Évolution intra-hôte de Vibrio cholerae et interactions avec le microbiome intestinal

Le choléra est une infection diarrhéique aiguë qui représente encore aujourd’hui un grave problème de santé publique dans les pays où l’accès à l’eau potable et un système d’assainissement adéquat ne peut pas être garanti. Vibrio cholerae, le pathogène bactérien responsable de cette maladie, peut provoquer toute une série de symptômes chez les individus infectés, allant d’une diarrhée intense conduisant à une déshydratation sévère, au portage asymptomatique de la bactérie. Bien que notre compréhension du choléra à une échelle macro-épidémiologique a considérablement été améliorée par le développement des techniques de séquençage à haut débit et par les avancées dans le domaine de la génomique bactérienne, aucune étude n’a encore été menée pour caractériser son évolution à l’échelle des individus infectés. De plus, le rôle des porteurs asymptomatiques au sein d’une épidémie et la raison derrière l’absence de symptômes chez ces individus infectés sont encore méconnus. L’objectif principal de cette thèse est donc de (1) caractériser la diversité génomique de V. cholerae au niveau des individus et des cercles familiaux, mais aussi (2) d’évaluer le rôle potentiel du microbiome intestinal dans la susceptibilité de contracter cette maladie entérique aiguë et de présenter des symptômes sévères. Dans un premier temps, nous caractérisons la diversité génomique de colonies isolées à partir de patients symptomatiques. Le séquençage de génomes entiers de souches provenant de patients du Bangladesh et d’Haïti révèle que cette diversité sous la forme de mutations ponctuelles reste limitée, mais détectable au sein des hôtes. Une grande partie de la variation du contenu génétique semble être surtout due au gain et à la perte de phages et de plasmides au sein de la population de V. cholerae, avec des échanges occasionnels entre le pathogène et d’autres membres commensaux du microbiote intestinal. Cela contredit l’hypothèse couramment acceptée que les infections par V. cholerae sont majoritairement clonales, et confirme que le transfert horizontal de gènes est un facteur important dans l’évolution de V. cholerae. De plus, nos résultats montrent que certains de ces variants peuvent avoir un effet phénotypique, impactant par exemple la formation de biofilms, et peuvent être sélectionnés au sein des individus infectés. Par la suite, nous appliquons une association de méthodes de séquençage de génomes entiers et de méthodes métagénomiques afin d’améliorer la détection des variants intra-hôte, à la fois chez des patients symptomatiques, mais aussi chez des porteurs asymptomatiques. Notre étude montre que l’approche métagénomique offre une meilleure résolution dans la détection de la diversité dans la population microbienne, mais reste difficile à appliquer chez des patients asymptomatiques, en raison du faible nombre de cellules de V. cholerae chez ces patients. Dans l’ensemble, nous constatons que le niveau de diversité au sein de la population bactérienne intra-hôte est similaire entre les patients symptomatiques et asymptomatiques. Nous détectons aussi la présence de souches hypermutantes chez certains patients. De plus, alors que les mutations chez les patients porteurs de phénotypes d’hypermutations ne semblent pas sous l’effet de la sélection, des signes d'évolution parallèle sont détectés chez les patients présentant un plus faible nombre de mutations, suggérant des mécanismes d’adaptation au sein de l’hôte. Nos résultats soulignent la puissance de la métagénomique combinée au séquençage de génomes entiers pour caractériser la diversité intra-hôte dans le cas d’une infection aiguë du choléra, mais aussi dans le cas de portage asymptomatique, tout en identifiant pour la première fois le phénotype d’hypermutation chez des patients infectés. Finalement, nous nous intéressons aux facteurs liés à la susceptibilité à la maladie et à la sévérité des symptômes. Basée sur une étude récente utilisant le séquençage 16S pour montrer le lien potentiel entre le microbiome intestinal et la susceptibilité à l’infection par V. cholerae, nos analyses utilisent les méthodes de séquençage métagénomique sur les mêmes échantillons de cette précédente étude afin de caractériser les profils taxonomiques et fonctionnels du microbiome intestinal de contacts familiaux exposés à V. cholerae. Les échantillons sont prélevés avant l’infection de ces contacts familiaux et l’apparition ou non de symptômes, et sont analysés pour identifier des prédicteurs à la maladie symptomatique. Grâce à un algorithme d’apprentissage machine, nous pouvons identifier des espèces, des familles de gènes et des voies métaboliques du microbiome au moment de l'exposition à V. cholerae pour détecter des biomarqueurs potentiels corrélés avec les risques d'infection et la gravité des symptômes. Nos résultats montrent que l’utilisation du séquençage métagénomique améliore la précision et l’exactitude des prévisions par rapport au séquençage 16S. Nos analyses permettent aussi de prédire la gravité de la maladie, bien qu’avec une plus grande incertitude que la prédiction de l’infection. Des taxons bactériens des genres Prevotella et Bifidobacterium ont été identifiées comme des marqueurs potentiels de protection contre l’infection, tout comme gènes impliqués dans le métabolisme du fer. Nos résultats soulignent le pouvoir de la métagénomique pour prédire l’évolution des maladies et identifient des espèces et des gènes spécifiques pouvant être impliqués dans des tests expérimentaux afin d’étudier les mécanismes liés au microbiome intestinal expliquant la potentielle protection contre le choléra.Cholera is an acute diarrhoeal disease that remains a global threat to public health in countries where access to safe water and adequate sanitation cannot be guaranteed. Vibrio cholerae, the bacterial pathogen responsible for this disease, can cause a range of symptoms in infected individuals, from intense diarrhea leading to severe dehydration, to asymptomatic carriage of the bacteria. Although our understanding of cholera on a macro-epidemiological scale has been considerably improved by the development of high-throughput sequencing techniques and by advances in bacterial genomics, no studies have yet been conducted to characterize its evolution at the scale of infected individuals. Furthermore, the role of asymptomatic carriers in an epidemic and the reason behind the absence of symptoms in these infected individuals remains unknown. The main objective of this thesis is therefore to characterize the genomic diversity of V. cholerae at the level of individuals and households, but also to evaluate the potential role of the gut microbiome in the susceptibility to contract this acute enteric disease and to present severe symptoms. First, we characterize the genomic diversity of colonies isolated from symptomatic patients. The whole genome sequencing of strains from patients in Bangladesh and Haiti reveals that this diversity is detectable in the form of point mutations within hosts, but remains limited. Much of the variation detected within patients appears to be due to the gain and loss of phages and plasmids within the V. cholerae population, with occasional exchanges between the pathogen and other commensal members of the gut microbiota. These results challenge the commonly accepted assumption that V. cholerae infections are predominantly clonal, and confirm that horizontal gene transfer is an important factor in the evolution of V. cholerae. In addition, our results show that some of these variants may also have a phenotypic effect, for example by impacting biofilm formation, and can be selected within infected individuals. Next, we apply a combination of whole genome sequencing and metagenomic approaches to improve the detection of intra-host variants, both in symptomatic patients and in asymptomatic carriers. Our study shows that the metagenomic approach offers a better resolution in the detection of the diversity in the microbial population, but remains difficult to apply in asymptomatic patients, due to the low number of V. cholerae cells in these individuals. Overall, we find that the level of diversity within the intra-host bacterial population is similar between symptomatic and asymptomatic patients. We also detect the presence of hypermutator strains in some patients. In addition, while mutations in patients with hypermutator phenotypes did not appear to be driven by selection, signs of parallel evolution are detected in patients with fewer mutations, suggesting adaptive mechanisms within the host. Our results underline the power of metagenomics combined with whole genome sequencing to characterize intra-host diversity in acute cholera infection, but also in asymptomatic carriers, while identifying for the first time an hypermutator phenotype in infected patients. Finally, we are interested in factors related to susceptibility to the disease and related to the severity of symptoms. Based on a recent study using 16S rRNA amplicon sequencing to show the potential link between the intestinal microbiome and susceptibility to V. cholerae infection, our study uses metagenomic sequencing methods on the same samples from this previous study to characterize the taxonomic and functional profiles of the gut microbiome of household contacts exposed to V. cholerae. Samples are collected prior to infection of these household contacts, and used to identify predictors of symptomatic disease. Using a machine learning algorithm, we can identify species, gene families and metabolic pathways in the microbiome at the time of exposure to V. cholerae to detect potential biomarkers correlated with risk of infection and symptom severity. Our results show that the use of metagenomic sequencing improves the precision and accuracy of predictions compared to 16S rRNA amplicon sequencing. Our analyses also predict disease severity, although with greater uncertainty than the prediction of infection. Bacterial taxa from the genera Prevotella and Bifidobacterium have been identified as potential markers of protection against infection, as well as genes involved in iron metabolism. Our results highlight the power of metagenomics to predict disease progression and identify specific species and genes that could be involved in experimental tests to study the mechanisms related to the microbiome explaining potential protection against cholera

Vibrio cholerae genomic diversity within and between patients

Cholera is a severe, water-borne diarrhoeal disease caused by toxin-producing strains of the bacterium Vibrio cholerae. Comparative genomics has revealed ‘waves’ of cholera transmission and evolution, in which clones are successively replaced over decades and centuries. However, the extent of V. cholerae genetic diversity within an epidemic or even within an individual patient is poorly understood. Here, we characterized V. cholerae genomic diversity at a micro-epidemiological level within and between individual patients from Bangladesh and Haiti. To capture within-patient diversity, we isolated multiple (8 to 20) V. cholerae colonies from each of eight patients, sequenced their genomes and identified point mutations and gene gain/loss events. We found limited but detectable diversity at the level of point mutations within hosts (zero to three single nucleotide variants within each patient), and comparatively higher gene content variation within hosts (at least one gain/loss event per patient, and up to 103 events in one patient). Much of the gene content variation appeared to be due to gain and loss of phage and plasmids within the V. cholerae population, with occasional exchanges between V. cholerae and other members of the gut microbiota. We also show that certain intra-host variants have phenotypic consequences. For example, the acquisition of a Bacteroides plasmid and non-synonymous mutations in a sensor histidine kinase gene both reduced biofilm formation, an important trait for environmental survival. Together, our results show that V. cholerae is measurably evolving within patients, with possible implications for disease outcomes and transmission dynamics

Origins Of Pandemic Vibrio Cholerae From Environmental Gene Pools

Some microorganisms can transition from an environmental lifestyle to a pathogenic one1-3. This ecological switch typically occurs through the acquisition of horizontally acquired virulence genes4,5. However, the genomic features that must be present in a population before the acquisition of virulence genes and emergence of pathogenic clones remain unknown. We hypothesized that virulence adaptive polymorphisms (VAPs) circulate in environmental populations and are required for this transition. We developed a comparative genomic framework for identifying VAPs, using Vibrio cholerae as a model. We then characterized several environmental VAP alleles to show that while some of them reduced the ability of clinical strains to colonize a mammalian host, other alleles conferred efficient host colonization. These results show that VAPs are present in environmental bacterial populations before the emergence of virulent clones. We propose a scenario in which VAPs circulate in the environment and become selected and enriched under certain ecological conditions, and finally a genomic background containing several VAPs acquires virulence factors that allow for its emergence as a pathogenic clone

A Recent SARS-CoV-2 Infection Enhances Antibody-Dependent Cellular Cytotoxicity against Several Omicron Subvariants following a Fourth mRNA Vaccine Dose

Since the beginning of the SARS-CoV-2 pandemic, several variants of concern (VOCs), such as the Alpha, Beta, Gamma, Delta and Omicron variants, have arisen and spread worldwide. Today, the predominant circulating subvariants are sublineages of the Omicron variant, which have more than 30 mutations in their Spike glycoprotein compared to the ancestral strain. The Omicron subvariants were significantly less recognized and neutralized by antibodies from vaccinated individuals. This resulted in a surge in the number of infections, and booster shots were recommended to improve responses against these variants. While most studies mainly measured the neutralizing activity against variants, we and others previously reported that Fc-effector functions, including antibody-dependent cellular cytotoxicity (ADCC), play an important role in humoral responses against SARS-CoV-2. In this study, we analyzed Spike recognition and ADCC activity against several Omicron subvariants by generating cell lines expressing different Omicron subvariant Spikes. We tested these responses in a cohort of donors, who were recently infected or not, before and after a fourth dose of mRNA vaccine. We showed that ADCC activity is less affected than neutralization by the antigenic shift of the tested Omicron subvariant Spikes. Moreover, we found that individuals with a history of recent infection have higher antibody binding and ADCC activity against all Omicron subvariants than people who were not recently infected. With an increase in the number of reinfections, this study helps better understand Fc-effector responses in the context of hybrid immunity

Temperature Influences the Interaction between SARS-CoV-2 Spike from Omicron Subvariants and Human ACE2

SARS-CoV-2 continues to infect millions of people worldwide. The subvariants arising from the variant-of-concern (VOC) Omicron include BA.1, BA.1.1, BA.2, BA.2.12.1, BA.4, and BA.5. All possess multiple mutations in their Spike glycoprotein, notably in its immunogenic receptor-binding domain (RBD), and present enhanced viral transmission. The highly mutated Spike glycoproteins from these subvariants present different degrees of resistance to recognition and cross-neutralisation by plasma from previously infected and/or vaccinated individuals. We have recently shown that the temperature affects the interaction between the Spike and its receptor, the angiotensin converting enzyme 2 (ACE2). The affinity of RBD for ACE2 is significantly increased at lower temperatures. However, whether this is also observed with the Spike of Omicron and sub-lineages is not known. Here we show that, similar to other variants, Spikes from Omicron sub-lineages bind better the ACE2 receptor at lower temperatures. Whether this translates into enhanced transmission during the fall and winter seasons remains to be determined

Humoral Responses against BQ.1.1 Elicited after Breakthrough Infection and SARS-CoV-2 mRNA Vaccination

The Omicron BQ.1.1 variant is now the major SARS-CoV-2 circulating strain in many countries. Because of the many mutations present in its Spike glycoprotein, this variant is resistant to humoral responses elicited by monovalent mRNA vaccines. With the goal to improve immune responses against Omicron subvariants, bivalent mRNA vaccines have recently been approved in several countries. In this study, we measure the capacity of plasma from vaccinated individuals, before and after a fourth dose of mono- or bivalent mRNA vaccine, to recognize and neutralize the ancestral (D614G) and the BQ.1.1 Spikes. Before and after the fourth dose, we observe a significantly better recognition and neutralization of the ancestral Spike. We also observe that fourth-dose vaccinated individuals who have been recently infected better recognize and neutralize the BQ.1.1 Spike, independently of the mRNA vaccine used, than donors who have never been infected or have an older infection. Our study supports that hybrid immunity, generated by vaccination and a recent infection, induces higher humoral responses than vaccination alone, independently of the mRNA vaccine used

Humoral Responses Elicited after a Fifth Dose of SARS-CoV-2 mRNA Bivalent Vaccine

While an important part of the world’s population is vaccinated against SARS-CoV-2, new variants continue to emerge. We observe that even after a fifth dose of the mRNA bivalent vaccine, most vaccinated individuals have antibodies that poorly neutralize several Omicron subvariants, including BQ.1.1, XBB, XBB.1.5, FD.1.1, and CH.1.1. However, Fc-effector functions remain strong and stable over time against new variants, which may partially explain why vaccines continue to be effective. We also observe that donors who have been recently infected have stronger antibody functional activities, including neutralization and Fc-effector functions, supporting the observations that hybrid immunity leads to better humoral responses