Description
One histological hallmark of neuropathies is loss of intraepidermal nerve fibers, as shown by skin punch biopsy from the distal and proximal leg. While the procedure is fast and simple, even small but missteps may lead to clinically relevant misinterpretations. Following standardised guidelines for processing and analysing skin samples should be mandatory to ensure accurate data.
Even so, the literature is filled with heterogeneous and erroneous methodology, making comparison between studies difficult and, in worst cases, leading to inaccurate findings. Advance in methodology has carried skin biopsies far beyond the mere determination of nerve fiber density. It is, for example, possible to distinguish between somatosensory and autonomic nerve fibres, assess sweat gland innervation, quantify morphological abnormalities of the nerve fibers such as axonal swellings, and identify nerve fiber subtypes. Skin punch biopsy also allows the investigation of other cells such as keratinocytes, Langerhans cells, inflammatory cells, glia cells and many more.
This interactive workshop will teach the audience how to accurately obtain, process, and analyse skin punch biopsies for clinical and research purposes using short presentations, live demonstrations, pre-recorded videos, and on-stage microscopy.
Contributors
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Pall R. Karlsson, PhD
Pall Karlsson is Associate Professor at the Danish Pain Research Center at Aarhus University, Denmark, where he has been employed since 2009. Pall achieved a bachelor's degree in molecular biology from the University of Iceland, a master‘s degree in molecular biology from Aarhus University, and a PhD from the Department of Clinical Medicine at Aarhus University in 2013. He is responsible for the skin biopsy laboratory at Aarhus University and Aarhus University Hospital, overseeing both clinical and research-related skin biopsies. His research is focused on understanding why some - but not all - patients with diabetes develop neuropathic pain and identifying novel biomarkers of neuropathic pain. Pall has authored over 45 research papers, has ongoing international collaborations with several institutions in both Europe and the United States, and is a part of the International Diabetic Neuropathy Consortium (IDNC).
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Roy Freeman, M.B.Ch.B
Roy Freeman is Professor of Neurology at Harvard Medical School and Director of the Center for Autonomic and Peripheral Nerve Disorders in the Department of Neurology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. Roy's research and clinical interests are in the physiology and pathophysiology of the small nerve fibers and the autonomic nervous system. He achieved his M.B.Ch.B at the University of Cape Town Medical School in South Africa. Subsequently, he completed his neurology residency and served as chief resident in neurology at Brigham and Women’s Hospital and at the Beth Israel Hospital in Boston.
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Eleonora Galosi, MD, PhD
Eleonora Galosi is a Neurologist currently employed in the Department of Human Neuroscience at Sapienza University of Rome, Italy, where she has acquired skills in clinical, neurophysiological, and skin biopsy assessment, as well as the therapeutical management of patients suffering from peripheral nervous system diseases and neuropathic pain conditions. She has focused her research activity on intraepidermal innervation morphometry assessment by skin biopsy in different neuropathic pain conditions, getting experienced with skin samples immunohistochemical processing and morphometric analysis. She's currently carrying out diverse research projects based on nociceptive system assessment in distinct painful conditions, such as diabetic neuropathy, familiar amyloid polyneuropathy, Lupus Erythematosus Sistemicus associated neuropathy, trigeminal neuralgia, and fibromyalgia.