Insuffisance rénale chronique chez l'humain

L’insuffisance rénale chronique (IRC) se caractérise par une altération irréversible du système de filtration glomérulaire, de la fonction tubulaire et endocrine des reins. On constate une destruction du parenchyme rénal puis des anomalies métaboliques, hormonales et cliniques définissant le syndrome urémique. On estime l'importance de l'insuffisance rénale chronique par le calcul de la clairance de la créatinine par les formules de Cockcroft & Gault, MDRD ou CKD-EPI pour l'adulte et la formule de Schwartz chez l'enfant. L'insuffisance rénale chronique évolue très lentement. Au stade débutant, elle est peu symptomatique voire silencieuse. Lorsque les premiers symptômes apparaissent la destruction rénale est déjà souvent importante ; lorsqu'elle devient sévère, le retentissement viscéral et métabolique est important et conduit, en l'absence de traitement, à la mort. Histoire de l'insuffisance rénale chronique Inspiré par les travaux de Claude Bernard, le médecin hongrois

Interactions between Personality, Depression, Anxiety and Cognition to Understand Early Stage of Alzheimer's Disease

Valérie Rita Madeleine Zufferey

The multifaceted nature of Alzheimer's disease (AD) and Mild cognitive impairment (MCI) can lead to wide inter-individual differences in disease manifestation in terms of brain pathology and cognition. The lack of understanding of phenotypic diversity in AD arises from a difficulty in understanding the integration of different levels of network organization (i.e. genes, neurons, synapses, anatomical regions, functions) and in inclusion of other information such as neuropsychiatric characteristics, personal history, information regarding general health or subjective cognitive complaints in a coherent model. Non-cognitive factors, such as personality traits and behavioral and psychiatric symptoms, can be informative markers of early disease stage. It is known that personality can affect cognition and behavioral symptoms. The aim of the paper is to review the different types of interactions existing between personality, depression/anxiety, and cognition and cognitive disorders at behavioral and brain/genetic levels.

BENTHAM SCIENCE PUBL LTD2020

Role of Bicaudal-C in Left-Right Axis Formation and Kidney Morphogenesis

Charlotte Maisonneuve

The KH domain RNA binding protein Bicaudal-C is known to play a role in anterior-posterior (AP) patterning in Drosophila by acting on oskar mRNA. In mammals, its expression is induced at late gastrulation in the mesodermal layer of the ventral node. Renal cysts arise in mice and frogs lacking Bicaudal-C. Polycystic diseases and left-right (LR) axis malformations are frequently linked to cilia defects. However, a role for BicC in cilia function has not been demonstrated. Here, I report that targeted inactivation of BicC confirms a role in inducing polycystic kidney disease (PKD). In addition, this targeted mutation was found to randomize left-right (LR) asymmetry by disrupting the planar alignment of motile cilia required for cilia-driven fluid flow. Furthermore, depending on its SAM domain, BicC can uncouple Dvl2 signaling from the canonical Wnt pathway, which has been implicated in antagonizing planar cell polarity (PCP). The SAM domain is shown to concentrate BicC in cytoplasmic structures harboring RNA-processing bodies (P-bodies) and Dvl2. P-bodies are implicated degrading target mRNAs that are silenced by microRNAs. These results suggest a model whereby BicC links the orientation of cilia to PCP, possibly by regulating RNA silencing in P-bodies. In the kidney, BicC is localized in proximal tubules. The cystic phenotype is accompanied by increased levels of cAMP and of Adcy6 protein. BicC is proposed to inhibit target mRNA at the translation-initiation stage by regulating the assembly of miRNP/P-bodies.

EPFL2010

Neuroprosthetic rehabilitation and translational mechanism after severe spinal cord injury

Lucia Florinda Friedli Wittler

Traumatic SCIs have long-term health, economic and social consequences, stressing the urgency to develop interventions to improve recovery after such injuries. Today, the only proven effective interventions to enhance recovery after SCI are activity-based rehabilitation therapies, such as locomotor training. However, locomotor training shows no or very limited efficacy to improve function after a severe SCI that induces paralysis of the limbs. To mimic the outcome of severe but incomplete SCI in rodents, we developed a model of double opposite-side lateral hemisections termed staggered hemisection in adult rats. This model induced permanent paralysis below the level of injury but leaves an intervening gap of intact neural tissue that provides a substrate for recovery. We showed that this SCI leads to degradation of motor functions, which correlates with the formation of aberrant neuronal connections below the lesion. Robotic devices with a rehabilitative purpose should act as propulsive or postural neuroprosthesis allowing training under natural conditions. Our versatile robotic interface provides multidirectional bodyweight support during overground locomotion in rats. We next evaluated the effects of robot-assisted gait training enabled by electrochemical stimulation of spinal circuits to restore locomotion after staggered hemisection SCI. We found that after two months of daily training, paralyzed rats recovered the ability to initiate, sustain and adjust bipedal locomotion while supported in the robot under electrochemical stimulation. This recovery correlated with ubiquitous reorganization of corticospinal, brainstem, and intraspinal fibers. We next evaluated whether this treatment was capable of restoring supraspinal control of locomotion after a clinically relevant SCI. Rats received a severe contusion of the spinal cord that spared less than 10% of intact tissue. Robot-assisted rehabilitation restored weight-bearing locomotion in all the trained rats when stimulated electrochemicallay and in a subset of rats in the absence of any enabling factors which paralelled with the reorganization of axonal projections of reticulospinal fibers below the contusion. Virus-mediated silencing of reticulospinal neurons projecting to lumbar segments demonstrated that these inputs were necessary to initiate and sustain walking after training. When delaying the onset of training by two months, in the chronic stage, all the rats regained voluntary locomotor movements but the extent of the recovery was reduced compared to rats trained early after SCI. The results provide a strong rationale to evaluate the impact of neuroprosthetic training to improve motor functions in human patients with incomplete SCI. Translation of treatment paradigms developed in rodent models into effective clinical applications remains a major challenge in biomedical research. Here, we studied recovery of motor functions in more than 400 quadriplegic patients who presented various degree of spinal cord damage laterality. We found that recovery increases with the asymmetry of early motor deficits. We conclude that emergence of spinal cord decussating corticospinal fibers and bilateral motor cortex projections during mammalian evolution supports greater recovery after lateralized SCI primates compared to rodents. Novel experimental models and dedicated therapeutic strategies are necessary to take advantage of this powerful neuronal substrate for recovery after SCI.

EPFL2014

Neuroprosthetic rehabilitation and translational mechanism after severe spinal cord injury

Lucia Florinda Friedli Wittler

EPFL2014