Le Syndrome d’Ehlers-Danlos vasculaire (SEDv) est une pathologie génétique rare à transmission autosomique dominante. Les patients sont prédisposés à la survenue de ruptures vasculaires, digestives et utérines induisant une létalité précoce. Cette pathologie est due à des mutations du gène COL3A1 (codant le collagène de type III), majoritairement de type faux-sens, agissant via un mécanisme dominant négatif. Plus rarement, de larges délétions ou des mutations non-sens induisent une haplo-insuffisance. In fine, les conséquences de ces mutations portent essentiellement sur la synthèse du collagène de type III, aboutissant à une fragilité artérielle importante. A ce jour, aucun traitement curatif n’est disponible. L’inactivation du gène Col3a1 chez la souris entraine une mortalité in utero et néonatale quasi-systématique en cas d’homozygotie, mais les souris Col3a1+/- sont exemptes de phénotype vasculaire évident. Afin d’obtenir un modèle de dissection artérielle liée à un défaut de collagène de type III, une perfusion chronique d’Angiotensine II (Ang II) à dose pressive a été utilisée. Nos résultats montrent que l’haplo-insuffisance en collagène de type III confère une sensibilité artérielle majeure à l’Ang II. Cette fragilité est caractérisée par le développement de dissections/ruptures de l’aorte ascendante et induit des décès prématurés de ces animaux. Ce phénotype est lié non seulement à l’élévation de pression artérielle mais aussi à l’activation des voies de signalisation de l’Ang II. Enfin, nous montrons qu’un traitement associant un bêtabloquant (propranolol) et un vasodilatateur artériel (hydralazine) permet de réduire la mortalité induite par l’Ang II. Ces résultats suggèrent l’intérêt de l’ajout d’un traitement préventif par inhibiteur de l’Ang II au traitement bêtabloquant (Celiprolol) recommandé dans la pathologie humaine.Parallèlement, nous avons généré un modèle murin knock-in génétiquement plus proche des patients SEDv, par l’introduction d’une mutation ponctuelle faux-sens (Gly183Ser) observée chez un patient. L’analyse préliminaire de ce modèle montre que les souris Col3a1+/G183S décèdent spontanément, dès 4 semaines, de ruptures/dissections de l’aorte ascendante. Cependant, ces souris ne présentent de modification ni de leurs paramètres hémodynamiques, ni de leurs diamètres aortiques. En revanche, environ 20 % des souris Col3a1+/G183S présentent des plaies au niveau du dos et des pattes. Ce nouveau modèle de souris est actuellement le seul à récapituler aussi fidèlement le phénotype des patients SEDv. Il devrait donc permettre de tester différentes approches thérapeutiques. / Vascular Ehlers-Danlos (vEDS) syndrome is a rare, inherited, autosomal dominant disease that results from mutations in the COL3A1 gene, encoding type III collagen. Patients are mostly affected by missense mutations probably acting through a dominant negative mechanism. A few patients present large deletions or nonsense mutations leading to a haploinsufficient mechanism. These mutations are supposed to lead to a defect in the synthesis and secretion of collagen type III, resulting in arterial wall fragility. Consequently, vEDS is mostly characterized by ruptures/dissections in arteries at a young age, which ultimately lead to premature death. While there is currently no surgical or therapeutic treatments available, a recent study reported the beneficial effect of the beta-blocker celiprolol, which prevents vascular complications in patients.To investigate the vascular phenotype of vEDS, a mouse model of this disease has been generated by the complete and ubiquitous inactivation of the COL3A1 gene. Col3a1-/- mice exhibit severe perinatal mortality and die prematurely from spontaneous vascular rupture. However, Col3a1+/- mice are viable and exhibit no obvious vascular phenotype. To determine the susceptibility of Col3a1+/- mice to develop vascular rupture/dissection, an experimental model of aneurysm induction was used, through the chronic infusion of Angiotensin II (Ang II). Our results showed that Ang II infusion led to severe premature mortality in Col3a1+/- compared to wild type. This fragility was characterized by the development of rupture/dissection in the ascending aorta. These lesions could be caused by the elevation of blood pressure and/or the activation of Ang II signaling pathways. We showed that treatment with a beta-blocker (propranolol) and an arterial vasodilator (hydralazine) reduced the mortality induced by Ang II in Col3a1+/- mice. These results suggest the beneficial effect of adding a preventive treatment inhibitor of Ang II to the beta-blocker treatment recommended in human pathology.Meanwhile, given that a majority of human vEDS cases is caused by missense mutations in the COL3A1 gene, we established a knock-in mouse model bearing a point mutation (Gly183Ser) found in vEDS patients. The preliminary characterization of this model showed that Col3a1+/G183S mice die spontaneously as early as 4 weeks of age from a dissection or rupture of the ascending aorta. However, these mice do not showed any changes of their hemodynamic parameters or aortic diameter. Furthermore, about 20 % of mouse Col3a1+/G183S display wounds in the back and legs. This new mouse model is currently the only that mimic more closely the human disease and could therefore be used to test different therapeutic strategies.

Abstract Calcified aortic valve disease represents a spectrum of disease spanning from mild aortic valve sclerosis to severe aortic valve stenosis (AS), being an actively regulated disease process and showing some hallmarks of atherosclerosis. The calcified aortic valve lesion develops endothelial injury and is characterized by inflammation, lipid accumulation, renin-angiotensin system activation and fibrosis. There is no approved pharmacological treatment available in AS. This study was aimed to characterize gene expression of endothelial factors in aortic valves in patients representing different stages of calcified aortic valve disease to reveal new targets for pharmacological interventions in AS. Aortic valves obtained from 75 patients undergoing valve replacement surgery were studied. Expression of natriuretic peptides (ANP, BNP and CNP), their processing enzymes (corin and furin), natriuretic receptors (NPR-A, NPR-B and NPR-C), endothelin-1 (ET-1), endothelin converting enzyme-1 (ECE-1), endothelin receptors A and B (ETA and ETB), and apelin pathway (apelin and its receptor APJ) was characterized by reverse-transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry. AS was characterized by distinct downregulation of gene expression of CNP, its processing enzyme furin and the target receptor NPR-B. Furthermore, increased amount of ET-1 and its target receptor ETA as well as imbalance between ETA and ETB receptors and downregulated endothelial nitric oxide synthase (eNOS) gene expression were observed. Finally, gene expression of apelin and APJ receptor were significantly upregulated in stenotic valves when compared to controls in combination with disequilibrium between expression of angiotensin II receptors AT1 and AT2. The study provides a better understanding of molecular mechanisms associated with calcific aortic valve disease and suggest potential targets for novel therapeutic interventions.

Abstract There is a lack of reliable methods of evaluation of brain ischemic injury in patients undergoing cardiac surgery. The present study was, therefore, planned to evaluate whether serum S100β protein (I), brain cortical microdialysis (II), intracranial pressure (III) and electroencephalography (EEG) (IV) are predictive of postoperative death and brain ischemic injury in an experimental surviving porcine model of hypothermic circulatory arrest (HCA). One hundred and twenty eight (128) female, juvenile (8 to 10 weeks of age) pigs of native stock, weighing 21.0 to 38.2 kg, underwent cardio-pulmonary bypass prior to, and following, a 75-minute period of HCA at a brain temperature of 18°C. During the operation, hemodynamic, electrocardiograph and temperature monitoring was performed continuously. Furthermore, metabolic parameters were monitored at baseline, end of cooling, at intervals of two, four and eight hours after HCA and before extubation. Electroencephalographic recording was performed in all animals, serum S100β protein measurement in 18 animals, cortical microdialysis in 109 animals, and intracranial pressure monitoring in 58 animals. After the operation, assessment of behavior was made on a daily basis until death or elective sacrifice on the seventh postoperative day. All four studies showed that these parameters were predictive of postoperative outcome. Animals with severe histopathological injury had higher serum S100β protein levels at every time interval after HCA. Analysis of cortical brain microdialysis showed that the lactate/glucose ratio was significantly lower and the brain glucose concentration significantly higher among survivors during the early postoperative hours. Intracranial pressure increased significantly after 75 minutes of HCA, and this was associated with a significantly increased risk of postoperative death and brain infarction. A slower recovery of EEG burst percentage after HCA was significantly associated with the development of severe cerebral cortex, brain stem and cerebellum ischemic injury. In conclusion, serum S100β protein proved to be a reliable marker of brain ischemic injury as assessed on histopathological examination. Cerebral microdialysis is a useful method of cerebral monitoring during experimental HCA. Low brain glucose concentrations and high brain lactate/ glucose ratios after HCA are strong predictors of postoperative death. Increased intracranial pressure severely affected the postoperative outcome and may be a potential target for treatment. EEG burst percentage as a sum effect of anesthetic agent and ischemic brain damage is a useful tool for early prediction of severe brain damage after HCA. Among these monitoring methods, brain cortical microdialysis seems to be the most powerful one in predicting brain injury after experimental hypothermic circulatory arrest.

Les pathologies valvulaires aortiques sont des pathologies plurifactorielles, comportant un déterminisme génétique indiscutable mais peu caractérisé. Ma thèse a pour but d’étudier le rôle du facteur de transcription Krox20 au cours du développement et de la maturation valvulaire à travers l’analyse de modèles murins. Nous avons montré que ce gène est nécessaire au développement et à la maturation de la valve aortique. L’invalidation de Krox20 chez la souris conduit à une hypertrophie des feuillets aortiques dès les stades fœtaux et à des insuffisances aortiques chez l’adulte. Ces anomalies sont associées à des défauts d’organisation de la matrice extracellulaire en partie liée à une régulation directe de l’expression des collagènes de type I et III. 25% des souris déficientes pour Krox20 présentent une bicuspidie de la valve aortique. Nous avons observé une diminution de l’expression de eNos chez ces mutants et pu mettre en évidence une interaction génétique entre Krox20 et eNos. De plus, nous avons identifié une sous population de cellules des crêtes neurales cardiaques impliquées dans l’apparition de la bicuspidie chez les mutants Krox20. Afin d’explorer le rôle de Krox20 dans la calcification de la valve aortique, nous avons étudié les conséquences de la surexpression de ce gène dans un modèle et montré que lcela induisait une activation de gènes pro-fibrotiques et pro-ostéogénique sans conduire à des dépôts calciques. Krox20 est donc un facteur de transcription important pour la valvulogenèse et à l’homéostasie valvulaire chez l’adulte. Mes travaux ont contribué à l’identification de Krox20 comme gène candidat potentiel aux valvulopathies rencontrées chez l’homme. / Long seen as a consequence of aging and mechanical wear of aortic cusps, aortic valve diseases are currently considered multifactorial diseases, with an indisputable genetic determinism but not well characterized. My thesis aims to study the role of the transcription factor Krox20 during development and maturation of the valve through the analysis of mouse models. We have shown that this gene is necessary for the development and maturation of the aortic valve. Indeed, the deletion of Krox20 in the mouse leads to thickened aortic leaflets from the fetal stage and the onset of aortic valve disease in adults. These anomalies are associated with defects in the organization of the extracellular matrix and more particularly to direct regulsation of collagen type I and type III expression. Our analysis showed that 25% Krox20-/- mice have a bicuspid aortic valve. The analysis of this model has allowed us to identify a population of cardiac neural crest cells involved in the occurrence of this phenotype. In addition, we were able to observe a down regulation of eNos in Krox20-/- embryos and show a genetic interaction between Krox20 and eNos. To address the role of Krox20 in the process of calcification of the aortic valve, we have studied the effects of its overexpression. Our preliminary results indicate that this overexpression leads to activation of pro-fibrotic and pro-osteogenic genes, however, this is not sufficient to induce calcification of aortic valve leaflets.Therefore Krox20 is important for valvulogenesis but also for valvular homeostasis in the adult. My work has contributed to the identification of a potential candidate gene involved in human valve diseases.

Objectives: Cardiovascular disease is the leading cause of mortality and morbidity in the developed world. Surgery can improve prognosis and relieve symptoms. Risk prediction models are increasingly being used to inform clinicians and patients about the risks of surgery, to facilitate clinical decision making and for the risk-adjustment of surgical outcome data. The importance of risk prediction models in cardiovascular surgery has been highlighted by the publication of cardiovascular surgery outcome data and the need for risk-adjustment. The overall objective of this thesis is to advance risk prediction modelling in cardiovascular surgery with a focus on the development of models for elective AAA repair and assessment of models for cardiac surgery. Methods: Three large clinical databases (two elective AAA repair and one cardiac surgery) were utilised. Each database was cleaned prior to analysis. Logistic regression was used to develop both regional and national risk prediction models for mortality following elective AAA repair. A regional model to identify the risk of developing renal failure following elective AAA repair was also developed. The performance of a widely used cardiac surgery risk prediction model (the logistic EuroSCORE) over time was evaluated using a national cardiac database. In addition an updated model version (EuroSCORE II) was validated and both models’ performance in emergency cardiac surgery was evaluated. Results: Regional risk models for mortality following elective AAA repair (VGNW model) and a model to predict post-operative renal failure were developed. Validation of the model for mortality using a national dataset demonstrated good performance compared to other available risk models. To improve generalisability a national model (the BAR score) with better discriminatory ability was developed. In a prospective validation of both models using regional data, the BAR score demonstrated excellent discrimination overall and good discrimination in procedural sub-groups. The EuroSCORE was found to have lost calibration over time due to a fall in observed mortality despite an increase in the predicted mortality of patients undergoing cardiac surgery. The EuroSCORE II demonstrated good performance for contemporary cardiac surgery. Both EuroSCORE models demonstrated inadequate performance for emergency cardiac surgery. Conclusions: Risk prediction models play an important role in cardiovascular surgery. Two accurate risk prediction models for mortality following elective AAA repair have been developed and can be used to risk-adjust surgical outcomes and facilitate clinical decision making. As surgical practice changes over time risk prediction models may lose accuracy which has implications for their application. Cardiac risk models may not be sufficiently accurate for high-risk patient groups such as those undergoing emergency surgery and specific emergency models may be required. Continuing research into new risk factors and model outcomes is needed and risk prediction models may play an increasing role in clinical decision making in the future.

La rigidité artérielle ayant une valeur prédictive forte et indépendante d'évènements cardiovasculaires, nous émettons l'hypothèse que l'accumulation de variations de contraintes hémodynamiques altère la fonction et la structure des gros troncs artériels, indépendamment du niveau de pression artérielle. Nous avons donc mesuré l'impact de la variabilité tensionnelle sur la rigidité et la structure artérielles dans différents modèles de variabilité tensionnelle chez le rat.Chez le rat barodénervé et le rat sympathectomisé par la guanéthidine, 2 modèles de variabilité tensionnelle à court terme, une augmentation de la rigidité artérielle est associée à des altérations tissulaires différentes. En effet chez les rats barodénervés, une hypertrophie aortique est couplée à une augmentation du collagène et des attachements cellule-matrice (fibronectine et intégrine α5). Au contraire, chez les rats sympathectomisés, une hypotrophie vasculaire est associée à une diminution de l'élastine et une augmentation des attachements via l'intégrine αv.Nous avons ensuite créé, caractérisé et validé un modèle de variabilité tensionnelle à long terme, le rat spontanément hypertendu traité de façon discontinue par un antihypertenseur. Le traitement discontinu réduit la pression artérielle systolique tout en augmentant isolément la variabilité tensionnelle à long terme. La rigidité artérielle, élevée sous traitement discontinu, est associée à une hypertrophie vasculaire avec augmentation des attachements (fibronectine et intégrine αv) et sans modification du rapport élastine/collagène.En conclusion, l'élevation de variabilité tensionnelle engendre de la rigidité artérielle, et ce à pression artérielle constante. Les altérations structurales dans les modèles de variabilité tensionnelle étudiés impliquent des mécanismes différents reposant sur des modifications des relations cellule-matrice, mettant en jeu la fibronectine et les intégrines α5 et αv. / Arterial stiffness is nowadays accepted as a strong and independent predictor of cardiovascular disease. We hypothesized that increased blood pressure variability (BPV) may lead to arterial damage, independently of the blood pressure level. We thus aimed investigating the relationship between BPV and arterial stiffness and composition of the aorta in different rat models of increased BPV.In a first study performed in two models of increased short term BPV, sinoaortic denervated and chemically sympathectomized rats, an increase in wall stiffness was associated with different modifications of cell-extracellular matrix adhesion. Indeed in sinoaortic denervated rats, increased media cross-sectional area was coupled with an increased collagen content and muscle cell attachments to its cell-extracellular matrix (fibronectin and its α5β1 integrin). In contrast, chemically sympathectomized rats were characterized by a reduced media cross-sectional area associated to a reduction of elastin content and upregulation of αvβ3 integrin.In a second study, we created, characterized and validated a new experimental model of long term BPV by discontinuously treating spontaneously hypertensive rats with valsartan. Discontinuous treatment reduced systolic blood pressure level but increased long term BPV. In addition, this treatment regimen failed to reduce arterial stiffness and induced a vascular hypertrophy without modification of elastin/collagen ratio. Discontinuous treatment also highly increased vascular fibronectin in parallel to αv integrin.In conclusion, a rise of both short- and long-term BPV leads to an increase in arterial stiffness, independently of blood pressure level. The structural changes at the origin of this increase in arterial rigidity involve different mechanisms, in which fibronectin and integrin α5 and αv play a key role.

La traumatologie est la première cause de mortalité chez les sujets de moins de 40 ans dans les pays industrialisés. Le choc hypovolémique lié à une hémorragie du tronc est une cause fréquente de décès, à la fois sur les lieux de l’accident mais également pendant la prise en charge pré-hospitalière et intra-hospitalière. L’existence d’un hémopéritoine est un facteur de sous estimation du traumatisé grave.Le contrôle lésionnel, mieux connu sous les anglicismes « damage control ressucitation » et « damage control surgery », est le paradigme moderne de la prise en charge du choc hémorragique d’origine traumatique. Il comprend une mise en condition minimaliste privilégiant la réalisation d’une hémostase chirurgicale précoce et rapide, suivie d’une réanimation intensive associant transfusion massive, réchauffement et optimisation de la coagulation. Le traitement chirurgical exhaustif des lésions traumatiques est différé au delà de la période d’instabilité.Chez le blessé hémorragique agonique, la thoracotomie de ressuscitation avec clampage de l’aorte thoracique est une pratique courante mais dont les bases factuelles ne sont pas bien établies. En revanche en pathologie artérielle, la voie d’abord endovasculaire a très largement fait preuve de son efficacité.Nous avons émis l’hypothèse qu’un clampage aortique endovasculaire de l’aorte thoracique par voie rétrograde est possible et que cette technique améliore le profil hémodynamique dans le territoire myocardique et cérébral tout en augmentant la survie en cas de choc hémorragique lié à un traumatisme abdominal.Nos résultats suggèrent que cette technique de sauvetage est efficace, même s’il semble exister des limites corrélées à la durée de l’ischémie/reperfusion viscérale et médullaire. / Trauma is the leading cause of mortality in industrialized countries for people aged below 40 years. Fifty percent of the pre hospital and in hospital mortality from severe blunt and penetrating abdominal traumas is due to an hemorrhagic shock. Peritoneal bloody effusion is the main reason to under estimate the seriousness of trauma.Damage control resuscitation (DCR) and damage control surgery (DCS) typify the current paradigm of hemorrhagic torso trauma management. Damage control includes a basic pre operative management before a short surgical control of bleeding followed by intensive resuscitation care based on massive blood transfusion, palliation of hypothermia and correction of biological coagulation disorders. According to this strategy, the curative surgical treatment is postponed until the patient has been stabilized.Some authors have reported on the efficacy of resuscitation thoracotomy with aortic crossclamping in the emergency room in patients with severe abdominal trauma . However, the end results of such a procedure are contrasted and its use is still debated. More recently, endovascular approach has emerged in the management algorithm of some vascular emergencies. We hypothesized that an endovascular retrograde occlusion of the thoracic aorta would be a safe and efficient to preserve hemodynamic profile in cardiac and cerebral area, and to improve survival in case of uncontrolled hemorrhagic shock caused by an abdominal trauma.Our results sustain this hypothesis, even if its benefits seem time-limited, according to the medullar and visceral side-effects of ischemia/reperfusion.

The aim of this study is to create CFD tools and models capable of simulating pulsatile blood flow in abdominal aortic aneurysm (AAA) and stent graft. It helps to increase the current physiological understanding of rupture risk of AAA and stent graft fixation or migration. Firstly, in order to build a general solver for the AAA modeling with reasonable accuracy, a third/fourth order modified OCI scheme is originally developed for general numerical simulation. The modified OCI scheme has a wider cell Reynolds number limitation. This high order scheme performs well with general rectangular mesh for incompressible fluid. Second, a velocity based finite volume method is originally developed to calculate the stress field for solid in order to capture the transient changes of the blood vessel since the artery is a rubber like material. All one, two and three dimensional classical cases for solid are tested and good results are obtained. The velocity based finite volume method show good potential to calculate the stress field for solid and easy to blend with the finite volume fluid solver. It has been recognized that fluid structure interaction (FSI) is very crucial in biomechanics. In this regard, the velocity based finite volume method is then further developed for FSI application. A well known one dimensional piston problem is studied to understand the feasibility of the fluid structure coupling. The numerical prediction matches the analytical solution very well. The velocity based method introduces less numerical damping compared with a stagger method and a monolithic method. Finally, the work focuses on practical pulsatile boundary conditions, non-Newtonian blood viscous properties and bifurcating geometry, and provides an overview of the hemodynamic within the AAA model. A modified Womersley inlet and imbalance pressure outlet boundary conditions are originally used in this study. The Womersley inlet boundary represents better approximation for pulsatile flow compared with the parabolic inlet condition. Numerical results are presented providing comparison between different boundary conditions using different viscous models in both 2D and 3D aneurysms. Good agreement between the numerical predictions and the experimental data is achieved for 2D case. 3D stent models with different bifurcation angles are also tested. The Womersley inlet boundary condition improves the existing inlet conditions significantly and it can reduce the Aneurysm neck computation domain. The influence of the non-Newtonian model to the wall shear stress (WSS) and strain-rate is also studied. The non-Newtonian model tends to produce higher WSS at both proximal and distal end of the aneurysm as compared with the Newtonian model (both 2D and 3D cases). The computed strain-rate distribution at the centre of the aneurysm is different between these two models. The influence of imbalance outlet pressure at the iliac arteries to the blood flow is originally investigated. The imbalance outlet pressure boundary conditions affect the computed wall shear stress significantly near the bifurcation point. All the pulsatile Womersley inlet, non-Newtonian viscosity properties and the imbalance pressure outlet need to be considered in blood flow simulation of AAA.

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy

L'anévrysme de l'aorte abdominale (AAA) est un problème de Santé Publique qui touche principalement les hommes de plus de 65 ans. L'AAA souvent asymptomatique évolue vers la rupture associée à un taux de mortalité élevé. Parmi les acides ribonucléiques (ARNs) non codants, les microARNs (miARNs), stables dans le tissu et les biofluides, sont des candidats intéressant dans la recherche de biomarqueurs. L'inflammation, la dégradation de la matrice extra-cellulaire (MEC) et la raréfaction de la média participent à l'AAA. De nombreuses cellules inflammatoires sont impliquées dans l'AAA. La raréfaction des cellules musculaires lisses (CML) est secondaire à l'anoïkis, apoptose par détachement cellulaire de la MEC. Une analyse protéomique différentielle de CML en culture, issues de patients porteurs d'AAA, réalisée au laboratoire a montré que la désintégrine et metalloprotéinase avec un motif de thrombospondine 5 (ADAMTS 5) est surexprimée dans les CML de patients présentant un AAA. L'isolement des cellules par la microdissection laser permet de conserver le phénotype des cellules isolées et de mettre en évidence des marqueurs potentiels de l'AAA masqués par l'analyse du tissu global. Mon travail de thèse a consisté à partir des cellules isolées de la paroi anévrysmale de l'aorte abdominale sous-rénale chez l'Homme: à effectuer une analyse globale des miARNS et une analyse ciblée de l'ADAMTS 5, métalloprotéase qui a une action enzymatique sur les protéines de la MEC. Les objectifs de ce travail sont une meilleure compréhension de l'AAA et l'identification de nouveaux biomarqueurs.La distribution des cellules dans la paroi anévrysmale est étudiée par immunohistochimie sur des biopsies anévrysmales et d'aortes saine obtenues chez l'Homme. Les cellules localisées sont isolées par microdissection laser. L'analyse par criblage de l'expression des miARNs des cellules isolées de l'AAA et des CML issues d'aorte saine est réalisée sur puce. L'expression différentielle de miARNs sélectionnés est analysée par PCR quantitative dans des cellules isolées de l'AAA et dans du tissu global. L'expression des miARNs sélectionnés est ensuite comparée dans le plasma des patients présentant un AAA et de patients athérosclérotiques sans AAA par PCR pour identifier de potentiels biomarqueurs. Dans l'AAA, les macrophages M1 proinflammatoires sont retrouvés dans l'adventice et les macrophages M2 anti inflammatoires dans le thrombus intraluminal, les lymphocytes de type B sont retrouvés organisé en organe lymphoïde tertiaire adventitielle ou ATLOs dans 11 échantillons sur 20 analysés. Les CML sont rares et strictement localises au niveau de la média. Sur 850 miARNs testés dans la puce, 205 miARNs sont exprimés dans les cellules isolées. Les miR-29b et let-7f sont augmentés dans le plasma de patients porteurs d'AAA et représentent de potentiel biomarqueurs.L'expression d'ADAMTS 5 dans les CML de la paroi anévrysmale est évaluée par immunohistochimie dans la paroi aortique saine et anévrysmale et quantifiée par Western-blot dans les CML isolées de la paroi aortique saine et anévrysmale.Deux morphotypes de CML anévrysmales ont été identifiés: un morphotype arrondi positif au marqueur de l'apoptose, caspase 3 et un morphotype allongé, similaire aux CML de l'aorte saine. Le profil d'expression des sous-unités d'ADAMTS 5 est diffèrent dans les CML arrondies et les CML allongées anévrysmales et saines. La mise en apoptose des CML a été mise au point in vitro pour étudier les mécanismes impliqués dans les modifications d’ expression d'ADAMTS 5 dans l'AAA et les conséquences sur son action enzymatique.L'approche systématique de l'expression transcriptomique des cellules anévrysmales isolées a identifié des marqueurs potentiels de l'AAA, les miR-29b et let-7f et l'analyse ciblée suggère l'implication d'ADAMTS 5 dans le profil évolutif des CML vers l'anoïkis dans l'AAA. Des études complémentaires permettront une meilleure compréhension de l'AAA. / Abdominal aortic aneurysm (AAA) is a public health problem, which mainly affects men older than 65 year. AAA are usually asymptomatic with a natural evolution towards rupture associated with a high mortality rate. Among non coding ribonucleic acids (RNAs), microRNAs are stable in tissue and biofluids and are interesting candidates for the search of biomarkers. Inflammation, extracellular matrix (ECM) degradation and media rarefaction are involved in AAA. Many inflammatory cells are involved in AAA. Anoikis is an apoptosis secondary to a cell detachment from ECM and is responsible for rarefaction of smooth muscle cells (SMC). Differential proteomic analysis of cultured SMC from AAA patients was performed in the laboratory and highlighted the overexpression of a disintegrin and metalloproteinase with thrombospondin motif of type 5 (ADAMTS 5) in SMC of AAA patients. Isolation of cells with laser microdissection allows to keep their phenotype and to find potential markers that may be masked by global tissue analysis.The aim of my PhD work was to perform a global miRNA screening of cells isolated from human aneurysmal wall and an analysis targeted on ADAMTS 5, a metalloprotease with an enzymatic activity on ECM proteins. The main objectives were a better understanding of AAA and the identification of new biomarkers.The distribution of cells in the aneurysmal wall was studied by immunohistochemistry in human aneurysmal and healthy aortic samples. Once located, the cells were isolated by laser microdissection and screened for miRNAs by microarrays. Differential expression of selected miRNAs was quantified by PCR in the cells isolated by laser microdissection and in whole aortas. They were then compared in plasma of AAA patients and atherosclerotic patients without AAA by quantitative PCR to identify potential biomarkers.In AAA, the M1 proinflammatory macrophages were located in the adventitia and the M2 antiinflammatory macrophages in the intraluminal thrombus; the type B lymphocytes were organized in tertiary lymphoid organs (ATLOs) in 11/20 of analysed samples. SMC were rare and restricted to the media. Among the 850 miRNAs tested on microarray, 205 miRNAs were detected in isolated cells. MiR-29b and let-7f were upregulated in plasma of AAA patients, and thus are potential biomarkers.The expression of ADAMTS 5 in aneurysmal SMC was evaluated by immunohistochemistry of healthy and aneurysmal aortic wall and quantified by Western blot in isolated SMC from healthy and aneurysmal wall.Two aneurysmal SMC morphotypes were identified: a rounded morphotype positive for caspase 3, an apoptotic marker, and a spindle-shaped morphotype similar to the healthy aortic SMC. The expression profile of ADAMTS 5 subunits was different in rounded SMC compared to aneurysmal and healthy spindle-shaped SMC. In vitro induction of apoptosis of SMC was established in order to study the mechanisms involved in ADAMTS 5 expression in AAA and their consequences on enzymatic actions.The global transcriptomic screening of aneurysmal cells isolated by laser microdissection has identified potential markers of AAA, miR-29b and let-7f. The targeted analysis suggested that ADAMTS 5 is involved in the evolution profile of SMC towards anoikis in AAA. Further investigations will allow a better understanding of AAA pathophysiology.