Objetivo: Avaliar e comparar os achados dos Potenciais Evocados Auditivos de Tronco Encefálico em indivíduos com holoprosencefalia (HPE) e holoprosencefalia-like (HPE-like). Modelo: Análise prospectiva comparando os achados dos PEATE entre três grupos: indivíduos com HPE clássica (GH), indivíduos com HPE-like (GHL) e grupo controle (GC), a um nível de significância de 5%. Local de Execução: Setor de Genética, HRAC-USP. Participantes: 57 pacientes, com idades entre 1 ano e 6 meses e 22 anos, sendo 13 com HPE clássica, 22 com HPE-like, e um grupo controle de 22 indivíduos normais. Variáveis: Latências absolutas das ondas I, III e V; latências interpicos I-V, III-V e I-III e diferença interaural da onda V do PEATE, em milissegundos, para cada orelha. Resultados: Os valores médios em milissegundos das latências absolutas e interpicos nas orelhas direita e esquerda respectivamente foram os seguintes. ara a onda I: 2,21 e 2,19 (GH); 1,99 e 2,01 (GHL); 1,92 e 1,91 (GC). Para a onda III: 4,35 e 4,52 (GH); 4,04 e 4,04 (GHL); 3,97 e 3,94 (GC). Para a onda V: 6,47 e 6,51 (GH); 5,95 e 5,94 (GHL); 5,90 e 5,90 (GC). Para o interpicos I-V: 4,20 e 4,24 (GH); 3,94 e 3,92 (GHL); 3,97 e 3,97 (GC). Para o interpicos III-V: 2,27 e 2,07 (GH); 1,91 e 1,90 (GHL); 1,92 e 1,95 (GC). Para o interpicos I-III: 2,14 e 2,33 (GH); 1,03 e 2,01 (GHL); 2,04 e 2,01 (GC). Os valores de diferença interaural da onda V foram: 0,13 (GH); 0,06 (GHL) e 0,03 (GC). Conclusões: Os dados sugerem que grande parte dos indivíduos com HPE clássica apresentam alterações de PEATE compatíveis com o grau de comprometimento neurológico, enquanto aqueles com HPE-like apresentam poucas alterações, sendo estas justificadas pelas patologias de orelha média decorrentes da fissura de palato. / Objective: To evaluate and compare Auditory Brainstem Response (ABR) findings in patients with holoprosencephaly (HPE) and the “HPE-like” phenotype. Model: A prospective analysis comparing ABR results among three different groups: patients with classic HPE (GH), patients with HPE-like (GHL) and control group (GC), at a 5% significance level. Setting: Genetics Department, HRAC-USP. Participants: 57 patients, aged from 18 months to 22 years. Thirteen of them had classic HPE, 22 had HPE-like, and 22 were audiologically normal individuals, who joined the GC. Variables: Waves I, III and V absolute latencies; interpeak intervals I-V, III-V and I-III and wave V interear difference of ABR, in milisseconds, considering both right and left ears. Results: Mean values, in milisseconds, of absolute latencies and interpeaks recorded from right and left ears, respectivelly, were: Wave I: 2,21 and 2,19 (GH); 1,99 and 2,01 (GHL); 1,92 and 1,91 (GC). Wave III: 4,35 and 4,52 (GH); 4,04 and 4,04 (GHL); 3,97 and 3,94 (GC). Wave V: 6,47 and 6,51 (GH); 5,95 and 5,94 (GHL); 5,90 and 5,90 (GC). Interpeak I-V: 4,20 and 4,24 (GH); 3,94 and 3,92 (GHL); 3,97 and 3,97 (GC). Interpeak III-V: 2,27 and 2,07 (GH); 1,91 and 1,90 (GHL); 1,92 and 1,95 (GC). Interpeak I-III: 2,14 and 2,33 (GH); 1,03 and 2,01 (GHL); 2,04 and 2,01 (GC). Wave V interear difference were: 0,13 (GH); 0,06 (GHL) and 0,03 (GC). Conclusions: Results suggest that most patients with classic HPE have abnormalities detected by ABR testing, which are related to the severity of neurologic impairment. Otherwise, those with the HPE-like phenotype have few alterations, most likely resulting from middle ear pathologies that occur in presence of cleft palate.

No description available.

No description available.

LRP2 wird waehrend der fruehen Embryonalentwicklung hauptsaechlich im Dottersack und im Neuroepithel exprimiert. Der funktionelle Verlust dieses 600 kDa grossen Proteins in Maeusen fuehrt zu Fehlbildungen bei der Vorderhirnentwicklung, die als Holoprosenzephalie bezeichnet werden. LRP2 kommt daher eine wichtige Funktion waehrend der Vorderhirnentwicklung zu. Fuer diese Arbeit wurden Maeuse verwendet, bei denen lrp2 im gesamten Tier oder nur in bestimmten Geweben inaktiviert war. Die Expression von LRP2 im Neuroepithel, nicht aber im Dottersack ist wichtig fuer die korrekte Vorderhirnentwicklung. Das Fehlen des Proteins fuehrte am Tag 9.5 der Embryonalentwicklung zu einer UEberaktivierung des Bmp4 Signalweges im rostralen Telencephalon. Am Tag 10.5 war ein Verlust der shh-Expression in der anterioren entopeduncularen Zone (AEP) zu sehen. Das Fehlen von Shh in der AEP fuehrte zum Verlust von ventralen Oligodendrozyten und Interneuronen. AEhnliche Defekte wurden ebenfalls in Maeusen beschrieben, bei denen der Bmp4 Signalweg verstaerkt ist. Bmp4 bindet in vitro an LRP2. Diese Ergebnisse deuten darauf hin, dass LRP2 an der Entwicklung des ventralen Telencephalons beteiligt ist - moeglicherweise indem es die verfuegbare Menge an Bmp4 durch Endozytose reguliert. Die Signalwege, in die LRP2 eingebunden ist, sollten im Zebrafisch weiter untersucht werden. Tiere, denen funktionelles LRP2 fehlte, wurden durch die Injektion von Morpholinos generiert. Injizierte Tiere zeigten Stoerungen bei Resorptionsvorgaengen im Pronephros, was darauf hin deutet, dass die Funktion von LRP2 im Zebrafisch Pronephros und in der Niere der Saeugetiere konserviert ist. Die Expressionsmuster von Markergenen fuer die Vorderhirnentwicklung waren allerdings normal.Vermutlich war die Stoerung der lrp2-mRNA Prozessierung nicht ausreichend, um hier einen Effekt hervorzurufen, da bereits im 1-Zell Stadium genuegend komplett prozessierte maternale lrp2-mRNA fuer die Translation von LRP2 vorhanden war. / LRP2 is mainly expressed in the yolk sac and in the neuroepithelium of the early embryo. Deficiency for this 600 kDa protein in mice results in holoprosencephaly, indicating a role for LRP2 in forebrain development. Mice with a complete or a conditional loss of lrp2 function were used to elucidate the consequences of the lack of LRP2 expression. The presence of LRP2 in the neuroepithelium but not in the yolk sac is crucial for early forebrain development. Lack of the receptor resulted in an increase of Bmp4 signaling in the rostral telencephalon at E9.5. As a consequence, shh expression at E10.5 was lost completely in a ventral region of the telencephalon termed anterior entopeduncular area (AEP). The absence of Shh activity in this area led to the loss of ventrally induced oligodendroglial and interneuronal cell populations in lrp2-deficient mice. Similar dorsalizing effects have also been observed in mice with increased Bmp4 signaling. Taking into account that Bmp4 was found to bind to LRP2 in vitro and in vivo, these results suggest a role for LRP2 in patterning the rostral ventral neural tube, possibly by acting as a clearance receptor for Bmp4. The underlying molecular mechanisms were then further analyzed in the zebrafish. LRP2-deficient animals were generated by injecting Morpholinos that interfered with the splicing of the lrp2-pre-mRNA leading to a deletion of the transmembrane-exon. Injected animals suffered from impaired renal clearance processes, demonstrating the functional conservation of LRP2 in the larval zebrafish pronephros. Brain structures were not affected in these animals and the expression patterns of marker genes for early forebrain development that were changed in the mouse were not changed. Apparently, Morpholino mediated interfering with the splicing of the lrp2-pre-mRNA did not affect the early forebrain formation because properly processed lrp2-mRNA was supplied maternally and sufficient for proper brain formation.

L'holoprosencéphalie (HPE) est une maladie rare due à une anomalie du développement précoce du prosencéphale. Les gènes impliqués appartiennent à des voies de signalisation cruciales pour le développement embryonnaire telles que les Nodal, Shh et Fgf. Des mutations de ces gènes n'expliquent que 30% des cas d'HPE. Différentes stratégies ont été mises en œuvre pour déterminer de nouveaux gènes responsables de l'HPE. Récemment, des délétions du gène DLL1, un ligand du récepteur Notch ont été identifiées chez des patients HPE. L'objectif de mon travail de thèse était de tester l'hypothèse d'un rôle de la voie Notch au cours du développement précoce du prosencéphale. Dans ce but, une inhibition de la voie Notch a été réalisée en utilisant une culture ex ovo d'embryon de poulet. Grâce à cela, j'ai pu identifier une activité de la voie Notch au niveau de l'hypothalamus présomptif, une structure ventrale du cerveau antérieur. Une approche transcriptomique a ensuite permis d'identifier les dérégulations survenant lors de l'inhibition pharmacologique de la voie Notch. Les expressions des cibles trancriptionnelles de la voie Notch telles que Hes5, Hey1, Ascl1 ou Nhlh1 m'ont permis de suggérer un modèle d'action par inhibition latérale lors de la neurogénèse de l'hypothalamus en développement. Les données transcriptomiques générées m'ont permis d'identifier de nouveaux gènes marqueurs de l'hypothalamus dont l'expression est sous l'influence de la voie Notch. Nos résultats suggèrent que ces gènes appartiennent à une boucle de régulation comprenant la voie Notch et des facteurs de neurogénèse tels que les gènes proneuraux. Mon travail a également permis de montrer que l'expression du gène majeur de l'HPE, le gène Shh, requérait une activité de la voie Notch précisément au niveau de l'hypothalamus. En conclusion, mes résultats montrent que la voie Notch contribue au développement précoce du cerveau. Ce constat ajoute un autre niveau de complexité à l'apparition de l'HPE et apporte de nouveaux arguments en faveur d'un modèle « multi-hit » pour cette pathologie. / Holoprosencephaly (HPE) is a rare disease corresponding to a failure of early prosencephalon development. Genes involved in HPE, belong to crucial signalling pathways for embryonic development as Nodal, Shh and Fgf. Mutations in these genes could explain only 30% of HPE cases. Different strategies were used to identify new genes in HPE. Recently, deletions of DLL1, a ligand of Notch receptor, have been identified in HPE patients. The aim of my thesis was to test hypothesis that Notch pathway has a role during the early prosencephalon development. First, I performed a pharmacological inhibition of Notch pathway in embryos that were cultured ex ovo. Thus, I could identify Notch activity at the level of primordium hypothalamus, a ventral structure of prosencephalon. Then, transcriptomic analyses were performed to identify deregulations occurring during Notch inhibition. Expressions of well known transcriptional targets of Notch pathway, Hes5, Hey1, Ascl1 and Nhlh1, indicated that Notch pathway might act by lateral inhibition in the neurogenesis of developing hypothalamus. From transcriptomic data, we identified novel markers of developing hypothalamus that will be regulated by Notch pathway. Our results suggest that these novel genes could be involved in the regulatory loop associating with Notch pathway and proneural genes. Then, I demonstrated that Notch activity is required to maintain Shh expression, a major gene involved in HPE, particularly in the hypothalamus. To conclude, adding the Notch pathway in the signalling pathway network involved in prosencephalon development, we provide other complexity level in the HPE appearance. Thus, these results support the hypothesis of a « multi-hit » model of HPE.

Hartsfield syndrome is a rare clinical entity characterized by holoprosencephaly and ectrodactyly with the variable feature of cleft lip/palate. In addition to these symptoms patients with Hartsfield syndrome can show developmental delay of variable severity, isolated hypogonadotropic hypogonadism, central diabetes insipidus, vertebral anomalies, eye anomalies, and cardiac malformations. Pathogenic variants in FGFR1 have been described to cause phenotypically different FGFR1-related disorders such as Hartsfield syndrome, hypogonadotropic hypogonadism with or without anosmia, Jackson–Weiss syndrome, osteoglophonic dysplasia, Pfeiffer syndrome, and trigonocephaly Type 1. Here, we report three patients with Hartsfield syndrome from two unrelated families. Exome sequencing revealed two siblings harboring a novel de novo heterozygous synonymous variant c.1029G>A, p.Ala343Ala causing a cryptic splice donor site in exon 8 of FGFR1 likely due to gonadal mosaicism in one parent. The third case was a sporadic patient with a novel de novo heterozygous missense variant c.1868A>G, p.(Asp623Gly).

Die Signalübertragung durch Wnt/beta-Catenin stellt einen der wichtigsten Signalwege während der Embryogenese sowie im adulten Organismus dar. Die homologen Gerüstproteine Conductin und Axin stehen im Mittelpunkt eines zentralen Multiproteinkomplexes, der im Zytoplasma für die Regulation des Wnt/beta-Catenin-Signalwegs verantwortlich ist. In der vorliegenden Arbeit habe ich eine kombinierte genetische Analyse von Conductin und Axin in der Maus durchgeführt. Dazu habe ich mit Hilfe der Technik der homologen Rekombination das Conductin-Gen deletiert und ein Reportergen unter die Kontrolle des endogenen Conductin-Promotors gebracht. Im Weiteren habe ich festgestellt, dass der gemeinsame Verlust von Conductin und einem Axin-Allel (Con-/-;Ax+/-) zu Holoprosenzephalie (HPE) führt, die durch schwere kraniofazialen und Vorderhirndefekten in der Maus charakterisiert ist. Dabei zeigte die detaillierte Analyse eine genetische Interaktion des Wnt-Signalwegs mit dem Shh-Signalweg. Störungen im Shh-Signalweg sind auch beim Menschen für die Ausbildung von HPE verantwortlich gemacht worden. Daneben führt die gleichzeitige Abwesenheit von Conductin und Axin (Con-/-;Ax-/-) zum Verlust der anterior-posterioren Achse in einem frühen Entwicklungsstadium und zum Absterben der Embryonen nach dem Tag 6,5 der Entwicklung. Die vorliegende Arbeit zeigt, wie Unterschiede in der biologischen Bedeutung zweier funktionell redundanter Faktoren mit genetischen Methoden in der Maus aufgeklärt werden können. / The Wnt/beta-Catenin pathway represents one of the most important signaling cascades during development as well as in the adult organism. The homologous scaffolding proteins Conductin and Axin are the backbone of a central multi protein complex that is responsible for the tight regulation of the Wnt/beta-Catenin pathway in the cytoplasm. In the present study I have performed a combined genetic analysis of Conductin and Axin in the mouse. To this end I have deleted the Conductin gene by homologous recombination in embryonic stem cells and inserted a reporter gene under the control of the endogenous Conductin promoter. I could show that the simultaneous loss of Conductin and one Axin allele (Con-/-;Ax+/-) causes Holoprosencephaly (HPE), which is characterized by severe craniofacial and forebrain defects in the mouse. The detailed analysis of the mutant mice reveals a genetic interaction of Wnt and Shh signaling and defective Shh signaling has previously been implicated in the formation of HPE in human patients. Moreover, complete absence of both Conductin and Axin (Con-/-;Ax-/-) leads to loss of the anterior-posterior axis early in development and death of the embryos after E6.5. The present study exemplifies how differences in the biological function of two mechanistically redundant factors can be studied by genetic means in the mouse.