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Skin Biopsy Technique for Cutaneous Nerve Evaluation

Johns Hopkins University Department of Neurology. Skin Biopsy Technique for Cutaneous Nerve Evaluation. Johns Hopkins Medical Institution. Cancer Research Building.

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Skin Biopsy Technique for Cutaneous Nerve Evaluation

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  1. Johns Hopkins University Department of Neurology Skin BiopsyTechnique for Cutaneous Nerve Evaluation

  2. Johns HopkinsMedical Institution

  3. Cancer Research Building

  4. Johns HopkinsNeurologyCutaneousNerveLab30,000+ biopsiesprocessed to dateState of the art labsClinical diagnosticPharmaceutical researchBasic science

  5. Why Skin?

  6. Biopsy Supplies

  7. Location of skin biopsies: To determine Length dependent neuropathy Distal leg (lateral) Distal thigh (lateral) Proximal thigh (lateral) Distal thigh biopsy: 10cm proximal to patella Lateral aspect * ----

  8. Use of counter traction and single slice to obtain biopsy Grasp EDGE of deep dermis Do NOT touch epidermis

  9. &&&& ****

  10. Rabbit Anti-PGP antibodies Goat anti-rabbit antibodies PGP9.5 protein on nerve (antigen) Immunohistochemistry BLUE color! Nerve

  11. PGP9.5 Immunohistochemistry Stratum corneum Sensory nerves Epidermis Dermis

  12. Length dependent dying back sensory neuropathy Normal control

  13. Meissner’s corpuscle fine touch: shape, texture density mechanoreceptor proprioception Intra-epidermal unmyelinated sensory nerve Innervated sweat glands autonomic fibers Denervated HIV sweat glands dysautonomia Innervated hair follicle and erector pilli muscle thermoregulation Autonomic nerves next to a blood vessel thermoregulation

  14. Johns Hopkins Cutaneous Nerve Lab Clinical lab for diagnostic purposes CAP, JCAHO, CQI, CLIA, HIPAA, OSEH, training, parallel testing Pharmaceutical clinical trials research lab (multi-cohort center, core lab) Diabetes HIV – USA, Uganda, Thailand Amyloid - International SIV – Primate studies – HAART – D drugs Leprosy – India/Human – Louisiana/Armadillo Toxic chemotherapeutic and HIV drugs Investigators meetings, online technical protocol training Basic research lab Nerve degeneration and regeneration Stereologic models, Confocal, EM, Palm Laser, Micro Array Capsaicin models SIV - pigtail macaque and rhesus monkeys Restless leg, scleroderma NIH, private, pharmaceutical funds Transgenic animal models

  15. Johns Hopkins Cutaneous Nerve Lab • Clinical diagnostic lab • Clinical licenses and monitoring through Dept of Pathology • Johns Hopkins Medical Laboratory – certified through • Johns Hopkins Continuous Quality Improvement Program • CLIA – 21D0709511 • MD State Licensed Medical Lab #471 • CAP certified lab LAP# 1353003, AU-ID# 1008616 • HIPAA, Fire, Chemical Safety, DOT IATA shipping compliant • Pharmaceutical research lab • FDA compliant - 21 CFR Part 11 • Core laboratory for all participating pharmaceutical studies

  16. Study Considerations Participating centers need to be properly trained Lines of communication must be open between centers, monitors and lab – Consider IVRS online Immediate feedback is important Attention to detail – Quality Control for biopsies and requisition forms Database management and data sets at study end

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