Quantification of myelinated endings and mechanoreceptors in human digital skin

We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calc...

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Published inAnnals of neurology Vol. 54; no. 2; pp. 197 - 205
Main Authors Nolano, Maria, Provitera, Vincenzo, Crisci, Claudio, Stancanelli, Annamaria, Wendelschafer-Crabb, Gwen, Kennedy, William Robert, Santoro, Lucio
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2003
Willey-Liss
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Online AccessGet full text
ISSN0364-5134
1531-8249
DOI10.1002/ana.10615

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Abstract We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calculated caliber, internodal and nodal length, and G‐ratio of the last four internodes of the myelinated endings. In our skin samples, we found a mean density of 59.0 ± 29.3 myelinated endings per square millimeter with a mean diameter of 3.3 ± 0.5μm and an internodal length of 79.1 ± 13.8μm. These findings indicate that Aβ fibers undergo drastic changes in their course from the nerve trunk to the target organ, with repeated branching and consequent tapering and shortening of internodal length. Our work demonstrates that skin biopsy can give information on the status of large myelinated endings as well as unmyelinated sensory and autonomic nerves. Since distal endings are primarily involved in distal axonopathy, skin biopsy can be more suitable than sural nerve biopsy to detect early abnormalities. In addition to diagnostic applications, this technique allows clarification of the mode of termination of Aβ fibers and their relationship with mechanoreceptors, leading to relevant electrophysiological speculations. Ann Neurol 2003
AbstractList We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calculated caliber, internodal and nodal length, and G-ratio of the last four internodes of the myelinated endings. In our skin samples, we found a mean density of 59.0 +/- 29.3 myelinated endings per square millimeter with a mean diameter of 3.3 +/- 0.5 microm and an internodal length of 79.1 +/- 13.8 microm. These findings indicate that Abeta fibers undergo drastic changes in their course from the nerve trunk to the target organ, with repeated branching and consequent tapering and shortening of internodal length. Our work demonstrates that skin biopsy can give information on the status of large myelinated endings as well as unmyelinated sensory and autonomic nerves. Since distal endings are primarily involved in distal axonopathy, skin biopsy can be more suitable than sural nerve biopsy to detect early abnormalities. In addition to diagnostic applications, this technique allows clarification of the mode of termination of Abeta fibers and their relationship with mechanoreceptors, leading to relevant electrophysiological speculations.
We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calculated caliber, internodal and nodal length, and G‐ratio of the last four internodes of the myelinated endings. In our skin samples, we found a mean density of 59.0 ± 29.3 myelinated endings per square millimeter with a mean diameter of 3.3 ± 0.5μm and an internodal length of 79.1 ± 13.8μm. These findings indicate that Aβ fibers undergo drastic changes in their course from the nerve trunk to the target organ, with repeated branching and consequent tapering and shortening of internodal length. Our work demonstrates that skin biopsy can give information on the status of large myelinated endings as well as unmyelinated sensory and autonomic nerves. Since distal endings are primarily involved in distal axonopathy, skin biopsy can be more suitable than sural nerve biopsy to detect early abnormalities. In addition to diagnostic applications, this technique allows clarification of the mode of termination of Aβ fibers and their relationship with mechanoreceptors, leading to relevant electrophysiological speculations. Ann Neurol 2003
We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calculated caliber, internodal and nodal length, and G-ratio of the last four internodes of the myelinated endings. In our skin samples, we found a mean density of 59.0 +/- 29.3 myelinated endings per square millimeter with a mean diameter of 3.3 +/- 0.5 microm and an internodal length of 79.1 +/- 13.8 microm. These findings indicate that Abeta fibers undergo drastic changes in their course from the nerve trunk to the target organ, with repeated branching and consequent tapering and shortening of internodal length. Our work demonstrates that skin biopsy can give information on the status of large myelinated endings as well as unmyelinated sensory and autonomic nerves. Since distal endings are primarily involved in distal axonopathy, skin biopsy can be more suitable than sural nerve biopsy to detect early abnormalities. In addition to diagnostic applications, this technique allows clarification of the mode of termination of Abeta fibers and their relationship with mechanoreceptors, leading to relevant electrophysiological speculations.We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition to epidermal nerve fibers, we quantified mechanoreceptors and their myelinated afferents. Using digital images and dedicated software, we calculated caliber, internodal and nodal length, and G-ratio of the last four internodes of the myelinated endings. In our skin samples, we found a mean density of 59.0 +/- 29.3 myelinated endings per square millimeter with a mean diameter of 3.3 +/- 0.5 microm and an internodal length of 79.1 +/- 13.8 microm. These findings indicate that Abeta fibers undergo drastic changes in their course from the nerve trunk to the target organ, with repeated branching and consequent tapering and shortening of internodal length. Our work demonstrates that skin biopsy can give information on the status of large myelinated endings as well as unmyelinated sensory and autonomic nerves. Since distal endings are primarily involved in distal axonopathy, skin biopsy can be more suitable than sural nerve biopsy to detect early abnormalities. In addition to diagnostic applications, this technique allows clarification of the mode of termination of Abeta fibers and their relationship with mechanoreceptors, leading to relevant electrophysiological speculations.
Author Kennedy, William Robert
Stancanelli, Annamaria
Crisci, Claudio
Wendelschafer-Crabb, Gwen
Provitera, Vincenzo
Santoro, Lucio
Nolano, Maria
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  fullname: Provitera, Vincenzo
  organization: Salvatore Maugeri Foundation, IRCCS, Center of Telese Terme, Italy
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  surname: Crisci
  fullname: Crisci, Claudio
  organization: Salvatore Maugeri Foundation, IRCCS, Center of Telese Terme, Italy
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  givenname: Annamaria
  surname: Stancanelli
  fullname: Stancanelli, Annamaria
  organization: Salvatore Maugeri Foundation, IRCCS, Center of Telese Terme, Italy
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  givenname: Gwen
  surname: Wendelschafer-Crabb
  fullname: Wendelschafer-Crabb, Gwen
  organization: Department of Neurology University of Minnesota, Minneapolis, MN
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  organization: Department of Neurology University of Minnesota, Minneapolis, MN
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  givenname: Lucio
  surname: Santoro
  fullname: Santoro, Lucio
  organization: Department of Neurological Sciences, University of Naples, Federico II, Naples, Italy
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Keywords Human
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Mechanoreceptor
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PublicationDecade 2000
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PublicationPlace_xml – name: Hoboken
– name: United States
PublicationTitle Annals of neurology
PublicationTitleAlternate Ann Neurol
PublicationYear 2003
Publisher Wiley Subscription Services, Inc., A Wiley Company
Willey-Liss
Publisher_xml – name: Wiley Subscription Services, Inc., A Wiley Company
– name: Willey-Liss
References Nolano M, Provitera V, Lullo F, et al. Meissner corpuscles and myelinated nerve fibers in human digital skin: a correlation with electrophysiological findings. J Peripher Nerv Syst 2001; 6: 165.
Castano P, Rumio C, Morini L, et al. Three-dimensional reconstruction of the Meissner's corpuscles of man after silver impregnation and immunofluorescence with PGP 9.5 antibodies using confocal scanning laser microscopy. J Anat 1995; 186: 261-270.
Vittadini G, Buonocore M, Colli G, et al. Alcoholic polyneuropathy: a clinical and epidemiological study. Alcohol Alcohol 2001; 36: 393-400.
Winkelmann RK. Cutaneous sensory nerves. Semin Dermatol 1988; 7: 236-268.
Caruso G, Massini R, Crisci C, et al. The relationship between electrophysiological findings, upper limb growth and histological features of median and ulnar nerves in man. Brain 1992; 115: 1925-1945.
Marolda M, Filla A, Giordano-Lanza G, et al. Diagnostic significance of pacinian corpuscle degeneration in Friedreich's ataxia. Acta Neurol 1980; 5: 373-381.
Paré M, Elde R, Mazurkiewicz JE, et al. The Meissner corpuscle revised: a multiafferented mechanoreceptor with nociceptor immunochemical properties. J Neurosci 2001; 21: 7236-7246.
Holland NR, Crawford TO, Hauer P, et al. Small-fiber sensory neuropathies: clinical course and neuropathology of idiopathic cases. Ann Neurol 1998; 44: 47-59.
Kennedy WR, Wendelschafer-Crabb G. The innervation of human epidermis. J Neurol Sci 1993; 115: 184-190.
Polydefkis M, Yiannoutsos CT, Cohen BA, et al. Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neurology 2002; 58: 115-119.
Caruso G, Nilsson J, Crisci C, et al. Sensory nerve findings by tactile stimulation of median and ulnar nerves in healthy subjects of different ages. Electroenceph Clin Neurophysiol 1993; 89: 392-398.
Nolano M, Provitera V, Lullo F, et al. Tactile stimulation and mechanoreceptors in sensory neuropathies. Neurol Sci 2001; 22: S31-S36.
Behse F. Morphometric studies on the human sural nerve. Acta Neurol Scand Suppl 1990; 82: 1-38.
Cauna N. Nerve supply and nerve endings in Meissner corpuscles. Am J Anat 1956; 99: 315.
McCarthy BG, Hsieh ST, Stocks MA, et al. Cutaneous innervation in sensory neuropathies: evaluation by skin biopsy. Neurology 1995; 45: 1848-1855.
Kennedy WR, Wendelschafer-Crabb G, Johnson T. Quantitation of epidermal nerves in diabetic neuropathy. Neurology 1996; 47: 1042-1048.
Dickens NW, Winkelmann RK, Mulder DW. Cholinesterase demonstration of dermal nerve endings in patients with impaired sensation. Neurology 1962; 13: 91-100.
Periquet MI, Novak V, Collins MP, et al. Painful sensory neuropathy: prospective evaluation using skin biopsy. Neurology 1999; 53: 1641-1647.
Nolano M, Provitera V, Crisci C, et al. Small fibers involvement in Friedreich's ataxia. Ann Neurol 2001; 50: 17-25.
Guinard D, Usson Y, Guillermet C, et al. PS-100 and NF 70-200 double immunolabeling for human digital skin Meissner corpuscles 3d imaging. J Histochem Cytochem 2000; 48: 295-302.
Wang L, Hilliges M, Jernberg T, et al. Protein gene product 9.5-immunoreactive nerve fibers and cell in human skin. Cell Tissue Res 1990; 261: 25-33.
Sherrington CS. On the anatomical constitution of nerves of skeletal muscles; with remarks on recurrent fibers in the ventral spinal root. J Physiol (Lond) 1894; 17: 211-258.
Caruso G, Nolano M, Lullo F, et al. Median nerve sensory responses evoked by tactile stimulation of the finger proximal and distal phalanx in normal subjects. Muscle Nerve 1994; 17: 269-275.
Holland NR, Stocks MA, Hauer P, et al. Intraepidermal nerve fiber density in patients with painful sensory neuropathy. Neurology 1997; 48: 708-711.
Ochoa J, Mair WPG. The normal sural nerve in man. I. Ultrastructure and numbers of fibres and cells. Acta Neuropathol (Berlin) 1969; 13: 197-216.
Halata Z, Munger BL. The terminal myelin segments of afferent axons to cutaneous mechanoreceptors. Brain Res 1985; 347: 177-182.
Barnouin J, Perez Cristia R, Chassagne M, et al. Vitamin and nutritional status in Cuban smokers and nonsmokers in the context of an emerging epidemic neuropathy. Int J Vitam Nutr Res 2000; 70: 126-138.
Johansson O, Fantini F, Hu H. Neuronal structural proteins, transmitters, transmitter enzymes and neuropeptides in human Meissner's corpuscles: a reappraisal using immunohistochemistry. Arch Dermatol Res 1999; 291: 419-424.
Sunderland S, Lavarack JO, Ray LJ. The caliber of nerve fibers in human cutaneous nerves. J Comp Neurol 1949; 91: 87-101.
Ronge H. Alterveränderungen der Meissnerschen körperchen in der fingerhaut. Z Mikrosk Anat Forsch 1943: 54: 167.
Bolton CF, Winkelmann RK, Dyck PJ. A quantitative study of Meissner's corpuscles in man. Neurology 1966; 16: 1-9.
Scott LJ, Griffin JW, Luciano C, et al. Quantitative analysis of epidermal innervation in Fabry disease. Neurology 1999; 52: 1249-1254.
Faden A, Mendoza E, Flynn F. Subclinical neuropathy associated with chronic obstructive pulmonary disease: possible pathophysiologic role of smoking. Arch Neurol 1981; 38: 639-642.
Dyck PJ, Winkelmann RK, Bolton CF. Quantitation of Meissner corpuscles in hereditary neurologic disorders. Neurology 1966; 16: 10-17.
Cauna N. The mode of termination of the sensory nerves and its significance. J Comp Neurol 1959; 113: 169-209.
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2001; 36
Ronge H (e_1_2_6_23_2) 1943; 54
Marolda M (e_1_2_6_16_2) 1980; 5
Winkelmann RK (e_1_2_6_26_2) 1988; 7
Behse F (e_1_2_6_31_2) 1990; 82
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Castano P (e_1_2_6_27_2) 1995; 186
Thomas PK (e_1_2_6_15_2) 1993
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References_xml – reference: Kennedy WR, Wendelschafer-Crabb G. The innervation of human epidermis. J Neurol Sci 1993; 115: 184-190.
– reference: Halata Z, Munger BL. The terminal myelin segments of afferent axons to cutaneous mechanoreceptors. Brain Res 1985; 347: 177-182.
– reference: Holland NR, Stocks MA, Hauer P, et al. Intraepidermal nerve fiber density in patients with painful sensory neuropathy. Neurology 1997; 48: 708-711.
– reference: Scott LJ, Griffin JW, Luciano C, et al. Quantitative analysis of epidermal innervation in Fabry disease. Neurology 1999; 52: 1249-1254.
– reference: Behse F. Morphometric studies on the human sural nerve. Acta Neurol Scand Suppl 1990; 82: 1-38.
– reference: Bolton CF, Winkelmann RK, Dyck PJ. A quantitative study of Meissner's corpuscles in man. Neurology 1966; 16: 1-9.
– reference: Paré M, Elde R, Mazurkiewicz JE, et al. The Meissner corpuscle revised: a multiafferented mechanoreceptor with nociceptor immunochemical properties. J Neurosci 2001; 21: 7236-7246.
– reference: Winkelmann RK. Cutaneous sensory nerves. Semin Dermatol 1988; 7: 236-268.
– reference: Vittadini G, Buonocore M, Colli G, et al. Alcoholic polyneuropathy: a clinical and epidemiological study. Alcohol Alcohol 2001; 36: 393-400.
– reference: Polydefkis M, Yiannoutsos CT, Cohen BA, et al. Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neurology 2002; 58: 115-119.
– reference: Marolda M, Filla A, Giordano-Lanza G, et al. Diagnostic significance of pacinian corpuscle degeneration in Friedreich's ataxia. Acta Neurol 1980; 5: 373-381.
– reference: Cauna N. Nerve supply and nerve endings in Meissner corpuscles. Am J Anat 1956; 99: 315.
– reference: Caruso G, Nolano M, Lullo F, et al. Median nerve sensory responses evoked by tactile stimulation of the finger proximal and distal phalanx in normal subjects. Muscle Nerve 1994; 17: 269-275.
– reference: Ronge H. Alterveränderungen der Meissnerschen körperchen in der fingerhaut. Z Mikrosk Anat Forsch 1943: 54: 167.
– reference: Holland NR, Crawford TO, Hauer P, et al. Small-fiber sensory neuropathies: clinical course and neuropathology of idiopathic cases. Ann Neurol 1998; 44: 47-59.
– reference: Dyck PJ, Winkelmann RK, Bolton CF. Quantitation of Meissner corpuscles in hereditary neurologic disorders. Neurology 1966; 16: 10-17.
– reference: Nolano M, Provitera V, Lullo F, et al. Tactile stimulation and mechanoreceptors in sensory neuropathies. Neurol Sci 2001; 22: S31-S36.
– reference: Castano P, Rumio C, Morini L, et al. Three-dimensional reconstruction of the Meissner's corpuscles of man after silver impregnation and immunofluorescence with PGP 9.5 antibodies using confocal scanning laser microscopy. J Anat 1995; 186: 261-270.
– reference: Wang L, Hilliges M, Jernberg T, et al. Protein gene product 9.5-immunoreactive nerve fibers and cell in human skin. Cell Tissue Res 1990; 261: 25-33.
– reference: Faden A, Mendoza E, Flynn F. Subclinical neuropathy associated with chronic obstructive pulmonary disease: possible pathophysiologic role of smoking. Arch Neurol 1981; 38: 639-642.
– reference: McCarthy BG, Hsieh ST, Stocks MA, et al. Cutaneous innervation in sensory neuropathies: evaluation by skin biopsy. Neurology 1995; 45: 1848-1855.
– reference: Nolano M, Provitera V, Lullo F, et al. Meissner corpuscles and myelinated nerve fibers in human digital skin: a correlation with electrophysiological findings. J Peripher Nerv Syst 2001; 6: 165.
– reference: Barnouin J, Perez Cristia R, Chassagne M, et al. Vitamin and nutritional status in Cuban smokers and nonsmokers in the context of an emerging epidemic neuropathy. Int J Vitam Nutr Res 2000; 70: 126-138.
– reference: Sunderland S, Lavarack JO, Ray LJ. The caliber of nerve fibers in human cutaneous nerves. J Comp Neurol 1949; 91: 87-101.
– reference: Ochoa J, Mair WPG. The normal sural nerve in man. I. Ultrastructure and numbers of fibres and cells. Acta Neuropathol (Berlin) 1969; 13: 197-216.
– reference: Nolano M, Provitera V, Crisci C, et al. Small fibers involvement in Friedreich's ataxia. Ann Neurol 2001; 50: 17-25.
– reference: Caruso G, Nilsson J, Crisci C, et al. Sensory nerve findings by tactile stimulation of median and ulnar nerves in healthy subjects of different ages. Electroenceph Clin Neurophysiol 1993; 89: 392-398.
– reference: Dickens NW, Winkelmann RK, Mulder DW. Cholinesterase demonstration of dermal nerve endings in patients with impaired sensation. Neurology 1962; 13: 91-100.
– reference: Johansson O, Fantini F, Hu H. Neuronal structural proteins, transmitters, transmitter enzymes and neuropeptides in human Meissner's corpuscles: a reappraisal using immunohistochemistry. Arch Dermatol Res 1999; 291: 419-424.
– reference: Cauna N. The mode of termination of the sensory nerves and its significance. J Comp Neurol 1959; 113: 169-209.
– reference: Kennedy WR, Wendelschafer-Crabb G, Johnson T. Quantitation of epidermal nerves in diabetic neuropathy. Neurology 1996; 47: 1042-1048.
– reference: Guinard D, Usson Y, Guillermet C, et al. PS-100 and NF 70-200 double immunolabeling for human digital skin Meissner corpuscles 3d imaging. J Histochem Cytochem 2000; 48: 295-302.
– reference: Periquet MI, Novak V, Collins MP, et al. Painful sensory neuropathy: prospective evaluation using skin biopsy. Neurology 1999; 53: 1641-1647.
– reference: Caruso G, Massini R, Crisci C, et al. The relationship between electrophysiological findings, upper limb growth and histological features of median and ulnar nerves in man. Brain 1992; 115: 1925-1945.
– reference: Sherrington CS. On the anatomical constitution of nerves of skeletal muscles; with remarks on recurrent fibers in the ventral spinal root. J Physiol (Lond) 1894; 17: 211-258.
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SSID ssj0009610
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Snippet We used immunohistochemistry and confocal microscopy applied to fingertip punch biopsy to study glabrous skin innervation in 14 healthy subjects. In addition...
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SourceType Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage 197
SubjectTerms Adult
Amyloid beta-Peptides - metabolism
Autonomic Nervous System - cytology
Autonomic Nervous System - physiology
Biological and medical sciences
Cell Count
Female
Fingers - innervation
Humans
Immunohistochemistry
Male
Mechanoreceptors - physiology
Medical sciences
Microscopy, Confocal
Middle Aged
Myelin Basic Protein - metabolism
Myelin Sheath - physiology
Nerve Endings - physiology
Nerve Fibers - physiology
Nervous system involvement in other diseases. Miscellaneous
Neurology
Reference Values
Skin - innervation
Title Quantification of myelinated endings and mechanoreceptors in human digital skin
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https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fana.10615
https://www.ncbi.nlm.nih.gov/pubmed/12891672
https://www.proquest.com/docview/73523429
Volume 54
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