Génotypage des papillomavirus humains par séquençage haut-débit : conséquences dans le dépistage du cancer du col de l’utérus et apport conceptuel au virome cutané

Abstract : Human papillomaviruses (HPV) are classified into 5 genera α, β, γ, μ and η. Their genome comprises six early genes including two oncogenes E6 and E7, and two late genes encoding the L1 and L2 capsid proteins. β- and γ-HPV constitute an important part of the cutaneous virome; usually asymptomatic, they can manifest as papillomatosis like warts and are associated with certain skin cancers, especially in immunocompromised patients. α-HPV has a mucosal tropism; high-risk (HR) α-HPV16 and 18 are involved in 99% of cervical cancers.Detection of α-HR-HPV in cervical samples guide the management of women whose Pap smear result shows atypical squamous cells of undetermined significance (ASCUS), although genotyping targets only the most common HPV types. Genotyping of β- and γ-HPV becomes necessary for the study of the virome especially in contexts of susceptibility to HPV pathogenesis (i.e. WHIM syndrome (for Warts, Hypogammaglobulimemia, Infections and Myelokathexis)). WHIM syndrome is a rare congenital immunodeficiency caused by a gain-of-function mutation of the CXCR4 receptor of the chemokine CXCL12 and manifests in 70% of cases by extensive cutaneous papillomatosis and ano-genital lesions that often evolve into cancer. Studies in our laboratory have identified the intrinsic role of the dysregulated CXCL12/CXCR4 axis in viral pathogenesis by demonstrating in particular the beneficial action of the blocking of this axis by an antagonist of CXCR4 (AMD3100) in vitro and in vivo on HPV-associated oncogenesis.Our objectives were: (i) to identify HPV whose genotype could not be determined (HPV-X) by a conventional test (INNO-LiPA HPV Genotyping Extra II®) in cervical samples with Pap smear report of ASCUS (ii) to characterize the HPV virome of a patient suffering from WHIM syndrom during a 7-month compassionate AMD3100 clinical trial to assess its impact on HPV-associated abnormalities.In both cases, we have developed a high-throughput sequencing genotyping method on Illumina Miseq®. The distribution of genotypes and their nucleotide polymorphism were studied by comparative and phylogenetic analyzes. (i) Our strategy identified in the 54 investigated ASCUS/HPV-X a majority of low-risk HPV, achieving a multiple infection (2 to 7 genotypes) in 41% of cases, and also the existence of quasi-species (41% of FCU) comprising up to 17 variants for the same genotype. Thus, probable competitions or hybridization defects of the minority variants may explain the lack of performance of the INNO-LiPA test. (ii) In the WHIM patient, sequencing was supplemented with type-specific qPCRs, allowing a qualitative and quantitative study. AMD3100 did not qualitatively modify the cutaneous HPV virome composed of 16 types, mainly β- and γ-HPV. In contrast, the quantitative analysis shows changes in the relative proportions of viral genomes suggesting a treatment effect on the expression of certain types that can be selectively associated with. papillomatosis. In this respect, one of the HPVs belonging to the cutaneous virome of the patient was found to be one of only two types present in a deep wart biopsy. This result supports the hypothesis of HPV selection in the lesion process. In addition, the oncogenic proteins E6 and E7 of this virus have mutations which could promote the pathogenic potential of this viral variant in comparison with the sequence of the reference HPV genome; a hypothesis that is under investigation.In conclusion, the high throughput sequencing techniques that we have developed have made it possible to better characterize the composition of the HPV virome demonstrating both its complexity in viral genotypes or in derivatives (i.e. quasi-species concept). The dynamics of which may underlie the pathogenic potential of this HPV virome.
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Lucie Molet. Génotypage des papillomavirus humains par séquençage haut-débit : conséquences dans le dépistage du cancer du col de l’utérus et apport conceptuel au virome cutané. Virologie. Université Paris-Saclay, 2018. Français. ⟨NNT : 2018SACLS231⟩. ⟨tel-02179631⟩

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