Introdução: A doença de Machado-Joseph, também conhecida como ataxia espinocerebelar tipo 3 (DMJ/SCA3), é de inicio na vida adulta, uma doença neurodegenerativa autossômica dominante causada por uma expansão CAG no gene ATXN3. A DMJ/SCA3 pertence ao grupo de doenças chamado de poliglutaminopatias (PoliQ). A redução do risco de câncer em indivíduos com PolyQ tais como a doença de Huntington foi previamente relatada em um população diferente. Nenhum estudo buscando essa associação em DMJ/SCA3 já foi realizada.Objetivos: comparar os 15 anos de incidência cumulativa de câncer (ICC) e a proporção de câncer como causa de morte em portadores de DMJ/SCA3 sintomáticos observados e nos controles. Métodos: Indivíduos com DMJ/SCA3 pertencentes ao Rio Grande do Sul em uma coorte de 2000 a 2015 foram identificados. Entrevistas estruturadas foram feitas com indivíduos afetados e com controles não relacionados. A CIC conforme publicado pelo Instituto Nacional de Câncer (INCA), do Brasil, foi usado como um controle populacional. As causas de morte entre as famílias com DMJ/SCA3 e controles não relacionados pareados também foram obtidos pelo Sistema de Informações sobre Mortalidade Pública. Foram entrevistados 154 pacientes com DMJ/SCA3 e 80 controles não relacionados: Resultados: A CIC foi de 7/154 (4,5%) e 5/80 (6,3%) entre DMJ/SCA3 e nos indivíduos controles não relacionados, respectivamente. Para obter uma redução do risco absoluto de 1,8 entre os casos e controles, seriam necessários 1.938 indivíduos por grupo para detectar uma diferença significativa entre os grupos. A população total de sintomáticos com DMJ/SCA3 igualou-se a 625 indivíduos em 2015, esse estudo foi interrompido. O câncer foi a causa da morte em 9/101 (8,9%) DMJ/SCA3 e em 52/202 (26,2%) controles, com uma redução do risco absoluto de 17,3% no grupo DMJ/SCA3 (χ² = 12,421; p = 0,001 ; OR 0,27, IC 95% 0,13-0,58). Indivíduos com DMJ/SCA3 que morreram de câncer eram mais velhos e tinham uma menor CAGexp que os casos que faleceram de outras causas.Discussão: Devido à raridade da DMJ/SCA3, estudos de CIC em indivíduos vivos com poder estatístico são inviáveis. No entanto, uma redução significativa de câncer como uma causa de morte foi detectada em DMJ/SCA3. Estes dados confirmam a associação de polyQ com proteção contra o câncer e sugerem que polyQ de fato são doenças de multissistemas. / Introduction: Machado-Joseph disease, also known as Spinocerebellar Ataxia type 3 (MJD/SCA3), is an adult-onset autosomal dominant neurodegenerative disease caused by an expanded CAG repeat in the ATXN3 gene. MJD/SCA3 belongs to the so-called group of polyglutamine disorders (PolyQ). Reduced risk of câncer in individuals with PolyQ such as Huntington disease was previously reported in different population. No study searching for this association in MJD/SCA3 was already performed. Objectives: We aimed to compare the 15 years cumulative incidence of câncer (ICC) and the proportion of câncer as a cause of death in symptomatic SCA3/MJD carriers with those observed in controls. Methods: SCA3/MJD individuals belonging to the Rio Grande do Sul cohort from 2000 to 2015 were identified. A structured interview was done with affected individuals and with unrelated controls. CIC as published by the National Institute of Câncer (INCA), Brazil, was used as a population control. Causes of death among SCA3/MJD families and paired unrelated controls were also obtained from the Public Information System on Mortality. Results: 154 SCA3/MJD patients and 80 unrelated controls were interviewed. CIC were 7/154 (4.5%) and 5/80 (6.3%) among SCA3/MJD and unrelated control individuals, respectively. For an absolute risk reduction of 1.8 between cases and controls, 1,938 individuals per group would be needed to detect a significant difference between groups. Since the total symptomatic SCA3/MJD population equaled 625 individuals in 2015, this study was interrupted. Câncer was a cause of death in 9/101 (8.9%) SCA3/MJD and in 52/202 (26.2%) controls, with an absolute reduction risk of 17.3% in the SCA3/MJD group (χ²=12.421; p=0.001; OR 0.27, IC95% 0.13 to 0.58). SCA3/MJD individuals who died from câncer were older and carried shorter CAGexp than those SCA3/MJD cases who died from other causes. Discussion: Due to the rarity of SCA3/MJD, CIC studies in living individuals with statistical power are unfeasible. However, a significant reduction of câncer as a cause of death was detected in SCA3/MJD. This data confirm the association of PolyQ with protection against câncer and suggest that PolyQ are indeed multisystem disorders.

Introdução: A doença de Machado-Joseph, também conhecida como ataxia espinocerebelar tipo 3 (DMJ/SCA3), é de inicio na vida adulta, uma doença neurodegenerativa autossômica dominante causada por uma expansão CAG no gene ATXN3. A DMJ/SCA3 pertence ao grupo de doenças chamado de poliglutaminopatias (PoliQ). A redução do risco de câncer em indivíduos com PolyQ tais como a doença de Huntington foi previamente relatada em um população diferente. Nenhum estudo buscando essa associação em DMJ/SCA3 já foi realizada.Objetivos: comparar os 15 anos de incidência cumulativa de câncer (ICC) e a proporção de câncer como causa de morte em portadores de DMJ/SCA3 sintomáticos observados e nos controles. Métodos: Indivíduos com DMJ/SCA3 pertencentes ao Rio Grande do Sul em uma coorte de 2000 a 2015 foram identificados. Entrevistas estruturadas foram feitas com indivíduos afetados e com controles não relacionados. A CIC conforme publicado pelo Instituto Nacional de Câncer (INCA), do Brasil, foi usado como um controle populacional. As causas de morte entre as famílias com DMJ/SCA3 e controles não relacionados pareados também foram obtidos pelo Sistema de Informações sobre Mortalidade Pública. Foram entrevistados 154 pacientes com DMJ/SCA3 e 80 controles não relacionados: Resultados: A CIC foi de 7/154 (4,5%) e 5/80 (6,3%) entre DMJ/SCA3 e nos indivíduos controles não relacionados, respectivamente. Para obter uma redução do risco absoluto de 1,8 entre os casos e controles, seriam necessários 1.938 indivíduos por grupo para detectar uma diferença significativa entre os grupos. A população total de sintomáticos com DMJ/SCA3 igualou-se a 625 indivíduos em 2015, esse estudo foi interrompido. O câncer foi a causa da morte em 9/101 (8,9%) DMJ/SCA3 e em 52/202 (26,2%) controles, com uma redução do risco absoluto de 17,3% no grupo DMJ/SCA3 (χ² = 12,421; p = 0,001 ; OR 0,27, IC 95% 0,13-0,58). Indivíduos com DMJ/SCA3 que morreram de câncer eram mais velhos e tinham uma menor CAGexp que os casos que faleceram de outras causas.Discussão: Devido à raridade da DMJ/SCA3, estudos de CIC em indivíduos vivos com poder estatístico são inviáveis. No entanto, uma redução significativa de câncer como uma causa de morte foi detectada em DMJ/SCA3. Estes dados confirmam a associação de polyQ com proteção contra o câncer e sugerem que polyQ de fato são doenças de multissistemas. / Introduction: Machado-Joseph disease, also known as Spinocerebellar Ataxia type 3 (MJD/SCA3), is an adult-onset autosomal dominant neurodegenerative disease caused by an expanded CAG repeat in the ATXN3 gene. MJD/SCA3 belongs to the so-called group of polyglutamine disorders (PolyQ). Reduced risk of câncer in individuals with PolyQ such as Huntington disease was previously reported in different population. No study searching for this association in MJD/SCA3 was already performed. Objectives: We aimed to compare the 15 years cumulative incidence of câncer (ICC) and the proportion of câncer as a cause of death in symptomatic SCA3/MJD carriers with those observed in controls. Methods: SCA3/MJD individuals belonging to the Rio Grande do Sul cohort from 2000 to 2015 were identified. A structured interview was done with affected individuals and with unrelated controls. CIC as published by the National Institute of Câncer (INCA), Brazil, was used as a population control. Causes of death among SCA3/MJD families and paired unrelated controls were also obtained from the Public Information System on Mortality. Results: 154 SCA3/MJD patients and 80 unrelated controls were interviewed. CIC were 7/154 (4.5%) and 5/80 (6.3%) among SCA3/MJD and unrelated control individuals, respectively. For an absolute risk reduction of 1.8 between cases and controls, 1,938 individuals per group would be needed to detect a significant difference between groups. Since the total symptomatic SCA3/MJD population equaled 625 individuals in 2015, this study was interrupted. Câncer was a cause of death in 9/101 (8.9%) SCA3/MJD and in 52/202 (26.2%) controls, with an absolute reduction risk of 17.3% in the SCA3/MJD group (χ²=12.421; p=0.001; OR 0.27, IC95% 0.13 to 0.58). SCA3/MJD individuals who died from câncer were older and carried shorter CAGexp than those SCA3/MJD cases who died from other causes. Discussion: Due to the rarity of SCA3/MJD, CIC studies in living individuals with statistical power are unfeasible. However, a significant reduction of câncer as a cause of death was detected in SCA3/MJD. This data confirm the association of PolyQ with protection against câncer and suggest that PolyQ are indeed multisystem disorders.

Les maladies à polyglutamines (polyQ) sont des maladies neurodégénératives héréditaires dominantes causées par une expansion de CAG traduite en longue expansion de polyglutamine dans la protéine correspondante. Ces maladies comprennent l’ataxie spinocérébélleuse 7 (SCA7) et la maladie de Huntington (MH) causées par une expansion de polyQ dans les protéines ataxine-7 (ATXN7) et huntingtine (htt), respectivement. Les souris SCA7 et MH développent des rétinopathies similaires suggérant des pathomécanismes communs toujours inexpliqués. Durant ma thèse, j’ai trouvé qu’en réponse à la toxicité des polyQ, les photorécépteurs (PR) perdent leur différenciation alors que d’autres migrent ou meurent. De plus, cette mortalité cellulaire active la prolifération des cellules gliales de Müller et leur différenciation en PR. Récemment, j’ai trouvé que l’ATXN7 et la htt se trouvent dans le cil primaire et leur mutation mène à une perte des protéines endogènes des cils associée à des défauts du cil. / Polyglutamine (polyQ) disorders are dominantly inherited neurodegenerative disorders caused by the expansion of CAG repeats translated into long polyQ tracts in the corresponding proteins. These diseases include Spinocerebellar ataxia 7(SCA7) and Huntington’s Disease (HD), caused by polyQ expansion ataxin-7 (ATXN7) and huntingtin (htt), respectively. SCA7 and HD mouse models develop similar retinopathies suggesting common pathomechanisms. In my thesis, I found that, in response to polyQ toxicity, SCA7 photoreceptors (PR) undergo several cell fates ranging from their deconstruction, to their migration and their death. Moreover, this cell death activates the proliferation of Müller glial cells and their differentiation into PR like cells. The pathomechanisms underlying HD and SCA7 are still unknown. Recently, I found that ATXN7 and htt are localized to the PR cilia and that the mutant proteins lead to a progressive loss of the wild-type proteins that correlates with defects in the PR cilia.

L’ataxie spinocérébelleuse de type 7 (SCA7) est une maladie neurodégénérative à transmission autosomale dominante, causée par une expansion toxique de polyglutamine (polyQ) dans la protéine Ataxine-7. Elle se caractérise par une dégénérescence des photorécepteurs en cônes et en bâtonnets, ainsi que des cellules cérébelleuses de Purkinje et granuleuses. La nature sélective de cette dégénérescence reste peu claire, l’expression d’Ataxine-7 étant ubiquitaire. Dans ce contexte, nous avons exploré la fonction de l’orthologue d’Ataxine-7 chez le poisson-zèbre au cours du développement de l’œil. L’inactivation d’atxn7 chez le poisson-zèbre – par des approches utilisant des oligonucléotides anti-sens ou par CRISPR/Cas9 – résulte principalement en un colobome, malformation structurelle de l’œil causée par un défaut de fermeture de la fissure choroïde. Les morphants atxn7 présentent une altération du motif proximo-distal de la vésicule optique causée par une élévation de la signalisation Hedgehog (Hh). Une étude minutieuse des photorécepteurs révèle un défaut de la morphogénèse des segments externes. La sensibilité de l’œil aux variations de fonction d’atxn7 pourrait expliquer la phyiopathologie SCA7. Notre étude suggère également qu’une perte de fonction d’atxn7 contribuerait au développement du colobome chez l’Homme. / Spinocerebellar ataxia type 7 (SCA7) is an autosomal-dominant neurodegenerative disorder caused by a toxic polyglutamine (polyQ) expansion in Ataxin-7 which leads to degeneration of cone and rod photoreceptors. The selective nature of degeneration remains unclear since Ataxin-7 is ubiquitously expressed. Here, we have explored the function of the Ataxin-7 ortholog in zebrafish during eye development. Inactivation of atxn7 in zebrafish primarily resulted in a coloboma defect, a structural malformation of the eye caused by failure of the choroid fissure to close. atxn7 morphants displayed altered proximo-distal patterning of the optic vesicle, caused by elevated Hedgehog (Hh) signaling. Careful examination of the photoreceptors reveals a defect in the morphogenesis of the outer segments. The eye sensitivity to variations in atxn7 function could account for SCA7 physiopathology. Our study also suggests that atxn7 loss of function may contribute to the development of human coloboma.

Les ataxies forment un groupe de maladies neurodégénératives qui sont caractérisées par un manque de coordination des mouvements volontaires. Mes travaux ont porté sur une forme d'ataxie à début tardif (LOCA), après l’âge de 50 ans. Les principales caractéristiques cliniques sont: atrophie cérébelleuse à l’IRM (88%), dysarthrie (81%), atrophie du lobe frontal (50%) et nystagmus (52%). La ségrégation dans les familles de cette ataxie est en faveur d’une transmission récessive. Afin d'identifier le gène responsable de LOCA, nous avons recruté 38 patients affectés d'une forme tardive d'ataxie, issus du SLSJ, des Cantons de l’Est ou d’autres régions du Québec. Un premier criblage du génome a été effectué avec des marqueurs microsatellites sur une famille clé. Une analyse de liaison paramétrique nous a suggéré une liaison au chromosome 13 (4.4Mb). Une recherche d’un haplotype partagé entre 17 familles LOCA a diminué la taille de l'intervalle candidat à 1.6Mb, mais l’haplotype s’est avéré fréquent dans la population canadienne-française. Un second criblage du génome avec des marqueurs SNP nous a permis d’évaluer par cartographie d’homozygotie la possibilité qu’une mutation fondatrice partagée dans des sous-groupes de malades. Plusieurs stratégies d'analyse ont été effectuées, entre autre par regroupement régional. Aucun loci candidats ne fut identifié avec confiance. Nous avons donc combiné les données de génotypage avec le séquençage exomique afin d'identifier le gène responsable. L'analyse de six individus atteints nous a permis d'obtenir une liste de variants rare contenant quatre gènes potentiels. Cette analyse doit se poursuivre pour identifier le gène responsable de LOCA. / Ataxias are a heterogeneous group of neurodegenerative diseases and are characterized by a lack of voluntary movements. My Master's project was on a late-onset ataxia (LOCA), after 50 years of age. The main clinical features are: cerebellar atrophy on MRI (88%), dysarthria (81%), frontal lobe atrophy (50%) and nystagmus (52%). Disease segregation in the family is suggestive of a recessive transmission. In order to identify the causal gene of LOCA, we have recruited 38 patients affected by a late-onset ataxia, originated from SLSJ, Eastern townships or other region in Quebec. A first genome scan was done with microsatellite markers on an informative family. Parametric linkage analysis suggested linkage on chromosome 13 (4.4Mb). Haplotype sharing analysis on 17 families reduced the candidate interval to 1.6Mb, but this haplotype was found to be frequent in the French-Canadian population. A second genome scan with SNPs markers allowed us to performed homozygozity mapping and look for founder mutations in subgroup of patients. Many strategies were performed, including regional clustering. No candidate loci were identified with confidence. We decided to combine the genotyping analysis results with exome sequencing to uncover the causative gene. The analysis on six affected individuals allowed us to obtain a rare variants list with four putative genes. More analysis is needed to identify the gene responsible for LOCA.

付記する学位プログラム名: 充実した健康長寿社会を築く総合医療開発リーダー育成プログラム / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第24520号 / 医博第4962号 / 新制||医||1065(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 万代 昌紀, 教授 松田 文彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(生命科学) / 甲第24753号 / 生博第494号 / 新制||生||66(附属図書館) / 京都大学大学院生命科学研究科統合生命科学専攻 / (主査)教授 片山 高嶺, 教授 高田 穣, 教授 原田 浩 / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

Pathogenic variants in KCNA2, encoding for the voltage-gated potassium channel Kv1.2, have been identified as the cause for an evolving spectrum of neurological disorders. Affected individuals show early-onset developmental and epileptic encephalopathy, intellectual disability, and movement disorders resulting from cerebellar dysfunction. In addition, individuals with a milder course of epilepsy, complicated hereditary spastic paraplegia, and episodic ataxia have been reported. By analyzing phenotypic, functional, and genetic data from published reports and novel cases, we refine and further delineate phenotypic as well as functional subgroups of KCNA2-associated disorders. Carriers of variants, leading to complex and mixed channel dysfunction that are associated with a gain- and loss-of-potassium conductance, more often show early developmental abnormalities and an earlier onset of epilepsy compared to individuals with variants resulting in loss- or gain-of- function. We describe seven additional individuals harboring three known and the novel KCNA2 variants p.(Pro407Ala) and p.(Tyr417Cys). The location of variants reported here highlights the importance of the proline(405)–valine(406)–proline(407) (PVP) motif in transmembrane domain S6 as a mutational hotspot. A novel case of self-limited infantile seizures suggests a continuous clinical spectrum of KCNA2-related disorders. Our study provides further insights into the clinical spectrum, genotype–phenotype correlation, variability, and predicted functional impact of KCNA2 variants.

For many dominant diseases, conventional treatment options are limited. This makes them attractive candidates for gene therapy, which may be directed to specifically silence a disease-causing allele. However, many mutations are not easily amenable to this technique, including nucleotide repeat expansions, which cause numerous neurodegenerative diseases such as Huntington’s disease and several Spinocerebellar Ataxias. Combined gene knockdown and replacement (K&R) may present a more practical approach for such conditions, whereby the gene of interest is subject to mutation-independent non-allele-specific silencing and concurrently replaced with a functional copy. Artificial mimics of naturally occurring intronic microRNAs are theoretically ideal for this purpose, since they can be nested within the replacement gene. This thesis investigates the development of mimics of two different intronic miRNA systems (mirtron miR-1224 and the miR-106b cluster) to silence Ataxin-7 and to be incorporated into novel single K&R constructs for testing in vitro. Artificial mirtrons and intronic miRNAs were successfully developed and shown to silence Ataxin-7 mRNA in numerous cell lines. An RNAi-resistant gene was developed and mirtrons could be successfully incorporated as introns. Patient-derived fibroblasts and iPSC-derived neuronal cells were investigated as models for testing of gene silencing therapies. This work suggests that mirtron-based K&R is achievable, and warrants further investigation.

Les ataxies spastiques héréditaires forment une famille hétérogène de désordres qui ont des points communs avec les ataxies héréditaires et les paraplégies spastiques héréditaires. Un de ces éléments est une ataxie, soit une difficulté de coordination des membres souvent due à un dommage au cervelet. L’autre est une spasticité des membres inférieurs, souvent due à des dommages à la voie cortico-spinale. Une seule ataxie spastique à hérédité autosomique dominante a été rapportée dans la littérature, et il s’agit de SPAX1. À l’aide de trois familles de Terre-Neuve présentant ce phénotype, le locus a été identifié en 2002. Dans ce mémoire, c’est de la découverte du gène causal dont il est question. La mutation a été trouvée dans le gène VAMP1, qui encode la protéine synaptobrévine 1, une protéine synaptique impliquée dans l’exocytose des neurotransmetteurs. Il est aussi question de la caractérisation fonctionnelle de la mutation sur l’ARN et des conséquences possibles sur la protéine, concordant avec les symptômes de la maladie. / Hereditary spastic ataxias comprise a family of heterogeneous disorders resembling both hereditary ataxias and hereditary spastic paraplegias. The similar symptoms are ataxia, which is a problem with limb coordination due to cerebellar damage, and lower-limb spasticity due to corticospinal tract degeneration. Only one spastic ataxia inherited in an autosomal dominant fashion has been reported in the literature: SPAX1. The locus was identified in 2002 using three families from Newfoundland with the specific phenotype. This thesis reports the discovery of the causative mutation in the VAMP1 gene, which encodes VAMP1/synaptobrevin 1, a synaptic protein involved in neurotransmitter exocytosis. Experiments characterizing the effect of the mutation on RNA were conducted, leading to a possible molecular explanation of the symptoms.