Os praguicidas organofosforados (OPs) são amplamente utilizados na indústria química e na agricultura em todo o mundo. Muitos deles são potenciais causadores da \"Neuropatia Retardada Induzida por Organofosforados\" (NRIOP), caracterizada pela degeneração distal de axônios do sistema nervoso central e periférico (degeneração do tipo Walleriana). O praguicida triclorfom (dimetil 2,2,2-tricloro-1-hidroxietil fosfonato) tem sido utilizado em larga escala na produção agrícola e também no controle de vetores transmissores de várias doenças. Há relatos de efeitos neuropáticos em seres humanos expostos ao triclorfom, mas apesar disso, o seu potencial neuropático e seus mecanismos de neurotoxicidade ainda não foram elucidados. Assim, no presente estudo foram avaliados os mecanismos de toxicidade do praguicida OP triclorfom utilizando linhagem SH-SY5Y de neuroblastoma humano como modelo, e também foram avaliados possíveis agentes neuroprotetores em células tratadas com o bem estabelecido indutor da neuropatia mipafox. Foram utilizados como possíveis neuroprotetores: a amilorida e nimodipino (bloqueadores de canais de cálcio tipo T e L respectivamente), MDL 28170 (inibidor (III) de calpaína) e liraglutida (um agonista do \"glucagon like peptide\" -GLP-1). Foram usados o mipafox, como modelo de indução da NRIOP e o paraoxon, como modelo não indutor da NRIOP. Os ensaios de inibição e reativação da esterase susceptível à neuropatia (ESNp) e de citotoxicidade mostraram que somente o mipafox e o triclorfom apresentaram inibição e envelhecimento da ESNp superiores a 70% em concentrações com baixa toxicidade, condição compatível com a indução da NRIOP. A ativação das calpaínas foi observada apenas no tratamento com mipafox, efeito este inibido pela nimodipina, amilorida e pelo MDL 28170. Triclorfom e o mipafox causaram elevação significativa nos níveis de cálcio intracelular e da caspase-3, além de inibir significativamente o crescimento de neuritos. Os três OPs avaliados foram capazes de diminuir a captação da glicose, que foi aumentada nos grupos tratados com mipafox associado com neuroprotetores. As quatro substâncias utilizadas como possíveis neuroprotetoras reduziram significativamente o dano causado pelo mipafox sobre os neuritos. O modelo usado no estudo mostrou-se apropriado para a caracterização dos OP neuropáticos, pois permitiu a diferenciação dos efeitos do mipafox (neuropático) e do paraoxon (não-neuropático). Os dados obtidos indicam que o triclorfom tem potencial indutor de NRIOP, e a amilorida, nimodipino liraglutida e MDL apresentaram potencial neuroprotetor / Organophosphorus (OP) pesticides are widely used in the chemical industry and agriculture around the world. \"Organophosphate Induced Delayed Neuropathy\" (OPIDN) is characterized by distal degeneration of axons of the central and peripheral nervous system (Wallerian-type degeneration). The OP trichlorfom (dimethyl 2,2,2-trichloro-1-hydroxyethyl phosphonate) has been used in large scale in agricultural production and also for the control of vectors that are transmitter of diseases. There are reports of neuropathic effects in humans exposed to trichlorfon, but despite this, its neuropathic potential and mechanisms of neurotoxicity have not yet been elucidated. Thus, in the present study we evaluated the mechanisms of toxicity of trichlorfom and possible neuroprotective agents in SH-SY5Y human neuroblastoma cells treated with the well-established neuropathy inducer mipafox. The following neuroprotective agents were used: amyloride and nimodipine (T and L-type calcium channel blockers, respectively), MDL 28170 (calpain inhibitor (III) and liraglutide (a \"glucagon-like peptide\" - GLP-1 agonist). Mipafox was used as neuropathic OP and paraoxon was used as a non-neuropathic OP. Inhibition and reactivation assays of neurpathy target esterase (NTE) and cytotoxicity showed that only mipafox and trichlorfon showed inhibition and aging of 70% of the NTE in concentrations that presented low toxicity, consistent with development of OPIDN. Activation of calpain was observed only in the treatment with mipafox, an effect inhibited by nimodipine, amyloride and MDL 28170. Triclorfom and mipafox caused significant increase in the levels of intracellular calcium, caspase-3 and significantly inhibiting neurite growth. All three OPs assessed in this work caused a decrease in glucose uptake, which was increased in groups treated whith mipafox plus neuroprotectors. Substances used as possible neuroprotective agents significantly reduced the inhibitory effect of mipafox on neurite outgrowth. The model used in the study proved to be appropriate for characterizing neuropathic OPs, because it allowed a differentiation of the effects of mipafox (neuropathic) and paraoxon (non-neuropathic). The data obtained indicate that trichlorfonm has potential in cause OPIDN. Amiloride, nimodipine, MDL and liraglutide have presented potential neuroprotective effects

Neurodegenerative diseases are becoming increasingly prevalent due to the ageing population, and are among the major contributors to disability and disease worldwide. The identification of the gene defects responsible for many of these conditions has played a major role in our understanding of the pathogenic processes involved, and provided opportunity to develop targeted treatment strategies. Cholinergic neurotransmission supports a wide range of physiological and behavioural processes and its dysfunction of cholinergic signalling has been associated with a number of disorders, including myasthenias, cardiovascular disease(1), attention-deficit hyperactivity disorder (ADHD) (2), Alzheimer’s disease (ADi), schizophrenia, addiction(3), and depression(4). SLC5A7 encodes the Na+/Cl- dependent, high-affinity choline transporter (CHT) which represents the rate limiting step in acetylcholine (Ach) synthesis and is critical for normal cholinergic signalling. The work in this thesis details two new inherited disorders, caused by distinct pathogenic disease mechanisms, associated with novel SLC5A7 mutations. Chapter three documents the discovery of two autosomal-dominantly acting SLC5A7/CHT mutations associated with adult onset motor neurone disorders. Initially we identified a frameshift mutation that results in premature truncation of the transporter protein in a large Welsh kindred affected with distal hereditary motor neuropathy type VII (dHMN-VII), in which neurodegeneration and muscle paresis is largely restricted to the distal limb muscles and vocal cords. The mutation responsible results in the dominant-negative interference of the mutant molecule with function of the wild type choline transporter, resulting in significantly reduced (although not completely abolished) transporter activity. This finding is further evidenced by the discovery of a second dHMN family associated with a distinct frameshift SLC5A7 mutation indicative of a similar dominant-negative disease mechanism. Together these findings corroborate a dominant-negative disease mechanism arising from C-terminal truncating SLC5A7 mutations associated with dHMN, and provide further insight into the role of aberrant choline transporter function in neurological disease. Chapter four describes N-terminal missense mutations located in the transmembrane spanning region of SLC5A7/CHT, associated with a severe infantile neuromuscular disorder characterised by predominantly central hypotonia and developmental delay. The phenotypic effects of these mutations are likely to result from the near abolition of CHT-mediated choline transport in homozygous individuals, and are in keeping with those observed in CHT knock-out mouse models(5). The development of a mouse model of the human motor neurone disease arising from SLC5A7 frameshift mutations should allow for further investigation of the mechanism by which truncated CHT leads to the dHMN phenotype. Chapter 5 details treatment hypotheses for dHMN, as well as the generation of a patient-specific knock-in mouse model carrying an Slc5a7 mutation orthologous to that identified in dHMN-VII families in chapter 3, and results from preliminary neurological phenotyping of the mouse model. This model will be crucially important for the exploration of treatment options in dHMN-VII motor neurone disease as a prelude to clinical trials in humans.

Title: Electromyographic and clinical evaluation of vincristine-induced peripheral neuropathy in pediatric patients after treatment of acute lymphoblastic leukemia and correlation with the Bruinkins-Oseretsky Test of Motor Proficiency Second Edition Objectives: The aim of this work was to characterize the neurological consequences of vincristine-induced peripheral neuropathy (VIPN) clinically and electromyographically and to evaluate motor skills of pediatric patients after the end of treatment of acute lymphoblastic leukemia. We also determined the relationship between the results of the clinical and electromyographic evaluation of VIPN and the correlation with the results of motor skills tests. Methods: The study involved 35 probands (19 girls and 16 boys) with a mean age of 10.7 years (SD ± 4.3) and a mean time since the last dose of vincristine of 2.3 years (SD ± 1.2). VIPN was assessed using a clinical pediatric-modified Total Neuropathy Score (ped-mTNS) and nerve conduction studies (NCS). Motor skills were assessed using the Bruinkins-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Results: The clinical presence of VIPN, according to ped-mTNS, was found in 20 % of probands. Abnormalities in nerve conduction studies were reported by 60.9 % of probands. Of these, 92.9 % had motor...

Le diabète, caractérisé notamment par une atteinte neuro-vasculaire, représente aujourd’hui un réel problème de santé publique. Cependant plus de 30% des patients, ne peuvent bénéficier des traitements actuels (chirurgie et pharmacothérapie) d’où, la nécessité de développer de nouvelles approches thérapeutiques innovantes. L’objectif de ce travail a été de caractériser un modèle murin de neuro-angiopathie diabétique, représentatif de la pathologie humaine puis, d’évaluer les effets des molécules guidance neuronale dans la récupération de la fonction neuro-vasculaire. Dans un premier temps, nous avons mis en place un modèle et des techniques exploratoires de l’étude de la fonction neuro-vasculaire chez les souris diabétiques. Nous avons observé que suite à l’ischémie du membre inférieur, la revascularisation est altérée chez les animaux diabétiques par comparaison aux animaux non-diabétiques. A ce défaut de la fonction vasculaire, s’ajoute également un défaut de la fonction nerveuse. En effet, les paramètres électrophysiologiques, le flux sanguin nerveux, le nombre de capillaires dans le nerf sciatique et la régénération nerveuse sont fortement impactés chez les animaux diabétiques. Afin de palier au défaut de revascularisation et/ou de régénération nerveuse, nous avons proposé que le ciblage thérapeutique des molécules de guidance neuronale, éphrine-B2 et Sémaphorine-3A (Séma-3A) améliorerait la fonction neuro-vasculaire. Après ischémie, les cellules mononuclées du sang périphérique (CM-SP) provenant de patients diabétiques ou de sujets contrôles, traitées préalablement avec l’éphrine-B2/Fc, ont été ensuite injectées aux animaux diabétiques. Une nette amélioration de la revascularisation a été observée dans les groupes d’animaux traités avec l’éphrine-B2/Fc par rapport aux animaux non-traités ou traités avec des CM-SP non stimulées. Enfin, nous avons administré un inhibiteur de Séma-3A, SM-345431 (Vinaxanthone) à des animaux contrôles et diabétiques après ischémie du membre inférieur. Ce qui nous a permis de montrer que cette inhibition améliore significativement la revascularisation et régule notamment la voie de signalisation des MAPK, Erk1/2 et p38 ainsi que, les niveaux de VEGF et de TGF-β1. Dans l’ensemble, l’effet sur la fonction nerveuse périphérique n’a pas montré de différences majeures entre les groupes traités et non-traités. En somme, nos travaux ont permis de montrer que la thérapie cellulaire utilisant les CM-SP stimulées avec l’éphrine-B2/Fc, ou bien l’injection intramusculaire d’un inhibiteur de Séma-3A, à visée pro-angiogénique et/ou pro-neurorégénérative, apparaît comme une stratégie prometteuse et susceptible d’améliorer la qualité de vie des malades atteints de diabète. / Diabetes, characterized by neuro-vascular damages, is a real public health problem. More than 30% of diabetic patients can benefit from existing therapies (surgery and drug therapy), therefore, the need to develop new innovative therapeutic approaches. The objective of this work was to characterize a diabetic neuro-angiopathy mouse model, reproducible of human pathology and to assess the effects of neuronal guidance molecules in recovery of the neuro-vascular function. Firstly, we characterized a model and exploratory techniques to study the neuro-vascular functions in diabetic mice. After hindlimb ischemia induction, we observed that revascularization were impaired in diabetic animals compared to non diabetic animals. This alteration is associated of the nerve function defect. Indeed, the electrophysiological parameters, nerve blood flow, the number of capillaries in sciatic nerve and nerve regeneration are strongly affected in diabetic animals. Then, to rescue the revascularization or nerve regeneration, we proposed that the therapeutic targeting of molecules of neuronal guidance, ephrin-B2 and Semaphorin-3A (Sema-3A) would improve neuro-vascular functions. After ischemia induction, peripheral mononuclear blood mononuclear cells (PBMNC) from diabetic patients or subjects controls, pre-treated with ephrin-B2/Fc, were then injected in diabetic animals. A significant improvement of revascularization was observed in both groups, animals treated with ephrin-B2/Fc compared to untreated animals or treaties with PBMNC unstimulated. Finally, after hindlimb ischemia, we administrated a pharmacological inhibitor of Sema-3A, the SM-345431 (Vinaxanthone) in diabetic and control animals. We showed this selective inhibition significantly improved the post-ischemic revascularization, regulates the MAPK Erk1/2 and p38 signaling pathway, increased the levels of CXCL12, VEGF and TGF-β1. In our experiment conditions, we did not observe the significant effects of SM-345431 on peripheral nerve function between treated and untreated animal groups. Finally, our work showed that cell therapy using PBMNC stimulated with ephrin-B2/Fc, or the intramuscular injection of Sema-3A inhibitor referred to pro-angiogenic and/or pro-neuroregenerative, appears as a strategy promising and likely to improve the quality of life of diabetic patients.

La neuropathie humaine sensitive et autonome de type 2 (NHSA 2) est une pathologie héréditaire rare caractérisée par une apparition précoce des symptômes et une absence d’affectation motrice. Cette pathologie entraîne la perte de perception de la douleur, de la chaleur et du froid ainsi que de la pression (toucher) dans les membres supérieurs et inférieurs et est due à des mutations autosomales récessives confinées à l’exon HSN2 de la protéine kinase à sérine/thréonine WNK1 (with-no-lysine protein kinase 1). Cet exon spécifique permettrait de conférer une spécificité au système nerveux à l’isoforme protéique WNK1/HSN2. La kinase WNK1 est étudiée en détails, en particulier au niveau du rein, mais son rôle au sein du système nerveux demeure inconnu. Considérant le début précoce de la neuropathie et le manque d’innervation sensorielle révélé par des biopsies chez les patients NHSA2, notre hypothèse de recherche est que les mutations tronquantes menant à la NHSA de type 2 causent une perte de fonction de l’isoforme WNK1/HSN2 spécifique au système nerveux entraînant un défaut dans le développement du système nerveux sensoriel périphérique. Chez l’embryon du poisson zèbre, WNK1/HSN2 est exprimé au niveau des neuromastes de la ligne latérale postérieure, un système mécanosensoriel périphérique. Nous avons obtenu des embryons knockdown pour WNK1/HSN2 par usage d’oligonucléotides morpholino antisens (AMO). Nos trois approches AMO ont révélé des embryons présentant des défauts d’établissement au niveau de la ligne latérale postérieure. Afin de déterminer la voie pathogène impliquant l’isoforme WNK1/HSN2, nous nous sommes intéressés à l’interaction rapportée entre la kinase WNK1 et le co-transporteur neuronal KCC2. Ce dernier est une cible de phosphorylation de WNK1 et son rôle dans la promotion de la neurogenèse est bien connu. Nous avons détecté l’expression de KCC2 au niveau de neuromastes de la ligne latérale postérieure et observé une expression accrue de KCC2 chez les embryons knockdown pour WNK1/HSN2 à l’aide de RT-PCR semi-quantitative. De plus, une sur-expression d’ARN humain de KCC2 chez des embryons a produit des défauts dans la ligne latérale postérieure, phénocopiant le knockdown de WNK1/HSN2. Ces résultats furent validés par un double knockdown, produisant des embryons n’exprimant ni KCC2, ni WNK1/HSN2, dont le phénotype fut atténué. Ces résultats nous mènent à suggérer une voie de signalisation où WNK1/HSN2 est en amont de KCC2, régulant son activation, et possiblement son expression. Nous proposons donc que la perte de fonction de l’isoforme spécifique cause un débalancement dans les niveaux de KCC2 activée, menant à une prolifération et une différenciation réduites des progéniteurs neuronaux du système nerveux périphérique. Les défauts associés à la NHSA de type 2 seraient donc de nature développementale et non neurodégénérative. / Human sensory and autonomic neuropathy type 2 (HSNA2) is a rare human hereditary pathology characterized by an early onset severe sensory loss (for all modalities) in the distal limbs. It is due to autosomal recessive mutations confined to exon HSN2 of the WNK1 (with-no-lysine protein kinase 1) serine-threonine kinase; the specific exon confers nervous system specificity to target isoform WNK1/HSN2. While this kinase is widely studied in the kidneys, little is known about its role in the nervous system. Due to its role in HSAN type 2, we hypothesized that the truncating mutations present in the HSN2 exon lead to a loss-of-function of the WNK1 kinase, impairing development of the peripheral sensory system. In order to investigate the mechanisms by which the lack of the WNK1/HSN2 isoform acts to cause HSAN type 2, we examined its expression pattern in our zebrafish model and observed strong expression in neuromasts of the peripheral sensory lateral line system. We then knocked down the HSN2 exon in zebrafish embryos using antisense morpholino oligonucleotides. Our three approaches to knockdown the WNK1/HSN2 isoform led to embryos with a defective lateral line. In order to establish a pathogenic pathway involving the WNK1/HSN2 isoform, we investigated the reported interaction between the WNK1 kinase and neuronal potassium chloride co-transporter KCC2. This transporter is a target of WNK1 phosphorylation and also has a known role in promoting neurogenesis. We have also showed its expression in mature neuromasts of the posterior lateral line, and observed an increased expression of KCC2 in WNK1/HSN2 knockdown embryos by semi-quantitative RT-PCR, lending credence to our interaction hypothesis. Furthermore, overexpression of human KCC2 RNA in embryos led to an impaired mechanosensory lateral line system, phenocopying the WNK1/HSN2 knockdown. We then validated these results by obtaining double knockdown embryos, both for WNK1/HSN2 and KCC2, which alleviated the lateral line defect phenotype. These results led us to suggest a pathway in which WNK1/HSN2 is upstream of the KCC2 co-transporter. WNK1 is believed to regulate the level of activation, and possibly level of expression, of KCC2 and we therefore hypothesize that the loss-of-function of the specific isoform causes an imbalance in the levels of activated KCC2. This would then lead to decreased progenitor proliferation and hindered differentiation of neurons, causing the defects associated with HSAN type 2.

In the first part of the thesis Objectification of disorders of the fine motor skills of the upper extremities in the patients with hereditary neuropathies there are mentioned some brief informations about characteristics, classifications, clinical symptoms, deformities and testing of upper extremities, rehabilitation and treatment of CMT neuropathy. The practical part of this thesis is concerned with testing and evaluating of strength, fine motor skills and sensation of the upper extremities in the patients with CMT. For the measurement of the hand strenght the dynamometry and the functional muscle test are used. The Jebsen-Taylor test, the Nine-Hole Peg Test and the examination of static and dynamic handgrip rating are used. For the examination of the sensation the Nottingham Sensory Assessment is used. CMT neuropathy score and Overall Neuropathy Disability Scaleare are used for the classification of disability. The aim of this thesis is the comparison of the muscle strength and the function of the dominant and non-dominant hand. Partial aim of thesis is detection of the correlations between tests. According to the results CMT disease leads to the muscle strenght weakness and to worsening of the fine motor skills mainly of the dominant upper extremity. This may be the result of overwork weakness. For...

La Neuropathie à Axones Géants (NAG) est une maladie neurodégénérative rare et fatale caractérisée par une détérioration du système nerveux central et périphérique, impliquant les fonctions motrices et sensorielles. La détérioration massive du système nerveux est accompagnée d'une désorganisation générale des Filaments Intermédiaires ce qui la différencie de nombreuses maladies neurodégénératives où seuls les neurofilaments(NFs) sont affectés. La protéine déficiente, la gigaxonine, est la sous-unité d'une ubiquitine ligase E3, responsable de la reconnaissance spécifique des substrats MAP1B, MAP1S et TBCB, seuls connus à ce jour.Dans le but d'étudier le rôle de la gigaxonine sur la survie neuronale, la désorganisation du cytosquelette et d'avoir un modèle animal suffisamment fort pour envisager des tests thérapeutiques, j'ai caractérisé un modèle murin de NAG. Pour ce faire, j'ai réalisé une étude comportementale des fonctions motrices et sensorielles ainsi qu'une étude histopathologique. Les souris NAG (129/SvJ) développent un phénotype moteur modéré dès 60 semaines alors que les souris NAG (C57BL/6) présentent un phénotype sensoriel dès 60 semaines. Les données histopathologiques ne présentent pas de mort neuronale mais les NFs sont sévèrement altérés. Les NFs sont plus abondant, leur diamètre est augmenté et leur orientation hétérogène, comme c'est observé chez les patients NAG.Nos résultats montrent que l'absence de gigaxonine induit un phénotype moteur et sensoriel modéré mais par contre reproduit la désorganisation massive des NFs observée chez les patients. Ce modèle va nous permettred'étudier le rôle de la gigaxonine, une ligase E3, sur l'organisation des NFs et ainsi comprendre les processus pathologiques impliqués dans d'autres maladies neurodégénératives caractérisée par une accumulation des NFs et un dysfonctionnement du système ubiquitine-protéasome comme les maladies d'Azheimer, de Parkinson etd'huntington ou la sclérose latérale amyotrophique. / Giant Axonal Neuropathy (GAN) is a rare and fatale neurodegenerative disorder characterized by a deterioration of the peripheral and central nervous system. The broad deterioration of the nervous system is accompanied with a general disorganization of the Intermediate Filaments which makes it different from other neurodegenerative disorders wherein only neurofilaments (NFs) are affected. The defective protein, gigaxonin, is the substrate adaptator of an E3 ubiquitin ligase, in charge of the specific recognition of MAP1B, MAP1S and TBCB. In order to study the role of gigaxonin on neuronal survival, the cytoskeleton disorganization and to have a relevant GAN animal model to evaluate efficacy of GAN treatments, I have characterized a GAN mouse model. I did a motor and sensory behavioural study and an histopathologic study. The GAN mice (129/SvJ) shown mild motordeficits starting at 60 weeks of age while sensory deficits were evidenced in C57BL/6 GAN mice. No apparent neurodegeneration was evidenced in GAN mice, but dysregulation of NFs was massive. NFs were more abundant, they shown the abnormal increased diameter and misorientation that are characteristics of the human pathology. Our results show that gigaxonin depletion induces mild motor and sensory deficits but recapitulates the severe NFs dysregulation seen in patients. Our model will allow us to study the role of the gigaxonin-E3 ligase in organizing NFs and understand the pathological processes engaged in other neurodegenerative disorders characterized by accumulation of NFs and dysfunction of the Ubiquitin Proteasome System, such as Amyotrophic Lateral Sclerosis, Huntington's, Alzheimer's and Parkinson's diseases.

Le diabète, caractérisé notamment par une atteinte neuro-vasculaire, représente aujourd’hui un réel problème de santé publique. Cependant plus de 30% des patients, ne peuvent bénéficier des traitements actuels (chirurgie et pharmacothérapie) d’où, la nécessité de développer de nouvelles approches thérapeutiques innovantes. L’objectif de ce travail a été de caractériser un modèle murin de neuro-angiopathie diabétique, représentatif de la pathologie humaine puis, d’évaluer les effets des molécules guidance neuronale dans la récupération de la fonction neuro-vasculaire. Dans un premier temps, nous avons mis en place un modèle et des techniques exploratoires de l’étude de la fonction neuro-vasculaire chez les souris diabétiques. Nous avons observé que suite à l’ischémie du membre inférieur, la revascularisation est altérée chez les animaux diabétiques par comparaison aux animaux non-diabétiques. A ce défaut de la fonction vasculaire, s’ajoute également un défaut de la fonction nerveuse. En effet, les paramètres électrophysiologiques, le flux sanguin nerveux, le nombre de capillaires dans le nerf sciatique et la régénération nerveuse sont fortement impactés chez les animaux diabétiques. Afin de palier au défaut de revascularisation et/ou de régénération nerveuse, nous avons proposé que le ciblage thérapeutique des molécules de guidance neuronale, éphrine-B2 et Sémaphorine-3A (Séma-3A) améliorerait la fonction neuro-vasculaire. Après ischémie, les cellules mononuclées du sang périphérique (CM-SP) provenant de patients diabétiques ou de sujets contrôles, traitées préalablement avec l’éphrine-B2/Fc, ont été ensuite injectées aux animaux diabétiques. Une nette amélioration de la revascularisation a été observée dans les groupes d’animaux traités avec l’éphrine-B2/Fc par rapport aux animaux non-traités ou traités avec des CM-SP non stimulées. Enfin, nous avons administré un inhibiteur de Séma-3A, SM-345431 (Vinaxanthone) à des animaux contrôles et diabétiques après ischémie du membre inférieur. Ce qui nous a permis de montrer que cette inhibition améliore significativement la revascularisation et régule notamment la voie de signalisation des MAPK, Erk1/2 et p38 ainsi que, les niveaux de VEGF et de TGF-β1. Dans l’ensemble, l’effet sur la fonction nerveuse périphérique n’a pas montré de différences majeures entre les groupes traités et non-traités. En somme, nos travaux ont permis de montrer que la thérapie cellulaire utilisant les CM-SP stimulées avec l’éphrine-B2/Fc, ou bien l’injection intramusculaire d’un inhibiteur de Séma-3A, à visée pro-angiogénique et/ou pro-neurorégénérative, apparaît comme une stratégie prometteuse et susceptible d’améliorer la qualité de vie des malades atteints de diabète. / Diabetes, characterized by neuro-vascular damages, is a real public health problem. More than 30% of diabetic patients can benefit from existing therapies (surgery and drug therapy), therefore, the need to develop new innovative therapeutic approaches. The objective of this work was to characterize a diabetic neuro-angiopathy mouse model, reproducible of human pathology and to assess the effects of neuronal guidance molecules in recovery of the neuro-vascular function. Firstly, we characterized a model and exploratory techniques to study the neuro-vascular functions in diabetic mice. After hindlimb ischemia induction, we observed that revascularization were impaired in diabetic animals compared to non diabetic animals. This alteration is associated of the nerve function defect. Indeed, the electrophysiological parameters, nerve blood flow, the number of capillaries in sciatic nerve and nerve regeneration are strongly affected in diabetic animals. Then, to rescue the revascularization or nerve regeneration, we proposed that the therapeutic targeting of molecules of neuronal guidance, ephrin-B2 and Semaphorin-3A (Sema-3A) would improve neuro-vascular functions. After ischemia induction, peripheral mononuclear blood mononuclear cells (PBMNC) from diabetic patients or subjects controls, pre-treated with ephrin-B2/Fc, were then injected in diabetic animals. A significant improvement of revascularization was observed in both groups, animals treated with ephrin-B2/Fc compared to untreated animals or treaties with PBMNC unstimulated. Finally, after hindlimb ischemia, we administrated a pharmacological inhibitor of Sema-3A, the SM-345431 (Vinaxanthone) in diabetic and control animals. We showed this selective inhibition significantly improved the post-ischemic revascularization, regulates the MAPK Erk1/2 and p38 signaling pathway, increased the levels of CXCL12, VEGF and TGF-β1. In our experiment conditions, we did not observe the significant effects of SM-345431 on peripheral nerve function between treated and untreated animal groups. Finally, our work showed that cell therapy using PBMNC stimulated with ephrin-B2/Fc, or the intramuscular injection of Sema-3A inhibitor referred to pro-angiogenic and/or pro-neuroregenerative, appears as a strategy promising and likely to improve the quality of life of diabetic patients.

A neuropatia motora multifocal (NMM) é uma doença rara, que compromete as fibras nervosas motoras e que pode levar a incapacidades de gravidade variável, provavelmente na dependência do seu diagnóstico e tratamento precoces. O uso de imunoglobulina humana por via endovenosa em altas doses é considerado o tratamento mais eficaz para NMM. A objetivação das incapacidades funcionais que a NMM provoca e da sua reversão parcial ou completa em decorrência do tratamento ou de sua evolução não tem sido uniforme. Tais dificuldades se devem ao fato de que os instrumentos utilizados para a mensuração das incapacidades têm sido variados e não uniformes. A escala global de avaliação das incapacidades na neuropatia motora multifocal construída pelo método Rasch (GIR - MNN) ou Multifocal Motor Neuropathy - Rasch-built Overal Disability Scale (MMN-RODS©) foi desenvolvida especificamente para a avaliação das incapacidades funcionais dos pacientes com NMM. Em recente estudo, multicêntrico, foi verificado que a MMN-RODS©, originalmente desenvolvida em inglês, preenche as expectativas do modelo de Rasch. Para aplicação no Brasil, o presente trabalho realizou a tradução, a adaptação transcultural, conforme metodologia descrita na literatura, e a aplicação da escala em pacientes com Neuropatia Motora Multifocal / Multifocal Motor Neuropathy (MMN) is a rare disease that involves the motor nerve fibers. A better prognosis for MMN is probably linked to early diagnoses and treatment. Even so, MMN can lead to severe incapacities. The use of intravenous high doses of human immunoglobulin (IgIV) is considered efficacious to treat MMN. The objectification of the incapacities provoked by MNN, their evolution, and partial or complete deficits reversion due to the treatment has not been standardized. This lack of uniformity is due to the variety of tools used for the measurement of the deficits in MMN. The multifocal motor neuropathy - Raschbuilt overall disability scale (MMN-RODS©) was developed specifically for evaluation of the functional incapacities in MNN patients. In a recent multicentric study, it was verified that MMN-RODS© fulfill the expectations of the Rasch method. The present work realized the translation, transcultural adaptation and validation of the scale to the Brazilian Portuguese context aiming to use this tool to evaluate MMN patients living in Brazil

O Diabetes mellitus (DM) é o transtorno endócrino mais comum e afeta 6% da população mundial. A neuropatia diabética é uma das complicações do DM e acomete até 60% dos doentes diabéticos. Este é um estudo descritivo que teve como objetivo avaliar as condições odontológicas e a prevalência da ardência bucal nos doentes diabéticos tipo 2 com neuropatia diabética. Foram utilizados os seguintes instrumentos de avaliação: exame sensitivo padronizado da face (algiometria), questionário RDC/TMD eixos 1 e 2, (critérios de diagnóstico em pesquisa) para o diagnóstico de disfunção temporomandibular (DTM), protocolo de avaliação de dor orofacial (EDOF-HC), questionário McGill para avaliação de dor e exame periodontal (IS índice de sangramento, PCS profundidade clínica de sondagem, PCI profundidade clínica de inserção). A prevalência de dor orofacial foi 55,2% e de ardor bucal foi 17,2%. Os valores de glicemia em jejum e HbA1c apresentaram-se acima dos valores normais. Dos doentes avaliados, 44,8% eram totalmente desdentados, 41,2% dos doentes apresentaram doença periodontal avançada, prevalência de dor miofascial mastigatória foi 31%. Traços de depressão moderada e grave e de sintomas físicos inespecíficos moderados e graves foram encontrados em 51,7% dos doentes, de incapacidade baixa e moderada em 37,9%. Observou-se comprometimento da sensibilidade dolorosa em V2 lado D (p=0,007), correlacionada com os valores de HbA1c. / Diabetes mellitus (DM) is one of the most common metabolic diseases affecting 6% of the world population. Diabetic neuropathy is one of DM complications and it affects up to 60% of diabetic patients. This descriptive study aimed to evaluate the dental characteristics and burning mouth prevalence of type 2 DM patients. The following instruments were used: pain sensory test, RDC/TMD questionnaire axis 1 and 2 (research diagnostic criteria for temporomandibular disorders), EDOF-HC protocol (for orofacial pain), Mcgills pain questionnaire and periodontal evaluation (bleeding index, clinical probing depth, clinical probing insertion). Orofacial pain was found in 55,2% of the patients, burning mouth was found in 17,2%. Fasting blood glucose and HbA1c levels were found to be higher than the recommended. 44,8% of the patients were totally edentulous, severe periodontal disease prevalence was 41,2%. Masticatory myofascial pain was found in 31% of the evaluated patients. Traces of severe and moderate depression and severe and moderate nonspecific physical symptoms were found in 51,7% of the patients; moderate and low disability in 37,9%. There was significative difference in the algometry values of the V2 right side compared to the left side and to the study group (p=0,007), with positive correlation with the increased values of the HbA1c.