The genetic diagnosis of rare endocrine disorders of sex development and maturation : a survey among Endo-ERN centres

Differences of sex development and maturation (SDM) represent a heterogeneous puzzle of rare conditions with a large genetic component whose management and treatment could be improved by an accurate classification of underlying molecular conditions, and next-generation sequencing (NGS) should represent the most appropriate approach. Therefore, we conducted a survey dedicated to the use and potential outcomes of NGS for SDM disorders diagnosis among the 53 health care providers (HCP) of the European Reference Network for rare endocrine conditions. The response rate was 49% with a total of 26 HCPs from 13 countries. All HCPs, except 1, performed NGS investigations for SDM disorders on 6720 patients, 3764 (56%) with differences of sex development (DSD), including 811 unexplained primary ovarian insufficiency, and 2956 (44%) with congenital hypogonadotropic hypogonadism (CHH). The approaches varied from targeted analysis of custom gene panels (range: 11-490 genes) in 81.5% of cases or whole exome sequencing with the extraction of a virtual panel in the remaining cases. These analyses were performed for diagnostic purposes in 21 HCPs, supported by the National Health Systems in 16 cases. The likelihood of finding a variant ranged between 7 and 60%, mainly depending upon the number of analysed genes or criteria used for reporting, most HCPs also reporting variants of uncertain significance. These data illustrate the status of genetic diagnosis of DSD and CHH across Europe. In most countries, these analyses are performed for diagnostic purposes, yielding highly variable results, thus suggesting the need for harmonization and general improvements of NGS approaches.publishersversionPeer reviewe

Développement et caractérisation d’anticorps de camélidés dirigés contre des récepteurs couplés aux protéines G et leur utilisation dans des approches structurales

Les camélidés possèdent une caractéristique immunologique particulière parmi les mammifères. En plus des anticorps conventionnels tétramériques composés de 2 chaînes lourdes et de 2 chaînes légères, on retrouve dans des proportions variant de 25 à 50% des anticorps dépourvus de chaînes légères. Le paratope de ces anticorps est dès lors constitué de la partie variable monomérique des chaînes lourdes. Ce domaine d’environ 15 kDa représente le plus petit fragment capable de lier un antigène et est communément appelé nanobody de par sa petite taille. Les nanobodies possèdent des propriétés uniques considérables comparés aux anticorps conventionnels, comme leur capacité à reconnaître des épitopes cryptiques mais aussi la possibilité de les modifier et les assembler facilement afin d’améliorer leurs propriétés. Ces dernières années, les nanobodies ont connu un intérêt grandissant tant au niveau de la recherche fondamentale qu’au niveau du développement de nouvelles solutions diagnostiques et thérapeutiques. Grâce à leur utilisation, la biologie structurale des RCPGs a connu des avancées significatives avec notamment l’obtention de la structure du récepteur β2-adrénergique dans une conformation active et complexé à une protéine G hétérotrimérique. Les RCPGs représentent la plus grande famille de récepteurs membranaires avec près de 800 récepteurs différents. Ils sont exprimés dans toutes les cellules de l’organisme et répondent à une large variété de ligands, les rendant indispensables dans la régulation de nombreux processus physiologiques. Ce rôle central dans la modulation des fonctions biologiques fait des RCPGs des cibles thérapeutiques de premier choix, comme en atteste le pourcentage élevé (30 à 40%) de médicaments dirigés contre cette classe de récepteurs et actuellement sur le marché. Depuis quelques années maintenant, la biologie structurale des RCPGs a connu un essor sans précédent avec à ce jour, près de 190 structures tridimensionnelles expérimentales résolues. Ces avancées ont permis de mieux comprendre les mécanismes d’action de ces récepteurs ainsi que le mode de liaison de ligands, ouvrant notamment de nouvelles perspectives thérapeutiques par le développement rationnel de nouvelles molécules.Au cours de ce travail, nous nous sommes efforcés de développer des outils et une méthodologie nous permettant de résoudre la structure expérimentale de 2 récepteurs :ChemR23 et VPAC1. Pour cela, nous avons développé et caractérisé des nanobodies dirigés contre ces 2 récepteurs. Nous avons montré que les nanobodies dirigés contre le récepteur ChemR23 possèdent des propriétés antagonistes en inhibant partiellement la libération calcique de cellules CHO surexprimant ChemR23 ainsi que le chimiotactisme de cellules dendritiques induit par la chémérine. Profitant de la modularité offerte par les nanobodies, nous avons conçu un nanobody bivalent, dont les propriétés antagonistes sont significativement améliorées. Concernant le récepteur VPAC1, nous avons identifié que les nanobodies générés reconnaissent un épitope présent au niveau du large domaine amino-terminal et distinct du site orthostérique du peptide VIP. Bien que dépourvu de propriétés fonctionnelles, 2 de ces nanobodies voient leur affinité augmentée en présence d’un agoniste, et diminué en présence d’un agoniste inverse. Enfin, nous montrons qu’ils sont utilisables pour la détection du récepteur endogène présent à la surface de leucocytes mais également au niveau de coupes de tissus gastro-intestinaux sains.En parallèle, nous avons mis au point la production de ces récepteurs dans des cellules d’insecte, permettant de produire les quantités nécessaires à des études structurales. Nous avons également apporté et validé diverses modifications à la structure de ces récepteurs, en vue d’augmenter leur stabilité une fois extraits de leur environnement natif. Un processus itératif nous a permis de déterminer les conditions optimales de solubilisation de ces récepteurs afin de maximiser l’obtention d’une forme monomérique et de minimiser la présence de formes multimériques ou dégradées. Nos premiers essais de purification par chromatographie d’affinité sur colonnes de nickel, ainsi que par chromatographie d’exclusion de taille, nous ont permis d’isoler des récepteurs entiers. Cependant, les chromatogrammes issus des purifications par chromatographie d’exclusion de taille suggèrent la présence de récepteurs en partie agrégés. De plus, nous n’avons pu déterminer précisément à ce jour si les récepteurs purifiés maintenaient une conformation native, prérequis indispensable pour réaliser des études cristallographiques.Bien que nous n’ayons pas résolu la structure expérimentale de ces 2 récepteurs, le travail réalisé dans le cadre de notre thèse de doctorat a permis de développer des nanobodies qui représentent des outils innovants pour l’études des RCPGs ainsi que de mettre au point des protocoles de production et de purification préliminaire des récepteurs ChemR23 et VPAC1 en vue de leur étude cristallographique.Doctorat en Sciences biomédicales et pharmaceutiques (Médecine)info:eu-repo/semantics/nonPublishe

Development by genetic immunization of monovalent antibodies against human vasoactive intestinal peptide receptor 1 (VPAC1), new innovative, and versatile tools to study VPAC1 receptor function

Multi-membrane spanning proteins, such as G protein-coupled receptors (GPCRs) and ion channels, are extremely difficult to purify as native proteins. Consequently, the generation of antibodies that recognize the native conformation can be challenging. By combining genetic immunization, phage display, and biopanning, we identified a panel of monovalent antibodies (nanobodies) targeting the vasoactive intestinal peptide receptor 1 (VPAC1) receptor. The nine unique nanobodies that were classified into four different families based on their CDR3 amino acid sequence and length, were highly specific for the human receptor and bind VPAC1 with moderate affinity. They all recognize a similar epitope localized in the extracellular N-terminal domain of the receptor and distinct from the orthosteric binding site. In agreement with binding studies, which showed that the nanobodies did not interfere with VIP binding, all nanobodies were devoid of any functional properties. However, we observed that the binding of two nanobodies was slightly increased in the presence of VPAC1 agonists [vasoactive intestinal polypeptide (VIP) and pituitary adenylate cyclase-activating polypeptide-27 (PACAP-27)], but decreased in the presence of VPAC1 antagonist. As no evidence of allosteric activity was seen in VIP binding studies nor in functional assays, it is, therefore, possible that the two nanobodies may behave as very weak allosteric modulators of VPAC1, detectable only in some sensitive settings, but not in others. We demonstrated that the fluorescently labeled nanobodies detect VPAC1 on the surface of human leukocytes as efficiently as a reference mouse monoclonal antibody. We also developed a protocol allowing efficient detection of VPAC1 by immunohistochemistry in paraffin-embedded human gastrointestinal tissue sections. Thus, these nanobodies constitute new original tools to further investigate the role of VPAC1 in physiological and pathological conditions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Development by genetic immunization of monovalent antibodies (nanobodies) behaving as antagonists of the human ChemR23 receptor

The generation of Abs that recognize the native conformation of G protein-coupled receptors can be a challenging task because, like most multimembrane-spanning proteins, they are extremely difficult to purify as native protein. By combining genetic immunization, phage display, and biopanning, we identified two functional monovalent Abs (nanobodies) targeting ChemR23. The two nanobodies (CA4910 and CA5183) were highly specific for the human receptor and bind ChemR23 with moderate affinity. Binding studies also showed that they share a common binding site that overlaps with that of chemerin, the natural ligand of ChemR23. Consistent with these results, we found that the nanobodies were able to antagonize chemerin-induced intracellular calcium increase. The inhibition was partial when chemerin was used as agonist and complete when the chemerin(149-157) nonapeptide was used as agonist. Engineering of a bivalent CA4910 nanobody resulted in a relatively modest increase in affinity but a marked enhancement of efficacy as an antagonist of chemerin induced intracellular calcium mobilization and a much higher potency against the chemerin(149-157) nonapeptide-induced response. We also demonstrated that the fluorescently labeled nanobodies detect ChemR23 on the surface of human primary cell populations as efficiently as a reference mouse mAb and that the bivalent CA4910 nanobody behaves as an efficient antagonist of chemerin-induced chemotaxis of human primary cells. Thus, these nanobodies constitute new tools to study the role of the chemerin/ChemR23 system in physiological and pathological conditions.status: publishe

Case Report of an Unusual Tumor in an Adult With a TP53 Germline Mutation.

info:eu-repo/semantics/publishe

Heterogeneous colonic content: A prenatal sonographic manifestation of lysinuric protein intolerance

We report a fetus with heterogeneous colonic content, an isolated sonographic prenatal sign of lysinuric protein intolerance, a very rare metabolic disease. Familial genetic enquiries confirmed heterozygote mutation in the implicated gene in parents. The prenatal diagnosis led to neonatal dietary adaptation and avoided acute complications.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Development by Genetic Immunization of Monovalent Antibodies (Nanobodies) Behaving as Antagonists of the Human ChemR23 Receptor.

The generation of Abs that recognize the native conformation of G protein-coupled receptors can be a challenging task because, like most multimembrane-spanning proteins, they are extremely difficult to purify as native protein. By combining genetic immunization, phage display, and biopanning, we identified two functional monovalent Abs (nanobodies) targeting ChemR23. The two nanobodies (CA4910 and CA5183) were highly specific for the human receptor and bind ChemR23 with moderate affinity. Binding studies also showed that they share a common binding site that overlaps with that of chemerin, the natural ligand of ChemR23. Consistent with these results, we found that the nanobodies were able to antagonize chemerin-induced intracellular calcium increase. The inhibition was partial when chemerin was used as agonist and complete when the chemerin(149-157) nonapeptide was used as agonist. Engineering of a bivalent CA4910 nanobody resulted in a relatively modest increase in affinity but a marked enhancement of efficacy as an antagonist of chemerin induced intracellular calcium mobilization and a much higher potency against the chemerin(149-157) nonapeptide-induced response. We also demonstrated that the fluorescently labeled nanobodies detect ChemR23 on the surface of human primary cell populations as efficiently as a reference mouse mAb and that the bivalent CA4910 nanobody behaves as an efficient antagonist of chemerin-induced chemotaxis of human primary cells. Thus, these nanobodies constitute new tools to study the role of the chemerin/ChemR23 system in physiological and pathological conditions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Development by Genetic Immunization of Monovalent Antibodies Against Human Vasoactive Intestinal Peptide Receptor 1 (VPAC1), New Innovative, and Versatile Tools to Study VPAC1 Receptor Function

Multi-membrane spanning proteins, such as G protein-coupled receptors (GPCRs) and ion channels, are extremely difficult to purify as native proteins. Consequently, the generation of antibodies that recognize the native conformation can be challenging. By combining genetic immunization, phage display, and biopanning, we identified a panel of monovalent antibodies (nanobodies) targeting the vasoactive intestinal peptide receptor 1 (VPAC1) receptor. The nine unique nanobodies that were classified into four different families based on their CDR3 amino acid sequence and length, were highly specific for the human receptor and bind VPAC1 with moderate affinity. They all recognize a similar epitope localized in the extracellular N-terminal domain of the receptor and distinct from the orthosteric binding site. In agreement with binding studies, which showed that the nanobodies did not interfere with VIP binding, all nanobodies were devoid of any functional properties. However, we observed that the binding of two nanobodies was slightly increased in the presence of VPAC1 agonists [vasoactive intestinal polypeptide (VIP) and pituitary adenylate cyclase-activating polypeptide-27 (PACAP-27)], but decreased in the presence of VPAC1 antagonist. As no evidence of allosteric activity was seen in VIP binding studies nor in functional assays, it is, therefore, possible that the two nanobodies may behave as very weak allosteric modulators of VPAC1, detectable only in some sensitive settings, but not in others. We demonstrated that the fluorescently labeled nanobodies detect VPAC1 on the surface of human leukocytes as efficiently as a reference mouse monoclonal antibody. We also developed a protocol allowing efficient detection of VPAC1 by immunohistochemistry in paraffin-embedded human gastrointestinal tissue sections. Thus, these nanobodies constitute new original tools to further investigate the role of VPAC1 in physiological and pathological conditions

The genetic diagnosis of rare endocrine disorders of sex development and maturation: a survey among Endo-ERN centres

Differences of sex development and maturation (SDM) represent a heterogeneous puzzle of rare conditions with a large genetic component whose management and treatment could be improved by an accurate classification of underlying molecular conditions, and next-generation sequencing (NGS) should represent the most appropriate approach. Therefore, we conducted a survey dedicated to the use and potential outcomes of NGS for SDM disorders diagnosis among the 53 health care providers (HCP) of the European Reference Network for rare endocrine conditions. The response rate was 49% with a total of 26 HCPs from 13 countries. All HCPs, except 1, performed NGS investigations for SDM disorders on 6720 patients, 3764 (56%) with differences of sex development (DSD), including 811 unexplained primary ovarian insufficiency, and 2956 (44%) with congenital hypogonadotropic hypogonadism (CHH). The approaches varied from targeted analysis of custom gene panels (range: 11–490 genes) in 81.5% of cases or whole exome sequencing with the extraction of a virtual panel in the remaining cases. These analyses were performed for diagnostic purposes in 21 HCPs, supported by the National Health Systems in 16 cases. The likelihood of finding a variant ranged between 7 and 60%, mainly depending upon the number of analysed genes or criteria used for reporting, most HCPs also reporting variants of uncertain significance. These data illustrate the status of genetic diagnosis of DSD and CHH across Europe. In most countries, these analyses are performed for diagnostic purposes, yielding highly variable results, thus suggesting the need for harmonization and general improvements of NGS approaches