A miosite por corpos de inclusão (inclusion body myositis - IBM), na sua forma esporádica, é considerada a miopatia adquirida mais comum após os 50 anos de idade. Embora seja incluída no grupo das miopatias inflamatórias, estudos recentes mostram um processo particular de degeneração muscular caracterizado por deposição anormal de agregados de proteínas nas fibras musculares e funcionamento anormal dos principais sistemas de degradação proteica. O objetivo deste estudo foi o de avaliar os aspectos clínicos, histológicos e imunoistoquímicos de pacientes com IBM. Avaliamos 18 casos com diagnóstico de IBM de dois dos principais centros de doenças neuromusculares do Brasil (25 biópsias musculares). Na tentativa de diferenciar os casos de IBM das outras miopatias inflamatórias, determinamos o padrão de expressão tecidual da p-tau (p62), alfa-sinucleína e TDP-43. Também foi avaliada a função lisossomal através da reação da fosfatase ácida (marcação da atividade lisossomal global) e determinação da marcação para LC3B (marcador de autofagia). Foi observado que a IBM predominou no sexo masculino (61% dos casos), da cor branca, com início das manifestações clínicas ao redor dos 59 anos de idade e os sintomas mais frequentes foram fraqueza muscular, instabilidade postural com quedas da própria altura, disfagia e perda ponderal, podendo ainda apresentar dispneia. O diagnóstico demorou em média 7,4 anos após o início dos sintomas e frequentemente esteve associada às seguintes comorbidades: hipertensão arterial sistêmica, diabetes mellitus tipo 2, osteopenia / osteoporose, dislipidemia e hiperuricemia / gota. O padrão de comprometimento muscular na IBM foi caracterizado por tetraparesia de predomínio proximal em membros inferiores e distal em membros superiores. Os valores séricos da creatinofosfoquinase em pelo menos uma das medições foram elevados em todos os pacientes, porém sem ultrapassar 10 vezes o limite superior da normalidade. O uso de imunossupressão não se mostrou eficaz nos pacientes com IBM. Os achados histológicos na IBM incluíram alterações distróficas variáveis com a presença de inflamação endomisial, assim como a ocorrência de vacúolos marginados, além da elevada frequência de alterações mitocondriais. Outros achados histológicos musculares característicos na IBM foram o aumento da atividade lisossomal (aumento global da marcação para fosfatase ácida), a presença de marcação positiva para beta-amilóide (marcação intra-vacuolar pelo vermelho-Congo), o aumento na degradação muscular (relacionada com ativação de LC3B, p-tau, e p62/SQSTM1) e a degeneração muscular (marcação para anti-phospo TDP-43 e para ?-sinucleína). Tais alterações apresentaram alta sensibilidade e especificidade. Sugerimos que a redução do critério de idade do início dos sintomas de mais de 45 anos para mais de 35 anos aumentaria a sensibilidade diagnóstica para os casos com IBM deste estudo de 83% para 100%. Com este estudo, foi possível caracterizar clínica e histológicamente pacientes com IBM em nosso meio, e fornecer indícios do benefício do uso de marcadores de degeneração e autofagia para o diagnóstico e para a determinação de vias ou sistemas celulares envolvidos na patogênese da doença / Sporadic inclusion body myositis (sIBM) is considered the most common acquired myopathy affecting adults aged over 50 years. Although included in the group of inflammatory myopathies, recent studies show a particular process of muscle degeneration characterized by abnormal deposit of protein aggregates in muscle fibers and abnormal operation of the main protein degradation systems. The aim of this study was to evaluate the clinical, histological and immunohistochemical patients with IBM. We evaluated 18 cases with IBM diagnostic of two of the main centers of neuromuscular diseases in Brazil (25 muscle biopsies). In an attempt to differentiate the IBM cases of other inflammatory myopathies, we determined the pattern of tissue expression of p-tau (p62), alfa-synuclein and TDP-43. Also evaluated the lysosomal function by acid phosphatase reaction (marking global lysosomal activity) and determining the markup for LC3B (autophagy marker). It was observed that IBM was predominant in males (61% of cases), white colored, with onset of clinical manifestations around 59 years old and the most common symptoms are muscle weakness, postural instability with high falls, dysphagia and weight loss, and may also present dyspnea. The diagnosis took an average of 7.4 years after the onset of symptoms and was often associated with the following comorbidities: hypertension, type 2 diabetes mellitus, osteopenia / osteoporosis, dyslipidemia and hyperuricemia / gout. The muscular damage pattern at IBM was characterized by tetraparesis predominantly proximal lower limbs and distal upper limbs. Serum creatine kinase levels in at least one of the measurements were elevated in all patients, but not exceeding 10 times normal. Immunosuppression was not effective in patients with IBM. The IBM histological findings included diversify dystrophic changes, endomysial inflammation, as well as the occurrence of rimmed vacuoles, in addition to high frequency of mitochondrial changes. Other characteristic muscle histological findings in IBM were increased lysosomal activity (overall increase in labeling for acid phosphatase), the presence of positive staining for beta-amyloid (intra-vacuolar by Congo red marking), increased muscle degradation (related to activation of LC3B, p-tau and p62 / SQSTM1) and muscle degeneration (marking for anti-phospo TDP-43 and ?-synuclein). Such changes have a high sensitivity and specificity. which makes these important complementary analyzes for accurate pathological diagnosis. We suggest that lowering the age of the onset of symptoms of greater than 45 years to older than 35 years would increase the diagnostic sensitivity for cases with IBM this study from 83% to 100%. With this study, it was possible to characterize clinically and histologically the patients with IBM in our centers, and provide evidence of the benefit of using degeneration and autophagy markers for diagnosis and for determining pathways or cellular systems involved in the pathogenesis of the disease

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In recent years, mass spectrometry (MS) become the dominant technology in lipidomic analysis and widely influenced research and diagnosis of diseases of lipid metabolism, e.g. lysosomal storage disorders (LSD) characterized by impairment of the lysosomal functions. Defects in lysosomal processing of sphingolipids SFL belong to the category of sphingolipidoses. This condition has severe and even fatal clinical outcome. The primary aim of this work was to establish quantitative and qualitative methods of SFL analysis useful for research and diagnosis of LSD. At first, semisynthesis of mass labeled lipid standards utilizing immobilized sphingolipid ceramide N-deacylase was performed. Established methods of quantitative analysis were then used to prove the increased excretion of urinary SFL in LSD with characteristic storage in the kidney. Determination of excreted urinary SFL was found useful for differential diagnosis of prosaposin and saposin B deficiences for which routine enzymology is failing. MS also enabled monitoring of individual molecular species (isoforms) of SFL, which led to the finding that their urinary pattern is changing in some LSD. This resulted in the development of new screening method in dry urinary samples based on isoform profile evaluation. Another MS application referred to...

Pathogenesis of mucopolysaccharidosis type IIIC (MPS IIIC) and Gaucher disease has not been yet fully clarified, and the causes of phenotypical variability between the patients with the same genotype in Gaucher disease remain obscure. Because the variants in the regulatory regions of genes can cause phenotypical differences mentioned above, I have studied promoter regions of HGSNAT and GBA genes mutated in these lysosomal disorders. I have shown that there is an alternative promoter of GBA (P2). Additional studies were aimed to elucidate possible physiological functions of P2, and its possible role in the pathogenesis of Gaucher disease. I have found that P2 is not tissue specific, and that its variants do not influence the variability of phenotype in Gaucher patients with the same genotype. P2 is used differentially neither during the differentiation of monocytes to macrophages nor in macrophages from controls and Gaucher patients, in whom there is a prominent storage only in cells of macrophage origin. We have thus not found any changes that would suggest a role for P2 in the pathogenesis of Gaucher disease. I have characterized the promoter region of HGSNAT and shown that the binding of Sp1 transcription factor is important for its expression. Sequence variants found in HGSNAT promoter in...

A miosite por corpos de inclusão (inclusion body myositis - IBM), na sua forma esporádica, é considerada a miopatia adquirida mais comum após os 50 anos de idade. Embora seja incluída no grupo das miopatias inflamatórias, estudos recentes mostram um processo particular de degeneração muscular caracterizado por deposição anormal de agregados de proteínas nas fibras musculares e funcionamento anormal dos principais sistemas de degradação proteica. O objetivo deste estudo foi o de avaliar os aspectos clínicos, histológicos e imunoistoquímicos de pacientes com IBM. Avaliamos 18 casos com diagnóstico de IBM de dois dos principais centros de doenças neuromusculares do Brasil (25 biópsias musculares). Na tentativa de diferenciar os casos de IBM das outras miopatias inflamatórias, determinamos o padrão de expressão tecidual da p-tau (p62), alfa-sinucleína e TDP-43. Também foi avaliada a função lisossomal através da reação da fosfatase ácida (marcação da atividade lisossomal global) e determinação da marcação para LC3B (marcador de autofagia). Foi observado que a IBM predominou no sexo masculino (61% dos casos), da cor branca, com início das manifestações clínicas ao redor dos 59 anos de idade e os sintomas mais frequentes foram fraqueza muscular, instabilidade postural com quedas da própria altura, disfagia e perda ponderal, podendo ainda apresentar dispneia. O diagnóstico demorou em média 7,4 anos após o início dos sintomas e frequentemente esteve associada às seguintes comorbidades: hipertensão arterial sistêmica, diabetes mellitus tipo 2, osteopenia / osteoporose, dislipidemia e hiperuricemia / gota. O padrão de comprometimento muscular na IBM foi caracterizado por tetraparesia de predomínio proximal em membros inferiores e distal em membros superiores. Os valores séricos da creatinofosfoquinase em pelo menos uma das medições foram elevados em todos os pacientes, porém sem ultrapassar 10 vezes o limite superior da normalidade. O uso de imunossupressão não se mostrou eficaz nos pacientes com IBM. Os achados histológicos na IBM incluíram alterações distróficas variáveis com a presença de inflamação endomisial, assim como a ocorrência de vacúolos marginados, além da elevada frequência de alterações mitocondriais. Outros achados histológicos musculares característicos na IBM foram o aumento da atividade lisossomal (aumento global da marcação para fosfatase ácida), a presença de marcação positiva para beta-amilóide (marcação intra-vacuolar pelo vermelho-Congo), o aumento na degradação muscular (relacionada com ativação de LC3B, p-tau, e p62/SQSTM1) e a degeneração muscular (marcação para anti-phospo TDP-43 e para ?-sinucleína). Tais alterações apresentaram alta sensibilidade e especificidade. Sugerimos que a redução do critério de idade do início dos sintomas de mais de 45 anos para mais de 35 anos aumentaria a sensibilidade diagnóstica para os casos com IBM deste estudo de 83% para 100%. Com este estudo, foi possível caracterizar clínica e histológicamente pacientes com IBM em nosso meio, e fornecer indícios do benefício do uso de marcadores de degeneração e autofagia para o diagnóstico e para a determinação de vias ou sistemas celulares envolvidos na patogênese da doença / Sporadic inclusion body myositis (sIBM) is considered the most common acquired myopathy affecting adults aged over 50 years. Although included in the group of inflammatory myopathies, recent studies show a particular process of muscle degeneration characterized by abnormal deposit of protein aggregates in muscle fibers and abnormal operation of the main protein degradation systems. The aim of this study was to evaluate the clinical, histological and immunohistochemical patients with IBM. We evaluated 18 cases with IBM diagnostic of two of the main centers of neuromuscular diseases in Brazil (25 muscle biopsies). In an attempt to differentiate the IBM cases of other inflammatory myopathies, we determined the pattern of tissue expression of p-tau (p62), alfa-synuclein and TDP-43. Also evaluated the lysosomal function by acid phosphatase reaction (marking global lysosomal activity) and determining the markup for LC3B (autophagy marker). It was observed that IBM was predominant in males (61% of cases), white colored, with onset of clinical manifestations around 59 years old and the most common symptoms are muscle weakness, postural instability with high falls, dysphagia and weight loss, and may also present dyspnea. The diagnosis took an average of 7.4 years after the onset of symptoms and was often associated with the following comorbidities: hypertension, type 2 diabetes mellitus, osteopenia / osteoporosis, dyslipidemia and hyperuricemia / gout. The muscular damage pattern at IBM was characterized by tetraparesis predominantly proximal lower limbs and distal upper limbs. Serum creatine kinase levels in at least one of the measurements were elevated in all patients, but not exceeding 10 times normal. Immunosuppression was not effective in patients with IBM. The IBM histological findings included diversify dystrophic changes, endomysial inflammation, as well as the occurrence of rimmed vacuoles, in addition to high frequency of mitochondrial changes. Other characteristic muscle histological findings in IBM were increased lysosomal activity (overall increase in labeling for acid phosphatase), the presence of positive staining for beta-amyloid (intra-vacuolar by Congo red marking), increased muscle degradation (related to activation of LC3B, p-tau and p62 / SQSTM1) and muscle degeneration (marking for anti-phospo TDP-43 and ?-synuclein). Such changes have a high sensitivity and specificity. which makes these important complementary analyzes for accurate pathological diagnosis. We suggest that lowering the age of the onset of symptoms of greater than 45 years to older than 35 years would increase the diagnostic sensitivity for cases with IBM this study from 83% to 100%. With this study, it was possible to characterize clinically and histologically the patients with IBM in our centers, and provide evidence of the benefit of using degeneration and autophagy markers for diagnosis and for determining pathways or cellular systems involved in the pathogenesis of the disease

Alzheimers sjukdom är den vanligaste orsaken till demens och i samband med att befolkningen blir större och allt äldre ökar även antalet patienter. Vid sjukdomen sker en hjärnatrofi och de mikroskopiska fynd man ser är extracellulära plack av β-amyloid, intracellulära neurofibriller av fosforylerat tau och förlust av nervcellsutskott, axoner, synapser och dendriter. Några av de tidiga patologiska förändringarna man kan se är störningar i nervcellernas lysosomala system som fyller en viktig roll vid nedbrytning av makromolekyler. I en tidigare studie har man påvisat förhöjda nivåer av proteiner från det lysosomala systemet i cerebrospinalvätska. Syftet med den här studien var att mäta nivåer av det lysosomala systemets proteiner i human hjärnvävnad från patienter med Alzheimer och jämföra dessa med kontrollprover. De sex proteiner som analyserades med Western blot var EEA1, PICALM, LAMP-1, LAMP-2, LC3 och TFEB. Resultaten visar på signifikant ökning i temporala cortex av LAMP-1 och LAMP-2 och en signifikant minskning av LC3 och EEA1 hos patienter med Alzheimers sjukdom. För att kunna dra riktiga slutsatser kring hur de ökade nivåerna i cerebrospinalvätska speglar de olika sjukdomsmekanismerna i hjärnan krävs vidare analyser av fler patientprover samt prover från andra områden i hjärnan. / Alzheimer's disease is the most common cause of dementia, and when the population becomes larger and older also the number of patients increase. A cerebral atrophy and microscopic findings of extracellular plaques of β-amyloid, intracellular neurofibrillary of phosphorylated tau and loss of nerve cell protrusions, axons, synapses and dendrites are seen during the disease. One of the early pathological changes is the disruption of the neuronal lysosomal network that plays an important role in the degradation of macromolecules. In a previous study elevated levels of proteins of the lysosomal network in cerebrospinal fluid from Alzheimer’s disease patients was demonstrated. The purpose of this study was to measure levels of the lysosomal network system in the brain. The six proteins EEA1, PICALM, LAMP-1, LAMP -2, LC3 and TFEB were analyzed in human brain tissue from five Alzheimer's disease cases and five control cases by Western blot. The results show a significant increase in the temporal cortex of LAMP-1 and LAMP -2 and a significant decrease of LC3 and EEA1 in patients with Alzheimer's disease. In order to draw proper conclusions about how the increased levels in cerebrospinal fluid reflect the different disease mechanisms in the brain it requires further analysis of more patient samples and from other areas of the brain.

L’accumulation cérébrale progressive de peptides amyloïdes générés à partir du clivage du précurseur du peptide amyloïde (APP) par les sécrétases est un mécanisme central de la maladie d’Alzheimer. C’est pourquoi, améliorer la compréhension de la régulation et de l’homéostasie du métabolisme de l’APP est devenu primordial. Partant de ce constat, nous avons supposé qu’une partie de la réponse pourrait être apportée par la caractérisation de nouveaux acteurs du métabolisme de l’APP. De part leurs rôles cruciaux dans le cerveau (développement, plasticité et réparations) et dans le métabolisme de l’APP (α-sécrétases), les ADAMs sont des protéines d’intérêt dont certaines fonctions ou rôles restent à déterminer. Précédemment, par une approche transcriptomique ciblant la famille des ADAMs dans des cerveaux de patients et de contrôles, ADAM30 a été retrouvée sous-exprimée dans le cerveau des patients atteints de la pathologie. Dans deux modèles cellulaires nous avions constaté que la sous-expression d’ADAM30 entraînait une augmentation de tous les produits du métabolisme de l’APP comme chez les patients. Le résultat opposé a été obtenu lors de la sur-expression d’ADAM30 dans ces cellules. Pour tenter de répliquer ces résultats dans un modèle plus proche de la physiopathologie humaine, nous avons développé un modèle de souris triples transgéniques surexprimant l’APPSweInd et ADAM30 de manière conditionnelle. Dans ce modèle nous avons observé et mesuré une diminution des dépôts amyloïdes dans le cerveau des souris exprimant ADAM30. Dans un second temps puisqu’il avait été montré au laboratoire qu’ADAM30 ne module pas l’activité des sécrétases et ne clive pas directement l’APP, nous avons cherché à déterminer les substrats d’ADAM30 dans le cadre du métabolisme de l’APP. Par une approche systématique nous avons pu déterminer que la Cathepsine D (CTSD) et l’Insuline Receptor Substrat 4 (IRS4) sont deux substrats potentiels d’ADAM30. Dans nos modèles cellulaires et de souris, nous avons pu constater qu’ADAM30 est capable de cliver et d’activer la CTSD. L’activité de la CTSD semble nécessaire pour l’action d’ADAM30 sur le métabolisme de l’APP. Nous avons pu déterminer que l’action spécifique d’ADAM30 pour la CTSD est dépendante de la séquence d’adressage au lysosome située dans l’extrémité C-terminale de l’APP. Comme la CTSD est une protéine Lysosomale, ADAM30 pourrait favoriser spécifiquement l’activation de la CTSD augmentant ainsi la dégradation de l’APP au sein de la voie endosome/lysosome. Ce mécanisme limiterait l’entrée de l’APP dans son métabolisme et donc la production de peptides amyloïdes. Afin de mieux comprendre la spécificité d’action d’ADAM30 pour la CTSD et l’APP, nous avons commencé à travailler sur le rôle potentiel d’IRS4 et la relation entre la voie de signalisation de l’Insuline et le métabolisme de l’APP. Nos travaux nous ont donc permis de mettre en évidence un nouvel acteur du métabolisme de l’APP, ADAM30, intervenant dans la régulation et la dégradation de ce dernier et ainsi d’améliorer notre compréhension des mécanismes de régulations fins impliqués dans le processus physiopathologique de la maladie d’Alzheimer. / Progressive intra-cerebral accumulation of amyloid peptides formed after sequential cleavage of the amyloid peptide precursor (APP) by secretases , is a central mecanism for Alzheimer’s disease. Therefore, a better understanding of APP regulation and homeostasy is now crucial. With this background, we postulate that the characterization of new actors in the APP metabolism could provide a more subtle understanding of this APP metabolism and trafficking. From their obvious implication in brain (development, plasticity and repair) and in APP metabolism (α-secretases), ADAMs (A Disintegrin And Metalloprotease) are an important protein proteins family which still have some undetermined function or role. Previously, a transcriptomic approach targeting ADAMs family bas been done at the laboratory on Alzheimer’s patient or control brains and found ADAM30 as under-expressed in Alzheimer’s patient brains. On cellular models, we confirmed that ADAM30 under-expression was associate with an increase in production/secretion of all the APP metabolim byproducts. Opposite results were found with ADAM30 over-expression. To replicate those results in another model closest to human pathophysiology, we have developed a triple transgenic mice model over-expressing APPSweInd and conditionally over-expressing ADAM30. In this model, we have observed and measured a decrease in amyloid deposits in mice brains over-expressing ADAM30. Secondly, because ADAM30 did not modulate secretase activities and did not cleave APP directly, we decided to determine ADAM30 substrats in the APP metabolism context. With a systematic approach, we have determined that Cathepsin D (CTSD) and Insulin Receptor Substrat 4 (IRS4) are two ADAM30 potential substrats. In our cellular models, we have found that ADAM30 is able to cleave and activate CTSD. This CTSD activity is required for ADAM30 action on APP metabolism. We have determined that ADAM30 specific action for CTSD is dependent on lysosome adressing sequence localised in APP C-terminal part. CTSD is a lysosomal protein and so ADAM30 would make CTSD specific activation easier. This mecanism would be able to increase APP degradation in endosome/lysosome pathway and reduce APP entry in its metabolism. To better understand ADAM30 specific action on CTSD and APP, we begin to investigate the potential role of IRS4 and the relation between insulin signaling pathway ans APP metabolism. Combined together, those data suggest that ADAM30 is a new APP metabolism actor, involved in an early APP regulation and degradation pathway dependent on lysosome activation. This study participate in a better understanding of the fine mecanism regulations involved in Alzheimer’s disease pathophysiological process.

Pathogenesis of mucopolysaccharidosis type IIIC (MPS IIIC) and Gaucher disease has not been yet fully clarified, and the causes of phenotypical variability between the patients with the same genotype in Gaucher disease remain obscure. Because the variants in the regulatory regions of genes can cause phenotypical differences mentioned above, I have studied promoter regions of HGSNAT and GBA genes mutated in these lysosomal disorders. I have shown that there is an alternative promoter of GBA (P2). Additional studies were aimed to elucidate possible physiological functions of P2, and its possible role in the pathogenesis of Gaucher disease. I have found that P2 is not tissue specific, and that its variants do not influence the variability of phenotype in Gaucher patients with the same genotype. P2 is used differentially neither during the differentiation of monocytes to macrophages nor in macrophages from controls and Gaucher patients, in whom there is a prominent storage only in cells of macrophage origin. We have thus not found any changes that would suggest a role for P2 in the pathogenesis of Gaucher disease. I have characterized the promoter region of HGSNAT and shown that the binding of Sp1 transcription factor is important for its expression. Sequence variants found in HGSNAT promoter in...

No description available.