Contexte : L’anémie falciforme ou drépanocytose est un problème de santé important, particulièrement pour les patients d’origine africaine. La variation phénotypique de l’anémie falciforme est problématique pour le suivi et le traitement des patients. L’architecture génomique responsable de cette variabilité est peu connue. Principe : Mieux saisir la contribution génétique de la variation clinique de cette maladie facilitera l’identification des patients à risque de développer des phénotypes sévères, ainsi que l’adaptation des soins. Objectifs : L’objectif général de cette thèse est de combler les lacunes relatives aux connaissances sur l’épidémiologie génomique de l’anémie falciforme à l’aide d’une cohorte issue au Bénin. Les objectifs spécifiques sont les suivants : 1) caractériser les profils d’expressions génomiques associés à la sévérité de l’anémie falciforme ; 2) identifier des biomarqueurs de la sévérité de l’anémie falciforme ; 3) identifier la régulation génétique des variations transcriptionelles ; 4) identifier des interactions statistiques entre le génotype et le niveau de sévérité associé à l’expression ; 5) identifier des cibles de médicaments pour améliorer l’état des patients atteints d’anémie falciforme. Méthode : Une étude cas-témoins de 250 patients et 61 frères et soeurs non-atteints a été menée au Centre de Prise en charge Médical Intégré du Nourrisson et de la Femme Enceinte atteints de Drépanocytose, au Bénin entre février et décembre 2010. Résultats : Notre analyse a montré que des profils d’expressions sont associés avec la sévérité de l’anémie falciforme. Ces profils sont enrichis de génes des voies biologiques qui contribuent à la progression de la maladie : l’activation plaquettaire, les lymphocytes B, le stress, l’inflammation et la prolifération cellulaire. Des biomarqueurs transcriptionnels ont permis de distinguer les patients ayant des niveaux de sévérité clinique différents. La régulation génétique de la variation de l’expression des gènes a été démontrée et des interactions ont été identifiées. Sur la base de ces résultats génétiques, des cibles de médicaments sont proposées. Conclusion: Ce travail de thèse permet de mieux comprendre l’impact de la génomique sur la sévérité de l’anémie falciforme et ouvre des perspectives de développement de traitements ciblés pour améliorer les soins offerts aux patients. / Background: Sickle Cell Disease (SCD) is an important public health issue, particularly in Africa. Phenotypic heterogeneity of SCD is problematic for follow-up and treatment of patients. Little is known about the underlying genomic architecture responsible for this variation. Rationale: Understanding the genetic contribution to the inter-patient variability will help in identifying patients at risk of developing more severe clinical outcomes, as well as help guide future developments for treatment options. Objectives: To characterize genome-wide gene expression patterns associated with SCD clinical severities and to identify genetic regulators of this variation. More specifically, our objectives were to associate gene expression profiles with SCD severity, identify transciptional biomarkers, characterise the genetic control of gene expression variation, and propose drug targets. Methods: A case-control population of 250 SCD patients and 61 unaffected siblings from the National SCD Center in Benin were recruited. Genome-wide gene expression profiles and genotypic data were generated. Results: Genome-wide gene expression patterns associated with SCD clinical variation were enriched in B-lymphocyte development, platelet activation, stress, inflammation and cell proliferation pathways. Transcriptional biomarkers that can discriminate SCD patients with respect to clinical severities were identified. Hundreds of genetic regulators were significantly associated with gene expression variation and potential drug targets are suggested. Conclusion: This work improves our understanding of the biological basis of SCD clinical variation and has the potential to guide development of targeted treatments for SCD patients.

Os praguicidas organofosforados (OPs) são amplamente utilizados na indústria química e na agricultura em todo o mundo. Muitos deles são potenciais causadores da \"Neuropatia Retardada Induzida por Organofosforados\" (NRIOP), caracterizada pela degeneração distal de axônios do sistema nervoso central e periférico (degeneração do tipo Walleriana). O praguicida triclorfom (dimetil 2,2,2-tricloro-1-hidroxietil fosfonato) tem sido utilizado em larga escala na produção agrícola e também no controle de vetores transmissores de várias doenças. Há relatos de efeitos neuropáticos em seres humanos expostos ao triclorfom, mas apesar disso, o seu potencial neuropático e seus mecanismos de neurotoxicidade ainda não foram elucidados. Assim, no presente estudo foram avaliados os mecanismos de toxicidade do praguicida OP triclorfom utilizando linhagem SH-SY5Y de neuroblastoma humano como modelo, e também foram avaliados possíveis agentes neuroprotetores em células tratadas com o bem estabelecido indutor da neuropatia mipafox. Foram utilizados como possíveis neuroprotetores: a amilorida e nimodipino (bloqueadores de canais de cálcio tipo T e L respectivamente), MDL 28170 (inibidor (III) de calpaína) e liraglutida (um agonista do \"glucagon like peptide\" -GLP-1). Foram usados o mipafox, como modelo de indução da NRIOP e o paraoxon, como modelo não indutor da NRIOP. Os ensaios de inibição e reativação da esterase susceptível à neuropatia (ESNp) e de citotoxicidade mostraram que somente o mipafox e o triclorfom apresentaram inibição e envelhecimento da ESNp superiores a 70% em concentrações com baixa toxicidade, condição compatível com a indução da NRIOP. A ativação das calpaínas foi observada apenas no tratamento com mipafox, efeito este inibido pela nimodipina, amilorida e pelo MDL 28170. Triclorfom e o mipafox causaram elevação significativa nos níveis de cálcio intracelular e da caspase-3, além de inibir significativamente o crescimento de neuritos. Os três OPs avaliados foram capazes de diminuir a captação da glicose, que foi aumentada nos grupos tratados com mipafox associado com neuroprotetores. As quatro substâncias utilizadas como possíveis neuroprotetoras reduziram significativamente o dano causado pelo mipafox sobre os neuritos. O modelo usado no estudo mostrou-se apropriado para a caracterização dos OP neuropáticos, pois permitiu a diferenciação dos efeitos do mipafox (neuropático) e do paraoxon (não-neuropático). Os dados obtidos indicam que o triclorfom tem potencial indutor de NRIOP, e a amilorida, nimodipino liraglutida e MDL apresentaram potencial neuroprotetor / Organophosphorus (OP) pesticides are widely used in the chemical industry and agriculture around the world. \"Organophosphate Induced Delayed Neuropathy\" (OPIDN) is characterized by distal degeneration of axons of the central and peripheral nervous system (Wallerian-type degeneration). The OP trichlorfom (dimethyl 2,2,2-trichloro-1-hydroxyethyl phosphonate) has been used in large scale in agricultural production and also for the control of vectors that are transmitter of diseases. There are reports of neuropathic effects in humans exposed to trichlorfon, but despite this, its neuropathic potential and mechanisms of neurotoxicity have not yet been elucidated. Thus, in the present study we evaluated the mechanisms of toxicity of trichlorfom and possible neuroprotective agents in SH-SY5Y human neuroblastoma cells treated with the well-established neuropathy inducer mipafox. The following neuroprotective agents were used: amyloride and nimodipine (T and L-type calcium channel blockers, respectively), MDL 28170 (calpain inhibitor (III) and liraglutide (a \"glucagon-like peptide\" - GLP-1 agonist). Mipafox was used as neuropathic OP and paraoxon was used as a non-neuropathic OP. Inhibition and reactivation assays of neurpathy target esterase (NTE) and cytotoxicity showed that only mipafox and trichlorfon showed inhibition and aging of 70% of the NTE in concentrations that presented low toxicity, consistent with development of OPIDN. Activation of calpain was observed only in the treatment with mipafox, an effect inhibited by nimodipine, amyloride and MDL 28170. Triclorfom and mipafox caused significant increase in the levels of intracellular calcium, caspase-3 and significantly inhibiting neurite growth. All three OPs assessed in this work caused a decrease in glucose uptake, which was increased in groups treated whith mipafox plus neuroprotectors. Substances used as possible neuroprotective agents significantly reduced the inhibitory effect of mipafox on neurite outgrowth. The model used in the study proved to be appropriate for characterizing neuropathic OPs, because it allowed a differentiation of the effects of mipafox (neuropathic) and paraoxon (non-neuropathic). The data obtained indicate that trichlorfonm has potential in cause OPIDN. Amiloride, nimodipine, MDL and liraglutide have presented potential neuroprotective effects