Une craniosynostose est une pathologie caractérisée par la fusion prématurée d'une ou plusieurs sutures crâniennes. C'est un défaut de naissance assez fréquent (1/2500 naissances) qui résulte en une forme anormale du crâne et qui peut être accompagné d'une déficience mentale dans certains cas. Des mutations du gène TWIST1, qui encode un facteur de transcription basique Helix-Loop-Helix (bHLH) de classe II, causent le syndrome de Saethre-Chotzen qui est associé à une synostose de la suture coronale (El Ghouzzi et al. 1997; Howard et al. 1997). Un nouveau gène a récemment été découvert comme étant une nouvelle cause du syndrome Saethre-Chotzen ainsi que de synostose coronale asyndromique (Sharma, Fenwick, Brockop, et al., 2013): il s'agit du gène TCF12, qui encode un facteur de transcription bHLH de classe I.Nous démontrons qu'une reduction de l'expression génique de Twist1 et Tcf12 chez la souris cause une synostose coronale, et nous suggérons que les protéines bHLH Twist1 et Tcf12 forment des hétérodimères dont le dosage est critique pour le développement de la suture coronale.Nous nous concentrons aussi sur Twist1 et prouvons que son expression est requise dans les tissus dérivant du mésoderme ainsi que ceux dérivant des crêtes neurales pour le développement normal de la suture coronale.De plus, nous notons que dans la suture coronale, Twist1 exclut Notch2 afin de garder la suture ouverte, et beta-catenin joue un rôle dans la maintenance de l'ouverture de la suture en ciblant Jagged1 lors du développement de la suture coronale chez la souris.Enfin, nous mentionnons de nouveaux gènes qui pourraient avoir un impact sur le développement normal de la suture coronale: Aggrecan, Goosecoid, Gucy1a3 et Gucy1b3. / Craniosynostosis, the premature fusion of one or more cranial sutures, is a common birth defect (1/2500 live births) that results in abnormalities in skull shape and sometimes in neurological deficiencies (Wilkie, 1997; Wilkie and Morriss-Kay, 2001). Mutations in TWIST1, which encodes a class II basic helix-loop-helix (bHLH) transcription factor, cause Saethre-Chotzen syndrome, associated with coronal synostosis (El Ghouzzi et al. 1997; Howard et al. 1997). We recently discovered a new craniosynostosis gene, TCF12, which encodes a class I bHLH transcription factor. Tcf12 causes.Saethre-Chotzen syndrome and asyndromic coronal synostosis. (Sharma, Fenwick, Brockop, et al., 2013). We show that a reduction in the dosage of Twist1 and Tcf12 in mouse causes coronal synostosis, and we suggest that the Twist1 and Tcf12 form heterodimers whose dosage is critical for coronal suture development. We also demonstrate that Twist1 is required in both neural-crest and mesoderm-derived tissues for the normal coronal suture development. Moreover, we show that in the coronal suture, Twist1 excludes Notch2 thus maintaining suture patency. and we show that beta-catenin also plays a role in the maintenance of suture patency by regulating Jagged1. Finally, we identified Aggrecan, Goosecoid, Gucy1a3 and Gucy1b3 as Twist1-regulated genes that could have an impact on the normal development of the coronal suture.

This thesis further delineates the molecular genetic basis of a relatively common craniofacial condition, coronal craniosynostosis. It used whole-exome sequencing to identify novel disease genes in patients with non-syndromic coronal synostosis and negative genetic testing. Initially, 2 patients were identified with damaging, frameshift mutations in a gene not previously linked with craniosynostosis – Transcription Factor 12 (TCF12). A further intronic mutation was identified in a third patient. This gene encodes a transcription factor that dimerises with TWIST1, mutations of which cause Saethre-Chotzen syndrome, also associated with coronal synostosis. Screening 344 undiagnosed patients identified 35 further mutations, all with coronal synostosis with 14 cases arising de novo. This work was published and testing for TCF12-related craniosynostosis was translated clinically. Significant non-penetrance (60%) was identified in mutation-positive relatives and the genetic background was investigated. Firstly, analysis of parental origins of de novo mutations identified 6 of paternal origin and helped refine haplotype assignment. Secondly, haplotype analysis of TCF12-mutation carriers revealed modest correlation with phenotypic status, but this was insufficient to be useful in clinical testing. Thirdly, TCF12 haplotypes were analysed for association with non-syndromic coronal synostosis, but no significant association was found. Further exome sequencing revealed a de novo frameshift mutation in Transcription Factor 20 (TCF20) in a patient with coronal synostosis and autism, although the mutation only correlated with the latter phenotype. Analysis of 5 trios revealed a novel variant in myosin heavy chain 4 (MYH4) in 1 family, although its role in suture development is uncertain. Reviewing pooled exome data from 19 mutation-negative patients revealed no further disease genes. In summary, this thesis describes novel gene discovery, defines a new clinical entity and investigates genetic background of penetrant and non-penetrant individuals. Further exome sequencing identified another disease gene, a de novo mutation and compiled lists of damaging variants to allow future work.