Les anévrysmes de l'aorte abdominale sont retrouvés chez 5 à 9 % de la population après l'âge de 65 ans, et la rupture de ces anévrysmes cause chaque année au moins 15000 décès. Bien que la plupart soient petits et asymptomatiques, typiquement leur diamètre s'accroît avec le temps et environ 60% finissent par nécessiter une réparation chirurgicale. A ce jour, aucune thérapeutique ne permet de ralentir ou de stopper la croissance des petits anévrysmes. La paroi anévrysmale est caractérisée par une inflammation chronique et un remodelage du tissu conjonctif associant synthèse et destruction qui conduisent à l'appauvrissement de la paroi en élastine. Tous ces éléments sont présents dans le modèle d'anévrysme à l'élastase chez la souris. Alors que de nombreuses données ont été accumulées sur l'implication des metalloprotéinases dans la dégradation de la matrice extracellulaire, le rôle des serines protéases a reçu beaucoup moins d'intérêt. En utilisant le modèle d'anévrysme à l'élastase chez les souris cathepsine S et cathepsine C knockout, nous avons montré que leur présence était indispensable au développement anévrysmal. Nous avons également montré qu'il était possible de bloquer le modèle au moyen d'un inhibiteur des cathepsines, l'E64. L'ensemble de nos travaux semblent montrer que les cathepsines jouent un rôle prépondérant dans la phase d'initiation de la réaction inflammatoire et que les cathepsines sont une voie de recherche potentielle pour le développement de traitements médicamenteux pouvant ralentir la croissance des AAAs. / Abdominal aortic aneurysms occur in 5-9% of the population over the age of 65, and rupture of these aneurysms cause every year at least 15,000 deaths. Although most AAAs are small and asymptomatic, their diameter typically increases over time and about 60% eventually require surgical repair. To date, no therapy can slow or stop the growth of small aneurysms. The aneurysmal wall is characterized by chronic inflammation and tissue remodeling involving synthesis and destruction that leads to the loss of elastin. All these elements are present in the elastase model of aneurysm in mice. While many data have been accumulated on the involvement of metalloproteinases in the degradation of the extracellular matrix, the role of serine proteases has received much less interest. Using this model in mice cathepsin S and cathepsin C knockout, we have shown that their presence was essential for aneurysmal development. We also showed that it was possible to block the model using E64, an inhibitor of cathepsins. Taken together these data suggest that cathepsins play a role in the initiation of the inflammatory reaction and that cathepsins are a potential way of research for the development of medication which could slow down the AAAs growth. In order to block by pharmacological means the model, we developed the possibility to infuse doxycyline directly on the aneurysm. These studies showed that it was possible to block the model with an infusion of local doxycycline without blood levels of doxycycline. This experimental work opens the way for the development of drug-eluting stent graft, i.e. a stent graft able to infuse an active product which can stabilize the wall of the aneurysm.

Cerebral aneurysms occur due to the ballooning of blood vessels in the brain. Rupture of aneurysms can cause a subarachnoid hemorrhage, which, if not fatal, can cause permanent neurologic deficits. Minimally invasive neurovascular devices, such as embolization coils and flow diverters, are methods of treatment utilized to prevent aneurysm rupture. The rapidly growing market for neurovascular devices necessitates the development of accurate aneurysm models for preclinical testing. In vivo models, such as the rabbit elastase model, are commonly chosen for preclinical device testing; however, these studies are expensive, and aneurysm geometries are difficult to control and often do not replicate the variety of geometries found in clinical cases. A promising alternative for preclinical testing of neurovascular devices is an aneurysm blood vessel mimic (aBVM), which is an in vitro tissue-engineered model of a human blood vessel composed of an electrospun scaffold with an aneurysm geometry and human vascular cells. Previous work in the Cal Poly Tissue Engineering Lab has established a process for creating different aneurysm scaffolds based on the shape of different geometries, and this work aimed to further advance these aneurysm geometries in order to enhance the versatility of the in vitro model. The overall goal of this thesis was to customize the aBVM model through variations of different dimensions and to validate the scaffold variations for neurovascular device testing. First, a literature review was performed to identify critical ranges of aneurysm neck diameters and heights that are commonly seen in rabbit elastase models and in human clinical settings in order to set a foundation for creating new geometries. Based on the results, aneurysm geometries with varying neck sizes and heights were modeled and molded, and scaffolds were fabricated through electrospinning. Methods were developed to characterize scaffolds with internal measurements through imaging techniques using a scanning electron microscope. To validate these scaffolds for use as aBVMs for neurovascular device testing, constructs were created by dual-sodding human endothelial cells and smooth muscle cells into scaffolds with varying neck sizes. Finally, flow diverters were deployed in constructs with varying neck sizes in order to evaluate feasibility and initial healing. Customized aneurysm scaffolds can eventually be used with a variety of device studies for screening of neurovascular devices or as a predecessor for in vivo preclinical testing.