Identification et caractérisation des cellules tumorales circulantes dans le cancer rénal à cellules claires

La diffusion dans le sang des cellules tumorales circulantes (CTC) à partir de la tumeur primitive est un signe précoce d invasivité tumorale et du risque de développer des métastases. Par conséquent, la capacité à les détecter de façon très sensible et spécifique est censée constituer un test cliniquement important pour le pronostic du cancer, le suivi des patients et la personnalisation de la thérapie. Les CTC sont des cellules rares, et plusieurs méthodes ont été proposées pour leur détection. La technique ISET (Isolation by Size of Epithelial/Tumor cells) se base sur la différence de taille des CTC par rapport aux cellules leucocytaires et a montré une très grande sensibilité d isolement et spécificité d identification des CTC. Elle permet l analyse cytopathologique, immunologique et moléculaire des cellules isolées.Le cancer du rein représente 3% des cancers de l adulte, dans 75% des cas il s agit d un carcinome rénal à cellules claires (RCC). Sur le plan génétique, il est un des rarissimes cancers solides caractérisé par des variations de l ADN, il s agit de mutations au niveau du gène VHL.Ce projet de recherche vise l analyse comparative, moléculaire et cytopathologique, des CTC isolées à partir des patients avec RCC dans le but d évaluer, par une approche moléculaire, les critères cytopathologiques diagnostiques des CTC. Notre étude a porté sur 29 patients ayant bénéficié de l isolement des CTC par ISET avant toute intervention chirurgicale.L analyse cytopathologique a été réalisée utilisant les critères décrits par l équipe de P. Hofman pour définir les CTC (CNHC-MF) et les Cellules Atypiques Circulantes CAC (CNHC-UMF). L analyse génétique par séquençage du gène VHL a été réalisée avec succès sur l ADN de 205 cellules individuelles, sur l ADN issu du tissu tumoral et sur l ADN génomique de chaque patient.Sur les 29 tumeurs étudiées, 25 étaient caractérisées par des mutations du gène VHL. Cent soixante et une cellules, CTC et CAC, isolées à partir du sang de ces 25 patients, ont présenté des variations génétiques du gène VHL identiques à l ADN issu du tissu tumoral. Il s agit de 18 mutations différentes affectant les 3 exons de ce gène. Nous avons trouvé des CTC/CAC dans 29/30 des patients avec CCRC analysés. Des mutations VHL ont été trouvées dans 25 des 29 tumeurs CCRC correspondantes. Nous avons obtenu des résultats spécifiques VHL dans 205 des 327 CTC/CAC microdisséquées, comprenant 64 CTC et 141 CAC, selon l analyse cytopathologique. Les mutations VHL ont été détectées en aveugle dans 57/64 CTC et dans 125/141 CAC. Cependant, nous avons observé que les 8 et 16 CTC et CAC restantes, respectivement, avaient été isolées de patients sans mutations VHL détectables dans le tissu tumoral.Conclusion : Ceci est la première étude comparative de diagnostic génétique et cytopathologique des CTC/CAC chez des patients avec un cancer solide, le CRCC. Nos résultats suggèrent que des critères cytopathologiques élargis pourraient être appliqués au diagnostic des CTC chez les patients avec CCRC. Bien que des études complémentaires et plus élargies soient maintenant nécessaires, cette méthode ouvre la voie à une approche génétique pour le diagnostic des Cellules Tumorales CirculantesDissemination in the circulating tumor cells (CTC) from the primary tumor is an early sign of tumor invasion and risk of metastases. Therefore, the ability to detect CTC through a very sensitive and specific test is expected to be clinically important for cancer prognosis, patient monitoring and customization of therapy. CTCs are rare cells, and several methods have been proposed for their detection. The ISET technique (Isolation by Size of Epithelial /Tumor cells) is based on the difference in size of CTC as compared to leucocytes and provides high sensitivity of CTC isolation and high specificity of CTC identification. This methods also allows cytopathological, immunological and molecular analyses of the isolated cellsKidney cancer accounts for 3% of adult cancers and is a clear cell renal cell carcinoma (RCC) in 75% of cases. RCC is one of very rare cancers characterized by a DNA mutations. IRCC tumor cells are in fact characterized by by mutations in the VHL gene. This research project aims at a comparative molecular and cytopathological analysis of, CTCs isolated from patients with RCC in order to evaluate, through a molecular approach, the diagnostic criteria used for cytopathological identification of CTC. Our study included 29 patients tested by the ISET technique before surgery.The cytopathological analysis was performed using the criteria described by the group of P. Hofman to define CTC (CNHC-MF) and Circulating Atypical Cells "CAC" (UMF-CNHC). Genetic analysis of the VHL gene was successfully performed by sequencing on DNA from 205 individual cells isolated by ISET, on DNA from tumor tissue and on genomic DNA from each patient. Of the 29 tumors studied, 25 were characterized by mutations in the VHL gene. One hundred and sixty-one cells, CTC and CAC, isolated from the blood of the 25 patients, with the tumor having VHL mutation, showed genetic variations in the VHL gene identical to those found in the DNA from the tumor tissue. We found 18 different mutations affecting the three exons of this gene.We found CTC/CAC in 29/30 analyzed patients with CCRC. VHL mutations were found in the tumor of 25 out of the corresponding 29 CCRC tumors. Among 327 microdissected CTC/CAC, we obtained VHL-specific results in 205 including 64 CTC and 141 CAC, according to the cytopathological analysis. VHL mutations were blindly detected in 57/64 CTC and in 125/141 CAC. However, we then observed that the 8 and 16 residual CTC and CAC, respectively, had been isolated from patients without detectable VHL mutations in the tumor tissue. Conclusion: This is the first study comparing genetic and cytopathological diagnosis of CTC/CAC in patients with a solid cancer, CRCC. Our results suggest that broaden cytopathological criteria could be applied to the diagnosis of CTC in patients with CCRC. Although further and larger studies are now needed, this approach opens the way to a genetic approach for the accurate diagnosis of Circulating Tumor Cells.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Exploring the 7p22.1 Chromosome as a Candidate Region for Autism

A high incidence of de novo chromosomal aberrations in a population of persons with autism suggests a causal relationship between certain chromosomal aberrations and the occurrence of autism. A previous study on a Tunisian boy carrying a t(7;16) translocation identified the 7p22.1 as a positional candidate region for autism on chromosome 7. The characterization of the chromosomal breakpoints helped us to identify new candidate regions on chromosome 16p11.2 which contain no known genes and the other one on 7p22.1 containing a portion of genes (NP 976327.1, RBAK, Q6NUR6 also called RNF216L and MMD2). We proposed Q6NUR6 (RNF216L) as a candidate gene for autism due to its vicinity to the translocation breakpoint on the chromosome derivative 7. Q6NUR6 is predicted to be an E3ubiquitin-ligase. Quantitative PCR demonstrates that Q6NUR6 gene has an ubiquitous expression and that it is strongly expressed in fetal and adult brain. The Q6NUR6 expression is increased in the patient blood cells in comparison to controls. This is the first report of Q6NUR6 gene (E3 ubiquitin ligase TRIAD3 EC 6.3.2) increasing blood levels in a patient with autism. It's probably caused by a position effect involving this gene and modifying its expression

De Novo Balanced Translocation t (7;16) (p22.1; p11.2) Associated with Autistic Disorder

The high incidence of de novo chromosomal aberrations in a population of persons with autism suggests a causal relationship between certain chromosomal aberrations and the occurrence of isolated idiopathic autism. We report on the clinical and cytogenetic findings in a male patient with autism, no physical abnormalities and a de novo balanced (7;16)(p22.1;p16.2) translocation. G-banded chromosomes and fluorescent in situ hybridization (FISH) were used to examine the patient's karyotype as well as his parents'. FISH with specific RP11-BAC clones mapping near 7p22.1 and 16p11.2 was used to refine the location of the breakpoints. This is, in the best of our knowledge, the first report of an individual with autism and this specific chromosomal aberration

Absence of mutations in four genes encoding for congenital cataract and expressed in the human brain in Tunisian families with cataract and mental retardation

<p>Abstract</p> <p>Background</p> <p>To identify the genetic defect associated with autosomal recessive congenital cataract (ARCC), mental retardation (MR) and ARCC, MR and microcephaly present in most patients in four Tunisian consanguineous families.</p> <p>Methods</p> <p>We screened four genes implicated in congenital cataract by direct sequencing in two groups of patients; those affected by ARCC associated to MR and those who presented also microcephaly. Among its three genes <it>PAX6</it>, <it>PITX3 </it>and <it>HSF4 </it>are expressed in human brain and one gene <it>LIM2 </it>encodes for the protein MP20 that interact with the protein galectin-3 expressed in human brain and plays a crucial role in its development. All genes were screened by direct sequencing in two groups of patients; those affected by ARCC associated to MR and those who presented also microcephaly.</p> <p>Results</p> <p>We report no mutation in the four genes of congenital cataract and its flanking regions. Only variations that did not segregate with the studied phenotypes (ARCC associated to MR, ARCC associated with MR and microcephaly) are reported. We detected three intronic variations in <it>PAX6 </it>gene: IVS4 -274insG (intron 4), IVS12 -174G>A (intron12) in the four studied families and IVS4 -195G>A (intron 4) in two families. Two substitutions polymorphisms in <it>PITX3 </it>gene: c.439 C>T (exon 3) and c.930 C>A (exon4) in one family. One intronic variation in <it>HSF4 </it>gene: IVS7 +93C>T (intron 7) identified in one family. And three intronic substitutions in <it>LIM2 </it>gene identified in all four studied families: IVS2 -24A>G (intron 2), IVS4 +32C>T (intron 4) and c.*15A>C (3'-downstream sequence).</p> <p>Conclusion</p> <p>Although the role of the four studied genes: <it>PAX6</it>, <it>PITX3</it>, <it>HSF4 </it>and <it>LIM2 </it>in both ocular and central nervous system development, we report the absence of mutations in all studied genes in four families with phenotypes associating cataract, MR and microcephaly.</p

Tolllike receptor 4 (TLR4) polymorphisms in Tunisian patients with Crohn's disease: genotype-phenotype correlation

<p>Abstract</p> <p>Background</p> <p>The immune responses to bacterial products through the pattern recognition receptor (PRR) play a pivotal role in pathogenesis of Crohn's disease. A recent study described an association between CD and some gene coding for bacterial receptor like NOD2/CARD15 gene and TLR4. In this study, we sought to determine whether TLR4 gene was associated with Crohn's disease (CD) among the Tunisian population and its correlation with clinical manifestation of the disease.</p> <p>Methods</p> <p>90 patients with CD and 80 healthy individuals are genotyped for the <it>Asp299Gly </it>and <it>Thr399Ile </it>polymorphisms by restriction fragment length polymorphism analysis.</p> <p>Results</p> <p>The allele and genotype frequency of the TLR4 polymorphisms did not differ between patients and controls. The genotype-phenotype correlation permitted to show that the <it>Thr399Ile </it>polymorphism was associated with early onset disease.</p> <p>Conclusion</p> <p>this study reported the absence of association between CD and TLR4 gene in the Tunisian population, but this gene could play a role in clinical expression of the disease.</p

Coexistence of Behçet’s disease with ankylosing spondylitis and familial Mediterranean fever: a rare occurrence

Behçet's disease (BD) and familial Mediterranean fever (FMF), which are two separate diseases sharing some clinical features, may also coexist in the same patient. Further investigations are needed to understand whether this coexistence is due to either chance or geographical distribution patterns of these diseases or to common etiopathogenetic characteristics. Spondylarthritis as part of the clinical picture in these two diseases has been questioned and probably it is not a prominent characteristic of any of them. We report a 35- year-old Tunisian man who had an association of BD, FMF and Human Leukocyte Antigen (HLA) B27 positive ankylosing spondylitis. Although that spondylarthritis is an infrequent joint involvement of FMF and BD, it must be looked for in case of association of these diseases