Human Vastus Lateralis Skeletal Muscle Biopsy Using the Weil-Blakesley Conchotome

The Skeletal Muscle Microbiopsy Method in Exercise and Sports Science Research: A Narrative and Methodological Review

BACKGROUND

The skeletal muscle microbiopsy protocol was introduced to the Exercise and Sports Science (ESS) research field in 1999 and has been used as a protocol to directly examine muscular structural and biochemical changes. There is much variation in the reporting of the microbiopsy protocol and its related pre-and post-procedure for participant care and sample collection. The purpose of this narrative and methodological review is to compare the microbiopsy to the traditional Bergström protocol used in the ESS field, identify and summarize all related microbiopsy protocols used in previous ESS studies and determine the most frequently used microbiopsy protocols aspects and associated pre- and post-biopsy procedures; METHODS: A review of literature up to January, 2022 was used following the PRISMA and Cochrane Methodological Review Guide to determine frequently used methods that may facilitate optimal and potential recommendations for muscle microbiopsy needle gauge (G), concentration or dose (% or mL) and administration of local anesthetic, co-axial/cannula introducer gauge (G), muscle depth (cm), muscle sample size collected (mg), passes to collect samples, time points of muscle sampling, and promotion of participant compliance and minimization of adverse events; RESULTS: 85 articles were selected based on the inclusionary requirements related to the ESS field or methodological considerations. The most frequently reported aspects in previous research to suggest the location of the vastus lateralis is the midpoint between the patella and the greater trochanter of the femur or 1/3 or 2/3 the distance from the patella to anterior superior iliac spine, 14 G biopsy needle, subcutaneous injected lidocaine administration (2 mL; 1%), 13 G co-axial/cannula, 1-2 cm muscle depth, 10-20 mg of muscle sample, ~3-time points, 2-3 passes; DISCUSSION: There is much variation in the reporting of the microbiopsy protocol and its related pre-and post-biopsy procedures. Standardization in reporting may promote recommendations to optimize data integrity, participant safety, participant adherence to the study design, and increase reproducibility. Recommendations are made for the microbiopsy procedure based on frequently reported characteristics.

A Coupled Mechanobiological Model of Muscle Regeneration In Cerebral Palsy

Cerebral palsy is a neuromusculoskeletal disorder associated with muscle weakness, altered muscle architecture, and progressive musculoskeletal symptoms that worsen with age. Pathological changes at the level of the whole muscle have been shown; however, it is unclear why this progression of muscle impairment occurs at the cellular level. The process of muscle regeneration is complex, and the interactions between cells in the muscle milieu should be considered in the context of cerebral palsy. In this work, we built a coupled mechanobiological model of muscle damage and regeneration to explore the process of muscle regeneration in typical and cerebral palsy conditions, and whether a reduced number of satellite cells in the cerebral palsy muscle environment could cause the muscle regeneration cycle to lead to progressive degeneration of muscle. The coupled model consisted of a finite element model of a muscle fiber bundle undergoing eccentric contraction, and an agent-based model of muscle regeneration incorporating satellite cells, inflammatory cells, muscle fibers, extracellular matrix, fibroblasts, and secreted cytokines. Our coupled model simulated damage from eccentric contraction followed by 28 days of regeneration within the muscle. We simulated cyclic damage and regeneration for both cerebral palsy and typically developing muscle milieus. Here we show the nonlinear effects of altered satellite cell numbers on muscle regeneration, where muscle repair is relatively insensitive to satellite cell concentration above a threshold, but relatively sensitive below that threshold. With the coupled model, we show that the fiber bundle geometry undergoes atrophy and fibrosis with too few satellite cells and excess extracellular matrix, representative of the progression of cerebral palsy in muscle. This work uses in silico modeling to demonstrate how muscle degeneration in cerebral palsy may arise from the process of cellular regeneration and a reduced number of satellite cells.

The Art of Muscle Biopsy in the New Genetic Era: A Narrative Review

Muscle biopsy has been practiced as a well-established part of paraclinical workup in patients with neuromuscular diseases since late 1960s. In this narrative review paper, the role of some pre and post muscle biopsy factors and their importance in achieving the best diagnostic results will be explained. Considering the new advances in diagnostic molecular techniques and the availability of local standard myopathology laboratory as well as the presence of a dedicated myopathologist, the indications of muscle biopsy in four major types of neuromuscular diseases will be shortly reviewed. Moreover, indications of muscle biopsy in four major types of neuromuscular diseases will be shortly discussed based on literature review of recent published diagnostic algorithms and our 11 years' experience of performing about 4000 muscle biopsies cases in the only standard referral diagnostic center for muscle biopsy in Iran. Although diagnostic algorithms of some muscle diseases have been changed based on recent advances in biochemical and molecular diagnostic techniques, still muscle biopsy continues to play a major role in the diagnosis and management of variety of neuromuscular disorders and has proved to be a preferable diagnostic procedure by some neuromuscular specialists for the cases who can benefit from rapid therapeutic management. The application of diagnostic algorithms should be practiced in accordance with geographic distribution of the diseases, the availability of diagnostic techniques and the presence of specialists in each center considering the local insurance coverage and the cost to be paid by the patient in every center.