       Document 0264
 DOCN  M9620264
 TI    Cutaneous innervation in sensory neuropathies: evaluation by skin
       biopsy.
 DT    9602
 AU    McCarthy BG; Hsieh ST; Stocks A; Hauer P; Macko C; Cornblath DR; Griffin
       JW; McArthur JC; Department of Neurology, Johns Hopkins University
       School of; Medicine, Baltimore, MD, USA.
 SO    Neurology. 1995 Oct;45(10):1848-55. Unique Identifier : AIDSLINE
       MED/96022162
 AB    OBJECTIVE: To use punch skin biopsies to evaluate the loss of
       intra-epidermal nerve fibers in sensory neuropathies. BACKGROUND:
       Previous assessments of epidermal nerve fibers have been constrained by
       relatively insensitive staining techniques and variability in
       quantification. METHODS: Punch skin biopsies were performed on the heel
       and leg of HIV-seronegative controls, HIV-seropositive individuals
       without neuropathy, and patients with sensory neuropathies, including
       HIV-seronegative and HIV-positive individuals. After formalin fixation,
       50-microns free-floating sections were stained with a monoclonal
       antibody to neuron-specific ubiquitin hydrolase, PGP9.5. The number of
       intraepidermal fibers/mm in at least three sections from each patient
       was counted by one observer blinded to site and clinical status.
       RESULTS: Dermal and epidermal nerve fibers were readily identified and
       quantified. The immunostaining technique reliably demonstrated a dermal
       plexus of myelinated and unmyelinated fibers parallel to the surface of
       the skin. In the epidermis, unmyelinated fibers ascended vertically
       between the keratinocytes to reach the stratum corneum. The number of
       intra-epidermal fibers/mm in the distal leg (mean +/- SEM) was 17.84 +/-
       3.03 in seven HIV-seronegative controls. Epidermal fiber number was
       significantly reduced (p = 0.01) in five HIV-infected patients with
       sensory neuropathies associated with didanosine or zalcitabine therapy
       (1.07 +/- 0.40) and in eight HIV-seronegative patients with sensory
       neuropathies (3.1 +/- 3.1). Four of five neurologically normal
       HIV-seropositive subjects had reduced numbers of epidermal fibers,
       suggesting a subclinical neuropathy. Serial biopsies in one individual
       demonstrated the evolution of degenerating epidermal fibers after
       development of zalcitabine-induced sensory neuropathy. CONCLUSION: Skin
       biopsies stained with the sensitive panaxonal marker anti-PGP9.5
       demonstrated significant reduction in intraepidermal fibers in sensory
       neuropathies. This simple and repeatable technique is a reliable method
       for quantitation of small cutaneous sensory fibers. In addition, skin
       biopsies may be useful in assessing the course and spatial distribution
       of involvement in peripheral nerve disease.
 DE    Adult  Aged  Aged, 80 and over  Biopsy  Human  Middle Age  Nerve
       Fibers/PATHOLOGY  Peripheral Nervous System Diseases/*PATHOLOGY
       *Sensation  Skin/*INNERVATION/PATHOLOGY  Staining  Support, Non-U.S.
       Gov't  Support, U.S. Gov't, P.H.S.  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

