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Skin biopsy analysis in diabetic neuropathy

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Skin biopsies and estimation of intraepidermal nerve fiber density (IENFD) upon immunohistological staining have proven useful in the diagnosis of diabetic neuropathy (DN) with good diagnostic performance. They can be repeated over time to follow disease progression or to follow efficacy of an intervention. However, the low IENFD observed in patients does not seem to explain why some DN patients develop neuropathic pain while others do not. It is therefore important to extract further information from the biopsies. In addition, immunohistological stainings are difficult to standardize, and processing and staining protocols of skin biopsies are heterogeneous, often resulting in varying results between laboratories. This chapter discusses in detail the advantages and disadvantages of skin biopsies, what they can and cannot do, and gives a detailed protocol on how to take and process the skin biopsies and how to stain the IENFs. Lastly, the chapter provides a number of examples of promising biomarkers that may increase our knowledge of why some patients develop painful DN.

Original languageEnglish
Title of host publicationDiabetic Neuropathy
Number of pages12
Publication year2022
ISBN (print)9780128206706
ISBN (electronic)9780128206690
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Inc. All rights reserved.

    Research areas

  • Diabetes, Diabetic neuropathy, IENFD, Neuropathic pain, PGP 9.5, Skin biopsy

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