Les télomères sont les extrémités des chromosomes linéaires des eucaryotes.Ils sont constitués de répétitions en tandem d'un motif court riche enguanine, et liés par des protéines spécifiques. Chez les vertébrés cesprotéines forment un complexe appelé le shelterin et dont l'intégrité estcritique pour assurer la réplication correcte des extrémités deschromosomes, et pour les protéger contre une prise en charge illicite parles voies de réparation des cassures double-brin de l'ADN. Des dysfonctionsdes télomères engendrent une instabilité du génome qui peut conduire à lasénescence ou au cancer. Les télomères représentent une région subnucléaireoù les protéines du shelterin sont fortement enrichies, ce qui permetl'implication dans les fonctions biologiques d'interactions de basseaffinité. Parmi les protéines du shelterin, la protéine de liaison auxrépétitions télomériques TRF2 et son partenaire constitutif RAP1 sont lesfacteurs majeurs responsables de la protection des extrémités. Nous avonsétudié en détails l'assemblage du complexe TRF2/RAP1 par des approchesintégrées de biologie structurale, de biophysique et de biochimie.Nous avons montré que cet assemblage s'accompagne d'importants ajustementsde conformation des deux protéines, et implique une interaction de basseaffinité qui engage de grandes régions des deux protéines et affecte leurspropriétés d'interactions. / Telomeres are the ends of eukaryotic linear chromosomes. They are made oftandem repeats of a short guanine-rich motif and bound by specific proteins.In vertebrates, these proteins form a complex called shelterin, theintegrity of which is critical to ensure proper replication of chromosomeends and to protect them against illicit targeting by DNA double-strandbreak repair pathways. Telomere dysfunctions lead to genome instability,which can ultimately cause senescence or cancer. Telomeres are a subnuclearregion in which shelterin proteins are highly enriched, enhancing lowaffinity interactions of important biological function. Among shelterinproteins, telomeric repeat-binding protein TRF2 and its constitutive partnerRAP1 are the main factors responsible for end protection. We studied indetails the assembly of TRF2/RAP1 complex by means of integrated structural,biophysical and biochemical approaches. We showed that this assemblydisplays important conformational adjustments of both proteins, and involvesa low affinity interaction engaging large regions in both proteins whichaffects their interaction properties.

A anemia aplástica (AA) é uma doença hematológica rara caracterizada pela hipocelularidade da medula óssea, o que provoca pancitopenia. Esta pode ser de origem genética (associada a encurtamento telomérico) ou adquirida (não-associada a desgaste excessivo dos telômeros). Na forma adquirida, a ativação anormal de linfócitos T provoca a destruição das células hematopoéticas. O mecanismo que leva a essa destruição ainda não foi elucidado. Um dos tratamentos mais eficazes para repovoar a medula óssea hipocelular é o transplante com célulastronco hematopoéticas (CTHs). Porém, uma grande porcentagem de pacientes não se beneficia de nenhum tratamento, fazendo-se necessário o desenvolvimento de novas alternativas para terapia. A geração de células-tronco pluripotentes induzidas (iPSCs) a partir de células somáticas (reprogramação) representa uma ferramenta promissora para o estudo de doenças e para o desenvolvimento de possíveis terapias paciente-especificas, como transplantes autólogos. Neste trabalho, avaliamos a capacidade de reprogramação de fibroblastos e eritroblastos de pacientes com AA adquirida. Metodologias de reprogramação utilizando lentivírus ou plasmídeos epissomais não integrativos foram testadas em células de quatro pacientes e de um controle saudável. Eritroblastos dos quatro pacientes e do controle foram reprogramados utilizando os plasmídeos não integrativos. As iPSCs geradas apresentaram-se similares a células-tronco embrionárias quanto à morfologia, expressão dos marcadores de pluripotência OCT4, SOX2, NANOG, SSEA-4, Tra-1-60 e Tra-1-81, e capacidade de diferenciação in vitro em corpos embrioides (EBs). A dinâmica telomérica das células pré- e pós-reprogramação foi avaliada em diferentes passagens utilizando a técnica de flow-FISH. O comprimento telomérico foi aumentado nas iPSCs quando comparado às células parentais o que indica que a célula foi completamente reprogramada. No presente trabalho, células de pacientes com AA adquirida foram reprogramadas a um estado de pluripotência por meio de um método não integrativo. As iPSCs geradas serão essenciais para futuros ensaios de diferenciação hematopoética, o que poderá contribuir para o entendimento dos mecanismos envolvidos no desenvolvimento dessa doença. Além disso, a diferenciação dessas células livres de transgenes poderá servir como uma alternativa terapêutica para os pacientes com AA como, por exemplo, em transplantes autólogos / Aplastic anemia (AA) is a rare hematological disease characterized by bone marrow hypocellularity that leads to pancytopenia. Its origin can be genetic (associated with telomere shortening) or acquired (non-associated with telomere shortening). The acquired form exhibit T lymphocytes abnormal activation, which leads to hematopoietic cells destruction. The mechanisms behind this phenomenon are still unclear. One of the most effective treatments for hypocelullar bone marrow repopulation is hematopoietic stem cell (HSCs) transplantation. However, a large percentage of patients do not benefit from any of the available treatments. This highlights the need to develop new therapeutic strategies. The generation of induced pluripotent stem cells (iPSCs) from somatic cells (reprogramming) represents a powerful tool for disease modeling and for the development of patient-specific therapies such as autologous transplants. In this study, we evaluate the capacity of reprogramming acquired AA patients\' fibroblasts and erythroblasts. Reprogramming methods using lentivirus or non-integrative episomal plasmids were tested in four patients\' cells and in cells from one healthy donor. Erythroblasts from these four patients and healthy donor were reprogrammed using non-integrative plasmids. The iPSCs resembled human embryonic stem cells in morphology, in the expression of pluripotent markers such as OCT4, SOX2, NANOG, SSEA-4, Tra-1-60 and Tra-1-81, and in in vitro differentiation (capacity to form embryoid bodies). The telomere dynamics of the cells before and after reprogramming was assessed along passaging using flow-FISH. The telomere length in the iPSCs was increased when compared to the parental cells. Thus, acquire AA patients\' cells could be reprogrammed to a pluripotent state by a nonintegrative method. The iPSCs will be essential for future hematopoietic differentiation assays that could contribute to the understanding of the mechanisms involved in the disease development. Furthermore, the differentiation of transgene-free cells may serve as an alternative therapy for patients with AA such as autologous transplants

Sous conditions de stress métabolique ou environnemental, l’activation instantanée de voies moléculaires puissantes permet aux cellules de prévenir la formation et l’accumulation d’agrégats protéiques toxiques. HSF1 (Heat Shock Factor 1) est le facteur de transcription majeur capable d’orchestrer cette réponse cellulaire au stress et cela via l’activation de protéines au rôle protecteur nommées chaperonnes. Cependant, il est aujourd’hui évident que les fonctions initialement attribuées au facteur HSF1 s’étendent bien au-delà de l’activation de la transcription de chaperonnes. En effet, il a été démontré que HSF1 joue un rôle essentiel dans l’activation et le remodelage de régions répétées appartenant à l’hétérochromatine péricentromérique sous stress thermique et plus récemment qu’HSF1 contribuerait significativement au processus de tumorigenèse dans différents types de cancers. Dans cette étude, nous avons identifié pour la première fois les régions subtélomériques comme étant une nouvelle cible génomique d’HSF1 sous conditions de stress thermique. Nous avons démontré, que la liaison directe et spécifique d’HSF1 avec plusieurs de ces régions sous stress thermique est à l’origine d’une surexpression de longs ARNs non codants issus des télomères, aussi connus sous le nom de TERRA. De façon intéressante nous avons trouvé que cette transcription était corrélée à un enrichissement de la marque épigénétique répressive H3K9me3 au niveau télomérique. De plus, nos données ont permis de démontrer que l’intégrité de la chromatine télomérique était significativement atteinte sous conditions de stress thermique. Nous observons à la fois, une dissociation partielle de la protéine TRF2 (Telomeric repeat-binding factor 2) et une accumulation de dommages à l’ADN détectés grâce au marqueur moléculaire H2AX-P, au niveau des télomères. Finalement, nos résultats ont également permis de souligner un rôle d’HSF1 dans le maintien de cette intégrité télomérique. L’ensemble de ce travail établit un premier lien entre la voie cellulaire puissante de réponse au stress, son acteur majeur HSF1 et les régions de l’hétérochromatine télomérique, dans des lignées de cellules humaines cancéreuses. Ces données fournissent des indications précieuses sur une voie de maintien de télomères sous stress et nous permettant de proposer un modèle dans lequel cette nouvelle fonction d’HSF1 aux télomères pourrait être étroitement liée à l’expression des ARNs non codants télomériques. Sur la base de nos données ainsi que sur les multiples publications démontrant l’implication d’HSF1 dans la tumorigenèse, la définition exacte du rôle d’HSF1 au niveau de l’intégrité des télomères dans un contexte pathologique comme le cancer apparait aujourd’hui comme un défi prometteur. / In response to metabolic or environmental stress, cells rapidly activate powerful defense mechanisms to prevent the formation and accumulation of toxic protein aggregates. The main orchestrator of this cellular response is HSF1 (Heat Shock Factor 1), a transcription factor involved in the up-regulation of protein-coding genes with protective roles. However, it is now becoming clear, that HSF1 function extends beyond what was previously predicted and that HSF1 can contribute to pericentromeric heterochromatin remodeling and activation as well as to efficiently support malignancy. In this study, we identify subtelomeric DNA as a new genomic target of HSF1 upon heat shock (HS). We show that HSF1 binding to subtelomeric regions plays an essential role in the upregulation of TERRA lncRNAs transcription and in the accumulation of repressive H3K9me3 histone mark at telomeres upon HS. Additionally, we demonstrate that HS significantly affects telomere capping and telomere integrity. We bring evidence of a partial TRF2 telomeric-binding factor dissociation and we reveal an accumulation of DNA damage at telomeres using the DNA damage marker H2A.X-P. In line with this, we bring solid evidences that under heat shock, HSF1 contributes to preserve telomere integrity by significantly limiting telomeric DNA damage accumulation. Altogether, our findings therefore reveal a new direct and essential function of HSF1 in transcription activation of TERRA and in telomere protection upon stress in human cancer cell lines. This work provides new insights into how telomeres are preserved under stressful heat shock conditions and allow us to propose a model where HSF1 may exert its protective function at telomeres via the expression of TERRA ncRNAs. Based on our results and given the important role of HSF1 in tumor development, defining the role of HSF1 with regard to telomere stability in tumor development already emerges as a promising challenge.

Marine mammals comprise a paraphyletic group of species whose current abundance and distribution has been greatly shaped by past environmental changes and anthropogenic impacts. This thesis describes molecular ecological approaches to answer questions regarding habitat requirements, genetic differentiation, and life-history trade-offs in three species of marine mammals.  The annual sea-ice dynamics of the Arctic may have large effects on the abundance and distribution of Arctic species such as the pagophilic ringed seal (Pusa hispida). Paper I describes and applies a simple molecular method for isolating and characterizing a relatively large set of single nucleotide polymorphisms (SNPs) in the ringed seal. These SNPs have been genotyped in a yet-to-be-analysed dataset which will form the basis in an assessment of the micro-evolutionary effects of annual sea-ice dynamics on ringed seal.  Current management efforts directed towards the North Atlantic fin whale (Balaenoptera physalus) are hampered by an unclear understanding of population structure. Paper II investigates the DNA basis for the high levels of genetic differentiation that have been reported in allozyme studies of the North Atlantic fin whale. We find that additional processes (at the organismal level) may have contributed to shaping the phenotype of the underlying allozyme variation. Telomeres may potentially serve as markers for determining the chronological and biological age of animals where other means of inference is difficult. Paper III describes the application and evaluation of four qPCR assays for telomere length estimation in humpback whales (Megaptera novaeangliae), finding that reliable telomere length estimates require extensive quality control. Paper IV applies the best performing qPCR assay to test whether telomeres may provide a method for genetic determination of chronological age in whales and concludes that the biological and experimental variation in telomere length estimates is too large to determine age with sufficient resolution. Finally, because telomere length and rate of telomere loss also may be affected by other cellular and organismal processes, such as resource allocation among self-maintenance mechanisms, growth and reproduction, Paper V describes the correlations between individual telomere length and rate of telomere loss, and sex, maturity status and female reproductive output. We found that the costs of reproduction in terms of telomere loss are higher in mature humpback whales than in juveniles; that reproductive costs are higher in males than females; and that differences among females tend to correlate with reproductive output. / At the time of doctoral defence the following papers were unpublished and had a status as follows: Paper 2: Submitted; Paper 3:Submitted; Paper 4: Manuscript; Paper 5:Manuscript

In most eukaryotes, chromosomes ends are protected by telomeres which are formed by repetitive DNA, specialized binding proteins, and higher order structures. Telomeres become shorter following replication due to the positioning and degradation of terminal RNA primers, as well as resection by nucleases. Extensive telomere shortening over many cell cycles elicits a DNA damage checkpoint that culminates in senescence or, in the absence of tumor suppressor pathways, apoptosis. These effects block the expansion of cells with unstable genomes, but can also precipitate disease in tissues that rely on regeneration for function. In many unicellular eukaryotes and proliferative human cells including cancer cells, telomeres can be maintained by the telomerase reverse transcriptase (TERT) and its associated RNA (TR). The elongation of telomeric DNA by telomerase depends on the telomerase essential N-terminal (TEN) and C terminal reverse transcriptase (RT) domains. We found that human TEN interacted with single-stranded telomeric DNA and restored function, in trans, to an hTERT mutant lacking hTEN. Telomerase required hTEN residues for activity, telomere maintenance, and extension of cellular replicative lifespan. Two inactive hTERT variants bearing mutations in TEN and RT domains, respectively, cooperated to regenerate telomerase activity in vitro. hTEN interacted with several regions of hTERT suggesting that dimerization may occur via TEN-TERT interactions. The in vivo defect of certain hTEN mutants may involve an inability to interact with factors that recruit the enzyme to the telomere and/or stimulate activity. Human homologs of the S. cerevisiae recruitment factor Est1 interacted with telomerase in a species-specific manner. The TPR domain of hEST1A interacted with the N-terminus of hTERT. The TPR domain of ScEst1 was required for telomere length maintenance by telomerase, and, paradoxically, also negatively regulated telomere length. In preliminary experiments, hTERT interacted with hPOT1/hTPP1. This interaction may stimulate the elongation of telomeres by telomerase. The DNA and protein interactions described herein expand our knowledge of telomerase and present new targets for the manipulation of telomerase function in human disease.

In the absence of telomerase activity, a subset of cancerous and immortalized cells maintain telomere length by means of a poorly understood mechanism, termed alternative lengthening of telomeres (ALT). Many details of telomere maintenance in ALT positive cells remain unclear, but significant evidence implicates a homologous recombination mechanism. ALT specific nuclear structures, known as ALT-associated promyelocytic leukemia nuclear bodies (APBs), are thought to serve as the site of telomere extension. Using electron spectroscopic imaging we have demonstrated that APBs contain substantial amounts of nucleic acid sequestered within the bodies. In contrast, promyelocytic leukemia nuclear bodies in non-ALT cell lines contain no significant nucleic acid. We show that the nucleic acid found in APBs is not RNA and provide evidence that it is in fact telomeric repeat DNA. This evidence supports a role for APBs to sequester extrachromosomal telomeric DNA in order to suppress the activation of DNA repair.

In the absence of telomerase activity, a subset of cancerous and immortalized cells maintain telomere length by means of a poorly understood mechanism, termed alternative lengthening of telomeres (ALT). Many details of telomere maintenance in ALT positive cells remain unclear, but significant evidence implicates a homologous recombination mechanism. ALT specific nuclear structures, known as ALT-associated promyelocytic leukemia nuclear bodies (APBs), are thought to serve as the site of telomere extension. Using electron spectroscopic imaging we have demonstrated that APBs contain substantial amounts of nucleic acid sequestered within the bodies. In contrast, promyelocytic leukemia nuclear bodies in non-ALT cell lines contain no significant nucleic acid. We show that the nucleic acid found in APBs is not RNA and provide evidence that it is in fact telomeric repeat DNA. This evidence supports a role for APBs to sequester extrachromosomal telomeric DNA in order to suppress the activation of DNA repair.

In most eukaryotes, chromosomes ends are protected by telomeres which are formed by repetitive DNA, specialized binding proteins, and higher order structures. Telomeres become shorter following replication due to the positioning and degradation of terminal RNA primers, as well as resection by nucleases. Extensive telomere shortening over many cell cycles elicits a DNA damage checkpoint that culminates in senescence or, in the absence of tumor suppressor pathways, apoptosis. These effects block the expansion of cells with unstable genomes, but can also precipitate disease in tissues that rely on regeneration for function. In many unicellular eukaryotes and proliferative human cells including cancer cells, telomeres can be maintained by the telomerase reverse transcriptase (TERT) and its associated RNA (TR). The elongation of telomeric DNA by telomerase depends on the telomerase essential N-terminal (TEN) and C terminal reverse transcriptase (RT) domains. We found that human TEN interacted with single-stranded telomeric DNA and restored function, in trans, to an hTERT mutant lacking hTEN. Telomerase required hTEN residues for activity, telomere maintenance, and extension of cellular replicative lifespan. Two inactive hTERT variants bearing mutations in TEN and RT domains, respectively, cooperated to regenerate telomerase activity in vitro. hTEN interacted with several regions of hTERT suggesting that dimerization may occur via TEN-TERT interactions. The in vivo defect of certain hTEN mutants may involve an inability to interact with factors that recruit the enzyme to the telomere and/or stimulate activity. Human homologs of the S. cerevisiae recruitment factor Est1 interacted with telomerase in a species-specific manner. The TPR domain of hEST1A interacted with the N-terminus of hTERT. The TPR domain of ScEst1 was required for telomere length maintenance by telomerase, and, paradoxically, also negatively regulated telomere length. In preliminary experiments, hTERT interacted with hPOT1/hTPP1. This interaction may stimulate the elongation of telomeres by telomerase. The DNA and protein interactions described herein expand our knowledge of telomerase and present new targets for the manipulation of telomerase function in human disease.

Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disorder, caused by a GAA repeat expansion mutation within intron 1 of the FXN gene, resulting in reduced level of frataxin protein. Normal individuals have 5 to 40 GAA repeat sequences, whereas affected individuals have approximately 70 to more than 1000 GAA triplets. Frataxin is a mitochondrial protein involved in iron-sulphur cluster and heme biosynthesis. The reduction in frataxin expression leads to oxidative stress, mitochondrial iron accumulation and consequential cell death with the primary sites of neurons of the dorsal root ganglia and the dentate nucleus of the cerebellum. FRDA, which is the most common inherited ataxia, affecting 1:50,000 Caucasians, is characterised by neurodegeneration, cardiomyopathy, diabetes mellitus and skeletal deformities. To investigate FRDA molecular disease mechanisms and therapy, several human FXN YAC transgenic mouse models have been established: Y47R, containing normal-sized (GAA)9 repeats; YG8R and YG22R, which initially contained expanded GAA repeats of 90-190 units and 190 units, respectively, but which have subsequently been bred to now contain expanded GAA repeats of 120-220 units and 170-260 units, respectively, and YG8sR (YG8R with a small GAA band) that was recently generated from YG8R breeding. To determine the FXN transgene copy number in the enhanced GAA repeat expansion-based FRDA mouse lines, a TaqMan qPCR assay was developed. The results demonstrated that the YG22R and Y47R lines had a single copy of the FXN transgene while the YG8R line had two copies. The YG8s lines showed less than one copy of the target gene, suggesting potential deletion of the FXN gene. Single integration sites of all transgenes were confirmed by fluorescence in situ hybridisation (FISH) analysis of metaphase and interphase chromosomes. However, in the YG8s line, at least 25% of the YG8s cells had no signals, while the remaining cells showed one signal corresponding to the transgenic FXN gene. In addition, the analysis of FXN exons in YG8s rescue mice by PCR confirmed the presence of all FXN exons in these lines, suggesting the incidence of somatic mosaicism in these lines. Extended functional analysis was carried out on these mice from 4 to 12 months of age. Coordination ability of YG8R, YG8sR and YG22R ‘FRDA-like’ mice, together with Y47R and C57BL6/J wild-type control mice, was assessed using accelerating rotarod analysis. The results indicated a progressive decrease in the motor coordination of YG8R, YG22R and YG8sR mice compared to Y47R or C57BL6/J controls. Locomotor activity was also assessed using an open field beam-breaker apparatus followed by four additional functional analyses including beam-walk, hang wire, grip strength and foot print tests. The results indicated significant functional deficits in the FRDA mouse models. Glucose and insulin tolerance tests were also conducted in the FRDA mouse models, indicating glucose intolerance and insulin hypersensitivity in the aforementioned lines. To investigate the correlation between the FRDA-like pathological phenotype and frataxin deficiency in the FRDA mouse models, frataxin mRNA and protein levels as well as somatic GAA repeat instability were examined. The results indicated that somatic GAA repeats increased in the cerebellum and brain of YG22R, YG8R and YG8sR mice, together with significantly reduced levels of FXN mRNA and protein in the liver of YG8R and YG22R compared to Y47R. However, YG8sR lines showed a significant decrease in FXN mRNA in all of the examined tissues compared to Y47R human FXN and C57BL6/J mouse Fxn mRNA. Protein expression levels were also considerably reduced in all the tissues of YG8sR mice compared to Y47R. Subsequently, the telomere length of human and mouse FRDA and control fibroblasts was assessed using qPCR and Q-FISH. The results indicated that the FRDA cells had chromosomes with relatively longer telomeric repeats in comparison to the controls. FRDA cells were screened for expression of telomerase activity using the TRAP assay and a quantitative assay for hTERT mRNA expression using TaqMan qRT-PCR. The results indicated that telomerase activity was not present in the FRDA cells. To investigate whether FRDA cells maintained their telomeres by ALT associated PML bodies (APBs), co-localisation of PML bodies with telomeres was assessed in these cells using combined immunofluorescence to PML and Q-FISH for telomere detection. The results demonstrated that the FRDA cells had significantly higher co-localised PML foci with telomeric DNA compared to the normal cells. Moreover, telomere sister chromatid exchange (T-SCE) frequencies were analysed in the human FRDA cell lines using chromosome orientation FISH (CO-FISH). The results indicated a significant increase in T-SCE levels of the FRDA cell lines relative to the controls. Furthermore, growth curve and population doubling analysis of the human FRDA and control fibroblasts was carried out. The results showed that the FRDA fibroblast cell cultures underwent growth arrest with higher cumulative population doubling compared to the controls. Though, further analysis of telomere length at different passage numbers revealed that the FRDA cells lost telomeres faster than the controls. Finally, the telomere dysfunction-induced foci (TIF) assay was performed to detect DNA damage in the human FRDA fibroblast cells using an antibody against DNA damage marker γ-H2AX and a synthetic PNA probe for telomeres. The frequency of γ-H2AX foci was significantly higher in the FRDA cells compared to the controls. Similarly, the FRDA cells had greater frequencies of TIFs in comparison to the controls, suggesting induced telomere dysfunction in the FRDA cells.

En hématologie, du fait de leur évolution favorable, les tumeurs spontanément regressives comme lesmodèles myéloïde de la mastocytose, et lymphoïde de la papulose lymphomatoïde sont peu étudiés. Lamastocytose est une hémopathie myéloproliférative clonale dont les lésions cutanées peuvent régresserspontanément chez l'enfant alors que la maladie est chronique chez l'adulte. Les mutations chezl'enfant sont en partie différentes de celles retrouvées chez l'adulte. Nous avons montré in vivo dansles mastocytoses pédiatriques une expression diminuée de la télomérase, associée à des télomèrescourts. In vitro, grâce à deux modèles cellulaires comportant différents mutants de KIT de " typepédiatriques " ou de " type adulte ", nous avons montré une augmentation de la longueur destélomères dans le mutant adulte, associée à une moindre sénescence comparées aux mutantspédiatriques sans pour autant mettre en évidence de différence dans l'expression et l'activité de latélomérase. Ces observations permettent en partie d'expliquer la régression des formes pédiatriques.La papulose lymphomatoïde est une lymphoprolifération cutanée T CD30+ dont les lésions régressentspontanément sans traitement. Cependant 10 à 20% des cas sont associés à un lymphome. Nous avonsétudié la physiopathologie d'expression du PDGFRβ dans les cellules tumorales via l'activation deNotch1. L'étude des télomères et de la télomérase in vivo et in vitro est préliminaire, et montrenotamment des télomères courts dans les cellules tumorales. En conclusion, nous montrons d'une partque la longueur des télomères dans les mastocytoses et la papulose lymphomatoïde est corrélée àl'évolution de la maladie, d'autre part, nous identifions un type de mutation potentiellement agressivedans les mastocytoses. Nous recommandons le génotypage systématique de cette pathologie dans lebut d'un suivi clinique attentif lorsque les lésions sont persistantes ou évolutives.