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De la stimulation cérébrale profonde à l’étude physiopathologique de certaines formes génétiques de la Maladie de Parkinson

Abstract : Objectives: First, to study the mid- and long term effects of DBS in patients with a genetic form of PD from our clinic, and second, to achieve a clinical, genetic and transcriptomic study of a group of parkinsonian patients bearing a mutation in the SCA2 gene (so called SCA2 patients)Methods: 1/ Effects of DBS in patients with a genetic form of PD: five patients with a genetic form of PD, belonging to a cohort of 52 PD patients who underwent a subthalamic nucleus high frequency stimulation between 1998 and 2000, were evaluated before surgery and then after 1 and 5 years with and without L-dopa, using several scales: UPDRS II and III, dyskinesia, Schwab and England, Mattis and MADRS. The results were compared with the patients of the same cohort having a sporadic form of PD. 2/ Study of the parkinsonian SCA2 patients: the clinical picture is related retrospectively. Genetic and transcriptomic studies were performed on blood mononuclear cells from 7 parkinsonian and 8 cerebellar SCA2 patients. DNA sequencing allowed to determine the length of the CAG triplets repeat and to identify the interruptions by CAA triplets. Transcriptomes of these patients and of 13 matched controls (healthy subjects paired according to gender and age) were profiled using 2 platforms of whole human genome expression micro-arrays (Agilent and Illumina). Analyses of differential expression in cerebellar and parkinsonian patients vs their respective controls were performed with GeneSpring GX software. Genes with significant differences (fold change >1.3 and Welch t-test p< 0.05) were analyzed using Ingenuity Pathway Analysis software which identified significantly deregulated canonical pathways.Results: 1/ Effects of DBS in patients with a genetic form of PD: the results concerning the whole cohort of PD patients were similar to the literature. L-dopa-induced involuntary movements improved over time. Patients with a genetic form of PD had a best result than other patients on dopa-responsive signs and dopa-induced complications.2/ study of the parkinsonian SCA2 patients: clinical features were very typical of PD, with a mean age of onset of 55.2 years, a good L-dopa responsiveness, and classical complications of PD. DNA sequencing showed slightly longer expansions in cerebellar (37-41 triplets) than in parkinsonian patients (35-39). Cerebellar patients had no CAA interruption on their mutated allele. All parkinsonian patients had an unusual pattern of CAA interruptions. Concerning the transcriptomic study, cerebellar and parkinsonian patients had a deregulation in the expression of genes known to interact with ataxin-2 (DDX6, PABP, genes in the inositol phosphates metabolism pathway), as well as genes involved in the metabolism of cancer and in immunity. Parkinsonian patients had a deregulation of amyotrophic lateral sclerosis, VEGF and HIF1 signaling pathways. In these patients, including the least symptomatic ones, SNCA expression was down-regulated, whereas it was not in cerebellar patients. In cerebellar patients, several pathways concerning the metabolism or RNAs were deregulated, as well as p53 signaling. Several canonical pathways involving apoptosis were deregulated in both groups of patients, with an expression of pro- and antiapoptotic genes in favor of apoptosis in cerebellar patients and going against apoptosis in parkinsonian patients. .
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Clémence Simonin. De la stimulation cérébrale profonde à l’étude physiopathologique de certaines formes génétiques de la Maladie de Parkinson. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2011. Français. ⟨NNT : 2011LIL2S032⟩. ⟨tel-00988248⟩

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