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京都大学 / 新制・課程博士 / 博士(医学) / 甲第24522号 / 医博第4964号 / 新制||医||1065(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 誠司, 教授 萩原 正敏, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

TDP-43 est une protéine de liaison aux acides nucléiques qui joue un rôle essentiel dans le métabolisme de l'ARN. À l'état physiologique, un contrôle strict des niveaux d’expression de cette protéine est critique pour la fonction et la survie cellulaire. Une boucle d'autorégulation négative est à la base de ce contrôle du taux intracellulaire de TDP-43. Laquelle a été identifiée comme le constituant principal des inclusions observées chez une majorité des patients atteints de Sclérose Latérale Amyotrophique (SLA) ou de Dégénérescence Lobaire Fronto-Temporale (DLFT). A ce jour, plus de 50 mutations faux-sensdu gène TARDBP/TDP-43 ont été décrites chez des patients DLFT/SLA, démontrant le rôle clé de TDP-43 dans ces pathologies neurodégénératives. Notons cependant que les conséquences fonctionnelles de ces mutations ne sont pas complètement déterminées. Plusieurs études suggèrent qu’une élévation des niveaux d’accumulation de TDP-43 pourraitparticiper aux mécanismes physiopathologiques. La modulation du cycle de production de TDP-43 pourrait donc constituer une nouvelle stratégie thérapeutique. Ce travail de recherche avait donc pour principal objectif d’identifier des modulateurs génétiques de la production de TDP-43 en utilisant un nouveau modèle de drosophile transgénique mimant les principales étapes d’autorégulation de TDP-43. Nous avons ainsi pu montrer que la modulation des niveaux d’expression de la protéine TCERG1 et de plusieurs facteurs d'épissage, parmi lesquels SRSF1, SRSF3 et SF3B1, influe sur les niveaux de production deTDP-43. Nous avons également montré que la présence des mutations DLFT/SLA n’altère pas la capacité de la protéine à s’autoréguler. / TDP-43 is a DNA/RNA binding protein that plays an important role in RNA metabolism. In the physiological state, strict control of its expression levels is critical for cell function and survival. TDP-43 expression is tightly regulated through an autoregulatory negative feedback loop. This protein has been identified as the principal component of the inclusions observed in a majority of patients with Amyotrophic Lateral Sclerosis (ALS) or FrontoTemporal Lobar Degeneration (FTLD). To date, more than 50 missense mutations of the TARDBP / TDP-43 gene have been described in FTLD / ALS patients, demonstrating the key role of TDP-43 in these neurodegenerative pathologies. However, the functional consequences of TDP-43 mutations are not completely determined. Several studies suggest that high accumulation levels of TDP-43 may participate in pathophysiological mechanisms. The modulation of the production cycle of TDP-43 may therefore provide a new therapeutic strategy. The main goal of this research project was to identify genetic modulators of TDP-43 production by using a novel transgenic Drosophila model mimicking main steps of TDP-43 the autoregulatory mechanism. We identified several splicing factors, including SF2, Rbp1 and Sf3b1, as genetic modulators of TDP-43 production. We have also shown that modulation of TCERG1 expression levels affect TDP-43 production levels in flies. Finally, we found that FTLD/ALSlinked TDP-43 mutations do not alter TDP-43’s ability to self-regulate its expression and consequently of the homeostasis of TDP-43 protein levels.

Identification of recurrent mutations through next-generation sequencing (NGS) has given us a deeper understanding of the molecular mechanisms involved in chronic lymphocytic leukemia (CLL) development and progression and provided novel means for risk assessment in this clinically heterogeneous disease. In paper I, we screened a population-based cohort of CLL patients (n=364) for TP53, NOTCH1, SF3B1, BIRC3 and MYD88 mutations using Sanger sequencing, and confirmed the negative prognostic impact of TP53, SF3B1 or NOTCH1 aberrations, though at lower frequencies compared to previous studies. In paper II, we assessed the feasibility of targeted NGS using a gene panel including 9 CLL-related genes in a large patient cohort (n=188). We could validate 93% (144/155) of mutations with Sanger sequencing; the remaining were at the detection limit of the latter technique, and technical replication showed a high concordance (77/82 mutations, 94%). In paper III, we performed a longitudinal study of CLL patients (n=41) relapsing after fludarabine, cyclophosphamide and rituximab (FCR) therapy using whole-exome sequencing. In addition to known poor-prognostic mutations (NOTCH1, TP53, ATM, SF3B1, BIRC3, and NFKBIE), we detected mutations in a ribosomal gene, RPS15, in almost 20% of cases (8/41). In extended patient series, RPS15-mutant cases had a poor survival similar to patients with NOTCH1, SF3B1, or 11q aberrations. In vitro studies revealed that RPS15mut cases displayed reduced p53 stabilization compared to cases wildtype for RPS15. In paper IV, we performed RNA-sequencing in CLL patients (n=50) assigned to 3 clinically and biologically distinct subsets carrying stereotyped B-cell receptors (i.e. subsets #1, #2 and #4) and revealed unique gene expression profiles for each subset. Analysis of SF3B1-mutated versus wildtype subset #2 patients revealed a large number of splice variants (n=187) in genes involved in chromatin remodeling and ribosome biogenesis. Taken together, this thesis confirms the prognostic impact of recurrent mutations and provides data supporting implementation of targeted NGS in clinical routine practice. Moreover, we provide evidence for the involvement of novel players, such as RPS15, in disease progression and present transcriptome data highlighting the potential of global approaches for the identification of molecular mechanisms contributing to CLL development within prognostically relevant subgroups.

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