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Morphological and Biochemical Measures

Sural nerve biopsy studies in diabetic populations, such as those participating in clinical drug trials and in well-defined cross-sectional studies examining pathogenetic mechanisms, present opportunities to study biochemical and morphometric parameters of myelinated and unmyelinated fiber populations (1-5), vasculature and perineurium, and their basement membranes (7-9). Information from such studies enhances our understanding of the natural history of the disease and the role of various pathogenetic mechanisms. These advantages have to be weighed against J) information from the biopsy is usually of no direct benefit to the patient, 2) the procedure is associated with a certain but small morbidity, and 3) may be associated with complications. Therefore, such studies should be limited to addressing well-defined clinical and research questions. Biopsy should be performed by a surgeon experienced in this procedure and working in close collaboration with the neuropathologist to optimize the quality of the biopsy. Currently, only a few laboratories have the expertise to perform the laboratory examinations of sural nerve biopsies, which involve detailed light microscopic and ulrrastructural morphometric assessments, biochemical analyses, and immunocytochemical examinations.