The limbal stem cell population is located in the limbal junctional zone between the cornea and the conjunctiva, and is responsible for maintaining the corneal epithelium. Damage to the limbal stem cell population results in a condition known as limbal stem cell deficiency (LSCD), which is characterised by conjunctivalisation of the cornea, visual impairment and persistent irritation. To treat LSCD, an alternative source of human limbal epithelial (HLE) cells must be transplanted back onto the diseased cornea. Limbal tissue grafts have had a moderate degree of success. However, autologous grafts risk damage to the healthy eye, whilst allogeneic grafts are susceptible to immunological rejection. Cultured HLE grafts offer a promising alternative to whole tissue grafts. The production of cultured HLE grafts involves the removal of a small (1-2 mm2) biopsy from the patient’s healthy limbus, followed by ex vivo expansion to produce an epithelial sheet, which is subsequently transplanted onto the damaged corneal surface. However, the production of cultured HLE grafts usually requires the addition of animal-derived products during cell culture. Animal-derived components, such as foetal bovine serum (FBS) and murine 3T3 feeder cells, introduce the patient to potential crossspecies infection and immune responses to xenogeneic antigens. Consequently, the overall aim of this project has been to develop a culture technique free of xenogeneic products for the establishment and propagation of HLE cells. To achieve this aim, alternatives to FBS in the culture medium and 3T3 feeder cells were pursued. A defined serum-free medium (SFM) containing vitronectin (VN), insulin-like growth factor binding protein 3 (IGFBP3), insulin-like growth factor-I (IGF-I), and epidermal growth factor (EGF) was investigated as an alternative to serumsupplemented medium (SSM) for HLE cell culture. Initial studies focused on the effects of these growth factors on HLE cell metabolic activity and migration. Metabolic activity was primarily stimulated by IGF-I and EGF, with the combination of IGF-I and EGF in solution stimulating metabolic activity to a significantly greater extent than the SSM positive control (p = 0.006). HLE cell migration was also effected by combinations of VN, IGFBP3, IGF-I and EGF. Migration was stimulated above the SFM negative control by the combination of IGFBP3 and IGF-I either with or without the addition of EGF. However, the presence of VN was required for optimal migratory responses (p < 0.003). Hepatocyte growth factor (HGF) and keratinocyte growth factor (KGF) were also investigated as additional components to the SFM formulation. HGF significantly stimulated HLE cell metabolic activity and migration (p < 0.02). In contrast, KGF did not significantly stimulate either HLE cell metabolic activity or migration. The addition of either HGF or KGF to the SFM supplemented with VN, IGFBP3, IGF-I and EGF did not significantly enhance the metabolic activity of HLE cells. Therefore, HGF and KGF were no longer pursued as additional components to the SFM formulation. Additional studies were conducted to examine the efficacy of replacing murine 3T3 feeder cells with human ocular stromal cells during HLE cell culture. Initially, stromal cells were isolated from the cornea, limbus and sclera to determine whether there were differences between these stromal cell populations. The results indicated that scleral stromal cells had a significantly larger area and perimeter than either corneal or limbal stromal cells (p < 0.001). Scleral stromal cells were also significantly more rounded than either corneal or limbal stromal cells, as determined by the elliptical factor equation (p < 0.001). Immunocytochemistry also revealed that scleral stromal cells expressed significantly more of the myofibroblast marker ..- smooth muscle actin than either corneal or limbal stromal cells (p < 0.001), and significantly less of the fibroblast/myofibroblast marker Thy-1 than corneal or limbal stromal cells (p < 0.001). Therefore, scleral stromal cells were identified as different in comparison to corneal and limbal stromal cells. Primary HLE cells were cultured with irradiated corneal, limbal and scleral stromal cells. HLE cultures established with either corneal or limbal stromal feeder cells contained more cellular protein (as measured by rhodamine B dye absorbance) than cultures established without feeder cells (p < 0.001). The colony forming efficiency (CFE) of HLE cells established with corneal or limbal stromal feeder cells was also significantly greater than HLE cells established without feeder cells (p < 0.001). In contrast, HLE cultures established with scleral stromal feeder cells contained low levels of cellular protein and had a low CFE, which was not significantly different to the HLE cultures established without feeder cells. Immunocytochemistry indicated that HLE cultures established with scleral feeder cells also showed lower expression of the stem cell markers ABCG2 and C/EBP ... These results suggest that freshly isolated HLE cells can be cultured with irradiated corneal or limbal stromal cells as a replacement for murine 3T3 feeder cells. Finally, the SFM supplemented with VN+IGFBP3+IGF-I+EGF was combined with limbal stromal feeder cells, and examined as a culture technique free of animalderived products. Freshly isolated HLE cells established in SFM supplemented with VN+IGFBP3+IGF-I+EGF and limbal feeder cells contained a similar amount of cellular protein (as measured by crystal violet dye absorbance) when compared to the SSM+3T3 positive control. In addition, the CFE of freshly isolated HLE cells established in VN+IGFBP3+IGF-I+EGF and limbal feeder cells was significantly higher than the SSM+3T3 positive control (p = 0.004). However, a live/dead assay revealed a reduced HLE cell viability in SFM supplemented with VN+IGFBP3+IGFI+ EGF and limbal feeder cells after seven days in culture. In addition, immunocytochemistry demonstrated a lower expression of the stem cell markers ABCG2 and C/EBP .. in the SFM treatment with limbal feeder cells. Therefore, freshly isolated HLE cells can be cultured in SFM supplemented with VN+IGFBP3 +IGF-I+EGF and limbal feeder cells. However, this culture technique is less likely to support the growth of immature limbal stem cells when compared to the SSM+3T3 positive control. Overall, this research has attempted to create a culture system free of animal-derived products for the production of cultured HLE grafts to treat limbal stem cell deficiency. The results show that HLE cells respond to a serum-free medium formulation containing VN+IGFBP3+IGF-I+EGF. In addition, this culture medium can be combined with irradiated stromal cells isolated from the limbus to support HLE culture production. However, the combination of VN+IGFBP3+IGF-I+EGF and limbal feeder cells demonstrated a reduced viability, which indicates that further refinement of the formulation is required. This thesis has also demonstrated differences between stromal cells isolated from the cornea, limbus, and sclera, and has generated knowledge which may impact on the understanding of stromalepithelial regulation.

OBJETIVOS: Determinar a correlação entre a completa regeneração da membrana basal epitelial (MBE) e o desaparecimento de miofibroblastos do estroma anterior e consequente restauração da transparência corneana após diferentes mecanismos de trauma em coelhos. MÉTODOS: Foram utilizados 32 coelhos que tiveram um de seus olhos incluídos em um dos três grupos de estudo: (1) -9 dioptrias (D) ceratectomia fotorrefrativa (PRK), (2) Incisões corneanas verticais de espessura parcial (350 um), ou (3) Ceratite bacteriana, enquanto os olhos contralaterais compuseram o grupo controle. Os animais foram examinados, sacrificados, e tiveram suas córneas analisadas em diferentes momentos afim de investigar com detalhes o processo de cicatrização corneano usando técnicas de imunohistoquímica (IHQ) e microscopia de transmissão eletrônica (MTE). RESULTADOS: No grupo \"-9D PRK\", as córneas apresentavam opacidade corneana densa e nenhuma evidência de regeneração da MBE 1 mês após a cirurgia. Dois meses após a cirurgia, no entanto, pequenas áreas de córnea transparente começaram a surgir em meio à opacidade difusa, correspondendo a pequenas ilhas de MBE completamente regenerada. Após 4 meses da cirurgia a MBE estava completamente regenerada e a transparência corneana havia sido reestabelecida na região ablada pelo laser. No grupo \"incisões corneanas\", o par de densas opacidades corneanas lineares observadas após 1 mês do procedimento tornou-se progressivamente mais tênue ao longo dos próximos 2 meses. A ultraestrutura da MBE estava completamente regenerada e não houve formação de miofibroblastos no local das incisões 1 mês após o procedimento, inclusive ao redor dos plugs epiteliais que se estendiam até o estroma. No grupo \"ceratite bacteriana\", as córneas que haviam sido infectadas apresentaram opacidade densa, vascularização, miofibroblastos em toda a sua espessura, e nenhuma evidência de regeneração da MBE 1 mês após a infecção. Observou-se ao longo dos próximos 3 meses substancial redução da opacidade, evidências ultraestruturais de regeneração da MBE, e desaparecimento de miofibroblastos das porções mais anteriores do estroma, persistindo apenas nas regiões do estroma mais posterior nas quais o endotélio e a membrana de Descemet encontravam-se lesadas. CONCLUSÃO: No modelo animal apresentado, a resolução espontânea da opacidade corneana tardia mediada por miofibroblastos após a ablação com excimer laser ou ceratites infeciosas graves é desencadeada pela completa regeneração da estrutura e função da MBE. As incisões corneanas de espessura parcial em coelhos, no entanto, cicatrizam sem geração de miofibroblastos devido à completa regeneração da MBE após 1 mês do procedimento. Determinou-se, portanto, a correlação entre a reparação da membrana basal epitelial e a consequente redução da opacidade e restauração da transparência corneana / PURPOSE: To determine the correlation between epithelial basement membrane (EBM) regeneration and the disappearance of myofibroblasts from anterior stroma and consequent restoration of corneal transparency after different types of injury in rabbits. METHODS: Thirty-two rabbits had one of their eyes included in one of the 3 study groups: (1) -9 diopters (D) photorefractive keratectomy (PRK), (2) Two vertical partial-thickness (350 um) corneal incisions, or (3) Bacterial keratitis, whereas the opposite eyes served as unwounded control group. The animals were examined, sacrificed, and had their corneas analysed in different time points in order to investigate the corneal wound healing process using immunohistochemistry and transmission electron microscopy. RESULTS: In the \"-9D PRK\" group, corneas at 1 month after surgery had dense corneal opacity and no evidence of regenerated EBM. However, by 2 months after surgery small areas of stromal clearing began to appear within the confluent opacity, and these corresponded to small islands of normally regenerated EBM. By 4 months after surgery, the EBM was fully regenerated and the corneal transparency was completely restored in the ablated zone. In the \"corneal incisions\" group, the two dense, linear corneal opacities observed at 1 month after the procedure progressively faded during the next 2 months. The EBM ultrastructure was fully regenerated and there were no myofibroblasts at the site of the incisions by 1 month after the procedure, including around the epithelial plugs that extended into the stroma. In the \"bacterial keratitis\" group, all the corneas that have been infected presented dense stromal scarring, vascularization, myofibroblasts in the full stromal thickness and no evidence of EBM regeneration by 1 month after the infection. There was a definite decrease in opacity during the next 3 months, besides ultrastructural evidence of EBM regeneration and disappearance of myofibroblasts in the most anterior part of the stroma, which persisted only in the most posterior stroma where the endothelium and Descemet\'s membrane were damaged. CONCLUSION: In the rabbit model, spontaneous resolution of myofibroblast-mediated corneal opacity (fibrosis) after high correction PRK or infectious keratitis is triggered by regeneration of normal EBM structure and function. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by 1 month after the injury. Therefore, it has been determined the correlation between the EBM regeneration and the restoration of corneal transparency after different types of corneal injury

OBJETIVOS: Determinar a correlação entre a completa regeneração da membrana basal epitelial (MBE) e o desaparecimento de miofibroblastos do estroma anterior e consequente restauração da transparência corneana após diferentes mecanismos de trauma em coelhos. MÉTODOS: Foram utilizados 32 coelhos que tiveram um de seus olhos incluídos em um dos três grupos de estudo: (1) -9 dioptrias (D) ceratectomia fotorrefrativa (PRK), (2) Incisões corneanas verticais de espessura parcial (350 um), ou (3) Ceratite bacteriana, enquanto os olhos contralaterais compuseram o grupo controle. Os animais foram examinados, sacrificados, e tiveram suas córneas analisadas em diferentes momentos afim de investigar com detalhes o processo de cicatrização corneano usando técnicas de imunohistoquímica (IHQ) e microscopia de transmissão eletrônica (MTE). RESULTADOS: No grupo \"-9D PRK\", as córneas apresentavam opacidade corneana densa e nenhuma evidência de regeneração da MBE 1 mês após a cirurgia. Dois meses após a cirurgia, no entanto, pequenas áreas de córnea transparente começaram a surgir em meio à opacidade difusa, correspondendo a pequenas ilhas de MBE completamente regenerada. Após 4 meses da cirurgia a MBE estava completamente regenerada e a transparência corneana havia sido reestabelecida na região ablada pelo laser. No grupo \"incisões corneanas\", o par de densas opacidades corneanas lineares observadas após 1 mês do procedimento tornou-se progressivamente mais tênue ao longo dos próximos 2 meses. A ultraestrutura da MBE estava completamente regenerada e não houve formação de miofibroblastos no local das incisões 1 mês após o procedimento, inclusive ao redor dos plugs epiteliais que se estendiam até o estroma. No grupo \"ceratite bacteriana\", as córneas que haviam sido infectadas apresentaram opacidade densa, vascularização, miofibroblastos em toda a sua espessura, e nenhuma evidência de regeneração da MBE 1 mês após a infecção. Observou-se ao longo dos próximos 3 meses substancial redução da opacidade, evidências ultraestruturais de regeneração da MBE, e desaparecimento de miofibroblastos das porções mais anteriores do estroma, persistindo apenas nas regiões do estroma mais posterior nas quais o endotélio e a membrana de Descemet encontravam-se lesadas. CONCLUSÃO: No modelo animal apresentado, a resolução espontânea da opacidade corneana tardia mediada por miofibroblastos após a ablação com excimer laser ou ceratites infeciosas graves é desencadeada pela completa regeneração da estrutura e função da MBE. As incisões corneanas de espessura parcial em coelhos, no entanto, cicatrizam sem geração de miofibroblastos devido à completa regeneração da MBE após 1 mês do procedimento. Determinou-se, portanto, a correlação entre a reparação da membrana basal epitelial e a consequente redução da opacidade e restauração da transparência corneana / PURPOSE: To determine the correlation between epithelial basement membrane (EBM) regeneration and the disappearance of myofibroblasts from anterior stroma and consequent restoration of corneal transparency after different types of injury in rabbits. METHODS: Thirty-two rabbits had one of their eyes included in one of the 3 study groups: (1) -9 diopters (D) photorefractive keratectomy (PRK), (2) Two vertical partial-thickness (350 um) corneal incisions, or (3) Bacterial keratitis, whereas the opposite eyes served as unwounded control group. The animals were examined, sacrificed, and had their corneas analysed in different time points in order to investigate the corneal wound healing process using immunohistochemistry and transmission electron microscopy. RESULTS: In the \"-9D PRK\" group, corneas at 1 month after surgery had dense corneal opacity and no evidence of regenerated EBM. However, by 2 months after surgery small areas of stromal clearing began to appear within the confluent opacity, and these corresponded to small islands of normally regenerated EBM. By 4 months after surgery, the EBM was fully regenerated and the corneal transparency was completely restored in the ablated zone. In the \"corneal incisions\" group, the two dense, linear corneal opacities observed at 1 month after the procedure progressively faded during the next 2 months. The EBM ultrastructure was fully regenerated and there were no myofibroblasts at the site of the incisions by 1 month after the procedure, including around the epithelial plugs that extended into the stroma. In the \"bacterial keratitis\" group, all the corneas that have been infected presented dense stromal scarring, vascularization, myofibroblasts in the full stromal thickness and no evidence of EBM regeneration by 1 month after the infection. There was a definite decrease in opacity during the next 3 months, besides ultrastructural evidence of EBM regeneration and disappearance of myofibroblasts in the most anterior part of the stroma, which persisted only in the most posterior stroma where the endothelium and Descemet\'s membrane were damaged. CONCLUSION: In the rabbit model, spontaneous resolution of myofibroblast-mediated corneal opacity (fibrosis) after high correction PRK or infectious keratitis is triggered by regeneration of normal EBM structure and function. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by 1 month after the injury. Therefore, it has been determined the correlation between the EBM regeneration and the restoration of corneal transparency after different types of corneal injury