Comprendre les processus menant à l’émergence des insectes ravageurs indigènes, impliquant les interactions entre l’insecte, sa plante-hôte et son environnement, représente un enjeu scientifique majeur. Signalées depuis les années 1990 dans les peupleraies du Sud-Ouest de la France, les pullulations du puceron lanigère du peuplier, Phloeomyzus passerinii (Signoret) (Hemiptera : Aphididae), sont en constante expansion géographique. Nous avons adopté une approche pluridisciplinaire pour éclaircir la biologie de l’insecte et ses interactions avec l’hôte ainsi que pour déterminer si les pullulations étaient liées à des conditions environnementales favorisant des populations locales ou à l'expansion de populations méridionales. Une première approche, centrée sur les interactions peuplier-puceron a montré un comportement atypique du puceron traversant les cellules du parenchyme cortical pour atteindre son site d’alimentation localisé dans ce tissu. La résistance du peuplier affecte les performances du puceron de manière multifactorielle, mettant en évidence des propriétés antibiotique et antixénotique localisées dans le parenchyme après analyses par électropénétrographie. Une seconde approche modélisant le potentiel de croissance annuel des populations en conditions optimales a révélé que le réchauffement climatique et la composition génotypique des peupleraies auraient contribué à l’émergence des pullulations. Les risques seraient accrus dans le Nord pour un réchauffement de 1 °C. Enfin, une approche génétique retraçant l’histoire évolutive des populations du puceron a révélé une diversité génétique microsatellite assez élevée, avec 28 génotypes pour 44 individus analysés. On observe une certaine structure entre les régions populicoles, sans toutefois que l’on puisse négliger l’existence d’un flux génique entre les populations dû à une dispersion à longue distance. Ce travail apporte les bases de méthodes de prévision et prévention des risques. / Understanding the processes leading to the emergence of indigenous insect pests, involving interactions between the insect, its host plant and its environment, represents a major scientific challenge. Reported since the 1990s in poplar stands of South-Western France, the outbreaks of the woolly poplar aphid, Phloeomyzus passerinii (Signoret) (Hemiptera: Aphididae), have been expanding geographically. We have adopted a multidisciplinary approach to clarify the biology of the insect and its interactions with its host, and to determine whether the outbreaks were related to environmental conditions promoting local populations or expansion of southern populations. One approach, focusing on poplar-aphid interactions has shown an atypical feeding behaviour of the aphid, crossing the cortical parenchyma cells to reach its feeding site located in this tissue. Aphids’ performances were affected by poplar resistance in many ways, which highlights antibiotic and antixenotic properties localized in the cortical parenchyma after electrical penetration graph analysis. In a second approach, a model simulating the annual growth potential of aphid populations in optimal conditions was developed. It has revealed that global warming and genotypic composition of poplar stands have contributed to the emergence of outbreaks. A warming of 1 °C may increase the risks in the North. Finally, a genetic approach drawing the evolutionary history of aphid populations shows a relatively high microsatellite genetic diversity, with 28 genotypes out of 44 individuals tested. There is some structure between poplar stand regions, but we can’t ignore gene flow between populations due to long-distance dispersal. This work has provided the basis for forecasting methods and risk prevention.

Les études préexistantes identifient quatre taxons de base (C. reticulata les mandariniers, C. maxima les pamplemoussiers, C. medica les cédratiers et C. micrantha) à l'origine de l'ensemble des formes cultivées suite à des événements de réticulations. Il en résulte des structures génotypiques complexes, généralement fixées par l'apomixie, fortement hétérozygotes et formées d'une mosaïque de grands fragments chromosomiques d'origines phylogénétiques différentes. La structuration de la variabilité phénotypique suggère que la différenciation initiale des taxons ancestraux est à l'origine d'une part importante de la variabilité utile des agrumes. La connaissance de l'origine des formes cultivées et de leurs structures phylogénomiques est donc indispensable à la bonne gestion des collections et à l'optimisation des programmes d'amélioration génétique. A cette fin, cette thèse explore différentes approches d'analyse de la diversité des génomes. Elle a bénéficié de l'évolution rapide des NGS et propose une utilisation raisonnée des outils disponibles en fonction des questions de recherches. Une analyse plus poussée a été conduite sur les limettiers et citronniers. Le pyroséquençage 454 (Roche) d'amplicons a été utilisé pour décrypter la structure en mosaïque interspécifique du chromosome 2 de 50 variétés à partir d'une information haplotypique multiloci et pour identifier des marqueurs diagnostiques des taxons ancestraux. Ces marqueurs ont permis, en association avec des SSR et indels, d'apporter un nouvel éclairage sur l'origine des limettiers et citronniers, par un génotypage exhaustif des collections Inra/Cirad et Ivia. Enfin, les données de re-séquençage complet Illumina de sept variétés de limettiers et de citronniers comparées à celles de représentants des taxons ancestraux nous ont permis de reconstituer la structure interspécifique de leurs génomes et de schématiser leurs caryotypes phylogénomiques. Les différentes approches ont conduit à des conclusions convergentes. Nos résultats confirment les hypothèses concernant la séquence évolutive à l'origine des bigaradiers (C. aurantium), des orangers (C. sinensis) et des pomelos (C. paradisi) à partir des pools géniques de C. maxima et C. reticulata. Ils mettent en évidence de fréquentes introgressions de C. maxima dans le génome de mandariniers considérées comme représentatifs de C. reticulata. Les contributions relatives de ces deux taxons ancestraux aux génomes de nombreuses variétés de petits agrumes (mandariniers, tangors et tangelos) ont pu être estimées. Les limettiers et citronniers résultent de multiples évènements de réticulation et C. medica est identifié comme parent mâle de la majorité des variétés diploïdes. Deux grands groupes de citronniers, sont différenciés, ceux issus d'hybridations directes C. reticulata × C. medica et ceux impliquant trois taxons ancestraux (C. maxima, C. reticulata et C. medica). Le bigaradier serait le parent femelle à l'origine des citronniers type Lisbonne (C. limon). Les limettiers de type Mexicain (C. aurantifolia) seraient issus d'une hybridation directe C. micrantha × C. medica. Enfin, les limes à gros fruits, triploïdes, ont deux origines. Les types Tahiti résulteraient probablement de la fécondation d'un ovule de citronnier type Lisbonne par un gamète diploïde de limettier type Mexicain. L'autre grand type serait issu d'un backcross entre C. aurantifolia (gamète diploïde) et C. medica. Ces connaissances sur la structure génomique des espèces secondaires permettent d'envisager une reconstruction d'idéotypes à partir du germplasm des taxons ancestraux. Elles ouvrent également la voie à des études de génétique d'association s'appuyant sur la phylogénomique des gènes impliqués dans l'élaboration des caractères de qualité, de résistance et d'adaptation. Enfin, les marqueurs diagnostiques d'espèces développés trouveront de nombreuses applications pour la caractérisation des collections et diverses études de génétiques. / Citrus fruit, the most important fruit crop in the world, show a wide phenotypic diversity. Previous studies (molecular markers) identified four ancestral taxa (Citrus reticulata Blanco, mandarins; C. maxima (Burm.) Merr., pummelos; C. medica L., citrons; C. micrantha Wester, papedas) as the ancestors of all cultivated Citrus after reticulate evolutions. As a result, modern citrus varieties have complex and highly heterozygous genotypic structures, generally fixed by apomixis, and formed by a mosaic of large chromosomal fragments of different phylogenetic origins. Furthermore, the structuration of the phenotypic variability suggests that the initial differentiation of the basic taxa is the main source of most of the variability of the useful citrus phenotypic diversity. A thorough knowledge of the origin of cultivated citrus and their phylogenomic structure are essential for the management of biological resources and breeding program optimization. This thesis explores different approaches for analyzing genome diversity in order to identify the phylogenetic origins of the various horticultural citrus groups and to decipher their phylogenomic genome's structures. We focused on limes and lemons. This thesis takes advantage of the rapid evolution of NGS and proposes a rational use of available tools, based on research questions. Roche 454 parallel sequencing of amplicons provides multi-loci haplotype information on 500 base fragments. It was used to decipher the interspecific mosaic structure of chromosome 2 for fifty varieties and to identify ancestral taxa diagnostic SNP markers. The genotyping of all limes and lemons of the Inra/Cirad and Ivia germplasms with these markers, in association with SSR and indel markers, allowed to propose new hypothesis on the origins of limes and lemons. Data from Illumina whole genome re-sequencing of 7 varieties of limes and lemons, compared to those of representatives of the ancestral taxa, allowed to infer the interspecific structure of their genomes and to map out, for the first time, their phylogenomic karyotypes. The different approaches led to similar conclusions. Our results confirm previous hypothesis about the evolutionary steps at the origin of sour orange (C. aurantium), sweet orange (C. sinensis) and grapefruit (C. paradisi) involving C. maxima and C. reticulata gene pools. They highlight frequent introgressions of C. maxima in the genome of mandarin varieties despite the fact they were considered as representative of C. reticulata. We were also able to quantify the relative proportions of these two ancestral taxa in the genome of many varieties of small citrus fruit (mandarin hybrids, tangors and tangelos). Our work on limes and lemons demonstrate that C. medica is the male parent of this varietal group at the diploid level. Two groups of lemons are clearly differentiated: one from direct hybridizations between C. reticulata and C. medica, and one from crosses between hybrids (C. maxima × C. reticulata) and C. medica. Sour orange seems to be the female parent of ‘Eureka' type lemons (C. limon). The ‘Mexican' limes (C. aurantifolia) seems to come from a direct hybridization C. micrantha × C. medica. Finally, triploid big fruit limes have two major origins. The ‘Tahiti' type probably results from an ‘Eureka' type lemon (C. limon) ovule fecundated by a diploid gamete of a ‘Mexican' type lime (C. aurantifolia), while the other type would come from a back-cross between C. aurantifolia (diploid gamete) and C. medica. This new insights in genomic structure of secondary species makes to consider possible a reconstruction of these ideotypes from ancestral taxa germplasm. They also open new ways for association genetic studies based on phylogenomics of genes involved in the development of quality, resistance and adaptation traits. Finally, developed specific taxa diagnostic markers will find many applications for the characterization of collections and further genetic studies.

La résistance à l’insuline (RI) est un processus biologique fondamental impliqué dans la plupart des maladies complexes avec un important impact dans la mortalité des populations humaines et qui reconnaît une composante génétique en interaction avec les facteurs nutritionnels. Les aminoacides ramifiés (BCAA) sont des composantes essentielles de notre diète et ont été reconnus comme de nouveaux acteurs dans la pathogénie de l’obésité et du diabète sucré soit comme des bio-marqueurs soit comme des régulateurs au niveau périphérique ou dans le système nerveux central. Ce travail a été proposé dans le cadre du projet Européen MEDIGENE (FP7-279171) visant le syndrome métabolique dans les populations Méditerranéennes. Dans ce contexte, nous avons utilisé une approche génétique combinant les SNP (single nucleotide polymorphism) et la cartographie dense des haplotypes. Nous avons mis en évidence de nouveaux gènes dans les phases tardives du catabolisme des BCAA, bien que le signal d’association ait été en relation complexe avec les taux plasmatiques de BCAA et la mesure in vivo de la RI. Dans une approche similaire, nous avons identifié sur le chromosome 4p14 un nouveau locus en relation avec la RI et le système de récompense cérébral impliquant le fibroblast growth factor (FGF) 21. Ces données ont soulevé l’intérêt pour une estimation rapide et efficace de l’apport en BCAA dans la diète nous emmenant à développer une nouvelle base de données du contenu des aliments en BCAA. Cette base est intégrée dans un nouveau logiciel pour le recueil des enquêtes alimentaires (rappels de 24h) et qui pourra être utilisée par des praticiens d’une manière sécurisée dans les pays de la Méditerranée, ouvrant ainsi de nouvelles perspectives en nutrigénomique. / Insulin resistance (IR) is a fundamental biological process involved in majority of complex disorders with high impact on mortality of human populations and with a strong genetic component in interaction with nutritional factors. Branched chain amino acids (BCAA) are essential components of human diet and recognized as new actors in pathogenesis of obesity and diabetes mellitus either as biomarkers or regulators at the peripheral systemic and nervous system. This work was proposed in the frame of the European project MEDIGENE (FP7-279171) studying the metabolic syndrome in several Mediterranean populations. In this context, we have used a genetic approach combining SNP (single nucleotide polymorphism) and fine scale haplotype mapping. We identified new genes in the later steps of BCAA catabolism responsible for IR, albeit displaying a complex signal in relation with BCAA plasma levels and in vivo IR measured by minimal model. With a similar approach, we identified equally a new locus of Chromosome 4p14 for IR in cooperation with the cerebral rewarding system involving fibroblast growth factor (FGF) 21 regulation. These data roused particular interest in estimating BCAA intake leading to the development of a novel database of BCAA content in food. This database is embedded in a new computer program for collecting dietary records (24HDR) and can be used securely by practitioners around Mediterranean countries and opening new perspectives in the nutrigenomic field.

In large-scale population genomic data sets, individual chromosomes are likely to share extended regions of haplotype identity with others in the sample. Patterns of local haplotype sharing can be highly informative about many processes including historical demography, selection and recombination. However, in outbred diploid populations, the identification of extended shared haplotypes is not straightforward, particularly in the presence of low levels of genotyping error. Here, we introduce a model-based method for accurately detecting extended haplotype sharing between sets of individuals from unphased data. We describe two implementations of the algorithm that can be applied to data sets consisting of thousands of samples. The method leads naturally to an approach for statistical haplotype estimation, which is shown to be comparable in accuracy to current methods. By applying the method to genome-wide SNP data from over 5,000 samples from the UK we show that the N50 maximal haplotype sharing between unrelated samples is typically 2cM, consistent with a population history of rapid exponential growth that started approx. 125 generations ago. In contrast, within two Greek population isolates of approx. 700 individuals the N50 for maximal haplotype sharing is 12.5cM, while for an unrelated Greek sample of the same size the N50 is 1.3cM. By assessing the size and geographical distribution of maximal haplotype sharing within and between all Greek cohorts, we make inference on the extent of isolatedness of each cohort and on recent migration. We additionally date recent coancestry to about 10 generations for the isolates and 90 generations for the unrelated sample, and finnally attempt to date the time of divergence between them.

A role for gene variants in regulating the pharmacokinetics of systemically available toxicants has not yet been established. A panel of 18 genetically-diverse inbred mouse strains was used to determine the range of total exposure kinetic parameters in blood and bone marrow following a single oral administration of benzene (100 μg/kg) to male and female mice. Large ranges in several pharmacokinetic parameters were found when data from blood and bone marrow were analyzed. AUC and CL_F pharmacokinetic parameters in blood and bone marrow pharmacokinetics were strikingly different as were these parameters in males and females. Final clearance (CL_F) was found to be the most statistically robust pharmacokinetic parameter as it accounted for exposure of the matrix (AUC) and normalized for dose variations among the strains. The CL_F values in blood and bone marrow used for haplotype association mapping showed 331 and 164 quantitative trait loci with statistical significance, respectively (male mice; -logP>4). Two loci were found to be shared between males and females QTL bone marrow data sets and one common locus was found for male blood and bone marrow data. No overlap was found among blood QTL in males and females (or between blood and bone marrow data from females). Protein and mRNA expression data for the primary benzene-metabolizing enzymes CYP2E1 and UGT1A6 showed very little strain-dependent variation. Strain dependent differences in mRNA levels of NQO1 and MPO were small but statistically significant, as were those for GAPDH and β2-microglobulin. These data demonstrated that polymorphisms with the greatest contribution toward overall variations in systemic exposures occurred in genes encoding for non-metabolic proteins. While exposure does not equate to toxicity, identification of the genes regulating distribution and clearance may be useful for investigating host susceptibility to toxic effects following benzene exposure. This research was supported in part by the NIEHS NTP Grant N01ES45529, NIEHS Toxicology and Toxicogenomics Training Grant (5T32ES007091-29), NIEHS/NTP Division of Intramural Research, and Southwest Environmental Science Center Grant P3ES06694.

Otter populations declined drastically across many areas of England and Wales during the 1960s to 1980s. The main cause of this decline is thought to have been high concentrations of organic pollutants, in particular PCBs and dieldrin. Here we look at the health of the present day otter population, focussing on the numbers of otters, the genetic diversity of populations and investigating a possible new organic pollutant threat, polybrominated diphenyl ethers (PBDEs). A non-invasive spraint genotyping study of the otter population inhabiting the River Camel in Cornwall not only revealed that the river was capable of supporting a minimum number of 12 otters over a 9 month period, but gave insight into the ranges and genetic relationships of the individuals using the river system. A further population genetic study was carried out focussing on the River Itchen in Hampshire, a population which declined drastically to just a few isolated individuals before receiving otters through a captive breeding programme. Microsatellite genotyping of tissue samples showed the River Itchen population to be relatively diverse, indicating a successful population recovery, and haplotype analysis reveals that captive bred otters have successfully bred within the River Itchen population. However, haplotype analysis also indicates that the otters used to found the captive breeding programme were unlikely to have originated from a native British population. Concentrations of PBDEs in otters rival the high concentrations observed in many marine mammal species and are approaching the concentrations of PCBs and DDTs already observed in otters. The profile of the PBDE congeners found shows that lower congeners show relative concentrations similar to those observed in many other species of biota, with high BDE-47 dominating the profile and BDE-99 and -100 also found at significant concentrations. Otters also contain relatively high concentrations of the congeners BDE-153 and BDE-209, a trend generally typical of terrestrial top predators. In summary, the otter populations studied appear to be recovering well. However, increasing concentrations of PBDEs may cause problems for otter populations in the future.

Data from a Croatian isolate population are analysed in a genome-wide association study (GWAS) for a variety of disease-related quantitative traits. A novel genomewide approach to analysing pedigree-based association data called GRAMMAR is utilised. One of the significant findings, for uric acid, is followed up in greater detail, and is replicated in another isolate population, from Orkney. The associated SNPs are located in the SLC2A9 gene, coding for a known glucose transporter, which leads to identification of SLC2A9 as a urate transporter too (Vitart et al., 2008). These SNPs are later implicated in affecting gout, a disease known to be linked with high serum uric acid levels, in an independent study (Dehghan et al., 2008). Subsequently, investigation into different ways in which to use SNP data to identify quantitative trait loci (QTL) for genome-wide association (GWA) studies is performed. Several multi-marker approaches are compared to single SNP analysis using simulated phenotypes and real genotype data, and results show that for rare variants haplotype analysis is the most effective method of detection. Finally, the multi-marker methods are compared with single SNP analysis on the real uric acid data. Interpretation of real data results was complicated due to low sample size, since only founder and unrelated individuals may be used for population-based haplotype analysis, nonetheless, results of the prior analyses of simulated data indicate that multi-marker methods, in particular haplotypes, may greatly facilitate detection of QTL with low minor allele frequency in GWA studies.

<p>A major challenge in human genetics is to understand the genetic variation underlying common diseases. In this thesis, I focus on forces creating differences between individuals and genomic regions, methods for characterizing genomic variation, and the association between genomic and phenotypic variation. Genetic markers are widely used to locate genes associated with different phenotypes. In my first paper, I describe novel algorithms for automatic genotype determination of microsatellite markers, a procedure which is currently both time-consuming and error prone. </p><p>The co-segregation of genetic markers in a population leads to non-random association of alleles at different loci - linkage disequilibrium (LD). LD varies throughout the genome and differs between populations due to factors such as their demographic history. In my second paper, I discuss the increased power, for mapping of human traits, that results from studying a population with appreciable levels of LD such as is found in the Swedish Sami population. </p><p>Lately, large-scale analyses of single nucleotide polymorphisms (SNPs) have become available and efforts have been made to identify a set of SNPs, which captures most of the genome variation in a population (tagSNPs). In my third paper, I describe the limitations of this approach when applied to data from an independent population sample of randomly ascertained SNPs. The transferability of tagSNPs between populations is poor, presumably due to variation in allele frequencies and the bias towards common SNPs used in most studies. </p><p>The level of genomic variation is influenced by population structure, recombination and mutation rate, as well as natural selection. During the exodus from Africa, humans have adapted to new environmental conditions. In my fourth paper, I describe a new method for identifying genomic regions carrying signatures of recent positive selection and apply this to an available dataset of millions of SNPs.</p>

Sequence variation of a 238 bp segment of the mitochondrial control region was analyzed for 1,568 Steller sea lions (2.8% of the estimated species population) sampled from 50 rookeries representing nearly every locality at which Steller sea lions are known to breed in significant numbers. Haplotype diversity (H = 0.9164 ± 0.0035) was high and nucleotide diversity (π = 0.00967 ± 0.00586) was moderate. No evidence was observed for significant genetic bottleneck effects. Rookeries were grouped into regions and stocks to examine structure at different spatial scales. F- and Φ-statistics were computed for all pairwise comparisons of rookeries, regions and stocks. Significant (P<0.05) divergence of eastern stock (southeastern Alaska to California) animals from western stock animals was supported in analyses at all spatial scales. Likewise, rookeries and regions from Asia were found to be significantly different from all other western stock rookeries. This was most clearly demonstrated using Φ-statistics at the regional level. The Commander Islands clearly associate with Alaskan western stock rookeries, not with the Asian rookeries. Within each of the three stocks there is significant isolation by distance among rookeries. This relationship does not hold for inter-stock comparisons indicating that there are important barriers to gene flow among stocks. Mitochondrial DNA analysis supports the recognition of three stocks for appropriate conservation of the species. The currently recognized eastern stock is unaffected, but the western stock is now partitioned west of the Commander Islands yielding a western stock which ranges from Prince William Sound west to the Commander Islands, and an Asian stock including rookeries from the Kamchatka Peninsula, Kuril Islands, and Sea of Okhtosk.

Waran används sedan 60 år som blodförtunnande läkemedel för att förebygga eller förhindra progress av blodproppssjukdom. I Sverige behandlas årligen cirka 1 % av befolkningen med waran. I Östergötland uppskattas antal waranpatienter till cirka 3000. Waran hämmar enzymet VKORC1 som ansvarar för vitamin K omsättningen i kroppen. Vitamin K behövs som kofaktor för flera koagulationsfaktorer. Behandling med waran är förenad med en svår balansgång och kräver en noggrann dosering. Stora skillnader i dosbehov mellan olika individer, beroende på ärftliga och miljöfaktorer, gör waran till ett svårhanterligt läkemedel. För låg dos medför otillräcklig effekt och därmed risk för minskat skydd mot blodproppssjukdom. För hög dos leder till allvarliga blödningskomplikationer. Uppskattningsvis 1 – 3 % livshotande blödningsfall registreras årligen efter waranbehandling. Därför måste behandlingen kontrolleras noga med analys av protrombinkomplex (PK) och dosjusteringar göras med ledning av resultaten. Två olika metoder finns att använda för mätning av PK. I Norden och i Japan används Owrens metod (utvecklat i Norge under 40- och 50-talet av Paul Owren). I de flesta andra länder används Quickmetoden (utvecklat i USA under 30-talet av Armand Quick). Den senare metoden är förenad med stora variationer mellan olika analyslaboratorier. I Norden, däremot, där Owrens metod används finns det ofta bra överensstämmelse mellan olika laboratorier i PK-resultat. Beroende på vilken PK-metod som används, kan samma patient få olika warandoser vilket ökar risker för under- eller överbehandling. Vi har i samarbete med flera sjukhus och antikoagulationsmottagningar (AK-mottagningar) i sydöstra Sverige studerat dels mekanismerna bakom skillnader i warandos mellan olika patienter, och dels tittat varför de olika PK-metoder skiljer sig så mycket som de gör. I studien har vi identifierat genetiska varianter av enzymet VKORC1. Av de undersökta patienter som gick på waran under längre tid, har vi identifierat en grupp som markant skiljde sig från de övriga. Denna grupp hade warandoser som var betydligt lägre än de övriga. När vi kartlade deras arvsmassa, fann vi att lågdospatienterna hade genvarianten VKORC1*2. Dessutom hade patienter med denna variant svårigheter att få stabila PK-värden. De gjorde också fler besök på AK-mottagningar än andra patienter. Vi har därför konstaterat att en del av de problem som är förenade med waranbehnadlingen kan förklaras av VKORC1*2 varianten. Vetskap om denna variant skulle troligen underlätta behandlingen framför allt under inledningsfasen då patienter med VKORC1*2 riskerar blödningar på grund av överdosering. Vi har identifierat att provförspädning enligt Owrens metod är nödvändig för harmonisering av PK-resultatet mellan olika länder. Quickmetoden använder inte förspädning av patientprov till skillnad från Owrens metod. När vi modifierade en Quickmetod genom att förspäda prover enligt Owrens metod noterade vi en bra överensstämmelse mellan de två olika metoderna. Däremot var resultatet sämre utan provförspädning. Vi anser att Quickmetoder kan uppnå lika bra resultat som Owrens metod om prover förspäds som i Owrens metod. Det skulle gynna patienter som reser mellan olika regioner eller länder och leda till en bättre övervakning av waranbehandling internationellt. I studien har dessutom en metod för mätning av waran i blodet utvecklats. Metoden som är den enda i sitt slag i Norden ger möjlighet att studera hur läkemedlet beter sig i kroppen. Vi har med denna metod kunnat upptäcka patienter som har onormala nedbrytningar av waran. / Warfarin was introduced more than 60 years ago and is used worldwide for the prophylaxis of arterial and venous thromboembolism in primary and secondary prevention. The drug is orally administered as a racemic mixture of (R)- and (S)-enantiomers. The (S)-form is mainly responsible for the anticoagulant effect and is metabolised by CYP2C9 enzyme in the liver microsomes. Warfarin exerts its pharmacological action by inhibiting the key enzyme (VKORC1) that regenerates vitamin K from an oxidised state to a reduced form. The latter is a cofactor for the post-translational modification of a number of proteins including coagulation factors II, VII, IX and X. The vitamin K-dependent modification provides these factors with the calcium-binding ability they require for the interaction with cell membranes of their target cells such as platelets. Warfarin is monitored by measuring prothrombin time (PT) expressed as INR. Two main methods exist for PT analysis. The Owren method is used mainly in the Nordic and Baltic countries, in Japan, whereas the Quick method is employed in most other countries. Warfarin management is associated with some complications. Unlike many other drugs the dose for a given patient cannot be estimated beforehand, dose-response relationship is not predictable, and the prevention of thrombosis must be balanced against the risk of bleeding. Furthermore, the different PT methods used to monitor the drug are sometimes not in agreement and show significant discrepancies in results. In an attempt to clarify the mechanisms influencing the inter-individual variations in warfarin therapy and to detect the factors that contribute to differences between PT methods, studies were conducted in collaboration with hospitals and anticoagulation clinics in the south-eastern region of Sweden. First, a stereo-specific HPLC method for measurement of warfarin enantiomers was developed and validated. With this method, the levels of plasma warfarin following its oral administration can be studied and evaluated. Abnormal clearance in some patients can be detected, and patient compliance can be verified. Furthermore, differing ratios of (S)- and (R)-isomers can be identified. The impact of common VKORC1 polymorphisms on warfarin therapy was investigated. This study has shown that the VKORC1*2 haplotype is an important genetic determinant for warfarin dosage and is associated with difficulties in attaining and retaining therapeutic PT-INR. Further, significant differences in warfarin S/R-ratio was detected between patients with VKORC1*2 and VKORC1*3 or VKORC1*4 variants. This difference was not coupled with CYP2C9 genotype. The effects of predilution of patient plasma samples, sources of thromboplastin and deficient plasma on between PT methods agreement were studied. This study has revealed that sample predilution according to the Owren method is to be preferred for the harmonisation of PT results. Undiluted samples, in contrast, according to the Quick method have shown reduced correlation between two different thromboplastin reagents. Sources of thromboplastin and deficient plasma were only of minor importance.