京都大学 / 新制・課程博士 / 博士(医学) / 甲第25158号 / 医博第5044号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 小川 誠司, 教授 後藤 慎平 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Master of Science / Department of Animal Sciences and Industry / Barry J. Bradford / The prevalence of fatty liver in transition dairy cattle has been reported to be as high as 50%. There are a few reliable on-farm diagnostic tools and even fewer methods to effectively prevent fatty liver. Non-alcoholic steatohepatitis, an advanced form of non-alcoholic fatty liver in humans, is accurately diagnosed with a commercial blood test that detects plasma cytokeratin-18 (CK18) fragments released during hepatocyte apoptosis. A study was performed using 89 Holstein cows in early lactation to determine if CK18 could serve as a novel indicator of liver triglyceride (TG) content. Although no previous work has been done with CK18 in bovine plasma, our results indicated that CK18 fragments were present in plasma. However, CK18 concentrations did not correlate with liver TG content or other measures of liver function, suggesting it is not a reliable diagnostic tool. Nevertheless, based on liver TG, plasma non-esterified fatty acid (NEFA), and plasma β-hydroxybutyric acid (BHBA) concentrations, this sample population as a whole was not suffering from severe metabolic problems or fatty liver, making it possible that plasma CK18 fragments are elevated only in the most extreme cases. Currently, there is no widely-adopted preventative strategy for fatty liver. A second study was performed to evaluate if encapsulated niacin (EN) could prevent liver TG accumulation during the transition period. Twenty-four primiparous (n=9) and multiparous (n=13) cows were randomly assigned to receive 0 or 24 g of dietary EN, beginning 3 weeks prior to expected calving until 21 days postpartum. Feeding EN did not influence liver TG content, but decreased plasma NEFA concentrations, suggesting inhibition of lipolysis. Multiparous EN cows also experienced depressed dry matter intake (DMI) in the 4 days prior to calving. However, even when EN reduced DMI, plasma NEFA was still suppressed. A novel finding was the prolonged clearance of caffeine in plasma on day 7 postpartum in EN-treated animals. In contrast to other studies, this dose and delivery method of EN did not result in an increase in plasma NEFA after EN treatment ended. These research projects determined that plasma CK18 is likely not a useful diagnostic tool for mild to moderate bovine fatty liver and that feeding EN can inhibit lipolysis but may influence DMI as well. This is one of the first studies into the metabolic effects of feeding EN, and further research is needed in this field.

Tripomastigotas, formas infectivas do T. cruzi, expressam em sua superfície uma família de glicoproteínas denominada Tc-85, que pertence à superfamília gênica das gp85/trans-sialidases. Nosso laboratório clonou e caracterizou um membro da família da Tc85 (Tc85-11), cuja região carboxila terminal (clone Tc85-1) adere em laminina e em células de mamíferos. O uso de peptídeos sintéticos, correspondendo em sequência à Tc85-1 possibilitou a caracterização do motivo mais conservado da superfamília gênica das gp85/trans-sialidases (VTVxNVfLYNR), que não está relacionado com a adesão a laminina, como o domínio de adesão em células de mamíferos. Por cromatografia de extratos de membrana de células LLC-MK2 numa coluna de afinidade contendo o motivo de adesão, foi isolada uma molécula de 45 kDa identificada como citoqueratina 18 (CK18). Dados da literatura, de acordo com experimentos realizados em nosso laboratório, indicam que células epiteliais apresentam CK18 em sua superfície. Além disso, células K562, que não são infectadas pelo T. cruzi e não ligam ao motivo VTVxNVfLYNR nem à Tc85-1, não expõem CK18 em sua superfície. A adição de anticorpos anti-CK18 ao meio de cultura inibe a infecção de células epiteliais pelo T. cruzi, enquanto que a adição de pf-Tc85-11 ou VTVxNVfLYNR estimula a infecção. Esses dados sugerem que a adesão de membros da família das trans-sialidases a CK18 prepara a célula para invasão. / Trypomastigotes, which are the infective form of Trypanosoma cruzi, express a set of surface glycoproteins known, collectively, as Tc-85, a subset of the gp85/transsialidase supergene family. A member of that family, Tc85-11, has been cloned, whose carboxy-terminal fragment (Tc85-1) showed adhesive properties to laminin and cell surfaces (Giordano et al., 1999). The use of synthetic peptides, corresponding to the Tc85-1 sequence, enabled us to characterize the most conserved motif of the Trypanosoma trans-sialidase supergene family (VTVxNVfLYNR) as the mammalian cell binding domain. Although Tc85-1 binds to laminin, this domain does not bind to laminin nor inhibits cell binding to it. Affinity chromatography experiments with LLC-MK2 cell membrane extract enabled us to isolate the VTVxNVfLYNR motif receptor as a 45 kDa molecule that was identified as cytokeratin 18 (CK18) after trypsin digestion. This result is in agreement with published data, showing that CK18 is exposed on the outer membrane surface of epithelial cells. Furthermore, K562 cells which are not susceptible to T. cruzi infection, did not bind to Tc85-1 nor showed CK18 on their surface. The addition of anti-cytokeratin antibodies to the culture medium significantly inhibited the infection of epithelial cells by T. cruzi, while addition of fusion proteinTc85-11 or VTVxNVFLYNR slightly stimulated the infection. These results indicate that, the binding of the trans-sialidase family members to CK18 may prepare the hostcell for parasite invasion. Furthermore, our data suggest that Tc85-11 is a multiadhesive glycoprotein, encoding at least two diferent binding sites, one for laminin and one for CK18 that help the parasite to overcome the barriers interposed by cell membranes, extracellular matrices and basal laminae.

In Anlehnung an die Definition beim Pferd (SCHOON et al. 1992, 1997) wird die bovine Endometrose als endometriale periglanduläre und/oder stromale Fibrose mit Alteration der betroffenen Drüsen definiert (RODENBUSCH 2011). Eine eingehende histomorphologische und immunhistologische Charakterisierung der Endometrose existiert bisher bei der Stute (KENNEY u. DOIG 1986, SCHOON et al. 1992, HOFFMANN et al. 2009), jedoch nicht beim Rind. Das Ziel dieser Arbeit ist daher die histomorphologische und immunhistologische Charakterisierung der verschiedenen Endometroseformen beim Rind. Die Auswertung der Proben erfolgt am Institut für Veterinär-Pathologie der Universität Leipzig. In Abhängigkeit von den klinisch-gynäkologischen Befunden werden diese Proben in drei Gruppen unterteilt. Gruppe A1: Endometriumbioptate (n=12) von vier klinisch-gynäkologisch gesunden fertilen Rindern in definierten Zyklusphasen; Gruppe A2: Endometriumbioptate (n=36) von 36 klinisch genitalgesunden Rindern mit mindestens einer Abkalbung und Gruppe B: Uterusquerschnitte (n=69) von 69 sub-/ infertilen Rindern. Die Proben werden anhand der von HOFFMANN (2006) definierten Kriterien auf histopathologische Veränderungen hin untersucht und charakterisiert. Das histomorphologische Erscheinungsbild der involvierten periglandulären Stromazellen erlaubt die Einteilung der Endometrose in eine aktive, inaktive und gemischte Fibrose, die, je nach der Integrität des Drüsenepithels, einen destruierenden oder nicht destruierenden Charakter aufweist. Zur Charakterisierung der Endometroseformen werden neben histomorphologischen Kriterien die Intermediärfilamente Desmin, Vimentin und Zytokeratin sowie die Expression von α-Aktin und Laminin berücksichtigt. Die deskriptive statistische sowie die Inferenzstatistik-Auswertung erfolgen unter Zuhilfenahme der Software SPSS 18. Eine aktive Fibrose tritt bei 96,2 % der Rinder auf; 1,9 % weisen eine inaktive und 1,9 % eine gemischte Endometrose auf. Ein nicht destruierendes Erscheinungsbild der Endometrose kann bei 88,6 % der untersuchten Rinder nachgewiesen werden. Bei 11,4 % der untersuchten Rinder liegt eine Endometrose mit destruierendem Charakter vor. Die Endometrose betrifft bei 81 % der Rinder Einzeldrüsen und bei 19 % Drüsennester. Drüsennester sind häufiger bei mittel- und hochgradigen Endometrosen nachweisbar. 20 % der Proben mit nicht destruierender Endometrose und 58 % der Proben mit destruierender Endometrose weisen eine entzündliche Infiltration der Drüsen auf, wobei ein Zusammenhang zwischen der entzündlichen Infiltration der endometrotischen Drüsen und dem destruierenden Charakter der Endometrose festgestellt werden kann. Zusätzlich zur Endometrose zeigen 61 % der Rinder eine Endometritis, 12,4 % eine Perivaskulitis und 66 % eine interkarunkuläre und/oder intrakarunkuläre Angiosklerose. Insgesamt findet sich nur bei 24 % der Fälle ausschließlich eine Endometrose, bei 10,5 % eine Endometrose und zugleich eine Endometritis, bei 16 % liegt eine Endometrose zusammen mit einer Angiosklerose vor. Eine Kombination von Endometrose, Angiosklerose und Endometritis ist bei 49,5 % der Proben nachweisbar. Insgesamt bestehen jedoch keine erkennbaren statistischen Zusammenhänge zwischen den einzelnen Befundkombinationen. Aufgrund der immunhistologischen Untersuchung kann konstatiert werden, dass die periglandulären Stromazellen innerhalb der Endometrose eine stromale Koexpression von Desmin, Vimentin und α-Aktin aufweisen, welche ein für Myofibroblasten charakteristisches Merkmal ist. Ein kleiner Prozentsatz der Drüsenepithelzellen in der destruierenden Endometrose reagiert multifokal positiv mit dem Vimentinantikörper. Dies ist möglicherweise Ausdruck einer Fehldifferenzierung zur Stabilisierung der Zelle oder Anzeichen einer intensivierten (pathologischen) Proliferation. Die Lamininexpression der Basallamina der endometrotisch veränderten Drüsen ist, insbesondere bei der destruierenden Endometrose, diskontinuierlich und geht mit einer Auffaserung der Basallamina einher. Vermutlich lassen sich die umfangreichen Basallaminaalterationen auf von Myofibroblasten sezernierte Enzyme zurückführen. Bei Rindern kann kein Zusammenhang zwischen der Endometrose und dem Alter der Rinder oder der Anzahl der Kalbungen festgestellt werden. In der vorliegenden Arbeit dominiert die geringgradig aktive nicht destruierende Endometrose gegenüber den anderen bovinen Endometroseformen. Die sub-/ infertilen Kühe (Gruppe B) zeigen häufiger eine schwerere und destruierende Endometrose als die klinisch gesunden Rinder (Gruppe A1, A2). Die klinisch-gynäkologisch gesunden Rinder in definierten Zyklusphasen weisen variable Endometroseformen oder Endometrosegrade auf. Die sub-/ infertilen Rinder zeigen eine höhere Güstzeit (252,82 ± 163,83 Tage) als die klinisch-gynäkologisch gesunden Tiere mit mindestens einer Abkalbung (94 ± 28,4 Tage). Die längere Güstzeit bei den sub- und infertilen Rindern könnte somit eine Folge des insgesamt in Charakter und Grad stärker geschädigten Endometriums bei dieser Gruppe sein. Somit kann unter Berücksichtigung der vorliegenden Ergebnisse angenommen werden, dass die aufgeführten Alterationen die Fertilität des Rindes negativ beeinflussen. Die Ergebnisse ermöglichen eine histomorphologische und immunhistologische Charakterisierung der Endometrose beim Rind. Anhand der Ergebnisse der hier durchgeführten detaillierten Untersuchungen ist es möglich, eine präzisere Deskription degenerativer endometrialer Befunde vorzunehmen. In Hinblick auf die Fertilität bei Vorliegen einer bovinen Endometrose wird somit die Grundlage für zukünftige prognostische Bewertungen gelegt.

Submitted by Vasti Diniz (vastijpa@hotmail.com) on 2017-09-05T14:37:36Z No. of bitstreams: 1 arquivototal.pdf: 798401 bytes, checksum: 41671bb8b384bd28413ef4c5851e99ce (MD5) / Made available in DSpace on 2017-09-05T14:37:36Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 798401 bytes, checksum: 41671bb8b384bd28413ef4c5851e99ce (MD5) Previous issue date: 2015-02-27 / It is well established that solar UV radiation can cause mutations in DNA and increase the risk of developing skin cancer. However, little is known about the ability of UV radiation to cause epigenetic changes in the skin. DNA methylation, characterised by the addition of a methyl group in cytosines within CpG dinucleotides, can modify gene transcription, leading to decreased expression or even silencing of a gene. Epigenetic changes could represent an important pathway by which environmental factors influence aging and disease risks, with a tissue-specific manner. Epithelial keratins are called cytokeratins, the main function of cytokeratins is to maintain the integrity and mechanical stability through cell-cell contacts with epithelial tissue. The aim of this study was to investigate the sun exposure influence on DNA methylation status in the cytokeratin 14 (KRT14) and 19 (KRT19) genes of skin cells of subjects whithout history of skin disease. Skin biopsies were obtained by punch of sun-exposed (outer forearm) and sun-protected areas (inner arm) from 30 corpses of the Brazilian Services of Death Investigation. The KRT14 gene DNA methylation analysis was performed using Methylation-Specific PCR (MSP), and the KRT19 gene DNA methylation analysis was performed using Methylation-Sensitive Restriction Enzymes (MSRE) of sun-exposed and sun-protected skin areas. Statistical analysis showed no significant differences between sun-protected and sun-exposed areas and the most frequently methylated condition for CpG studied for KRT14 and KRT19 genes (p> 0.05; McNemar). We conclude that sun exposure does not induce changes in DNA methylation status in the KRT14 and KRT19 genes. / Pesquisas tem mostrado que a radiação UV do sol pode causar mutações no DNA e aumentar o risco para o desenvolvimento de câncer de pele. Entretanto, ainda pouco se sabe sobre a capacidade da radiação UV em causar alterações epigenéticas na pele. A metilação do DNA é caracterizada pela adição do grupo metil em uma citosina precedida por uma guanina (dinucleotídeo CpG), o que pode alterar a transcrição gênica, diminuindo a expressão ou silenciando um gene. Alterações epigenéticas podem representar um importante caminho de como os fatores ambientais influenciam no envelhecimento e no desenvolvimento de certas doenças de maneira tecido específica. Queratinas epiteliais são chamadas de citoqueratinas, e sua principal função é manter a integridade e estabilidade mecânica do tecido epitelial. Neste trabalho investigamos se há influência da exposição solar sobre o perfil de metilação de DNA nos genes das citoqueratinas 14 (KRT14) e (KRT19), em células da pele de indivíduos sem histórico de doenças de pele. Biopsias de pele foram obtidas através de um Punch circular da de área exposta e não exposta ao sol de 30 cadáveres do Serviço de Verificação de Óbito. A análise de metilação do gene KRT14 foi realizada pelo método de PCR Específica para Metilação (MSP), e para o gene KRT19 foi realizado o método de Restrição Enzimática Sensível à Metilação (MSRE) das áreas expostas e protegidas do sol. A análise estatística mostrou que não há diferenças significativas entre as regiões exposta e não exposta ao sol, sendo a condição metilada a mais frequente tanto para o gene KRT14 quanto para o gene KRT19 (p>0,05; McNemar). Assim, concluímos que não há influência da exposição solar no perfil de metilação de DNA nos genes KRT14 e KRT19.

Purpose: The aim of this work was to characterize the healthy human cornea and the cornea of patients suffering from posterior polymorphous corneal dystrophy (PPCD) using different antibodies. Despite the fact that PPCD is a very rare disorder, one of the largest groups of PPCD patients in the world comes from the Czech Republic. This offers us the opportunity to investigate the changes on the clinical, cellular and molecular levels. Material and Methods: A collection of 25 control corneas as well as 16 pathological corneas from PPCD patients were used. Epithelial (cytokeratins) and mesothelial markers (mesothelin, calbindin 2, HBME-1 protein) were detected in all layers of the healthy corneas using immunocyto- and immunohistochemistry. The expression of all markers was confirmed using molecular methods as well (RT-PCR and Western blot). Changes in the expression of cytokeratins and changes in the extracellular matrix structure (collagen IV and VIII) were studied in the PPCD corneas. Combined fluorescent immunohistochemistry with fluorescence in situ hybridization were used in order to characterize the origin of abnormal cells on the posterior graft surface, which cause the recurrence of the PPCD after penetrating keratoplasty surgery. Results: Changes in the cytokeratin expression (strong...

Purpose: The aim of this work was to characterize the healthy human cornea and the cornea of patients suffering from posterior polymorphous corneal dystrophy (PPCD) using different antibodies. Despite the fact that PPCD is a very rare disorder, one of the largest groups of PPCD patients in the world comes from the Czech Republic. This offers us the opportunity to investigate the changes on the clinical, cellular and molecular levels. Material and Methods: A collection of 25 control corneas as well as 16 pathological corneas from PPCD patients were used. Epithelial (cytokeratins) and mesothelial markers (mesothelin, calbindin 2, HBME-1 protein) were detected in all layers of the healthy corneas using immunocyto- and immunohistochemistry. The expression of all markers was confirmed using molecular methods as well (RT-PCR and Western blot). Changes in the expression of cytokeratins and changes in the extracellular matrix structure (collagen IV and VIII) were studied in the PPCD corneas. Combined fluorescent immunohistochemistry with fluorescence in situ hybridization were used in order to characterize the origin of abnormal cells on the posterior graft surface, which cause the recurrence of the PPCD after penetrating keratoplasty surgery. Results: Changes in the cytokeratin expression (strong...

Introdução: Caderinas e integrinas são importantes para a manutenção da integridade tecidual e transdução de sinal durante o desenvolvimento da pele. A distribuição destas moléculas no desenvolvimento da pele humana foi investigada e associada com os marcadores de diferenciação, Citoqueratinas (CK) e involucrina (INV). Método: Usando a técnica de imunoistoquímica foram investigadas as proteínas E- e P- caderinas, integrinas beta- 1 e -4, CK 10, CK 14 e INV em fragmentos de pele de várias regiões corpóreas de 7 fetos humanos (semana gestacional de 4 a 24, todos pesando até 500 g). Resultados: Na fase inicial do desenvolvimento, integrinas beta-1 e -4 and E- and P- caderinas estavam presentes na membrana plasmática das células epiteliais em todos as camadas do epitélio. CK14 e CK10 foram observadas em todas as camadas epiteliais e a INV fracamente detectada em células da camada mais superficial. Em estágios mais avançados, integrinas foram detectadas em todas as camadas epiteliais, com expressão polarizada principalmente na camada basal. E- caderina foi detctada em todas as camadas, menos no estrato cornificado e a P- caderina foi observada em camadas mais profundas do epitélio. CK14 estava presente na camada basal, CK 10 no estrato suprabasal e a INV foi observada no estrato cornificado. Conclusão: Caderinas e integrinas são essenciais para o desenvolvimento da pele, sendo espacialmente e temporalmente regulados. Suas expressões são relatas com a expressão da maturação de marcadores da epiderme. / Introduction: Cadherins and integrins are important for maintenance of tissue integrity and in signal transduction during skin development. Distribution of these molecules in human skin development was investigated and associated with markers of differentiation, cytokeratins (CK) and involucrin (INV). Methods: Using immunohistochemistry expression of E- and P- cadherins, integrins beta-1 and -4, CK10, CK 14 and INV was assessed in skin fragments of 7 human fetuses (gestacional weeks ranged from 4 to 24, all weighing up to 500 g). Results: At initial phases of development, integrins beta-1 and -4 and E- and P- cadherins were present on epithelial cell membranes in all layers. CK 14 and CK 10 were expressed in all epithelial layers and INV weakly detected in the superficial layer. In more advanced stages, integrins were detected in all layers, but a marked polarized expression was seen in basal layer. E- cadherin was detected in all layers, but the cornified stratum and P- cadherin were observed in the lower layers. CK 14 was expressed in layer, CK 10 in suprabasal stratum and INV was observed in cornified layer. Conclusions: Cadherins and integrins are essential for skin development, being spatially and temporally regulated. Their expression is related with the expression of maturation markers of the epidermis.

Introdução: Caderinas e integrinas são importantes para a manutenção da integridade tecidual e transdução de sinal durante o desenvolvimento da pele. A distribuição destas moléculas no desenvolvimento da pele humana foi investigada e associada com os marcadores de diferenciação, Citoqueratinas (CK) e involucrina (INV). Método: Usando a técnica de imunoistoquímica foram investigadas as proteínas E- e P- caderinas, integrinas beta- 1 e -4, CK 10, CK 14 e INV em fragmentos de pele de várias regiões corpóreas de 7 fetos humanos (semana gestacional de 4 a 24, todos pesando até 500 g). Resultados: Na fase inicial do desenvolvimento, integrinas beta-1 e -4 and E- and P- caderinas estavam presentes na membrana plasmática das células epiteliais em todos as camadas do epitélio. CK14 e CK10 foram observadas em todas as camadas epiteliais e a INV fracamente detectada em células da camada mais superficial. Em estágios mais avançados, integrinas foram detectadas em todas as camadas epiteliais, com expressão polarizada principalmente na camada basal. E- caderina foi detctada em todas as camadas, menos no estrato cornificado e a P- caderina foi observada em camadas mais profundas do epitélio. CK14 estava presente na camada basal, CK 10 no estrato suprabasal e a INV foi observada no estrato cornificado. Conclusão: Caderinas e integrinas são essenciais para o desenvolvimento da pele, sendo espacialmente e temporalmente regulados. Suas expressões são relatas com a expressão da maturação de marcadores da epiderme. / Introduction: Cadherins and integrins are important for maintenance of tissue integrity and in signal transduction during skin development. Distribution of these molecules in human skin development was investigated and associated with markers of differentiation, cytokeratins (CK) and involucrin (INV). Methods: Using immunohistochemistry expression of E- and P- cadherins, integrins beta-1 and -4, CK10, CK 14 and INV was assessed in skin fragments of 7 human fetuses (gestacional weeks ranged from 4 to 24, all weighing up to 500 g). Results: At initial phases of development, integrins beta-1 and -4 and E- and P- cadherins were present on epithelial cell membranes in all layers. CK 14 and CK 10 were expressed in all epithelial layers and INV weakly detected in the superficial layer. In more advanced stages, integrins were detected in all layers, but a marked polarized expression was seen in basal layer. E- cadherin was detected in all layers, but the cornified stratum and P- cadherin were observed in the lower layers. CK 14 was expressed in layer, CK 10 in suprabasal stratum and INV was observed in cornified layer. Conclusions: Cadherins and integrins are essential for skin development, being spatially and temporally regulated. Their expression is related with the expression of maturation markers of the epidermis.

Optimiser le diagnostic paraclinique prédictif et non invasif du déficit en cellules souches limbiques (DCSL) : in vitro après empreinte cytologique (EC) par la recherche immunohistochimique (IH) de marqueurs pertinents et par reverse-transcription polymerase chain reaction (RT-PCR), technique de haute sensibilité ; in vivo par microscopie confocale (MCIV). Matériel et Méthodes: La preuve diagnostique de DCSL est la présence de cellules conjonctivales au sein de la cornée, la persistance de cellules cornéennes signant un DCSL partiel. L'EC a été standardisée. La spécificité de chacun des marqueurs cornéens ou conjonctivaux sélectionnés a été recherchée sur des tissus normaux avant d'aborder une étude prospective monocentrique, sur 22 yeux de 18 patients cliniquement suspects de DCSL. Les cellules épithéliales de la cornée centrale étaient recueillies par EC puis transférées sur lame. L'expression des marqueurs de différentiation conjonctivale (K7, K13, K19, MUC5AC) et cornéenne (K12) a été recherchée par IH sur les 22 EC et celle de la MUC5AC par RT-PCR sur 4 d'entre elles. Enfin, la cornée et le limbe de 7 patients ont étés analysés par MCIV. La concordance entre les techniques est évaluée. Conclusion: Ces techniques complémentaires dépendent de l'équipement du service et de l'accessibilité à un laboratoire compétent. Un organigramme décisionnel a été établi pour permettre de faire un diagnostic fiable de DCSL, les examens paracliniques étant inutiles dans certains cas. La recherche IH de kératines conjonctivales K7/K13 et/ou la détection de MUC5AC par RT-PCR sur cellules cornéennes recueillies par EC sont des techniques diagnostiques de haute valeur scientifique, tandis que l'IH K12/MUC5AC doit être abandonnée pour manque de sensibilité et celle de K3/K19 pour manque de spécificité. La MCIV, quand elle est réalisable, est une technique hautement sensible qui permet une quantification du degré de sévérité de la maladie avec une forte concordance avec les autres examens / Purpose: to optimize minimally invasive techniques for diagnosing limbal stem cell deficiency: in vitro after impression cytology (IC) by means of immunocytochemical detection of relevant markers and reverse-transcription polymerase chain reaction (RT PCR), an highly sensitive method; in vivo by confocal microscopy (IVCM). Material and Methods: Presence of conjunctival cells in central cornea was diagnosis proof of LSCD, whereas corneal epithelial cells’ remaining traduces partial LSCD. IC was labeled. Corneal or conjunctival specificity of each marker was previously assessed on healthy tissues. In a prospective case control observational study, 22 eyes of 18 patients clinically suspected of LSCD were enrolled. Epithelial cells from central cornea were collected by IC. Conjunctival (K7, K13, K19, MUC5AC) and corneal (K12) differentiation markers were assessed by immunocytochemistry on each of 22 eyes and MUC5AC RT-PCR was assessed for 4 of them. Cornea and limbus of 7 eyes were assessed by IVCM. The inter-examination agreement was determined. Conclusion: These techniques require skilled technicians and laboratory facilities. We propose a decision tree model to provide unfailing LSCD diagnosis, complementary examinations being sometimes useless. Clinical examination can lead to LSCD misdiagnosis. Immunostaining of conjunctival keratins K7 and K13 as well as MUC5AC detection by RT-PCR are highly effective methods whereas MUC5AC/K12 immuno staining are not sensible and both K3 and K19 are not specific. IVCM of great sensitivity if realizable allows quantification of LSCD severity. Combining both methods provides in every case unfailing diagnosis of LSCD and evaluation of the extent of the disease with high agreement