L’objet de cette thèse est de réaliser une analyse économique du champ de l’aide informelle des personnes adultes jeunes vivant à domicile et atteintes de maladie neurologique grave. La question de recherche posée concerne l’articulation entre l’organisation de l’aide informelle et la cinétique de la pathologie neurologique. La méthodologie repose sur la construction de quatre modèles neuro-pathologiques et économiques d’une part, et sur la constitution de quatre cohortes représentatives, comportant chacune une centaine de binômes « aidant-aidés » d’autre part. Ainsi, les modèles de la pathologie brutale avec handicap résiduel stabilisé, de la pathologie progressive avec handicap croissant, de la pathologie à cinétique déficitaire rapide, de la pathologie dégénérative héréditaire sont-ils respectivement illustrés par le traumatisme crânien, la sclérose en plaques, la tumeur cérébrale et la maladie de Huntington. Nos travaux (1) mettent en évidence les caractéristiques sur le plan économique des aidants informels (conjoints jeunes) qui sont fortement impliqués dans la production du soin, experts d’un accompagnement complexe et déstabilisés dans leur trajectoire professionnelle (2) font la démonstration de la prédétermination forte de la cinétique de la pathologie neurologique sur les comportements d’aide informelle à travers différents indicateurs temporels dont la prise en compte s’avère incontournable pour l’analyse économique (3) montrent la nécessité d’avoir recours à une mesure bidimensionnelle (subjective et objective) dans l’analyse du fardeau des aidants informels. Une telle mesure souligne d’une part l’insuffisance du recours à l’aide professionnelle publique et d’autre part l’impact sur les aidants des troubles cognitivo-comportementaux (handicap invisible) et de la phase neuro-palliative à domicile d’une pathologie neurologique grave. Ces résultats ouvrent des perspectives pour la mise en place de mesures d’action publiques en France dans le champ complexe du handicap neurologique. / The purpose of this thesis is to achieve an economic analysis of informal caregiving of young adults living at home and suffering from a severe neurological disease. The research questions the relationship between the organization of informal care and kinetics of neurological pathology. The methodology is based on the construction of four neuro-pathological and economic models on the one hand, and on the constitution of four representative cohorts, each with a hundred pairs of "patients-caregivers" on the other. Thus, models of brutal disease stabilized with residual disability, progressive disease with increasing disability, fast kinetics disease and neuro-degenerative hereditary disease are respectively illustrated by traumatic brain injury, multiple sclerosis, malignant brain tumor and Huntington's Disease. Our work (1) highlights the economic characteristics of informal caregivers (young spouses) who are highly involved in the production of care, expert of complex care and therapeutic pathways and destabilized in their professional careers (2) demonstrates that the kinetics of neurological disease predicts the economic behavior of informal caregivers : taking account of different time indicators is crucial for economic analysis in neurodisability (3) shows that a two-dimensional subjective and objective outcome measure is necessary in the analysis of the burden of informal caregivers. Such a double indicator first stresses the inadequate use of publicly funded professional care ; it also points out the impact of cognitive-behavioral disorders (so-called “invisible disability”) and of the home neuro-palliative phase on caregivers in case of a severe neurological disease. These results open perspectives for the development of public action measures in France in the complex field of neurological disability.

The increasing transparence of the human genome has profound implications for how we understand health and illness and perceive our biological and social relatedness to others. Presymptomatic testing for adult onset conditions, in particular, creates the novel situation in which some individuals know in advance of impending illness while others learn that they have escaped such a fate. How families at risk for one adult onset condition — Huntington Disease (HD) — communicate about such information is the topic of this dissertation. HD is often described as a 'genetic time bomb'. It is an autosomal dominant neuropsychiatric disorder characterized by mid-life onset, involuntary movements, cognitive impairment, and depression. There is no effective prevention or cure but with the advent of predictive testing in 1987 it became possible for at risk individuals to learn if they had inherited the mutation associated with HL\ Empirical studies on predictive testing for HD focus primarily on the individual psychological impacts of the test; few studies consider how families understand and attempt to manage genetic information in their everyday lives. This dissertation begins to address these lacunae by examining the stories that test candidates and their families tell about hereditary risk and predictive testing. These stories derive from a prospectively designed study which includes 102 in-depth, at-home interviews conducted in the pre and post-results period with 16 test candidates and 33 family members. Focusing on three narrative 'moments', the dissertation explores how study participants storied their experiences of: 1) learning about the family history of HD, 2) deciding to request the predictive test and, 3) making sense of an informative result. Drawing upon a social constructionist approach, the analysis emphasizes the processual nature of predictive testing as well as the significance of interpersonal communication in producing and reproducing the social realities in which genetic information acquires a particular salience. Given the recent proliferation of genetic tests as well as the absence of an adequate popular discourse on embodied risk, the research underscores lay actors' abilities to reframe existing clinical schema in order to interpret and manage hereditary risk in an intersubjectively meaningful way. / Arts, Faculty of / Anthropology, Department of / Graduate

Genomic instability, in the form of gene mutations, insertions/deletions, and gene amplifications, is one of the hallmarks in many types of cancers and other inheritable genetic disorders. Trinucleotide repeat (TNR) disorders, such as Huntington’s disease (HD) and Myotonic dystrophy (DM) can be inherited and repeats may be extended through subsequent generations. However, it is not clear how the CAG repeats expand through generations in HD. Two possible repeat expansion mechanisms include: 1) polymerase mediated repeat extension; 2) persistent TNR hairpin structure formation persisting in the genome resulting in expansion after subsequent cell division. Recent in vitro studies suggested that a family A translesion polymerase, polymerase θ (Polθ), was able to synthesize DNA larger than the template DNA. Clinical and in vivo studies showed either overexpression or knock down of Polθ caused poor survival in breast cancer patients and genomic instability. However, the role of Polθ in TNR expansion remains unelucidated. Therefore, we hypothesize that Polθ can directly cause TNR expansion during DNA synthesis. The investigation of the functional properties of Polθ during DNA replication and TNR synthesis will provide insight for the mechanism of TNR expansion through generations.

Huntington’s disease (HD) and Spinocerebellar ataxia (SCA) are incurable neurodegenerative diseases that affect the central nervous system. Amyloids, highly organized protein aggregates, are a hallmark for many neurodegenerative diseases. The presence and accumulation of amyloids are toxic and constitute the major cause of neuron cell death. Both genetic and environmental factors contribute to the onset and progression of these diseases. However, despite intensive research, the underlying cause remains unclear. The role of viral infection as an environmental factor in the context of neurodegenerative diseases has not received much attention. The purpose of this study is to investigate the effects of Herpes Simplex Virus 1 (HSV-1) infection on nuclear amyloid aggregation in model cell lines of HD and SCA. The research process consists mainly of laboratory work which involved the use of several molecular techniques used in the field of biotechnology. The work comprises cultivating cells, infecting cells with HSV-1, Fluorescence microscopy, Western Blot and isolation and detection of amyloids. Western Blot is used for the analysis of specific proteins associated with protein aggregation in HD and SCA. The techniques used for detecting amyloids are Dot Blot and Antibody-staining of amyloids in cells. The results from Western Blot showed that aggregates changed in the presence of the virus. This pattern is observed for both HD and SCA1 cell lines. A big effort is done in this study to optimize Dot Blot as it is method that could be applied in every lab. Normalization of samples proved to be the most challenging part with Dot Blot. No definitive conclusions can be drawn from the Dot Blot results as reproducibility and sensitivity were lacking. This work addresses some of the difficulties encountered when working with detection of amyloids especially Dot Blot. Antibody-staining of amyloids showed that amyloids were formed in the presence of virus in comparison to non-infected. To conclude, aggregates changed, and amyloids were formed in the presence of virus. These results point to the fact that HSV-1 infection could be involved in the process of nuclear amyloid aggregation. The data presented in this thesis will need further investigation and characterization to identify the precise role of viral-induced amyloid formation in HD and SCA patient cells. / Huntingtons sjukdom (HD) och Spinocerebellära ataxier (SCA) är obotliga neurodegenerativa sjukdomar som påverkar det centrala nervsystemet. Amyloid, proteinaggregat som har en viss konformation är ett kännemärke för många neurodegenerativa sjukdomar. Ackumulering av dessa amyloider är toxiskt och är den främsta orsaken till att nervceller dör. Både genetiska faktorer och miljöfaktorer bidrar till uppkomsten och progressionen av dessa sjukdomar. Trots intensiv forskning är den bakomliggande orsaken emellertid fortfarande oklar. Virusinfektion som en potentiell miljöfaktor har i detta sammanhang inte fått mycket uppmärksamhet. Syftet med denna studie är att undersöka effekterna av Herpes Simplex Virus 1 (HSV-1) infektion på amyloid aggregering i modellcellinjer av HD och SCA. Forskningsarbetet bestod i huvudsakligen av experimentellt arbete med hjälp av flera molekylära tekniker inom bioteknikområdet som cell odling, infektering av celler med HSV-1, fluorescensmikroskopi, Western Blot och isolering och detektion av amyloider. Western Blot användes for att analysera specifika proteiner associerade med protein aggregering i HD och SCA. Amyloider detekterades med Dot Blot och med antikroppar specifika för amyloider. Resultat från Western Blot visade att amyloiderna förändras i virusinfekterade celler. Detta mönster observerades i både HD and SCA1 cellinjer. En stor bemöda görs i denna studie för att optimera Dot Blot eftersom det är en metod som kan användas i alla laboratorier. Normalisering visade sig vara det svåraste med detektion av amyloider. Inga definitiva slutsatser kan dras från dessa experiment, eftersom reproducerbarhet och känslighet var bristande. Detta arbete tar upp några av de svårigheter som uppstod vid arbetande med detektion av amyloider speciellt Dot Blot. Detektion av amyloider med antikropp visade att amyloider bildades till stor utsträckning i infekterade cellinjer i jämförelse med icke-infekterade. Sammanfattningsvis, amyloider förändrades och amyloider bildades i närvaro av virus. Dessa resultat indikerar på att HSV-1 infektion skulle kunna vara involverad i processen av amyloid aggregering. De presenterade uppgifter i detta examensarbete är preliminära och behöver följas upp med ytterligare studier för att identifiera virusens exakta roll i amyloid bildning i HD och SCA patient celler.

Huntingtons sjukdom (HD) är ett neurodegenerativt tillstånd som orsakas av mutationer i huntingtin gen (Htt), och resulterar till upprepade glutamin (polyQ) i Htt-proteinet. Muterad Htt kan inte vika sig ordentligt och börjar därför aggregera i celler. I detta projekt undersöktes molekylära mekanismerna bakom HD genom att analysera genuttryck hos musvävnader och jämföra detta med biomarkörer identifierats hos HD-patienter. För närvarande finns det ingen behandling för att stoppa utveckling av HD. Därför behövs det mer kunskap om sjukdomen. Projektets mål var att öka vår förståelse på regulatoriska mekanismer som ligger bakom den neurodegenerativa sjukdomen och identifiera potentiella diagnostiska biomarkörer. För denna studie användes mRNA-seq-data från 11 distinkta vävnader från Q175 HD-möss. Vävnader som analyserades inkluderar hjärnstammen, cerebellum, corpus callosum, hippocampus och thalamus/hypothalamus, fettvävnader (brun, vit nära gonad och vit nära tarm) och andra vävnader så som hjärta, hud och gastrocnemius muskel. Efter en grundlig genomgång av HD-litteraturen valdes biomarkörer som sedan undersöktes för mRNA-uttryck hos Q175-möss via Gene Set Enrichment Analysis (GSEA). Genuttrycksförändringar hos HD-möss visade sig vara vävnadsspecifika, med betydande effekter på hud och fettvävnader, men mindre effekter hos hjärnvävnader. Även om gemensamma mRNA-förändringar inte hittas bland de olika vävnader, uppvisade relaterade vävnader förändringar i samma pathways. Immunsvar och ribosomal dysfunktion var utbredd, men varje hjärnregion visade unika förändringar relaterade till sömn, synaptisk signalering och energiprocesser. Muskel- och fettvävnader uppvisar också distinkta mönstrar. Detta understryker vikten av vävnadsspecifik biomarkörforskning för neurodegenerativa sjukdomar. / Huntington's disease (HD) is a neurodegenerative condition caused by a mutation in the Huntingtin (Htt) gene which results in glutamine repeats (polyQ) and a longer Htt-protein. The mutated Htt-protein cannot fold properly and thus, is prone to aggregate in cells. There is currently no treatment available to stop the progression of HD. Therefore, there is a need for more knowledge regarding the disease. This project investigates the molecular mechanisms underlying HD by analysing gene expression program in wild type (Wt) and HD mice. The objective is to investigate changes in gene regulatory mechanisms underlying the neurodegenerative disease and identify potential diagnostic markers. For this study, mRNA-seq data from 11 distinct tissues from Q175 HD model mouse were analysed. These tissues included brainstem, cerebellum, corpus callosum, hippocampus, and thalamus/hypothalamus, adipose tissues (brown, white near gonad and white near intestine), heart, skin and gastrocnemius muscle. Following a thorough literature review, biomarkers of HD were chosen, and their expression investigated in the HD mouse using Gene Set Enrichment Analysis (GSEA). Gene expression changes in HD mouse were specific to different tissues, with significant changes identified in skin and adipose tissues, while smaller changes were detected in the brain tissues. While common changes across the 11 tissues were not found, related tissues exhibited alterations in the same pathways. Changes in immune response and ribosomal dysfunction were widespread across tissues. Moreover, each brain region showed unique changes related to sleep, synaptic signalling, and energy processes. Muscle and adipose tissues displayed distinctive patterns. These results underscore the importance of tissue-specific biomarker research for neurodegenerative diseases.

Chorea Huntington (HD) ist eine neurodegenerative Erkrankung, die durch Ablagerungen von N-terminal Polyglutamin-reichen Huntingtin (Htt) -Fragmenten in den betroffenen Neuronen charakterisiert ist. Das mutierte Htt (mHtt) Protein wird ubiquitär exprimiert. Das zellspezifische Absterben von „medium-sized spiny neurons“ (MSN) wird jedoch im Striatum von HD Patienten verursacht (Albin, 1995). Es wird angenommen, dass Striatum-spezifische Proteine, die mit Htt interagieren, eine wichtige Rolle in der Pathogenese von HD spielen (Ross, 1995). Protein-Protein-Interaktionsstudien haben gezeigt, dass einige der Htt-Interaktionspartner mit unlöslichen Htt-Ablagerungen in den Gehirnen von HD-Patienten kolokalisieren und die Bildung von Protein-Aggregaten beeinflussen (Goehler, 2004). Kürzlich wurde durch die Integration von Genexpressions- und Interaktionsdaten ein Striatum-spezifisches Protein-Interaktionsnetzwerk erstellt (Chaurasia, unveröffentlichte Daten). Eines der identifizierten Proteine ist CRMP1 (collapsin response mediator protein 1), das spezifisch in Neuronen exprimiert wird und möglicherweise eine wichtige Rolle bei der Pathogenese von HD spielt. Experimentelle Untersuchungen mithilfe eines Filter-Retardationsassays zeigten, dass CRMP1 die Anordnung von Htt zu fibrillären, SDS-unlöslichen Aggregaten verringert. Durch Rasterkraftmikroskopie wurde der direkte Effekt von CRMP1 auf den Aggregationsprozess von Htt bestätigt. Ko-Immunopräzipitationsstudien zeigten, dass CRMP1 und Htt in Säugerzellen unter physiologischen Bedingungen miteinander interagieren. Es wurde nachgewiesen, dass CRMP1 die Polyglutamin-abhängige Aggregation und Toxizität von Htt in Zell- und Drosophila-Modellen von HD moduliert. Außerdem konnte CRMP1 in neuronalen Ablagerungen in R6/2 Mäusegehirnen und dessen selektive Spaltung durch Calpaine gezeigt werden. Diese Ergebnisse deuten darauf hin, dass die Lokalisation und Funktion von CRMP1 bei der Krankheitsentstehung verändert werden. / Huntington’s disease (HD) is a neurodegenerative disorder characterized by the accumulation of N-terminal polyglutamine (polyQ)-containing huntingtin (Htt) fragments in affected neurons. The mutant Htt (mHtt) protein is ubiquitously expressed but causes specific dysfunction and death of striatal medium-sized spiny neurons (MSNs) (Albin, 1995). It is assumed that striatum specific proteins interacting with Htt might play an important role in HD pathogenesis (Ross, 1995). Previous protein-protein interaction (PPI) studies demonstrated that many Htt-interacting proteins colocalize with insoluble Htt inclusions in HD brains and modulate the mHtt phenotype (Goehler 2004). A striatum-specific, dysregulated PPI network has been created recently by integrating PPI networks with information from gene expression profiling data (Chaurasia, unpublished data). One of the identified dysregulated proteins potentially involved in HD pathogenesis was the neuron-specific collapsin response-mediator protein 1 (CRMP1). Here, I show that CRMP1 reduces the self-assembly of SDS-insoluble mHtt protein aggregates in vitro, indicating a direct role of CRMP1 on the mHtt aggregation process. Coimmunoprecipitation studies showed that CRMP1 and Htt associate in mammalian cells under physiological conditions. In addition, CRMP1 localizes to abnormal neuronal inclusions and efficiently modulates polyQ-mediated Htt aggregation and toxicity in cell and Drosophila models of HD. This suggests that dysfunction of the protein is crucial for disease pathogenesis. Finally, I observed that CRMP1 localizes to neuronal inclusions and is selectively cleaved by calpains in R6/2 mouse brains, indicating that its distribution and function are altered in pathogenesis. In conclusion, this study presents new findings on the function of CRMP1 and its role in the pathogenesis of HD. The protein interacts with Htt and modulates its aggregation and toxicity, in this way influencing the molecular course of the disease.

Der erste Teil dieser Arbeit beschreibt die Durchführung eines quantitativen Ansatzes zur Detektion von Protein-Protein-Interaktionen (PPI) mit einem Schwerpunkt für Proteine, die in vier häufigen neurodegenerativen Krankheiten eine Rolle spielen: die Alzheimer-, Parkinson- und Huntington-Krankheit, sowie die spinozerebelläre Ataxie Typ 1 (SCA1). Die Interaktionsstudie kombiniert die stabile Isotopen-Markierung von Aminosäuren in der Zellkultur mit der Affinitätsaufreinigung von Proteinen und hochauflösender Massenspektrometrie. Dieser Ansatz zielt darauf ab, systematisch die Interaktionspartner von gesunden und krankheitsassoziierten Proteinvarianten zu identifizieren und zu quantifizieren. Darüber hinaus wurde das quantitative Interaktionsverfahren genutzt, um zu prüfen ob PPI durch krankheitsassoziierte Mutationen beeinträchtigt werden. Neben der Validierung möglicher Nebeneffekte, sowie dem Vergleich mit Informationen über PPI aus der Literatur, wurde ein Teil der identifizierten Interaktoren durch zusätzliche Koimmunopräzipitations-Experimente in zwei verschiedenen Zelllinien bestätigt. Mit Hilfe von Drosophila SCA1-Krankheitsmodellen und in Kombination mit RNAi-basierter Stummschaltung identifizierter Interaktoren wurde festgestellt, dass ein großer Teil der Kandidaten Neurodegeneration in vivo beeinflusst. Zusätzlich wurden die Alzheimer-spezifischen PPI-Daten auf genomweite Assoziationsstudien übertragen. Bemerkenswerterweise waren Polymorphismen in einzelnen Nukleotiden in den Genen zugehöriger Interaktoren wahrscheinlicher mit solchen Genen assoziiert, die eine Prädisposition für die Alzheimer-Krankheit haben, als mit zufällig ausgewählten Genen. Schlussendlich konnten Folgeexperimente für zwei ausgewählte Interaktionspartner den Nachweis für eine bislang unbekannte Rolle der N-Glykosylierung und einen neuen Zusammenhang zwischen dem RNA-bindenden Protein LRPPRC und mitochondrialer Dysfunktion in der Alzheimer-Krankheit vorlegen. / The first part of the present thesis describes the establishment of a quantitative protein-protein interaction (PPI) screen with a focus on proteins involved in four common neurodegenerative diseases (NDDs): Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD) and spinocerebellar ataxia type 1 (SCA1). The interaction screen combines stable-isotope labeling by amino acids in cell culture (SILAC) with protein affinity purification and high-resolution mass spectrometry. This approach aims to systematically identify and quantify interaction partners of normal and known disease-associated variants of proteins involved in NDDs. Moreover, the quantitative interaction screen was employed to study how PPIs are affected by disease-associated mutations. Along with validation of possible off-target effects and comparison of the data with literature-reported PPIs, a subset of identified interactors was validated by additional co-immunoprecipitation experiments in two different cell lines. Utilizing Drosophila models for SCA1 in combination with RNAi-mediated silencing of identified interactors, a large fraction of candidates was observed to also affect neurodegeneration in vivo. In addition, AD-specific PPI data was mapped to patient cohort data obtained from genome-wide associations studies. Notably, single-nucleotide polymorphisms in the genes of interactors of the disease-associated protein variants were more likely associated with susceptibility to AD than randomly selected genes. Finally, functional follow-ups for two selected interaction partners provided evidence for a yet unreported role of N-linked glycosylation in AD, and a novel link to mitochondrial dysfunction in AD by means of the RNA-binding protein LRPPRC.