Dans ce travail de thèse, nous nous sommes intéressés à mieux comprendre le rôle du métabolisme du tryptophane (TRP), et en particulier de la voie de la kynurénine (KYN), dans la physiopathologie des troubles dépressifs en utilisant un modèle murin de dépression - le stress chronique imprédictible modéré (Unpredictable Chronic Mild Stress = UCMS). Nous avons montré que 1) l'UCMS affecte de façon différentielle le métabolisme de la KYN selon qu'il se déroule en périphérie ou dans le SNC 2) l'UCMS induit l'accumulation de certains métabolites toxiques de la KYN en périphérie alors que dans le cerveau, l'effet est structure-dépendant 3) la concentration en KYN est inversement proportionnelle à la concentration en 5-HT dans le SNC 4) que l'activation de la voie KYN périphérique est positivement corrélée à l'expression de comportements anxio-dépressifs 5) que l'inhibition pharmacologique de la voie KYN a des effets antidépresseurs. / During this thesis, we were interested in better understand the role of the kynurenine pathway (KP) in the pathophysiology of depressive disorders by using a murine model of depression - the Unpredictable Chronic Mils StressProcedure = UCMS). We have shown that 1) UCMS has different effects on peripheral and cerebral tissues 2) UCMS induces accumulation of some toxic KP metabolites in the periphery and the CNS 3) the cerebral level of KYN innegatively correlated to the level of 5-HT 4) activation of the peripheral KP is positively correlated to the expression of anxiety-like and depressive-like behaviors, only in UCMS mice 5) pharmacological inhibition of the KP have antidepressant properties.

BACKGROUND: Acute pancreatitis (AP) is a sterile initiator of systemic inflammation that can trigger multiple organ dysfunction syndrome (MODS). In the acute phase of AP, the kynurenine pathway of tryptophan metabolism plays an important role in the genesis of AP-MODS in experimental animal models, but it is unknown whether the pathway is activated in human AP. Human data are required to support the rationale for kynurenine 3- monooxygenase (KMO) inhibition as a treatment for AP-MODS and reinforce the translational potential. Additionally, as respiratory dysfunction is frequent in severe AP, the role of lung ultrasonography in severity stratification deserves investigation. Furthermore, the effect of AP-MODS on long-term survival is unknown. OBJECTIVES: My objectives were to: 1) Define the temporal and quantitative relationship of kynurenine metabolites with the onset and severity of APMODS, 2) Investigate the value of lung ultrasonography in the early diagnosis of respiratory dysfunction in human AP-MODS, and 3) Examine whether early AP-MODS impacts on long-term survival. METHODS: 1) A prospective, observational, clinical experimental medicine study titled “Inflammation, Metabolism, and Organ Failure in Acute Pancreatitis” (IMOFAP) was performed. For 90 days, consecutive patients with a potential diagnosis of AP were recruited and venous blood was sampled at 0, 3, 6, 12, 24, 48, 72 and 168 hours post-recruitment. Kynurenine metabolite concentrations were measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS) and analysed in the context of clinical data, disease severity indices, and cytokine profiles. 2) In a nested cohort within IMOFAP, 41 participants underwent lung ultrasonography to evaluate whether this imaging modality can detect respiratory dysfunction in AP. 3) Survival data for a prospectively maintained database of patients with AP was analysed after accounting for in-hospital deaths. RESULTS: 1) During the IMOFAP study, 79 patients were recruited with an elevated serum amylase, of which 57 patients met the diagnostic criteria for AP; 9 had severe disease. Temporal profiling revealed early tryptophan depletion and contemporaneous elevation of plasma concentrations of 3- hydroxykynurenine, which paralleled systemic inflammation and AP severity. 2) Lung ultrasonography findings correlated with respiratory dysfunction. 3) 694 patients were followed up for a median of 8.8 years. AP-MODS conferred a deleterious effect on overall survival which persisted after the exclusion of inhospital deaths (10.0 years, 95% C.I. = 9.4-10.6 years) compared to AP without MODS (11.6 years, 95% C.I. = 11.2-11.9 years; P = 0.001). This effect was independent of age. CONCLUSIONS: In the acute phase of AP, metabolic flux through KMO is elevated and proportionate to AP severity. Lung ultrasonography may be a useful technique for evaluating AP-MODS. AP-MODS is an independent predictor of long-term mortality. Together, this work reinforces the rationale for investigating early phase KMO inhibition as a therapeutic strategy in humans.