LPIN1 - étude génétique d'une nouvelle cause de rhabdomyolyse héréditaire et analyses physiopathologiques à partir de myoblastes de patients

Abstract : Rhabdomyolyses correspond to the destruction of skeletal muscular fibers and are possibly life-threatening. The main genetic cause is linked to defects of fatty acid oxidation (FAO) ; nevertheless, half of the cases have no identified aetiology. In 2008, mutations of LPIN1 gene have been reported as a new cause of autosomal recessive rhabdomyolysis. Lipin1 protein has a double function : 1) a role of phosphatidate phosphatase 1 (PAP1) involved in synthesis of triacylglycerol and membrane phospholipids ; 2) a role of transcriptional co-activator which regulates, in association with the PPARs (peroxysome-proliferator activated receptor) and PGC1α (PPARγ-coactivator1α), numerous genes involved in the metabolism including some genes encoding FAO enzymes. Lipin1 has got two homologues, lipin2 and lipin3, which have a PAP1 activity and a binding site for nuclear receptors, such as the PPARs. We have shown that LPIN1 mutations account for more than 50% of the cases of severe rhabdomyolysis of early infancy, when FAO defects have been excluded. An intragenic in frame deletion has been frequently identified in Caucasians. We have shown that it probably comes from a founding effect and that this deletion is deleterious. Unlike normal lipin1, deleted lipin1 protein is unable to complement the Δpah1 yeast which is defective for the yeast LPIN1 homolog. In a series of 171 patients, we have further studied the involvement LPIN1 in less severe muscular diseases, as well as the role of the two homologues LPIN2 and LPIN3. LPIN1 mutations are involved only in severe and early rhabdomyolyses and the bouts of rhabdomyolysis always have a triggerring factor, mainly acute febrile infections. No major alteration of LPIN2 and LPIN3 has been identified, even in milder phenotypes. Eventually, we have cultivated myoblasts and myotubes of patients with LPIN1 mutations in order to study the mechanisms of the rhabdomyolysis. Lipin1-deficient myoblasts have a drastically decreased PAP1 activity and an accumulation of lipid droplets. The expression level of target genes of the transcription factors co-activated by lipin1 (PPARδ, PPARα, PGC1α, acyl-Coenzyme A very long chain dehydrogenase (ACADVL), carnitine palmitoyl-transferase 1B and 2 (CPT1B and CPT2)) are similar to controls, whereas the level of lipin2 is increased. Transcriptomic analysis of myotube cultures have identified in patients 19 under-expressed genes and 51 over-expressed ones, notably ACACB, which encodes Accβ (acetyl-CoA carboxylase β), key enzyme of the balance between fatty acid synthesis and FAO. ACACB invalidation by siRNA in lipin1-deficient myoblasts decreases the number of lipid droplets, comforting the link between ACACB over-expression and free fatty acid accumulation in patients. However, the level of malonyl-CoA, product of Accβ, and CPT1 activity (limitative step of FAO, inhibited by malonyl-CoA), are similar between myoblasts of patients and controls. But treatment of the cultures with an association of tumor necrosis factor α and interleukin-1 β (TNFα + IL-1β), chosen for mimicking pro-inflammatory conditions of acute infections, leads to a further increase of the level of malonyl-CoA, a decrease of CPT1 activity and an increase of lipid droplets accumulation in patients. In total, our data show that LPIN1 is an important cause of inherited rhabdomyolysis. Lipin1 deficiency leads to a disturbance of the lipidic metabolism, via ACACB over-expression, which is exacerbated in pro-inflammatory conditions. Our results suggest that the consequences of lipin1 deficiency are counterbalanced by adaptative mechanisms which are sufficient at basal state, but insufficient for the metabolic request induced by environmental stresses, such as infections, leading to the rhabdomyolyses. Next step is the study of adipose tissue and the establishment of the inflammatory signature of the patients, in order to determine if this new disease is an auto-inflammatory pathology.
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Caroline Michot. LPIN1 - étude génétique d'une nouvelle cause de rhabdomyolyse héréditaire et analyses physiopathologiques à partir de myoblastes de patients. Médecine humaine et pathologie. Université René Descartes - Paris V, 2013. Français. ⟨NNT : 2013PA05T058⟩. ⟨tel-00931712⟩

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