Les rodonticides anticoagulants (AR) sont utilisés depuis les années 40 pour lutter contre les rongeurs. Seulement quelques années après leur commercialisation des cas de résistances ont été décrits. Les mécanismes à l'origine de ces résistances sont relativement bien décrits chez le rat brun et la souris domestique mais très peu chez le rat noir. Une étude de terrain a permis de mettre en évidence 8 mutations codantes du gène Vkorc1 chez le rat noir responsable d'un possible phénotype résistant. Actuellement, les résistances concernent surtout les AR de 1ère génération. Ainsi, les AR de 2nde génération qui sont encore actifs chez les rongeurs résistants sont de plus en plus utilisés. Cependant, en raison de leur longue rémanence tissulaire, ils sont responsables de phénomènes d'intoxication de la faune non cible. Face à ce problème majeur, une nouvelle génération d'anticoagulants plus écocompatible doit être développée. Ce travail propose une méthode pour le développement d'une 3ème génération d'AR en retravaillant la 2nde génération via le concept de la stéréochimie. En effet, les AR de 2nde génération sont un mélange de diastéréoisomères qu'il est possible de séparer. Les propriétés biologiques et toxicocinétiques des diastéréoisomères de chacune des molécules actuellement sur le marché ont été étudiées. Systématiquement, l'un des deux couples de diastéréoisomères est éliminé beaucoup plus rapidement que l'autre. Ainsi, le développement d'appâts enrichis avec le couple de diastéréoisomères les moins persistants, permettrait de réduire les risques écotoxicologiques associés à leur utilisation / Anticoagulant rodenticides (AR) have been used since the 1940s to control rodents. Only a few years after their commercialization, cases of resistance have been described. The mechanisms responsible for these resistances are relatively well described in brown rats and domestic mice but approximately unknown in black rats. A field study performed in France and Spain revealed 8 coding mutations of the Vkorc1 gene in black rat populations responsible for a possible resistant phenotype to 1st generation ARs essentially, as described for other rodents. 2nd generation ARs still active in resistant rodents are thus increasingly used. However, due to their long tissue persistence, their use is associated with an increased risk of secondary poisoning of wildlife. Faced to this major problem, a new generation of more ecofriendly anticoagulants must be developed. This work proposes a method for the development of a 3rd generation of AR by revisiting the 2nd generation AR based on the stereochemistry. Indeed, 2nd generation ARs are a mixture of diastereomers that can be easily separated. The biological and toxicokinetic properties of the diastereoisomers of each of the molecules currently on the market have been studied. Systematically, one of the two pairs of diastereoisomers is eliminated much faster than the other. Thus, the development of baits enriched with the pair of less persistent diastereoisomers would reduce the ecotoxicological risks associated with their use

Les populations de rongeurs sont responsables de nombreux problèmes économiques et sanitaires. Pour ces raisons certains rongeurs sont qualifiés de nuisibles, tels que le rat brun, le rat noir et la souris domestique. En conséquence, leurs populations doivent être gérées. Cette gestion implique des mesures sanitaires et écologiques strictement indispensables mais passe aussi par l'utilisation de produits chimiques toxiques. Dans le cadre de la lutte chimique, les AVKs sont actuellement les molécules les plus utilisées. Ces AVKs inhibent la coagulation sanguine et sont à l'origine d'hémorragies mortelles. La cible pharmacologique des AVK est l'enzyme VKOR, codée par le gène vkorc1. Cependant, l'utilisation intensive des AVKs depuis les années 1950 a eu pour conséquence, chez les rongeurs, la sélection de résistance à ces molécules. La résistance de cible a été bien étudiée chez le rat brun mais est très peu connue chez la souris domestique et le rat noir / Rodent populations are responsible for many economic and health problems. For these reasons different rodents species are called pests and particularly brown rats, house mice and black rats. Their populations need to be managed. This management involves health and environmental measures strictly necessary but is also based on the use of toxic chemicals. As part of chemical control, the AVKs are currently the most commonly used molecules. These AVKs inhibit blood coagulation and are the cause of fatal bleeding. The pharmacological target of AVK is the VKOR enzymatic activity, encoded by the vkorc1 gene. However, the intensive use of AVKs since the 1950s has led to the development of resistance to these molecules. The target resistance has been well studied in the brown rat, but little is known in the house mouse and the black rat

Vitamin K Antagonists [VKA] are the most frequently used oral anticoagulants in clinical practice; however, many patients fail to achieve adequate anticoagulation control. We conducted a randomized, placebo controlled, double blind study of Vitamin K1 (200mcg per day, Swanson Vitamins) in a population with predominantly venous thromboembolism aimed at evaluating its effectiveness in improving anticoagulation control in unstable patients. This study also aimed to evaluate the impact that clinical variables, patient anticoagulation knowledge, and genetic polymorphisms in genes known to impact warfarin and Vitamin K metabolism [VKORC1, CYP4F2, CYP2C9] had on anticoagulation control and intervention effectiveness. A total of N=54 patients were enrolled in the study over 15 months [January 2009 to June 2010]. Change score analysis and multivariate linear regression modelling of anticoagulation control measures were performed. No statistically significant reduction was observed in the Vitamin K1 arm for percent time in therapeutic range; however, reduction was observed in standard deviation of INRs [Change Score Vitamin K = -0.259, p=0.0261; Regression Model 95% C.I Beta Vitamin K = 0.38 to -0.08] during the intervention period. Adjusting for treatment group allocation, independent predictors of increased INR standard deviation included: >5 alcoholic drinks per week [95% C.I Beta = 0.04 to 0.41], self-reported dosing errors [95% C.I Beta = 0.13 to 0.47], and missed INR appointments [95% C.I Beta = 0.002 to 0.05]

Warfarin is the most widely prescribed oral anticoagulant used for the long-term treatment and prevention of thromboembolic events. Its administration is challenging as it may result in bleeding-related deaths, inadequate anticoagulation and fetal teratogenesis, including fetal warfarin syndrome. A number of environmental and genetic factors contribute to interindividual warfarin dosage variability. The CYP2C9 and VKORC1 genes explain 40- 50% of this variability. The aim of this study was to determine the frequency of known and any new variants in these genes in the SA black population, and correlate these variants and a small subset of environmental factors to dosage variability and pregnancy outcomes. I sequenced the exons and intron/exon boundaries of the CYP2C9 and VKORC1 genes in 100 random black control and 113 patient samples that had at least one pregnancy on warfarin. I observed six previously described CYP2C9 variants, 27 novel CYP2C9 variants, and three previously described VKORC1 variants. 14 of these variants were observed at an allele frequency of 0.02. Of these 14, six appear to decrease (all of which are CYP2C9 variants) and four increase (2 CYP2C9 variants and two VKORC1 variants) warfarin dosage requirement. These 14 CYP2C9 and VKORC1 variants along with a small subset of environmental factors account for 45.3% of warfarin dosage variability in the SA population. I observed an increase in the number of poor pregnancy outcomes in patients on high doses of warfarin. These results allow us to predict the maintenance dose of warfarin in SA black patients better, thereby reducing the risk of adverse effects, and identify those at risk of having a poor pregnancy outcome.

Warfarin is one of the most widely used anticoagulants in the world. Treatment is complicated by a large inter-individual variation in the dose needed to reach adequate levels of anticoagulation i.e. INR 2.0 – 3.0. The objective of this thesis was to evaluate which factors, mainly genetic but also non-genetic, that affect the response to warfarin in terms of required maintenance dose, efficacy and safety with special focus on warfarin dose prediction. Through candidate gene and genome-wide studies, we have shown that the genes CYP2C9 and VKORC1 are the major determinants of warfarin maintenance dose. By combining the SNPs CYP2C9 *2, CYP2C9 *3 and VKORC1 rs9923231 with the clinical factors age, height, weight, ethnicity, amiodarone and use of inducers (carbamazepine, phenytoin or rifampicin) into a prediction model (the IWPC model) we can explain 43 % to 51 % of the variation in warfarin maintenance dose. Patients requiring doses < 29 mg/week and doses ≥ 49 mg/week benefitted the most from pharmacogenetic dosing. Further, we have shown that the difference across ethnicities in percent variance explained by VKORC1 was largely accounted for by the allele frequency of rs9923231. Other novel genes affecting maintenance dose (NEDD4 and DDHD1), as well as the replicated CYP4F2 gene, have small effects on dose predictions and are not likely to be cost-effective, unless inexpensive genotyping is available. Three types of prediction models for warfarin dosing exist: maintenance dose models, loading dose models and dose revision models. The combination of these three models is currently being used in the warfarin treatment arm of the European Pharmacogenetics of Anticoagulant Therapy (EU-PACT) study. Other clinical trials aiming to prove the clinical validity and utility of pharmacogenetic dosing are also underway. The future of pharmacogenetic warfarin dosing relies on results from these ongoing studies, the availability of inexpensive genotyping and the cost-effectiveness of pharmacogenetic driven warfarin dosing compared with new oral anticoagulant drugs.

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.

Vitamin K Antagonists [VKA] are the most frequently used oral anticoagulants in clinical practice; however, many patients fail to achieve adequate anticoagulation control. We conducted a randomized, placebo controlled, double blind study of Vitamin K1 (200mcg per day, Swanson Vitamins) in a population with predominantly venous thromboembolism aimed at evaluating its effectiveness in improving anticoagulation control in unstable patients. This study also aimed to evaluate the impact that clinical variables, patient anticoagulation knowledge, and genetic polymorphisms in genes known to impact warfarin and Vitamin K metabolism [VKORC1, CYP4F2, CYP2C9] had on anticoagulation control and intervention effectiveness. A total of N=54 patients were enrolled in the study over 15 months [January 2009 to June 2010]. Change score analysis and multivariate linear regression modelling of anticoagulation control measures were performed. No statistically significant reduction was observed in the Vitamin K1 arm for percent time in therapeutic range; however, reduction was observed in standard deviation of INRs [Change Score Vitamin K = -0.259, p=0.0261; Regression Model 95% C.I Beta Vitamin K = 0.38 to -0.08] during the intervention period. Adjusting for treatment group allocation, independent predictors of increased INR standard deviation included: >5 alcoholic drinks per week [95% C.I Beta = 0.04 to 0.41], self-reported dosing errors [95% C.I Beta = 0.13 to 0.47], and missed INR appointments [95% C.I Beta = 0.002 to 0.05]

Vitamin K Antagonists [VKA] are the most frequently used oral anticoagulants in clinical practice; however, many patients fail to achieve adequate anticoagulation control. We conducted a randomized, placebo controlled, double blind study of Vitamin K1 (200mcg per day, Swanson Vitamins) in a population with predominantly venous thromboembolism aimed at evaluating its effectiveness in improving anticoagulation control in unstable patients. This study also aimed to evaluate the impact that clinical variables, patient anticoagulation knowledge, and genetic polymorphisms in genes known to impact warfarin and Vitamin K metabolism [VKORC1, CYP4F2, CYP2C9] had on anticoagulation control and intervention effectiveness. A total of N=54 patients were enrolled in the study over 15 months [January 2009 to June 2010]. Change score analysis and multivariate linear regression modelling of anticoagulation control measures were performed. No statistically significant reduction was observed in the Vitamin K1 arm for percent time in therapeutic range; however, reduction was observed in standard deviation of INRs [Change Score Vitamin K = -0.259, p=0.0261; Regression Model 95% C.I Beta Vitamin K = 0.38 to -0.08] during the intervention period. Adjusting for treatment group allocation, independent predictors of increased INR standard deviation included: >5 alcoholic drinks per week [95% C.I Beta = 0.04 to 0.41], self-reported dosing errors [95% C.I Beta = 0.13 to 0.47], and missed INR appointments [95% C.I Beta = 0.002 to 0.05]

VKORC1 est une enzyme membranaire du réticulum endoplasmique, responsable de la réduction de la vitamine K époxyde en vitamine K quinone, activant la synthèse des facteurs de coagulation. VKORC1 constitue ainsi une cible thérapeutique privilégiée des anticoagulants de type anti-vitamine K (AVKs). Cependant, certaines mutations de VKORC1 induisent une dérégulation physiologique et/ou une résistance aux AVKs. En l’absence de données structurales, plusieurs modèles topologiques de VKORC1 ont été proposés à partir des données biochimiques et biophysiques, fréquemment contradictoires. La topologie de VKORC1 ainsi que l'implication des résidus de cystéine (strictement conservés chez toutes les VKORs) dans le mécanisme enzymatique de la protéine restent incertaines. Nous avons construit, par des méthodes in silico, un modèle 3D de la VKORC1 humaine sauvage (hVKORC1WT) à l'échelle atomique. Des simulations de dynamique moléculaire de la protéine, en considérant tous les résidus de cystéine sous leur forme oxydée (SH), nous ont permis d'identifier les résidus de cystéine les plus susceptibles de former des ponts disulfures. Nous avons par conséquent décrit les conformations métastables de hVKORC1WT mimant les états fonctionnels de la protéine. L’étude de la reconnaissance des formes époxyde et réduites de la vitamine K par les conformations prédites de hVKORC1WT a mis en évidence leur sélectivité réciproque. Les conformations de hVKORC1WT ciblées par chaque forme de la vitamine K et leur rôle dans le mécanisme de réduction de la molécule ont ainsi été caractérisés. Nous avons postulé à partir de ces résultats le mécanisme enzymatique détaillé de hVKORC1WT et proposé la structure-cible des AVKs. Les interactions entre la cible prédite - hVKORC1WT à l'état actif - et trois AVKs différents ont été décrites en termes d’énergie libre de liaison. Ces résultats ont été corrélés avec les constantes d'inhibition mesurées in vivo, validant nos prédictions théoriques. Notre protocole, développé pour hVKORC1WT, est applicable aux formes mutées de l’enzyme. Il permettra la description des mécanismes modifiant l'activité réductase de hVKORC1 et/ou provoquant une résistance aux AVKs. Cette description ouvre la voie à la conception d'une nouvelle génération d'inhibiteurs surmontant les résistances aux AVKs. Notre concept et le protocole établi pour l’étude de hVKORC1 peuvent être étendus à l'analyse des VKORs mammaliennes et aux autres enzymes de la famille des oxydoréductases. / VKORC1 is an endoplasmic reticulum membrane-resident enzyme, responsible for vitamin K epoxide reduction to vitamin K quinone that activates coagulation factors synthesis. VKORC1 is thus a prominent target of vitamin K agonists (VKAs) in anticoagulant therapies. However, some VKORC1 mutations lead to physiological dysregulation and/or VKAs resistance. No VKORC1 structural data is available, and postulated topological models are based on biochemical and biophysical experimental observations frequently contradicting. Topology of VKORC1 and involvement of cysteines residues (highly conserved in VKORs) in the protein enzymatic mechanism remain unclear. We built an in silico 3D model of the wild-type human VKORC1 (hVKORC1WT) at the atomistic scale. Molecular dynamics simulations of the protein model, carrying all the cysteines residues in their oxidized form (SH), were used for identification of cysteines residues which may plausibly form disulfide bridges. We thus described hVKORC1WT metastable conformations depicting the functionally relevant states of protein. Study of the vitamin K (in epoxide and in reduced forms) recognition by the predicted conformations of hVKORC1WT revealed their reciprocal selectivity. The hVKORC1WT conformations targeted by each vitamin K form were established and their role in the reduction mechanism of this molecule was explained. Using our results, we postulated the comprehensive enzymatic mechanism of hVKORC1WT and we proposed the 3D structure as the VKAs target. Interactions between the predicted target - hVKORC1WT active state - and three different VKAs were characterized. The obtained affinities (free binding energy) were in good correlation with in vivo measured inhibition constants (Ki), thus validating our theoretical predictions. Our protocol developed for hVKORC1WT is suitable for a study of its mutants. Description of the enzymatic mechanisms of mutated hVKORC1 will lead to understanding of the modified reductase activity or/and to explaining of its resistance to VKAs. Such data are crucial for the development of novel strategies in the design of a new generation of inhibitors overcoming VKAs resistance. Our concept and the established in silico protocol can be extended to analysis of mammalian VKORs and other oxidoreductases family proteins.

Les perturbations environnementales d’origine anthropique favorisent l’établissement de populations invasives. La gestion de ces populations est primordiale pour la santé publique (zoonose, famine), l’environnent (perte de biodiversité), et l’économie (dégâts). L’objectif de cette thèse pluridisciplinaire, menée en conditions naturelles, est d’améliorer les connaissances sur les populations invasives de rongeurs dans des paysages agricoles à grande échelle et d’appréhender les mécanismes d’adaptation qui favorisent une réponse positive aux pressions anthropiques. Les résultats montrent que (1) le rat endémique Rattus tiomanicus, dont la présence est associée à la typologie de l’habitat naturel, et le rat introduit Rattus tanezumi-R3, dont la présence est associée aux activités humaines, constituent les populations invasives des plantations de palmier à huile en Indonésie; (2) leur distribution géographique clinale est probablement contemporaine à l’anthropisation des milieux, et suppose une compétition inter-spécifique; (3) ces grandes populations sont spatialement continues avec un flux génique limité par la distance géographique (caractérisées par un patron d’isolement par la distance) et potentiellement influencé par les transports routiers; (4) R. tanezumi-R3 possède une forte résistance physiologique aux raticides AVK, dont l’origine n’est pas associée à une mutation génétique de la molécule cible mais probablement liée aux enzymes du métabolisme. Ces travaux soulignent des stratégies d’adaptations comportementales et physiologiques des populations invasives de rongeurs en milieux agricoles et procurent des bases pour l’élaboration de stratégies de lutte adaptée / Anthropogenic activities modulate landscape and promote the establishment of invasive populations. Management of these populations represents a major issue for public health (zoonotic disease, famine), environment (biodiversity loss) and economy (damages). This multidisciplinary thesis has been conducted in natural conditions on populations of rodents infesting agricultural landscapes at large scale. This work aims to understand biological mechanisms that promote adaptations to anthropogenic pressures. The results suggest that (1) two species may infest oil palm plantations in Indonesia: an endemic rat Rattus tiomanicus - which presence is associated with natural habitat typology - and an introduced rats Rattus tanezumi-R3 - which occur in association with the Human Footprint- ; (2) clinal geographic distribution of these species is probably due to both phylogeography and contemporary human activities, and suggest interspecific competition; (3) genetic isolation by distance patterns among these populations, and restricted gene flow potentially influenced by road transport; (4) R. tanezumi-R3 developed a strong physiological resistance to coumatetralyl under AVK exposure. This resistance is not associated with a genetic mutation of the target molecule, and may relate to metabolic enzymes. This work highlights behavioral and physiological adaptations of invasive populations of rodents in agricultural landscape, and thus provides scientific basis for integrated pest management