No description available.

Myotonic dystrophy type 1 (DM1) is the most common adult muscular dystrophy affecting ~1/8000 people worldwide. DM1 is characterized by accelerated skeletal muscle weakness and wasting, myotonia and insulin resistance, ultimately causing impaired function and diminished quality of life. A trinucleotide (CTG) repeat expansion in the 3’ region upstream of the DMPK gene results in dysregulation of several RNA binding proteins (RNABPs) important for muscle health such as MBNL and CUGBP1. Exercise was shown to ameliorate DM1 pathology in mice and to be safe for DM1 patients. This thesis aimed to investigate the muscular adaptations of 12-weeks of aerobic exercise in DM1 patients. Eleven DM1 patients (DM1, 42.6 ± 3 y) were recruited from the Neuromuscular and Neurometabolic clinic at McMaster University and age matched to healthy controls (CON, 42.5 ± 2 y). DM1 and CON performed incremental VO2peak testing, muscle and spirometry functional tests and a skeletal muscle biopsy from the Vastus lateralis. After 12-weeks of training on a cycle ergometer (3x/wk @ ~65 %VO2peak), DM1 patients completed post-testing. Exercise training significantly increased total lean mass (TLM) by ~ 1.6 kg (p<0.05) and fibre cross-sectional area by ~30 % in DM1 patients. Aerobic fitness was enhanced following training from 19.7 ± 1.5 mL/kg/min to 26.0 ± 2.1 mL/kg/min (p<0.05). Furthermore, training improved 6-min walk test, timed up & go, and 5X sit-to-stand scores (p<0.05). Mechanistically, exercise modestly altered expression of RNABPs, and augmented mitochondrial function and protein content. This is the first study to comprehensively investigate the effects of aerobic training on muscle health and function in DM1. Our data provides evidence that exercise training can augment fitness, functional capacity and muscle mass in DM1. Further understanding the influence of exercise on DM1 pathology could outline the efficacy of a simple life intervention and provide insight for future pharmacological discoveries for DM1. / Thesis / Master of Science (MSc)

Myotonic dystrophy type 1 (DM1) is the most common form of adult muscular dystrophy (1:8000) and is caused by an abnormal expansion of CTG repeats in the 3’ untranslated region of the dystrophia myotonica protein kinase (DMPK) gene. The expanded repeats of the DMPK mRNA forms hairpin structures which sequester RNA-binding proteins (RBP) in intranuclear foci, such as the splicing regulator muscleblind-like 1 (MBNL1), which results in aberrant splicing of several mRNAs and underlie, at least in part, DM1 pathogenesis. It has been previously shown that disaggregating these RNA foci repletes free and thus functional MBNL1, rescuing DM1 spliceopathy and alleviating associated signs and symptoms such as myotonia. Importantly, the direct upregulation of MBNL1 has comparable beneficial outcomes. The focus of this thesis was to develop novel and practical therapeutic avenues for DM1 by employing high-throughput screening technology to identify key pathways and small molecule candidates which reduce CUG foci in patient cells, and ultimately correct DM1 spliceopathy and associated signs in vivo. First, a high-throughput kinome screen using an siRNA library targeting 692 kinase subunits identified PACT, HIPK4, and PKA2β as candidates for reducing CUG foci in patient fibroblasts. Knockdown of each gene resulted in a partial reduction in CUG foci, but ultimately did not correct aberrant splicing of insulin receptor (IR) or sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA1), two genes which are typically misspliced in DM1. A second set of screens focused on testing small molecules, several of which are FDA-approved for clinical use, in an effort to expedite drug discovery. One approach was to data-mine from a previously completed chemical screen, which used system-wide RNA sequencing to establish drug-gene interactions in mouse neuronal cultures treated with blood brain barrier-penetrant drugs, and specifically look for compounds which downregulate DMPK mRNA or upregulate MBNL mRNA (MBNL1 and MBNL2). No compounds were found to downregulate DMPK mRNA. However, several compounds upregulated MBNL mRNAs; the activity of one of these, nilotinib, was validated in human DM1 fibroblasts and converted myoblasts, mediating a small correction in SERCA1 spliceopathy. Administration of nilotinib to unaffected mice did not result in in vivo MBNL gene upregulation in mouse skeletal muscle, as was seen in vitro. Further testing of nilotinib in DM1 in vivo models is required. A final set of chemical screens in patient myoblasts using an FDA-approved drug library and a chemogenomic drug library identified several HDAC inhibitors which reduced foci and rescued SERCA1 spliceopathy in vitro in DM1 differentiated myoblasts. Of these, vorinostat (SAHA) was further tested in a mouse model of DM1 (HSALR), proving safe and effective in correcting aberrant muscle pathology as well as splicing defects of RYR1, SERCA1, and CLCN1. Functional validation, such as myotonia, remains to be completed, but given the strong evidence for CUG foci reduction and splicing correction, vorinostat has emerged as a promising novel candidate for DM1 therapy.

Myotonic dystrophy type 1 (DM1) is an autosomal dominant and progressive neuromuscular disorder caused by the CTG trinucleotide repeat expansion in the 3’ untranslated region of the DMPK gene. Clinical manifestations include extensive atrophy of skeletal muscle (SkM) concomitant with muscle weakness, that develops in a distal to proximal fashion. Central to muscle plasticity is the satellite cell (SC), a muscle specific stem cell that, upon activation, facilitates muscle repair and regeneration. To date, SCs have yet to be elucidated in DM1; therefore, the aim of the present study was to extensively characterize the PAX7+ SC population, along with other indices of muscle quality in SkM. DM1 patients (6 women, 5 men) performed stationary cycling 3 times per week for 12wks, with biopsies taken from the Vastus lateralis pre- (PRE) and post-endurance exercise intervention (POST). Age-matched, healthy controls (CTRL) were used for comparison of baseline measures. Type 1 and 2 myofiber-specific PAX7+ cells were significantly greater in DM1 patients (PRE), in comparison to CTRL (2.24- and 1.84-fold, respectively), with type 2 SC content further increasing following training (p<0.05). In addition, protein expression of myogenic regulatory factors PAX7 and myogenin were significantly higher in DM1 compared to CTRL, with no training effects observed. Both immunohistochemical and immunoblotting analysis showed that activated MYOD+/PAX7+ cells did not significantly differ in DM1 vs. CTRL. FISH- IF analysis of CUG repeats show that 30% of SCs in DM1 were positive for these inclusions. Muscle capillarization was significantly lower in type 2 fibers in DM1 vs CTRL, which was fully rescued with training (p<0.05). At baseline, DM1 muscle showed the presence of de novo and fat infiltrated fibres, as well as fibrosis, that were relatively non-existent in the CTRL. In vitro results show patient-derived myoblasts exhibit a proliferation defect. Furthermore, myoblasts showed impairments in both glycolysis and mitochondrial respiration, with the latter being completely normalized to CTRL in myotubes. Our novel findings display an increased, albeit non-functional, SC pool in DM1 SkM indicated by disturbances in the myogenic program and overall poor muscle quality. We show that both SCs and SkM remain responsive to exercise training, suggesting therapeutic potential. We also suggest that mitochondrial dysfunction may underpin these impairments in the myogenic program. / Thesis / Master of Science (MSc) / Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults worldwide affecting 1:8000 individuals, with certain areas in northeastern Quebec having a higher prevalence of 1:600 individuals. DM1 is caused by an autosomal dominant genetic mutation that leads to muscle weakness, respiratory insufficiency, cataracts and cardiac conduction block, ultimately resulting in poor quality of life and shortened lifespan. Preliminary evidence suggests that the maintenance of muscle health can greatly improve quality of life and life-span of these individuals, making an in-depth research focus on this therapeutic intervention extremely important. Optimal muscle health is maintained by the functionality of muscle stem cells, that aid in muscle repair and facilitate adaptations in muscle following exercise interventions. These cells are shown to be dys- or non-functional in various muscular dystrophies which coincide with the observation of poor muscle health. Therefore, the aim of this study was to examine the number and functionality of muscle stem cells, and physiological factors of muscle health in DM1. In addition, we also aimed to explore whether exercise has therapeutic potential to alleviate poor muscle quality in DM1. In general, we found that DM1 patients have a higher proportion of muscle stem cells; however, they are inherently dysfunctional but did respond to exercise. Consistent with the latter observation, we found poor muscle quality metrics in DM1 patients, with aerobic training leading to improvements in muscle health. Altogether, our results provide in-depth analysis that underscores muscle dysfunction observed in DM1 and the benefits of exercise interventions.

No description available.

O gene DMPK (Dystrophia Myotonica-Protein Kinase) humano está localizado no locus 19q13.3, sendo dividido em 15 éxons, com uma região polimórfica de repetições CTG em sua região 3’ não traduzida. Indivíduos normais apresentam de 5 a 34 repetições CTG. Indivíduos com alelos com mais de 50 repetições CTG apresentam distrofia miotônica tipo 1 (DM1), uma doença multissistêmica de herança autossômica dominante. Os sintomas incluem miotonia, fraqueza muscular progressiva, hipogonadismo, entre outros. Neste trabalho, a distribuição dos alelos do gene DMPK em indivíduos controles foi estabelecida em duas populações (brasileira e peruana), por meio de PCR convencional utilizando iniciadores fluorescentes e repeat-primed PCR. O protocolo confirmou 93 casos não relacionados de DM1 (76 brasileiros e 17 peruanos) após a análise de 224 amostras com suspeita clínica. A distribuição e as frequências dos alelos normais foram estabelecidas em ambas as populações e os alelos mais frequentes foram 5 (frequência = 0,326) e 13 (frequência = 0,545) repetições de CTG em brasileiros e peruanos, respectivamente. A frequência de alelos normais grandes (aqueles com mais de 45 repetições CTGs) foi de 9% e 4% em brasileiros e peruanos, respectivamente. Neste trabalho é descrita a análise molecular de DM1 na maior coorte brasileira até o momento e é o primeiro trabalho em que foi analisada a população peruana. A distribuição e a frequência de alelos normais também foram estabelecidas e alelos mutáveis foram detectados entre os indivíduos controles. / The human DMPK (Dystrophia Myotonica-Protein Kinase) gene is located at 19q13.3 locus, being organized into 15 exons, with a polymorphic tract of CTG repeats in its 3' untranslated region. Normal individuals have 5-34 CTG repeats. Individuals carrying alleles with more than 50 CTG repeats have myotonic dystrophy type 1 (DM1), a multisystemic disease of autosomal dominant inheritance. Symptoms include myotonia, progressive muscle weakness, hypogonadism, among others. Disease prevalence is variable among populations and may be related to the frequency of large normal alleles (those with more than 18 CTG repeats). Here we determined here the distribution of alleles of DMPK gene in healthy and DM1 patients in Brazilian and Peruvian populations, through conventional PCR using fluorescent primers and repeat-primed PCR. This protocol confirmed 93 unrelated cases of DM1 (76 Brazilians and 17 Peruvians) following the analysis of 224 samples with clinical suspicion. Distribution and frequencies of normal alleles were also established in both populations and the most frequent alleles were 5 (frequency of 0.326) and 13 (frequency of 0.545) CTG repeats in Brazilians and Peruvians, respectively. Frequency of large normal alleles (those with more than 45 CTG repeats) was established to be 9% and 4% in Brazilians and Peruvians, respectively. This report describes molecular analysis of DM1 in the largest Brazilian cohort so far, and is the first to report any data in the Peruvian population. Distribution and frequency of normal alleles were also established and mutable alleles were detected among controls.

Les cellules souches pluripotentes (CSP) humaines sont devenues en quelques années des modèles de choix pour étudier les mécanismes cellulaires et moléculaires qui gouvernent l'apparition de maladies monogéniques, mais également pour le développement de criblages à haut débits afin d'identifier parmi plusieurs milliers de molécules chimiques celles qui ont un potentiel thérapeutique. C'est dans ce contexte de criblage que mes travaux de thèse s'inscrivent, alliant automatisation et miniaturisation de la biologie des CSP dans le cadre de deux maladies monogéniques, l'amyotrophie spinale infantile (SMA) et la dystrophie myotonique de type I (DM1). De manière générale, la mise en place d'une telle stratégie repose sur trois étapes essentielles qui sont l'obtention de CSP porteuses d'une mutation donnée, l'identification d'un modèle d'étude pertinent et la réalisation du criblage à proprement parlé. L'obtention de CSP humaines repose sur deux approches principales. La première consiste en la dérivation de cellules embryonnaires humaine (hES) issues de diagnostiques préimplantatoires et la seconde repose sur la reprogrammation de cellules somatiques par l'induction de pluripotence (iPS). Une partie de mon travail a consisté en la création de cellules iPS modèles de la SMA et leur caractérisation par une approche à haut débit. Par la suite un travail d'optimisation du protocole de génération de motoneurones à partir de CSP humaines a permis d'accélérer et augmenter les rendements de production de ces cellules qui sont principalement affectées dans la SMA. Enfin, l'utilisation de cellules hES porteuses de la mutation causale de la DM1 a permis le criblage de 12000 molécules et a conduit à l'identification d'une famille chimique capable de restaurer plusieurs défauts typiques de cette maladie tels que des défauts d'épissage et de fusion moléculaire. / For only few years, Human pluripotent stem cells (PSC) have become wide spread models in order to study and decipher cellular or molecular mechanims involved in monogenic diseases, but also for the development of large scale screening strategies allowing the identification of new therapeutics among thousands of chemicals. Mythesis research aimed at the development of such strategies, miniaturizing and automating PSC biology within the framework of two monogenic diseases, namely spinal muscular atrophy (SMA) and myotonic dystrophy type 1 (DM1).Basically, PSC based screening programs are generally built around three main steps which are the access to a stem cell model, the identification of a relevant cell type and lastly the screening campaign. There is actually two main ways to generate human PSC. Firstly, human embryonic stem cells (hES) can be derived from the inner cell mass of blastocyte through a pre-implantation diagnosis and secondly, induced pluripotent stem cells (iPS) can be generated after somatic cell reprogramming in vitro. A part of my work has consisted in the generation of hiPS cellular models for SMA by reprogramming fibroplasts that carried SMN1 gene deletion, followed bay the characterization of several dozen of independant clones with high throughput. Then an optimization process of the protocol for the generation of Motoneuron from PSC has been done multiplying experimental conditions. This finally allowed the description of a fast and efficient protocol to generate the most affected cell type in SMA. Finally, DM1 mutated hES were uded for the screening of 12.000 compounds among which a chemical family has been identified to rescue DM1 typical splicing and myogenesis defects.

O gene DMPK (Dystrophia Myotonica-Protein Kinase) humano está localizado no locus 19q13.3, sendo dividido em 15 éxons, com uma região polimórfica de repetições CTG em sua região 3’ não traduzida. Indivíduos normais apresentam de 5 a 34 repetições CTG. Indivíduos com alelos com mais de 50 repetições CTG apresentam distrofia miotônica tipo 1 (DM1), uma doença multissistêmica de herança autossômica dominante. Os sintomas incluem miotonia, fraqueza muscular progressiva, hipogonadismo, entre outros. Neste trabalho, a distribuição dos alelos do gene DMPK em indivíduos controles foi estabelecida em duas populações (brasileira e peruana), por meio de PCR convencional utilizando iniciadores fluorescentes e repeat-primed PCR. O protocolo confirmou 93 casos não relacionados de DM1 (76 brasileiros e 17 peruanos) após a análise de 224 amostras com suspeita clínica. A distribuição e as frequências dos alelos normais foram estabelecidas em ambas as populações e os alelos mais frequentes foram 5 (frequência = 0,326) e 13 (frequência = 0,545) repetições de CTG em brasileiros e peruanos, respectivamente. A frequência de alelos normais grandes (aqueles com mais de 45 repetições CTGs) foi de 9% e 4% em brasileiros e peruanos, respectivamente. Neste trabalho é descrita a análise molecular de DM1 na maior coorte brasileira até o momento e é o primeiro trabalho em que foi analisada a população peruana. A distribuição e a frequência de alelos normais também foram estabelecidas e alelos mutáveis foram detectados entre os indivíduos controles. / The human DMPK (Dystrophia Myotonica-Protein Kinase) gene is located at 19q13.3 locus, being organized into 15 exons, with a polymorphic tract of CTG repeats in its 3' untranslated region. Normal individuals have 5-34 CTG repeats. Individuals carrying alleles with more than 50 CTG repeats have myotonic dystrophy type 1 (DM1), a multisystemic disease of autosomal dominant inheritance. Symptoms include myotonia, progressive muscle weakness, hypogonadism, among others. Disease prevalence is variable among populations and may be related to the frequency of large normal alleles (those with more than 18 CTG repeats). Here we determined here the distribution of alleles of DMPK gene in healthy and DM1 patients in Brazilian and Peruvian populations, through conventional PCR using fluorescent primers and repeat-primed PCR. This protocol confirmed 93 unrelated cases of DM1 (76 Brazilians and 17 Peruvians) following the analysis of 224 samples with clinical suspicion. Distribution and frequencies of normal alleles were also established in both populations and the most frequent alleles were 5 (frequency of 0.326) and 13 (frequency of 0.545) CTG repeats in Brazilians and Peruvians, respectively. Frequency of large normal alleles (those with more than 45 CTG repeats) was established to be 9% and 4% in Brazilians and Peruvians, respectively. This report describes molecular analysis of DM1 in the largest Brazilian cohort so far, and is the first to report any data in the Peruvian population. Distribution and frequency of normal alleles were also established and mutable alleles were detected among controls.

O gene DMPK (Dystrophia Myotonica-Protein Kinase) humano está localizado no locus 19q13.3, sendo dividido em 15 éxons, com uma região polimórfica de repetições CTG em sua região 3’ não traduzida. Indivíduos normais apresentam de 5 a 34 repetições CTG. Indivíduos com alelos com mais de 50 repetições CTG apresentam distrofia miotônica tipo 1 (DM1), uma doença multissistêmica de herança autossômica dominante. Os sintomas incluem miotonia, fraqueza muscular progressiva, hipogonadismo, entre outros. Neste trabalho, a distribuição dos alelos do gene DMPK em indivíduos controles foi estabelecida em duas populações (brasileira e peruana), por meio de PCR convencional utilizando iniciadores fluorescentes e repeat-primed PCR. O protocolo confirmou 93 casos não relacionados de DM1 (76 brasileiros e 17 peruanos) após a análise de 224 amostras com suspeita clínica. A distribuição e as frequências dos alelos normais foram estabelecidas em ambas as populações e os alelos mais frequentes foram 5 (frequência = 0,326) e 13 (frequência = 0,545) repetições de CTG em brasileiros e peruanos, respectivamente. A frequência de alelos normais grandes (aqueles com mais de 45 repetições CTGs) foi de 9% e 4% em brasileiros e peruanos, respectivamente. Neste trabalho é descrita a análise molecular de DM1 na maior coorte brasileira até o momento e é o primeiro trabalho em que foi analisada a população peruana. A distribuição e a frequência de alelos normais também foram estabelecidas e alelos mutáveis foram detectados entre os indivíduos controles. / The human DMPK (Dystrophia Myotonica-Protein Kinase) gene is located at 19q13.3 locus, being organized into 15 exons, with a polymorphic tract of CTG repeats in its 3' untranslated region. Normal individuals have 5-34 CTG repeats. Individuals carrying alleles with more than 50 CTG repeats have myotonic dystrophy type 1 (DM1), a multisystemic disease of autosomal dominant inheritance. Symptoms include myotonia, progressive muscle weakness, hypogonadism, among others. Disease prevalence is variable among populations and may be related to the frequency of large normal alleles (those with more than 18 CTG repeats). Here we determined here the distribution of alleles of DMPK gene in healthy and DM1 patients in Brazilian and Peruvian populations, through conventional PCR using fluorescent primers and repeat-primed PCR. This protocol confirmed 93 unrelated cases of DM1 (76 Brazilians and 17 Peruvians) following the analysis of 224 samples with clinical suspicion. Distribution and frequencies of normal alleles were also established in both populations and the most frequent alleles were 5 (frequency of 0.326) and 13 (frequency of 0.545) CTG repeats in Brazilians and Peruvians, respectively. Frequency of large normal alleles (those with more than 45 CTG repeats) was established to be 9% and 4% in Brazilians and Peruvians, respectively. This report describes molecular analysis of DM1 in the largest Brazilian cohort so far, and is the first to report any data in the Peruvian population. Distribution and frequency of normal alleles were also established and mutable alleles were detected among controls.

La dystrophie myotonique de type 1 (DM1) est une maladie à transmission autosomale dominante causée par une répétition trinucléotidique CTG située dans la région 3’ non-traduite du gène dystrophia myotonica protein kinase (DMPK). La prévalence mondiale de la DM1 est de 8,26 personnes atteintes par 100 000 habitants : celle-ci est presque 20 fois plus importante au Saguenay-Lac-St-Jean en raison d’un effet fondateur. La présentation clinique de la DM1 peut comprendre divers symptômes dont de la faiblesse musculaire, de la myotonie, des cataractes, de l’insuffisance respiratoire, de l’arythmie cardiaque, de l’hypersomnolence et des troubles cognitifs et endocriniens. Par ailleurs, une grande variation dans la présence et la sévérité de ces symptômes est observée chez les patients et celle-ci n’est qu’en partie expliquée par la longueur des répétitions CTG. Plusieurs mécanismes pourraient expliquer la variabilité inexpliquée dont les défauts d’épissage, la mauvaise régulation des facteurs de transcription, la traduction non-ATG associée aux répétitions et les modifications épigénétiques, en particulier la méthylation de l’ADN. L’objectif de ce projet était donc d’évaluer l’impact de la méthylation de l’ADN au locus DMPK sur la variabilité phénotypique des patients atteints de DM1. Nous rapportons que la méthylation de l’ADN mesurée en amont et en aval de la répétition CTG est respectivement corrélée négativement et positivement avec la longueur de la répétition CTG. La présence d’une interruption de la répétition est associée à un niveau plus élevé de méthylation de l’ADN. À l’aide de modèles de régression linéaire multiple, nous démontrons que la méthylation de l’ADN contribue significativement et indépendamment de la longueur des répétitions CTG, à expliquer la variabilité́ de la force des dorsifléchisseurs de la cheville, de la force de préhension, de la force des pinces, de la capacité́ vitale forcée, du débit expiratoire de pointe, de la pression expiratoire et inspiratoire maximale. La méthylation de l’ADN explique une fraction de la variabilité phénotypique en DM1 et en association avec la longueur de la répétition CTG pourrait aider à améliorer la prédiction de la progression de la maladie chez ces patients. / Abstract : Myotonic dystrophy type 1 (DM1) is an autosomal dominant disorder caused by a CTG repeat extension in the 3’ untranslated region of the dystrophia myotonica protein kinase (DMPK) gene. Worldwide, the prevalence of DM1 is 8.26 affected persons per 100 000 persons, but it goes up to 158 affected persons per 100 000 in the Saguenay-Lac-St-Jean region of the province of Quebec (Canada) due to a founder effect. Clinical presentation includes muscular weakness, myotonia, cataracts, respiratory insufficiency, cardiac arrhythmia, hypersomnolence and endocrine and cognitive problems. There is a large variability in the presence and severity of these symptoms that is only partially explained by the CTG repeat length. Many mechanisms such as splicing defects, impaired regulation of transcription factors, repeat-associated non-ATG translation and epigenetic modifications, including DNA methylation, may explain this variability. The objective of this study was to assess the impacts of DNA methylation measured at the DMPK gene locus on phenotypic variability in DM1. We report that DNA methylation upstream of the repeat was negatively correlated with CTG repeat length whereas downstream DNA methylation was positively correlated. The presence of a variant repeat within the CTG repeat was associated with a higher level of DNA methylation. Linear multiple regression models support that DNA methylation contributes significantly and independently of the CTG repeat length to the variability of the ankle dorsiflexor, grip and pinch strengths, as well as forced vital capacity, peak expiratory flow and maximal inspiratory and expiratory pressures. DNA methylation could thus explain part of the phenotypic variability in DM1 and, together with CTG repeat length, could help improve the prediction of the progression of the disease.