Keloid scars (KS) are a type of abnormal scarring which is unique to humans. They extend beyond the confines of the original wound margins, do not regress over time and invade the surrounding unaffected skin. The mechanisms involved in the formation of KS remain largely unknown. Clinical observation has shown that in areas where increased tension occurs, such as the sternum, there is a greater propensity for developing KS. However, the precise relationship between skin tension and KS development is yet to be identified. In view of this, I hypothesize that skin tension plays a significant role in KS development by affecting tension-related biomarkers that may alter the phenotype of KS. Therefore, the objective of this research was to investigate the effect of skin tension in the formation of KS. To this end, the first aim was to identify possible targets among biomarkers that might contribute to the differentiation between KS and hypertrophic scars in tissue and cells obtained from diverse anatomical locations. The second aim was to investigate the effect of tension-related biomarkers on extracellular matrix (ECM) steady-state synthesis in keloid fibroblasts (KF) extracted from a highly tensioned body region (the sternum). The third aim was to develop a 3D in-vitro model to mimic in-vivo tension and to evaluate KF behaviour and ECM synthesis under tension. To achieve these aims 21 biomarkers were selected from published microarray and in-house microarray studies, the inclusion criteria was based on up-regulation of the genes in KS in relation to fibrosis, apoptosis and tension. For this purpose, samples from normal skin and KS were used to perform qRT-PCR screening in tissue and cells, as well as protein analysis by Western and In-cell Western blot. The siRNA knockdown technique was employed to evaluate the functional role of the tension-related markers in keloid fibroblasts. Finally, a photogrammetry technique was employed to evaluate skin tension in-vivo; the results from this evaluation were used in the development and design of a novel in-vitro 3D-model. The first biomarker screening in tissue showed convincing up-regulation of five tension-related targets (Hsp27, PAI-2 and α2β1-integrin, MMP-19 and CPRP). In addition, the expression of the above-mentioned targets was significantly higher in samples from the sternum compared to samples from other anatomical locations. To further validate these findings, the screening of the 21 biomarkers was assessed in KS and KF taken from the sternum. The results demonstrated over expression of 3 of the 5 tension-related targets (Hsp27, PAI-2 and α2β1-Integrin). It was also demonstrated that Hsp27, PAI-2 and α2β1-Integrin performed a functional role in terms of regulation of extracellular matrix production and deposition in KF when their expression was down-regulated by siRNA knockdown. Using the newly created 3D model, it was shown that mechanical tension significantly induced the expression of Hsp27, PAI-2 and α2β1-Integrin as well as ECM components such as Collagen I. Furthermore, the results showed that the knockdown of the expression of Hsp27, PAI-2 and α2β1-integrin in fibroblast populated collagen lattices subjected to tension influenced not only the ECM synthesis but also adhesion and spreading genes in keloid and normal fibroblasts. In summary, this research convincingly shows that skin tension alters keloid fibroblast behaviour, morphology, mechano-responsive gene expression and extracellular matrix production. The findings from my thesis offer insight into keloid pathobiology and provide options for targeted treatment of specific genes affected in keloids by biomechanical stress.

Les fibroses anormales sont responsables de plus de 40% des décès pour raison médicale ; elles se développent suite à une inflammation chronique. Les fibroses hépatiques causées par les schistosomes et par le virus HCV sont en grande partie déterminées par la génétique du malade. Notre thèse a consisté à poursuivre le travail de caractérisation du déterminisme génétique des fibroses hépatiques et cutanées.La première partie de notre thèse, est l’étude informatique et statistique des données de génotypage GWAS de Brésiliens qui présentent une fibrose hépatique bilharzienne grave sur plus de 2,5 millions de SNPs. 180 SNPs qui montraient une association suggestive avec les fibroses graves ont été sélectionnés, dont certains affectent les gènes des voies Wnt. Ces SNPs ont été testés sur une cohorte de 460 pêcheurs ougandais exposés à S.mansoni et nous avons confirmé l’association avec la fibrose de 4 SNPs.La deuxième partie de notre thèse est l’analyse transcriptômique (RNA-Seq) des mécanismes responsables des fibroses anormales de la peau de sujets affectés par des fibroses chéloïdes de 20 tissus chéloïdes, 7 tissus sains et 7 tissus affectés par des cicatrices hypertrophiques. Cette analyse montre que le développement des chéloïdes est la conséquence d’une stimulation anormale des voies de la cicatrisation en partie due à l’activation de la voie Wnt βcatenin et Wnt PCP. Pour conforter cette proposition, nous avons effectué une analyse génétique de la voie Wnt dans deux cohortes indépendantes. L’analyse statistique montre que des SNPs dans 6 gènes de la voie Wnt βcatenin contribuent au développement des fibroses chéloïdes. / Abnormal fibrosis is responsible for more than 40% of medical deaths. They develop as a result of chronicinflammation. Hepatic fibroses caused by schistosomes andHCV virus are largely determined by the genetic background of the patient. Our thesis consisted of continuing thework of characterizing the genetic determinism of liver and skin fibrosis.The first part of our thesis is the computer and statistical study of GWAS genotyping data of Brazilians whohave severe bilharzeal liver fibrosis on more than 2.5 million SNPs. 180 SNPs that showed suggestive associationwith severe fibrosis were selected, some of which affect the Wnt pathway. These SNPs were then tested on a cohortof 460 Ugandan fishers exposed to S.mansoni and the results confirmed the association of 4 SNPs with fibrosis.The second part of our thesis is the genomic analysis (transcriptome and genetics) of the mechanismsresponsible for the abnormal skin fibrosis with subjects affected by keloid scars. We performed an analysis of genes(RNASeq) expressed differently between 20 keloids, 7 healthy tissues and 7 tissues affected by hypertrophic scars.This analysis shows that the development of keloids is the consequence of an abnormal stimulation of cicatrizationpathways with strong activation of the Wnt βcatenin and Wnt PCP pathway. To support this proposal, we performeda genetic analysis of the Wnt pathway in two independant cohorts.The statistical analysis of the results shows that polymorphisms in 6 genes of the Wnt βcatenin pathway contributeto the development of keloid fibrosis.