Les connaissances actuelles en pathologie hépatique suggèrent que HCV n'est pas directement oncogénique mais expose les patients au risque de cancer du foie dans un contexte inflammatoire associé à une réponse UPR (Unfolded Protein Response) et une régénération hépatique. La nétrine-1, le ligand canonique de la famille des DRs (Récepteurs à dépendance), est une protéine anti-apoptotique impliquée dans le développement, l'inflammation et la tumorigenèse. Les DRs induisent l'apoptose en absence de leurs ligands. A ce jour, il n'existe aucune donnée reliant le concept de DR et les virus oncogènes. Au cours de ma thèse, j'ai contribué à démontrer que la fonctionnalité des DRs était altérée au cours de l'infection par HCV in vitro et in vivo. Nous avons montré que la surexpression de la nétrine-1 augmente l'infectivité des virions et promeut leur entrée via l'activation et la diminution du recyclage de l'EGFR. De son coté, HCV augmente l'expression de la nétrine-1 suite à l'activation de l'épissage de son ARN pré-messager. Nous avons aussi montré que l'expression du récepteur à la nétrine-1, UNC5A, était diminuée au cours de l'infection suite à des diminutions transcriptionnelle et traductionnelle. Dans ce cadre, la nétrine-1 joue le rôle de facteur proviral en inhibant une potentielle voie de signalisation antivirale induite par le récepteur UNC5A non lié. Nous avons ensuite voulu savoir quelles conséquences cette surexpression de nétrine-1 pourrait avoir en physiopathologie hépatique en contexte non infectieux. Un stress du RE (Réticulum Endoplasmique) est observé au cours de l'infection par HCV. Le stress du RE entraîne l'activation de la réponse UPR qui induit l'apoptose médiée par la DAPK1 en cas de stress prolongé. Le fait que le récepteur UNC5B active aussi l'apoptose via l'activation de la DAPK1 nous a conduit à étudier l'implication de la nétrine-1 dans la survie cellulaire au cours de la réponse UPR en contexte hépatique. Nous avons démontré à la fois in vitro et in vivo que l'expression de la nétrine-1 pourrait protéger les cellules contre l'apoptose induite par la réponse UPR suite à sa liaison aux récepteurs UNC5A et C qui entraîne l'inhibition de la DAPK1. De nombreuses études ont également reporté des rôles de la nétrine-1 dans l'inflammation et la néoangiogenèse. Nous avons montré que la nétrine-1 inhibe la migration transendothéliale hépatique des PBMCs (Peripheral Blood Mononucleated Cells) et accélère la tubulogenèse des cellules endothéliales intrasinusoïdales hépatiques. Dans leur ensemble, mes travaux de thèse suggèrent que la nétrine-1 via ses récepteurs UNC5s joue des rôles délétères en pathophysiologie hépatique favorables à la persistance virale et à la résistance à la mort cellulaire / Current knowledge in hepatic pathology suggests that HCV is not directly oncogenic but puts patients at risk for liver cancer in a context associated with a chronic inflammation, UPR (Unfolded Protein Response) and liver regeneration. Netrin-1, the canonical ligand of the DR (Dependence Receptor) family, is an antiapoptotic secreted factor implicated in development, cancer and cancer-associated inflammatory diseases. DRs induce cell death when unbound. No data linking the DR system to oncogenic viruses are available to date. During the first part of my PhD, I contributed to demonstrate that HCV infection alters DR functionality both in vitro and in vivo. We found that Netrin-1 conditions HCV virion infectivity and promotes virion entry by increasing the activation and decreasing the recycling of the EGFR. In turn, HCV increases Netrin-1 expression through enhanced Netrin-1 pre-mRNA splicing. The Netrin-1 UNC5A receptor expression was decreased upon HCV infection through diminished transcription and translation. In this setting, Netrin-1 acts as a proviral factor by inhibiting a putative antiviral signaling pathway conveyed by the unbound UNC5A receptor. In this context, we wanted to determine what consequences such Netrin-1 up-regulation could induce in non-infectious hepatic pathophysiology. Chronic ER (endoplasmic reticulum) stress is observed during HCV infection. ER stress leads to UPR activation which triggers apoptosis via DAPK1 activation upon prolonged stress. The fact that the UNC5B receptor induces apoptosis through DAPK1 activation led us to investigate Netrin-1 implication in cell survival upon UPR in the liver. During the second part of my PhD, I have demonstrated both in vitro and in vivo in mice that Netrin-1 translation during UPR could protect cells against UPR-related cell death after binding to UNC5A and C, in a DAPK1-mediated fashion. Several studies have also identified Netrin-1 roles in inflammation and neo-angiogenesis. We found that Netrin-1 inhibits hepatic transendothelial migration of PBMCs (Peripheral Blood Mononucleated Cells) and accelerates tubulogenesis of liver sinusoidal endothelial cells. Netrin-1’s role in a hepatic inflammation and neoangiogenesis, both events being tightly associated with viral hepatitis, remains to be thoroughly elucidated. Altogether, our results suggest that Netrin-1 plays UNC5-dependent deleterious roles in hepatic pathophysiology, leading to viral persistence as well as resistance to cell death

Η πολυλειτουργική πρωτεΐνη core του ιού της ηπατίτιδας C (HCV) εμπλέκεται στην ανάπτυξη ηπατοκυτταρικού καρκινώματος (HCC) που προκαλείται από τον ιό της ηπατίτιδας C, αλλά ο μηχανισμός με τον οποίο συμβαίνει αυτό δεν είναι κατανοητός. Η ενεργοποίηση του μονοπατιού Wnt/ β-κατενίνη, παίζει ένα σημαντικό ρόλο στην ανάπτυξη ηπατοκυττταρικού καρκίνου, και τροποποιείται από την πρωτεΐνη core του ιού της ηπατίτιδας C. Ο ιός της ηπατίτιδας C χαρακτηρίζεται από εκτεταμένη γενετική ποικιλομορφία και διαφορετικά κλινικά δείγματα διαφέρουν όσον αφορά την μολυσματικότητα τους και την παθογένεια που προκαλούν. Σκοπός αυτής της μελέτης είναι να καθοριστεί ο ρόλος της γενετικής ποικιλομορφίας της πρωτεΐνης HCV core στην ενεργοποίηση του μονοπατιού Wnt/ β-κατενίνη και να μελετηθεί ο μοριακός μηχανισμός με τον οποίο η πρωτεΐνη HCV core ρυθμίζει την ενεργοποίηση αυτή. Η ενεργότητα του μονοπατιού Wnt/β-κατενίνη μελετήθηκε σε HEK 293T και Huh 7.5 κυτταρικές σειρές που εκφράζουν παροδικά τις πρωτεΐνες core των γενοτύπων 1a, 1b, 3a, 4a, 4f και από ένα μοναδικό δείγμα του γενοτύπου 1a που προέρχεται από έναν ασθενή από την Καμπότζη (1aCam). Μελέτες βασισμένες στη μέτρηση ενεργότητας της λουσιφεράσης, Western blot ανάλυση και qPCR, χρησιμοποιήθηκαν για την μέτρηση των επιπέδων έκφρασης γονιδίων και πρωτεϊνών. Βρέθηκε ότι η HCV core πρωτεΐνη ρυθμίζει θετικά την μεσολαβούμενη από τη β-κατενίνη Tcf-εξαρτώμενη ενεργότητα της λουσιφεράσης σε ένα γενοτυπο-εξαρτώμενο τρόπο. Σε συμφωνά με τα αποτελέσματα αυτά βρέθηκε ότι η πρωτεΐνη HCV core σταθεροποίει τα επίπεδα της β-κατενίνης, τόσο σε παροδικά μετασχηματισμένα κύτταρα, όσο και σε κύτταρα που μολύνονται με βακουλοϊούς που εκφράσουν τις πρωτεΐνες core των υποτύπων 4a και 4f. Τέλος, βρέθηκε ότι η πρωτεΐνη HCV core συμβάλει στην θετική ρύθμιση των γονιδίων c-myc, αξίνης και Tbx3, τα οποία είναι καθοδικά γονίδια στόχοι του μονοπατιού Wnt/β-κατενίνη και εμπλέκονται στην ανάπτυξη ηπατοκυτταρικού καρκινώματος. Συμπερασματικά, οι πρωτεΐνες HCV core διαφορετικών γενοτύπων του ιού ρυθμίζουν διαφορετικά το μονοπάτι σηματοδότησης Wnt/β-κατενίνη και η διαφορετική αυτή ρύθμιση μπορεί να σχετίζεται με ικανότητα των διαφόρων γενοτύπων του ιού της ηπατίτιδας C να επάγουν την ανάπτυξη ηπατοκυτταρικού καρκινώματος. / The multifunctional HCV core protein is implicated in the development of hepatocellular carcinoma (HCC) caused by HCV infection, but the underlying mechanism is not fully understood. Activation of the Wnt/ β-catenin pathway plays a major role in HCC and is modulated by the HCV core protein. HCV is characterized by extensive genetic diversity and different clinical isolates do vary in their infectivity and pathogenesis mainly due to variations in the structure/function relationships of individual viral proteins. The aim of this study is to determine the possible influence of genetic variability in HCV core protein in enhancing the Wnt/ β-catenin signaling activity and to elucidate the molecular mechanisms by which HCV core modulates activation of β-catenin. The Wnt/β-catenin activity was investigated in transiently transfected HEK 293T and Huh 7.5 cell lines transiently expressing HCV core proteins from HCV genotypes 1a, 1b, 4a, 4f and from a unique isolate of genotype 1a obtained from a Cambodian patient (1aCam). Luciferase-based reporter assay, Western blot, and qPCR, were used to measure gene and protein expression levels. We found that, HCV core protein upregulates β-catenin-mediated Tcf-dependent luciferase activity in a genotype specific manner. Consistent to these findings, HCV core stabilizes β-catenin levels. Finally, we showed that HCV core contributes to the upregulation of Tbx3 gene expression, a downstream target gene of Wnt/ β-catenin pathway contributing to HCC development. In conclusion, HCV core protein from different genotypes appears to differentially regulate the Wnt/β-catenin signaling pathway and this finding may contribute to different potential of HCV genotypes to induce HCC.

Hepatitis C virus (HCV) establishes a chronic infection in about 70% of infected individuals that is associated with the development of liver cirrhosis and hepatocellular carcinoma. The mechanisms by which HCV avoids clearance by the host immune response are not fully understood. The first aim of this project was to determine whether immune cell subsets could become infected by HCV in vitro. None of the haematopoietic subsets analysed expressed all of the required entry factors, CD81, SR-BI, claudin-1 and occludin. Also, PBMCs were not susceptible to infection with HCVpp and HCVcc expressing glycoproteins of hepatotropic strains. Infection by a supposedly lymphotropic strain (SB) was found to be inefficient. The second aim was to identify in vitro immunomodulatory effects of HCV on innate immune cells that may impact on the immune response activated in acute infection. Crosslinking of CD81 on NK cells by antibody was found to have a minor inhibitory effect on their activation via CD16, but CD81 crosslinking by viral particles had no detectable effect. In contrast to other viruses, HCVcc elicited very little interferon-α production by pDC. HCVcc also did not affect pDC or mDC responses to TLR ligation. Systemic cytokine and chemokine responses were analysed in subjects with primary acute HCV infection and in HCV-infected patients undergoing liver transplantation (LT). Interestingly, induction of systemic type I and type III interferon was not observed in either group. Marked perturbations in systemic cytokine and chemokine levels were detected in uninfected LT patients, precluding use of HCV-infected LT patients to study the innate immune response activated in response to acute viral replication. Together, these results suggest that HCV may principally evade innate immune cell responses by avoidance rather than impairment strategies.

Hepatitis C virus (HCV) is a major global pathogen that infects an estimated 170 million people worldwide, and for which currently no vaccine is available. HCV is a highly diverse viral pathogen and exists as 6 major genotypes sharing only 75% sequence homology; developing a vaccine that is cross-reactive between genotypes is a major challenge. Defining immune responses that target different HCV genotypes will facilitate pan-genotypic T cell vaccine development. HCV genotype 3 (gt3) is now the most common infecting genotype in the United Kingdom and large parts of Asia; however, data regarding the T cell antigenic targets of this genotype is very limited. In this thesis, HCV gt3 specific T cell targets were defined in acute, chronic and spontaneously resolved infection: in chronic gt3 infection, T cell responses were low in magnitude and narrowly focused in specificity, similar to those previously reported for gt1; in contrast, resolved infection was associated with a higher magnitude and broader specificity of CD4+ and CD8+ T cell responses across the genome. Overall, T cell specificity in gt3 infection was markedly different to that previously described for gt1, confirming that sequence differences between genotypes result in distinct immunological profiles. Previous work from our laboratory demonstrated that, though T cell responses induced by a potent T cell vaccine containing HCV gt1b non-structural regions do target epitopes dominant in natural infection, induced T cells show limited cross-reactivity against other genotypes. In this thesis, it was assessed whether T cells primed in natural gt3 infection are able to recognize viral sequence variants at dominant epitopes, which would make these potential targets in cross-reactive vaccine design. For seven gt3-specific T cell epitopes identified here as dominant, major sequence variability was observed within and between genotypes, and limited T cell cross-reactivity observed against identified viral variants. This suggests that regions frequently targeted in natural infection may not serve as attractive targets for cross-reactive vaccine design. These results informed the subsequent design of a cross-reactive vaccine based on fragments of HCV that are conserved between genotypes. A generic algorithm was developed to define viral regions conserved between major HCV genotypes (for 1a/1b, 1/3a, 1-6), and these were joined to form immunogens between 819 and 1543 AA long. Possible artificial, non-HCV epitopes formed by junctions were identified using online epitope prediction servers, and abrogated through the insertion of 2-6 amino acid linkers. To address the concern that conserved regions may not be immunogenic, epitopes described in natural HCV infection were mapped on HCV sequences, showing that conserved segments are well populated with epitopes; additionally, strong binding peptides were predicted for conserved segments using online epitope prediction programs, suggesting potential in vivo immunogenicity. In conclusion, HCV T cell specificity is distinct between genotypes, with limited T cell cross-reactivity between viral variants. Leading from this result, vaccine immunogens were designed entirely based on conserved viral regions. This work paves the way for future studies of novel HCV immunogens based on conserved viral segments between genotypes.

Le virus de l’hépatite C (HCV) est l’agent responsable de l’hépatite C, maladie qui touche environ 3% de lapopulation mondiale. Une des caractéristiques de cette infection est son évolution dans 60 à 90% des casvers des formes chroniques avec des complications sévères telles que la cirrhose et le carcinomehépatocellulaire. Un des handicaps majeurs de la recherche sur le HCV est l’absence de systèmes decultures in vitro efficaces et de modèles animaux adaptés car le HCV n’infecte que l’homme et le chimpanzé.l’anticorps D32.10. Pour cela, nous avons développé un test de cellbindinget nous avons montré quel’interaction des particules virales sériques (HCVsp) radiomarquées à l’Iode 125 avec les celluleshépatocytaires (Huh‐7 et HepaRG) est spécifique et saturable impliquant des sites de haute et faible affinité.De plus, l’anticorps D32.10 est capable d’inhiber spécifiquement et efficacement les interactions de hauteaffinité entre les HCVsp et les cellules HepaRG avec une IC50 ≤ 0,5 μg/ml. Nous avons mis en évidence quel’inhibition est plus efficace lorsque nous utilisons sélectivement une population de particules HCVenveloppées exprimant fortement E1E2. Récemment, nous avons développé un système d’infection originaldes cellules HepaRG qui sont des cellules progénitrices du foie par les HCVsp et avons montré quel’infection, la réplication et la propagation dépendent de l’état de prolifération/différenciation de cescellules. Nous avons aussi démontré que les particules virales produites dans ce système contiennent del’ARN viral, expriment les protéines d’enveloppe E1E2 et sont infectieuses. Des études préliminairesmontrent que l’anticorps D32.10 inhibe fortement l’infection (95% à 80% aux jours 14 et 21 aprèsinfection) vraisemblablement au niveau des étapes précoces du cycle viral.Dans un second temps, nous avons recherché la prévalence des anticorps de même spécificité que le D32.10(anti‐E1E2A,B) dans différents groupes de patients HCV positifs afin de déterminer leur significationbiologique. Par un test ELISA utilisant les peptides biotinylés E1, E2A et E2B dans la phase de capture, nousavons démontré que la réponse anticorps anti‐E1E2A,B était présente dans 90% des cas chez les patientsqui guérissent spontanément avec des titres élevées (≥ 1/1000). Cette réponse humorale est absente ourare (< 10%) chez les patients porteurs chroniques non traités ou non répondeurs aux traitementsantiviraux. Une étude longitudinale a été réalisée chez des patients non répondeurs ou répondeursdéveloppant une réponse virologique soutenue à une bithérapie standard, interféron pégylé plus ribavirine.L’analyse statistique des résultats a montré que les anticorps anti‐E1E2A,B pouvaient être prédictifs de laréponse au traitement avec une spécificité et une valeur prédictive positive de 100%.La convergence des résultats in vitro et in vivo supporte un rôle neutralisant de l’anticorps monoclonalD32.10, permettant d’envisager son utilisation en immunothérapie. / Hepatitis C Virus (HCV) is the major etiological agent of liver disease in the world with approximately180 million people who are seropositive. The majority (60‐90%) of infected individuals progressesto chronic hepatitis that increases their risk for developing cirrhosis and hepatocellular carcinoma.One of the major limitations of HCV research is the lack of efficient in vitro culture systems andappropriateanimal models. vitro direct cell‐binding assay and an infection system of the human HepaRG cell line were developedby using HCVsp. The HepaRG cells possess potent ability to acquire a mature hepatocyte phenotype.The E1E2‐specific mAb D32.10 was shown to inhibit efficiently and specifically high affinityinteractionsthrough glycosaminoglycans and the CD81 tetraspanin between HCVsp and HepaRGcells with an IC50 = 0.5 μg/ml. This inhibition was more efficient when E1E2‐positive envelopedHCVsp were used selectively for binding studies (IC50 < 0.5 μg/ml). Establishment of infection,replication and propagation of HCVsp were shown to depend on the proliferation/differentiationstage of HepaRG cells. Persistent HCV infection in HepaRG cells could be obtained with production ofE1E2/RNA(+) infectious HCV particles. Preliminary data showed a complete early inhibitory effect ofthe D32.10 mAb on virion RNA production in HepaRG culture supernatants (95% at D14 and 80% atD21 post‐infection).Furthermore, the detection of the anti‐E1E2/D32.10‐binding peptide antibodies during natural HCVinfection demonstrated significant prevalence (90%) of these antibodies: (1) in patients whorecovered spontaneously from HCV infection with high titers compared to patients with chronichepatitis C, and (2) in patients who are complete responders compared to non responders toantivirals. Kinetic analyses revealed that the anti‐E1E2/D32.10‐like humoral response appeared veryearly with high titers (≥ 1/1000) and was associated with complete virus eradication. The positiveand negative predictive values (ROC curve analysis) for achieving or not a sustained viral response toantiviral therapy are 100% and 86%, respectively, reflecting diagnostic accuracy. The anti‐E1E2/D32.10‐binding peptide antibodies may thus predict the outcome of HCV infection andrepresent a new relevant pronostic marker in serum for the HCV diagnosis.Convergence of in vitro and in vivo data strongly support the neutralizing activity of the D32.10 mAb,and thus immunotherapeutic potential of this unique anti‐E1E2 D32.10 mAb.

L'infection par le virus de l'hépatite C (HCV) reste aujourd'hui une cause majeure d'hépatite chronique, de cirrhose du foie et de carcinome hépatocellulaire. L'attachement cellulaire et l'entrée de HCV sont médiés par les protéines d'enveloppe E1 et E2. De nouveaux récepteurs ont été récemment identifiés mais l'entrée du virus dans les hépatocytes reste énigmatique et n'a jamais été visualisée. Nous avons tout d'abord caractérisé le modèle des pseudo-particules HCV (HCVpp) encryomicroscopie électronique en transmission (cryo-MET). Ce sont des particules sphériques de 100 nm de diamètre portant à leur surface E1 et E2. Nous avons ensuite visualisé l'entrée des HCVpp dans les hépatocytes en MET conventionnelle en utilisant des lignées d'hépatome et des hépatocytes primaires humains(PHH). Ces derniers maintiennent leur polarité en culture comme en témoigne la persistance de canalicules biliaires, tels que dans les hépatocytes natifs. Après synchronisation à 4°C avec les cellules, les HCVpp sont retrouvées liées aux prolongements cellulaires via des 'piliers', et sont ensuite internalisées à 37°C par endocytose dépendante de la clathrine. Ces 'piliers', actuellement en cours d'identification par immunomarquages, sont internalisés avec les HCVpp dans les hépatocytes au sein de vésicules de clathrine ; ce suivi est effectué par des approches de congélation haute pression et de tomographie électronique. Enfin, les évènements d'endocytose des HCVpp dans les PHH se sont avérés rares, avec une cinétique ralentie comparée aux lignées cellulaires. Ces études en MET soulignent l'importance d'utiliser un modèle cellulaire physiologique polarisé pour l'étude du mécanisme d'entrée de HCV. / Hepatitis C virus (HCV) infection is a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Receptor recognition, cell binding and membrane fusion rely on HCV envelope proteins E1 and E2. New receptors were recently discovered; however HCV entry into hepatocytes remains largely unknown and has not yet been visualized. At first, we characterized HCV pseudoparticles (HCVpp) by cryo-transmission electron microscopy (cryo-TEM). They appeared as regular spherical structures of ca. 100-nm, with E1 and E2 at their surface. By conventional TEM, we then visualized HCVpp entry into hepatocytes, using hepatoma cells and primary human hepatocytes (PHH) as a more physiological cell model.PHH maintain their polarity in culture as attested by TEM observation of persistent bile canaliculi. At 4°C, viral particles were primarily found attached to microvilli at the cell surface via molecular bridges and, after warming to 37°C, they were internalized by endocytosis in clathrin-coated pits and vesicles. Using freeze substitution and electron tomographyapproaches, these bridges were found intimately surrounding HCVpp inside the clathrincoated vesicles, suggesting a concomitant internalization. The nature of these bridges is currently under investigation by immunogoldlabeling approaches. Finally, we reproducibly observed less HCVpp internalization events in PHH compared to hepatoma cells, and the kinetics of these events seemed delayed, probably due to PHH polarity. To conclude, ourTEM approach proved powerful to visualize HCV entry, and highlights the importance of studying a physiological cell model to understand HCV entry mechanism.

Si la découverte récente de la souche virale JFH1, capable de réaliser un cycle viral complet en culture cellulaire, a permis de mieux caractériser le déroulement de l’infection du virus de l’hépatite C VHC, de nombreux aspects de la biologie du virus demeurent méconnus. Parmi ceux-ci, les mécanismes gouvernant l’encapsidation de l’ARN génomique viral au sein des particules restent à élucider. Cette thèse décrit la mise point d’un système de mobilisation hétérologue permettant l’analyse de l’interaction de la protéine de capside Core avec l’ARN viral. Ce système nous a permis d’identifier les régions de la protéine impliquées dans la liaison au génome viral, tout en autorisant son transfert dans des cellules naïves. Cette approche de mobilisation dépendante de la Core est complétée d’une étude de recrutement hétérologue basée sur la reconnaissance de l’ARN du phage MS2 avec la protéine de manteau Coat. Cette stratégie novatrice permet le recrutement efficace des ARNs marqués tout en autorisant leur localisation cellulaire. / The advent of infectious molecular clones of Hepatitis C virus (HCV) has unlocked the understanding of HCV life cycle. However, packaging of the genomic RNA, which is crucial to generate infectious viral particles, remains poorly understood. To study packaging in vivo, we developed a novel heterologous system to evaluate the interactions of HCV Core capside with viral RNA. This system allowed us to pinpoint Core domains involved in RNA binding, and package and transfer HCV RNA into a lentiviral vector. Aside from this Core dependent recruitment, we engineered retoviral vectors to trans-package MS2-tagged RNAs using MS2 Coat protein interaction. This system allowed us to efficiently recruit MS2-tagged replicons into naive cells and offers the opportunity to visualize HCV RNAs in Huh7.5 cells.

O presente estudo realizou o sequenciamento de nova geração do vírus da hepatite C genótipo 1, incluindo os subtipos 1a (n=51) e 1b (n=49), e identificou variantes associadas com resistência (RAV) aos antivirais de ação direta em pacientes sem tratamento prévio. No subtipo 1a, foram encontradas RAV para as regiões NS3-4A, NS5A e NS5B em 10%, 22% e 8% dos pacientes, respectivamente. RAV detectadas foram: T54S (2%), V55A (2%), Q80K (4%) e R155K (2%) na protease NS3-4A; Q30H (4%), H58P (10%) e Q30H/R+Y93C/H/N (8%) na região NS5A; e A421V (8%) na polimerase NS5B. As frequências das RAV para o subtipo 1b foram 12%, 53% e 31% para as regiões NS3-4A, NS5A e NS5B, respectivamente. Foram encontradas as RAV F43I (2%), T54S (4%), Q80H (2%), D168E (2%) e M175L (2%) na região NS3-4A; L28M (2%), R30Q (2%), L31M (2%), Q54H (27%), A92T (2%), Y93H (4%), Q54H+A92T (6%), Q54H+Y93H (6%) e A92T+Y93H (2%) na região NS5A e, L159F (2%), C316N (4%), A421V (7%), L159F+C316N (9%) e S556G (9%) na polimerase. Utilizando esta metodologia, um recombinante inter-subtipo 1a/1b foi identificado. / This study performed the next-generation sequencing of the hepatitis C virus genotype 1, including subtypes 1a (n = 51) and 1b (n = 49), and identified resistance-associated variants (RAVs) to direct-acting antivirals in previously untreated patients. In subtype 1a, RAVs were found for NS3-4A, NS5A, and NS5B regions in 10%, 22% and 8% of patients, respectively. RAVs detected were: T54S (2%), V55A (2%), Q80K (4%) and R155K (2%) in NS3-4A protease; Q30H (4%), H58P (10%) and Q30H/R+Y93C/H/N (8%) in NS5A region; and A421V (8%) in NS5B polymerase. Frequencies of RAV for subtype 1b were 12%, 53% and 31% for NS3-4A, NS5A and NS5B regions, respectively. RAVs F43I (2%), T54S (4%), Q80H (2%), D168E (2%) and M175L (2%) were found in NS3-4a region; L28M (2%), R30Q (2%), L31M (2%), Q54H (27%), A92T (2%), Y93H (4%), Q54H+A92T (6%), Q54H+Y93H (6%) and A92T+Y93H (2%) in NS5A region and, L159F (2%), C316N (4%), A421V (7%), L159F+C316N (9%) and S556G (9%) in polymerase. By using this methodology, a recombinant inter-subtype 1a/1b was identified.

A Síndrome de Gilbert é caracterizada por uma hiperbilirrubinemia indireta benigna que ocorre na ausência de hemólise ou doença estrutural do fígado. Manifesta-se por episódios intermitentes de icterícia, desencadeados por exposição a estressores físicos, baixa ingesta calórica, entre outros. A base genética da redução da atividade da enzima UDP - Glucoroniltransferase foi descoberta em 1995: em uma população caucasiana. Todos os pacientes estudados apresentaram uma adição dos nucleotídeos Timina-Adenina (TA) na região TATA box presente no promotor do gene UGT1A1, em ambos os alelos. Embora considerada uma condição benigna, a síndrome de Gilbert tem sido recentemente associada à hiperbilirrubinemia e a outros efeitos colaterais na utilização de algumas drogas como o Indinavir e Irinotecan. Outro ponto importante diz respeito ao nível de bilirrubina sérica como um indicador da severidade do acometimento de hepatopatas. A presença de mutação no gene UGT1A1 em pacientes hepatopatas pode levar ao aumento da bilirrubina sérica, supervalorizando o acometimento hepático da condição patológica. O objetivo deste estudo foi verificar a frequência do alelo UGT1A1*28 em doadores de sangue da Fundação Pró-sangue Hemocentro de São Paulo HC-FMUSP e em pacientes portadores de hepatite crônica C atendidos no ambulatório de Gastroenterologia Clínica da FMUSP. Relacionar o genótipo TA7/7 com o aumento de bilirrubina sérica nos pacientes com hepatite crônica C e avaliar a técnica de análise de fragmento no rastreamento e genotipagem da Síndrome de Gilbert. A frequência encontrada para o genótipo TA7/7 no grupo doador foi de 9% (30/313) e no grupo de pacientes VHC, de 10% (51/494). O genótipo TA7/7 parece estar relacionado com o aumento de bilirrubina. A técnica de análise de fragmentos mostrou-se rápida, sendo possível para fazer uma análise em grande escala. A herança genética da população brasileira é muito heterogênea. É constituída de caucasianos, africanos, indios, orientais e outros. Os dados sugerem que a variação genética da região promotora do gene UGT1A1 é alta entre pacientes com bilirrubina maior que 1mg/dL, e que a genotipagem para UGT1A1*28 deve ser considerada na avaliação dos pacientes com hepatite C crônica com hiperbilirrubinemia. / Gilberts syndrome is a benign condition characterized by unconjugated hiperbilurubinemia that occurs in the absence of hemolysis or liver chronic disease. It is clinically manifested by intermittently jaundice, triggered by exposition to physical stress, low calory diet, among others. The genetic base is the reduction of the activity of UDP-glucuronosyltransferase enzyme described in 1995: in a Caucasian population, all patients studied presented a Thymine Adenine (TA) addition in the TATA box region in both alleles of the UGT1A1 gene promoter. Although, Gilberts syndrome has been considered a benign condition, recently it has been associated to hiperbilirrubinemia and other adverse events during the utilization of some drugs such as Indinavir and Irinotecan. Another important issue to consider is that bilirubin is used to evaluate the severity of liver dysfunction in chronic liver diseases. The presence of this mutation in those patients could increase bilirubin levels, overestimating liver damage. The aim of this study were: 1) to verify the frequency of the genotype UGT1A1*28 (TA7/7) in blood donors and in chronic hepatitis C patients from the Gastroenterology outpatients clinics of the University of São Paulo School of Medicine; 2) to establish a relationship with TA7/7 genotype and bilirubin elevation in chronic hepatitis C patients and 3) to evaluate the fragment analysis technique to screening and genotyping the Gilbert syndrome. The frequencies of TA7/7 genotype found in blood donors group were 9.6% (30/313) and in the chronic hepatitis C group were 10% (51/494). The TA7/7 genotype seems to be related with increase of bilirubin. The fragment analysis technique is fast and able to a large scale screening approach. The genetic background of Brazilian population is highly heterogeneous. It is comprised of Caucasians, Africans, Indians, Orientals and others. The data suggests that genetic variation of promoter region of UGT1A1 gene is high among patients with bilirubin levels greater than 1 mg/dl, and UGT1A1*28 genotypes should be considered when evaluating chronic hepatitis C patients with hiperbilirubinemia.

Les aurones, qui constituent une sous-classe des flavonoïdes, présentent un profil pharmacologique et un spectre d'activités biologiques prometteurs. Au cours de ce travail, nous avons mis à profit ce potentiel pour la modulation de deux cibles thérapeutiques majeures. En premier lieu, depuis la mise sur le marché d'inhibiteurs de la protéase NS3/4A, l'inhibition de la polymérase NS5B du virus de l'hépatite C représente un enjeu primordial dans la lutte contre cette maladie. L'utilisation des aurones contre cette polymérase trouve ici ses premiers développements. L'évaluation de quatre générations de composés a mené à l'identification de plusieurs dérivés actifs, dont certains produits naturels, présentant un IC50 inférieur à 5 μM. L'étude des interactions ligand – récepteur a en outre permis de déterminer que les aurones se fixent probablement sur le site « Thumb I ». En second lieu, si la modulation de la tyrosinase dans un cadre thérapeutique reste actuellement hypothétique, de nombreuses études voient en cette enzyme une cible pour le traitement futur de pathologies difficilement curables, comme le cancer ou la maladie de Parkinson. Les aurones ont fait preuve lors de ce travail d'une grande versatilité face à la tyrosinase, adoptant au gré des substitutions des comportements très différents de substrat alternatif, d'activateur hyperbolique ou d'inhibiteur mixte. Un modèle cohérent a cependant été proposé, qui regroupe et explique ces comportements. Au cours de ce travail, de nombreux dérivés d'aurone diversement substitués ou modifiés ont été préparés, par le biais de méthodes de synthèse adaptées à la structure de chaque produit formé. / Aurones, a subclass of flavonoids, present a favorable pharmacological profile and a wide, promising spectrum of biological activites. During this work, we used this potential for the modulation of two major therapeutic targets. Firstly, since several hepatitis C virus protease NS3/4A inhibitors were recently marketed, the inhibition of the polymerase NS5B is now the focus of research efforts in the fight against HCV. The use of aurones against the HCV polymerase is here reported for the first time. Four generations of compounds were synthesized and evaluated, and several bioactive derivatives were found, including some natural products, with an IC50 below 5 μM. Furthermore, additional investigations regarding inhibitor – receptor interactions allowed to identify the aurones binding site, which is Thumb Site I. Secondly, although the modulation of tyrosinase in a therapeutic aim remains a matter of discussion, a number of studies considers this enzyme as a potential target for future treatments against some hardly curable diseases, such as cancer or Parkinson's disease. During this work, aurones showed a great versatility toward tyrosinase. According to their substitution pattern, the compounds embraced very different behaviours, i.e. alternative substrate, hyperbolic activator or mixed inhibitor behaviour. However a consistent model was proposed, which gathers and explains all of these behaviours. During this study, a large number of widely substituted or modified aurone derivatives were prepared, according to structure-dependant adaptative synthetic methods.