La dynamique structurale de l'acétylcholinestérase: étude réalisée par cristallographie aux rayons X et une méthode spectroscopique complémentaire.

This work aimed at watching acetylcholinesterase (AChE) 'at work'. AChE is a very rapid enzyme and terminates the transmission of the nervous influx at cholinergic synapses. Conformational substates of Torpedo californica (Tc) AChE were trapped in x-ray crystallography structures of the enzyme in complex with putative anti-Alzheimer drugs. Structures of both nonaged and aged conjugates of TcAChE and soman were solved, which allowed to shed light on the mechanism of aging in organophosphate (OP) - inhibited AChE. The structure of the ternary complex of the nonaged conjugate and a reactivator was solved. All those structures will help designing new AChE-targeted drugs (anti-Alzheimer drugs or antidotes against OP poisoning) by taking into account flexibility and minor conformations of the enzyme. The structure of TcAChE in complex with the peripheral site (PAS) inhibitor aflatoxin B1 was solved in two crystal forms. This work revealed crystallography artifacts that should be avoided for correct biological interpretation. Measurement of the phosphorescence lifetime of AB1 allowed probing PAS dynamics on the timescale of seconds, thereby highlighting differential flexibility in two distinct crystal packing environments of TcAChE. This spectroscopic method is proposed as a complementary tool for kinetic crystallography experiments. An optimal cryogenic temperature range was identified, which could help exploring the reaction mechanisms of AChE by slowing down the enzyme motions without freezing them.L'objectif de la thèse était de regarder l'acétylcholinestérase (AChE) en mouvement. L'AChE est une enzyme très rapide qui met fin à la transmission de l'influx nerveux au sein des synapses cholinergiques. À l'aide de la cristallographie aux rayons X, des sous-états conformationnels de l'AChE de Torpedo californica (Tc) ont été piégés par sa liaison à des drogues anti-Alzheimer putatives. Les formes, non vieillie et vieillie, de la TcAChE conjuguée au soman ont été caractérisées structuralement, éclairant ainsi le mécanisme de vieillissement de la TcAChE inhibée par les organophosphorés (OP). La structure du complexe ternaire du conjugué vieilli avec un réactivateur a également été résolue. Toutes ces structures guideront l'élaboration de médicaments (drogues anti-Alzheimer ou antidotes contre l'empoisonnement par des OP) en prenant en compte la flexibilité de l'enzyme et ses conformations minoritaires. La structure du complexe de la TcAChE avec un inhibiteur de son site périphérique (PAS), l'aflatoxine B1 (AB1), a été résolue dans deux formes cristallines. Ce travail a mis en évidence des artefacts de la cristallographie nuisibles à l'interprétation biologique des structures. La mesure du temps de vie de phosphorescence de l'AB1 a permis de sonder les mouvements du PAS à l'échelle de la seconde et de révéler des différences de flexibilité liées à l'empilement cristallin de la TcAChE. Cette méthode spectroscopique est complémentaire à la cristallographie cinétique. La gamme de températures cryogéniques identifiée pourrait en effet faciliter l'exploration du mécanisme réactionnel de l'AChE, en ralentissant l'enzyme sans pour autant la figer

La dynamique structurale de l'acétylcholinestérase: étude réalisée par cristallographie aux rayons X et une méthode spectroscopique complémentaire.

This work aimed at watching acetylcholinesterase (AChE) 'at work'. AChE is a very rapid enzyme and terminates the transmission of the nervous influx at cholinergic synapses. Conformational substates of Torpedo californica (Tc) AChE were trapped in x-ray crystallography structures of the enzyme in complex with putative anti-Alzheimer drugs. Structures of both nonaged and aged conjugates of TcAChE and soman were solved, which allowed to shed light on the mechanism of aging in organophosphate (OP) - inhibited AChE. The structure of the ternary complex of the nonaged conjugate and a reactivator was solved. All those structures will help designing new AChE-targeted drugs (anti-Alzheimer drugs or antidotes against OP poisoning) by taking into account flexibility and minor conformations of the enzyme. The structure of TcAChE in complex with the peripheral site (PAS) inhibitor aflatoxin B1 was solved in two crystal forms. This work revealed crystallography artifacts that should be avoided for correct biological interpretation. Measurement of the phosphorescence lifetime of AB1 allowed probing PAS dynamics on the timescale of seconds, thereby highlighting differential flexibility in two distinct crystal packing environments of TcAChE. This spectroscopic method is proposed as a complementary tool for kinetic crystallography experiments. An optimal cryogenic temperature range was identified, which could help exploring the reaction mechanisms of AChE by slowing down the enzyme motions without freezing them.L'objectif de la thèse était de regarder l'acétylcholinestérase (AChE) en mouvement. L'AChE est une enzyme très rapide qui met fin à la transmission de l'influx nerveux au sein des synapses cholinergiques. À l'aide de la cristallographie aux rayons X, des sous-états conformationnels de l'AChE de Torpedo californica (Tc) ont été piégés par sa liaison à des drogues anti-Alzheimer putatives. Les formes, non vieillie et vieillie, de la TcAChE conjuguée au soman ont été caractérisées structuralement, éclairant ainsi le mécanisme de vieillissement de la TcAChE inhibée par les organophosphorés (OP). La structure du complexe ternaire du conjugué vieilli avec un réactivateur a également été résolue. Toutes ces structures guideront l'élaboration de médicaments (drogues anti-Alzheimer ou antidotes contre l'empoisonnement par des OP) en prenant en compte la flexibilité de l'enzyme et ses conformations minoritaires. La structure du complexe de la TcAChE avec un inhibiteur de son site périphérique (PAS), l'aflatoxine B1 (AB1), a été résolue dans deux formes cristallines. Ce travail a mis en évidence des artefacts de la cristallographie nuisibles à l'interprétation biologique des structures. La mesure du temps de vie de phosphorescence de l'AB1 a permis de sonder les mouvements du PAS à l'échelle de la seconde et de révéler des différences de flexibilité liées à l'empilement cristallin de la TcAChE. Cette méthode spectroscopique est complémentaire à la cristallographie cinétique. La gamme de températures cryogéniques identifiée pourrait en effet faciliter l'exploration du mécanisme réactionnel de l'AChE, en ralentissant l'enzyme sans pour autant la figer

18F-FDG-PET partial volume effect correction using a modified recovery coefficient approach based on functional volume and local contrast: physical validation and clinical feasibility in oncology.

International audience2-deoxy-2-[18F]fluoro-D-glucose 18F-FDG uptake within tumors reflects the glucose consumption of malignant tumors, i.e., the tumor activity. Thus, 18F-FDG uptake measurements enable improved therapeutic monitoring of patients in chemo- or radiotherapy treatment through the detection of changes in tumor uptake via quantitative measurements of the lesion standard uptake values (SUVs) or activity concentrations. A major bias that affects positron emission tomography (PET) image quantitation is the partial volume effect (PVE), which most strongly affects the smallest structures due to the poor spatial resolution of PET. Thus, PVE corrections are important when 18F-FDG-PET images are used as a quantitative tool for monitoring responses to therapy. The aim of this paper was to propose a PVE correction based on a modified recovery coefficient method (termed FARCAS) that considers the functional volumes and local contrasts of lesions that are automatically determined using a semi-automatic iterative segmentation algorithm

Diagnosis of Tetanus Immunization Status: Multicenter Assessment of a Rapid Biological Test

Diagnosis of tetanus immunization status by medical interview of patients with wounds is poor. Many protected patients receive unnecessary vaccine or immunoglobulin, and unprotected patients may receive nothing. The aim of this study is to evaluate the feasibility and accuracy of the Tetanos Quick Stick (TQS) rapid finger prick stick test in the emergency department for determining immunization status. We designed a prospective multicenter study for blinded comparison of TQS with an enzyme-linked immunosorbent assay (ELISA). Adults referred for open wounds in 37 French hospital emergency departments had the TQS after receiving standard care (emergency-TQS). TQS was also performed in the hospital laboratory on total blood (blood/lab-TQS) and serum (serum/lab-TQS). ELISA was performed with the same blood sample at a central laboratory. We assessed concordance between emergency-TQS and blood/lab-TQS by the kappa test and the diagnostic accuracy (likelihood ratios) of medical interview, emergency-TQS, and lab-TQS. ELISA was positive in 94.6% of the 988 patients included. Concordance between blood/emergency-TQS and blood/lab-TQS results was moderate (κ = 0.6), with a high proportion of inconclusive blood/emergency-TQS tests (9.8%). Likelihood ratios for immunization were 3.0 (95% confidence interval [CI], 1.8 to 5.1), 36.6 (95% CI, 5.3 to 255.3), 89.1 (95% CI, 5.6 to 1,405.0), and 92.7 (95% CI, 5.9 to 1,462.0) for medical interview, blood/emergency-TQS, blood/lab-TQS, and serum/lab-TQS, respectively. The sensitivity of the blood/emergency-TQS was 76.7%, and the specificity was 98% by reference to the ELISA. TQS use in the emergency room could make tetanus prevention more accurate if its technical feasibility were improved, and our assessment will be supplemented by a cost effectiveness study

Maintenance of a Gastric Pacemaker in the Excluded Stomach During a Roux-en-Y Gastric Bypass Procedure in a Patient with Obesity, Type 1 Diabetes and Refractory Gastroparesis

International audienc

The French National Registry of patients with Facioscapulohumeral muscular dystrophy

Abstract Background Facioscapulohumeral muscular dystrophy is a rare inherited neuromuscular disease with an estimated prevalence of 1/20,000 and France therefore harbors about 3000 FSHD patients. With research progress and the development of targeted therapies, patients’ identification through registries can facilitate and improve recruitment in clinical trials and studies. Results The French National Registry of FSHD patients was designed as a mixed model registry involving both patients and physicians, through self-report and clinical evaluation questionnaires respectively, to collect molecular and clinical data. Because of the limited number of patients, data quality is a major goal of the registry and various automatic data control features have been implemented in the bioinformatics system. In parallel, data are manually validated by molecular and clinical curators. Since its creation in 2013, data from 638 FSHD patients have been collected, representing about 21% of the French FSHD population. The mixed model strategy allowed to collect 59.1% of data from both patients and clinicians; 26 and 14.9% from respectively patients and clinicians only. With the identification of the FSHD1 and FSHD2 forms, specific questionnaires have been designed. Though FSHD2 patients are progressively included, FSHD1 patients still account for the majority (94.9%). The registry is compatible with the FAIR principles as data are Findable, Accessible and Interoperable. We thus used molecular standards and standardized clinical terms used by the FILNEMUS French network of reference centers for the diagnosis and follow-up of patients suffering from a rare neuromuscular disease. The implemented clinical terms mostly map to dictionaries and terminology systems such as SNOMED-CT (75% of terms), CTV3 (61.7%) and NCIt (53.3%). Because of the sensitive nature of data, they are not directly reusable and can only be accessed as aggregated data after evaluation and approval by the registry oversight committee. Conclusions The French National Registry of FSHD patients belongs to a national effort to develop databases, which should now interact with other initiatives to build a European and/or an international FSHD virtual registry for the benefits of patients. It is accessible at www.fshd.fr and various useful information, links, and documents, including a video, are available for patients and professionals

Delineation of small mobile tumours with FDG-PET/CT in comparison to pathology in breast cancer patients.

International audienceVarious segmentation methods for 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) images were correlated with pathological volume in breast cancer patients as a model of small mobile tumours. Thirty women with T2-T3/M0 breast invasive ductal carcinoma (IDC) were included prospectively. A FDG-PET/CT was acquired 4 ± 3d before surgery in prone and supine positions, with/without respiratory gating. The segmentation methods were as follows: manual (Vm), relative (Vt%) and adaptive (Va) standard uptake value (SUV) threshold and semi-automatic on CT (Vct). Pathological volumes (Vpath) were measured for 26 lesions. The mean (±SD) Vpath was 4.1 ± 2.9 mL, and the lesion displacements were 3.9 ± 2.8 mm (median value: 3 mm). The delineated VOIs did not vary with the acquisition position nor with respiration, regardless of the segmentation method. The Vm, Va, Vct and Vt% methods, except Vt30%, were correlated with Vpath (0.5<r<0.8). The Vt50% and Vm were the most accurate methods (mean±SD: 0.0 ± 1.6 mL and +0.6 ± 1.8 mL, respectively), followed by the Vct method. When compared with pathology, small lesions (diameter <50mm) with limited respiratory displacement (i.e., breast or apical lung lesions) are best delineated on FDG-PET/CT using a 50% SUVmax threshold. The acquisition position and respiratory gating did not modify the delineated volumes

Design, synthesis and biological evaluation of novel tetrahydroacridine pyridine- aldoxime and -amidoxime hybrids as efficient uncharged reactivators of nerve agent-inhibited human acetylcholinesterase

International audienceA series of new uncharged functional acetylcholinesterase (AChE) reactivators including heterodimers of tetrahydroacridine with 3-hydroxy-2-pyridine aldoximes and amidoximes has been synthesized. These novel molecules display in vitro reactivation potencies towards VX-, tabun- and paraoxon-inhibited human AChE that are superior to those of the mono- and bis-pyridinium aldoximes currently used against nerve agent and pesticide poisoning. Furthermore, these uncharged compounds exhibit a broader reactivity spectrum compared to currently approved remediation drugs