Colorectal cancer (CRC) is the third most common cancer worldwide; it is responsible for nearly 10% of all newly diagnosed cancers and is the second most cause of cancer related death in Europe. Biomarkers for therapy guidance, targeted therapy and survival prognosis are still limited. As CRC is a heterogeneous disease, different parts of the tumor might have varying molecular characteristics which may change during therapy or disease progression. Through solid biopsies and screenings, these local or temporal differences are impossible to monitor. To facilitate detection of these possible temporal changes, a regularly and non-invasively accessible biomarker is required for disease monitoring. Circulating tumor cells (CTCs) might represent such a biomarker as they have been shown to be fluid surrogates of the solid tumor. EpCAM positive CTCs have shown to be prognostic in CRC for survival, but their full potential has not yet been evaluated further. By using the High Definition Single Cell Analysis (HD-SCA) workflow, we were able to analyze the entire spectrum of CTCs and categorize them as the regular CTCs (HD-CTC), CTCs with a smaller nuclear area (CTC-Small), CTCs with low expression of epithelial marker cytokeratin (CTC-LowCK) and CTCs undergoing apoptosis and therefore releasing cell free DNA...

Les délétions et les duplications délétères (Variations de nombre de copies, CNV) sont identifiés dans environ 11% des individus référés dans des cliniques du neurodéveloppement pédiatrique. Certains CNVs récurrents ont été formellement associés avec des troubles du neurodéveloppement, mais la majorité des CNVs sont non-récurrents et donc trop rares pour être évalués par des études d’association. Dans cette optique, nous avons récemment développé une nouvelle approche pour estimer l’effet des CNVs non-documentés sur le quotient intellectuel non-verbal (QINV) et nous visons étendre cette approche pour l’appliquer sur une mesure de traits autistiques. Nous avons identifié les CNVs dans deux cohortes d’autisme du Simons Simplex Collection (SSC) et du MSSNG, dans leurs apparentés de premier-degré, dans une cohorte du neurodéveloppement et dans une population générale. Des modèles statistiques intégrant les scores des gènes inclus dans les CNVs ont été utilisés pour expliquer leur effet sur l’intelligence générale et sur la réciprocité sociale. Les délétions et les duplications diminuent le QINV et l’effet des duplications est 3 fois inférieur à celui des délétions. L’effet différentiel est aussi observé pour la réciprocité sociale avec un ratio d’altération de 2:1 pour les délétions et les duplications et cet effet est principalement expliqué par le QINV. Les estimés de notre modèle pour l’intelligence générale et la réciprocité sociale concordent bien avec des observations déjà publiés. Nos modèles entraînés sur des CNVs couvrant >4,500 gènes suggèrent que l’effet des CNVs sur la cognition et la réciprocité sociale est dû à leurs propriétés polygéniques. Ces modèles pourront aider dans l’interprétation des CNVs en clinique. / Deleterious deletions and duplications (copy number variations, CNVs) are identified in up to 11% of individuals referred to neurodevelopmental pediatric clinics. However, only few recurrent CNVs have been formally associated with neurodevelopmental disorders because the majority are too rare to perform individual association studies. We recently developed a new framework to estimate the effect size of undocumented CNVs on non-verbal intelligence quotient (NVIQ) and sought to extend this approach to another score measuring autistic traits. We identified CNVs in an autism sample from the Simons Simplex Collection (SSC) and MSSNG, in their first-degree relatives, in a neurodevelopmental cohort and in individuals from an unselected population. Statistical models integrating scores of the genes encompassed in the CNVs were used to explain their effect on general intelligence and on social responsiveness. Deletions and duplications decreased NVIQ and the effect of duplications was three-fold smaller than deletions. There was also a differential effect on social responsiveness: the ratio of the impairment conferred by deletions and duplications was 2:1 and this effect was mainly driven by NVIQ. Models estimates for general intelligence and social responsiveness were consistent with previously published observations. Our models, trained on CNVs encompassing >4,500 genes, suggest highly polygenic properties of CNVs with respect to cognition and social responsiveness. These models will help interpreting CNVs identified in the clinic.

Genome composition and architecture is shaped by two types of processes: those that introduce heritable changes (mutagenesis) and those that determine the fate of such changes in the populations (genetic drift and selection). Chemical and biological properties of mutagenesis determines the frequencies at which different type of mutations occur, which, in turn, determines their rates of fixation by drift and affects the spectrum of mutations available for selection to operate on. As the result, genomes of living organisms carry many signatures mutagenesis.

Colorectal cancer (CRC) is the third most common cancer worldwide; it is responsible for nearly 10% of all newly diagnosed cancers and is the second most cause of cancer related death in Europe. Biomarkers for therapy guidance, targeted therapy and survival prognosis are still limited. As CRC is a heterogeneous disease, different parts of the tumor might have varying molecular characteristics which may change during therapy or disease progression. Through solid biopsies and screenings, these local or temporal differences are impossible to monitor. To facilitate detection of these possible temporal changes, a regularly and non-invasively accessible biomarker is required for disease monitoring. Circulating tumor cells (CTCs) might represent such a biomarker as they have been shown to be fluid surrogates of the solid tumor. EpCAM positive CTCs have shown to be prognostic in CRC for survival, but their full potential has not yet been evaluated further. By using the High Definition Single Cell Analysis (HD-SCA) workflow, we were able to analyze the entire spectrum of CTCs and categorize them as the regular CTCs (HD-CTC), CTCs with a smaller nuclear area (CTC-Small), CTCs with low expression of epithelial marker cytokeratin (CTC-LowCK) and CTCs undergoing apoptosis and therefore releasing cell free DNA...

Les variants du nombre de copies (CNV) offre un cadre riche pour étudier les mécanismes neurobiologiques qui sous tendent la vulnérabilité aux troubles neuropsychiatriques. Notamment, les délétions du 16p11.2 et 22q11.2 sont parmi les facteurs génétiques les plus fréquents associés au trouble du spectre de l’autisme (TSA) et à la schizophrénie (SCZ). À l’heure actuelle, les perturbations fonctionnelles cérébrales qui sous-tendent cette vulnérabilité cognitive restent mécomprises. Récemment, l’analyse par gradient du connectome humain a révélé une réorganisation le long de l’axe dominant sensorimoteur à transmodal dans le TSA et la SCZ. Dans cette étude, nous avons cherché à étendre cette approche analytique aux porteurs d’une délétion du 16p11.2 et du 22q11.2 conférant un risque élevé pour de mêmes conditions. À cette fin, nous avons utilisé les données d’imagerie par résonance magnétique au repos combinant les données de deux cohortes génétiques, pour un total de 180 sujets incluant 61 porteurs. Par le biais d’un paradigme cas-contrôle, nous rapportons la première évidence d’une compression du gradient fonctionnel sensorimoteur à transmodal chez les porteurs de telles délétions. En dernier lieu, nous présentons une étude exploratoire d’association endophénotype-phénome dans la population générale du UK Biobank. Nous démontrons que la ressemblance aux profils de compression corticale des délétions est reliée à plusieurs traits humains complexes, en concordance avec les dimensions cliniques impactées par ces mêmes CNV. / Copy number variants (CNVs) present a unique opportunity to study the neural mechanisms underlying vulnerability to neuropsychiatric disorders. Notably, deletions of the 16p11.2 and 22q11.2 region are among the most common genetic variations associated with autism spectrum disorder (ASD) and schizophrenia (SCZ). However, brain functional disruptions underlying this cognitive vulnerability remains unclear. Recent gradient analysis framework developed to study parsimonious connectome dimensions at the system-level have reported disruptions along the overarching sensorimotor-to-transmodal gradient in ASD and SCZ. In this study, we sought to extend this gradient approach to carriers of a deletion at the 16p11.2 and 22q11.2 region. To achieve this, we pooled resting-state functional magnetic resonance imaging data from a total of 180 subjects, including 61 carriers, distributed among two genetic cohorts. By the means of a case-control study design, we provide the first evidence of a compressed cortical functional gradient in CNV carriers compared to healthy controls. Finally, we provide an exploratory endophenotype-phenome association study in the general UK Biobank population. We demonstrate that resemblance to 16p11.2 and 22q11.2 deletion profiles of cortical compression is related to several complex human traits, in concordance with clinical dimensions known to be impacted by the same CNV.

Bien que la majeure partie du génome humain soit présente en deux copies (une copie héritée de chaque parent), certains segments peuvent être délétés (une copie) ou dupliqués (trois copies). La recherche a montré que plusieurs variations du nombre de copies (CNVs) augmentent le risque de troubles neurodéveloppementaux (e.g. autisme, TDAH, schizophrénie). Or, on connait peu les effets des CNVs sur le développement et le fonctionnement cérébral. L’électroencéphalographie (EEG) au repos s’avère être une méthode adaptée pour étudier les perturbations de l’activité neuronale chez les porteurs de CNVs. L’objectif de ce projet était de déterminer s’il existe des signatures EEG à l’état de repos qui sont caractéristiques des enfants porteurs de CNVs pathogéniques. L’activité cérébrale au repos de 109 porteurs de CNVs (66 délétions, 43 duplications) âgés de 3 à 17 ans a été enregistrée en EEG durant 4 minutes. Pour mieux prendre en compte les variations développementales, les indices EEG (puissance spectrale et connectivité fonctionnelle) ont été corrigés avec un modèle normatif estimé à partir de 256 contrôles du Heatlhy Brain Network. Les résultats ont montré une puissance bêta et gamma accrue dans les régions postérieures ainsi qu’une sous-connectivité globale à des échelles temporelles distinctes chez les porteurs de CNVs. Les porteurs d’une délétion et d’une duplication pouvaient être différenciés par leur connectivité dans les fréquences bas-alpha: la connectivité des porteurs d’une duplication était plus perturbée que celle des porteurs d’une délétion. Les perturbations distinctives en connectivité se sont avérées plus proéminentes à l’adolescence. Les résultats suggèrent que les porteurs de CNVs présentent des altérations électrophysiologiques par rapport aux témoins neurotypiques, indépendamment de la région génomique affectée. / Although most of the human genome is present in two copies (one copy inherited from each parent), some segments can be deleted (one copy) or duplicated (three copies). Research has shown that many copy number variations (CNVs) increase the risk of neurodevelopmental disorders (e.g. autism, ADHD, schizophrenia). However, little is known about the effects of CNVs on brain development and function. Resting-state electroencephalography (EEG) is a suitable method to study the disturbances of neuronal functioning in CNVs. We aimed to determine whether there are resting-state EEG signatures that are characteristic of children with pathogenic CNVs. Resting-state brain activity of 109 CNVs carriers (66 deletions, 43 duplications) aged 3 to 17 years was recorded in EEG for 4 minutes. To better account for developmental variations, EEG indices (power spectral density and functional connectivity) were corrected with a normative model estimated from 256 Heatlhy Brain Network controls. Results showed increased beta and gamma power in posterior regions as well as a global under-connectivity at distinct frequency bands in CNVs carriers. Deletion and duplication carriers can be differentiated by their connectivity in low alpha frequencies: the connectivity of the duplication carriers was more disrupted than that of the deletion carriers. The distinctive connectivity perturbations were found to be most prominent during adolescence. The results suggest that CNVs carriers show electrophysiological alterations compared to neurotypical controls, regardless of the gene dosage effect and of their affected genomic region. Moreover, a specific signature of the molecular alterations associated with deletions was found.

Le caryotype moléculaire permet d’identifier un CNV chez 10-14% des individus atteints de déficience intellectuelle et/ou de malformations congénitales. C’est pourquoi il s’agit maintenant de l’analyse de première intention chez ces patients. Toutefois, le rendement diagnostique n’est pas aussi bien défini en contexte prénatal et l’identification de CNVs de signification clinique incertaine y est particulièrement problématique à cause du risque d’interruption de grossesse. Nous avons donc testé 49 fœtus avec malformations majeures et un caryotype conventionnel normal avec une micropuce CGH pangénomique, et obtenu un diagnostic dans 8,2% des cas. Par ailleurs, des micropuces à très haute résolution combinant le caryotype moléculaire et le génotypage de SNPs ont récemment été introduites sur le marché. En plus d’identifier les CNVs, ces plateformes détectent les LOHs, qui peuvent indiquer la présence d’une mutation homozygote ou de disomie uniparentale. Ces anomalies pouvant être associées à la déficience intellectuelle ou à des malformations, leur détection est particulièrement intéressante pour les patients dont le phénotype reste inexpliqué. Cependant, le rendement diagnostique de ces plateformes n’est pas confirmé, et l’utilité clinique réelle des LOHs n’est toujours pas établie. Nous avons donc testé 21 enfants atteints de déficience intellectuelle pour qui les méthodes standards d’analyse génétique n’avaient pas résulté en un diagnostic, et avons pu faire passer le rendement diagnostique de 14,3% à 28,6% grâce à l’information fournie par les LOHs. Cette étude démontre l’utilité clinique d’une micropuce CGH pangénomique chez des fœtus avec malformations, de même que celle d’une micropuce SNP chez des enfants avec déficience intellectuelle. / Molecular karyotyping identifies a CNV in 10-14% of individuals affected with intellectual disability and/or congenital abnormalities. Therefore, it is now the first-tier analysis for these patients. However, the diagnostic yield is not as clear in the prenatal context, and the risk of pregnancy termination makes the detection of variants of uncertain clinical significance particularly problematic. We tested 49 fetuses with major malformations and a normal karyotype, using a pangenomic CGH array, and obtained a diagnosis in 8.2% of cases. Furthermore, high-resolution microarrays combining molecular karyotyping and SNP genotyping were recently introduced on the market. In addition to identifying CNVs, these platforms detect LOHs, which can indicate the presence of a homozygous mutation or of uniparental disomy. Since these abnormalities can be associated with intellectual disability or congenital abnormalities, their detection is of particular interest for patients whose phenotype remains unexplained. However, the diagnostic yield obtained with these platforms is not confirmed, and the real clinical value of LOH detection is not yet established. We tested 21 children affected with intellectual disability for whom standard genetic analyses failed to provide a diagnosis, and were able to increase the diagnostic yield from 14.3% to 28.6% as a result of the information provided by LOHs. This study shows the clinical usefulness of pangenomic CGH arrays in fetuses with malformation(s), as well as that of SNP arrays in children with intellectual disability.

L’hypothyroïdie congénitale par dysgénésie thyroïdienne (HCDT) est la condition endocrinienne néonatale la plus fréquemment rencontrée, avec une incidence d’un cas sur 4000 naissances vivantes. L’HCDT comprend toutes les anomalies du développement de la thyroïde. Parmi ces anomalies, le diagnostic le plus fréquent est l’ectopie thyroïdienne (~ 50% des cas). L’HCDT est fréquemment associée à un déficit sévère en hormones thyroïdiennes (hypothyroïdisme) pouvant conduire à un retard mental sévère si non traitée. Le programme de dépistage néonatal assure un diagnostic et un traitement précoce par hormones thyroïdiennes. Cependant, même avec un traitement précoce (en moyenne à 9 jours de vie), un retard de développement est toujours observé, surtout dans les cas les plus sévères (c.-à-d., perte de 10 points de QI). Bien que des cas familiaux soient rapportés (2% des cas), l’HCTD est essentiellement considérée comme une entité sporadique. De plus, plus de 92% des jumeaux monozygotiques sont discordants pour les dysgénésies thyroïdiennes et une prédominance féminine est rapportée (spécialement dans le cas d’ectopies thyroïdiennes), ces deux observations étant clairement incompatible avec un mode de transmission héréditaire mendélien. Il est donc cohérent de constater que des mutations germinales dans les facteurs de transcription thyroïdiens connus (NKX2.1, PAX8, FOXE1, and NKX2.5) ont été identifiées dans seulement 3% des cas sporadiques testés et furent, de plus, exclues lors d’analyse d’association dans certaines familles multiplex. Collectivement, ces données suggèrent que des mécanismes non mendéliens sont à l’origine de la majorité des cas de dysgénésie thyroïdienne. Parmi ces mécanismes, nous devons considérer des modifications épigénétiques, des mutations somatiques précoces (au stade du bourgeon thyroïdien lors des premiers stades de l’embryogenèse) ou des défauts développementaux stochastiques (c.-à-d., accumulation aléatoire de mutations germinales ou somatiques). Voilà pourquoi nous proposons un modèle «2 hits » combinant des mutations (épi)génétiques germinales et somatiques; ce modèle étant compatible avec le manque de transmission familial observé dans la majorité des cas d’HCDT. Dans cette thèse, nous avons déterminé si des variations somatiques (épi)génétiques sont associées à l’HCTD via une approche génomique et une approche gène candidat. Notre approche génomique a révélé que les thyroïdes ectopiques ont un profil d’expression différent des thyroïdes eutopiques (contrôles) et que ce profil d’expression est enrichi en gènes de la voie de signalisation Wnt. La voie des Wnt est cruciale pour la migration cellulaire et pour le développement de plusieurs organes dérivés de l’endoderme (p.ex. le pancréas). De plus, le rôle de la voie des Wnt dans la morphogénèse thyroïdienne est supporté par de récentes études sur le poisson-zèbre qui montrent des anomalies du développement thyroïdien lors de la perturbation de la voie des Wnt durant différentes étapes de l’organogénèse. Par conséquent, l’implication de la voie des Wnt dans l’étiologie de la dysgénésie thyroïdienne est biologiquement plausible. Une trouvaille inattendue de notre approche génomique fut de constater que la calcitonine était exprimée autant dans les thyroïdes ectopiques que dans les thyroïdes eutopiques (contrôles). Cette trouvaille remet en doute un dogme de l’embryologie de la thyroïde voulant que les cellules sécrétant la calcitonine (cellules C) proviennent exclusivement d’une structure extrathyroïdienne (les corps ultimobranchiaux) fusionnant seulement avec la thyroïde en fin de développement, lorsque la thyroïde a atteint son emplacement anatomique définitif. Notre approche gène candidat ne démontra aucune différence épigénétique (c.-à-d. de profil de méthylation) entre thyroïdes ectopiques et eutopiques, mais elle révéla la présence d’une région différentiellement méthylée (RDM) entre thyroïdes et leucocytes dans le promoteur de FOXE1. Le rôle crucial de FOXE1 dans la migration thyroïdienne lors du développement est connu et démontré dans le modèle murin. Nous avons démontré in vivo et in vitro que le statut de méthylation de cette RDM est corrélé avec l’expression de FOXE1 dans les tissus non tumoraux (c.-à-d., thyroïdes et leucocytes). Fort de ces résultats et sachant que les RDMs sont de potentiels points chauds de variations (épi)génétiques, nous avons lancé une étude cas-contrôles afin de déterminer si des variants génétiques rares localisés dans cette RDM sont associés à la dysgénésie thyroïdienne. Tous ces résultats générés lors de mes études doctorales ont dévoilé de nouveaux mécanismes pouvant expliquer la pathogenèse de la dysgénésie thyroïdienne, condition dont l’étiologie reste toujours une énigme. Ces résultats ouvrent aussi plusieurs champs de recherche prometteurs et vont aider à mieux comprendre tant les causes des dysgénésies thyroïdiennes que le développement embryonnaire normal de la thyroïde chez l’homme. / Congenital hypothyroidism from thyroid dysgenesis (CHTD) is the most common congenital endocrine disorder with an incidence of 1 in 4,000 live births. CHTD includes multiple abnormalities in thyroid gland development. Among them, the most common diagnostic category is thyroid ectopy (~ 50 % of cases). CHTD is frequently associated with a severe deficiency in thyroid hormones (hypothyroidism), which can lead to severe mental retardation if left untreated. The newborn biochemical screening program insures the rapid institution of thyroid hormone replacement therapy. Even with early treatment (on average at 9 d), subtle developmental delay is still be observed in severe cases (i.e., IQ loss of 10 points). Although there have been some reports of familial occurrence (in 2% of the cases), CHTD is mainly considered as a sporadic entity. Furthermore, monozygotic (MZ) twins show a high discordance rate (92%) for thyroid dysgenesis and female predominance is observed in thyroid dysgenesis (especially thyroid ectopy), these two observations being incompatible with simple Mendelian inheritance. In addition, germline mutations in the thyroid related transcription factors NKX2.1, PAX8, FOXE1, and NKX2.5 have been identified in only 3% of sporadic cases and linkage analysis has excluded these genes in some multiplex families with CHTD. Collectively, these data point to the involvement of non-Mendelian mechanisms in the etiology of the majority of cases of thyroid dysgenesis. Among the plausible mechanisms are epigenetic modifications, somatic mutations occurring in the thyroid bud early during embryogenesis, or stochastic developmental events. Hence, we proposed a two-hit model combining germline and somatic (epi)genetic variations that can explain the lack of clear familial transmission of CTHD. In this present thesis, we assessed the role of somatic (epi)genetic variations in the pathogenesis of thyroid dysgenesis via a genome-wide as well as a candidate gene approach. Our genome wide approach revealed that ectopic thyroids show a differential gene expression compared to that of normal thyroids, with enrichment for the Wnt signalling pathway. The Wnt signalling pathway is crucial for cell migration and for the development of several endoderm-derived organs (e.g., pancreas). Moreover, a role of Wnt signalling in thyroid organogenesis was further supported by recent zebrafish studies which showed thyroid abnormalities resulting from the disruption of the Wnt pathway during different steps of organogenesis. Thus, Wnt pathway involvement in the etiology of thyroid ectopy is biologically plausible. An unexpected finding of our genome-wide gene expression analysis of ectopic thyroids was that they express calcitonin similar to normally located (orthotopic) thyroids. Such a finding, although in contradiction with our current knowledge of the embryological development of the thyroid attributes C cell origins to extrathyroidal structures (ultimobrachial bodies) upon fusion with a fully-formed, normally situated gland. Using a candidate gene approach, we were unable to demonstrate any differences in the methylation profile between ectopic and eutopic thyroids, but nevertheless we documented the presence of a differentially methylated region (DMR) between thyroids and leukocytes in the promoter of FOXE1, a gene encoding the only thyroid related transcription factor known to play a crucial role in regulating the migration of the thyroid precursors during development as shown by animal studies. We demonstrated by in vivo and in vitro studies that the methylation status of this DMR is correlated with differential expression of FOXE1 in non-tumoral tissues (thyroids and leukocytes). Knowing that DMRs are hotspots for epi(genetic) variations, its screening among CTHD patients is justifiable in our search for a molecular basis of thyroid dysgenesis, currently underway in a case-control study. The results generated during my graduate studies represent unique and novel mechanisms underlying the pathogenesis of CHTD, the etiology of which is still an enigma. They also paved the way for many future studies that will aid in better understanding both the normal and pathogenic development of the thyroid gland.

A variação do número de cópias (CNV) de genes e cromossomos é uma característica comum do genoma plástico de Leishmania major, que pode estar associada à resistência do parasita à quimioterapia das leishmanioses. Em outros eucariotos, alterações na replicação do DNA ou na resposta a danos no DNA (DDR) pode levar à CNV. Nestes organismos, o complexo de checkpoint 9-1-1 (RAD9, RAD1 e HUS1) é essencial para a detecção e a sinalização do estresse de replicação e para o recrutamento de uma apropriada DDR. Já demonstramos que L. major expressa um homólogo 9-1-1 funcional. Aqui, avaliamos a deficiência de subunidades de 9-1-1 na variação do número de cópias em células selecionadas em metotrexato (MTX), um inibidor da enzima diidrofolato redutase timidilato sintetase (DHFR-TS). A seleção em MTX facilita o isolamento de células que carregam amplificações contendo o locus da DHFR-TS. Assim, selecionamos células deficientes de HUS1 ou RAD9 para resistência ao MTX sem e com exposição previa a hidroxiureia (HU), uma droga que causa estresse de replicação por inibição da ribonucleotídeo redutase, e avaliamos o efeito da deficiência destas proteínas na CNV e no tipo de amplificação gerada. Avaliamos também o efeito da deficiência destas proteínas no processo de síntese do DNA medido pela incorporação de IdU e observamos que a deficiência destas proteínas levou a um incremento na síntese do DNA na ausência de estresse de replicação e a perfis opostos de síntese do DNA após a remoção do estresse replicativo. Análises da detecção de simples fita do DNA (ssDNA) e da histona H2A fosforilada (?H2A) como indicadores do processo de estresse de replicação e dano no DNA também foram conduzidas. Em conjunto, nossos resultados indicam que (i) os níveis alterados das proteínas HUS1 e RAD9 afetam o padrão da CNV após a seleção no MTX, assim como a natureza da amplificação; (ii) HUS1 e RAD9 parecem possuir mecanismos distintos para mediar a CNV; (iii) a função destas proteínas na CNV deve envolver o processo de replicação e (iv) HUS1 e RAD9 são requeridas para a manutenção da estabilidade genômica em Leishmania. Estes resultados contribuem para uma melhor compreensão não só da evolução da via de sinalização mediada pelo complexo de checkpoint 9-1-1 nos eucariotos, mas também da bases moleculares da plasticidade genômica e do fenômeno de amplificação gênica em Leishmania. / The copy number variation (CNV) of genes and chromosomes is a common feature of the plastic genome of Leishmania major, which is normally associated with resistance of the parasite to the chemotherapy of leishmaniasis. In other eukaryotes, alteration in DNA replication and DNA damage response (DDR) causes CNV. In these organisms, the RAD9-RAD1-HUS1 (9-1-1) checkpoint complex is essential for detection and signaling of replication stress and recruitment of an appropriate DDR. We have already demonstrated that L. major expresses a functional 9-1-1 homolog. Here we evaluated the effect of 9-1-1 subunit deficiency in CNV of cells selected in methotrexate (MTX), an inhibitor of the dihydrofolate reductase thymidylate synthetase (DHFR-TS) enzyme. Selection in MTX facilitates the isolation of cells that carry amplicons containing the DHFR-TS locus. Thus, we selected HUS1 or RAD9 deficient cells for MTX resistance without and prior exposure to hydroxyurea (HU), a drug that causes replication stress due to inhibition of ribonucleotide reductase, and evaluated not only CNV, but also the nature of the amplification generated. We also evaluated the effect of deficiency of these proteins in the DNA synthesis process measured by IdU incorporation and observed that the deficiency of these proteins led to an increase in DNA synthesis in the absence of replication stress, and to opposite profiles of DNA synthesis after removal of replicative stress. Analyzes of single-stranded DNA (ssDNA) and phosphorylated histone H2A (?H2A) as indicators of replication stress and DNA damage were also conducted in both presence and absence of replicative stress. Taken together, our results indicate that (i) altered levels of HUS1 and RAD9 proteins affect the CNV pattern after selection in MTX, as well as the nature of amplification; (ii) HUS1 and RAD9 possibly have different mechanisms to mediate CNV; (iii) the function of these proteins in CNV seems to involve replication process and (iv) HUS1 and RAD9 are required for the maintenance of genomic stability in Leishmania. These findings contribute to a better understanding not only of the evolution of the signaling pathway mediated by 9-1-1 checkpoint complex in eukaryotes, but also of the molecular basis of the genome plasticity and the gene amplification phenomenon in Leishmania.

O genoma humano é composto por diversos tipos de variações estruturais, como por exemplo, as variações no número de cópias (CNVs), que, mesmo sendo muito pequenas, podem gerar diversas alterações clínicas específicas, como as malformações congênitas e o atraso do desenvolvimento neuropsicomotor (MC/ADNPM). Para a detecção destas alterações existem diferentes técnicas citogenômicas dentre elas a FISH (Fluorescent in situ Hibridization) e a MLPA (Multiplex Ligation-dependent Probe Amplification), que investigam um número limitado de regiões do genoma, como as regiões envolvidas nas síndromes de microdeleções/microduplicações mais comuns e as regiões subteloméricas. Outros métodos como a cariotipagem clássica e o array genômico possibilitam uma análise completa do DNA em uma única reação, aumentando a taxa de detecção de desequilíbrios complexos. Alcançar um diagnóstico inequívoco é fundamental para entender a natureza da doença, fornecendo respostas sobre o prognóstico, sobre os riscos de recorrência e direcionando o paciente à terapia específica, o que pode minimizar o custo financeiro dessas doenças e até mesmo possibilitar a inclusão desses indivíduos na sociedade. O projeto teve como objetivo comparar a capacidade diagnóstica destas tecnologias (FISH, MLPA e array) para a elucidação etiológica de pacientes sindrômicos encaminhados para a unidade de genética. A casuística deste trabalho foi composta pela análise dos resultados das técnicas de FISH e/ou MLPA e array, utilizadas no diagnóstico de 78 pacientes com MC/ADNPM. Na técnica de FISH, empregada na análise genômica de 22 pacientes, foram utilizadas sondas locus específicas para as regiões das principais síndromes de microdeleção/microduplicação e para as regiões subteloméricas de cromossomos específicos. Por meio desta metodologia, foram identificados ~18,2% dos pacientes com diferentes alterações. Já a técnica de MLPA, utilizada no diagnóstico dos 78 pacientes, por meio dos kits para as principais síndromes de microdeleção/microduplicação e para as regiões subteloméricas, detectou ~34,6% de pacientes com diversas alterações. A técnica de array, realizada em todos os pacientes utilizando diferentes plataformas (Agilent, Affymetrix ou Illumina) apresentou uma taxa de ~42,3% de detecção de pacientes com pelo menos uma alteração patogênica e ~38,5% de pacientes com alterações benignas ou de significado clínico incerto. Ao avaliar as três técnicas concomitantemente foi verificada uma taxa de ~93,6% de concordância, apesar dos resultados não serem iguais em todos os casos e da técnica de MLPA não detectar ~66,2% das alterações em relação ao array. Os resultados obtidos corroboraram com dados da literatura, mas no geral a taxa de detecção foi superior às taxas descritas, o em que em parte pode ser devido ao critério de seleção dos pacientes, sugerindo fortemente que a hipótese clínica adequada é crucial para o sucesso da detecção de alteração. Embora o array seja a ferramenta mais eficiente para o diagnóstico de pacientes com malformações, seu uso como primeiro teste diagnóstico nem sempre é o mais apropriado devido ao seu custo elevado ou sua limitação em detectar inversões e translocações balanceadas. Portanto todas as técnicas estudadas têm suas vantagens e desvantagens, e poderão ser aplicadas em conjunto para que o diagnóstico molecular seja concluído. Dessa forma, são necessárias uma interação clínico-laboratorial e uma equipe técnica multiprofissional especializada para o direcionamento do diagnóstico molecular mais eficaz em relação ao custo-benefício / The human genome is composed of several types of structural variations, such as copy number variation (CNVs) which, although very small, can generate several specific clinical abnormalities, such as congenital malformations and developmental delay (CM/DD). To detect these changes there are different cytogenomics techniques, among them, FISH (Fluorescent in situ Hybridization) and MLPA (Multiplex Ligation-dependent Probe Amplification) that can investigate a limited number of genomic regions for example the most common microdeletion/microduplications syndromes and subtelomeric regions. Other methods such as classical karyotyping and array provide a complete DNA analysis in a single reaction, increasing the detection rate of complex imbalances. Acquire an unequivocal diagnosis is critical to understand the nature of the disease, providing answers about the prognosis, risks of recurrence and directing the patients to specific therapy, which can minimize the cost of these diseases and even allow the inclusion of these individuals in society. The objective of this project was to compare the diagnostic ability of these technologies (FISH, MLPA and array) for the etiologic diagnosis of syndromic patients referred to the clinical unit of genetics. The casuistry was composed by the results of analysis of 78 patients with CM/DD using FISH and/or MLPA and array. The FISH technique was utilized in genomic analysis for 22 patients and locus specific probes were used for regions of the microdeletion/microduplication syndromes and the subtelomeric regions of specific chromosomes. By this methodology ~18.2% of the patients were identified with different genomic changes. The MLPA technique was used in the diagnosis of 78 patients, with microdeletion/microduplication syndrome and subtelomeric regions, and detected ~34.6% of patients with several changes. The array technique was performed in all patients using different platforms (Agilent, Illumina or Affymetrix) and shows a rate of ~42.3% of detection at least one pathogenic change and ~38.5% of patients with benign or uncertain clinical significance changes. In assessment of the three techniques concomitantly was observed a rate of ~93.6% of concordance, although the results are not the same in all cases and the MLPA technique to detect ~ 66.2% of the changes in relation to the array. The results obtained corroborated with literature data, but the overall detection rate was higher than the rates described in the literature, due in part to the criteria selection of patients. Our results strongly suggesting that appropriate clinical hypothesis is crucial for successful change detection. Although the array is the most efficient tool for the diagnosis of patients with abnormalities, using this test as a first diagnostic approach is not always the most suitable tool because of the high cost or the limitation to detect inversions and balanced translocations. Therefore, all techniques studied have their advantages and disadvantages, and could be applied together for the completed molecular diagnosis. Thus, a clinical laboratory interaction and multidisciplinary skilled technicians is required for targeting the most effective molecular diagnosis in relation to cost-benefit