Sialidosis is caused by the accumulation of the ganglioside GM3 and other sialoglycoproteins within the cells of the liver, kidney and brain. Currently there is no treatment for sialidosis, while other lysosomal storage disorders are being treated through enzyme replacement therapy or bone marrow transplantation. The helper-dependent, or "gutless" adenovirus system (HD) has recently been improved upon with reportedly less immunogenicity than its first-generation (FG) predecessor and lifelong transgene expression produced in its hosts. To this end, the complete mouse lysosomal sialidase gene was cloned into a HD-vector (AdmsialHD) and a FG-vector (AdmsialFG) in an attempt to rescue the sialidase deficiency and associated phenotype in B6.SM fibroblasts and in the SM/J mouse. Lysosomal sialidase levels were increased to normal levels in vitro following both AdmsialHD and AdmsialFG infections while SM/J mouse infections at doses of 5 x 10^9 particles/mouse did not yield any increase in lysosomal sialidase activity or correct the associated phenotype. Interestingly, AdmsialHD only up-regulated sialidase to high levels in sialidase-null cells whereas AdmsialFG up-regulated sialidase significantly in all cell lines tested. Together, these data suggest that the therapeutic dose for both AdmsialFG and AdmsialHD should be elevated at least 10-fold in order to achieve phenotypic rescue and that FG-vectors possess some viral property, perhaps the E4 gene products, enabling them to attain greater transgene expression relative to HD-vectors. / Thesis / Master of Science (MSc)

Background: Lysosomal storage diseases (LSD) often manifest with cherry red macular spots. Diagnosis is based on clinical features and specific biochemical and enzymatic patterns. In uncertain cases, genetic testing with next generation sequencing can establish a diagnosis, especially in milder or atypical phenotypes. We report on the diagnostic work-up in a boy with sialidosis type I, presenting initially with marked cherry red macular spots but non-specific urinary oligosaccharide patterns and unusually mild excretion of bound sialic acid. Methods: Biochemical, enzymatic and genetic tests were performed in the patient. The clinical and electrophysiological data was reviewed and a genotype-phenotype analysis was performed. In addition a systematic literature review was carried out. Case report and results: Cherry red macular spotswere first noted at 6 years of age after routine screening myopia. Physical examination, psychometric testing, laboratory investigations aswell as cerebralMRIwere unremarkable at 9 years of age. So far no clinical myoclonic seizures occurred, but EEG displays generalized epileptic discharges and visual evoked potentials are prolonged bilaterally. Urine thin layer chromatography showed an oligosaccharide pattern compatible with different LSD including sialidosis, galactosialidosis, GM1 gangliosidosis or mucopolysaccharidosis type IV B. Urinary bound sialic acid excretion was mildly elevated in spontaneous and 24 h urine samples. In cultured fibroblasts, α-sialidase activity was markedly decreased to b1%; however, bound and free sialic acid were within normal range. Diagnosis was eventually established by multigene panel next generation sequencing of genes associated to LSD, identifying two novel, compound heterozygous variants in NEU1 gene (c.699CNA, p.S233R in exon 4 and c.803ANG; p.Y268C in Exon 5 in NEU1 transcriptNM_000434.3), leading to amino acid changes predicted to impair protein function. Discussion: Sialidosis should be suspected in patients with cherry red macular spots, even with non-significant urinary sialic acid excretion. Multigene panel next generation sequencing can establish a definite diagnosis, allowing for counseling of the patient and family.

INTRODUÇÃO:A neuraminidase 1 (chamada a seguir por Neu1) regula o catabolismo de sialoglicoconjugados nos lisossomos. A deficiência congênita da Neu1 é a base da sialidose, doença neurossomática grave associada a deformidades osteoesqueléticas, hipotonia e fraqueza muscular. Camundongos com deficiência de Neu1 desenvolvem uma forma atípica de degeneração muscular caracterizada porproliferação anormal de fibroblastoslevando a invasão nas fibras musculares, expansão da matriz extracelular (MEC), fragmentação do citoplasma, formação vacuolar e atrofia muscular. A ocorrência de atrofia muscular indica que a deficiência da Neu1 podeestar relacionada com o controle da massa muscular, a qual é dependente do equilíbrio entre síntese e degradação proteica.Uma característica principalnaMacroautofagia (denominada a seguir por autofagia) é a principal via de degradação intracelular sendo expressamente essencial para a homeostase celular e remoção de materiais citoplasmáticos. Objetivos: Avaliarseos efeitos da deficiência da Neuraminidase 1 afetama indução de autofagia e a formação de autofagossomos e determinar os efeitos do bloqueio da função lisossomal sobre o fenótipo muscular na deficiência da Neuraminidase1.Metodologia:Camundongos Neu1+/-foram cruzados e os filhotes genotipados, onde camundongos Neu1-/-(nocaute) e Neu1+/+(normal),foram utilizados no estudon total=90, sendo 10 em padronizações, 20 para coleta de fibroblastos e 60 para procedimentos in vivo, os grupos experimentais foram divididos em privação alimentar por 2 dias que, por meio da inibição do mTOR, induz a autofagia;grupo detratamento com Colchicina por 4 dias onde irá impedir a junção autofagossomo/lisossomonão havendo a degradaçãolisossomaleadicionado nos dois últimos dias de privação alimentar e o grupo de tratamento comRapamicina por 7 dias, droga com função de inibir seletivamente o mTOR.Após os tratamentos, os animais foram eutanasiadospara coleta dos músculos gastrocnêmios e tibiais anterior. Os músculos foram analisados apósas coloraçõeshistológicas porHematoxilina & Eosina e Fosfatase Ácida; Imunofluorescência de LC3-I/II; Western Blottingdas proteínas LC3-I/II, Lamp-1 e p62/SQSTM e a análise Ultra-estrutural. Além disso, foi realizada cultura de fibroblastos, os quais foram submetidos à privação de nutrientes e ao tratamento com Rapamicina, seguidos dasmesmas metodologias de análise invivo. Resultados:As análises histológicas através de H&E e Fosfatase Ácida não revelaram alterações consistentes na musculatura esquelética de animais submetidos aos tratamentos, mostrando em animais com deficiência de Neu1 um aumento anormal do espaço endomisial, e aumento da atividade lisossomalintracitoplasmáticos. Na análise ultra-estruturalobservou-se em todos os grupos, a presença de diversas estruturas com aspecto autofágico, de diferentes tamanhos, formas e constituintes. Naanálise da expressão do LC3 através de Western Blottingmostrou importante ativação do LC3-II na privação alimentar (com e sem administração de Colchicina) tanto em animais controles quanto em animais com deficiência de Neu1 e uma importante ativação do LC3-I em Rapamicina em ambos os grupos mostrando assim que houve um aumento da via da autofagia através do bloqueio do mTOR. Já na análise de Imunofluorescência não foi possível observar diferença consistenteentre os grupos.A análise in vitrode Western Blottingmostrou que tal ativação foi similar entre fibroblastos Neu1+/+e Neu1-/-. Conclusão:Os experimentos relacionados com a ativação ou inibição da autofagia, não resultaram em diferenças consideráveis entre músculos normais e músculos com deficiência de Neu1. Desta forma, podemos concluir com estes experimentos que aparentemente a Neu1, apesar de ser uma importante enzima lisossomal, não interfere com o processo de autofagia / Introduction:Neuraminidase 1 (hereinafter Neu1) regulates the catabolism of sialoglycoconjugates in lysosomes. The congenital deficiency of Neu1 is the basis of sialidosis, a severe neurosomatic disease associated with osteo-skeletal deformities, hypotonia, and muscle weakness. Mice with Neu1deficient develop an atypical form of muscle degeneration characterized by abnormal fibroblast proliferation leading to muscle fiber invasion, extracellular matrix expansion (ECM), cytoplasm fragmentation, vacuolar formation, and muscle atrophy. The occurrence of muscle atrophy indicates that deficiencyofNeu1 may be related to the control of muscle mass, which is dependent on the balance between synthesis and protein degradation. A major feature in Macroautophagy (hereinafter referred to as autophagy) is the main pathway of intracellular degradation being expressly essential for cellular homeostasis and removal of cytoplasmic materials. Objectives:To evaluate whether the effects of neuraminidase 1 deficiency affect autophagy induction and autophagosome formation and to determine the effects of lysosomal function block on muscle phenotype in neuraminidase 1 deficiency. Methodos:Mice Neu1+/-were crossbred and the genotyped pups, where mice Neu1-/-(knockout) and Neu1+/+(normal), were used in the study ntotal = 90, 10 for standardization, 20 for fibroblast collection and 60 for in vivo procedures, experimental groups were divided into food deprivation for 2 days that, through mTOR inhibition, induces autophagy; Colchicine treatment group for 4 days whereit will prevent autophagosome/lysosome junction without lysosomal degradation and added in the last two days of food deprivation and Rapamycin treatment group for 7 days, drug with function to selectively inhibit mTOR. After the treatments, the animals were euthanized to collect the anterior gastrocnemius and tibial muscles. The muscles were analyzed after histological staining by Hematoxylin & Eosin and Acid Phosphatase; LC3-I/II immunofluorescence; Western Blottingof LC3-I/II, Lamp-1 and p62/SQSTM proteins and Ultra-structural analysis. In addition, fibroblasts were cultured and subjected to nutrient deprivation and Rapamycin treatment, followed by the same in vivo analysis methodologies. Results:Histological analyzes by H&E and Acid Phosphatase did notreveal consistent changes in skeletal muscle of animals submitted to treatments, showing in animals with Neu1 deficiency an abnormal increase in endomysial space and increased intracytoplasmic lysosomal activity.In ultrastructural analysis, it was observed in all groups, the presence of several structures with autophagic aspect, of different sizes, shapes and constituents. The analysis of LC3 expression by Western Blottingshowed important activation of LC3-II in food deprivation (with and without Colchicine administration) in both control and Neu1 deficient animals and an important activation of LC3-I in Rapamycininboth groups,thus showing an increase in the autophagy pathway through mTOR blockade. In the immunofluorescence analysis, it was not possible to observe consistent difference between the groups. In vitro Western Blottinganalysis showed that such activation was similar between Neu1+/+and Neu1-/-fibroblasts. Conclusion: Experiments related to activation or inhibition of autophagy did not result in considerable differencesbetween normal muscles and Neu1 deficient muscles. Thus, we can conclude from these experiments that apparently Neu1, despite being an important lysosomal enzyme, does not interfere with the autophagy process

Background: Lysosomal storage diseases (LSD) often manifest with cherry red macular spots. Diagnosis is based on clinical features and specific biochemical and enzymatic patterns. In uncertain cases, genetic testing with next generation sequencing can establish a diagnosis, especially in milder or atypical phenotypes. We report on the diagnostic work-up in a boy with sialidosis type I, presenting initially with marked cherry red macular spots but non-specific urinary oligosaccharide patterns and unusually mild excretion of bound sialic acid. Methods: Biochemical, enzymatic and genetic tests were performed in the patient. The clinical and electrophysiological data was reviewed and a genotype-phenotype analysis was performed. In addition a systematic literature review was carried out. Case report and results: Cherry red macular spotswere first noted at 6 years of age after routine screening myopia. Physical examination, psychometric testing, laboratory investigations aswell as cerebralMRIwere unremarkable at 9 years of age. So far no clinical myoclonic seizures occurred, but EEG displays generalized epileptic discharges and visual evoked potentials are prolonged bilaterally. Urine thin layer chromatography showed an oligosaccharide pattern compatible with different LSD including sialidosis, galactosialidosis, GM1 gangliosidosis or mucopolysaccharidosis type IV B. Urinary bound sialic acid excretion was mildly elevated in spontaneous and 24 h urine samples. In cultured fibroblasts, α-sialidase activity was markedly decreased to b1%; however, bound and free sialic acid were within normal range. Diagnosis was eventually established by multigene panel next generation sequencing of genes associated to LSD, identifying two novel, compound heterozygous variants in NEU1 gene (c.699CNA, p.S233R in exon 4 and c.803ANG; p.Y268C in Exon 5 in NEU1 transcriptNM_000434.3), leading to amino acid changes predicted to impair protein function. Discussion: Sialidosis should be suspected in patients with cherry red macular spots, even with non-significant urinary sialic acid excretion. Multigene panel next generation sequencing can establish a definite diagnosis, allowing for counseling of the patient and family.

Sialidose é uma doença neurossomática causada pela deficiência congênita da neuraminidase-1 (Neu1), enzima envolvida na regulação do catabolismo de sialoglicoconjugados nos lisossomos. Com o acúmulo de sialoglicoconjugados, ocorre comprometimento sistêmico e neurológico. Achados histológicos musculares incluem expansão da matriz extracelular (MEC) devido à proliferação anormal de fibroblastos, invasão das fibras musculares por componentes da MEC, fragmentação do citoplasma, formação vacuolar e atrofia das fibras musculares. Entretanto o mecanismo da atrofia muscular na deficiência de Neu1 não está completamente esclarecido, sendo o objetivo desse estudo. Desnervou-se o músculo gastrocnêmio direito de camundongos com deficiência de Neu1 (Neu1 -/-) e de controles Neu1 +/+. Os animais foram eutanasiados 0, 3, 7, 14 e 21 dias pós desnervação. Os músculos desnervados e contralaterais foram submetidos às seguintes análises: 1) histologia geral e medida da área transversa das fibras; 2) autofagia, através da avaliação da presença de vacúolos autofágicos por estudo ultraestrutural e da análise da expressão da proteína LC3; 3) ativação do sistema lisossomal, por reação de fosfatase ácida e análise da expressão proteica de catepsina L e lamp1; 4) deposição de colágeno e infiltração de tecido conjuntivo no tecido muscular; 5) níveis das proteínas Akt e GSK3b; 6) expressão dos atrogenes MuRF1 e Atrogina-1; 7) níveis da proteína MyoD, relacionada à diferenciação muscular; e 8) expressão dos genes Neu1, Neu2, Neu3 e Neu4. Os animais Neu1-/- apresentaram menor peso corporal e muscular compararando-se com animais Neu1 +/+. Houve redução progressiva da área das fibras dos músculos desnervados em relação aos músculos contralaterais. Os animais Neu1-/- apresentaram atrofia muscular basal, com aumento acentuado dos espaços endomisiais e perimisiais. Ocorreu formação de vacúolos autofágicos a partir de 14 dias de desnervação tanto em animais Neu1+/+ quanto em Neu1-/-. Os níveis de expressão proteica de catepsina L e de lamp1 aumentaram a partir de 14 dias de desnervação, mais notadamente em músculos desnervados de camundongos Neu1-/-. A expressão proteica de colágeno III mostrou-se aumentada em animais Neu1-/-, principalmente após desnervação. A expressão proteica da forma fosforilada do Akt (forma ativada) diminuiu após 21 dias de desnervação principalmente em músculos desnervados de animais Neu1+/+. Os níveis de PGSK3 b, forma inativa de GSK3b, diminuíram após a desnervação, em animais Neu1+/+ e animais Neu1-/-. Houve aumento na expressão gênica de Atrogina-1 e MuRF1 após 3 e 7 dias de desnervação, respectivamente; a expressão gênica de Atrogina-1 nos camundongos Neu1-/- teve um aumento atrasado, mostrando diferença significante após 7 dias de desnervação. Não houve diferença significativa entre níveis proteicos de MyoD. A expressão gênica de Neu1 mostrou-se elevada em músculos desnervados de animais Neu1+/+. Conclui-se, portanto, que a Neu1 parece atuar na regulação da massa muscular principalmente controlando o processo de ativação do sistema lisossomal, porém aparentemente sem afetar a autofagia / Sialidosis, a severe neurosomatic disease, results from congenital neuraminidase-1 (Neu1) deficiency. This enzyme regulates the catabolism of sialoglycoconjugates in the lysosomes. Systemic and neurologic manifestations occur due to the sialoglycoconjugates accumulation. In the mouse model for Neu1 deficiency, the muscle histologic findings include extracellular matrix (ECM) expansion, due to abnormal fibroblast proliferation, muscle fibers invasion by ECM components, cytoplasm fragmentation, vacuolar formation and muscle atrophy. Nevertheless the mechanisms of muscle atrophy in Neu1 deficiency are not completely known. This study was designed to investigate Neu1 involvement in muscle atrophy process. Denervation of gastrocnemius muscle was performed by sectioning sciatic nerve from Neu1 deficient mice (Neu1 -/-) and from normal control Neu1 +/+; the animals were euthanized 0, 3, 7, 14 and 21 days after denervation. Denervated and control muscles were collected and submitted to several analysis: 1) histological; 2) autophagic vacuoles formation, performed by ultrastructural analysis and LC3 protein expression; 3) acid phosphatase reaction, lamp1 and cathepsin L protein expression, to analyze lysosomal activation; 4) collagen deposition and fibrous formation; 5) proteins involved with muscle trophism, Akt and GSK3b; 6) MuRF1 and Atrogin-1 gene expression; 7) MyoD protein expression; 8) Neu1, Neu2, Neu3 and Neu4 genes expression. Neu1 -/- mice presented decreased body and muscle weight comparing to Neu1 +/+ animals. Muscle fiber cross-sectional area was reduced in denervated muscles comparing to contralateral muscles. Neu1 -/- mice muscles presented basal atrophy and increase of endomisial and perimisial spaces, which became more evident after denervation. After 14 days of denervation, autophagosome formation was noticed on Neu1 +/+ and Neu1-/- animals. Cathepsin L protein levels were increased after 14 and 21 days of denervation, especially in denervated muscles from Neu1 -/- mice. Lamp1 protein expression was increased in Neu1-/- animals. Type III collagen protein levels were increased in Neu1-/- animals. There were no significant differences between MyoD protein levels. P-Akt, active form of Akt protein levels, decreased after 21 days of denervation, especially in denervated muscles from control group animals, indicating that protein synthesis is decreased. P-GSK3b, inactive form of GSK3b decreased in denervated muscles from Neu1 -/- and Neu1 +/+ animals, which indicates that this protein remained activated during muscle atrophy process. There were significant differences in Atrogin-1 and MuRF1 gene expression levels after 3 and 7 days of denervation. Neu1 -/- animals muscles presented a delayed Atrogin-1 response. Neu1 gene expression was increased in denervated muscles from Neu1 +/+ mice. These findings suggest that Neu1 seems to act in the regulation of muscle mass mainly by controlling the process of lysosomal system activation, but apparently without affecting autophagy

Sialidose é uma doença neurossomática causada pela deficiência congênita da neuraminidase-1 (Neu1), enzima envolvida na regulação do catabolismo de sialoglicoconjugados nos lisossomos. Com o acúmulo de sialoglicoconjugados, ocorre comprometimento sistêmico e neurológico. Achados histológicos musculares incluem expansão da matriz extracelular (MEC) devido à proliferação anormal de fibroblastos, invasão das fibras musculares por componentes da MEC, fragmentação do citoplasma, formação vacuolar e atrofia das fibras musculares. Entretanto o mecanismo da atrofia muscular na deficiência de Neu1 não está completamente esclarecido, sendo o objetivo desse estudo. Desnervou-se o músculo gastrocnêmio direito de camundongos com deficiência de Neu1 (Neu1 -/-) e de controles Neu1 +/+. Os animais foram eutanasiados 0, 3, 7, 14 e 21 dias pós desnervação. Os músculos desnervados e contralaterais foram submetidos às seguintes análises: 1) histologia geral e medida da área transversa das fibras; 2) autofagia, através da avaliação da presença de vacúolos autofágicos por estudo ultraestrutural e da análise da expressão da proteína LC3; 3) ativação do sistema lisossomal, por reação de fosfatase ácida e análise da expressão proteica de catepsina L e lamp1; 4) deposição de colágeno e infiltração de tecido conjuntivo no tecido muscular; 5) níveis das proteínas Akt e GSK3b; 6) expressão dos atrogenes MuRF1 e Atrogina-1; 7) níveis da proteína MyoD, relacionada à diferenciação muscular; e 8) expressão dos genes Neu1, Neu2, Neu3 e Neu4. Os animais Neu1-/- apresentaram menor peso corporal e muscular compararando-se com animais Neu1 +/+. Houve redução progressiva da área das fibras dos músculos desnervados em relação aos músculos contralaterais. Os animais Neu1-/- apresentaram atrofia muscular basal, com aumento acentuado dos espaços endomisiais e perimisiais. Ocorreu formação de vacúolos autofágicos a partir de 14 dias de desnervação tanto em animais Neu1+/+ quanto em Neu1-/-. Os níveis de expressão proteica de catepsina L e de lamp1 aumentaram a partir de 14 dias de desnervação, mais notadamente em músculos desnervados de camundongos Neu1-/-. A expressão proteica de colágeno III mostrou-se aumentada em animais Neu1-/-, principalmente após desnervação. A expressão proteica da forma fosforilada do Akt (forma ativada) diminuiu após 21 dias de desnervação principalmente em músculos desnervados de animais Neu1+/+. Os níveis de PGSK3 b, forma inativa de GSK3b, diminuíram após a desnervação, em animais Neu1+/+ e animais Neu1-/-. Houve aumento na expressão gênica de Atrogina-1 e MuRF1 após 3 e 7 dias de desnervação, respectivamente; a expressão gênica de Atrogina-1 nos camundongos Neu1-/- teve um aumento atrasado, mostrando diferença significante após 7 dias de desnervação. Não houve diferença significativa entre níveis proteicos de MyoD. A expressão gênica de Neu1 mostrou-se elevada em músculos desnervados de animais Neu1+/+. Conclui-se, portanto, que a Neu1 parece atuar na regulação da massa muscular principalmente controlando o processo de ativação do sistema lisossomal, porém aparentemente sem afetar a autofagia / Sialidosis, a severe neurosomatic disease, results from congenital neuraminidase-1 (Neu1) deficiency. This enzyme regulates the catabolism of sialoglycoconjugates in the lysosomes. Systemic and neurologic manifestations occur due to the sialoglycoconjugates accumulation. In the mouse model for Neu1 deficiency, the muscle histologic findings include extracellular matrix (ECM) expansion, due to abnormal fibroblast proliferation, muscle fibers invasion by ECM components, cytoplasm fragmentation, vacuolar formation and muscle atrophy. Nevertheless the mechanisms of muscle atrophy in Neu1 deficiency are not completely known. This study was designed to investigate Neu1 involvement in muscle atrophy process. Denervation of gastrocnemius muscle was performed by sectioning sciatic nerve from Neu1 deficient mice (Neu1 -/-) and from normal control Neu1 +/+; the animals were euthanized 0, 3, 7, 14 and 21 days after denervation. Denervated and control muscles were collected and submitted to several analysis: 1) histological; 2) autophagic vacuoles formation, performed by ultrastructural analysis and LC3 protein expression; 3) acid phosphatase reaction, lamp1 and cathepsin L protein expression, to analyze lysosomal activation; 4) collagen deposition and fibrous formation; 5) proteins involved with muscle trophism, Akt and GSK3b; 6) MuRF1 and Atrogin-1 gene expression; 7) MyoD protein expression; 8) Neu1, Neu2, Neu3 and Neu4 genes expression. Neu1 -/- mice presented decreased body and muscle weight comparing to Neu1 +/+ animals. Muscle fiber cross-sectional area was reduced in denervated muscles comparing to contralateral muscles. Neu1 -/- mice muscles presented basal atrophy and increase of endomisial and perimisial spaces, which became more evident after denervation. After 14 days of denervation, autophagosome formation was noticed on Neu1 +/+ and Neu1-/- animals. Cathepsin L protein levels were increased after 14 and 21 days of denervation, especially in denervated muscles from Neu1 -/- mice. Lamp1 protein expression was increased in Neu1-/- animals. Type III collagen protein levels were increased in Neu1-/- animals. There were no significant differences between MyoD protein levels. P-Akt, active form of Akt protein levels, decreased after 21 days of denervation, especially in denervated muscles from control group animals, indicating that protein synthesis is decreased. P-GSK3b, inactive form of GSK3b decreased in denervated muscles from Neu1 -/- and Neu1 +/+ animals, which indicates that this protein remained activated during muscle atrophy process. There were significant differences in Atrogin-1 and MuRF1 gene expression levels after 3 and 7 days of denervation. Neu1 -/- animals muscles presented a delayed Atrogin-1 response. Neu1 gene expression was increased in denervated muscles from Neu1 +/+ mice. These findings suggest that Neu1 seems to act in the regulation of muscle mass mainly by controlling the process of lysosomal system activation, but apparently without affecting autophagy