L’anémie de Blackfan-Diamond (ABD) est une érythroblastopénie congénitale rare, secondaire à un blocage de la maturation érythroïde entre les stades BFU-e et CFU-e. L’ABD est le plus souvent la conséquence d’une mutation germinale affectant un gène codant pour une protéine ribosomique (RP) de la petite ou de la grande sous-unité du ribosome. Quatorze gènes distincts ont été identifiés. Les gènes les plus fréquemment mutés sont les gènes RPL5, RPL11 et RPS19 (37% des patients). Plus rarement, l’ABD est la conséquence de mutations dans le gène TSR2 ou dans le gène GATA-1. Ce dernier code pour un facteur de transcription majeur de l’érythropoïèse. Chez les patients ABD, les mutations de GATA-1 induisent une perte quasi-totale de la forme longue de GATA-1 qui est nécessaire à la différenciation de la cellule érythroïde. Notre groupe a identifié deux phénotypes de l’ABD in vitro en fonction du gène muté. En cas d’haploinsuffisance RPS19, la prolifération érythroïde est moins réduite qu’en cas d’haploinsuffisance RPL5 ou de RPL11. Une haploinsuffisance RPS19 n’altère pas la différenciation érythroïde et n’induit pas d’apoptose contrairement à l’haploinsuffisance RPL5 ou RPL11 où il existe un retard de différenciation érythroïde et un excès net d’apoptose responsable au moins en partie de la diminution drastique de la prolifération érythroïde dans ces phénotypes.HSP70 est impliquée dans la survie cellulaire et la différenciation érythroïde en protégeant GATA-1 du clivage par la caspase-3, une protéase activée lors de la différenciation érythroïde terminale. Comme la différence entre les deux phénotypes d’ABD in vitro concernait la différenciation érythroïde et la survie cellulaire, nous avons émis l’hypothèse selon laquelle la mutation de certains gènes RP provoque un défaut d’expression d’HSP70 conduisant au blocage de la différenciation érythroïde et à l’excès d’apoptose retrouvés dans les phénotypes sévères d’ABD.Nous avons étudié différents patients atteints d’ABD, porteurs de mutations dans les gènes RPS19, RPL5 ou RPL11 et généré un modèle in vitro d’ABD en exprimant, dans des cellules CD34+ humaines issues de sang de cordon, des ARN interférents ciblant RPL5, RPL11 ou RPS19. Chez les patients comme dans le modèle reproduisant l’ABD, l’haploinsuffisance RPL5 ou RPL11 diminue drastiquement l’expression protéique de HSP70 et de GATA-1 (Western blot, microscopie confocale et en cytométrie couplée à des techniques d’imagerie, (technologie ImageStream) à la différence de 1’haploinsuffisance RPS19. Dans tous les cas, HSP70 est normalement transcrite et traduite. Les inhibiteurs du protéasome (MG132, lactacystine, bortezomib) restaurent l’expression10de HSP70. La diminution d’expression de HSP70 est donc liée à une dégradation protéasomale. L’invalidation de RPL11 induit une polyubiquitinylation importante de HSP70. La transduction lentivirale de l’ADN complémentaire d’HSP70 dans les cellules primitives invalidées pour RPL11 permet de restaurer l’expression de HSP70 et de GATA-1 à un niveau similaire aux contrôles et de rétablir la prolifération cellulaire et la différenciation érythroïde, confirmant le rôle clé de HSP70 dans le phénotype sévère RPL5+/Mut ou RPL11+/Mut. Les formes les plus sévères de l’ABD sont associées à la dégradation de HSP70 par le protéasome. La perte de la protéine chaperone de GATA-1 induit la perte de GATA-1, facteur de transcription majeur de la différenciation érythroïde. Une augmentation de l’expression de HSP70 pourrait ainsi constituer une nouvelle approche thérapeutique dans l’ABD. / Diamond-Blackfan anemia (DBA) is the first ribosomopathy identified and is characterized by a moderate to severe, usually macrocytic aregenerative anemia associated with congenital malformations in 50% of the DBA cases. This congenital rare erythroblastopenia is due to a blockade in erythroid differentiation between the BFU-e and CFU-e stages. The link between a haploinsufficiency in a ribosomal protein (RP) gene that now encompass 15 different RP genes and the erythroid defect is still to be fully defined. Recently, mutations in TSR2 and GATA-1 genes have been identified in a few DBA families. The GATA-1 gene encodes for the major transcription factor critical for erythropoiesis and mutation in this gene that lead to loss of expression of the long form of the protein, necessary for the erythroid differentiation accounts for erythroblastopenia of DBA phenotype. Our group and others (Dutt et al., Blood 2011) have shown previously that p53 plays an important role in the DBA erythroblastopenia, inducing cell cycle arrest in G0/G1 and depending on the nature of RP gene mutation, a delayed erythroid differentiation and an increased apoptosis. Indeed, we identified two distinct DBA phenotypes (H. Moniz, M. Gastou, Cell Death Dis, 2012): a haploinsufficiency in RPL5 or RPL11 reduced dramatically the erythroid proliferation, delayed the erythroid differentiation, and markedly increased apoptosis, while RPS19 haploinsufficiency while reduced the extent of erythroid proliferation without inducing significant apoptosis. While p53 pathway has been found to be activated in RP haploinsufficient erythroid cells in DBA patients or shRNA-RPS19, -RPL5, or -RPL11 infected CD34+ erythroid cells, the intensity of the p53 activation pathway (p21, BAX, NOXA) is different depending on the mutated RP gene. Since the differences between the two phenotypes involved the eytrhoid differentiation and the degree of apoptosis we hypothesized that HSP70, a chaperone protein of GATA-1 may play a key role in the erythroid defect of DBA. Indeed, HSP70 protects GATA-1 from the cleavage by the caspase 3, a protease activated during erythroid differentiation. As such reduced levels of HSP70 related to a RP haploinsufficiency could account for increased apoptosis and delayed erythroid differentiation of erythroid cells in DBA. Indeed, a defect in RPL5 or RPL11 decreased dramatically the expression level of HSP70 and GATA-1 in primary human erythroid cells from DBA patients and following in vitro knockdown of the proteins in CD34+ cells by RPL5 or RPL11 shRNA. Importantly, RPS19 haploinsufficiency did not exhibit this effect in conjunction with normal levels of HSP70 expression. Furthermore, we found that the decreased expression level of12HSP70 was independent on the p53 activation. Strikingly, HSP70 was noted to be degraded by the proteasome since the bortezomib, the MG132, or the lactacystin were able to restore both the HSP70 expression level and intracellular localization in the cell. The lentiviral infection of depleted RPL11 cord blood CD34+ cells with a wild type HSP70 cDNA restored both the erythroid proliferation and differentiation, and reduced apoptosis, confirming a critical role for HSP70 in the erythroid defect in the RPL11+/Mut DBA phenotypes. The loss of HSP70 may explain the loss of GATA-1 in DBA and also the erythroid tropism of the DBA disease. Restoration of the HSP70 expression level may be a viable and novel therapeutic option for management of this debilitating and difficult to manage erythroid disorder.

<p>Ribosomal proteins are components of the ribosome, the protein synthesis machinery. The ribosomal protein S19 gene (<i>RPS19</i>) is mutated in Diamond-Blackfan anemia, DBA, which is a rare congenital anemia with absence or reduction of erythroid precursors in bone marrow. In this thesis, the role of RPS19 in erythropoiesis is investigated.</p><p>A genetic analysis of <i>RPS19</i> in 24 DBA cases was performed. Four novel <i>RPS19</i> mutations were identified with evidence of wide clinical expression of the disease.</p><p>Due to the clinical overlap in Transient Erythroblastopenia of Childhood, TEC, and DBA, the two diseases may be caused by a common genetic factor. In a study of seven TEC families, all affected shared at least one parental haplotype in the <i>RPS19</i> gene region. Coding exons of <i>RPS19</i> were normal for all affected, although mutations in intronic and regulatory sequences are not excluded. This indicates a genetic factor behind TEC and a possible association between <i>RPS19</i> and TEC. </p><p>To investigate the role of RPS19 in erythropoiesis in a mammal, we created a mouse model for the targeted disruption of the homologue <i>Rps19</i> on the C57BL/6J genetic background. Null mutants are embryonic lethal prior to implantation. The <i>Rps19</i>^+/- mice, however, are viable with normal development including the hematopoietic system. The <i>Rps19</i> transcript level in <i>Rps19</i>^+/- mice is normal. Accordingly, RPS19 protein levels are similar in <i>Rps19</i>^+/- and <i>Rps19</i>^+/+ mice. This argues for a transcriptional up-regulation to compensate for the loss of one <i>Rps19</i> allele. </p><p>Peripheral blood is normal in <i>Rps19</i>^+/- mice also on the FVB/NJ strain which argues against strain-specific effects of the <i>Rps19</i> disruption. Preliminary results indicate a reduced erythroid proliferation in response to erythropoietin in <i>Rps19</i>^+/- mice, suggesting the requirement of both <i>Rps19</i> alleles for normal erythroid proliferation under stress. This would support a mechanism by which haplo-insufficiency for RPS19 causes DBA.</p>

Ribosomal proteins are components of the ribosome, the protein synthesis machinery. The ribosomal protein S19 gene (RPS19) is mutated in Diamond-Blackfan anemia, DBA, which is a rare congenital anemia with absence or reduction of erythroid precursors in bone marrow. In this thesis, the role of RPS19 in erythropoiesis is investigated. A genetic analysis of RPS19 in 24 DBA cases was performed. Four novel RPS19 mutations were identified with evidence of wide clinical expression of the disease. Due to the clinical overlap in Transient Erythroblastopenia of Childhood, TEC, and DBA, the two diseases may be caused by a common genetic factor. In a study of seven TEC families, all affected shared at least one parental haplotype in the RPS19 gene region. Coding exons of RPS19 were normal for all affected, although mutations in intronic and regulatory sequences are not excluded. This indicates a genetic factor behind TEC and a possible association between RPS19 and TEC. To investigate the role of RPS19 in erythropoiesis in a mammal, we created a mouse model for the targeted disruption of the homologue Rps19 on the C57BL/6J genetic background. Null mutants are embryonic lethal prior to implantation. The Rps19+/- mice, however, are viable with normal development including the hematopoietic system. The Rps19 transcript level in Rps19+/- mice is normal. Accordingly, RPS19 protein levels are similar in Rps19+/- and Rps19+/+ mice. This argues for a transcriptional up-regulation to compensate for the loss of one Rps19 allele. Peripheral blood is normal in Rps19+/- mice also on the FVB/NJ strain which argues against strain-specific effects of the Rps19 disruption. Preliminary results indicate a reduced erythroid proliferation in response to erythropoietin in Rps19+/- mice, suggesting the requirement of both Rps19 alleles for normal erythroid proliferation under stress. This would support a mechanism by which haplo-insufficiency for RPS19 causes DBA.