Introduction:
The Muhieddine M. Ahdab Neuromuscular Diagnostic Laboratory (MMA-NMD) is a newly established facility dedicated to the study and full diagnostic evaluation of muscle and nerve biopsies. Updated diagnostic methodology is currently available, and will improve understanding and therapy of muscle and nerve diseases. The laboratory is fully equipped with state of the art histological, histochemical, immunocytochemical and quantitative image analysis with morphometric evaluative techniques and instruments.
Diagnostic evaluation of biopsies is specifically adapted to each case, using the information obtained from clinical consultation with the referring physician.
Specific methodology is routinely used for the storage of biopsy tissue for possible further ultrastructural, biochemical, molecular and genetic studies, if needed to confirm diagnosis.
Available Routine Processing Techniques
� Processing of tissue through paraffin sections, microscopic evaluation of H&E stained sections and routine special stains for trichrome, elastic tissue, glycogen and amyloid.
� Rapid freezing of non-fixed portions of muscle and nerve biopsies at very low temperatures (-185oC), for diverse histochemical, trichrome, fat, glycogen and amyloid stains.
� Histochemical panel of mitochondrial enzymes to evaluate the five complexes of OXPHOS energy production.
� Immunocytochemical evaluation of inflammatory markers and cytokines whenever required for the diagnosis of inflammatory and immune neuropathies/myopathies.
� Immunocytochemical evaluation of sarcolemmal and cytoskeletal proteins in the study of dystrophies and other congenital myopathies and neuropathies.
� Quantitative morphometric evaluation of myofiber size, type and distribution in frozen and plastic embedded sections, for the differential diagnosis of congenital and acquired myopathies.
� Morphometric evaluation of myelinated nerve fiber density and distribution in one micron thick plastic sections of the nerve processed through metacrylate embedding.
� Teased nerve preparations to separate myelinated nerve fibers for the evaluation of myelin sheath and axonal damage.