O complexo da esclerose tuberosa (TSC) é um transtorno genético, sistêmico, com expressividade variável e herança autossômica dominante. Clinicamente manifesta-se devido ao desenvolvimento de hamartomas e hamártias em diferentes tecidos, principalmente no cérebro, rins, coração, pele e pulmões, podendo causar disfunção do órgão. Mutação em um de dois genes supressores tumorais, TSC1 ou TSC2, são responsáveis pelo TSC. Os genes TSC1 e TSC2 codificam para hamartina e tuberina, respectivamente. Ambas as proteínas interagem fisicamente formando um complexo citosólico que inibe mTOR (mammalian target of rapamycin). Testes moleculares para TSC1 e TSC2 são úteis para auxiliar no diagnóstico de casos clínicos difíceis, em aconselhamento genético e estudos de associação genótipo-fenotípica, além de permitirem a caracterização molecular de mecanismos patogenéticos da formação dos hamartomas e análises funcionais de seus produtos gênicos. Apesar de o diagnóstico de TSC ser basicamente clínico, a partir da revisão de seus critérios em 2012 por um grupo de especialistas, o achado de uma mutação em TSC1 ou TSC2 passou a ser considerado suficiente para o diagnóstico definitivo da doença. O estudo apresentado aqui é parte de um projeto em andamento para estabelecer condições ao desenvolvimento de análise de mutações causadoras de TSC nos genes TSC1 e TSC2. Nosso objetivo neste trabalho foi avaliar por sequenciamento de Sanger o DNA genômico de 28 pacientes brasileiros com diagnóstico definitivo de TSC, procedentes dos estados de São Paulo ou Paraná, tendo como alvo a sequência codificadora do gene TSC1, parte de seus segmentos intrônicos, o promotor basal, bem como o segmento imediatamente a 5\' deste. Sete pacientes (25%) apresentaram mutações de sentido trocado (nonsense) ou com deslocamento da leitura à tradução (frameshift) no gene TSC1. Entre 31 outras variantes de DNA encontradas, 23 são polimorfismos conhecidos e oito apresentaram frequência inferior a 1%, como verificado in silico entre mais de mil sequências de genomas humanos. Entre essas oito variantes de DNA novas ou raras, quatro foram detectadas em pacientes para os quais uma mutação patogênica havia sido identificada e, por isso, foram reclassificadas como polimorfismos. Duas e uma variantes de DNA do mesmo paciente flanqueavam um sítio de ligação em potencial para um fator de transcrição específico, a 5\' do promotor basal de TSC1. Por fim, uma nova variante de DNA na região não codificadora do éxon 2 do gene TSC1 foi predita com potencial para alterar um elemento candidato a acentuador de splicing. Em resumo, como observado em estudos anteriores, descrevemos aqui 25% dos pacientes com TSC apresentando mutações patogênicas na sequência codificadora do gene TSC1. Nossos dados mostraram quatro novas variantes de DNA em regiões potencialmente reguladoras da expressão do gene TSC1, que podem revelar-se como mutações patogênicas e, portanto, necessitam ser testadas experimentalmente / Tuberous sclerosis complex (TSC) is a multisystem disorder, with variable expression and autosomal dominant inheritance. Clinically it is due to hamartia and hamartoma development in different tissues, notably in the brain, kidneys, heart, skin and lungs, causing organ dysfunction. Mutations in either tumor suppressor gene, TSC1 or TSC2, are responsible for TSC. TSC1 and TSC2 genes code for hamartin and tuberin, respectively. Both proteins physically interact forming a cytosolic complex that inhibits the mammalian target of rapamycin (mTOR). TSC1 and TSC2 molecular testing has been useful in diagnosing clinically challenging cases, in genetic counseling and genotype/phenotype association studies, besides evaluation of the molecular basis of hamartoma formation and functional analyses of both gene products. Although TSC diagnosis is basically clinical, since the 2012 specialist panel review the finding of a TSC1 or TSC2 mutation has been considered sufficient for the definite diagnosis of the disease. The results presented here are part of an ongoing project to establish conditions for TSC1 and TSC2 mutation studies. Our first aim is to evaluate by Sanger sequencing TSC1 coding sequence, and an average of 132 base pairs of intronic regions next to exon boundaries from TSC patients, in addition to the gene core promoter. We present preliminary results of a sample of 28 patients with definite TSC diagnosis, from São Paulo and Paraná states. Seven patients (25%) displayed TSC1 nonsense or frameshift mutations. Among 31 other DNA variants identified, 23 were known polymorphisms, and eight had frequencies below 1% as verified in silico among more than a thousand human genomes. Out of eight novel or rare DNA variants, four were detected in patients for whom a pathogenic mutation had been found. Two and one additional DNA point variants from the same patient flanked a putative transcription factor binding site. Finally, a novel DNA variant residing in the TSC1 noncoding exon 2 was predicted to change the sequence potential to behave as a splicing enhancer. In summary, similar to previous studies, we describe 25% of TSC patients with mutations in the TSC1 coding sequence. Differently from other reports, our data disclose four novel DNA variants in TSC1 potentially regulatory regions that are likely to unravel novel pathogenic mutations, and thus need to be experimentally tested

O complexo da esclerose tuberosa (TSC) é uma doença genética que pode afetar órgãos específicos de qualquer sistema do organismo humano. Em geral, as lesões surgem pela inativação bialélica de um dos genes supressores tumorais Tuberous Sclerosis Complex 1 (TSC1) ou 2 (TSC2). Por outro lado, nas regiões corticais e subcorticais do cérebro, as lesões decorrentes de falhas de migração neuronal e sua arborização podem ser explicadas pela haploinsuficiência de TSC1 ou TSC2. As lesões do córtex cerebral apresentam-se comumente com epilepsia refratária, a qual, por sua vez, pode se associar a deficiência intelectual e transtornos do comportamento. Estes quadros clínicos podem estar presentes em pacientes com TSC sem lesão anatômica detectável à ressonância nuclear magnética do crânio. As proteínas hamartina ou tuberina, conhecidas também como TSC1 e TSC2, são codificadas respectivamente pelos genes TSC1 e TSC2. Elas agem juntas em um complexo molecular citosólico que inativa a pequena GTPase Rheb, a qual tem ação ativadora da cinase alvo da rapamicina em mamíferos (mTOR), regulando diversos processos celulares, como proliferação, diferenciação, crescimento, migração e metabolismo. Com a hipótese de que a quantidade de TSC1 ou TSC2 no neurônio pode alterar suas funções de forma dependente do estado metabólico, tivemos, neste trabalho, o objetivo geral de caracterizar os padrões de expressão e atividade de TSC1 e TSC2 em dois modelos de neurodegeneração induzida no camundongo adulto e verificar se a redução de quantidade de TSC1 tem efeito sobre a extensão da lesão de neurônios dopaminérgicos em modelo de hemiparkinsonismo. No primeiro modelo empregado, cinco estruturas encefálicas de camundongos submetidos a dieta hiperlipídica mostraram alteração da quantidade de RNAm de Tsc1 e/ou Tsc2 ou sinais de estresse oxidativo. A redução de transcritos de Tsc1 e Tsc2 no córtex cerebral foi dependente de jejum realizado imediatamente antes da eutanásia. No córtex cingulado, houve evidência de estresse oxidativo. O aumento específico de RNAm foi observado no hipocampo (Tsc1 e Tsc2) e no estriado e hipotálamo (Tsc1), embora de forma independente do jejum, sugerindo se tratar de alterações relacionadas à dieta hiperlipídica. No modelo de hemiparkinsonismo, camundongos adultos submetidos a injeção intracerebral de 6-hidroxidopamina apresentaram redução da quantidade total de proteína S6 no lado encefálico tratado quando comparado ao segmento contralateral (p =0,004, r=0,8795; teste de Pearson, IC: 95%), sem alteração de TSC1 ou TSC2. Em análises de imunoperoxidase do encéfalo, descrevemos, de forma independente da lesão, a expressão de TSC1 no estriado, núcleos entopeduncular e arqueado e de TSC2 no tálamo e hipotálamo. Com o objetivo de obter um modelo de camundongo sem expressão pós-natal de Tsc1 em várias regiões encefálicas, de forma independente do tipo celular, realizamos cruzamentos entre uma linhagem de camundongo transgênico em que o gene Tsc1 contém sequências lox nos íntrons 16 e 18 e outra linhagem com Tsc1 tipo-selvagem (WT) em homozigose e o transgene para expressão da recombinase Cre em fusão ao domínio de ligação ao ligante do receptor de estrógeno humano (ESR1) sob o controle de expressão do promotor de ubiquitina C (UBC). Em F1, obtivemos camundongos portadores do transgene UBC-CreESR1 e heterozigotos para Tsc1 (Tsc1WT/Flox). Em F2, entre os animais homozigotos Tsc1Flox/Flox (N = 153) gerados por retrocruzamento, nenhum era portador do transgene (Nesperado = 85; Nobservado = 0; X2 = 348,185; p < 0,0001) É possível que o segmento genômico em que houve inserção do vetor lentiviral que carrega o transgene UBC-CreESR1 esteja ligado ao loco de Tsc1 no cromossomo 2 do camundongo, segregando juntos. O tratamento com 4-hidroxitamoxifeno de animais heterozigotos e portadores do transgene aumentou a quantidade de TSC1 no estriado (p < 0,05) e o cerebelo não apresentou alteração. É possível que mecanismos transcricionais ou traducionais, funcionais no estriado, tenham favorecido o aumento de TSC1 de forma dependente de 4-hidroxitamoxifeno / Tuberous sclerosis complex (TSC) is a genetic disorder that can affect any specific organs. In general, lesions are caused by biallelic inactivation of the tumor suppressor genes Tuberous Sclerosis Complex 1 (TSC1) or 2 (TSC2). On the other hand, in cortical and subcortical brain regions, lesions associated with neuronal migration and arborization failures can be explained by TSC1 or TSC2 haploinsufficiency. Brain cortical lesions commonly cause refractory epilepsy, which, in turn, may be associated with intellectual disabilities and behavioral disorders. These medical conditions may be present in TSC patients without detectable anatomic lesion on magnetic resonance images. TSC1 and TSC2 genes encode hamartin and tuberin, also known as TSC1 and TSC2, respectively. They act together in a cytosolic molecular complex that inactivates small GTPase Rheb, which is a mammalian target of rapamycin (mTOR) activator, regulating diverse cellular processes such as proliferation, differentiation, growth, migration and metabolism. With the hypothesis that the amount of TSC1 or TSC2 in the neuron can change its function depending on the metabolic state, the overall objective of this study was to characterize TSC1 and TSC2 expression patterns and activity in two mice models of induced neurodegeneration; and check whether TSC1 reduction changes dopaminergic neurons damage extent in a hemiparkinsonins model. For the first model, five brain structures from mice fed with high fat diet showed alterations in Tsc1 and/or Tsc2 mRNA, or oxidative stress signals. Reduction of Tsc1 and Tsc2 transcripts in the cerebral cortex was dependent on fasting performed immediately prior to euthanasiaThere was evidence of oxidative stress in the cingulate cortex. Increase in mRNA was observed in the hippocampus (Tsc1 and Tsc2) and striatum and hypothalamus (Tsc1), although independent of the fasting, suggesting that this effect is related to the high fat diet. In hemiparkinsonism model, adult mice subjected to intracerebral injection of 6-hydroxydopamine had decreased levels of S6 in the brain treated side compared to the contralateral segment (p = 0.004, r = 0.8795; Pearson test, CI: 95 %), without alterations in TSC1 nor TSC2. Using imunoperoxidase analysis, we described TSC1 expression in the striatum, entopeduncular and arcuate nuclei, and TSC2 in the thalamus and hypothalamus, independently from the 6-OHDA lesion. To obtain a mouse model without TSC1 postnatal expression in different brain regions, independently of the cell type, we performed crosses between transgenic mouse strain in which the Tsc1 gene contains lox sequences in introns 16 and 18 and strain with Tsc1 wild-type (WT) and the transgene for expression of Cre recombinase fused to the binding domain of the human estrogen receptor (ESR1) ligand, controlled by ubiquitin C (UBC) promoter expression. In F1, we obtained mice carrying the transgene UBC-CreESR1 and heterozygous for Tsc1 (Tsc1WT/flox). In F2, among animals homozygous Tsc1Flox/Flox (N=153) generated by backcrossing, none was carrying the transgene (Nexpected = 85; Nobserved = 0; X2= 348.185, p <0.0001) It is possible that the genomic segment containing the lentiviral vector insertion bearing UBC-CreESR1 transgene is linked to the TSC1 region on mouse chromosome 2, and they segregate together. Treatment with 4-hydroxytamoxifen in animals heterozygous and positive for the transgene showed increased TSC1 in the striatum (p <0.05), while there was no change in the cerebellum. It is possible that transcriptional or translational functional striatum mechanisms favored TSC1 increasing, in a 4-hydroxytamoxifen-dependent manner

La Sclérose Tubéreuse de Bourneville est une pathologie génétique rare qui se caractérise par la survenue de crises épileptiques précoces à l’origine du développement de nombreux troubles neurologiques tels que des symptômes autistiques ou des retards mentaux. Les épilepsies retrouvées dans la Sclérose Tubéreuse de Bourneville sont souvent résistantes aux traitements pharmacologiques disponibles soulevant la nécessité de trouver de nouvelles approches médicamenteuses plus efficaces pour traiter les patients. Dans cette étude nous avons mis en évidence que l’AppCH2ppA est une molécule efficace pour bloquer la survenue des crises épileptiques dans un modèle de souris pour la Sclérose Tubéreuse de Bourneville ainsi que sur des résections chirurgicales de tissu provenant de patients humains atteints par la Sclérose Tubéreuse de Bourneville. Nous avons montré que les propriétés antiépileptiques de l’AppCH2ppA s’appuient sur une libération autocrine d’adénosine par les neurones de la couche IV du cortex somatosensoriel et d’une activation consécutive des récepteurs à l’adénosine de type A1. Cette activation a lieu spécifiquement au niveau du compartiment postsynaptique et est responsable d’une activation de conductances potassiques et d’une diminution de l’excitabilité des neurones. L’administration d’AppCH2ppA n’est associé à aucun effet secondaire notables sur la santé des souris. Ainsi l’AppCH2ppA semble être un outil thérapeutique prometteur et peu risqué qui stimule des mécanismes antiépileptiques endogènes naturellement sollicités par le cerveau et efficaces pour stopper et limiter la survenue des crises épileptiques. / Tuberous Sclerosis Complex (TSC) is a rare genetic disease characterized by the presence of epilepsies that appear early and in the life of patients and are responsible for the development of several neurological disorders such as autistic symptoms or mental retardations.In TSC, epileptic seizures often resist to pharmacological approaches raising the importance to find new molecules to treat more efficiently the patients.In this study we showed that AppCH2ppA is an effective molecule to block the onset of epileptic seizures in a mouse model for Tuberous Sclerosis as well as on human patients tissues.We have shown that AppCH2ppA nduce an autocrine release of adenosine by the spiny stellate cells present in the layer IV of the somatosensory cortex. This release is responsible for a subsequent activation of adenosine A1 receptors that occur specifically in the postsynaptic compartment of neurons and is responsible for an activation of potassium channels and a decrease of the excitability of neurons. The administration of AppCH2ppA is not associated with any significant side effects on mouse health. Thus, AppCH2ppA appears to be a promising and low-risk therapeutic tool that stimulates an endogenous antiepileptic pathway that is naturally used in the brain and that is efficient to stop and limit the appearance of epileptic seizures.

O complexo da esclerose tuberosa (TSC) é uma doença genética que pode afetar órgãos específicos de qualquer sistema do organismo humano. Em geral, as lesões surgem pela inativação bialélica de um dos genes supressores tumorais Tuberous Sclerosis Complex 1 (TSC1) ou 2 (TSC2). Por outro lado, nas regiões corticais e subcorticais do cérebro, as lesões decorrentes de falhas de migração neuronal e sua arborização podem ser explicadas pela haploinsuficiência de TSC1 ou TSC2. As lesões do córtex cerebral apresentam-se comumente com epilepsia refratária, a qual, por sua vez, pode se associar a deficiência intelectual e transtornos do comportamento. Estes quadros clínicos podem estar presentes em pacientes com TSC sem lesão anatômica detectável à ressonância nuclear magnética do crânio. As proteínas hamartina ou tuberina, conhecidas também como TSC1 e TSC2, são codificadas respectivamente pelos genes TSC1 e TSC2. Elas agem juntas em um complexo molecular citosólico que inativa a pequena GTPase Rheb, a qual tem ação ativadora da cinase alvo da rapamicina em mamíferos (mTOR), regulando diversos processos celulares, como proliferação, diferenciação, crescimento, migração e metabolismo. Com a hipótese de que a quantidade de TSC1 ou TSC2 no neurônio pode alterar suas funções de forma dependente do estado metabólico, tivemos, neste trabalho, o objetivo geral de caracterizar os padrões de expressão e atividade de TSC1 e TSC2 em dois modelos de neurodegeneração induzida no camundongo adulto e verificar se a redução de quantidade de TSC1 tem efeito sobre a extensão da lesão de neurônios dopaminérgicos em modelo de hemiparkinsonismo. No primeiro modelo empregado, cinco estruturas encefálicas de camundongos submetidos a dieta hiperlipídica mostraram alteração da quantidade de RNAm de Tsc1 e/ou Tsc2 ou sinais de estresse oxidativo. A redução de transcritos de Tsc1 e Tsc2 no córtex cerebral foi dependente de jejum realizado imediatamente antes da eutanásia. No córtex cingulado, houve evidência de estresse oxidativo. O aumento específico de RNAm foi observado no hipocampo (Tsc1 e Tsc2) e no estriado e hipotálamo (Tsc1), embora de forma independente do jejum, sugerindo se tratar de alterações relacionadas à dieta hiperlipídica. No modelo de hemiparkinsonismo, camundongos adultos submetidos a injeção intracerebral de 6-hidroxidopamina apresentaram redução da quantidade total de proteína S6 no lado encefálico tratado quando comparado ao segmento contralateral (p =0,004, r=0,8795; teste de Pearson, IC: 95%), sem alteração de TSC1 ou TSC2. Em análises de imunoperoxidase do encéfalo, descrevemos, de forma independente da lesão, a expressão de TSC1 no estriado, núcleos entopeduncular e arqueado e de TSC2 no tálamo e hipotálamo. Com o objetivo de obter um modelo de camundongo sem expressão pós-natal de Tsc1 em várias regiões encefálicas, de forma independente do tipo celular, realizamos cruzamentos entre uma linhagem de camundongo transgênico em que o gene Tsc1 contém sequências lox nos íntrons 16 e 18 e outra linhagem com Tsc1 tipo-selvagem (WT) em homozigose e o transgene para expressão da recombinase Cre em fusão ao domínio de ligação ao ligante do receptor de estrógeno humano (ESR1) sob o controle de expressão do promotor de ubiquitina C (UBC). Em F1, obtivemos camundongos portadores do transgene UBC-CreESR1 e heterozigotos para Tsc1 (Tsc1WT/Flox). Em F2, entre os animais homozigotos Tsc1Flox/Flox (N = 153) gerados por retrocruzamento, nenhum era portador do transgene (Nesperado = 85; Nobservado = 0; X2 = 348,185; p < 0,0001) É possível que o segmento genômico em que houve inserção do vetor lentiviral que carrega o transgene UBC-CreESR1 esteja ligado ao loco de Tsc1 no cromossomo 2 do camundongo, segregando juntos. O tratamento com 4-hidroxitamoxifeno de animais heterozigotos e portadores do transgene aumentou a quantidade de TSC1 no estriado (p < 0,05) e o cerebelo não apresentou alteração. É possível que mecanismos transcricionais ou traducionais, funcionais no estriado, tenham favorecido o aumento de TSC1 de forma dependente de 4-hidroxitamoxifeno / Tuberous sclerosis complex (TSC) is a genetic disorder that can affect any specific organs. In general, lesions are caused by biallelic inactivation of the tumor suppressor genes Tuberous Sclerosis Complex 1 (TSC1) or 2 (TSC2). On the other hand, in cortical and subcortical brain regions, lesions associated with neuronal migration and arborization failures can be explained by TSC1 or TSC2 haploinsufficiency. Brain cortical lesions commonly cause refractory epilepsy, which, in turn, may be associated with intellectual disabilities and behavioral disorders. These medical conditions may be present in TSC patients without detectable anatomic lesion on magnetic resonance images. TSC1 and TSC2 genes encode hamartin and tuberin, also known as TSC1 and TSC2, respectively. They act together in a cytosolic molecular complex that inactivates small GTPase Rheb, which is a mammalian target of rapamycin (mTOR) activator, regulating diverse cellular processes such as proliferation, differentiation, growth, migration and metabolism. With the hypothesis that the amount of TSC1 or TSC2 in the neuron can change its function depending on the metabolic state, the overall objective of this study was to characterize TSC1 and TSC2 expression patterns and activity in two mice models of induced neurodegeneration; and check whether TSC1 reduction changes dopaminergic neurons damage extent in a hemiparkinsonins model. For the first model, five brain structures from mice fed with high fat diet showed alterations in Tsc1 and/or Tsc2 mRNA, or oxidative stress signals. Reduction of Tsc1 and Tsc2 transcripts in the cerebral cortex was dependent on fasting performed immediately prior to euthanasiaThere was evidence of oxidative stress in the cingulate cortex. Increase in mRNA was observed in the hippocampus (Tsc1 and Tsc2) and striatum and hypothalamus (Tsc1), although independent of the fasting, suggesting that this effect is related to the high fat diet. In hemiparkinsonism model, adult mice subjected to intracerebral injection of 6-hydroxydopamine had decreased levels of S6 in the brain treated side compared to the contralateral segment (p = 0.004, r = 0.8795; Pearson test, CI: 95 %), without alterations in TSC1 nor TSC2. Using imunoperoxidase analysis, we described TSC1 expression in the striatum, entopeduncular and arcuate nuclei, and TSC2 in the thalamus and hypothalamus, independently from the 6-OHDA lesion. To obtain a mouse model without TSC1 postnatal expression in different brain regions, independently of the cell type, we performed crosses between transgenic mouse strain in which the Tsc1 gene contains lox sequences in introns 16 and 18 and strain with Tsc1 wild-type (WT) and the transgene for expression of Cre recombinase fused to the binding domain of the human estrogen receptor (ESR1) ligand, controlled by ubiquitin C (UBC) promoter expression. In F1, we obtained mice carrying the transgene UBC-CreESR1 and heterozygous for Tsc1 (Tsc1WT/flox). In F2, among animals homozygous Tsc1Flox/Flox (N=153) generated by backcrossing, none was carrying the transgene (Nexpected = 85; Nobserved = 0; X2= 348.185, p <0.0001) It is possible that the genomic segment containing the lentiviral vector insertion bearing UBC-CreESR1 transgene is linked to the TSC1 region on mouse chromosome 2, and they segregate together. Treatment with 4-hydroxytamoxifen in animals heterozygous and positive for the transgene showed increased TSC1 in the striatum (p <0.05), while there was no change in the cerebellum. It is possible that transcriptional or translational functional striatum mechanisms favored TSC1 increasing, in a 4-hydroxytamoxifen-dependent manner

O complexo da esclerose tuberosa (TSC) é um transtorno genético, sistêmico, com expressividade variável e herança autossômica dominante. Clinicamente manifesta-se devido ao desenvolvimento de hamartomas e hamártias em diferentes tecidos, principalmente no cérebro, rins, coração, pele e pulmões, podendo causar disfunção do órgão. Mutação em um de dois genes supressores tumorais, TSC1 ou TSC2, são responsáveis pelo TSC. Os genes TSC1 e TSC2 codificam para hamartina e tuberina, respectivamente. Ambas as proteínas interagem fisicamente formando um complexo citosólico que inibe mTOR (mammalian target of rapamycin). Testes moleculares para TSC1 e TSC2 são úteis para auxiliar no diagnóstico de casos clínicos difíceis, em aconselhamento genético e estudos de associação genótipo-fenotípica, além de permitirem a caracterização molecular de mecanismos patogenéticos da formação dos hamartomas e análises funcionais de seus produtos gênicos. Apesar de o diagnóstico de TSC ser basicamente clínico, a partir da revisão de seus critérios em 2012 por um grupo de especialistas, o achado de uma mutação em TSC1 ou TSC2 passou a ser considerado suficiente para o diagnóstico definitivo da doença. O estudo apresentado aqui é parte de um projeto em andamento para estabelecer condições ao desenvolvimento de análise de mutações causadoras de TSC nos genes TSC1 e TSC2. Nosso objetivo neste trabalho foi avaliar por sequenciamento de Sanger o DNA genômico de 28 pacientes brasileiros com diagnóstico definitivo de TSC, procedentes dos estados de São Paulo ou Paraná, tendo como alvo a sequência codificadora do gene TSC1, parte de seus segmentos intrônicos, o promotor basal, bem como o segmento imediatamente a 5\' deste. Sete pacientes (25%) apresentaram mutações de sentido trocado (nonsense) ou com deslocamento da leitura à tradução (frameshift) no gene TSC1. Entre 31 outras variantes de DNA encontradas, 23 são polimorfismos conhecidos e oito apresentaram frequência inferior a 1%, como verificado in silico entre mais de mil sequências de genomas humanos. Entre essas oito variantes de DNA novas ou raras, quatro foram detectadas em pacientes para os quais uma mutação patogênica havia sido identificada e, por isso, foram reclassificadas como polimorfismos. Duas e uma variantes de DNA do mesmo paciente flanqueavam um sítio de ligação em potencial para um fator de transcrição específico, a 5\' do promotor basal de TSC1. Por fim, uma nova variante de DNA na região não codificadora do éxon 2 do gene TSC1 foi predita com potencial para alterar um elemento candidato a acentuador de splicing. Em resumo, como observado em estudos anteriores, descrevemos aqui 25% dos pacientes com TSC apresentando mutações patogênicas na sequência codificadora do gene TSC1. Nossos dados mostraram quatro novas variantes de DNA em regiões potencialmente reguladoras da expressão do gene TSC1, que podem revelar-se como mutações patogênicas e, portanto, necessitam ser testadas experimentalmente / Tuberous sclerosis complex (TSC) is a multisystem disorder, with variable expression and autosomal dominant inheritance. Clinically it is due to hamartia and hamartoma development in different tissues, notably in the brain, kidneys, heart, skin and lungs, causing organ dysfunction. Mutations in either tumor suppressor gene, TSC1 or TSC2, are responsible for TSC. TSC1 and TSC2 genes code for hamartin and tuberin, respectively. Both proteins physically interact forming a cytosolic complex that inhibits the mammalian target of rapamycin (mTOR). TSC1 and TSC2 molecular testing has been useful in diagnosing clinically challenging cases, in genetic counseling and genotype/phenotype association studies, besides evaluation of the molecular basis of hamartoma formation and functional analyses of both gene products. Although TSC diagnosis is basically clinical, since the 2012 specialist panel review the finding of a TSC1 or TSC2 mutation has been considered sufficient for the definite diagnosis of the disease. The results presented here are part of an ongoing project to establish conditions for TSC1 and TSC2 mutation studies. Our first aim is to evaluate by Sanger sequencing TSC1 coding sequence, and an average of 132 base pairs of intronic regions next to exon boundaries from TSC patients, in addition to the gene core promoter. We present preliminary results of a sample of 28 patients with definite TSC diagnosis, from São Paulo and Paraná states. Seven patients (25%) displayed TSC1 nonsense or frameshift mutations. Among 31 other DNA variants identified, 23 were known polymorphisms, and eight had frequencies below 1% as verified in silico among more than a thousand human genomes. Out of eight novel or rare DNA variants, four were detected in patients for whom a pathogenic mutation had been found. Two and one additional DNA point variants from the same patient flanked a putative transcription factor binding site. Finally, a novel DNA variant residing in the TSC1 noncoding exon 2 was predicted to change the sequence potential to behave as a splicing enhancer. In summary, similar to previous studies, we describe 25% of TSC patients with mutations in the TSC1 coding sequence. Differently from other reports, our data disclose four novel DNA variants in TSC1 potentially regulatory regions that are likely to unravel novel pathogenic mutations, and thus need to be experimentally tested

Novartis a subventionné ce projet de recherche / La sclérose tubéreuse de Bourneville (STB) est une affection caractérisée par la formation de tumeurs bénignes dans différents organes dont le cœur. Elle est due à la désinhibition de la cible mammalienne de la rapamycine (mTOR). Ces tumeurs encore appelées rhabdomyomes (RHM) au niveau cardiaque régressent spontanément dans la plupart des cas mais peuvent se compliquer d’arythmie ou d’obstruction ce qui peut compromettre le débit cardiaque et nécessiter un traitement. Les objectifs généraux de ce travail étaient d’étudier les perturbations des paramètres fonctionnels cardiaques et d’analyser la variabilité de la fréquece cardiaque chez une population porteuse de rhabdomyomes cardiaques dans la sclérose tubéreuse de Bourneville. Méthodes : Nous avons mené cette étude transversale entre février 2013 et mars 2015 afin de déterminer l'impact de la RHM sur le système de conduction cardiaque, sur l'homéostasie nerveuse autonome et sur le fonctionnement du coeur. Trente sujets avec TSC ont été recrutés pour participer à cette étude et ils ont été comparés à 13 contrôles sains qui étaient des membres de la famille libres de RHM. Les séries d’échocardiogrammes qui ont été précédemment enregistrées ont servi à documenter la taille de la tumeur au cours de la petite enfance. Un enregistrement Holter de 24 heures a été effectué pour la détection éventuelle d'arythmies et l'analyse de la variabilité de la fréquence cardiaque (VFC). Nous avons aussi rapporté quatre cas de régression de gros rhabdomyomes obstructifs chez des nouveaux nés sous everolimus par rapport à dix contrôles historiques non traités de notre centre. Résultats : La durée moyenne du suivi était de 4.5 ans. La prévalence des RHM était de 46.8% (37 RHM) entre 0-5 ans, 13.9% (11 RHM) entre 6-11 ans et 39.2% (31 RHM) entre 12- 33 ans. Dans 20% des cas, les RHM étaient responsables d’obstacles à l’éjection ou au remplissage du cœur. Les troubles du rythme retrouvés étaient de bénignes extrasystoles ventriculaires (55%) et des extrasystoles supraventriculaires (50%), Ces extrasystoles étaient plus fréquentes chez ces patients comparés à la population générale. Des arythmies significatives étaient notées chez 3 patients (30%) porteurs de large RHM: l’un présentait une tachycardie supraventriculaire sur syndrome de Wolff Parkinson White, l’autre une fibrillation auriculaire et le dernier des tachycardies supraventriculaires paroxystiques. Dans ii cette étude, nous avons aussi noté une augmentation de la variabilité de la fréquence cardiaque chez les cas dans les domaines et temporels spatial. En analyse régression linéaire on note une inversion de la pente de la courbe de variabilité de la fréquence cardiaque selon l'âge comparée à celle des témoins sains. Chez quatre patients pour qui les RHM obstructifs étaient traités par everolimus, la régression était en moyenne 11.8 fois plus rapide (droite de régression linéaire -0.0285 vs. -0.0024; p<0.001). La durée moyenne de régression de 50% de la taille des masses était de 1.13 ± 0.33 mois (extrêmes 0.66 à 1.4 mois) pour les patients traités par everolimus comparée à 72.9 ± 53.03 mois dans le groupe contrôle historique (p = 0.026). Aucun effet secondaire significatif n’a été observé. Conclusion: Dans cette série les arythmies cardiaques sont plus fréquentes chez les porteurs de sclérose tubéreuse de Bourneville comparés à la population générale avec une tendance plus importante chez les cas avec de gros rhabdomyomes. Pour ces derniers, l’everolimus est efficace pour la réduction de leur taille durant la période néonatale. Mais avec le peu de données de sécurité et d’innocuité disponibles cette approche thérapeutique ne doit être considérée que pour un nombre de cas limités. / Background: Tuberous Sclerosis Complex is caracterised by the formation of benign tumors in various organs, including the heart. It is caused by the disinhibition of the mammalian target of rapamycin (mTOR) protein. RHM (rhabdomyomas) regress spontaneously in most cases but can be complicated by serious arrhythmias or obstruction that may compromise cardiac output requiring treatement. The main objectives of this work were to study functional and electrical cardiac desorders and to analyze the heart rate variability in population of TSC with cardiac rhabdomyoma. Methods: We conducted this cross-sectional study between February 2013 and March 2015 to determine the impact of HMR on the cardiac conduction system and on autonomic nervous homeostasis. Thirty subjects with TSC were recruited to participate in this study and compared to 13 healthy controls that were free family members of RHM. The serial echocardiograms that were previously recorded were used to document the size of the tumor during early childhood. A 24-hour Holter record was performed for possible arrhythmia detection and heart rate variability (VFC) analysis. Results: The median follow-up time was 4.5 years. The prevalence of RHM was 46.8% (37 RHM) between 0-5 years, 39.2% (31 RHM) between 12-33 years and 13.9% (11 RHM) between 6-11 years. RHM causes in 20% an obstacle to inflow or outflow tract. The encountered benign arrhythmias founded were isolated ventricular premature beats (55%) and supraventricular premature beats (50%), which were 2 times fold and 4 times fold more compared to reported prevalence in the general pediatric population, respectively (p<0.05). Significant arrhythmias were noted in 3 (30%) patients with large RHM: one patient with Wolff Parkinson White syndrome had supraventricular tachycardia, one with atrial fibrillation, a third patient had symptomatic paroxysmal supraventricular tachycardia. There was a trend which did not reach statistical significance difference in the prevalence of cardiac arrhythmias between cases with small versus large RHM (p=0.07). In this study heart rate variability was increased in patients with TSC according to time, frequency and non-linear domains. For this heart rate variabity TSC patients with RHM showed an inversed relationship towards age compared to controls, Studies from four everolimus treated cases were compared to 10 controls. Compared to historic controls, everolimus treated patients had a RHM size regression rate 11.8 times faster (linear regression slope -0.0285 vs. -0.0024; p<0.001). The average time to 50% size reduction was 1.13 ± 0.33 month (range 0.66 to 1.4 months) for everolimus treated patients compared to 72.9 ± 53.03 months in the historic controls (p = 0.026). No significant side effect were observed. Conclusion: In this series, arrhythmia was more prevalent in TSC compared to general pediatric population, with a trend towards higher prevalence in cases with larger RHM. Everolimus is effective for size reduction of RHM during the neonatal period. With limited safety data this approach should be used with caution, only in selective cases.

Tuberous sclerosis complex (TSC) is a multisystem tumor-forming disorder caused by biallelic inactivation of TSC1 or TSC2. The primary cause of mortality arises from mesenchymal manifestations in the lung and kidney: pulmonary lymphangioleiomyomatosis (LAM) and renal angiomyolipomas (RAMLs). Despite a well-described monogenic etiology, there remains an incomplete understanding of disease pathogenesis. Consequentially, tractable models which fully recapitulate disease characteristics are lacking. Here, I develop and study novel tissue-engineered models of TSC lung and kidney disease. In my first chapter, I demonstrate that lung-mimetic hydrogel culture of pluripotent stem cell-derived diseased cells more faithfully recapitulates human LAM biology compared to conventional culture on two-dimensional plastic. Leveraging this culture system, I conducted a three-dimensional drug screen using a custom 800-compound library, tracking cytotoxicity and invasion modulation phenotypes at the single cell level. I identified histone deacetylase (HDAC) inhibitors as a group of anti-invasive agents that are also selectively cytotoxic towards TSC2-/- cells. HDAC inhibitor therapeutic effects remained consistent in vivo upon xenotransplantation of LAM cellular models into zebrafish. In my second chapter, I develop a genetically-engineered human renal organoid model which recapitulates pleiotropic features of RAMLs in vitro and upon orthotopic xenotransplantation. I find that loss of TSC1/2 affects multiple developmental processes in the renal epithelial, stromal, and glial compartments. First, loss of TSC1/2 leads to an expanded stroma by favouring stromal cell fate acquisition and alters terminal stromal cell identity. Second, epithelial cells in the TSC1/2-/- organoids exhibit a rapamycin-insensitive epithelial-to-mesenchymal transition. Third, a melanocytic population forms exclusively in TSC1/2-/- organoids, branching from MITF+ Schwann cell precursors of a bona fide neural crest-to-Schwann cell differentiation trajectory. Through these two thesis chapters, I realize the power of tissue-engineered models for the study of TSC. This work offers novel insights into the pathogenesis of RAMLs and identifies a new class of therapeutics suitable for trialing in patients with pulmonary LAM.

No description available.

La trisomie 21 (T21), le Syndrome X Fragile (SXF), la Sclérose tubéreuse de Bourneville (STB) et les mutations SYNGAP1 sont causés par des dysfonctionnements des voies moléculaires qui entraînent notamment un déséquilibre dans l’excitation et l’inhibition de l’activité neuronale qui aurait des impacts sur le développement et le fonctionnement du cerveau. Toutefois, il est difficile de faire le pont entre les déséquilibres moléculaires observés dans les modèles animaux et les particularités structurelles, fonctionnelles et cognitives observées dans ces syndromes chez l’humain. À notre connaissance, peu d’études ont comparé différents syndromes génétiques sur les processus sensoriels, l’apprentissage de base ou encore leurs caractéristiques comportementales en utilisant des paradigmes similaires et translationnels, permettant de mieux comprendre leurs particularités. Le premier volet de cette thèse vise à identifier si l’activité électroencéphalographique serait un biomarqueur adéquat représentant les altérations neurobiologiques tant des processus sensoriels que d’apprentissage chez les humains présentant ces syndromes. L’étude #1 avait comme objectif de décrire le traitement sensoriel auditif, comme il s’agit d’un processus élémentaire, et ce, chez les mutations SYNGAP1 qui représentent une condition génétique encore peu étudiée chez l’humain. Les résultats ont d’ailleurs permis d’identifier une diminution de la synchronisation de phase et une augmentation de la puissance dans la bande gamma qui distinguent cette condition génétique tant des participants sans DI que de la T21. Toujours dans l’esprit d’identifier des biomarqueurs électroencéphalographiques, mais cette fois au niveau d’un processus cognitif de base, l’étude #2 avait pour objectif de comparer tous ces syndromes dans un paradigme de suppression neuronale (SN) afin de vérifier la présence de SN et de comparer l’apprentissage de base chez ces populations. Les résultats ont identifiés que la T21 et le SXF présentaient tous les deux un patron de SN et que le SXF présentait relativement une plus forte habituation indiquant des particularités spécifiques selon les syndromes. Le deuxième volet, davantage clinique, permet de comparer les profils comportementaux associés au fonctionnement adaptatif entre les syndromes et à décrire les pistes d’intervention existantes. L’étude #3 a notamment mis en évidence que le QI et les symptômes de TDAH sont associés au fonctionnement adaptatif auprès de ces différents syndromes dont le SXF et la STB. Cet article a aussi permis de décrire les profils comportementaux de ces mêmes conditions en révélant davantage de difficultés rapportées chez les individus présentant un SXF, alors que la T21 présentait moins de particularités cliniques au niveau comportemental. Enfin, l’article #4 a mis en lumière diverses interventions utilisées auprès de la population présentant une DI notamment des stratégies cognitivo-comportementales et compensatoires. Cette thèse permet donc de dresser un portrait spécifique de ces syndromes génétiques concernant leur signature électrophysiologique lors du traitement sensoriel et de l’apprentissage ainsi que sur le plan des comorbidités comportementales et de leur relation avec le fonctionnement adaptatif, pour ensuite aborder les interventions actuelles en DI. Les diverses particularités identifiées à plusieurs niveaux ont permis de générer des suggestions pouvant guider certaines interventions futures. / Down syndrome (DS), Fragile X syndrome (FXS), Tuberous sclerosis complex (TSC) and SYNGAP1 mutations are caused by dysfunctions of the molecular pathways which lead among others to an imbalance in excitation and inhibition of the neuronal activity that would impact the brain development and its functioning. However, it is difficult to directly bridge the gap between the molecular imbalances observed in animal models with the structural, functional and cognitive characteristics observed in human with these syndromes. To our knowledge, few studies have compared those different genetic syndromes on sensory processing, basic learning or on their behavioural issues using similar and translational paradigms then allowing a better understanding of their specificities. The first part of this thesis aims to identify whether electroencephalographic activity would be an adequate biomarker representing neurobiological alterations both in sensory processing and learning in humans with these syndromes. The goal of study #1 was to describe auditory sensory processing, as a very first basic process, in SYNGAP1 mutations being a genetic condition still little studied in humans. Results showed a decrease in phase synchronization and an increase in the power of gamma band which distinguish this genetic condition both from participants without ID and from DS. Still in order to identify electroencephalographic biomarkers, but this time at a basic cognitive level, study #2 aimed to compare all these syndromes in a repetition suppression (RS) paradigm in order to observe the presence of RS and compare basic learning in these populations. The results identified a RS pattern in both DS and FXS. FXS also exhibited relatively higher habituation then indicating specific features according to the syndrome. The second part, addressing clinical aspects, permits to compare the behavioural profiles associated with adaptive functioning between syndromes and to describe existing interventions on ID population. Study #3 notably highlighted that IQ and ADHD symptoms are associated with adaptive functioning especially in FXS and TSC. This article also made it possible to describe the behavioural profiles of these syndromes, revealing more difficulties reported in individuals with FXS, while DS presented fewer behavioural issues. Finally, article #4 highlighted various interventions used with ID population, notably cognitive-behavioural and compensatory strategies. This thesis therefore makes it possible to gain a better understanding of these genetic syndromes concerning their electrophysiological signature during sensory processing and learning as well as in terms of behavioural comorbidities and their relationship with adaptive functioning, to then address current ID interventions. These different syndromic particularities identified at several levels made it possible to generate suggestions that could guide future interventions in this field.