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ohns Hopkins University ohns Hopkins University partment of Neurology partment of Neurology

Skin Biopsy Technique for Cutaneous Nerve Evaluation

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

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Page 1: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Johns Hopkins UniversityJohns Hopkins UniversityDepartment of NeurologyDepartment of Neurology

Page 2: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 3: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 4: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 5: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 6: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 7: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 8: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 9: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Location of skinLocation of skinbiopsies:biopsies:

To determineTo determineLength dependent neuropathyLength dependent neuropathy

Distal legDistal leg(lateral)(lateral)

Distal thighDistal thigh(lateral)(lateral)

Proximal thighProximal thigh(lateral)(lateral)

**

Distal thigh biopsy:Distal thigh biopsy:10cm proximal to patella10cm proximal to patellaLateral aspectLateral aspect

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Page 10: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Grasp EDGE of deep dermisGrasp EDGE of deep dermisDo NOT touch epidermisDo NOT touch epidermis

Page 11: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation
Page 12: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

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Page 13: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

ImmunohistochemistryImmunohistochemistry

PGP9.5 PGP9.5 proteinprotein on on nervenerve

(antigen)(antigen)

RabbitRabbitAnti-PGPAnti-PGPantibodiesantibodies Goat anti-rabbit antibodiesGoat anti-rabbit antibodies

BLUE color!BLUE color!

NerveNerve

Page 14: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

DermisDermis

EpidermisEpidermis

Stratum Stratum

corneumcorneum SensorySensory

nervesnerves

Page 15: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

NormalNormalcontrolcontrol

LengthLengthdependentdependentdying backdying back

sensorysensoryneuropathyneuropathy

Page 16: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Intra-epidermalIntra-epidermalunmyelinatedunmyelinatedsensory nervesensory nerve

InnervatedInnervatedsweat glandssweat glands

autonomicautonomicfibersfibers

InnervatedInnervatedhair folliclehair follicle

andanderector pilli muscleerector pilli musclethermoregulationthermoregulation

DenervatedDenervatedHIVHIV

sweat glandssweat glandsdysautonomiadysautonomia

AutonomicAutonomicnervesnerves

next to anext to ablood vesselblood vessel

thermoregulationthermoregulation

Meissner’sMeissner’scorpusclecorpusclefine touch:fine touch:

shape, textureshape, texturedensitydensity

mechanoreceptormechanoreceptorproprioceptionproprioception

Page 17: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Johns Hopkins Cutaneous Nerve LabJohns Hopkins Cutaneous Nerve LabClinical lab for diagnostic purposesClinical lab for diagnostic purposes

CAP, JCAHO, CQI, CLIA, HIPAA, OSEH, training, parallel testingCAP, JCAHO, CQI, CLIA, HIPAA, OSEH, training, parallel testing

Pharmaceutical clinical trials research lab (multi-cohort center, Pharmaceutical clinical trials research lab (multi-cohort center, core lab)core lab)

DiabetesDiabetesHIV – USA, Uganda, ThailandHIV – USA, Uganda, ThailandAmyloid - InternationalAmyloid - InternationalSIV – Primate studies – HAART – D drugsSIV – Primate studies – HAART – D drugsLeprosy – India/Human – Louisiana/ArmadilloLeprosy – India/Human – Louisiana/ArmadilloToxic chemotherapeutic and HIV drugsToxic chemotherapeutic and HIV drugsInvestigators meetings, online technical protocol trainingInvestigators meetings, online technical protocol training

Basic research labBasic research labNerve degeneration and regenerationNerve degeneration and regenerationStereologic models, Confocal, EM, Palm Laser, Micro ArrayStereologic models, Confocal, EM, Palm Laser, Micro ArrayCapsaicin modelsCapsaicin modelsSIV - pigtail macaque and rhesus monkeysSIV - pigtail macaque and rhesus monkeysRestless leg, sclerodermaRestless leg, sclerodermaNIH, private, pharmaceutical fundsNIH, private, pharmaceutical fundsTransgenic animal modelsTransgenic animal models

Page 18: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Johns Hopkins Cutaneous Nerve LabJohns Hopkins Cutaneous Nerve LabClinical diagnostic labClinical diagnostic lab

Clinical licenses and monitoring through Dept of PathologyClinical licenses and monitoring through Dept of Pathology

Johns Hopkins Medical Laboratory – certified through Johns Hopkins Medical Laboratory – certified through Johns Hopkins Continuous Quality Improvement ProgramJohns Hopkins Continuous Quality Improvement Program

CLIA – 21D0709511CLIA – 21D0709511

MD State Licensed Medical Lab #471MD State Licensed Medical Lab #471

CAP certified lab LAP# 1353003, AU-ID# 1008616CAP certified lab LAP# 1353003, AU-ID# 1008616

HIPAA, Fire, Chemical Safety, DOT IATA shipping compliantHIPAA, Fire, Chemical Safety, DOT IATA shipping compliant

Pharmaceutical research labPharmaceutical research lab

FDA compliant - 21 CFR Part 11FDA compliant - 21 CFR Part 11

Core laboratory for all participating pharmaceutical studiesCore laboratory for all participating pharmaceutical studies

Page 19: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation

Study ConsiderationsStudy Considerations

Participating centers need to be properly Participating centers need to be properly trainedtrained

Lines of communication must be open Lines of communication must be open between centers, monitors and lab – Consider between centers, monitors and lab – Consider IVRS onlineIVRS online

Immediate feedback is importantImmediate feedback is important

Attention to detail – Quality Control for Attention to detail – Quality Control for biopsies and requisition formsbiopsies and requisition forms

Database management and data sets at Database management and data sets at study endstudy end

Page 20: Skin Biopsy Technique for  Cutaneous  Nerve Evaluation