No description available.

Le rétinoblastome est une tumeur rare qui touche la rétine du jeune enfant. L’inactivation bi-allélique du gène RB1 est à l’origine du développement tumoral. RB1 est le premier gène suppresseur de tumeur qui ait été identifié et la prédisposition au rétinoblastome constitue un véritable paradigme de la prédisposition aux cancers. Dans les formes non prédisposées génétiquement, les deux mutations apparaissent dans une cellule rétinienne unique ; le rétinoblastome est alors unilatéral. Dans les formes à prédisposition génétique, la première mutation est constitutionnelle et la deuxième est somatique. La mutation constitutionnelle est une néo-mutation pré- ou post- zygotique dans les formes sporadiques, alors qu’elle est héritée dans les formes familiales. Dans les formes avec prédisposition génétique, le diagnostic est plus précoce que dans les formes sans prédisposition et la bilatérisation du rétinoblastome est généralement la règle. Néanmoins, de rares familles présentent une pénétrance réduite et une variabilité phénotypique se traduisant par la coexistence de patients atteints de rétinoblastome bilatéral ou unilatéral, d’apparentés porteurs sains et d’apparentés présentant des rétinomes. Les mécanismes responsables de la variabilité phénotypique intrafamiliale sont inconnus et l’existence de facteurs génétiques modulant le phénotype tumoral est probable.L’origine de la variabilité de l’expression phénotypique du rétinoblastome peut être la résultante (i) de l’existence de mutations en mosaïque, (ii) de mutations de RB1 et (iii) de facteurs modificateurs génétiques indépendants du locus de RB1. Trois axes distincts et originaux basés sur ces origines possibles de variabilité phénotypique ont été développés pour caractériser les relations génotype/phénotype dans le rétinoblastome. Premièrement, les conséquences d’une mosaïque somatique ont été illustrées grâce à l’étude d’une famille ayant bénéficié de cinq diagnostics prénatals. Dans ces familles, certains fœtus porteurs de l’allèle à risque identifié par une approche indirecte basée sur l’étude de microsatellites au locus de RB1, n’étaient pas porteurs de la mutation du parent atteint, lui-même atteint d’un rétinoblastome bilatéral. Ainsi, nous avons démontré la présence d’une mosaïque somatique et gonadique chez ce parent lourdement atteint. La conséquence de l’existence de patients présentant une mosaïque dans le cadre du conseil génétique a été discutée. La suite de nos travaux a pris en compte ces résultats afin de limiter les biais que pourrait induire la présence de mutations en mosaïque dans des études de corrélation génotype/phénotype dans le rétinoblastome. Deuxièmement, l’association de grandes délétions emportant RB1 avec des retards psychomoteurs chez des patients atteints de rétinoblastome a été étudiée. Une approche de CGH hautement résolutive, ciblée sur le locus de RB1, a été mise en place afin de caractériser le rôle des gènes contigus de RB1 dans ce syndrome. Ainsi, cette approche a permis de définir une zone à risque de retard psychomoteur que nous proposons comme seuil d’alerte pour le généticien. Cette zone définit un gène, PCDH8 d’expression cérébrale exclusive, comme un excellent candidat au retard psychomoteur. Enfin, troisièmement, une approche « gène candidat » reposant sur l’étude du SNP309 du promoteur de MDM2, a été mise en œuvre. / Retinoblastoma is the most common intraocular childhood cancer and occurs when both alleles of the RB1 gene are inactivated in the retina. In patients without genetic predisposition, the two mutations occurred in a single unique retinal cell. In subjects with a genetic predisposition to retinoblastoma, the first RB1 mutation is found in the germline and the second appears as a somatic mutation. Germline carriers usually develop bilateral or multifocal tumors and the diagnosis is earlier. However, some rare families exhibit low penetrance and variable expressivity of the disease because bilaterally affected, unilaterally affected, and unaffected mutation carriers are known to coexist. The existence of genetic modifiers in retinoblastoma therefore appears highly probable and must be considered. The lack of penetrance and the variable expressivity could be the sum of three independent causes. The presence of a mosaic can affect the phenotype, the nature of the mutation can drive low penetrance and particular phenotype like psychomotor delay in case of large genomic deletions and genetic modifier factors could modulate the phenotype. These three major keys have been studied in order to highlight the relations between the phenotype and the genotype. Firstly, the consequences of mosaicism have been illustrated by a prenatal diagnosis concerning a couple with a bilateral retinoblastoma-affected male patient who requested five successive prenatal diagnoses and in whom RB1 mutation mosaicism had important implications. Implications of mosaicism in genetic counseling have been discussed and taken into consideration in order to limit bias in the two following genotype/phenotype studies. Secondly, the association between whole germline monoallelic deletions of the RB1 gene and psychomotor delay was studied by a high-resolution CGH array focusing on RB1 and its flanking region. Comparative analysis detected a four megabase critical interval including a candidate gene, protocadherin 8 (PCDH8). PCDH8 is thought to function in signaling pathways and cell adhesion in a central nervous system-specific manner, making loss of PCDH8 one of the probable causes of psychomotor delay in RB1-deleted patients. Thirdly, a candidate gene approach based on partners that are necessary for the development of the tumor attempted to find possible genetic modifiers. MDM2, which increases p53 and pRB catabolism, was therefore a prominent candidate. The minor allele of MDM2 that includes a 309T>G transversion (SNP rs2279744) in the MDM2 promoter is known to enhance MDM2 expression. In family-based association analyses performed in 70 retinoblastoma families, the MDM2 309G allele was found to be statistically significantly associated with incidence of bilateral or unilateral retinoblastoma among members of retinoblastoma families under a recessive model (Z = 3.305, two-sided exact P = .001). The strong association of this genotype with retinoblastoma development designates MDM2 as the first modifier gene to be identified among retinoblastoma patients

La porphyrie aiguë intermittente (PAI) est la plus fréquente des porphyries hépatiques aiguës. Elle est décrite comme une maladie autosomique dominante dont le trait génétique est estimé à 1/1675 en France avec une pénétrance faible et variable allant de 10% à 50% dans les familles connues de PAI. La PAI est due à des mutations réduisant le niveau d’activité de l’hydroxyméthylbilane-synthase (HMBS). Son déficit entraîne l’accumulation de précurseurs neurotoxiques responsables de la symptomatologie clinique. Dans le foie, la synthèse d’hème est contrôlée par l’enzyme ALA-Synthétase 1 (ALAS1) dont l’activité est régulée par un rétrocontrôle négatif par le produit final : l’hème. Le traitement consiste à freiner l’induction d’ALAS1 induit par la carence en hème, par l’administration d’hème exogène. Ce traitement de la crise aiguë est très efficace mais génère rapidement une dépendance physique avec apparition de crises récurrentes nécessitant l’administration chronique d’hème exogène. L’objectif principal de ce projet a été d’étudier les mécanismes physiopathologiques et génétiques liés à cette pathologie afin de traiter et conseiller au mieux les patients. Une partie du projet a consisté à explorer les facteurs génétiques modulateurs de la pénétrance de la maladie. Tout d’abord, une prévalence minimale du trait génétique dans la population générale a été estimée à 1/1299 permettant d’en déduire une pénétrance de l’ordre de 1% alors que celle dans les familles PAI suivies par le CFP est estimée à 22,9 %. Ensuite, concernant les facteurs pouvant expliquer cette différence, la présence d’une mutation type non-sens est plus fréquemment associée aux formes sévères et à une pénétrance plus élevée. De plus, les études de corrélation et d’héritabilité suggèrent plutôt une transmission de type oligogénique associée à des facteurs épigénétiques modulateurs de la pénétrance dont le facteur environnemental. Une autre partie a consisté à explorer les effets de l’administration d’hème exogène sur les patients et un modèle murin de PAI créé génétiquement. Chez l’homme, le traitement est associé à une augmentation des formes chroniques (1,7 % avant vs 7,5 % après l’introduction du celui-ci). Dans le modèle murin de PAI, les injections intrapéritonéales répétées induisent une augmentation paradoxale d’ALAS1 (3 fois), une augmentation de l’hème oxygénase 1 qui catabolise l’hème (HMOX1, 9 fois) ainsi que des voies de l’inflammation (analyse transcriptomique et protéomique hépatique) et une surcharge en fer. De plus, cette administration induit une altération des complexes de la chaine respiratoire mitochondriale responsable d’anomalies du métabolisme énergétique au niveau hépatique, cérébral et musculaire pouvant expliquer la symptomatologie neuroviscérale. En conclusion, ce travail a permis d’explorer les caractéristiques génétiques de la maladie (prévalence, pénétrance) en remettant en cause le mode de transmission autosomique dominant jusqu’ici admis, et d’explorer les mécanismes physiopathologiques associées à l’administration d’hème exogène faisant de cette thérapeutique un pharmakon / The biosynthesis of porphyrins is one of the most conserved pathways known. By associating different metals, porphyrins give rise to the "pigments of life". The formation of haem is accomplished by a sequence of eight dedicated enzymes encoded by different genes, some being active in ubiquitous as well as in erythroid isoforms. In humans, the genes for each of the haem synthetic enzymes may become the target of mutations that give rise to an impaired cellular enzyme activity called porphyrias. The acute porphyrias are characterized by attacks of neuropsychiatric symptoms, which may be due to a toxic surplus of the porphyrin precursor 5-aminolevulinic acid, or a consequence of a deficit of vital hemoproteins. Mutations of the gene encoding the third enzyme: hydroxymethylbilane synthase, are associated with the most frequent type of acute hepatic porphyria, acute intermittent porphyria. AIP is thought to display autosomal dominant inheritance with incomplete penetrance. In the classical form of AIP, HMBS activity is about 50% lower than normal in all tissues. These levels of activity in basal conditions are not sufficiently low to cause symptoms. However, factors increasing hepatic heme demand, resulting in an upregulation of hepatic aminolevulinate synthase (ALAS1, the first enzyme of the heme biosynthesis pathway), precipitate acute attacks. The treatment of the attack of AIP consists to repress ALAS1 and restores metabolic equilibrium. But this treatment leads side effects and dependency. The pathophysiological mechanism of the disease is partially known and difficult to explore because there is not an AIP model or prediction model of porphyrogenicity. We aimed to obtain further insight into the pathophysiological mechanism of AIP and into the genetic (prevalence and penetrance) of AIP, and the contribution of genetic factors to the variable clinical expression of HMBS mutations.We first calculated the penetrance of HMBS mutations in AIP patients seen at the French reference center for porphyria: 22.9%. We then used the Exome Variant Server (EVS) to estimate the prevalence of deleterious HMBS mutations in the general population: 1/1299; and the penetrance of the AIP genetic trait in France: 1%. Finally, we investigated further the genetic factors underlying the penetrance of AIP by analyzing genotype/phenotype correlations, and the pattern of familial correlations for the symptoms of the acute crises of AIP. Intrafamily correlation studies showed correlations to be strong overall and modulated by kinship and the era in which the person was living, demonstrating strong influences of genetic and environmental modifiers on inheritance suggesting that AIP inheritance does not follow the classical autosomal dominant model. Null alleles were associated with a more severe phenotype and a higher penetrance than for other mutant alleles.On the other hand, we explored the effect of heme administration. In human, the introduction of hemin into the pharmacopeia has coincided with a 4.4-fold increase in the prevalence of chronic patients. We show that repeated hemin infusions in mice trigger a high level heme oxygenase 1 response, induce a pro-oxidative iron accumulation, a complex pattern of liver inflammation with macrophage infiltration and an alteration of oxidative phosphorylation

L'hémochromatose HFE due à la mutation C282Y entraine une surcharge en fer progressive. La surmortalité se produit après 50ans. La saignée répétée est un traitement efficace de peu d'effets secondaires. Justifier le dépistage est discuté depuis 60ans et dépend de l'efficacité du traitement et de la pénétrance en fonction d'enjeux économiques et sociaux. Ce travail apporte des éléments tirés de la cohorte LOGIFER depuis 25ans au CHU de Rennes, composée de 1835 homozygotes consultants du CHU, issus d'enquêtes ciblées, référés au CNR ou parents. Les motifs de recrutement, le sexe et l'âge ont évolué. 2/3 des patients sont des probants dont la moitié issus de dépistage, d'une meilleure représentativité. Le sexe-ratio est de 1.2. Ils sont caractérisés par la mélanodermie et les hépatopathies. Les atteintes articulaires sont peu spécifiques. Les mesures classiques de la surcharge sont univoques, très hétérogène selon les individus, elle augmente au moins jusque 60ans. Les femmes stockent le fer lentement jusqu'à la ménopause. L'alcool et le syndrome métabolique aggravent la surcharge. L'alcool accélère le dépistage clinique. Le syndrome métabolique crée une surcharge modérée, les arthropathies associées concernent d'autres articulations. Environ 20% des troubles au diagnostic contribuent à la pénétrance. L'Iron removal index repose sur la quantité de fer ôté pour entretenir le statut martial. Il a 2 usages probablement valables pour d'autres hémochromatoses. Mesurer la vitesse d'absorption du fer propre à un patient, complétant le phénotype et donnant une vue dynamique du risque de surcharge au contraire des critères classiques. Fournir un cadre de pilotage des saignées. Le rythme de traitement est personnalisable et prévisible au diagnostic (âge, sexe, fibrose, objectif de ferritine, poids). Corollairement, l'évolution du statut martial sous saignées implique des explorations complémentaires. Les patients génotypés suivis 8.5ans pendant le traitement ont une mortalité de 5%. A 54ans, il n'y a pas de surmortalité après ajustement sur le sexe, le lieu et l'année de naissance. Il y a une mortalité hépatique significative surtout des cancers primaires (ICM=18). Ils décèdent dans les 5ans du diagnostic. Elle est compensée par une sous-mortalité ultérieure cardiaque ou par d'autres cancers. La durée de vie baisse pour les patients anciennement recrutés en partie due au diagnostic tardif et aux traitements adjuvants moins efficaces. L'âge au décès va de 64 à 68ans. L'effet des saignées n'est pas quantifiable mais milite pour le traitement précoce. Le prédicteur de cirrhose de Guyader s'adapte à la prédiction des fibroses (indice de Youden similaire). L'analyse discriminante prédit les stades METAVIR avec un contrôle de fiabilité. Ces équations sont les meilleurs prédicteurs parmi les index proposés par la littérature. Le développement des résultats passe par la mise en place d'études longitudinales entre 65 et 80ans et l'étude des pathologies non létales. / Hemochromatosis due to the HFE mutation C282Y causes a progressive iron overload. The mortality occurs after 50 years. Repeated bleeding is an effective treatment with marginal side effects. The rationale for screening, debated for 60 years, depends on the penetrance and the effectiveness of treatment relatively to economic and social issues. This work provides evidence from cohort LOGIFER, 25 years old at the CHU of Rennes, composed of 1835 homozygous: consultants from CHU, from targeted surveys, referred to the NRC or related. The reasons for recruitment, gender and age have changed. 2/3 of patients are probants, half of them coming from screening, providing better representativity. The sex ratio was 1.2. They are characterized by skin pigmentation and liver disease. Joint involvement are nonspecific. Traditional measures of overload are unequivocal , highly heterogeneous among individuals and increases until at least 60 years. Women store iron slowly until menopause. Alcohol and metabolic syndrome worse overload. Alcohol accelerates the clinical discover. Metabolic syndrome creates a moderate overload, associated arthropathies involve other joints. Approximately 20% of clinical signs at diagnosis contribute to the penetrance. The Iron removal index is based on the amount of iron removed to maintain iron status . It has two usages probably valid for other hemochromatosis. Measuring the rate of absorption of iron for a specific patient, supplementing the phenotype and giving a dynamic view of the risk of overload unlike conventional criteria. Providing a framework for controlling the bleeding pattern. The processing rate is customizable and predictable at diagnosis (age, sex, fibrosis, ferritin target, weight). Con,sequently, changes in iron status during maintaining treatment involves complementary explorations. Genotyped patients monitored for 8.5 years during treatment have a mortality rate of 5%. At 54 years, there is no excess mortality after adjustment for sex, place and year of birth. There is a significant hepatic mortality especially primary liver cancers (ICM=18). They die within 5 years of diagnosis. It is offset by a subsequent under mortality from heart diseases or other cancers. Life expectancy down for patients initially enrolled in part due to delayed diagnosis and less effective adjuvant treatments. The age at death is 64 to 68 years. The effect of phelbotomies is not quantifiable but advocates for early treatment. The Guyader's predictor of cirrhosis adapts to the prediction of fibrosis (similar Youden index). Discriminant analysis predicts METAVIR stages with the benefit of a reliability check. These equations are the best predictors among candidates proposed by the literature. Development goes through the implementation of longitudinal studies between 65 and 80 years and the study of non-lethal forms.

Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2.

O objetivo principal do trabalho foi o desenvolvimento de um programa computacional, em linguagem Microsoft Visual Basic 6.0 (versão executável), para estimativa da taxa de penetrância a partir da análise de genealogias com casos de doenças com herança autossômica dominante. Embora muitos dos algoritmos empregados no programa tenham se baseado em idéias já publicadas na literatura (em sua maioria por pesquisadores e pós-graduandos do Laboratório de Genética Humana do Instituto de Biociências da Universidade de São Paulo), desenvolvemos alguns métodos inéditos para lidar com situações encontradas com certa frequência nos heredogramas publicados na literatura, como: a) ausência de informações sobre o fenótipo do indivíduo gerador da genealogia; b) agrupamento de árvores de indivíduos normais sem a descrição da distribuição de filhos entre os progenitores; c) análise de estruturas da genealogia contendo uniões consanguíneas, utilizando um método alternativo ao descrito na literatura; d) determinação de soluções gerais para as funções de verossimilhança de árvores de indivíduos normais com ramificação regular e para as probabilidades de heterozigose de qualquer indivíduo pertencente a essas árvores. Além da versão executável, o programa, denominado PenCalc, é apresentado também numa versão para Internet (PenCalc Web), a qual fornece adicionalmente as probabilidades de heterozigose e o cálculo de afecção na prole de todos os indivíduos da genealogia. Essa versão pode ser acessada livre e gratuitamente no endereço http://www.ib.usp.br/~otto/pencalcweb. Desenvolvemos também um modelo com taxa de penetrância variável dependente da geração, uma vez que a inspeção de famílias com doenças autossômicas dominantes, como é o caso da síndrome da ectrodactilia associada à hemimelia tibial (EHT), sugere a existência de um fenômeno similar à antecipação, em relação à taxa de penetrância. Os modelos com taxa de penetrância constante e variável, e os métodos desenvolvidos neste trabalho foram aplicados a 21 heredogramas de famílias com afetados pela EHT e ao conjunto das informações de todas essas genealogias (meta-análise), obtendo-se em todos os casos estimativas da taxa de penetrância. / The main objective of this dissertation was the development of a computer program, in Microsoft® Visual Basic® 6.0, for estimating the penetrance rate of autosomal dominant diseases by means of the information contained on genealogies. Some of the algorithms we used in the program were based on ideas already published in the literature by researchers and (post-) graduate students of the Laboratory of Human Genetics, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo. We developed several other methods to deal with particular structures found frequently in the genealogies published in the literature, such as: a) the absence of information on the phenotype of the individual generating of the genealogy; b) the grouping of trees of normal individuals without the separate description of the offspring number per individual; c) the analysis of structures containing consanguineous unions; d) the determination of general solutions in simple analytic form for the likelihood functions of trees of normal individuals with regular branching and for the heterozygosis probabilities of any individual belonging to these trees. In addition to the executable version of the program summarized above, we also prepared, in collaboration with the dissertation supervisor and the undergraduate student Marcio T. Onodera (main author of this particular version), another program, represented by a web version (PenCalc Web). It enables the calculation of heterozygosis probabilities and the offspring risk for all individuals of the genealogy, two details we did not include in the present version of our program. The program PenCalc Web can be accessed freely at the home-page address http://www.ib.usp.br/~otto/pencalcweb. Another important contribution of this dissertation was the development of a model of estimation with generationdependent penetrance rate, as suggested by the inspection of families with some autosomal dominant diseases, such as the ectrodactyly-tibial hemimelia syndrome (ETH), a condition which exhibits a phenomenon similar to anticipation in relation to the penetrance rate. The models with constant and variable penetrance rates, as well as practically all the methods developed in this dissertation, were applied to 21 individual genealogies from the literature with cases of ETH and to the set of all these genealogies (meta-analysis). The corresponding results of all these analysis are comprehensively presented.

L’hémochromatose HFE est une maladie du métabolisme du fer liée au gène HFE dont la principale mutation est C282Y. L’objectif général de ce travail était d’étudier l’influence de facteurs génétiques et non génétiques sur l’expression phénotypique de patients atteints d’hémochromatose HFE. Cette étude prospective incluait les patients C282Y/C282Y etC282Y/H63D inclus en protocole de saignées entre janvier 2004 et décembre 2011 au centre de santé brestois de l’EFS-Bretagne. Dans un premier temps, nous avons étudié l’influence du génotype C282Y/H63D sur la survenue d’une surcharge en fer. Nous avons confirmé que le variant H63D doit être considéré comme un facteur de susceptibilité dont l’expression est liée à la présence de co-facteurs responsables d’une hyper ferritinémie. Ensuite, nous avons étudié le rôle des grossesses et de l’alimentation sur l’expression phénotypique du génotype C282Yhomozygote. Nous avons montré qu’il existe bien une différence d’expressivité clinique liée au sexe chez les patients C282Y/C282Y. Cependant, nos données n’ont pas confirmé l’effet protecteur typiquement attribué aux grossesses pour expliquer la plus lente accumulation de fer chez les femmes. Cette étude a également mis en évidence une association modérée entre la consommation d’aliments riches en fer et le degré de surcharge en fer des patients C282Yhomozygotes traités par phlébotomies. Ce travail contribue à mieux comprendre l’hétérogénéité phénotypique observée dans l’hémochromatose HFE. La finalité est de pouvoir repérer précocement les sujets les plus à risque de développer les surcharges en fer les plus sévères et par conséquent des complications cliniques. / HFE hemochromatosis is a disorder of iron metabolism related to the HFE gene whose mainmutation is C282Y. The overall aim of this study was to investigate the influence of genetic and non genetic factors on phenotypic expression of patients with HFE hemochromatosis. This prospective study included the C282Y/C282Y and C282Y/H63D patients enrolled in a phlebotomy program between 2004 and 2011 in a blood centre of western Brittany (Brest, France). First, weassessed the weight of the C282Y/H63D genotype in the occurrence of iron overload. We confirmed that H63D is a discrete genetic susceptibility factor whose expression is most visible in association with other co-factors responsible for hyper ferritinemia. Then we investigated the effect of pregnancies and iron-rich diet on phenotypic expressivity of the C282Y/C282Y genotype. We have shown that there is a difference in clinical expression related to gender in C282Y/C282Ypatients. However our findings did not confirm that pregnancies protect against iron accumulationin women. This study established a moderate link between dietary iron intake and the degree of iron overload in HFE hemochromatosis patients who come to medical attention. This work contributes to a better understanding of the phenotypic heterogeneity observed in HFE hemochromatosis. The purpose is to identify precociously subjects the most at risk of developing iron overload and therefore clinical complications.

O objetivo principal do trabalho foi o desenvolvimento de um programa computacional, em linguagem Microsoft Visual Basic 6.0 (versão executável), para estimativa da taxa de penetrância a partir da análise de genealogias com casos de doenças com herança autossômica dominante. Embora muitos dos algoritmos empregados no programa tenham se baseado em idéias já publicadas na literatura (em sua maioria por pesquisadores e pós-graduandos do Laboratório de Genética Humana do Instituto de Biociências da Universidade de São Paulo), desenvolvemos alguns métodos inéditos para lidar com situações encontradas com certa frequência nos heredogramas publicados na literatura, como: a) ausência de informações sobre o fenótipo do indivíduo gerador da genealogia; b) agrupamento de árvores de indivíduos normais sem a descrição da distribuição de filhos entre os progenitores; c) análise de estruturas da genealogia contendo uniões consanguíneas, utilizando um método alternativo ao descrito na literatura; d) determinação de soluções gerais para as funções de verossimilhança de árvores de indivíduos normais com ramificação regular e para as probabilidades de heterozigose de qualquer indivíduo pertencente a essas árvores. Além da versão executável, o programa, denominado PenCalc, é apresentado também numa versão para Internet (PenCalc Web), a qual fornece adicionalmente as probabilidades de heterozigose e o cálculo de afecção na prole de todos os indivíduos da genealogia. Essa versão pode ser acessada livre e gratuitamente no endereço http://www.ib.usp.br/~otto/pencalcweb. Desenvolvemos também um modelo com taxa de penetrância variável dependente da geração, uma vez que a inspeção de famílias com doenças autossômicas dominantes, como é o caso da síndrome da ectrodactilia associada à hemimelia tibial (EHT), sugere a existência de um fenômeno similar à antecipação, em relação à taxa de penetrância. Os modelos com taxa de penetrância constante e variável, e os métodos desenvolvidos neste trabalho foram aplicados a 21 heredogramas de famílias com afetados pela EHT e ao conjunto das informações de todas essas genealogias (meta-análise), obtendo-se em todos os casos estimativas da taxa de penetrância. / The main objective of this dissertation was the development of a computer program, in Microsoft® Visual Basic® 6.0, for estimating the penetrance rate of autosomal dominant diseases by means of the information contained on genealogies. Some of the algorithms we used in the program were based on ideas already published in the literature by researchers and (post-) graduate students of the Laboratory of Human Genetics, Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo. We developed several other methods to deal with particular structures found frequently in the genealogies published in the literature, such as: a) the absence of information on the phenotype of the individual generating of the genealogy; b) the grouping of trees of normal individuals without the separate description of the offspring number per individual; c) the analysis of structures containing consanguineous unions; d) the determination of general solutions in simple analytic form for the likelihood functions of trees of normal individuals with regular branching and for the heterozygosis probabilities of any individual belonging to these trees. In addition to the executable version of the program summarized above, we also prepared, in collaboration with the dissertation supervisor and the undergraduate student Marcio T. Onodera (main author of this particular version), another program, represented by a web version (PenCalc Web). It enables the calculation of heterozygosis probabilities and the offspring risk for all individuals of the genealogy, two details we did not include in the present version of our program. The program PenCalc Web can be accessed freely at the home-page address http://www.ib.usp.br/~otto/pencalcweb. Another important contribution of this dissertation was the development of a model of estimation with generationdependent penetrance rate, as suggested by the inspection of families with some autosomal dominant diseases, such as the ectrodactyly-tibial hemimelia syndrome (ETH), a condition which exhibits a phenomenon similar to anticipation in relation to the penetrance rate. The models with constant and variable penetrance rates, as well as practically all the methods developed in this dissertation, were applied to 21 individual genealogies from the literature with cases of ETH and to the set of all these genealogies (meta-analysis). The corresponding results of all these analysis are comprehensively presented.

No description available.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.