Identification et caractérisation moléculaire de la première étiologie génétique responsable de la maladie de Whipple chez l’homme

Abstract : Whipple's disease (WD) is a rare, severe and chronic infectious disease that affects only a small minority of individuals infected with Tropheryma whipplei (T. whipplei). The chronic and asymptomatic carriage of T. whipplei is less rare. The pathogenesis of WD remains largely unknown. Using a genetic approach combining genome-wide linkage and whole exon sequencing, we tested the hypothesis of a genetic predisposition to WD. We studied a multiplex family containing four otherwise healthy WD patients and five asymptomatic T. whipplei carriers. We tested the hypothesis that WD follows autosomal dominant (AD) inheritance with age-dependent incomplete penetrance. We showed that the c.292 C> T mutation (p.R98W) of IRF4 gene was the only heterozygote variant that was very rare and non-synonymous for all four patients. In mice, the Irf4 gene is a transcription factor that plays pleiotropic roles in immunity. Molecular characterization of the mutated allele showed a deleterious effect by a haplo-insufficiency mechanism for the transcription factor function of the protein. Increase localization of the protein in the cytoplasmic has also been observed. In addition, the defect IRF4 studied confers a distinct transcriptomic response in leukocytes stimulated by BCG or T. whipplei. In conclusion, we identified the first genetic etiology associated with WD. The mode of inheritance is AD with incomplete penetrance, chronic carriage probably preceding WD for several decades in heterozygous individuals infected with T. whipplei. This work will help to better understand the pathogenesis of WD, to better define the mechanisms of immunity against T. whipplei and to be able to offer a molecular and genetic adapted diagnosis to families.
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Antoine Guérin. Identification et caractérisation moléculaire de la première étiologie génétique responsable de la maladie de Whipple chez l’homme. Génétique. Université Sorbonne Paris Cité, 2017. Français. ⟨NNT : 2017USPCB057⟩. ⟨tel-02127266⟩

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