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No description available.

Although the management of Motor Neuron Disease (MND) remains devoid of a cure, persons affected by this devastating condition are nonetheless entitled to the best quality care that is available. A paucity of information exists documenting the perceptions of healthcare consumers regarding the management that is provided. In addition optimal healthcare comprises an intricate interaction of patient-centred care, patient-centred communication, and bioethical practice, and when these three dimensions are implemented according to acceptable standards, high-quality healthcare is perceived by the healthcare consumer. Given however the socio-political challenges that face healthcare systems, the management of MND needs to be considered against current trends in service delivery and the need for evidence-based medicine. An exploratory study was therefore conducted to investigate the perceptions of persons with MND and their family members regarding current medical and rehabilitative management. The sample comprised six persons with MND who presented with a communication impairment, as well as six family members. Participants’ perceptions were elicited through the use of a semi-structured interview schedule, and questions focused on healthcare professionals’ behaviours during healthcare encounters. In addition emphasis was placed on the potential of the communication impairment to influence management. A standardised dysarthria assessment was conducted to characterise the nature of the speech impairment in each person with MND. Qualitative responses obtained from the interviews were analysed in accordance with a matrix-based approach, while quantitative data from the dysarthria assessment were analysed using descriptive statistics. Despite individual variability, perceptions of both persons with MND and their family members revealed general dissatisfaction with regard to medical and rehabilitative management. The majority of persons with MND were not referred for intervention following diagnosis, and the recommended team approach for the management of MND was absent. In addition the bioethical practice of many healthcare professionals was deemed questionable, and the communication impairment was perceived to impose a significant burden on the healthcare encounter. Furthermore all participants perceived a lack of available support systems for persons with MND, and it was thus not uncommon for individuals to pursue complementary and alternative medicine. South Africa’s current healthcare climate also appeared to further limit healthcare for this clinical population. In an attempt to improve the management of MND, implications are provided in terms of health communication, intervention, bioethical practice, and support systems. A proposed new framework of ideal service delivery for healthcare consumers of MND management is also presented. Further implications are outlined with regard to the need for innovative models of service delivery in South Africa’s healthcare context, as well as the role of speech-language pathologists, other healthcare professionals, policy makers, and educators in the improvement of the medical and rehabilitative management of MND. Finally theoretical implications and implications for future research are also documented.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

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Yes / Motor neuron disease (MND) is a progressive neurodegenerative disease with no effective treatment. One of the principal pathological hallmarks is the deposition of TAR DNA binding protein 43 (TDP-43) in cytoplasmic inclusions. TDP-43 aggregation occurs in both familial and sporadic MND; however, the mechanism of endogenous TDP-43 aggregation in disease is incompletely understood. This study focused on the induction of cytoplasmic accumulation of endogenous TDP-43 in the motor neuronal cell line NSC-34. The endoplasmic reticulum (ER) stressor tunicamycin induced casein kinase 1 (CK1)-dependent cytoplasmic accumulation of endogenous TDP-43 in differentiated NSC-34 cells, as seen by immunocytochemistry. Immunoblotting showed that induction of ER stress had no effect on abundance of TDP-43 or phosphorylated TDP-43 in the NP-40/RIPA soluble fraction. However, there were significant increases in abundance of TDP-43 and phosphorylated TDP-43 in the NP-40/RIPA-insoluble, urea-soluble fraction, including high molecular weight species. In all cases, these increases were lowered by CK1 inhibition. Thus ER stress signalling, as induced by tunicamycin, causes CK1-dependent phosphorylation of TDP-43 and its consequent cytosolic accumulation. / Funded by a biomedical research grant from the Motor Neurone Disease Association (ref Rattray/Apr15/837-791). The Bioimaging Facility microscopes used in this study were purchased with grants from BBSRC, Wellcome Trust and the University of Manchester Strategic Fund.

Spinal Muscular Atrophy (SMA) is an autosomal recessive neurodegenerative disease, which, before the approval of therapies, was the leading genetic cause of infant mortality. The primary features of this pathology are progressive muscle weakness and atrophy, due to the degeneration of α-motor neurons in the anterior horn of the spinal cord. SMA is caused by deletions or mutations in the Survival Motor Neuron gene (Smn1), which induce reduced levels of the SMN protein. Since 1999, this disease has been primarily associated with splicing defects caused by loss of SMN protein due to its role in ribonucleoparticle biogenesis. However, further research revealed that this mechanism alone is not sufficient to explain the pathogenesis of the disease. More recent findings revealed that deficient SMN levels lead to defective translation in primary motor and cortical neurons, and in multiple tissues at the late stage of disease in the severe Taiwanese mouse model of SMA. Furthermore, SMN protein has been confirmed to be a ribosome-associated protein in vitro, in mouse cell lines and in vivo, and to physiologically regulate the translation of a particular subset of transcripts (defined as SMN-specific transcripts), which are characterized by specific sequence features. Upon SMN loss, the translation of this subset of transcripts is defective. SMN protein is ubiquitously expressed and its levels vary at different developmental stages and tissues in physiological conditions, leading to the hypothesis that translational defects may vary accordingly. However, the effect of SMN loss on translation across different tissue types, SMA mouse models, and disease stages is yet to be clarified. To investigate the link between SMN loss and translational defects in SMA, I took advantage of ribosome profiling to obtain the translatome from multiple tissues, stages and disease mouse models. Given that SMN is ubiquitously expressed, brain, spinal cord and liver were collected to investigate if common features underly translational defects upon its loss in these tissues. Since little is known about how translational impairments are modulated over time, tissues were collected from various developmental and disease stages, ranging from the embryo to the post-natal early-symptomatic stage of SMA. Furthermore, translation defects were studied in multiple models of SMA have ranging from severe to mild (i.e., Taiwanese, Delta7 and Smn2b/-), allowing for the exploration of the heterogeneity of the SMA clinical phenotype. Hence, the tissues were collected from three SMA mouse models (i.e., Taiwanese, Delta7, and Smn2b/-), allowing for the investigation of translational impairments in conditions that range from severe to mild SMA. A wide range of computational approaches was adopted to analyze ribosome profiling data from multiple perspectives, including Principal Component Analysis (PCA), pipelines for the analysis of RiboSeq positional information, differential and Gene Ontology enrichment analysis, and network methodologies. This set of tools applies to the study of ribosome profiling data and allows to investigate the translational mechanisms underlying SMA. This multilevel analysis holds difficulties in the representation and interpretation of the obtained results due to the number of variables (i.e., tissue, stage, model, and disease condition). I hence developed an R package to support the visualization of changes occurring in omics data from complex experimental designs. Next, I focused on the identification of translational defects in SMA through pairwise differential analyses performed on each set of experiments. This allowed me to identify significantly altered transcripts within each comparison. Despite poor overlaps between the sets of translationally dysregulated transcripts across the different stages, tissues, and models, commonly enriched biological processes were found. The analysis of sequence features on translationally dysregulated transcripts across all the stages, tissues, and models revealed the presence of features similar to those already found on the SMN-specific transcripts. In addition, based on network methodologies, I investigated the system-wide effects of SMN loss on connectivity patterns at the translational level, by taking advantage of network-based methodologies to integrate all sets of experiments and unravel any relationships between genes at the translatome level. Causal-inference networks, coupled with differential network analysis, complemented the standard differential analysis by modeling how the fluctuations in reciprocal transcript-specific ribosome occupancy might influence each other. This allowed to detect disrupted relationships in the disease condition across the multiple tissues, stages and models. In summary, this thesis provides, to my knowledge, the first multi-tissue, -stage, and -model translatome analysis to investigate the mechanisms underlying SMA. Furthermore, results provided within this work confirm that translation dysregulation is a common feature of SMA pathology across multiple tissues, stages, and SMA models. This highlights that the presence of specific sequence features of translationally dysregulated transcripts is a common link between defective translational regulation and SMN loss. Moreover, the detection of disrupted connectivity patterns at the translatome level underlies that a strong remodeling occurs upon SMN loss, and further emphasizes the pivotal role of this protein in translation. These outcomes highlight the importance of further investigating the mechanisms underlying defective translation in SMA from a system perspective to provide a comprehensive understanding of this pathology and promote the development of effective therapeutic strategies.

Amyotrophic Lateral Sclerosis is the most common type of motor neuron disease, characterized by progressive degeneration of the upper and lower motor neurons. Sufferers present with symptoms of muscle weakness and this quickly develops on to paralysis and finally death due to respiratory failure within 5 years of disease onset. Although the majority of cases are sporadic, about 10% are familial and it is hoped that through the investigation of these few cases a greater understanding of the disease process, the reasons for its delayed onset and vulnerability of motor neurons will be achieved. Recently a novel mutation linked to ALS was discovered in an evolutionary conserved protein named Vesicle associated membrane protein (VAMP) associated protein B (VAPB). VAPB is an integral type II membrane protein localised at the Endoplasmic Reticulum and thought to have a role in protein transport. The orthologue in Drosophila has been shown to be involved in the homeostatic regulation of bouton formation at the Neuromuscular Junction through an association with the microtubule network. To elucidate the mechanism through which this protein causes ALS, Pennetta et al have created a Drosophila model of the disease by expressing the mutated orthologue in the fly. To complement this model, I have undertaken a number of biochemical experiments to look for potential interactors of the VAP proteins. The yeast two hybrid system utilises the yeast GAL4 transcriptional activator to indicate a protein interaction within a yeast cell and can be used to test a cDNA library for interactors. Through this technique a number of interesting binding partners have been found that may play crucial roles in the progression of the disease.

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