Rare and common epilepsies converge on a shared gene regulatory network providing opportunities for novel antiepileptic drug discovery

Background The relationship between monogenic and polygenic forms of epilepsy is poorly understood, and the extent to which the genetic and acquired epilepsies share common pathways is unclear. Here, we use an integrated systems-level analysis of brain gene expression data to identify molecular networks disrupted in epilepsy. Results We identify a co-expression network of 320 genes (M30), which is significantly enriched for non-synonymous de novo mutations ascertained from patients with monogenic epilepsy, and for common variants associated with polygenic epilepsy. The genes in M30 network are expressed widely in the human brain under tight developmental control, and encode physically interacting proteins involved in synaptic processes. The most highly connected proteins within M30 network are preferentially disrupted by deleterious de novo mutations for monogenic epilepsy, in line with the centrality-lethality hypothesis. Analysis of M30 expression revealed consistent down-regulation in the epileptic brain in heterogeneous forms of epilepsy including human temporal lobe epilepsy, a mouse model of acquired temporal lobe epilepsy, and a mouse model of monogenic Dravet (SCN1A) disease. These results suggest functional disruption of M30 via gene mutation or altered expression as a convergent mechanism regulating susceptibility to epilepsy broadly. Using the large collection of drug-induced gene expression data from Connectivity Map, several drugs were predicted to preferentially restore the down-regulation of M30 in epilepsy toward health, most notably valproic acid, whose effect on M30 expression was replicated in neurons. Conclusions Taken together, our results suggest targeting the expression of M30 as a potential new therapeutic strategy in epilepsy

Delayed-Onset Hemolytic Anemia in Patients with Travel-Associated Severe Malaria Treated with Artesunate, France, 2011–2013

French Artesunate Working GroupInternational audienceArtesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate

Systems genetics identifies a convergent gene network for cognition and neurodevelopmental disease

Genetic determinants of cognition are poorly characterized, and their relationship to genes that confer risk for neurodevelopmental disease is unclear. Here we performed a systems-level analysis of genome-wide gene expression data to infer gene-regulatory networks conserved across species and brain regions. Two of these networks, M1 and M3, showed replicable enrichment for common genetic variants underlying healthy human cognitive abilities, including memory. Using exome sequence data from 6,871 trios, we found that M3 genes were also enriched for mutations ascertained from patients with neurodevelopmental disease generally, and intellectual disability and epileptic encephalopathy in particular. M3 consists of 150 genes whose expression is tightly developmentally regulated, but which are collectively poorly annotated for known functional pathways. These results illustrate how systems-level analyses can reveal previously unappreciated relationships between neurodevelopmental disease–associated genes in the developed human brain, and provide empirical support for a convergent gene-regulatory network influencing cognition and neurodevelopmental disease

A Solve-RD ClinVar-based reanalysis of 1522 index cases from ERN-ITHACA reveals common pitfalls and misinterpretations in exome sequencing

Purpose Within the Solve-RD project (https://solve-rd.eu/), the European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies aimed to investigate whether a reanalysis of exomes from unsolved cases based on ClinVar annotations could establish additional diagnoses. We present the results of the “ClinVar low-hanging fruit” reanalysis, reasons for the failure of previous analyses, and lessons learned. Methods Data from the first 3576 exomes (1522 probands and 2054 relatives) collected from European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies was reanalyzed by the Solve-RD consortium by evaluating for the presence of single-nucleotide variant, and small insertions and deletions already reported as (likely) pathogenic in ClinVar. Variants were filtered according to frequency, genotype, and mode of inheritance and reinterpreted. Results We identified causal variants in 59 cases (3.9%), 50 of them also raised by other approaches and 9 leading to new diagnoses, highlighting interpretation challenges: variants in genes not known to be involved in human disease at the time of the first analysis, misleading genotypes, or variants undetected by local pipelines (variants in off-target regions, low quality filters, low allelic balance, or high frequency). Conclusion The “ClinVar low-hanging fruit” analysis represents an effective, fast, and easy approach to recover causal variants from exome sequencing data, herewith contributing to the reduction of the diagnostic deadlock

Caractérisation des cellules dendritiques plasmacytoïdes dans le sang de cordon ombilical

Les cellules dendritiques plasmacytoïdes (pDCs) sont considérées comme quantitativement et qualitativement supérieures aux autres types cellulaires pour la synthèse des interférons (IFNs) de type I lors d’une infection virale. Plusieurs observations viennent supporter cette désignation. Tout d’abord, elles expriment un éventail très large des sous-types d’IFN-alpha en comparaison aux autres types cellulaires. Par ailleurs, elles possèdent la capacité de détecter la présence des virus via leurs TLR7 et TLR9, reconnaissant respectivement l’ARN ou l’ADN d’origine virale. Enfin, elles expriment de manière constitutive dans leur cytoplasme le facteur de transcription IRF-7 qui permet une synthèse rapide et robuste des IFNs de type I en réponse à l’infection. Dans un précédent travail, il a été montré que les pDCs néonatales présentent un défaut majeur de synthèse d’IFN-alpha en réponse aux CpG ODNs, ligands du TLR9. Nous avons ensuite étendu notre étude des pDCs néonatales en les stimulant avec le R-848, ligand du TLR7, mais également en présence de virus tels que HCMV et HSV. Dans ces conditions également, la synthèse de l’IFN-alpha est déficiente dans les pDCs du nouveau-né. Nous avons également observé une déficience de production de l’IFN-beta suite à une stimulation via les ligands TLR7 et TLR9, tant au niveau protéique que de l’expression de l’ARN messager. Par ailleurs, la synthèse des cytokines/chimiokines inflammatoires par les pDCs du sang de cordon ainsi que leur maturation, fonctions dépendantes du facteur NF-kappaB, sont également diminuées en comparaison aux pDCs adultes, suite à une stimulation en présence du CpG ODN ou du R-848.L’ensemble de ces données nous a amené à étudier de manière plus précise les voies de signalisation des pDCs néonatales suite à leur activation. Tout d’abord, nous avons observé que les taux d’expression des TLR7 et 9 tout comme le taux basal d’IRF-7 sont équivalents dans les pDCs néonatales et les pDCs adultes. Ensuite, grâce à la technique d’ImageStream (Amnis corporation), nous avons pu quantifier la translocation nucléaire des facteurs de transcription IRF-7 et de NF-kappaB dans les pDCs activées. Nous avons ainsi pu observer que la translocation de NF-kappaB est comparable dans les pDCs adultes et néonatales en réponse aux ligands TLR7 ou TLR9. Par contre, elle est déficiente lors d’une stimulation par HSV. La translocation du facteur IRF-7, quant à elle, est significativement déficiente en réponse au CpG ODN et au virus HSV dans les pDCs néonatales. Nous proposons que le défaut de translocation d’IRF-7 mis en évidence dans les pDCs néonatales pourrait en partie expliquer la déficience de synthèse des IFNs de type I de ces cellules et fournir une base moléculaire à la plus grande susceptibilité du nouveau-né vis-à-vis des infections virales.Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

Interferon regulatory factor 7-mediated responses are defective in cord blood plasmacytoid dendritic cells.

Plasmacytoid dendritic cells (pDC) are specialized in massive production of type I interferons (IFN) upon viral infections. Activation of IFN regulatory factor (IRF)-7 is critically required for the synthesis of type I IFN in pDC. IRF-7 is highly expressed by resting pDC and translocates into the nucleus to initiate type I IFN transcription. In a previous work, we observed an impaired IFN-alpha production in enriched cord blood pDC following a TLR9 stimulation using CpG oligonucleotides. Herein, we show that highly purified pDC from cord blood exhibit a profound defect in their capacity to produce IFN-alpha/beta in response to TLR9 as well as to TLR7 ligation or human CMV or HSV-1 exposure. Microarray experiments indicate that expression of the majority of type I IFN subtypes induced by a TLR7 agonist is reduced in cord blood pDC. We next demonstrated a reduced nuclear translocation of IRF-7 in cord blood pDC following CpG and HSV stimulation as compared to adult pDC. We conclude that impaired IRF-7 translocation in cord blood pDC is associated with defective expression of type I IFN genes. Our data provide a molecular understanding for the decreased ability of cord blood pDC to produce type I IFN upon viral stimulation.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tFLWINinfo:eu-repo/semantics/publishe

Relationship between serotypes, disease characteristics and 30-day mortality in adults with invasive pneumococcal disease

International audienc