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While previous research into the pathogenesis of ischaemic and reperfusion injuries has focussed on the cardiac myocyte, there is increasing evidence for a crucial role for coronary vascular injury in the genesis of the post-ischaemic phenotype [1-3]. Post-ischaemic vascular injury may be manifest as a transient or sustained loss of competent vessels, impairment of vascular regulatory mechanisms, and ultimately as the 'no-reflow' phenomenon (inability to sufficiently reperfuse previously ischaemic tissue despite the removal of the initial obstruction or occlusion). It is now appreciated that the earliest distinguishing feature of various forms of vascular injury (including atherosclerosis and infarction) is 'endothelial dysfunction', which is the marked reduction in endothelial-dependent relaxation due to reduced release or action of endothelial nitric oxide (NO). Importantly, vascular injury may worsen myocardial damage in vivo [4,5], significantly limiting tissue salvage and recovery. The pathogenesis of post-ischaemic vascular injury and endothelial dysfunction is incompletely understood, but has generally been considered to reflect a cardiovascular inflammatory response, neutrophils playing a key role. However, while blood-borne cells and inflammatory elements are undoubtedly involved in the 'progression' of vascular injury [6,7], accumulating evidence indicates that they are not the primary 'instigators' [8]. It should be noted that a wealth of controversial findings exists in the vascular injury literature and mechanisms involved remain unclear. Indeed, multiple mechanisms are likely to contribute to post-ischaemic vascular injury. Adenosine receptors are unique in playing a role in physical regulation of coronary function, and also in attenuating injury during and following ischaemia. While the adenosine receptor system has been extensively investigated in terms of effects on myocardial injury [9,10], little is known regarding potential effects of this receptor system on post-ischaemic coronary vascular injury. This thesis initially attempts to further our understanding of the role of adenosine in normal coronary vascular function, subsequent chapters assess the effect of ischaemia-reperfusion on vascular function, and adenosine receptor modification of vascular dysfunction in the isolated asanguinous mouse heart. Specifically, in Chapter 3 the receptor subtype and mechanisms involved in adenosine-receptor mediated coronary vasodilation were assessed in Langendorff perfused mouse and rat hearts. The study revealed that A2A adenosine receptors (A2AARs) mediate coronary dilation in the mouse vs. A2B adenosine receptors (A2BARs) in rat. Furthermore, responses in mouse involve a sensitive endothelial-dependent (NO-dependent) response and NO-independent (KATP-mediated) dilation. Interestingly, the ATP-sensitive potassium channel component predominates over NO-dependent dilation at moderate to high agonist levels. However, the high-sensitivity NO-dependent response may play an important role under physiological conditions when adenosine concentrations and the level of A2AAR activation are low. In Chapter 4 the mechanisms regulating coronary tone under basal conditions and during reactive hyperaemic responses were assessed in Langendorff perfused mouse hearts. The data support a primary role for KATP channels and NO in mediating sustained elevations in flow, irrespective of occlusion duration (5-40 s). However, KATP channels are of primary importance in mediating initial flow adjustments after brief (5-10 s) occlusions, while KATP (and NO) independent processes are increasingly important with longer (20-40 s) occlusion. Evidence is also presented for compensatory changes in KATP and/or NO mediated dilation when one pathway is blocked, and for a modest role for A2AARs in reactive hyperaemia. In Chapter 5 the impact of ischaemia-reperfusion on coronary function was examined, and the role of A1 adenosine receptor (A1AR) activation by endogenous adenosine in modifying post-ischaemic vascular function was assessed in isolated buffer perfused mouse hearts. The results demonstrate that ischaemia does modify vascular control and signficantly impairs coronary endothelial dilation in a model devoid of blood cells. Additionally, the data indicate that post-ischaemic reflow is significantly determined by A2AAR activation by endogenous adenosine, and that A1AR activation by endogenous adenosine protects against this model of vascular injury. Following from Chapter 5, the potential of A1, A2A and A3AR activation by exogenous and endogenous agonists to modulate post-ischaemic vascular dysfunction was examined in Chapter 6. Furthermore, potential mechanisms involved injury and protection were assessed by comparing effects of adenosine receptors to other 'vasoprotective' interventions, including anti-oxidant treatment, Na+/H+ exchange (NHE) inhibition, endothelin (ET) antagonism, and 2,3-butanedione monoxime (BDM). The data acquired confirm that post-ischaemic endothelial dysfunction is reduced by intrinsic A1AR activation, and also that exogenous A3AR activation potently reduces vascular injury. Protection appears unrelated to inhibition of ET or oxidant stress. However, preliminary data suggest A3AR vasoprotection may share signalling with NHE inhibition. Finally, the data reveal that coronary reflow in isolated buffer perfused hearts is not a critical determinant of cardiac injury, suggesting independent injury processes in post-ischaemic myocardium vs. vasculature. Collectively, these studies show that adenosine has a significant role in regulating coronary vascular tone and reactive hyperaemic responses via NO and KATP dependent mechanisms. Ischaemia-reperfusion modifies vascular control and induces significant endothelial dysfunction in the absence of blood, implicating neutrophil independent injury processes. Endogenous adenosine affords intrinsic vasoprotection via A1AR activation, while adenosinergic therapy via exogenous A3AR activation represents a new strategy for directly protecting against post-ischaemic vascular injury.

Le cil primaire est un organite présent à la surface de la plupart des cellules de Vertébrés. Il participe à l’organogénèse en régulant l’activité de voies de signalisation comme la voie Hedgehog. Une dysfonction du cil primaire mène à des maladies rares, sévères et pléiotropiques, les ciliopathies, qui peuvent inclure des défauts cardiaques. Cependant, le rôle que le cil primaire joue dans la morphogénèse cardiaque est encore mal compris. Le projet principal de la thèse porte sur l’étude du rôle du cil primaire des cellules cardiaques dans le développement du cœur. Dans ce but, nous avons utilisé un modèle murin de délétion conditionnelle de Ift20, un gène essentiel pour la ciliogénèse. La délétion est contrôlée par l’allèle Mesp1Cre exprimé dans la plupart des précurseurs précoces cardiaques. A la naissance, les mutants conditionnels présentent des défauts importants de septation des voies efférentes et des chambres cardiaques, les oreillettes et les ventricules. Ces défauts sont similaires à ceux caractérisés dans les mutants de la voie Hedgehog. Nous avons également identifié de nouveaux phénotypes associés à la suppression du cil. Les mutants présentent une augmentation significative de la taille du ventricule droit et des malformations du réseau de vascularisation coronaire. Pour mieux comprendre la cause des défauts de croissance observés à la naissance, nous avons analysé les comportements cellulaires sous-jacents. Aucune différence significative des taux de prolifération, de la taille et de la proportion des types cellulaires n’a été détectée au stade prénatal, suggérant que ces défauts ont une origine développementale plus précoce. Des expériences sont en cours pour déterminer les mécanismes moléculaires des défauts observés. Dans le cadre d’une collaboration avec le laboratoire de Julien Vermot, à Strasbourg, nous avons étudié le rôle du cil primaire dans le développement du proépicarde, un organe précurseur de l’épicarde du cœur mature. Nous avons montré que les embryons mutants Ift20 constitutifs présentent une augmentation significative du volume du proépicarde. Des analyses sont en cours pour identifier les voies de signalisation impliquées dans ce phénotype. Les travaux effectués durant ce projet de thèse ont permis de caractériser de nouveaux rôles du cil primaire dans le développement cardiaque. Nos résultats participent à une meilleure compréhension des ciliopathies et des défauts cardiaques qui leur sont associés. / The primary cilium is an organelle present at the surface of most of Vertebrate cells. It is involved in organogenesis by regulating signalling pathways such as Hedgehog signalling. Primary cilium dysfunction leads to severe, rare and pleiotropic diseases, ciliopathies, which can include cardiac defects. Howevr, the role that the primary cilia plays in cardiac morphogenesis is still poorly understood. The main project of the PhD focuses on the study of the role of primary cilia in cardiac cells during heart development. We have used a mouse mode of conditional deletion of Ift20, a gene essential for ciliogenesis. The deletion is controlled by the Mesp1Cre allele, expressed in the majority of cardiac precursors. At birth, conditional mutants display severe defects in septation of the outflow tract, the atria and the ventricles. These defects are similar to the ones characterized in Hedgehog signalling mutants. We also have identified novel phenotypes linked to cilium suppression. The mutants display a significant increase in the size of the right ventricle and defective coronary vasculature development. To better understand the growh defects observed at birth, we analysed the underlying cell behaviour. No significant differences in the proliferation rates, nor in the size and proportions of different cell types were detected at prenatal stages, suggesting that these defects have an earlier developmental origin. Experiments are underway to determine the molecular mechanisms of the observed defects. In collaboration with the laboratory of Julien Vermot, in Strasbourg, we studied the role of the primary cilium in the development of the proepicardium, a precursor organ of the mature epicardium. We have shown that Ift20 constitutive mutants show a significant increase in proepicardial volume. Analyses are ongoing to identify the signalling pathways involved in this phenotype. The works performed during this PhD project allowed the characterization of new roles for the primary cilium in cardiac development. Our results participate in a better understanding of ciliopathies and their associated cardiac defects.

Background: Research in heart disease can be aided by modelling myocardial hemodynamics with knowledge of coronary pressure and vascular resistance measured from the geometry and morphometry of coronary vasculature. This study presents methods to automatically reconstruct accurate detailed coronary vascular anatomical models from high-resolution three-dimensional optical fluorescence cryomicrotomography image volumes for simulating blood flow in coronary arterial trees. Methods: Images of fluorescent cast and bead particles perfused into the same heart comprise the vasculature and microsphere datasets, employed in a novel combined approach to measure vasculature and simulate a flow model on the extracted coronary vascular tree for estimating regional myocardial perfusion. The microspheres are used in two capacities - as fiducial biomarker point sources for measuring the image formation in order to accurately measure the vasculature dataset and as flowing particles for measuring regional myocardial perfusion through the reconstructed vasculature. A new model-based template-matching method of vascular radius estimation is proposed that incorporates a model of the optical fluorescent image formation measured from the microspheres and a template of the vessels’ tubular geometry. Results: The new method reduced the error in vessel radius estimation from 42.9% to 0.6% in a 170 micrometer vessel as compared to the Full-Width Half Maximum method. Whole-organ porcine coronary vascular trees, automatically reconstructed with the proposed method, contained on the order of 92,000+ vessel segments in the range 0.03 – 1.9 mm radius. Discrepancy between the microsphere perfusion measurements and regional flow estimated with a 1-D steady state linear static blood flow simulation on the reconstructed vasculature was modelled with daughter-to-parent area ratio and branching angle as the parameters. Correcting the flow simulation by incorporating this model of disproportionate distribution of microspheres reduced the error from 24% to 7.4% in the estimation of fractional microsphere distribution in oblique branches with angles of 100°-120°.