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Cours 12 - Maladies Complexes

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Cours PBC2060. 15 avril 2009. Physiothérapie. Université de Montréal.

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Cours 12 - Maladies Complexes

  1. 1. 12. Maladies complexes 15 avril 2009 PBC2060
  2. 2. Pathologie générale <ul><li>Mécanismes élémentaires </li></ul><ul><ul><li>Lésions cellulaires </li></ul></ul><ul><ul><li>Lésions tissulaires </li></ul></ul><ul><li>Pathologie génétique </li></ul><ul><li>Pathologie vasculaire </li></ul><ul><li>Pathologie inflammatoire </li></ul><ul><li>Pathologie immunitaire </li></ul><ul><li>Pathologie nutritionnelle et environnementale </li></ul><ul><li>Pathologie infectieuse </li></ul><ul><li>Pathologie tumorale </li></ul>
  3. 3. Étiologie / Physiopathologie <ul><li>Chaîne de causalité </li></ul><ul><li>1 étiologie > 1 maladie </li></ul><ul><li>Voies physiopathologiques </li></ul>A B C D E F G H I
  4. 4. Maladies complexes <ul><li>Athérome </li></ul><ul><li>Maladies dysimmunitaires </li></ul><ul><li>Diabète de type 2 – Obésité </li></ul><ul><li>Hypertension artérielle </li></ul><ul><li>Maladies neurodégénératives </li></ul><ul><ul><li>Maladie d’Alzheimer </li></ul></ul><ul><ul><li>Maladie de Parkinson </li></ul></ul><ul><ul><li>Sclérose latérale amyotrophique </li></ul></ul><ul><li>Arthrose / Arthrite </li></ul><ul><li>Maladies psychiatriques </li></ul><ul><li>Retard mental </li></ul><ul><li>Malformations </li></ul>
  5. 5. Maladies complexes <ul><li>86% des décès </li></ul><ul><li>77% des maladies </li></ul><ul><li>1994-2004: + 73.5% </li></ul><ul><ul><li>Cancer: 84% </li></ul></ul><ul><ul><li>Diabète: 83% </li></ul></ul><ul><li>5.7% / an </li></ul><ul><li>60% des dépenses de santé </li></ul>
  6. 6. <ul><li>Maladie d’Alzheimer </li></ul><ul><li>Maladie de Parkinson </li></ul><ul><li>Hypertension artérielle </li></ul><ul><li>Dyslipidémies </li></ul><ul><li>Athérosclérose </li></ul><ul><li>Diabète type 2 </li></ul><ul><li>Syndrome métabolique </li></ul><ul><li>Cancer </li></ul>Maladies associées au vieillissement
  7. 7. Interactions Génotype-Environnement
  8. 8. Obésité – Diabète sucré Indiens Pimas
  9. 9. Maladies complexes <ul><li>Diabète de type 2 </li></ul><ul><li>Obésité </li></ul><ul><li>Athérome </li></ul><ul><li>Hypertension artérielle </li></ul><ul><li>Maladies dysimmunitaires </li></ul><ul><li>Maladies neurodégénératives </li></ul><ul><ul><li>Maladie d’Alzheimer </li></ul></ul><ul><ul><li>Maladie de Parkinson </li></ul></ul><ul><ul><li>Sclérose latérale amyotrophique </li></ul></ul><ul><li>Arthrose / Arthrite </li></ul><ul><li>Maladies psychiatriques </li></ul><ul><li>Retard mental </li></ul><ul><li>Malformations </li></ul>
  10. 10. Maladies complexes
  11. 11. Maladies complexes <ul><li>Athérome </li></ul><ul><li>Maladies dysimmunitaires et allergiques </li></ul><ul><li>Diabète de type 2 – Obésité </li></ul><ul><li>Hypertension artérielle </li></ul><ul><li>Maladies neurodégénératives </li></ul><ul><ul><li>Maladie d’Alzheimer </li></ul></ul><ul><ul><li>Maladie de Parkinson </li></ul></ul><ul><ul><li>Sclérose latérale amyotrophique </li></ul></ul><ul><li>Arthrose / Arthrite </li></ul><ul><li>Maladies psychiatriques </li></ul><ul><li>Retard mental </li></ul><ul><li>Malformations </li></ul>
  12. 12. Hypertension artérielle (HTA)
  13. 13. Hypertension artérielle <ul><li>HTA secondaire </li></ul><ul><ul><li>Rénales </li></ul></ul><ul><ul><ul><li>Glomérulonéphrite aigue </li></ul></ul></ul><ul><ul><ul><li>Maladies rénales chroniques </li></ul></ul></ul><ul><ul><li>Endocrines </li></ul></ul><ul><ul><ul><li>Cortisol </li></ul></ul></ul><ul><ul><ul><li>Aldostérone </li></ul></ul></ul><ul><ul><li>Cardiovasculaires </li></ul></ul><ul><ul><li>Neurologiques </li></ul></ul><ul><li>HTA essentielle ++ </li></ul>
  14. 14. Hypertension artérielle (HTA)
  15. 15. Hypertension artérielle (HTA)
  16. 16. Hypertension artérielle (HTA)
  17. 17. Hypertension artérielle > Canalopathies
  18. 18. HTA > Complications HTA Athérome Lésions vasculaires
  19. 19. HTA > Artériolosclérose hyaline
  20. 20. HTA > Artériolosclérose hyperplasique
  21. 21. Maladies neurodégénératives
  22. 22. Maladies neurodégénératives <ul><li>Cortex cérébral </li></ul><ul><ul><li>Maladie d’Alzheimer </li></ul></ul><ul><ul><li>Démences fronto-temporales </li></ul></ul><ul><li>Noyaux gris (Système du ganglion basal) </li></ul><ul><ul><li>Maladie de Parkinson </li></ul></ul><ul><ul><li>Chorée de Huntington </li></ul></ul><ul><li>Nerfs moteurs </li></ul><ul><ul><li>Sclérose latérale amyotrophique </li></ul></ul>
  23. 23. Maladies neurodégénératives corticales
  24. 24. Maladies neurodégénératives corticales <ul><li>Cortex cérébral </li></ul><ul><ul><li>- APP: Maladie d’Alzheimer </li></ul></ul><ul><ul><li>TAU </li></ul></ul><ul><ul><li>. Démences fronto-temporales </li></ul></ul><ul><ul><li>. Syndrome de Pick </li></ul></ul><ul><ul><li>… </li></ul></ul>
  25. 25. Maladie d’Alzheimer
  26. 26. Maladie d’Alzheimer
  27. 27. Atrophie cérébrale Neurodégénération Maladie d’Alzheimer
  28. 28. Maladie d’Alzheimer
  29. 29. Alzheimer > Lésions
  30. 30. Alzheimer > Lésions
  31. 31. Alzheimer > Localisation
  32. 32. Alzheimer > Plaque neuritique
  33. 33. Alzheimer > Angiopathie amyloide
  34. 34. Alzheimer > Plaques neurofibrillaires
  35. 35. Alzheimer > Plaques neurofibrillaires
  36. 36. Maladie d’Alzheimer familial
  37. 37. Maladie d’Alzheimer familiale
  38. 38. Alzheimer > APP et Abeta
  39. 39. Alzheimer > APP et Abeta
  40. 40. Alzheimer > Plaques neurofibrillaires
  41. 41. Alzheimer > Abeta intracellulaire
  42. 42. Alzheimer > Abeta intracellulaire
  43. 43. Alzheimer > Inflammation
  44. 44. Alzheimer > Inflammation
  45. 45. Alzheimer > Inflammation
  46. 46. Lipoprotéines
  47. 47. Apolipoprotéine E
  48. 48. Alzheimer > ApoE
  49. 49. Alzheimer > ApoE
  50. 50. Alzheimer > Immunothérapie ?
  51. 51. Démences fronto-temporales
  52. 52. Démence frontotemporale
  53. 53. Maladies neurodégénératives corticales
  54. 54. Démence fronto-temporale familiale
  55. 55. Démence fronto-temporale > Tauopathie Microtubule Protéine Tau
  56. 56. Démence frontotemporale > Tauopathie <ul><li>Démence fronto-temporale (DFT) </li></ul><ul><li>Maladie de Pick </li></ul><ul><li>Dégénérescence cortico-basale (DCB) </li></ul><ul><li>Paralysie supranucléaire progressive (PSP) </li></ul><ul><li>Maladie d’Alzheimer </li></ul>
  57. 57. Maladies neurodégénératives corticales
  58. 58. Maladies neurodégénératives nucléaires
  59. 59. Noyaux gris centraux (Ganglions basaux)
  60. 60. Maladie de Parkinson
  61. 61. Maladie de Parkinson
  62. 62. Maladie de Parkinson
  63. 63. Maladie de Parkinson
  64. 64. Maladie de Parkinson > Corps de Lewy
  65. 65. Maladie de Parkinson familiale
  66. 66. Maladie de Parkinson
  67. 67. Maladie de Parkinson
  68. 68. Chorée de Huntington
  69. 69. Chorée de Huntington
  70. 70. Chorée de Huntington
  71. 71. Huntington > Répétitions CAG polyCAG > Polyglutamine
  72. 72. Huntington > Répétitions CAG polyCAG > Polyglutamine
  73. 73. Répétitions : CAG, CGG, GAA, CTG
  74. 74. Chorée de Huntington
  75. 75. Chorée de Huntington
  76. 76. Chorée de Huntington
  77. 77. Sclérose latérale amyotrophique
  78. 78. Maladies neurodégénératives neuronales
  79. 79. Sclérose latérale amyotrophique
  80. 80. Sclérose latérale amyotrophique
  81. 81. Sclérose latérale amyotrophique > Familles
  82. 82. Sclérose latérale amyotrophique > SOD1
  83. 83. Sclérose latérale amyotrophique > SOD1
  84. 84. Sclérose latérale amyotrophique
  85. 85. Sclérose latérale amyotrophique > SOD1
  86. 86. Sclérose latérale amyotrophique > SOD1
  87. 87. Sclérose latérale amyotrophique
  88. 88. Arthrose (Ostéoarthrite)
  89. 89. Arthrose (Ostéoarthrite)
  90. 90. Arthrose (Ostéoarthrite)
  91. 91. Arthrose (Ostéoarthrite) <ul><li>Arthrose primaire </li></ul><ul><li>Arthrose secondaire </li></ul><ul><ul><li>Anomalies articulaires congénitales </li></ul></ul><ul><ul><li>Traumatismes (sport) </li></ul></ul><ul><ul><li>Pression (obésité) </li></ul></ul><ul><ul><li>Maladies métaboliques </li></ul></ul><ul><ul><ul><li>Hémosidérose articulaire </li></ul></ul></ul><ul><ul><ul><ul><li>Hémophilie </li></ul></ul></ul></ul><ul><ul><ul><ul><li>hémochromatose (Fer) </li></ul></ul></ul></ul><ul><ul><ul><li>Maladie de Wilson (Cuivre) </li></ul></ul></ul>
  92. 92. Arthrose (Ostéoarthrite) <ul><li>Arthrose primaire </li></ul><ul><li>Arthrose secondaire </li></ul><ul><ul><li>Anomalies articulaires congénitales </li></ul></ul><ul><ul><li>Traumatismes (sport) </li></ul></ul><ul><ul><li>Pression (obésité) </li></ul></ul><ul><ul><li>Maladies métaboliques </li></ul></ul><ul><ul><ul><li>Hémosidérose articulaire </li></ul></ul></ul><ul><ul><ul><ul><li>Hémophilie </li></ul></ul></ul></ul><ul><ul><ul><ul><li>hémochromatose (Fer) </li></ul></ul></ul></ul><ul><ul><ul><li>Maladie de Wilson (Cuivre) </li></ul></ul></ul>
  93. 93. Arthrose primaire
  94. 94. Fin du cours 12

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