Malgré des recherches intensives portant sur l’hérédité et les aspects biologiques de la rétinite pigmentaire (RP), peu de recherches fondées ont porté sur les aspects psychologiques. Ces quelques études suggèrent que les personnes atteintes de rétinite pigmentaire s’adaptent différemment à la déficience visuelle. Le but de la présente étude était donc de vérifier si les personnes atteintes de rétinite pigmentaire s’adaptaient différemment d’un point de vue psychologique par rapport à des personnes ayant une déficience visuelle causée par une autre pathologie. Des entrevues téléphoniques incluant des personnes ayant la rétinite pigmentaire, la rétinopathie diabétique (RD) et l’albinisme ont été menées. Cinq questionnaires ont été utilisés afin d’évaluer le bien-être psychologique et de recueillir les données démographique. Les résultats de la première étude démontrent qu’il n’existe aucune différence entre les individus atteints de rétinite pigmentaire et ceux ayant d’autres pathologies visuelles d’un point de vue « bien-être psychologique ». En fait, les facteurs démographiques, la baisse de vision, les fluctuations et le type de perte de vision semblent être les seuls facteurs directement corrélés à l’adaptation et au bien-être psychologique. Dans la deuxième étude, aucune différence n’a pu être établie entre les trois types de pathologies. Ce sont plutôt, des facteurs comme la perception des capacités fonctionnelles, l’identité personnelle, l’appréhension de la perception sociale et le niveau d’indépendance qui étaient davantage reliés au bien-être psychologique associé à la déficience visuelle. Les résultats de cette étude suggèrent que les personnes atteintes de Rétinite pigmentaire ne présentent pas de différences au niveau du bien-être psychologique et de l’adaptation. Les facteurs démographiques et psychologiques sont plus importants que la pathologie elle-même. / While there is extensive research on retinitis pigmentosa (RP) focusing on biological and hereditary aspects of the disease, little research regarding psychological adjustment has been conducted. These few studies suggest that people with RP adapt differently to vision impairment. This study investigated whether those with RP adapt differently to vision loss/impairment than those with other vision disorders. Telephone interviews of those with RP, diabetic retinopathy (DR), and albinism were conducted. Demographic information was gathered and psychological wellbeing was assessed using the Visual Function-14, Centre of Epidemiology Studies Depression-10 symptoms index, Impact of Vision Impairment Profile, Brief COPE, and Adaptation to Vision Loss Scale. In Experiment I it was found that individuals with RP did not differ from those with other diagnoses on any of the measures of psychological wellbeing and adaptation. Rather, demographic factors, visual factors such as declining and fluctuating vision, and pattern of vision loss, were better correlates of adaptation to and psychological wellbeing associated with vision loss/impairment. In Experiment II there was no difference found between those with RP and other diagnoses on any of the measures. Rather, factors such as perceived visual ability, self-identity, fear of social stigma and level of dependence were more closely related to adaptation to and psychological wellbeing associated with vision loss/impairment. The results of this study suggest that individuals with RP do not differ from those with other vision disorders in their adaptation to and psychological wellbeing associated with vision loss/impairment, but that other demographic, visual and psychological factors are more important.

L’objectif de cette thèse est la validation fonctionnelle d’implants rétiniens pour la restauration fonctionnelle de la vision chez des patients non voyants suite à la perte de leurs photorécepteurs. Ce travail a été réalisé sur modèle animal et a évalué expérimentalement de nouveaux protocoles de stimulation. Tout d’abord nous avons utilisé la technique de spectroscopie d’impédance pour simuler mathématiquement l’interface tissu-implantafin de caractériser la présence d’un espace entre le tissu et l’implant. La seconde partie compare par imagerie optique (IO) les caractéristiques de la réponse corticale évoquée par stimulation visuelle ou électrique de la rétine par prothèse sous rétinienne. Nous avons retrouvé que la taille de l’activation par l’implant rétinien est beaucoup plus grande que son correspondant visuel. Dans une troisième partie, est réalisée une évaluation in vitro de la performance des stimulations sur rétine isolée pour définir comment les cellules ganglionnaires réagissent à différents modes de stimulations. Ce travail a permis d’établir la courbe des réponses en fonction de l’intensité des stimulations électriques. Enfin, la thèse décrit un modèle animal de dégénérescence rétinienne qui présente des désorganisations de la rétine externe. Une analyse en IO a été réalisée sur ce modèle afin d’évaluer la réponse corticale aux stimuli visuels et électriques. Ce travail de thèse, par des approches physiques et physiologiques complémentaires, apporte un certain nombre de réponses qui devraient permettre d’améliorer l’utilisation de futures prothèses rétiniennes par une adaptation physique des matrices d’électrodes ou des patrons de stimulations utilisées / The aim of this thesis is the functional validation of retinal implants used for vision restoration in blind patients due to the loss of photoreceptors. This work was designed to develop an animal model to experimentally validate prototypes of new implants and new stimulation protocols pattern. Firstly we used the technique of impedance spectroscopy to simulate mathematically the tissue/implant interface. These data confirm the importance of reducing the space between the stimulating electrodes and retinal tissue, as well as the importance of physical characteristics of the electrical stimulus used. In a second approach, we have compared responses of visual cortical neuronal population using optical imaging (OI), evoked either by visual or electric retinal stimulation through subretinal prosthesis. This approach has demonstrated that the stimulation of an electrode induces cortical activation that the size of the cortical response to the retinal implant stimulation is much larger than its corresponding visual stimulus. In the third part, I performed in vitro experiment to measure the performance of stimulation at the level of ganglion cells of isolated retina. We have quantified the response curve as a function of the intensity of the electrical stimulation. Finally, the thesis describes a new animal model of outter retinal degeneration. OI was also performed on this model to assess the response to the visual and retinal prosthesis stimulations. This thesis, through complementary physical and physiological approaches, provides a number of responses that can potentially improve the use of retinal prostheses through specification of their design or patterns of stimulation.

Deafblindness is a combined impairment of vision and hearing with an incidence of about 1: 8000 children and 1: 5500 adults. The most common genetic causes are the Stickler (STL) and Usher (USH) syndromes. The main goal of this work is to provide an up-to-date overview of STL and USH in the Czech and Slovak Republic (CR and SR), to determine the correlations between the genotype and phenotype in our population and the associated diagnostic criteria. Using sequencing and MLPA we examined 45 patients from 28 families for suspected STL. We found potentially causal variants of STL genes in 39 patients from 22 families. Fifteen different COL2A1 variants (8 being novel) were found in 28 patients from 18 families and 4 novel COL11A1 variants were found in 11 patients from 4 families. We identified the cause of the disease in 79 % of the families. The USH study involved 30 patients from 27 families. The most frequent cause was USH2A pathogenic variants, i.e. 19 variants in 14 families, 9 being novel. Less common were pathogenic variants in MYO7A (6 variants in 3 families, 5 being novel), USH1C and CDH23 (3 variants, 2 being novel, in 2 families both) genes. In 2 families, compound heterozygosity was found for variants in two different USH genes. The deafblindness etiology was clarified for 24 patients from...

The work focuses on molecular genetic testing of patients with Usher syndrome to confirm the diagnosis, to determine the causal cause of the disease and describe new mutations causing Usher syndrome in Czech patients. Usher syndrome is a clinically and genetically heterogeneous disease that is the most common cause of hereditary deafblindness. Based on responsible genes and disease onset is classified into three clinical subtypes. Given the fact that there is currently no specific treatment, there is a need to understand the pathophysiology of this disease and to broaden the spectrum of causal mutations. The theoretical part of the thesis deals with the anatomy of the eye, especially the structure of the retina. Attention is also paid to retinal diseases, such as the progressive loss of vision characteristic for retinitis pigmentosa (RP). RP may occur either as an isolated disorder or also affecting other organs, so-called syndromic RP. Classic syndromic RP includes Usher's syndrome, which the work mainly deals with. The theoretical part of the thesis describes mainly the mechanism of the disease, the functions of individual Usher proteins and the genes that encode these proteins. The haplotype analysis has been previously done for the most common mutations causing Usher's syndrome in Europe Based...

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Les ciliopathies rétiniennes sont un groupe de maladies rares causés par des mutations de gènes ciliaires. Les défauts des gènes ciliaires peuvent causer des défauts de trafic de protéines et induit l'apoptose des cellules photoréceptrices causés par le stress du réticulum endoplasmique (RE). On a étudié ciliopathies rétiniennes par modèle mourin, amaurose congénitale de Leber, rétinopathie pigmentaire liée à l’X, syndrome de Bardet-Biedl, syndrome d’Alström. Les souris Bbs1-/- , Bbs10-/- et CEP290-/- ont monté une diminution de la fonction rétinienne et sont causée par ER stress. Les souris Rd9/y et Alms1foz/foz présentent une apparition tardive et avec un faible taux de dégénérescence rétinienne et ils pourrait être causée par d'autres mécanismes. Le traitement GV-Ret basé sur le stress du RE pourrait sauver à la fois la fonction de et la morphologie de la rétine dans souris BBS. / Retinal ciliopathies are a group of rare diseases caused by mutations of ciliary genes. Defects in ciliary genes can cause defects in proteins traffics and induces apoptosis of photoreceptor cells caused by stress of the endoplasmic reticulum (ER) .We studied retinal ciliopathies by mice models, Leber congenital amaurosis, Xlinked retinitis pigmentosa, Bardet-Biedl syndrome and Alström Syndrome. The Bbs1-/-, Bbs10-/- and CEP290-/- mice exhibited a decrease in retinal function caused by ER stress. Rd9/y and Alms1foz/foz mice showed a late onset and a low rate of retinal degeneration and they could be caused by other mechanisms. The GV-Ret treatment based on ER stress could save both the function and morphology of the retina in BBS mice .

<p>The goal of this thesis is to algorithmically identify candidate modifiers for <i>retinitis pigmentosa</i> (RP) to help improve therapy and predictions for this genetic disorder that may lead to a complete loss of vision. A current research by (Chow et al., 2016) focused on the genetic contributors to RP by trying to recognize a correlation between genetic modifiers and phenotypic variation in female <i>Drosophila melanogaster</i>, or fruit flies. In comparison to the genome-wide association analysis carried out in Chow et al.’s research, this study proposes using a K-Means clustering algorithm on RNA expression data to better understand which genes best exhibit characteristics of the RP degenerative model. Validating this algorithm’s effectiveness in identifying suspected genes takes priority over their classification.</p><p>This study investigates the linear relationship between <i>Drosophila </i>eye size and genetic expression to gather statistically significant, strongly correlated genes from the clusters with abnormally high or low eye sizes. The clustering algorithm is implemented in the R scripting language, and supplemental information details the steps of this computational process. Running the mean eye size and genetic expression data of 18,140 female <i>Drosophila</i> genes and 171 strains through the proposed algorithm in its four variations helped identify 140 suspected candidate modifiers for retinal degeneration. Although none of the top candidate genes found in this study matched Chow’s candidates, they were all statistically significant and strongly correlated, with several showing links to RP. These results may continue to improve as more of the 140 suspected genes are annotated using identical or comparative approaches.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Human induced pluripotent stem (iPS) cells have the unique ability to differentiate into 200 or so somatic cell types that make up the adult human being. The use of human iPS cells to study development and disease is a highly exciting and interdependent field that holds great promise in understanding and elucidating mechanisms behind cellular differentiation with future applications in drug screening and cell replacement studies for complex and currently incurable cellular degenerative disorders. The recent advent of iPS cell technology allows for the generation of patient-specific cell lines that enable us to model the progression of a disease phenotype in a human in vitro model. Differentiation of iPS cells toward the affected cell type provides an unlimited source of diseased cells for examination, and to further study the developmental progression of the disease in vitro, also called the “disease-in-a-dish” model. In this study, efforts were undertaken to recapitulate the differentiation of distinct retinal cell affected in two highly prevalent retinal diseases, Usher syndrome and glaucoma. Using a line of Type III Usher Syndrome patient derived iPS cells efforts were undertaken to develop such an approach as an effective in vitro model for studies of Usher Syndrome, the most commonly inherited disorder affecting both vision and hearing. Using existing lines of iPS cells, studies were also aimed at differentiation and characterization of the more complex retinal cell types, retinal ganglion cells (RGCs) and astrocytes, the cell types affected in glaucoma, a severe neurodegenerative disease of the retina leading to eventual irreversible blindness. Using a previously described protocol, the iPS cells were directed to differentiate toward a retinal fate through a step-wise process that proceeds through all of the major stages of neuroretinal development. The differentiation process was monitored for a period of 70 days for the differentiation of retinal cell types and 150 days for astrocyte development. The different stages of differentiation and the individually derived somatic cell types were characterized by the expression of developmentally associated transcription factors specific to each cell type. Further approaches were undertaken to characterize the morphological differences between RGCs and other neuroretinal cell types derived in the process. The results of this study successfully demonstrated that Usher syndrome patient derived iPS cells differentiated to the affected photoreceptors of Usher syndrome along with other mature retinal cell types, chronologically analogous to the development of the cell types in a mature human retina. This study also established a robust method for the in vitro derivation of RGCs and astrocytes from human iPS cells and provided novel methodologies and evidence to characterize these individual somatic cell types. Overall, this study provides a unique insight into the application of human pluripotent stem cell biology by establishing a novel platform for future studies of in vitro disease modeling of the retinal degenerative diseases: Usher syndrome and glaucoma. In downstream applications of this study, the disease relevant cell types derived from human iPS cells can be used as tools to further study disease progression, drug screening and cell replacement strategies.