do grupo controle (-1,34 ± 1,15dB) para o assintomático (-2,81 ± 1,66dB) e do grupo assintomático para sintomático (-10,54 ± 6,95dB) (p = 0,027, ANOVA com Tukey). Além disso, o MD correlacionou-se com a AVMC (p = 0,020; r = 0,660) e apresentou tendência de correlação com a SARA (p= 0,073; r= -0,535). As medidas de espessura macular distinguem completamente os 3 grupos (grupo 0 = 243,6 ± 22,2 μ; grupo 1 = 204,5 ± 14,1 μ; grupo 2 = 137,95 ± 34,6 μ) (p = 0,0001, ANOVA) e também se correlacionou significativamente com os dois critérios planejados de gravidade, SARA (p = 0,050; r = -0,577) e AVMC (p = 0,007; r = 0,730). Discussão: alterações oftalmológicas estavam presentes já nas fases pré-clínicas da doença, quando os escores obtidos das escalas neurológicas ainda não distinguem portadores assintomáticos de não portadores: a espessura macular medida por OCT e o MD medido pela campimetria computadorizada. Esses achados demonstram que o processo neurodegenerativo já se encontra em curso e é detectável por essas medidas anatômicas e funcionais da retina. Além disso, ambas as alterações detectadas em fases pré-clínicas, ao serem estudadas no grupo total de portadores sintomáticos e assintomáticos, se correlacionaram com os nossos padrões-ouro da gravidade da doença, SARA e AVMC. Os dois achados - início em fase pré-clínica e correlação com a progressão da doença medida por escores independentes - sugerem que a espessura macular medida por OCT e o MD medido pela campimetria computadorizada são potenciais candidatos a biomarcadores de estado (de progressão da doença) desde fases pré-manifestas na SCA7. / Background: spinocerebellar ataxia type 7 (SCA7) is an autosomal dominant neurodegenerative disorder caused by an expanded CAG repeat (CAGexp) at ATXN7 gene, resulting in the insertion of an elongated polyglutamine (polyQ) into the ataxin-7 protein. As a consequence, patients with SCA7 develop ataxia, spasticity and other neurological symptoms. SCA7 stands out from other SCAs by associating it with retinal dystrophy, causing visual deficiencies that can lead to blindness. Being one of the rarest SCAs, small series of cases appear in the literature. Few of them sought to correlate neurological findings with ophthalmologic findings; and the preclinical stage has never been systematically investigated. Objective: to describe the neurological and ophthalmological findings of a cohort of cases of SCA7, comparing the manifestations found in symptomatic subjects with those found in asymptomatic carriers and in non-carrier relatives in an approach exploratory study that sought to raise potential biomarkers of disease progression. Methods: patients with a molecular diagnosis of SCA7 performed at our institution were identified in our protected files. Both they and their relatives were invited to participate in the present investigation. Subjects at risk of 50% were included if they were older than 18 years. After consent, clinical and demographic data were collected between June 2016 and September 2017. All participants then performed a battery of clinical scales aimed at the measurement of ataxia (SARA, CCFS, PATA and 8 MW) and neurological manifestations (NESSCA and INAS); a visual function questionnaire (NEI-VFQ 25); assessment of better corrected visual acuity (AVMC), mean deviation in computerized campimetry (MD), and thickness of the macula and ganglion cell layer on OCT. The SARA and AVMC scale were chosen as the reference variables for the severity of the frames. Molecular analysis of ATXN7 was done, but study participants and evaluators were kept blind to their results; the individuals at risk interested in receiving their results were sent to the presymptomatic testing program. As there were no a priori criteria for estimating effect sizes and because SCA7 is a rare condition, there was no way to decide on a sample size. The study was exploratory and therefore no corrections were made for multiple tests. A p of 0.05 was chosen to define significance, and statistical tests were applied according to the characteristics of the variables under study. Results: 12 symptomatic carriers (group 2) and 8 individuals at risk (5 carriers - group 1 - and 3 non-carriers - group 0) were included in this study between June 2016 and September 2017. All continuous variables with the exception of CAGexp had normal distribution. AVMC was reduced in all symptomatic participants and clearly different between these and the other two groups (p <0.0001, ANOVA), while asymptomatic and non-carriers had similar results. The mean BCVA was 20/143, 20/18 and 20/20 in groups 2,1 and 6 0, respectively. Not surprisingly, NEI-VFQ 25 also showed a statistically significant difference, but what was unexpected was the progressively different form between the 3 groups (group 0 = 92.76 ± 6.7, group 1 = 74.9 ± 55, 5, group 2 = 58.0 ± 21.3) (p = 0.012, ANOVA with Tukey). The MD showed a statistically significant linear pattern to worsen from the control group (-1.34 ± 1.15dB) to the asymptomatic (-2.81 ± 1.66dB) and from the asymptomatic to the symptomatic group (-10.54 ± 6, 95dB) (p = 0.027, ANOVA with Tukey). In addition, MD correlated with AVMC (p = 0.020; r = 0.660) and showed a correlation tendency with ARDS (p = 0.073; r = -0.535). The macular thickness scores completely distinguish the 3 groups (group 0 = 243.6 ± 22.2 μ, group 1 = 204.5 ± 14.1 μ, group 2 = 137.95 ± 34.6 μ) (p = 0.0001, ANOVA ...) and also correlated significantly with the two planned criteria of severity, SARA (p = 0.050, r = -0.577) and AVMC (p = 0.007, r = 0.730). Conclusion: ophthalmologic changes were present already in the preclinical stages of the disease, when the scores obtained from the neurological scales did not yet distinguish asymptomatic non-carrier patients: macular thickness measured by OCT and MD measured by computerized campimetry. These findings demonstrate that the neurodegenerative process is already underway and is detectable by these anatomical and functional measures of the retina. In addition, both changes detected in preclinical stages, when studied in the total group of symptomatic and asymptomatic carriers, correlated with our gold standard of disease severity, SARA and AVMC. The two findings - pre-clinical onset and correlation with disease progression measured by independent scores - suggest that the macular thickness measured by OCT and MD as measured by computerized campimetry are potential candidates for disease biomarkers (disease progression) from pre-manifest stages in SCA7.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-02-03T20:17:16Z No. of bitstreams: 1 JoseEdvanDeSouzaJunior_TESE.pdf: 4464573 bytes, checksum: 5324301dc91ae3b1ebc14996e9c4b9df (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-02-03T23:28:42Z (GMT) No. of bitstreams: 1 JoseEdvanDeSouzaJunior_TESE.pdf: 4464573 bytes, checksum: 5324301dc91ae3b1ebc14996e9c4b9df (MD5) / Made available in DSpace on 2016-02-03T23:28:42Z (GMT). No. of bitstreams: 1 JoseEdvanDeSouzaJunior_TESE.pdf: 4464573 bytes, checksum: 5324301dc91ae3b1ebc14996e9c4b9df (MD5) Previous issue date: 2014-12-12 / Objetivos: Estimar a preval?ncia de altera??es do filme lacrimal e da doen?a do olho seco (DOS), comparar as mudan?as na press?o intraocular (PIO) e comparar as espessuras macular e da camada de fibras nervosas da retina (CFNR), entre mulheres com s?ndrome dos ov?rios polic?sticos (SOP) e mulheres saud?veis, estratificando-as em condi??es cl?nicas, metab?licas e inflamat?rias. Metodologia: O estudo incluiu 45 mulheres com SOP e 47 mulheres saud?veis ovulat?rias submetidas a avalia??es cl?nico-ginecol?gicas e oftalmol?gicas, incluindo proped?uticas para a avalia??o do filme lacrimal e medida da PIO, e medi??o da espessura macular, da CFNR e par?metros do disco ?ptico usando tomografia de coer?ncia ?ptica. Resultados: Tempo de ruptura do filme lacrimal (TRFL; p=0.001) e impregna??o por fluoresce?na (p=0.006) apresentaram diferen?as estatisticamente significantes entre os grupos estudados. A preval?ncia de DOS foi de 44,4% nas portadoras de SOP. Houve redu??o estatisticamente significativa do TRFL na presen?a de SOP (p=0.001). Al?m disso, houve efeito estatisticamente significativo de intoler?ncia ? glicose e s?ndrome metab?lica/inflama??o na impregna??o por fluoresceina (p=0.004; p=0.015, respectivamente). A PIO encontrou-se estatisticamente mais elevada no grupo SOP que no grupo controle (p=0.011). Houve um aumento na m?dia do IPC (?ndice press?o-c?rnea) com a associa??o entre SOP e da s?ndrome metab?lica (p = 0.005); A m?dia da espessura da CNFR superior ao redor do nervo ?ptico foi estatisticamente mais espessa nas volunt?rias com SOP que nas volunt?rias saud?veis (p=0.036); Ap?s estratifica??o pela presen?a de resist?ncia insul?nica, as m?dias dos subcampos das espessuras maculares ?macular interno temporal, macular interno inferior, macular interno nasal e macular externo nasal, foram mais espessas no grupo SOP que no grupo controle (p<0.05); Houve associa??o significativa entre obesidade e resist?ncia insul?nica (p=0.037), e intoler?ncia ? glicose (p=0.001), com aumento m?dio do componente principal 1 (CP1), e, na presen?a de s?ndrome metab?lica (p<0.0001), com aumento m?dio do componente principal 2 (CP2), respectivamente, em rela??o ? espessura macular total. Na presen?a de obesidade e inflama??o, houve redu??o no escore m?dio da CP2 (p=0.034), em rela??o ? espessura da CFNR na m?cula. xviii Conclus?es: H? uma associa??o da SOP, suas altera??es metab?licas e inflamat?rias com altera??es do filme lacrimal e com mudan?as na PIO. A diminui??o na espessura da CFNR macular e aumento da espessura total macular est?o possivelmente associadas ?s altera??es metab?licas, e, o aumento na espessura da CFNR ao redor do nervo ?ptico est?o provavelmente associadas ?s altera??es hormonais, inerentes ? SOP.