Spécialisation de Ku80c dans le couplage entre coupure et réparation de l’ADN lors des réarrangements programmés du génome chez Paramecium tetraurelia

During its sexual cycle, the ciliate Paramecium tetraurelia undergoes massive Programmed Genome Rearrangements (PGR). They consist, among others, in excision of 45,000 precisely delimited sequences, called IES (Internal Eliminated Sequences). A domesticated transposase, PiggyMac (Pgm), introduces double-strand DNA breaks (DSB) at IES ends. The Non Homologous End Joining pathway (NHEJ) handles highly precise repair of DSB. One of the actors of this pathway is the heterodimer Ku70/Ku80. In P. tetraurelia, the KU80 gene is present in three paralogous copies. Only KU80c is specifically expressed during PGR and RNA interferences against KU80c showed a complete inhibition of DNA cleavage. Furthermore, a Co-IP experiment in a heterologous system showed that both Ku70/Ku80c interact with Pgm. These results provide evidence that Ku is an essential partner of Pgm for DSB introduction; raising the question of the activating mechanism involved. During my PhD, I characterized the coupling between Ku and Pgm by analyzing immunofluorescence experiments, with or without pre-extraction, allowing the determination of inter-dependencies between those proteins for their nuclear localization and stability. Those methods demonstrated that Pgm requires the presence of Ku for a stable nuclear localization during the PGR. Ku80c shares 74% of the protein sequence with Ku80a. Functional complementation assays overexpressing Ku80a during the PGR showed that Ku80a is not capable to stably localize in nuclei nor to participate in Pgm nuclear stability. Furthermore, PGR are inhibited. Those results show that Ku80c has specialized for the DSB introduction during PGR. The use of chimeric proteins allowed to determine that Ku80c specialization was carried out by its N terminal domain.Au cours de son cycle sexuel, le cilié Paramecium tetraurelia procède à de massifs réarrangements programmés de son génome (RPG). Ils consistent, entre autres choses, en l’excision de 45 000 séquences précisément délimitées, appelées IES (Internal Eliminated Sequences). La transposase domestiquée Piggymac (Pgm) introduit les cassures double-brin (CDB) à l’extrémité des IES. La réparation très précise de ces dommages est réalisée par la voie de réparation des extrémités non-homologues (NHEJ). Un des acteurs de cette voie est l’hétérodimère Ku70/Ku80. Suite à des duplications globales du génome, la paramécie possède trois gènes KU80, Un seul de ces gènes est induit lors des RPG (KU80c) et une expérience d’ARN interférence (ARNi) contre KU80c montre une complète inhibition de l’introduction des CDB. De plus, des expériences de Co-IP en système hétérologue montrent que Ku70/Ku80c interagit avec Pgm. Ces résultats prouvent le rôle essentiel de Ku dans l’introduction des CDB lors des RPG et soulèvent la question du mécanisme impliqué. Au cours de ma thèse j’ai caractérisé le couplage entre Ku et Pgm en analysant des expériences d’immunofluorescence avec ou sans pré-extraction, permettant de déterminer les interdépendances de ces protéines pour leur localisation et pour leur stabilité nucléaire. Ces approches ont permis de démontrer que Pgm requiert la présence de Ku pour être stablement localisé dans les noyaux lors des RPG. Ku80c partage 74% de sa séquence protéique avec Ku80a. Des expériences de complémentations fonctionnelles surexprimant Ku80a lors des RPG ont montré que Ku80a n’est pas capable ni de se localiser stablement dans les noyaux ni de participer à la stabilisation nucléaire de Pgm. De plus, les RPG sont inhibés. Ces résultats montrent que Ku80c s’est spécialisé dans le couplage avec Pgm pour l’introduction des CDB lors des RPG. L’utilisation de protéines chimériques a permis de déterminer que la spécialisation de Ku80c est portée par son domaine N-terminal ∝-β

Specialization of Ku80c in the coupling between DNA break and repair during programmed genome rearrangements in Paramecium tetraurelia

Au cours de son cycle sexuel, le cilié Paramecium tetraurelia procède à de massifs réarrangements programmés de son génome (RPG). Ils consistent, entre autres choses, en l’excision de 45 000 séquences précisément délimitées, appelées IES (Internal Eliminated Sequences). La transposase domestiquée Piggymac (Pgm) introduit les cassures double-brin (CDB) à l’extrémité des IES. La réparation très précise de ces dommages est réalisée par la voie de réparation des extrémités non-homologues (NHEJ). Un des acteurs de cette voie est l’hétérodimère Ku70/Ku80. Suite à des duplications globales du génome, la paramécie possède trois gènes KU80, Un seul de ces gènes est induit lors des RPG (KU80c) et une expérience d’ARN interférence (ARNi) contre KU80c montre une complète inhibition de l’introduction des CDB. De plus, des expériences de Co-IP en système hétérologue montrent que Ku70/Ku80c interagit avec Pgm. Ces résultats prouvent le rôle essentiel de Ku dans l’introduction des CDB lors des RPG et soulèvent la question du mécanisme impliqué. Au cours de ma thèse j’ai caractérisé le couplage entre Ku et Pgm en analysant des expériences d’immunofluorescence avec ou sans pré-extraction, permettant de déterminer les interdépendances de ces protéines pour leur localisation et pour leur stabilité nucléaire. Ces approches ont permis de démontrer que Pgm requiert la présence de Ku pour être stablement localisé dans les noyaux lors des RPG. Ku80c partage 74% de sa séquence protéique avec Ku80a. Des expériences de complémentations fonctionnelles surexprimant Ku80a lors des RPG ont montré que Ku80a n’est pas capable ni de se localiser stablement dans les noyaux ni de participer à la stabilisation nucléaire de Pgm. De plus, les RPG sont inhibés. Ces résultats montrent que Ku80c s’est spécialisé dans le couplage avec Pgm pour l’introduction des CDB lors des RPG. L’utilisation de protéines chimériques a permis de déterminer que la spécialisation de Ku80c est portée par son domaine N-terminal ∝-β.During its sexual cycle, the ciliate Paramecium tetraurelia undergoes massive Programmed Genome Rearrangements (PGR). They consist, among others, in excision of 45,000 precisely delimited sequences, called IES (Internal Eliminated Sequences). A domesticated transposase, PiggyMac (Pgm), introduces double-strand DNA breaks (DSB) at IES ends. The Non Homologous End Joining pathway (NHEJ) handles highly precise repair of DSB. One of the actors of this pathway is the heterodimer Ku70/Ku80. In P. tetraurelia, the KU80 gene is present in three paralogous copies. Only KU80c is specifically expressed during PGR and RNA interferences against KU80c showed a complete inhibition of DNA cleavage. Furthermore, a Co-IP experiment in a heterologous system showed that both Ku70/Ku80c interact with Pgm. These results provide evidence that Ku is an essential partner of Pgm for DSB introduction; raising the question of the activating mechanism involved. During my PhD, I characterized the coupling between Ku and Pgm by analyzing immunofluorescence experiments, with or without pre-extraction, allowing the determination of inter-dependencies between those proteins for their nuclear localization and stability. Those methods demonstrated that Pgm requires the presence of Ku for a stable nuclear localization during the PGR. Ku80c shares 74% of the protein sequence with Ku80a. Functional complementation assays overexpressing Ku80a during the PGR showed that Ku80a is not capable to stably localize in nuclei nor to participate in Pgm nuclear stability. Furthermore, PGR are inhibited. Those results show that Ku80c has specialized for the DSB introduction during PGR. The use of chimeric proteins allowed to determine that Ku80c specialization was carried out by its N terminal domain

Functional diversification of Paramecium Ku80 paralogs safeguards genome integrity during precise programmed DNA elimination

International audienceGene duplication and diversification drive the emergence of novel functions during evolution. Because of whole genome duplications, ciliates from the Paramecium aurelia group constitute a remarkable system to study the evolutionary fate of duplicated genes. Paramecium species harbor two types of nuclei: a germline micronucleus (MIC) and a somatic macronucleus (MAC) that forms from the MIC at each sexual cycle. During MAC development, ~45,000 germline Internal Eliminated Sequences (IES) are excised precisely from the genome through a 'cut-and-close' mechanism. Here, we have studied the P. tetraurelia paralogs of KU80, which encode a key DNA double-strand break repair factor involved in non-homologous end joining. The three KU80 genes have different transcription patterns, KU80a and KU80b being constitutively expressed, while KU80c is specifically induced during MAC development. Immunofluorescence microscopy and high-throughput DNA sequencing revealed that Ku80c stably anchors the PiggyMac (Pgm) endonuclease in the developing MAC and is essential for IES excision genome-wide, providing a molecular explanation for the previously reported Ku-dependent licensing of DNA cleavage at IES ends. Expressing Ku80a under KU80c transcription signals failed to complement a depletion of endogenous Ku80c, indicating that the two paralogous proteins have distinct properties. Domain-swap experiments identified the α/β domain of Ku80c as the major determinant for its specialized function, while its C-terminal part is required for excision of only a small subset of IESs located in IES-dense regions. We conclude that Ku80c has acquired the ability to license Pgm-dependent DNA cleavage, securing precise DNA elimination during programmed rearrangements. The present study thus provides novel evidence for functional diversification of genes issued from a whole-genome duplication

Fam72a enforces error-prone DNA repair during antibody diversification

International audienceEfficient humoral responses rely on DNA damage, mutagenesis and error-prone DNA repair. Diversification of B cell receptors through somatic hypermutation and class-switch recombination are initiated by cytidine deamination in DNA mediated by activation-induced cytidine deaminase (AID)1 and by the subsequent excision of the resulting uracils by uracil DNA glycosylase (UNG) and by mismatch repair proteins1,2,3. Although uracils arising in DNA are accurately repaired1,2,3,4, how these pathways are co-opted to generate mutations and double-strand DNA breaks in the context of somatic hypermutation and class-switch recombination is unknown1,2,3. Here we performed a genome-wide CRISPR–Cas9 knockout screen for genes involved in class-switch recombination and identified FAM72A, a protein that interacts with the nuclear isoform of UNG (UNG2)5 and is overexpressed in several cancers5. We show that the FAM72A–UNG2 interaction controls the levels of UNG2 and that class-switch recombination is defective in Fam72a−/− B cells due to the upregulation of UNG2. Moreover, we show that somatic hypermutation is reduced in Fam72a−/− B cells and that its pattern is skewed upon upregulation of UNG2. Our results are consistent with a model in which FAM72A interacts with UNG2 to control its physiological level by triggering its degradation, regulating the level of uracil excision and thus the balance between error-prone and error-free DNA repair. Our findings have potential implications for tumorigenesis, as reduced levels of UNG2 mediated by overexpression of Fam72a would shift the balance towards mutagenic DNA repair, rendering cells more prone to acquire mutations

The Entirely Subcutaneous Implantable Cardioverter-Defibrillator. Initial Clinical Experience in a Large Dutch Cohort

Objectives: The purpose of the study was to evaluate the efficacy and safety of the entirely subcutaneous implantable cardioverter-defibrillator (S-ICD). Background: A new entirely S-ICD has been introduced, that does not require lead placement in or on the heart. The authors report the largest multicenter experience to date with the S-ICD with a minimum of 1-year follow-up in the first 118 Dutch patients who were implanted with this device. Methods: Patients were selected if they had a class I or IIa indication for primary or secondary prevention of sudden cardiac death. All consecutive patients from 4 high-volume centers in the Netherlands with an S-ICD implanted between December 2008 and April 2011 were included. Results: A total of 118 patients (75% males, mean age 50 years) received the S-ICD. After 18 months of follow-up, 8 patients experienced 4

Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS)

International audienceAbstract Asymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting

Randomized trial of alendronate plus vitamin D3 versus standard care in osteoporotic postmenopausal women with vitamin D insufficiency.

Vitamin D insufficiency is common in patients with osteoporosis. We conducted a randomized trial comparing alendronate 70 mg combined with vitamin D(3) 5,600 IU in a single tablet (ALN/D5600, n = 257) with standard care chosen by the patients' personal physicians (n = 258) in patients with postmenopausal osteoporosis (BMD T score /=800 IU/day of supplemental vitamin D. At 6 months the proportion of patients with vitamin D insufficiency was 8.6% in the ALN/D5600 group compared with 31.0% in the standard care group (P < 0.001). Those in the ALN/D5600 group also had a greater reduction in urinary NTX/creatinine ratio (-57% vs. -46%, P < 0.001) and bone-specific alkaline phosphatase (-47% vs. -40%, P < 0.001). In the ALN/5600 group, by 12 months the increase in BMD was greater at the lumbar spine (4.9% vs. 3.9%, P = 0.047) and the total hip (2.2% vs. 1.4%, P = 0.035), significantly fewer patients were vitamin D-insufficient (11.3% vs. 36.9%, P < 0.001), and bone turnover marker (BTM) results were similar to those at 6 months. There was no difference between groups in those who experienced falls or fractures, and adverse events were similar. Based on the finding that ALN/D5600 was more effective than standard care at correcting vitamin D insufficiency, increasing BMD, and reducing BTMs in this patient group, greater attention needs to be directed toward optimizing the treatment of osteoporosis and correcting vitamin D deficiency in postmenopausal women

Odanacatib for the treatment of postmenopausal osteoporosis : Results of the LOFT multicentre, randomised, double-blind, placebo-controlled trial and LOFT Extension study

Background Odanacatib, a cathepsin K inhibitor, reduces bone resorption while maintaining bone formation. Previous work has shown that odanacatib increases bone mineral density in postmenopausal women with low bone mass. We aimed to investigate the efficacy and safety of odanacatib to reduce fracture risk in postmenopausal women with osteoporosis. Methods The Long-term Odanacatib Fracture Trial (LOFT) was a multicentre, randomised, double-blind, placebo-controlled, event-driven study at 388 outpatient clinics in 40 countries. Eligible participants were women aged at least 65 years who were postmenopausal for 5 years or more, with a femoral neck or total hip bone mineral density T-score between −2·5 and −4·0 if no previous radiographic vertebral fracture, or between −1·5 and −4·0 with a previous vertebral fracture. Women with a previous hip fracture, more than one vertebral fracture, or a T-score of less than −4·0 at the total hip or femoral neck were not eligible unless they were unable or unwilling to use approved osteoporosis treatment. Participants were randomly assigned (1:1) to either oral odanacatib (50 mg once per week) or matching placebo. Randomisation was done using an interactive voice recognition system after stratification for previous radiographic vertebral fracture, and treatment was masked to study participants, investigators and their staff, and sponsor personnel. If the study completed before 5 years of double-blind treatment, consenting participants could enrol in a double-blind extension study (LOFT Extension), continuing their original treatment assignment for up to 5 years from randomisation. Primary endpoints were incidence of vertebral fractures as assessed using radiographs collected at baseline, 6 and 12 months, yearly, and at final study visit in participants for whom evaluable radiograph images were available at baseline and at least one other timepoint, and hip and non-vertebral fractures adjudicated as being a result of osteoporosis as assessed by clinical history and radiograph. Safety was assessed in participants who received at least one dose of study drug. The adjudicated cardiovascular safety endpoints were a composite of cardiovascular death, myocardial infarction, or stroke, and new-onset atrial fibrillation or flutter. Individual cardiovascular endpoints and death were also assessed. LOFT and LOFT Extension are registered with ClinicalTrials.gov (number NCT00529373) and the European Clinical Trials Database (EudraCT number 2007-002693-66). Findings Between Sept 14, 2007, and Nov 17, 2009, we randomly assigned 16 071 evaluable patients to treatment: 8043 to odanacatib and 8028 to placebo. After a median follow-up of 36·5 months (IQR 34·43–40·15) 4297 women assigned to odanacatib and 3960 assigned to placebo enrolled in LOFT Extension (total median follow-up 47·6 months, IQR 35·45–60·06). In LOFT, cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 3·7% (251/6770) versus 7·8% (542/6910), hazard ratio (HR) 0·46, 95% CI 0·40–0·53; hip fractures 0·8% (65/8043) versus 1·6% (125/8028), 0·53, 0·39–0·71; non-vertebral fractures 5·1% (412/8043) versus 6·7% (541/8028), 0·77, 0·68–0·87; all p<0·0001. Combined results from LOFT plus LOFT Extension for cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 4·9% (341/6909) versus 9·6% (675/7011), HR 0·48, 95% CI 0·42–0·55; hip fractures 1·1% (86/8043) versus 2·0% (162/8028), 0·52, 0·40–0·67; non-vertebral fractures 6·4% (512/8043) versus 8·4% (675/8028), 0·74, 0·66–0·83; all p<0·0001. In LOFT, the composite cardiovascular endpoint of cardiovascular death, myocardial infarction, or stroke occurred in 273 (3·4%) of 8043 patients in the odanacatib group versus 245 (3·1%) of 8028 in the placebo group (HR 1·12, 95% CI 0·95–1·34; p=0·18). New-onset atrial fibrillation or flutter occurred in 112 (1·4%) of 8043 patients in the odanacatib group versus 96 (1·2%) of 8028 in the placebo group (HR 1·18, 0·90–1·55; p=0·24). Odanacatib was associated with an increased risk of stroke (1·7% [136/8043] vs 1·3% [104/8028], HR 1·32, 1·02–1·70; p=0·034), but not myocardial infarction (0·7% [60/8043] vs 0·9% [74/8028], HR 0·82, 0·58–1·15; p=0·26). The HR for all-cause mortality was 1·13 (5·0% [401/8043] vs 4·4% [356/8028], 0·98–1·30; p=0·10). When data from LOFT Extension were included, the composite of cardiovascular death, myocardial infarction, or stroke occurred in significantly more patients in the odanacatib group than in the placebo group (401 [5·0%] of 8043 vs 343 [4·3%] of 8028, HR 1·17, 1·02–1·36; p=0·029, as did stroke (2·3% [187/8043] vs 1·7% [137/8028], HR 1·37, 1·10–1·71; p=0·0051). Interpretation Odanacatib reduced the risk of fracture, but was associated with an increased risk of cardiovascular events, specifically stroke, in postmenopausal women with osteoporosis. Based on the overall balance between benefit and risk, the study's sponsor decided that they would no longer pursue development of odanacatib for treatment of osteoporosis

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien\u2013Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9\ub72 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4\u20137) and 7 (6\u20138) days respectively (P &lt; 0\ub7001). There were no significant differences in rates of readmission between these groups (6\ub76 versus 8\ub70 per cent; P = 0\ub7499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0\ub790, 95 per cent c.i. 0\ub755 to 1\ub746; P = 0\ub7659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34\ub77 versus 39\ub75 per cent; major 3\ub73 versus 3\ub74 per cent; P = 0\ub7110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients