Les démences représentent un problème de santé public majeur, notamment du fait du vieillissement des populations occidentales. Pourtant, le diagnostic étiologique de certitude d'un syndrome démentiel ne peut être obtenu que par l'analyse neuropathologique et/ou biochimique du tissu cérébral obtenu en post mortem. Les lésions cérébrales aboutissant au déclin cognitif ont des origines diverses (neurodégénératives, vasculaires, métaboliques...) et sont souvent associées. En analysant les données cliniques, neuropathologiques et biochimique issues de la cohorte autopsiques de patients déments suivis au Centre Mémoire de Ressources et de recherche du CHRU de Lille (127 cerveaux prélevés entre 1992 et 2009), nous avons étudié les corrélations entre l'expression clinique du syndrome démentiel et la nature des lésions cérébrales sous jacentes. Nous montrons que les fréquentes associations lésionnelles (lésions de maladie d'Alzheimer, de maladie à corps de Lewy, lésions vasculaires) ont des conséquences sur la pertinence du diagnostic étiologique du syndrome démentiel. Dans le domaine des dégénérescences lobaires frontotemporales (DLFT), nous avons étudié les corrélations clinicopathologiques de 18 patients ayant présenté des troubles inauguraux du langage ou de la parole. Nous avons pu établir des corrélations entre les syndromes cliniques et certaines protéinopathies (tau, TDP-43) associées aux DLFT. L'enquête génétique a permis de mettre en évidence une nouvelle mutation du gène de la progranuline chez un patient. L'analyse pluridisciplinaire des démences permet au clinicien de progresser dans la prédiction des lésions cérébrales du vivant du patient. Cette démarche s'avère indispensable dans l'optique du développement de traitements curatifs des démences neurodégénératives.

L'objectiu general d'aquest treball és el d'aprofundir en l'estudi de les sinucleïnopaties, principalment a nivell bioquímic, en les interaccions de l'alfa-sinucleïna amb altres proteïnes del cervell humà per tal d'estudiar l'efecte de la unió en aquestes patologies. També hem volgut comprovar la similitud de les sinucleïnopaties humanes amb un model animal transgènic per a la forma humana mutada de l'alfa-sinucleïna. D'altra banda i també relacionat amb aquestes neurodegenarions, s'ha estudiat de quina manera resultaven afectats diferents marcadors de l'estrès oxidatiu, que se sap juga un important paper en el desenvolupament d'aquestes patologies. Mitjançant estudis d'immunoprecipitació i de pull-down en cervell humà s'ha trobat interacció de l'alfa-sinucleïna amb les proteïnes sinàptiques rab3a i rabfilina a córtex de la sinucleïnopatia anomenada Demència amb cossos de Lewy (DLBD), i no en cervells control. Donada la interacció anòmala amb aquestes proteïnes sinàptiques podem afirmar que a DLBDs la transmissió sinàptica es troba alterada, i una de les causes és la interacció anòmala de l'alfa-sinucleïna amb rab3a i rabfilina. Aquest tipus d'interacció també s'ha estudiat a l'MSA o Atròfia Sistèmica Múltiple, una sinucleïnopatia que té afectat sobretot el cerebel, i no el córtex, com les DLBDs. Doncs, tot i estar classificada com a sinucleïnopatia a part, hem observat la mateixa interacció anòmala tan a cerebel com escorça de pacients d'MSA, suggerint-se un mecanisme comú de neurodegeneració per a totes les sinucleïnopaties. Paral.lelament també hem estudiat la via de transducció glutamatèrgica a pacients amb DLBDs, i s'ha trobat que en condicions normals exiteix interacció de l'alfa-sinucleïna amb un efector del receptors metabotròpics del glutmat tipus I, com és la PLC-beta-1. Al mateix temps, i a través d'estudis de solubilitat, s'han observat canvis en la solubilitat de PLC-beta-1 en aquestes patologies, tal com succeeix amb l'alfa-sinucleïna.Quan s'han estudiat marcadors d'estrès oxidatiu per una forma primerenca de la malaltia de Parkinson s'han trobat alterats a córtex d'aquest pacients, quan la patología, en els primers estadis només es detecta fins ara a substància negra. Per tant, l'estrès oxidatiu a córtex d'una forma pre-clínica de la malaltia de Parkinson, ja té un paper en el desenvolupament d'estadis posterior de la malaltia, com podrien ser les DLBDs. / The aim of this work is to study alpha-synuclein interactions in human brain to deep on the knowledge of a group of neurodegenerative diseases called synucleinopathies in which alpha-synuclein accumulates in the form of Lewy bodies. In human cortex we found alpha-synuclein interactions with the synaptic proteins rab3a and rabphilin in Dementia with Lewy Bodies (DLBDs) patients, and not in control brains. This interaction is corroborated in transgenic mice expressing human A30P human mutated alpha-synuclein. When a different synucleipathy , like Multiple Systemic Atrophy (MSA), is studied we found the same anomalous interaction even different areas were affected, cerebellum vs cortex in the case of MSA and DLBDs, indicating a common neurodegenerative mechanism for the synucleinopathies group. Also in DLBDs we studied the glutamatergic signal transduction pathway immunoprecipitating alpha-synuclein from brain cortex and we found that PLC-beta-1, an effector of the metabotropic glutamate receptors (mGLuR1) binds to alpha-synuclein only in control conditions and not in DLBDs. At the same time PLC-beta-1 showed changes in solubility like alpha-synuclein in DLBDs. So, the results presented here indicate a kind of relation between alpha-synuclein and PLC-beta-1 in DLBDs which damage can affect the mGLuR1 transduction pathway which is altered in cortex from DLBDs.The other factor studied in this work is the oxidative stress effect in brain cortex from early stages Parkinson's disease (PD) patients. We found an increase of the oxidative stress markers used in this work indicating that oxidative stress in cortex from PD patients starts at early stages in human cortex, even though in early stages only the substantia nigra seems to be affected. This markers of oxidative stress were also studied in Alzheimer's disease (AD) obtaining similar results. Finally another point of this work is the study of the Amyloid Precursor Protein (A-beta-PP) mRNA isoforms in human cortex from DLBDs. We found a relative increase of the isoforms contained the Kunitz Protease Inhibitor, implicating A-beta-PP the isoforms processing in the developing of DLBDs

The molecular mechanisms underlying the association between mutations in GBA1 and risk of developing the ‘synucleinopathy’ disorders Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) remain elusive. To better understand the precise molecular cascade that connects GBA1 mutations with α-synuclein dysregulation, a modified lipid extraction and HPTLC protocol was optimized to detect changes in levels of neutral sphingolipids (SLs) from neural cells and tissue expressing wild-type (WT) GBA1, mutant GBA1, or both. We demonstrate that mutant GBA1 does not confer a dominant-negative effect on WT GBA1-mediated activity; however, bona fide loss-of-enzymatic function mutation events led to the accumulation of lipid substrates in neural cells and tissue, and enhance α- synuclein/ubiquitin reactivity in brain tissue of mutant gba1 mice. Our HPLC-MS/MS data are consistent with other studies demonstrating that heterozygous GBA1 mutations do not lead to lipid accumulation, but may alter α-synuclein degradation through a yet-to-be defined novel gain-of-toxic function event.

Little is known about the specific cognitive impairments that may be the cause of the reported increased crash rate in individuals with early dementia. Though, it is widely accepted that attention, visuospatial and perceptual abilities are central in being able to operate a vehicle safely. This study had three objectives. The first was to clarify the neuropsychological profile, with an emphasis on attention, visuospatial and perceptual abilities, of individuals with early dementia with Lewy bodies (DLB), the next was to examine the driving performances of two groups of individuals with early dementia (i.e., early Alzheimer’s disease, AD, and early DLB) and the last was to examine the degree of association between neuropsychological impairments and driving impairments in hopes of predicting poor driving outcomes. Fifty-six participants were recruited from three groups; 20 individuals diagnosed with early AD, 15 individuals diagnosed with early DLB and 21 healthy age-matched controls. All participants were administered the following neuropsychological tests: the Mini-Mental Status Exam (MMSE), the Dementia Rating Scale (DRS-2), the Boston Naming Test (BNT), the Test of Everyday Attention (TEA), the Visual Object and Space Perception Test (VOSP) and the Useful Field of View (UFOV). Additionally, a simulated driving task was completed, with data being collected through primary measures recorded by the simulator as well as an experimenter based driving assessment using a demerit-point test. Results indicated that individuals with early DLB were found to be most impaired in their visuospatial abilities, selective and divided attention abilities, and were found to have significant cognitive fluctuations. Driving performances confirmed that drivers with early dementia were at greater risk for motor vehicle collisions (MVC) and they were found to commit a significant number of driving errors during the driving simulation. Finally, this study was able to demonstrate that in drivers with early AD, attentional impairments were the strongest predictors of driving impairment, whereas in drivers with early DLB, visuospatial impairments were indicative of driving impairment.

Parkinson’s disease is a neurodegenerative disease resulting primarily from loss of dopaminergic innervation in the striatum subsequent to cell loss in the substantia nigra pars compacta. The abnormal accumulation of the normal pre-synaptic protein α-synuclein (αsyn) forms intraneuronal inclusions known as Lewy neurites and Lewy bodies. The origins of central Lewy pathology have been suggested to lie in the enteric nervous system, ascending through the vagus nerve to the dorsal motor nucleus of the vagus. To ascertain gastrointestinal regions most likely to be the source of central Lewy pathology, αsyn expression was evaluated in the neural elements of gastrointestinal regions receiving the densest vagal innervation. The vermiform appendix was found to have the densest αsyn-immunoreactive innervation in all layers of the gut wall. In addition, macrophages in the appendiceal mucosa were laden with αsyn within lysosomes, consistent with attempts to prevent the spread of disease or to correct synaptic dysfunction.

Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy are disorders featuring accumulation of Lewy bodies in brain. The main component of these large insoluble intracellular inclusions is the presynaptic protein alpha-synuclein (α-synuclein). It is generally believed that α-synuclein monomers adopt an abnormal conformation that favors the formation of soluble oligomers or protofibrils and, eventually, insoluble fibrils depositing as Lewy bodies. Notably, the intermediately sized oligomers/protofibrils seem to have particular neurotoxic effects. Several factors may influence the formation of α-synuclein oligomers/protofibrils, e.g. the reactive aldehydes 4-hydroxy-2-nonenal (HNE) and 4-oxo-2-nonenal (ONE) formed during oxidative stress. The overall aims of this thesis were to investigate biophysical and biochemical properties of in vitro generated α-synuclein oligomers, characterize their functional effects on cell and animal disease models as well as to explore whether their formation could be prevented in a cell culture model for oligomerization.  Here, it was found that α-synuclein rapidly formed oligomers after incubation with both ONE and HNE. The resulting oligomers were stable and did not continue to form insoluble fibrils. By comparing HNE- and ONE induced α-synuclein oligomers biochemically they were both found to exhibit extensive β-beta sheet structure and had a molecular size of ~2000 kDa. However, they differed in morphology; the ONE induced α-synuclein oligomers described round amorphous species whereas the HNE induced α-synuclein oligomers appeared as elongated protofibril-like structures. Both these oligomers were cell internalized to varying degrees and induced toxicity in neuroblastoma cells. In addition, the ONE induced α-synuclein oligomers seemed to initiate aggregation of monomeric α-synuclein in vitro, but failed to do so in vivo. Finally, treatment of α-synuclein overexpressing cells with monoclonal antibodies specific for α-synuclein significantly reduced aggregation and lowered levels of the protein, suggesting increased turnover in these cells.  To conclude, this thesis has characterized different oligomeric α-synuclein species, which may have properties similar to soluble species central to the pathogenesis of Parkinson’s disease and other disorders with α-synuclein pathology. For therapeutic strategies it is important to selectively target such harmful protein species and avoid interaction with other forms of α-synuclein, which may have vital physiological cellular functions.

The molecular mechanisms underlying the association between mutations in GBA1 and risk of developing the ‘synucleinopathy’ disorders Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) remain elusive. To better understand the precise molecular cascade that connects GBA1 mutations with α-synuclein dysregulation, a modified lipid extraction and HPTLC protocol was optimized to detect changes in levels of neutral sphingolipids (SLs) from neural cells and tissue expressing wild-type (WT) GBA1, mutant GBA1, or both. We demonstrate that mutant GBA1 does not confer a dominant-negative effect on WT GBA1-mediated activity; however, bona fide loss-of-enzymatic function mutation events led to the accumulation of lipid substrates in neural cells and tissue, and enhance α- synuclein/ubiquitin reactivity in brain tissue of mutant gba1 mice. Our HPLC-MS/MS data are consistent with other studies demonstrating that heterozygous GBA1 mutations do not lead to lipid accumulation, but may alter α-synuclein degradation through a yet-to-be defined novel gain-of-toxic function event.

Little is known about the specific cognitive impairments that may be the cause of the reported increased crash rate in individuals with early dementia. Though, it is widely accepted that attention, visuospatial and perceptual abilities are central in being able to operate a vehicle safely. This study had three objectives. The first was to clarify the neuropsychological profile, with an emphasis on attention, visuospatial and perceptual abilities, of individuals with early dementia with Lewy bodies (DLB), the next was to examine the driving performances of two groups of individuals with early dementia (i.e., early Alzheimer’s disease, AD, and early DLB) and the last was to examine the degree of association between neuropsychological impairments and driving impairments in hopes of predicting poor driving outcomes. Fifty-six participants were recruited from three groups; 20 individuals diagnosed with early AD, 15 individuals diagnosed with early DLB and 21 healthy age-matched controls. All participants were administered the following neuropsychological tests: the Mini-Mental Status Exam (MMSE), the Dementia Rating Scale (DRS-2), the Boston Naming Test (BNT), the Test of Everyday Attention (TEA), the Visual Object and Space Perception Test (VOSP) and the Useful Field of View (UFOV). Additionally, a simulated driving task was completed, with data being collected through primary measures recorded by the simulator as well as an experimenter based driving assessment using a demerit-point test. Results indicated that individuals with early DLB were found to be most impaired in their visuospatial abilities, selective and divided attention abilities, and were found to have significant cognitive fluctuations. Driving performances confirmed that drivers with early dementia were at greater risk for motor vehicle collisions (MVC) and they were found to commit a significant number of driving errors during the driving simulation. Finally, this study was able to demonstrate that in drivers with early AD, attentional impairments were the strongest predictors of driving impairment, whereas in drivers with early DLB, visuospatial impairments were indicative of driving impairment.

Parkinson’s disease is a neurodegenerative disease resulting primarily from loss of dopaminergic innervation in the striatum subsequent to cell loss in the substantia nigra pars compacta. The abnormal accumulation of the normal pre-synaptic protein α-synuclein (αsyn) forms intraneuronal inclusions known as Lewy neurites and Lewy bodies. The origins of central Lewy pathology have been suggested to lie in the enteric nervous system, ascending through the vagus nerve to the dorsal motor nucleus of the vagus. To ascertain gastrointestinal regions most likely to be the source of central Lewy pathology, αsyn expression was evaluated in the neural elements of gastrointestinal regions receiving the densest vagal innervation. The vermiform appendix was found to have the densest αsyn-immunoreactive innervation in all layers of the gut wall. In addition, macrophages in the appendiceal mucosa were laden with αsyn within lysosomes, consistent with attempts to prevent the spread of disease or to correct synaptic dysfunction.

No description available.