Mécanismes traductionnels impliqués dans la potentialisation à long-terme de la transmission synaptique des cellules pyramidales de l’hippocampe chez le rongeur

La mémoire et l’apprentissage sont des phénomènes complexes dont on ne comprend pas encore bien l’origine au niveau cellulaire et moléculaire. Cependant, il est largement admis que des changements plus simples au niveau synaptique, tels que la potentialisation à long-terme (long-term potentiation ou LTP) pourraient constituer la base cellulaire de la formation des nouveaux souvenirs. Ces mécanismes sont couramment étudiés au niveau de l’hippocampe, une région du lobe temporal reconnue comme étant nécessaire à la formation de la mémoire explicite chez les mammifères. La LTP est classiquement définie comme un renforcement durable de l’efficacité de connexions synaptiques ayant été stimulées de façon répétée et soutenue. De plus, on peut distinguer deux formes de LTP: une LTP précoce, qui repose sur la modification de protéines déjà formées, et une LTP tardive, qui requiert, elle, la synthèse de nouvelles protéines. Cependant, bien que de nombreuses études se soient intéressées au rôle de la traduction pour la maintenance de la LTP, les mécanismes couplant l’activité synaptique à la machinerie de synthèse protéique, de même que l’identité des protéines requises sont encore peu connus. Dans cette optique, cette thèse de doctorat s’est intéressée aux interactions entre l’activité synaptique et la régulation de la traduction. Il est par ailleurs reconnu que la régulation de la traduction des ARNm eukaryotiques se fait principalement au niveau de l’initiation. Nous avons donc étudié la modulation de deux voies majeures pour la régulation de la traduction au cours de la LTP : la voie GCN2/eIF2α et la voie mTOR. Ainsi, nos travaux ont tout d’abord démontré que la régulation de la voie GCN2/eIF2α et de la formation du complexe ternaire sont nécessaires à la maintenance de la plasticité synaptique et de la mémoire à long-terme. En effet, l’activité synaptique régule la phosphorylation de GCN2 et d’eIF2α, ce qui permet de moduler les niveaux du facteur de transcription ATF4. Celui-ci régule à son tour la transcription CREB-dépendante et permet ainsi de contrôler les niveaux d’expression génique et la synthèse de protéines nécessaires pour la stabilisation à long-terme des modifications synaptiques. De plus, la régulation de la voie mTOR et de la traduction spécifique des ARNm 5’TOP semble également jouer un rôle important pour la plasticité synaptique à long-terme. La modulation de cette cascade par l’activité synaptique augmente en effet spécifiquement la capacité de traduction des synapses activées, ce qui leur permet de traduire et d’incorporer les protéines nécessaires au renforcement durable des synapses. De telles recherches permettront sans doute de mieux comprendre la régulation des mécanismes traductionnels par l’activité synaptique, ainsi que leur importance pour la maintenance de la potentialisation à long-terme et de la mémoire à long-terme.Learning and memory are complex processes that are not yet fully understood at the cellular and molecular levels. It is however widely accepted that persistent modifications of synaptic connections, like long-term potentiation (LTP), could be responsible for the encoding of new memories. These changes are frequently studied in the hippocampus, a temporal lobe structure that as been shown to be necessary for explicit memory in mammals. Long-term potentiation is classically defined as a persistent and stable modification of synaptic connections that have been repeatedly stimulated. Moreover, there are two different phases of LTP: an early-LTP, that only requires the modification of pre-existing proteins, and a late-LTP, that requires the synthesis of new proteins. Numerous studies have evaluated the role of new protein synthesis for the persistence of LTP, however, the mechanisms coupling synaptic activity and the translational machinery, as well as the identity of the necessary proteins are not yet fully understood. From this perspective, this Ph.D. thesis has evaluated the interactions between synaptic activity and the regulation of translation. As it is widely accepted that the regulation of translation is primarily at the initiation level, we therefore investigated the modulation of two major pathways for the regulation of translation during LTP: the GCN2/eIF2α pathway and the mTOR pathway. First, our studies have shown that the regulation of the GCN2/eIF2α pathway and of the ternary complex formation are necessary for the long-term maintenance of synaptic plasticity and memory. Indeed, synaptic activity regulates GCN2 and eIF2α phosphorylation, which modulates the transcription factor ATF4 levels. ATF4 in turn regulates CREB-dependent transcription, and therefore controls the levels of genetic expression and the synthesis of new proteins necessary for the long-term stabilization of synaptic modifications. Moreover, the regulation of the mTOR pathway and of the specific translation of 5’TOP mRNAs likely also play an important role for long-term synaptic plasticity. Modulation of this cascade by synaptic activity specifically increases the translational capacity of activated synapses, allowing them to translate and incorporate the necessary proteins for the lasting reinforcement of synapses. These studies will undoubtedly help to understand the regulation of translational mechanisms by synaptic activity and their significance for the maintenance of long-term potentiation and long-term memory

eIF2α Phosphorylation Bidirectionally Regulates the Switch from Short- to Long-Term Synaptic Plasticity and Memory

SummaryThe late phase of long-term potentiation (LTP) and memory (LTM) requires new gene expression, but the molecular mechanisms that underlie these processes are not fully understood. Phosphorylation of eIF2α inhibits general translation but selectively stimulates translation of ATF4, a repressor of CREB-mediated late-LTP (L-LTP) and LTM. We used a pharmacogenetic bidirectional approach to examine the role of eIF2α phosphorylation in synaptic plasticity and behavioral learning. We show that in eIF2α+/S51A mice, in which eIF2α phosphorylation is reduced, the threshold for eliciting L-LTP in hippocampal slices is lowered, and memory is enhanced. In contrast, only early-LTP is evoked by repeated tetanic stimulation and LTM is impaired, when eIF2α phosphorylation is increased by injecting into the hippocampus a small molecule, Sal003, which prevents the dephosphorylation of eIF2α. These findings highlight the importance of a single phosphorylation site in eIF2α as a key regulator of L-LTP and LTM formation

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Hereditary Angioedema with and Without C1-Inhibitor Deficiency in Postmenopausal Women

International audiencePurposeMost types of hereditary angioedema (HAE) are worsened by endogenous or exogenous estrogens. Conversely, androgens can improve HAE with abnormal C1-Inhibitor (C1-INH) by increasing C1-INH concentrations. Menopause is associated with an extinction of ovarian estrogenic and androgenic secretion. There is currently insufficient information on postmenopausal women with HAE. The objective of this study was to describe the activity of HAE in postmenopausal women.MethodsThis was a French retrospective, multicenter study in postmenopausal women with HAE with or without C1-INH deficiency/dysfunction. The patients were classified before and after menopause with a previously validated HAE disease severity score.ResultsWe included 65 women from 13 centers in France. The mean age was 62.7± 9.2 years, and the mean time between menopause and inclusion was 12.5± 9.1 years. HAE was associated with C1-INH deficiencyin 88% (n = 57) of the patients, a mutation of factor 12 in 8% (n = 5), a mutation in plasminogen gene in one, and unknown HAE for two. The HAE course was not different after menopause in 46.1% (n = 30), improved in 38.5% (n = 25), and worsened in 15.4% (n = 10). Improvement was correlated with estrogen sensitivity of angioedema before menopause (p = 0.06 for improvement vs no effect or worsening). In addition, we observed that only ten women received treatment (transdermal or oral estradiol+ progestogen) for their menopause symptoms. Among them, only 3 experienced worsening of symptoms (2 on transdermal and 1 on oral estradiol).ConclusionFollowing menopause, most women with HAE remain stable but some worsen. Improvement was mainly observed in patients with previous estrogen sensitivity. More research is required in menopausal women with HAE to better understand how to manage climacteric symptoms

Chronic myelomonocytic leukaemia associated with large- and medium-sized arteries vasculitis of the small bowel

Chronic myelomonocytic leukaemia associated with large-and medium-sized arteries vasculitis of the small bowel Rheumatology key message. Myelodysplastic syndromes associated vasculitis can be lethal and require early treatment of the haematological neoplasm

COVID‐19 as a trigger of acute attacks in people with hereditary angioedema

International audienc

Longer dupilumab dosing intervals in adult patients with atopic dermatitis: experience from a French multicentre retrospective cohort study

International audienceAbstract Background Hereditary angioedema (HAE) is associated with a heavy burden of illness. Objective To evaluate use of lanadelumab in a French Authorization for Temporary Use (ATU) program. Methods ATU requests were made between October 12, 2018, and March 13, 2019; patients were followed through September 23, 2019. At entry, patients received lanadelumab 300 mg every 2 weeks. HAE attack characteristics were evaluated at day (D) 0 and months (M) 3 and 6. Patients completed the Angioedema Quality of Life (AE-QoL) questionnaire at initiation and monthly and the Angioedema Activity Score questionnaire daily in 28 day cycles (AAS28). Results In total, 77 patients received ≥ 1 lanadelumab dose; 69 had ≥ 1 quarterly follow-up visit (analyzed population). Mean (standard deviation [SD]) lanadelumab exposure was 240.4 (53.7) days. Lanadelumab dose was modified in 12 patients (mostly to every 4 weeks). For the analyzed population, compared with attacks/month (mean [SD]) within 6 months before ATU (2.68 [2.54]), fewer attacks occurred between initiation and first visit (0.16 [0.42]; P < 0.001) or last visit (0.16 [0.42]; P < 0.001); D15 and last visit (0.15 [0.41]); and D70 and last visit (0.17 [0.70]). AE-QoL total and domain scores were significantly higher at initiation versus M3 and M6; 55% and 65% of patients, respectively, achieved a minimal clinically important difference from D0 to M3 and D0 to M6. Proportion of patients with AAS28 of 0 was higher during M3 (90%) and M6 (83%) than initiation (59%). The most frequently reported adverse events included headache (7.3%) and injection site pain (6.3%). Conclusions Lanadelumab reduced attack rates, improved quality of life, and was generally well tolerated