Long-term follow-up of patients with congenital myasthenic syndrome caused by COLQ mutations.

Congenital myasthenic syndromes (CMS) are clinically and genetically heterogeneous inherited disorders characterized by impaired neuromuscular transmission. Mutations in the acetylcholinesterase (AChE) collagen-like tail subunit gene (COlQ) cause recessive forms of synaptic CMS with end plate AChE deficiency. We present data on 15 COLQ -mutant CMS carrying 16 different mutations (9 novel ones identified) followed-up for an average period of 10 ears. The mean age at the first examination was 19 ears old (range from 3 to 48). We report relapses during short or long-term periods characterized by worsening of muscle weakness sometimes associated with respiratory crises. All the relapses ended spontaneously or with 3-4 DAP or ephedrine with no residual impairment. The triggering factors identified were esterase inhibitors, effort, puberty or pregnancy highlighting the importance of hormonal factors. There was no genotype-phenotype correlation. At the end of the follow-up, 80% of patients were ambulant and 87% of patients had no respiratory trouble in spite of severe relapses.

Le renouveau des antagonistes de l'atdostérone [The revived interest in aldosterone antagonists]

Aldosterone plays a pivotal role in sodium and water homeostasis, in particular in patients with heart failure or high blood pressure. These medications, when used on top of a standard therapy, improve the outcome of patients with heart failure and are also effective in lowering blood pressure of hypertensive patients. The major risk associated with the use of these antagonists is hyperkalemia, which can be prevented in avoiding their prescription in patients with impaired renal function. Eplerenone has the advantage, compared with spironolactone, to be better tolerated in terms of "hormonal" adverse effects.

Gériatrie [Geriatry]

This review discuss several studies published in 2007 that will modify current therapeutic attitudes. New evidence confirm that antipsychotics increase mortality in demented elderly persons with behavioral symptoms. Unfortunately, donepezil was no more effective than placebo to treat agitation in these patients. Aspirine, nonsteroidal anti-inflammatories, as well as supplementation with folate, vitamines B6 and B12 did not prove beneficial to prevent cognitive decline. Hormonal substitution with DHEA, testosterone, and growth hormone is ineffective as anti-aging medicine, while calcium and vitamin d'effectiveness was confirmed in fracture prevention. Finally, several studies report prognostic information that will prove important to improve preparation plan for future heat wave.

Histologia hepática e produção em tanques-rede de tilápia-do-nilo masculinizada hormonalmente ou não masculinizada

O objetivo deste trabalho foi avaliar o desempenho e a sanidade da estrutura hepática de tilápia-do-nilo, masculinizada hormonalmente ou não masculinizada, criada em tanques-rede com dois níveis proteicos. Tilápias-do-nilo da linhagem Tailandesa (total de 2.400), com peso médio inicial de 127 g, foram distribuídas em delineamento inteiramente casualizado, com quatro tratamentos, em arranjo fatorial 2×2, correspondente aos grupos de tilápias masculinizadas hormonalmente ou não masculinizadas e ao teor proteico na dieta de 28 ou 32% de proteína bruta, com três repetições. Após 115 dias de alimentação, não houve interação entre os fatores quanto a peso final, ganho de peso, conversão alimentar, comprimento final e sobrevivência. Não houve diferença entre os peixes masculinizados hormonalmente e os não masculinizados, quanto a peso final, ganho de peso e sobrevivência, o que mostra a possibilidade de sua produção em tanques-rede, sem a necessidade de masculinização hormonal. A proteína bruta a 32% na dieta possibita melhor desempenho para ambos os grupos. Alterações histológicas no fígado - como o incremento do volume das células, o desarranjo da disposição cordonal e o aumento de vesículas nos hepatócitos - são encontradas nos peixes masculinizados hormonalmente e são mais acentuadas nos peixes alimentados com 32% de proteína bruta na dieta.

Multi-scale systems analysis of plant development : beyond cellular signaling and tissue morphodynamics

Les plantes sont essentielles pour les sociétés humaines. Notre alimentation quotidienne, les matériaux de constructions et les sources énergétiques dérivent de la biomasse végétale. En revanche, la compréhension des multiples aspects développementaux des plantes est encore peu exploitée et représente un sujet de recherche majeur pour la science. L'émergence des technologies à haut débit pour le séquençage de génome à grande échelle ou l'imagerie de haute résolution permet à présent de produire des quantités énormes d'information. L'analyse informatique est une façon d'intégrer ces données et de réduire la complexité apparente vers une échelle d'abstraction appropriée, dont la finalité est de fournir des perspectives de recherches ciblées. Ceci représente la raison première de cette thèse. En d'autres termes, nous appliquons des méthodes descriptives et prédictives combinées à des simulations numériques afin d'apporter des solutions originales à des problèmes relatifs à la morphogénèse à l'échelle de la cellule et de l'organe. Nous nous sommes fixés parmi les objectifs principaux de cette thèse d'élucider de quelle manière l'interaction croisée des phytohormones auxine et brassinosteroïdes (BRs) détermine la croissance de la cellule dans la racine du méristème apical d'Arabidopsis thaliana, l'organisme modèle de référence pour les études moléculaires en plantes. Pour reconstruire le réseau de signalement cellulaire, nous avons extrait de la littérature les informations pertinentes concernant les relations entre les protéines impliquées dans la transduction des signaux hormonaux. Le réseau a ensuite été modélisé en utilisant un formalisme logique et qualitatif pour pallier l'absence de données quantitatives. Tout d'abord, Les résultats ont permis de confirmer que l'auxine et les BRs agissent en synergie pour contrôler la croissance de la cellule, puis, d'expliquer des observations phénotypiques paradoxales et au final, de mettre à jour une interaction clef entre deux protéines dans la maintenance du méristème de la racine. Une étude ultérieure chez la plante modèle Brachypodium dystachion (Brachypo- dium) a révélé l'ajustement du réseau d'interaction croisée entre auxine et éthylène par rapport à Arabidopsis. Chez ce dernier, interférer avec la biosynthèse de l'auxine mène à la formation d'une racine courte. Néanmoins, nous avons isolé chez Brachypodium un mutant hypomorphique dans la biosynthèse de l'auxine qui affiche une racine plus longue. Nous avons alors conduit une analyse morphométrique qui a confirmé que des cellules plus anisotropique (plus fines et longues) sont à l'origine de ce phénotype racinaire. Des analyses plus approfondies ont démontré que la différence phénotypique entre Brachypodium et Arabidopsis s'explique par une inversion de la fonction régulatrice dans la relation entre le réseau de signalisation par l'éthylène et la biosynthèse de l'auxine. L'analyse morphométrique utilisée dans l'étude précédente exploite le pipeline de traitement d'image de notre méthode d'histologie quantitative. Pendant la croissance secondaire, la symétrie bilatérale de l'hypocotyle est remplacée par une symétrie radiale et une organisation concentrique des tissus constitutifs. Ces tissus sont initialement composés d'une douzaine de cellules mais peuvent aisément atteindre des dizaines de milliers dans les derniers stades du développement. Cette échelle dépasse largement le seuil d'investigation par les moyens dits 'traditionnels' comme l'imagerie directe de tissus en profondeur. L'étude de ce système pendant cette phase de développement ne peut se faire qu'en réalisant des coupes fines de l'organe, ce qui empêche une compréhension des phénomènes cellulaires dynamiques sous-jacents. Nous y avons remédié en proposant une stratégie originale nommée, histologie quantitative. De fait, nous avons extrait l'information contenue dans des images de très haute résolution de sections transverses d'hypocotyles en utilisant un pipeline d'analyse et de segmentation d'image à grande échelle. Nous l'avons ensuite combiné avec un algorithme de reconnaissance automatique des cellules. Cet outil nous a permis de réaliser une description quantitative de la progression de la croissance secondaire révélant des schémas développementales non-apparents avec une inspection visuelle classique. La formation de pôle de phloèmes en structure répétée et espacée entre eux d'une longueur constante illustre les bénéfices de notre approche. Par ailleurs, l'exploitation approfondie de ces résultats a montré un changement de croissance anisotropique des cellules du cambium et du phloème qui semble en phase avec l'expansion du xylème. Combinant des outils génétiques et de la modélisation biomécanique, nous avons démontré que seule la croissance plus rapide des tissus internes peut produire une réorientation de l'axe de croissance anisotropique des tissus périphériques. Cette prédiction a été confirmée par le calcul du ratio des taux de croissance du xylème et du phloème au cours de développement secondaire ; des ratios élevés sont effectivement observés et concomitant à l'établissement progressif et tangentiel du cambium. Ces résultats suggèrent un mécanisme d'auto-organisation établi par un gradient de division méristématique qui génèrent une distribution de contraintes mécaniques. Ceci réoriente la croissance anisotropique des tissus périphériques pour supporter la croissance secondaire. - Plants are essential for human society, because our daily food, construction materials and sustainable energy are derived from plant biomass. Yet, despite this importance, the multiple developmental aspects of plants are still poorly understood and represent a major challenge for science. With the emergence of high throughput devices for genome sequencing and high-resolution imaging, data has never been so easy to collect, generating huge amounts of information. Computational analysis is one way to integrate those data and to decrease the apparent complexity towards an appropriate scale of abstraction with the aim to eventually provide new answers and direct further research perspectives. This is the motivation behind this thesis work, i.e. the application of descriptive and predictive analytics combined with computational modeling to answer problems that revolve around morphogenesis at the subcellular and organ scale. One of the goals of this thesis is to elucidate how the auxin-brassinosteroid phytohormone interaction determines the cell growth in the root apical meristem of Arabidopsis thaliana (Arabidopsis), the plant model of reference for molecular studies. The pertinent information about signaling protein relationships was obtained through the literature to reconstruct the entire hormonal crosstalk. Due to a lack of quantitative information, we employed a qualitative modeling formalism. This work permitted to confirm the synergistic effect of the hormonal crosstalk on cell elongation, to explain some of our paradoxical mutant phenotypes and to predict a novel interaction between the BREVIS RADIX (BRX) protein and the transcription factor MONOPTEROS (MP),which turned out to be critical for the maintenance of the root meristem. On the same subcellular scale, another study in the monocot model Brachypodium dystachion (Brachypodium) revealed an alternative wiring of auxin-ethylene crosstalk as compared to Arabidopsis. In the latter, increasing interference with auxin biosynthesis results in progressively shorter roots. By contrast, a hypomorphic Brachypodium mutant isolated in this study in an enzyme of the auxin biosynthesis pathway displayed a dramatically longer seminal root. Our morphometric analysis confirmed that more anisotropic cells (thinner and longer) are principally responsible for the mutant root phenotype. Further characterization pointed towards an inverted regulatory logic in the relation between ethylene signaling and auxin biosynthesis in Brachypodium as compared to Arabidopsis, which explains the phenotypic discrepancy. Finally, the morphometric analysis of hypocotyl secondary growth that we applied in this study was performed with the image-processing pipeline of our quantitative histology method. During its secondary growth, the hypocotyl reorganizes its primary bilateral symmetry to a radial symmetry of highly specialized tissues comprising several thousand cells, starting with a few dozens. However, such a scale only permits observations in thin cross-sections, severely hampering a comprehensive analysis of the morphodynamics involved. Our quantitative histology strategy overcomes this limitation. We acquired hypocotyl cross-sections from tiled high-resolution images and extracted their information content using custom high-throughput image processing and segmentation. Coupled with an automated cell type recognition algorithm, it allows precise quantitative characterization of vascular development and reveals developmental patterns that were not evident from visual inspection, for example the steady interspace distance of the phloem poles. Further analyses indicated a change in growth anisotropy of cambial and phloem cells, which appeared in phase with the expansion of xylem. Combining genetic tools and computational modeling, we showed that the reorientation of growth anisotropy axis of peripheral tissue layers only occurs when the growth rate of central tissue is higher than the peripheral one. This was confirmed by the calculation of the ratio of the growth rate xylem to phloem throughout secondary growth. High ratios are indeed observed and concomitant with the homogenization of cambium anisotropy. These results suggest a self-organization mechanism, promoted by a gradient of division in the cambium that generates a pattern of mechanical constraints. This, in turn, reorients the growth anisotropy of peripheral tissues to sustain the secondary growth.

Regulation of the vitellogenin gene B1 promoter after transfer into hepatocytes in primary cultures.

The estrogen-dependent and tissue-specific regulation of the Xenopus laevis vitellogenin gene B1 promoter has been studied by lipid-mediated DNA transfer into Xenopus hepatocytes in primary culture. Hepatocytes achieve an efficient hormonal control of this promoter through a functional interaction between the estrogen responsive elements and a promoter proximal region upstream of the TATA box, which is characterized by a high density of binding sites for the transcription factors CTF/NF-1, C/EBP and HNF3. DNA accessibility to restriction enzymes within the chromosomal copy of the vitellogenin gene B1 promoter shows that the estrogen responsive unit and the promoter proximal region are sensitive to digestion in uninduced and estrogen-induced hepatocytes but not in erythrocyte nuclei. Together, these findings support the notion that chromatin configuration as well as the interplay of promoter elements mediate proper hormone-dependent and tissue-specific expression of the B1 vitellogenin gene.

Acute toxicity of curative radiotherapy for intermediate risk localized prostate cancer in the EORTC trial 22991

Introduction: EORTC trial 22991 randomly assessed the addition of concomitant and adjuvant short-term hormonal therapy to curative conformal/intensity-modulated radiotherapy (RT) for intermediate risk localized prostate cancer. We report the acute toxicity (assessed weekly during RT) for the organs at risk (genito-urinary (GU) and gastro-intestinal (GI)) in relation to radiation parameters. Material and Methods: Eligibility criteria were age _80 years, PSA _ 50 ng/ml, N0M0 and either tumour stage cT2a (1997 UICC TNM) or cT1b-c combined with PSA_10 ng/ml and/or Gleason score _7. We report toxicity for all eligible patients who received the planned RT with documented acute toxicity (CTCAEv.2) and RT-quality assurance parameters. The RT dose (70 Gy, 74 Gy or 78 Gy) and technique (3DCRT vs IRMT) were per institution choice, the randomization was stratified for institution. Statistical significance was set at 0.05. (ClinicalTrials.gov: NCT00021450) Results: Of 819 randomized patients, 28 were excluded from the analysis (3 with <60 Gy RT, 25 with missing information). Of the 791 analysed patients, 652 (82.4%) were treated with 3D-CRT, 139 with IMRT. In the 3DCRT group, 195 patients (29.9%) were treated with a total prescribed dose of 70 Gy; 376 (57.7%) with 74 Gy and 81 (12.4%) with 78 Gy. In the IMRT group, 28 (20.1%) were treated to a total dose of 74 Gy and 111 (79.9%) with 78 Gy. Overall, only 7 of 791 patients (0.9%) had grade 3 GI toxicity during RT: diarrhea (N = 6), rectal bleeding (N = 1) and proctitis (N = 1). Fifty patients (6.3%) had grade 3 GU toxicity: urinary frequency (N = 38, 4.6%), dysuria (N = 14, 1.7%), urinary retention (N = 11, 1.3%), urinary incontinence (N = 2) and hematuria (N = 1). No grade 4 toxicity was reported. Hormonal treatment did not influence the risk of side effects (p>0.05). The risk of grade _2 GI toxicity significantly correlated to D50%-rectum (p = 0.004) with a cut-of value of 44 Gy. The risk of grade _2 GU toxicity was moderately affected by Dmax-bladder (p = 0.051). Overall, only 14 patients (1.8%) had residual grade 3 toxicities one month after RT. Conclusion: 3D-CRT and IMRT up to 78 Gy is well tolerated. Dmaxbladder and D50%-rectum were related to the risk of grade_2 GU and GI toxicity, respectively. IMRT lowered D50% rectum and Dmax-bladder. An irradiated volume >400 cc for 3D-RT and a dose of 78 Gy, even for IMRT, negatively affected those parameters and increased the risk for toxicity.

Predicting prognosis using molecular profiling in estrogen receptor-positive breast cancer treated with tamoxifen.

Background: Estrogen receptor positive (ER+) breast cancers (BC) are heterogeneous with regard to their clinical behavior and response to therapies. The ER is currently the best predictor of response to the anti-estrogen agent tamoxifen, yet up to 30-40% of ER+ BC will relapse despite tamoxifen treatment. New prognostic biomarkers and further biological understanding of tamoxifen resistance are required. We used gene expression profiling to develop an outcome-based predictor using a training set of 255 ER+ BC samples from women treated with adjuvant tamoxifen monotherapy. We used clusters of highly correlated genes to develop our predictor to facilitate both signature stability and biological interpretation. Independent validation was performed using 362 tamoxifen-treated ER+ BC samples obtained from multiple institutions and treated with tamoxifen only in the adjuvant and metastatic settings.Results: We developed a gene classifier consisting of 181 genes belonging to 13 biological clusters. In the independent set of adjuvantly-treated samples, it was able to define two distinct prognostic groups (HR 2.01 95% CI: 1.29-3.13; p = 0.002). Six of the 13 gene clusters represented pathways involved in cell cycle and proliferation. In 112 metastatic breast cancer patients treated with tamoxifen, one of the classifier components suggesting a cellular inflammatory mechanism was significantly predictive of response.Conclusion: We have developed a gene classifier that can predict clinical outcome in tamoxifen-treated ER+ BC patients. Whilst our study emphasizes the important role of proliferation genes in prognosis, our approach proposes other genes and pathways that may elucidate further mechanisms that influence clinical outcome and prediction of response to tamoxifen.

Transsexualisme: enjeux et spécificités liés à la prise en charge d'une demande de réassignation sexuelle [Gender identity disorder: challenges and specificity in the treatment of requests for sexual reassignment].

Gender identity disorder is defined as a permanent desire to relieve one's own sexual features to acquire the sexual features and line to life of the opposite sex. The diagnosis is based on the psychiatric evaluation and treatment on an interdisciplinary approach by endocrinologists, surgeons and psychiatrists, and can be conceptualized into distinct phases: diagnostic evaluation, real life experience, hormonal treatment and surgery. Multiples challenges have to be faced, especially by the psychiatrist who follows the patient during the whole process.

Division of labor in insect societies : genetic components and physiological regulation

The shift from solitary to social organisms constitutes one of the major transitions in evolution. The highest level of sociality is found in social insects (ants, termites and some species of bees and wasps). Division of labor is central to the organization of insect societies and is thought to be at the root of their ecological success. There are two main levels of division of labor in social insect colonies. The first relates to reproduction and involves the coexistence of queen and worker castes: while reproduction is usually monopolized by one or several queens, functionally sterile workers perform all the tasks to maintain the colony, such as nest building, foraging or brood care. The second level of division of labor, relating to such non-reproductive duties, is characterized by the performance of different tasks or roles by different groups of workers. This PhD aims to better understand the mechanisms underlying division of labor in insect societies, by investigating how genes and physiology influence caste determination and worker behavior in ants. In the first axis of this PhD, we studied the nature of genetic effects on division of labor. We used the Argentine ant Linepithema humile to conduct controlled crosses in the laboratory, which revealed the existence of non-additive genetic effects, such as parent-of-origin and genetic compatibility effects, on caste determination and worker behavior. In the second axis, we focused on the physiological regulation of division of labor. Using Pogonomyrmex seed- harvester ants, we performed experimental manipulation of hibernation, hormonal treatments, gene expression analyses and protein quantification to identify the physiological pathways regulating maternal effects on caste determination. Finally, comparing gene expression between nurses and foragers allowed us to reveal the association between vitellogenin and worker behavior in Pogonomyrmex ants. This PhD provides important insights into the role of genes and physiology in the regulation of division of labor in social insect colonies, helping to better understand the organization, evolution and ecological success of insect societies. - L'une des principales transitions évolutives est le passage de la vie solitaire à la vie sociale. La socialité atteint son paroxysme chez les insectes sociaux que sont les fourmis, les termites et certaines espèces d'abeilles et de guêpes. La division du travail est la clé de voûte de l'organisation de ces sociétés d'insectes et la raison principale de leur succès écologique. La division du travail s'effectue à deux niveaux dans les colonies d'insectes sociaux. Le premier niveau concerne la reproduction et implique la coexistence de deux castes : les reines et les ouvrières. Tandis que la reproduction est le plus souvent monopolisée par une ou plusieurs reines, les ouvrières stériles effectuent les tâches nécessaires au bon fonctionnement de la colonie, telles que la construction du nid, la recherche de nourriture ou le soin au couvain. Le second niveau de division du travail, qui concerne les tâches autres que la reproduction, implique la réalisation de différents travaux par différents groupes d'ouvrières. Le but de ce doctorat est de mieux comprendre les mécanismes sous-jacents de la division du travail dans les sociétés d'insectes en étudiant comment les gènes et la physiologie influencent la détermination de la caste et le comportement des ouvrières chez les fourmis. Dans le premier axe de ce doctorat, nous avons étudié la nature des influences génétiques sur la division du travail. Nous avons utilisé la fourmi d'Argentine, Linepithema humile, pour effectuer des croisements contrôlés en laboratoire. Cette méthode nous a permis de révéler l'existence d'influences génétiques non additives, telles que des influences dépendantes de l'origine parentale ou des effets de compatibilité génétique, sur la détermination de la caste et le comportement des ouvrières. Dans le second axe, nous nous sommes intéressés à la régulation physiologique de la division du travail. Nous avons utilisé des fourmis moissonneuses du genre Pogonomyrmex pour effectuer des hibernations artificieHes, des traitements hormonaux, des analyses d'expression de gènes et des mesures de vitellogénine, ce qui nous a permis d'identifier les mécanismes physiologiques régulant les effets maternels sur la détermination de la caste. Enfin, la comparaison d'expression de gènes entre nourrices et fourrageuses suggère un rôle de la vitellogénine dans la régulation du comportement des ouvrières chez les fourmis moissonneuses. En détaillant les influences des gènes et de la physiologie dans la régulation de la division du travail dans les colonies d'insectes sociaux, ce doctorat fournit d'importantes informations permettant de mieux comprendre l'organisation, l'évolution et le succès écologique des sociétés d'insectes.

cis- and trans-acting elements of the estrogen-regulated vitellogenin gene B1 of Xenopus laevis.

Vitellogenin genes are expressed under strict estrogen control in the liver of female oviparous vertebrates. Gene transfer experiments using estrogen-responsive cells have shown that the 13 bp perfect palindromic element GGTCACTGTGACC found upstream of the Xenopus laevis vitellogenin gene A2 promoter mediates hormonal stimulation and thus, was called the estrogen-responsive element (ERE). In the Xenopus vitellogenin genes B1 and B2 there are two closely adjacent EREs with one or more base substitutions when compared to the consensus ERE GGTCANNNTGACC. On their own, these degenerated elements have only a low or no regulatory capacity at all but act together synergistically to form an estrogen-responsive unit (ERU) with the same strength as the perfect palindromic 13 bp element. Analysis of estrogen receptor binding to the gene B1 ERU revealed a cooperative interaction of receptor dimers to the two adjacent imperfect EREs which most likely explains the synergistic stimulation observed in vivo. Furthermore, a promoter activator element located between positions --113 and --42 of the gene B1 and functional in the human MCF-7 and the Xenopus B3.2 cells has been identified and shown to be involved in the high level of induced transcription activity when the ERE is placed at a distance from the promoter. Finally, a hormone-controlled in vitro transcription system derived from Xenopus liver nuclear extracts was exploited to characterize two additional novel cis-acting elements within the vitellogenin gene B1 promoter. One of them, a negative regulatory element (NRE), is responsible for repression of promoter activity in the absence of hormone. The second is related to the NF-I binding site and is required, together with the ERE, to mediate hormonal induction. Moreover, we detected three trans-acting activities in Xenopus liver nuclear extracts that interact with these regions and demonstrated that they participate in the regulation of the expression of the vitellogenin promoter in vitro.

Role of amphiregulin in mammary gland development

Abstract Ovarian hormones are key regulators of postnatal mammary gland development and are linked to breast carcinogenesis. In particular, estrogens induce mammary epithelial cells to proliferate at the onset of puberty, leading to the elongation of the rudimental ductal tree into the fatty stromal tissue. Elucidating the molecular events underlying estrogen mitogenic activity in the mammary gland is of value in understanding how the deregulation of this signalling pathway can lead to breast tumorigenesis. Our lab has recently shown that estrogen induces mammary proliferation via epithelial estrogen receptor alpha (ERα) by a paracrine mechanism. Based on the finding that several EGF receptor (EGFR) ligands are able to substitute for estrogens and that amphiregulin (Areg), one of these ligands, is required during mammary development, we have hypothesized that Areg is a key mediator of estrogen induced paracrine signalling during ductal morphogenesis. Our analysis of the Areg -/- mice mammary phenotype reveals that epithelial Areg is required at the onset of puberty for epithelial proliferation, terminal end bud (TEB) formation and, subsequently, ductal elongation. Hormonal stimulation experiments show that among the EGFR ligands, only Arég is specifically controlled by estrogen at the transcriptional level, via ERα, in the mammary gland. Moreover, Areg is required for the estrogen-induced mammotrophic effects of epithelial proliferation and ductal elongation. We have shown that ectopic Areg expression in ERα -/- mammary epithelial cells is sufficient to induce ductal morphogenesis. Our transplantations experiment show that when Areg -/- cells are in the presence of wt cells they contribute to all aspects of ductal development, suggesting that this growth factor acts in a paracrine fashion. Moreover, this result shows that Areg -/- epithelial cells are not intrinsically impaired in proliferation. Our transplantation experiment carried out under physiological conditions confirmed previous reports showing that stromal EGFR is needed for ductal morphogenesis. This suggests that estrogen-driven Areg signalling involves an epithelium-stroma crosstalk. Thus, these data confirmed our hypothesis of Areg being an important estrogen mediator during ductal morphogenesis. Résumé Les hormones ovariennes, régulatrices clés du développement post-natal de la glande mammaire, sont également liées à la carcinogénèse du sein. En particulier, l'oestrogène induit la division des cellules épithéliales au début de la puberté. Cette prolifération amène à l'élongation du réseau canalaire rudimentaire et permet l'invasion du compartiment stromal. L'élucidation des mécanismes moléculaires responsables de l'activité mitogénique de l'oestrogène dans la glande mammaire est précieuse pour une meilleure compréhension du développement du cancer du sein. Notre laboratoire a récemment démontré que l'cestrogène induit la prolifération des cellules épithéliales par un signal paracrine, grâce au récepteur à l'oestrogène alpha (ERα). En se basant sur le fait que plusieurs ligands du récepteur à l'EGF (EGFR) sont capables de se substituer à l'cestrogène et d'induire la prolifération épithéliale et qu'amphiregulin (Areg), un de ces ligands, est essentielle au développement de la glande mammaire, nous avons émi l'hypothèse que Areg est un médiateur essentiel du signal paracrine induit par l'oestrogène pendant la croissance du système canalaire. Nos analyses phénotypiques des glandes mammaires issues de souris transgéniques Areg -/- démontrent que cette protéine est indispensable à la prolifération des cellules épithéliales mammaires au début de la puberté et à la formation des bourgeons terminaux qui conduisent à l'élongation des canaux. Nos expériences de stimulations hormonales démontrent que, parmi l'ensemble des ligands du EGFR, seule Areg est contrôlée au niveau transcriptionnel par l'cestrogène dans la glande mammaire, ceci via le récepteur ERα. De plus, Areg est essentielle pour le effets mammotrophique induit par l'cestrogène, à savoir la prolifération épithéliál et la croissance du système canalaire. Par ailleurs, l'expression ectopique d'Areg dans des cellules epithéliales mammaires de souris transgéniques ERα -/- est suffisante pour permettre la formation du réseau canalaire. En présence de cellules normales, les cellules dépourvues du gène d'Areg contribuent à la formation des canaux. Cette expérience suggère que ce facteur de croissance agit de manière paracrine. De plus, ce résultat montre que les cellules épithéliales Areg -/- conservent leur potentiel prolifératif. Nos expériences de transplantation, réalisées dans des conditions physiologiques, ont confirmé des précédentes études qui montraient que le récepteur stromal à l'EGF est nécessaire pour la morphogénèse du système canalaire. Ceci suggère que la voie de signalisation activée par l'oestrogène et dépendante d' implique une communication entre l'épithélium et le stroma. Ainsi, ces résultats valident notre hypothèse puisqu'ils confirment Areg en tant que médiateur majeur de l'oestrogène dans la morphogénèse du système canalaire.

Traumatismes précoces et réponses de stress, leur association aves la santé mentale, l'attachement et l'ocytocine

Lorsqu'un individu est confronté à une situation stressante, une des réponses les plus saillantes est l'activation de l'axe HPA, caractérisée par le déclenchement d'un taux élevé de glucocorticoïdes dans le sang. De manière générale, cette réponse hormonale est adaptative et elle a pour but la mobilisation des ressources physiques et cognitives de l'individu pour une action spécifique (Axelrod & Reisine, 1984; Chrousos & Gold, 1992; N. M. Kaplan, 1988; McEwen, 2004). Cependant, lorsque une personne est confrontée très tôt dans son développement, et de manière répétée, à des situations de stress, cette réponse physiologique peut s'altérer, devenir inadaptée (Anand, 1993; Bremner et al., 1995; Meaney et al., 1996; Mirescu, Peters, & Gould, 2004; Plotsky & Meaney, 1993; Sapolsky, 2000) et être associée à des troubles cognitifs (McEwen & Sapolsky, 1995) et émotionnels (McEwen, 2000). A l'âge adulte, le résultat de ces altérations psychoneuroendocriniennes se traduit au cours de l'activation de l'axe HPA et elles sont visibles lors de situations de stress moins intenses (Graham, Heim, Goodman, Miller, & Nemeroff, 1999; Mirescu et al., 2004; Stam, Bruijnzeel, & Wiegant, 2000; A. Taylor, Fisk, & Glover, 2000). La dysregulation de l'axe HPA semble représenter un facteur de vulnérabilité lié à des dysfonctionnements psychiques et physiologiques chez les adultes (Heim, Ehlert, & Hellhammer, 2000; Heim & Nemeroff, 1999; Heim, Newport, Mletzko, Miller, & Hemeroff, 2008). Cependant, des facteurs de protection peuvent influencer à leur tour ces vulnérabilités. La littérature, basée sur des études translationnelles (animaux, humains), converge vers le postulat selon lequel la dimension relationnelle apportée par l'environnement est fondamentale dans le développement des vulnérabilités physiologiques et psychiques du sujet. Dans ce sens, les relations d'attachement ont été particulièrement étudiées. A l'âge adulte, par exemple, la qualité des représentations d'attachement semble influencer directement l'expression de gènes impliqués dans les réponses hormonales de stress (Biagini, Pich, Carani, Marrama, & Agnati, 1998; Caldji, Diorio, & Meaney, 2000; Dallman, 2000; De Kloet, Rosenfeld, Van Eekelen, Sutanto, & Levine, 1988; Rincon-Cortes & Sullivan, 2014; Romeo, Tang, & Sullivan, 2009; van Oers, de Kloet, Whelan, & Levine, 1998), illustrant ainsi une perspective épigénétique. Traumatismes précoces et réponses de stress, leur association avec la santé mentale, l'attachement et l'ocytocine Deux objectifs principaux définissent ce travail de doctorat. Le premier est de comprendre comment un événement à portée traumatique, qui a eu lieu pendant la période périnatale, l'enfance ou l'adolescence, peut s'inscrire au niveau physiologique (axe hypotalamico- hypophysaire-surrénalien - axe HPA), au niveau psychopathologique ou encore au niveau de la régulation émotionnelle au cours de l'âge adulte. A ce propos, nous avons évalué les réponses physiologiques (telles que le Cortisol, l'ACTH et l'ocytocine), la présence de psychopathologies (relatives à l'axe I du DSM-IV) et les réponses émotionnelles (telles que la perception au stress) au cours d'une situation de stress de nature psychosociale, induite en laboratoire. Le deuxième objectif de ce travail est de savoir si les représentations d'attachement peuvent médiatiser ces effets, chez des individus exposés à différents événements à portée traumatique. Dans ce but, trois populations ont été considérées. La première est relative à des jeunes adultes nés grands prématurés ; la deuxième, concerne des femmes adultes ayant vécu un ou plusieurs abus sexuels au cours de leur enfance ou de leur adolescence et enfin la troisième est constituée de personnes adultes qui ont survécu à une maladie grave (cancer) pendant leur enfance ou leur adolescence. Enfin, ces trois populations sont comparées à des groupes contrôle. La prise en considération de différents types de traumatismes a permis de relever : premièrement, qu'un événement à portée traumatique de nature différente, peut influencer de manière semblable les structures neuronales, par exemple l'hypocortisolémie ; deuxièmement, qu'un dysfonctionnement de l'axe HPA n'aboutit pas nécessairement à la présence de signes de souffrance mentale ; enfin, des effets protecteurs ont été mis en évidence. Ces facteurs sont sous-tendus, d'un point de vue psychologique, par les représentations d'attachement et, d'un point de vue physiologique, par la sécrétion d'ocytocjne périphérique. Traumatismes précoces et réponses de stress, leur association avec la santé mentale, l'attachement et l'ocytocine -- When an individual is faced by a stressful situation, one of the most notable responses is the activation of the HPA axis, which is characterized by a heightened level of glucocortisoids in the blood. In general, this is an adaptive hormonal response which prepares the individual both physically and cognitively for a specific action (Axelrod & Reisine, 1984; Chrousos & Gold, 1992; N. M. Kaplan, 1988; McEwen, 2004). However, should a person be confronted to stressful situations very early and repeatedly in their development, this physiologic response may be altered and become maladapted (Anand, 1993; Bremner et al., 1995; Meaney et al., 1996; Mirescu et al., 2004; Plotsky & Meaney, 1993; Sapolsky, 2000) which can be associated to emotional (McEwen, 2000) and cognitive disorders(McEwen & Sapolsky, 1995). Throughout adulthood, the result of these psychoneuroendocrine alterations affects the activation of the HPA axis and are noticeable during less intense stressful situations (Graham et al., 1999; Mirescu et al., 2004; Stam et al., 2000; A. Taylor et al., 2000). HPA axis dysregulation appears to represent a factor of vulnerability linked to psychological and physical disorders in adults (Heim, Ehlert, et al., 2000; Heim & Nemeroff, 1999; Heim, Newport, et al., 2008). Nonetheless, these vulnerabilities may be influenced by further protection factors. The literature, based on translational studies (animals and humans), suggests that relationships formed in the context of the individual's environment are fundamental in the development of their physiological and psychological vulnerabilities. Thus, attachment relationships have been particularly studied. In adulthood, for example, the quality of attachment representations appear to influence directly the expression of genes involved in the hormonal responses to stress (Biagini et al., 1998; Caldji et al., 2000; Dallman, 2000; De Kloet et al., 1988; Rincon-Cortes & Sullivan, 2014; Romeo et al., 2009; van Oers et al., 1998). With the goal to study these dimensions, two principal objectives define these doctoral study. The first is to understand how an event considered to be traumatic, which took place during early infancy, infancy, or adolescence, could influence physiology (HPA axis), psychopathology or emotional regulation during adulthood. Therefore we have evaluated the presence of psychopathologies (relative to axis I of the DSM), physiological responses (such as Cortisol, ACTH and oxytocin) and emotional responses (such as perception of stress) throughout a psychosocial stress situation, conducted in a laboratory setting. The second objective of this study is to understand if attachment representations can mediate these effects, in individuals exposed to three different types of traumatic events. Therefore, three populations have been considered. The first is young adults who were born prematurely; the second concerns adult women who have suffered sexual abuse, on one or more occasions, during their childhood or adolescence; finally the third group is constituted of people who have survived a grave childhood illness. These populations were all compared to control groups. The consideration of different types of traumatic events has demonstrated, firstly, that different events which are considered to be traumatic can similarly influence neuronal structures, for example hypocortisolism. Secondly, that an HPA axis disorder does not necessarily lead to the presence of mental signs of distress, as is the case for those born very prematurely. Finally, protective effects were demonstrated, distinctively from a psychological point of view, by attachment representations and furthermore by peripheral oxytocin secretion from a physiological perspective.

Pharmacovigilance [Pharmacovigilance update].

The main pharmacovigilance updates in 2014 are reviewed. Ivabradine: increased risk of cardiovascular death and myocardial infarction in patients with symptomatic angina treated with high dosages. Clopidogrel: rare observations of acquired hemophilia. Orlistat: may reduce the absorption of HIV antiretrovirals. Ponatinib: increased risk of arteriopathy and thrombosis. Axitinib: significant risk of heart failure (class effect). Tocilizumab: possible causal relationship with the emergence or aggravation of psoriasis. Lithium: hypercalcemia and hyperparathyroidism commonly observed. Sildenalfil: suspected causal association with melanoma, so far not proven, Methylphenidate: rare observations of priapism. St John's wort (Hypericum): reduced effectiveness of hormonal contraceptives, including implants.

Dysménorrhée: patience, pilules ou bouillotte [Dysmenorrhea: patience, pills or hot-water bottle?].

Which treatments are used for dysmenorrhea and with what reported outcome? A questionnaire was sent to 2400 students and apprentices, following the "retrospective treatment-outcome" method. The response rate was 22%. Most frequent treatments used are ibuprofene (53%), paracetamol (51%), hormonal contraception (40%), hot-water bottle (or hot pad) (35%), food supplements or medicinal plants (23%). Physicians only discuss a tiny proportion of dysmenorrhea treatment in their consultation, because it is mostly a matter of self-treatment, with the family as the source of information in 80% of the cases. Rather surprising because not mentioned in most official guidelines, hot-water bottle (or hot pad) appears as the treatment followed by the best reported outcome (satisfactory in 92% of users).