Errata slip inserted at back / Bibliography: leaves 159-192 / vi, 142, [75] leaves : ill ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Summary: Primary object ... was to construct a pulsed field gel electrophoresis (PFGE) derived long range restriction map of this region by physically linking adjacent DNA probes to common high molecular weight genomic DNA fragments / Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 1994

Fragile X Syndrome (FXS) is the leading cause of inherited intellectual disability. The disorder is caused by a trinucleotide expansion that silences the Fragile X Mental Retardation 1 (Fmr1) gene resulting in the loss of its protein product, the Fragile X Mental Retardation Protein (FMRP). FXS patients show broad clinical phenotypes including intellectual disability, as well as a number of cognitive and behavioral problems. The lack of FMRP is believed to be the direct cause of the deficits seen in FXS patients. FMRP is an RNA-binding protein that is expressed in the brain and testes. This protein is believed to form a messenger ribonucleoprotein complex with mRNAs in the nucleus and subsequently export them to polyribosomes in the cytoplasm, therefore influencing translation of its bound mRNAs. Importantly, FMRP has long been suspected to be involved in synaptic plasticity due to its ability to bind several mRNAs that encode for proteins important in synaptic plasticity. Such proteins include the GluN1, GluN2A and GluN2B subunits of the N-methyl-D- aspartate receptor (NMDAR). FMRP is expressed in the hippocampus, a region of the brain involved in learning and memory processes. Recently, impaired NMDAR functioning in the dentate gyrus (DG) subregion of the hippocampus has been observed in Fmr1 knockout (-/y) mice. This impairment also resulted in reduction in long-term potentiation (LTP) and long-term depression (LTD) of synaptic efficacy, two biological models of learning and memory. In the present study, I focused on the levels of the NMDAR GluN1, GluN2B and Glu2B subunits in order to determine the synaptic plasticity alterations seen in the DG of Fmr1-/y mice. Using Western blotting, I found that there is a decrease in the GluN1, GluN2A and GluN2B subunits in the DG of young adult Fmr1-/y mice, indicating that these mice have significantly lower amounts of total NMDARs. These results could explain the altered LTP and LTD seen in Fmr1-/y mice at the molecular level and might contribute to the intellectual impairments seen in these KO mice. NMDARs appear to be important in the development and maturation of synapses. The GluN2A and GluN2B subunits are developmentally regulated, where GluN2B is predominantly expressed early in development and GluN2A in the adult brain. A dysregulation of GluN2A and GluN2B subunits has been proposed to affect the maturation and formation of synapses. Intriguingly, FMRP is also believed to play a functional role in early brain development. Thus, this study also focused on the developmental expression of the GluN1, GluN2A and GluN2B subunits in the DG, Cornu Ammonis, prefrontal cortex and cerebellum of Fmr1-/y mice, all of which are brain regions implicated in FXS. We found that the developmental expression of these subunits is altered in Fmr1-/y mice in specific brain regions. Together, these results demonstrate that the loss of FMRP differentially affects GluN1, GluN2A and GluN2B subunit expression both developmentally and spatially, further implicating NMDARs in the pathophysiology of FXS. / Graduate

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-07-25T21:04:26Z No. of bitstreams: 1 Marcela Kelly Astete Gómez Estudo dos alelos da região....pdf: 1187772 bytes, checksum: d35081c0e79dae64122fa5e5a15c60c3 (MD5) / Made available in DSpace on 2012-07-25T21:04:26Z (GMT). No. of bitstreams: 1 Marcela Kelly Astete Gómez Estudo dos alelos da região....pdf: 1187772 bytes, checksum: d35081c0e79dae64122fa5e5a15c60c3 (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / A Síndrome do X-Frágil (SXF) é a principal causa hereditária de deficiência mental de herança dominante ligada ao cromossomo X. Em 1991, o gene FMR1 (Fragile X Mental Retardation 1) foi descoberto como responsável pela SXF. De acordo com o número de repetições, os alelos se dividem em: (a) alelo normal compreendendo 6 a 55 repetições (b) pré-mutado: 61 a 200 repetições e (c) mutado: com >200 repetições. Os alelos que apresentam 45 a 60 repetições são considerados como zona intermediária ou gray-zone. A base molecular dessa doença é bastante peculiar quando comparada com os padrões típicos observados em outras desordens de etiologia genética. As pré-mutações podem agregar-se de forma silenciosa por muitas gerações de uma família antes de se expandir para a mutação completa, levando aos sinais clínicos da doença. Na Bahia existem poucas pesquisas envolvendo esta doença, consequentemente, é desconhecida sua frequência nessa região. Portanto, este trabalho tem como objetivo detectar a frequência das classes alélicas do gene FMR1 em uma amostra de indivíduos do sexo masculino da população geral de Salvador-BA. Este estudo foi realizado em 511 homens provenientes de outro amplo estudo desenvolvido pelo Instituto de Saúde Coletiva (ISC) da Universidade Federal da Bahia (UFBA) sendo utilizada a técnica da PCR e posterior classificação dos alelos baseando-se na relação entre o número de repetições CGG e o tamanho do fragmento obtido na PCR. Dos 511 homens analisados no presente estudo observou-se predominância de alelos normais pertencentes à classe 2 (11 a 26 repetições CGG) em 73,70% dos indivíduos analisados, seguido da classe 3 (27 a 40 repetições CGG) em 25,10% dos indivíduos. Apenas 1,20% foram incluídos na classe 1 (<10 repetições CGG) e nenhum alelo foi encontrado nas classes 4 (41 a 60 repetições CGG), classe 5 ( >60 repetições CGG) e classe 6 (>200 repetições CGG). Este é o primeiro estudo utilizando a técnica da PCR para detecção dos alelos do gene FMR1 em uma população geral de Salvador-BA, podendo direcionar futuros trabalhos envolvendo o gene FMR1 tanto para o estado da Bahia, quanto para a região Nordeste e também minimizar deficiências existentes em termos de diagnóstico da SXF na cidade de Salvador-BA. / The Fragile X syndrome (FXS) is the leading cause of inherited mental deficiency (MD) of dominant inheritance linked to X chromosome. In 1991, the FMR1 gene (Fragile X Mental Retardation 1) was discovered as responsible for FXS. According to the number of repetitions, the alleles are divided in: (a) normal stable allele comprising 6 to 55 repetitions; (b) premutation: 61 to 200 repetitions and (c) mutant with> 200 repeats. The molecular basis of this disease is quite unusual when compared with the typical patterns seen in other disorders of genetic etiology. The pre-change can add up so silent for many generations of a family before they expand to full mutation, leading to clinical signs of disease. In Bahia there are few studies involving this disease, therefore, its frequency is unknown in this region. So, this study aims to detect the frequency of allelic classes of FMR1 gene in a sample of males from the general population of Salvador-BA city. This study was conducted on 511 samples using the PCR technique and subsequent classification of alleles based on the number of CGG repeats and the size of the fragments in PCR. Of the 511 individuals examined was found to predominate among the normal alleles the class 2 (11 to 26 repetitions) with 73,70% followed alleles analyzed in Class 3 (27 to 40 repetitions) with 25,10%, and Class 1 (<10 repetitions) with only one 1,20% . No allele was found in class 4 (41 to 60 repetitions), which corresponds to gray zone and class 5 (> 60 repetitions) for the premutation and class 6 (>200 repetitions) the corresponds full mutation.This is the first study using the PCR technique for detection of alleles of the FMR1 gene in a general population of Salvador, Bahia, and may direct future studies involving the FMR1 gene for both the state of Bahia, the Northeast and to also minimize deficiencies existing in the diagnosis of FXS in Salvador, Bahia.

O retardo mental (RM) representa um problema de saúde pública mundial ainda negligenciado no Brasil e, em especial nas regiões mais pobres como o Nordeste. A síndrome do X frágil (SXF) é uma das formas mais estudadas de RM hereditário em seres humanos. Esta doença monogênica, de herança ligada ao X dominante, é decorrente de uma mutação no exon 1 do gene FMR1, localizado na região Xq27.3. A mutação no FMR1 se caracteriza pelo aumento de repetições de trinucleotídios CGG em tandem na região 5 UTR desse gene, sendo a expansão dessas trincas o principal evento mutacional responsável pela SXF. De maneira geral, os fenótipos cognitivos de indivíduos do sexo masculino com a síndrome incluem deficiência intelectual de moderada à grave. No presente trabalho, realizamos um estudo transversal da SXF em indivíduos portadores de retardo mental de causa desconhecida, engajados em Programas de Educação Especial e em instituições psiquiátricas de São Luís-MA, rastreando amplificações de sequências trinucleotídicas no gene FMR1. A amostra foi composta por 238 indivíduos do sexo masculino, não aparentados, na faixa etária de 4 a 60 anos (média = 21 9 anos). O DNA dos participantes foi obtido a partir de 5 mL de sangue coletados em tubos com anti-coagulante EDTA e a análise molecular da região gênica de interesse foi realizada através da reação em cadeia da polimerase, utilizando-se três primers. Dentre os indivíduos triados quanto à presença de mutações no gene FMR1, apenas um apresentou um resultado inconclusivo e 2 (0,84%) foram positivos para a SXF, sendo que um deles (3503) apresentou mais de 200 repetições CGG no locus FRAXA e o outro indivíduo (3660) apresentou uma deleção de ~197 pb envolvendo parte das repetições CGG e uma região proximal às repetições CGG. Ambos possuíam história familiar de RM ligado ao X. No indivíduo 3503 observamos as seguintes características clínicas: temperamento dócil, orelhas grandes, mandíbula proeminente e flacidez ligamentar. O indivíduo 3660 apresentava hiperatividade, contato pobre com os olhos, orelhas grandes, mandíbula proeminente, pectus excavatum, macroorquidismo e pouca comunicação. O esclarecimento sobre a doença oferecido às famílias de ambos contribuiu sobremaneira para o entendimento da condição, do prognóstico e dos riscos de recorrência. A prevalência da SXF em nossa amostra, 0,84%, embora relativamente baixa, encontra-se na faixa de incidência de casos diagnosticados em outras populações que, em sua maioria, relatam incidências variando de 0 a 3%. Em parte, atribuímos o percentual encontrado aos critérios de inclusão utilizados em nosso estudo. Concluímos que o protocolo de triagem molecular utilizado em nosso estudo se mostrou eficiente e adequado para a realidade do Maranhão, podendo constituir uma ferramenta auxiliar a ser aplicada na avaliação de rotina dos portadores de RM, com grandes benefícios para o Estado. / Mental retardation (MR) is considered a global public health problem in Brazil and it is still ignored mainly in poor regions like Northeast Brazil. The fragile X syndrome (FXS) is one of the most common heritable disease in humans. it is a monogenic disease with X-linked dominant inheritance due to a mutation in exon 1 of the FMR1 gene, located at Xq27.3 region. The mutation in FMR1 is characterized by the increase in number of CGG repeats in the 5 'UTR of the gene. This expansion of CGG triplets in the first exon of the FMR1 gene is the main mutational event responsible for FXS. In general, the cognitive phenotypes of males with this syndrome include intellectual disabilities from moderate to severe. In this work, we conducted a cross-sectional study of FXS in individuals with MR of unknown cause, in Especial Education Programs and Psyquiatric Instituitions in São Luís-MA, by screening for amplifications of trinucleotide sequences within the FMR1 gene. The sample consisted of 238 unrelated males, which ages were from 4 to 60 years (mean = 21 9 years). The DNA of all individuals was obtained from 5 mL of peripheral blood which was colected in EDTA-anticoagulated tubes. The molecular analysis of the genetic region of interest was performed by polimerase chain reaction using three primers. Of the individuals screened for the presence of the mutation in the FMR1 gene, only one was inconclusive and two (0.84%) were positive for FXS. One (3503) presented more than 200 CGG repeats in FRAXA locus, and the other (3660) presented with a ~ 197 bp deletion involving part of CGG repeats and a proximal region to the CGG repeats. Both of these individuals have family history of X-linked Mental Retardation. The individual 3503 has the following clinical features: docile temperament, large ears, prominent jaw and ligamentous laxity. The individual 3660 presents hyperactivity, poor contact with eyes, large ears, prominent jaw, pectus excavatum, macroorchidism and little communication. Information about the disease helped the families of both individuals with FXS to understand the condition, the prognosis and about the recurrence risk. We found a FXS prevalence of 0.84% in our sample, although relatively low, it is in the range of incidence of diagnosed cases in other populations that report mostly incidences ranging from 0 to 3%. We partially attribute the percentage found due to the inclusion criteria used in our study. We conclude that the protocol for molecular screening used in our study proved to be efficient and appropriate to the reality of Maranhão, constituting an auxiliary tool to be applied in the routine assessment of patients with MR, with great benefits for the state.

O retardo mental (RM) representa um problema de saúde pública mundial ainda negligenciado no Brasil e, em especial nas regiões mais pobres como o Nordeste. A síndrome do X frágil (SXF) é uma das formas mais estudadas de RM hereditário em seres humanos. Esta doença monogênica, de herança ligada ao X dominante, é decorrente de uma mutação no exon 1 do gene FMR1, localizado na região Xq27.3. A mutação no FMR1 se caracteriza pelo aumento de repetições de trinucleotídios CGG em tandem na região 5 UTR desse gene, sendo a expansão dessas trincas o principal evento mutacional responsável pela SXF. De maneira geral, os fenótipos cognitivos de indivíduos do sexo masculino com a síndrome incluem deficiência intelectual de moderada à grave. No presente trabalho, realizamos um estudo transversal da SXF em indivíduos portadores de retardo mental de causa desconhecida, engajados em Programas de Educação Especial e em instituições psiquiátricas de São Luís-MA, rastreando amplificações de sequências trinucleotídicas no gene FMR1. A amostra foi composta por 238 indivíduos do sexo masculino, não aparentados, na faixa etária de 4 a 60 anos (média = 21 9 anos). O DNA dos participantes foi obtido a partir de 5 mL de sangue coletados em tubos com anti-coagulante EDTA e a análise molecular da região gênica de interesse foi realizada através da reação em cadeia da polimerase, utilizando-se três primers. Dentre os indivíduos triados quanto à presença de mutações no gene FMR1, apenas um apresentou um resultado inconclusivo e 2 (0,84%) foram positivos para a SXF, sendo que um deles (3503) apresentou mais de 200 repetições CGG no locus FRAXA e o outro indivíduo (3660) apresentou uma deleção de ~197 pb envolvendo parte das repetições CGG e uma região proximal às repetições CGG. Ambos possuíam história familiar de RM ligado ao X. No indivíduo 3503 observamos as seguintes características clínicas: temperamento dócil, orelhas grandes, mandíbula proeminente e flacidez ligamentar. O indivíduo 3660 apresentava hiperatividade, contato pobre com os olhos, orelhas grandes, mandíbula proeminente, pectus excavatum, macroorquidismo e pouca comunicação. O esclarecimento sobre a doença oferecido às famílias de ambos contribuiu sobremaneira para o entendimento da condição, do prognóstico e dos riscos de recorrência. A prevalência da SXF em nossa amostra, 0,84%, embora relativamente baixa, encontra-se na faixa de incidência de casos diagnosticados em outras populações que, em sua maioria, relatam incidências variando de 0 a 3%. Em parte, atribuímos o percentual encontrado aos critérios de inclusão utilizados em nosso estudo. Concluímos que o protocolo de triagem molecular utilizado em nosso estudo se mostrou eficiente e adequado para a realidade do Maranhão, podendo constituir uma ferramenta auxiliar a ser aplicada na avaliação de rotina dos portadores de RM, com grandes benefícios para o Estado. / Mental retardation (MR) is considered a global public health problem in Brazil and it is still ignored mainly in poor regions like Northeast Brazil. The fragile X syndrome (FXS) is one of the most common heritable disease in humans. it is a monogenic disease with X-linked dominant inheritance due to a mutation in exon 1 of the FMR1 gene, located at Xq27.3 region. The mutation in FMR1 is characterized by the increase in number of CGG repeats in the 5 'UTR of the gene. This expansion of CGG triplets in the first exon of the FMR1 gene is the main mutational event responsible for FXS. In general, the cognitive phenotypes of males with this syndrome include intellectual disabilities from moderate to severe. In this work, we conducted a cross-sectional study of FXS in individuals with MR of unknown cause, in Especial Education Programs and Psyquiatric Instituitions in São Luís-MA, by screening for amplifications of trinucleotide sequences within the FMR1 gene. The sample consisted of 238 unrelated males, which ages were from 4 to 60 years (mean = 21 9 years). The DNA of all individuals was obtained from 5 mL of peripheral blood which was colected in EDTA-anticoagulated tubes. The molecular analysis of the genetic region of interest was performed by polimerase chain reaction using three primers. Of the individuals screened for the presence of the mutation in the FMR1 gene, only one was inconclusive and two (0.84%) were positive for FXS. One (3503) presented more than 200 CGG repeats in FRAXA locus, and the other (3660) presented with a ~ 197 bp deletion involving part of CGG repeats and a proximal region to the CGG repeats. Both of these individuals have family history of X-linked Mental Retardation. The individual 3503 has the following clinical features: docile temperament, large ears, prominent jaw and ligamentous laxity. The individual 3660 presents hyperactivity, poor contact with eyes, large ears, prominent jaw, pectus excavatum, macroorchidism and little communication. Information about the disease helped the families of both individuals with FXS to understand the condition, the prognosis and about the recurrence risk. We found a FXS prevalence of 0.84% in our sample, although relatively low, it is in the range of incidence of diagnosed cases in other populations that report mostly incidences ranging from 0 to 3%. We partially attribute the percentage found due to the inclusion criteria used in our study. We conclude that the protocol for molecular screening used in our study proved to be efficient and appropriate to the reality of Maranhão, constituting an auxiliary tool to be applied in the routine assessment of patients with MR, with great benefits for the state.

Cette thèse part de la proposition d\'une rencontre possible entre psychanalyse et génétique médicale par le biais des soins offerts aux enfants porteurs de syndromes génétiques, notamment le syndrome de l\'X fragile. Nous avons trouvé dans les recherches en épigénétique une voie de rapprochement de ces différents champs du savoir. L\'idée selon laquelle l\'environnement est capable de modifier l\'expression des gènes représente la rupture d\'un certain déterminisme génétique autrefois accepté, et ouvre un espace où penser la singularité. Notre travail propose d\'élargir le concept d\'environnement, en y considérant la relation de l\'enfant avec l\'Autre, lieu du langage, comme opérateur de marques sur son corps : marques symboliques, constituées dès le tout début de la rencontre de l\'infans et de ceux qui s\'occupent de lui. C\'est justement dans cet espace d\'échange avec l\'Autre qu\'a lieu l\'émergence d\'un sujet. Nous avons opté pour les concepts de sujet et de transfert pour soutenir l\'articulation de la clinique psychanalytique et de la génétique médicale en ce qui concerne le traitement. Nous avons donc exposé trois cas cliniques issus de notre pratique, d\'enfants traversés par le diagnostic de l\'X fragile afin d\'illustrer de quelle manière les conceptions de sujet et de transfert se reflètent dans la clinique. Tenant compte que la psychothérapie est également prise comme objet d\'étude de l\'épigénétique, et qu\'elle est donc considérée comme un environnement capable de provoquer, voire de renverser des marques épigénétiques, l\'enjeu de notre travail repose sur la proposition suivante : et pourquoi pas la psychanalyse également ? La psychothérapie psychanalytique, ancrée sur le transfert, ne peut-elle pas, elle aussi, laisser des marques sur le petit patient / The current thesis assumes a possible encounter between psychoanalysis and medical genetics based on the treatment applied to children carrying genetic syndromes such as the Fragile X Syndrome. Epigenetic studies are a way to approximate different knowledge fields. The assumption that the environment is able to change gene expression strays from the genetic determinism we once believed and opens the way for us to reason about singularity. The proposition in the present study lies on expanding the concept of environment, by taking into consideration the relation between the child and the Other in the environment in question, as well as the place of language as the operator marking the childs body. These symbolic marks start emerging in the first encounter between the infans and caregivers. The subject emerges precisely 3 within an environment of exchanges that is set with the Other. The concepts of subject and transference were chosen to support the treatment articulation between psychoanalytic clinic and medical genetics. Thus, the present study reports three clinical cases followed by the authors, which involved children diagnosed with fragile X syndrome. These cases illustrate how the aforementioned concepts affect the clinical practice. Since psychotherapy has also been taken as the object of epigenetic studies, and as it is considered an environment able to cause, and even reverse, epigenetic marks, the current study relies on the following proposition: why not psychoanalysis as well? Can the psychoanalytic psychotherapy, anchored in the concept of transference, leave marks on the little patient too?

<p> Fragile X Syndrome (FXS) is the most common inherited disease of mental impairment, typically caused by a mutation in the Fragile X mental retardation 1 (FMRJ) gene. The clinical features are thought to result from abnormal neurobiology due to a lack of the Fragile X mental retardation protein (FMRP). Previously, it was thought that FMRP was confined exclusively to neurons; however, our laboratory recently discovered that astrocytes also express FMRP. Consequently, it is possible that astrocytes also suffer abnormalities as a result of a lack of FMRP. Astrocytes play integral roles in the development and maintenance of communication in the central nervous system. Therefore, it is now important to determine the contribution of astrocytes to the abnormal neuronal phenotype seen in FXS. In these experiments, neurons and astrocytes were independently isolated from wild type (WT) or FMRJ null mice and grown in a coculture. Neurons were evaluated using immunocytochemistry in combination with computer-aided morphometric and synaptic protein analyses. The findings presented here provide convincing evidence that Fragile X astrocytes contribute to the abnormal neurobiology seen in FXS . Fragile X astrocytes alter the dendrite morphology and excitatory synaptic protein expression of WT neurons in culture; and, importantly, when Fragile X neurons are grown with WT astrocytes these changes are prevented. Interestingly, the Fragile X astrocytes appear to act by causing a delay in development; even WT neurons grown in the presence of Fragile X astrocytes, that displayed an abnormal phenotype at 7 days in culture, exhibited nearly normal dendrite morphology and expression of excitatory synapses at 21 days. Furthermore, the results suggest that the dendritic abnormalities induced by the Fragile X astrocytes specifically target neurons with a spiny stellate morphology. This research establishes a role for astrocytes in the development of the abnormal neurobiology seen in FXS, and as such, the results presented here have significant implications for Fragile X research. The novel prospect that astrocytes are key contributing components in the development of FXS provides an exciting new direction for investigations into the mechanisms underlying FXS, with many unexplored avenues for potential treatment strategies. </p> / Thesis / Doctor of Philosophy (PhD)

Made available in DSpace on 2016-08-10T10:38:29Z (GMT). No. of bitstreams: 1 Fernanda Carla Stegani.pdf: 10431040 bytes, checksum: 2702ca1faeabb2d893b8f2971288b01e (MD5) Previous issue date: 2011-12-08 / The Intellectual Disability (ID) is defined as a disability characterized by significant limitations both in intellectual functioning and in the adaptive behavior and it is expressed in practical, social and conceptual skills, originating before the age of 18. It is one of the most common neuropsychiatric disorders in children and adolescents, with a 5% prevalence in our population. The Fragile X Syndrome (FXS) is the most frequent and best documented DI heritable in humans. The phenotype of FXS is associated with mutations in the gene FMR1 (Fragile X Mental Retardation-linked type 1) and it covers a broad spectrum of behavioral and physical involvement. It is caused by a CGG trinucleotide expansion in the first exon of the FMR1 gene located in the region Xq27.3 on the X chromosome Because of its phenotypic diversity, this disease has been under diagnosed in the pediatric population. Among the techniques used for molecular diagnosis of FXS, the MLPA (Multiplex Ligation-dependent Probe Amplification) has been considered promising. In this context, this study aimed to validate the molecular diagnosis of patients suspected of FXS in the Laboratory of Cytogenetics and Molecular Genetics (Lagene) by the MLPA technique. We selected 33 patients referred by medical from public health to Lagene with clinical of FXS. To perform the analysis by MLPA the Salsa MLPA P106-B1 MRX kit was used. The amplificons were obtained only for 15% of the patients. The MLPA kit used did not detect changes in the copy number of the FMR1 gene in any examined patient, being useful the need of other molecular methods to confirm the diagnosis of FXS. Thus, we concluded that such MLPA kit was not useful to detect specific changes in the copy numbers of the FMR1 gene. So the Salsa MLPA Kit P106-B1 MRX should not be used to the trial of patients with FXS. / A Deficiência Intelectual (DI) é definida como uma incapacidade caracterizada por limitações significativas, tanto no funcionamento intelectual quanto no comportamento adaptativo e está expressa nas habilidades práticas, sociais e conceituais, originando-se antes dos 18 anos de idade. É um dos transtornos neuropsiquiátricos mais comuns em crianças e adolescentes, com taxa de prevalência de 5% na população brasileira. A Síndrome do X-Frágil (SXF) é a forma mais frequente, mais pesquisada e melhor documentada de DI herdável em seres humanos. O fenótipo da SXF está associado a mutações no gene FMR1 (Fragile Xlinked Mental Retardation type 1) e abrange um amplo espectro de envolvimento físico e comportamental. É causada por uma expansão de trinucleotídeos CGG no primeiro éxon do gene FMR1 localizado na região Xq27.3 no cromossomo X. Em função de sua diversidade fenotípica, esta doença tem sido subdiagnosticada na população pediátrica. A importância do reconhecimento clínico e diagnóstico específico da SXF vem do fato de que teoricamente todos os casos são hereditários e familiais. Entre as técnicas moleculares utilizadas para o diagnóstico da SXF, a MLPA (Multiplex Ligation-dependent Probe Amplification) tem sido considerada promissora. Nesse contexto, este estudo teve como objetivo validar o diagnóstico genético-molecular de pacientes com suspeita da SXF no Laboratório de Citogenética e Genética Molecular (LaGene) da Secretaria Estadual de Saúde do Estado de Goiás, na cidade de Goiânia, pela técnica de MLPA. Foram selecionados 33 pacientes encaminhados pelo serviço médico da rede pública de saúde ao LaGene com indicação clínica de diagnóstico da SXF. Para realização da análise por MLPA foi utilizado o Kit: Salsa MLPA P106-B1 MRX. Foram obtidas amplificações de apenas 15% dos pacientes. O Kit utilizado não detectou alterações no número de cópias do gene FMR1 em nenhum paciente analisado, sendo necessário a utilização de outros métodos moleculares para confirmação do diagnóstico da SXF. Dessa forma, concluímos que o Kit utilizado não foi específico para detectar alterações no número de cópias do gene FMR1, não se mostrou sensível e específico na detecção de portadores da SXF, sendo considerado oneroso. Assim a técnica de MLPA, com o uso do Kit Salsa MLPA P106-B1 MRX , não deverá ser utilizada para se triar pacientes com suspeita da SXF.

Made available in DSpace on 2016-04-27T18:12:37Z (GMT). No. of bitstreams: 1 Hedilamar Bortolotto.pdf: 842924 bytes, checksum: 44274588e35ebd044ff891e082281374 (MD5) Previous issue date: 2008-10-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present clinical-qualitative research deals with a case study based on the symptomatic speech of a male child affected by the Fragile X Syndrome, diagnosed at the age of four and a half year. This paper follows on the therapeutical process from the age of four years up to six years old, with the purpose of identifying, in a more specific way, how the language functioning laws emerge in the child s speech. The elected approach privileges a view on the relative autonomy of the speech and language, moving away from the notion of lineal causality of the genetic syndrome and the language symptoms. There were elected, for analysis, enigmatic episodes extracted from the therapeutical sessions. Based on the Linguistics, more specifically, the Brazilian Interacionism, on the Lacanian Psychoanalyses and on the Speech-Language Clinic Therapy focused on the subject relation with the Other/other, a clinical practice that lays on the subjectivity was aimed. The analyses allowed to outline the child s trajectory in the singular interlacement of his speech to the functioning laws of the language, pointing out the therapist s language interpretations and scansions, meaning cuts and variations of intonation, rhythm and melody in the therapist s speech that leaded to displacements in the child s position as a speaker of the language. It was concluded that interpretative actions resting on the verbal stereotype and echolalia generate changes in the child s position and that the therapist s silence can open spaces for the child to establish his speaker position, which represent promising paths to the pathological Speech-Language Clinic Therapy / A presente pesquisa clínico-qualitativa aborda um estudo de caso por meio da fala sintomática de um menino afetado pela Síndrome de X Frágil, diagnosticada aos quatro anos e meio de idade. O trabalho acompanha o processo terapêutico dos quatro aos seis anos de idade, visando identificar, de forma mais específica, como as leis de funcionamento da Língua se manifestam na fala da criança. O foco escolhido privilegia o olhar sobre o funcionamento relativamente autônomo da Língua, afastando-se da noção de causalidade linear entre a síndrome genética e os sintomas na linguagem. Elegeram-se, para análise, episódios enigmáticos extraídos de gravações de sessões fonoaudiológicas. Fundamentando-se na Lingüística, mais especificamente no Interacionismo, na Psicanálise Lacaniana e na Clínica Fonoaudiológica que mira a relação do sujeito com o Outro/outro, buscou-se uma prática clínica assentada sobre a subjetividade. As análises permitiram delinear o percurso da criança no enlaçamento singular de sua fala ao modo de funcionamento da Língua, pontuando interpretações e escansões, isto é, cortes e alterações de entonação, ritmo e melodia da fala da fonoaudióloga que provocaram deslocamentos na posição de falante da criança pesquisada. Conclui-se que ações interpretativas sobre as ecolalias e estereotipias geram mudanças na posição da criança e que o silenciamento do terapeuta pode abrir espaços para que a criança ocupe sua posição de falante, caminhos promissores para a Clínica Fonoaudiológica que atua com falas patológicas

Cette thèse part de la proposition d’une rencontre possible entre psychanalyse et génétique médicale par le biais des soins offerts aux enfants porteurs de syndromes génétiques, notamment le syndrome de l’X fragile. Nous avons trouvé dans les recherches en épigénétique une voie de rapprochement de ces différents champs du savoir. L’idée selon laquelle l’environnement est capable de modifier l’expression des gènes représente la rupture d’un certain déterminisme génétique autrefois accepté, et ouvre un espace où penser la singularité. Notre travail propose d’élargir le concept d’environnement, en y considérant la relation de l’enfant avec l'Autre, lieu du langage, comme opérateur de marques sur son corps : marques symboliques, constituées dès le tout début de la rencontre de l’infans et de ceux qui s’occupent de lui. C’est justement dans cet espace d’échange avec l'Autre qu’a lieu l’émergence d’un sujet. Nous avons opté pour les concepts de sujet et de transfert pour soutenir l’articulation de la clinique psychanalytique et de la génétique médicale en ce qui concerne le traitement. Nous avons donc exposé trois cas cliniques issus de notre pratique, d’enfants traversés par le diagnostic de l’X fragile afin d’illustrer de quelle manière les conceptions de sujet et de transfert se reflètent dans la clinique. Tenant compte que la psychothérapie est également prise comme objet d’étude de l’épigénétique, et qu’elle est donc considérée comme un environnement capable de provoquer, voire de renverser des marques épigénétiques, l’enjeu de notre travail repose sur la proposition suivante : et pourquoi pas la psychanalyse également ? La psychothérapie psychanalytique, ancrée sur le transfert, ne peut-elle pas, elle aussi, laisser des marques sur le petit patient ? / The current thesis assumes a possible encounter between psychoanalysis and medical genetics based on the treatment applied to children carrying genetic syndromes such as the Fragile X Syndrome. Epigenetic studies are a way to approximate different knowledge fields. The assumption that the environment is able to change gene expression strays from the genetic determinism we once believed and opens the way for us to reason about singularity. The proposition in the present study lies on expanding the concept of environment, by taking into consideration the relation between the child and the Other in the environment in question, as well as the place of language as the operator marking the child’s body. These symbolic marks start emerging in the first encounter between the infans and caregivers. The subject emerges precisely within an environment of exchanges that is set with the Other. The concepts of subject and transference were chosen to support the treatment articulation between psychoanalytic clinic and medical genetics. Thus, the present study reports three clinical cases followed by the authors, which involved children diagnosed with fragile X syndrome. These cases illustrate how the aforementioned concepts affect the clinical practice. Since psychotherapy has also been taken as the object of epigenetic studies, and as it is considered an environment able to cause, and even reverse, epigenetic marks, the current study relies on the following proposition: why not psychoanalysis as well? Can the psychoanalytic psychotherapy, anchored in the concept of transference, leave marks on the little patient too? / Esta tese parte da proposição de um encontro possível entre psicanálise e genética médica através do tratamento oferecido às crianças com síndromes genéticas, notadamente a Síndrome do X Frágil. Encontramos nas pesquisas em epigenética uma via de aproximação entre os distintos campos de saber. A ideia de que o ambiente é capaz de alterar a expressão dos genes quebra com um certo determinismo genético outrora acreditado, abrindo espaço para se pensar a singularidade. Nosso trabalho propõe a ampliação do conceito de ambiente, considerando nele a relação da criança com o Outro, lugar da linguagem, como operadora de marcas no seu corpo: marcas simbólicas, constituídas desde os primórdios do encontro do infans com seus cuidadores. É justamente nesse ambiente de trocas com o Outro que se dá a emergência de um sujeito. Os conceitos de sujeito e transferência foram escolhidos para sustentarmos a articulação da clínica psicanalítica com a genética médica no que concerne o tratamento. Assim, expusemos três casos clínicos oriundos de nossa prática, de crianças atravessadas pelo diagnóstico de X frágil no intuito de ilustrar de que forma as concepções de sujeito e transferência incidem na clínica. Levando-se em conta que a psicoterapia tem sido igualmente tomada como objeto de estudo da epigenética, sendo, desta forma, considerada como ambiente capaz de provocar e até mesmo reverter marcas epigenéticas, a aposta de nosso trabalho repousa na seguinte proposição: e por que não a psicanálise também? Será que a psicoterapia psicanalítica, ancorada na transferência, não pode ela também provocar marcas no pequeno paciente?