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Virus Herpès Simplex de type 1 : une cible potentielle pour la prévention de la maladie d’Alzheimer ?

Abstract : Despite many advances in the understanding of the mechanisms involved in Alzheimer's disease (AD), its precise etiology remains unknown. However, an increasing number of articles suggest that an involvement of the Herpes Simplex virus type 1 (HSV-1) could explain both the topographic and temporal sequences as well as the type of damage found in AD. Indeed, HSV-1 is a neurotropic virus found in the brains of elderly people and it has a particular tropism for the areas involved in AD. It is also able to spread from cell to cell. During life, HSV-1 remains latent in the body and is able to reactivate periodically. With advancing age, the decline of the immune system could allow more frequent and/or intense reactivations of the virus, potentially explaining the late and progressive onset of AD. In addition, the main pathological markers of AD (amyloid and tau pathologies, neuroinflammation) can be induced in vitro and in animal models by inoculation of the HSV-1 virus and the accumulation of the aβ peptide could be due to its involvement in antimicrobial defense. In this thesis, in order to test this hypothesis, we first evaluated the association between anti-HSV serologies and different markers of AD according to the presence of the APOE4 allele, a genetic risk factor for MA which may modulate the effect of the virus on the brain. Indeed, the presence of susceptibility factors, genetic or not, would explain why, despite a seroprevalence of approximately 80%, some infected subjects remain "healthy carriers" while others develop the disease. In the Trois Cités Bordeaux and the AMI (Aging Multidisciplinary Investigation) cohorts, we demonstrated that, among the APOE4 carriers, the infected subjects had 2 times the risk of developing AD than the non-infected and three times if they had a high level of anti-HSV IgG (possible reflection of more frequent viral reactivations over time); conversely, no association was found in APOE4 non-carriers. Infected subjects also had more alterations of the white matter microstructure in the parahippocampal cingulum and fornix than uninfected subjects, and if they had an elevated IgG levels, they also presented lower hippocampal volumes. Paradoxically, in the MAPT trial (Multidomain Alzheimer Preventive Trial), we demonstrated that, among APOE4 carriers, infected subjects (and particularly those with high IgG levels) had significantly less amyloid deposits than uninfected individuals while no association was found in APOE4 non carriers. This result, although going in the opposite direction to that expected, could potentially be explained by a selection bias of the subjects included in the trial. Then, using medico-administrative data from 68,291 elderly subjects monitored between 2009 and 2017, we demonstrated that taking at least one systemic anti-herpetic drug was associated with a 15% decrease in the risk of developing AD. Despite a low percentage of participants with regular intake during follow-up, this association could potentially reflect a protective effect of the treatment, in particular considering the possibility of more regular treatment during the period of life before inclusion. Overall, while our results seem in favor of the involvement of HSV-1 in AD, many questions still remain to confirm this hypothesis and its potential in terms of prevention.
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Submitted on : Saturday, January 1, 2022 - 1:15:48 AM
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Morgane Linard de Guertechin. Virus Herpès Simplex de type 1 : une cible potentielle pour la prévention de la maladie d’Alzheimer ?. Médecine humaine et pathologie. Université de Bordeaux, 2021. Français. ⟨NNT : 2021BORD0118⟩. ⟨tel-03505906⟩

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