Phenotypic Variability in Familial Amyloid Polyneuropathy: TTR Modifiers in Caenorhabditis Elegans and D.ICBAS 2019 Human Models

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Phenotypic Variability in Familial Amyloid Polyneuropathy: TTR Modifiers in Caenorhabditis Elegans and D.ICBAS 2019 Human Models and Human Human and Caenorhabditis Elegans DOUTORAMENTO CIÊNCIAS BIOMÉDICAS Phenotypic Variability in Familial TTR modifiers Polyneuropathy: Amyloid in Models. FerreiraMiguel Alves D 2019 Miguel Alves Ferreira. Phenotypic Variability in Familial Amyloid Polyneuropathy: TTR modifiers in Caenorhabditis Elegans and D.ICBAS 2019 Human Models. Phenotypic Variability in Familial Amyloid Polyneuropathy: TTR modifiers in Caenorhabditis Elegans and Human Models. Miguel Alves Ferreira INSTITUTO DE CIÊNCIAS BIOMÉDICAS ABEL SALAZAR D 2019 PHENOTYPIC VARIABILITY IN FAMILIAL AMYLOID POLYNEUROPATHY: TTR MODIFIERS IN CAENORHABDITIS ELEGANS AND HUMAN MODELS. Doctoral program in Biomedical Sciences MIGUEL FERNANDO ALVES FERREIRA PHENOTYPIC VARIABILITY IN FAMILIAL AMYLOID POLYNEUROPATHY: TTR MODIFIERS IN CAENORHABDITIS ELEGANS AND HUMAN MODELS. Tese de Candidatura ao grau de Doutor em Ciências Biomédicas submetida ao Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto. Orientador – Prof. Doutora Carolina Luísa Cardoso Lemos Categoria – Professora Auxiliar Convidada Afiliação – Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto. Co-orientadora – Prof. Doutora Alda Maria Botelho Correia de Sousa Categoria – Professora Associada com Agregação Afiliação – Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto. Co-orientadora – Prof. Doutora Sandra Encalada Categoria – Assistant Professor Afiliação – The Scripps Research Institute (TSRI) Porto, 2019 Financial support This study was supported by Fundação para a Ciência e Tecnologia, FCT, (PTDC/SAU- GMG/100240/2008) and PEsT, co-supported by ERDF and COMPETE, and by Financiamento Plurianual de Unidades de Investigação and through a PhD grant (SFRH/BD/101352/2014) financed by Programa Operacional and União Europeia. "Sou incapaz de dar respostas às minhas interrogações, exatamente porque sou um homem de interrogações." Corino de Andrade ACKNOWLEDGMENTS/AGRADECIMENTOS "Se vi mais longe foi por estar de pé sobre ombros de gigantes." (Isaac Newton) Quero agradecer a todas as pessoas que cientificamente e/ou pessoalmente me ajudaram a ver mais longe. À Prof. Doutora Carolina Lemos, por desde sempre ter confiado em mim e apoiado todos aqueles momentos em que eu surgia com “Tive uma ideia! Acho que podíamos…”. Pela orientação, incentivo e por mostrar o quão prazeroso é trabalhar em equipa. Gratidão! À Prof. Doutora Alda Sousa, um agradecimento muito especial, por toda a dedicação, racionalidade e partilha de conhecimentos demonstrada ao longo destes anos. Pelos conselhos tão imparciais e assertivos, sempre na altura certa. Ao Professor Jorge Sequeiros, por me ter aceitado desde início no seu grupo e continuar a apoiar os meus projetos. Pelas sábias correções e questões pertinentes que tem feito aos meus trabalhos. To Professor Sandra Encalada, thank you for welcoming me in your great lab and for everything you taught me about C. elegans. Your advice and support were very helpful to complete part of my graduate work. To Professor Jeffery Kelly, for the valuable collaboration, and for many insightful discussions and suggestions about amyloidosis. I also immensely appreciated the very kind and warm welcome to San Diego. À Dra. Teresa Coelho, por ter proporcionado as colaborações e fornecido muito do material que ajudaram a que esta tese fosse possível. Obrigado pelas interessantes e motivadoras reuniões e por ter partilhado tanto do seu excecional conhecimento sobre a PAF. À Prof. Doutora Isabel Alonso, pela disponibilidade e apoio neste projeto e por me ter transmitido muitas das minhas bases científicas. À Doutora Diana Santos, pela constante disponibilidade e ajuda. Pelo companheirismo neste mundo da PAF em que tantas histórias hilariantes partilhámos. À Dra. Ana Azevedo, pela estima, dedicação e contributo neste trabalho. Aos meus colegas da UnIGENe, Conceição, João, Sara, Marlene, Mariana, Joana, Cátia e Andreia, por todos os conselhos, amizade, pela prontidão em ajudar, boa disposição, e essencialmente por criarem um bom ambiente no laboratório. Aos meus colegas do CGPP, Ana Brandão, Ana Margarida, Rita, Patrícia, Susana, Paulo, Milena, Andreia e Victor, pela colaboração e ajuda ao longo destes anos. To Encalada Lab: Diana, Phil, Romain, George, Kayal and Shirley for their excellent team spirit and for making me feeling comfortable. I would like to specially mention Erin and Nirvan for your tremendously help, support and friendship. À Doutora Cecília Monteiro, por toda a amizade, encorajamento e constante cuidado. To everyone in Petrascheck, Wiseman and Kelly laboratories, for their support and assistance. À equipa da Unidade Corino de Andrade – CHP, pela disponibilidade e auxílio na recolha dos dados/amostras. Um especial agradecimento à Marta e à Vanessa, pela boa disposição e recetividade aos meus pedidos. Aos doentes e familiares, que foram imprescindíveis neste projeto. Aos meus Amigos, que durante estes anos compreenderam as minhas ausências e pelos desabafos e pelas tantas conversas não-científicas que me ajudavam a “desligar”. À Bárbara e Família, pelas palavras de ânimo, carinho, cuidado constante e motivação. Bem hajam! Aos meus Pais, pelo amor, alegria e apoio incondicional em tudo o que faço. Grato pela educação que também permitiu que esta tese fosse possível. Agradeço também à Fundação para a Ciência e a Tecnologia (FCT) a atribuição da bolsa de doutoramento SFRH/BD/101352/2014 e à Amyloidosis Foundation e à Pfizer o apoio nos projetos. Agradeço ao Instituto de Ciências Biomédicas de Abel Salazar (ICBAS); ao Instituto de Biologia Molecular e Celular (IBMC) - Instituto de Investigação e Inovação em Saúde (i3S) e ao The Scripps Research Institute por terem proporcionado as condições essenciais ao desenvolvimento desta tese. TABLE OF CONTENTS Publications .................................................................................................................................. I Abbreviations .............................................................................................................................. II Abstract ..................................................................................................................................... VI Sumário ................................................................................................................................... VIII INTRODUCTION ......................................................................................................................... 1 Transthyretin familial amyloid polyneuropathy (TTR-FAP) ....................................................... 5 History of FAP: Major Milestones ......................................................................................... 5 Genetic Scenario .................................................................................................................. 6 Epidemiology ........................................................................................................................ 8 Transthyretin Biochemistry ................................................................................................... 9 Transthyretin Aggregation .................................................................................................. 10 TTR Partners ...................................................................................................................... 11 Symptomatology ................................................................................................................ 13 Age-at-onset (AO) .............................................................................................................. 15 Genetic Modifiers ............................................................................................................... 17 Origin ................................................................................................................................. 19 Misdiagnosed/ Mimicking neuropathies .............................................................................. 19 Treatment ........................................................................................................................... 19 Animal Models .................................................................................................................... 22 MAIN OBJECTIVES .................................................................................................................. 25 Specific Objectives ................................................................................................................ 27 GENERAL METHODS .............................................................................................................. 29 RESULTS.................................................................................................................................. 35 Article 1: Beyond TTR Val30Met: potential regulatory variants associated with age-at-onset in familial amyloid polyneuropathy ............................................................................................. 38 Article 2: A trans-acting factor may modify age-at-onset in familial amyloid polyneuropathy ATTRV30M in Portugal .......................................................................................................... 56 Article 3: Large anticipation of genetic TTR Familial Amyloid Polyneuropathy Val30Met: MYH11 gene as a putative modulator .................................................................................... 80 Article 4: Cellular
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