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Feng P, Che Y, Gao C, Zhu L, Gao J, Vo NV. Immune exposure: how macrophages interact with the nucleus pulposus. Front Immunol 2023; 14:1155746. [PMID: 37122738 PMCID: PMC10140429 DOI: 10.3389/fimmu.2023.1155746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Intervertebral disc degeneration (IDD) is a primary contributor to low back pain. Immune cells play an extremely important role in modulating the progression of IDD by interacting with disc nucleus pulposus (NP) cells and extracellular matrix (ECM). Encased within the annulus fibrosus, healthy NP is an avascular and immune-privileged tissue that does not normally interact with macrophages. However, under pathological conditions in which neovascularization is established in the damaged disc, NP establishes extensive crosstalk with macrophages, leading to different outcomes depending on the different microenvironmental stimuli. M1 macrophages are a class of immune cells that are predominantly pro-inflammatory and promote inflammation and ECM degradation in the NP, creating a vicious cycle of matrix catabolism that drives IDD. In contrast, NP cells interacting with M2 macrophages promote disc tissue ECM remodeling and repair as M2 macrophages are primarily involved in anti-inflammatory cellular responses. Hence, depending on the crosstalk between NP and the type of immune cells (M1 vs. M2), the overall effects on IDD could be detrimental or regenerative. Drug or surgical treatment of IDD can modulate this crosstalk and hence the different treatment outcomes. This review comprehensively summarizes the interaction between macrophages and NP, aiming to highlight the important role of immunology in disc degeneration.
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Affiliation(s)
- Peng Feng
- School of Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Che
- School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunyu Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghua Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
| | - Nam V. Vo
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
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Ge Y, Chen Y, Guo C, Luo H, Fu F, Ji W, Wu C, Ruan H. Pyroptosis and Intervertebral Disc Degeneration: Mechanistic Insights and Therapeutic Implications. J Inflamm Res 2022; 15:5857-5871. [PMID: 36263145 PMCID: PMC9575467 DOI: 10.2147/jir.s382069] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Low back pain (LBP) is a common problem worldwide, resulting in great patient suffering and great challenges for the social health system. Intervertebral disc (IVD) degeneration (IVDD) is widely acknowledged as one of the key causes of LBP. Accumulating evidence suggests that aberrant pyroptosis of IVD cells is involved in the pathogenesis of IVDD progression, however, the comprehensive roles of pyroptosis in IVDD have not been fully established, leaving attempts to treat IVDD with anti-pyroptosis approaches questionable. In this review, we summarize the characteristics of pyroptosis and emphasize the effects of IVD cell pyroptosis on the pathological progression of IVDD, including secretion of cytokines, nucleus pulposus cell apoptosis and autophagy, accelerated extracellular matrix degradation, annulus fibrosus rupture, cartilage endplate calcification, vascularization, sensory and sympathetic fiber neoinnervation, and infiltrating lymphatic vessels. Finally, we discuss several interventions used to treat IVDD by targeting pyroptosis. This review provides novel insights into the crucial role of IVD cell pyroptosis in IVDD pathogenesis, and could be informative for developing novel therapeutic approaches for IVDD and LBP.
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Affiliation(s)
- Yuying Ge
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yuying Chen
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Chijiao Guo
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Huan Luo
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Fangda Fu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China,Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People’s Republic of China
| | - Weifeng Ji
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China,Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People’s Republic of China
| | - Chengliang Wu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China,Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People’s Republic of China,Correspondence: Chengliang Wu, Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, People’s Republic of China, Email
| | - Hongfeng Ruan
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China,Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People’s Republic of China,Hongfeng Ruan, Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, People’s Republic of China, Email
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Magrassi L, Mussa M, Montalbetti A, Colaneri M, di Matteo A, Malfitano A, Simoncelli AM, Egitto MG, Bernucci C, Brunetti E. Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis. Front Surg 2020; 7:20. [PMID: 32426366 PMCID: PMC7203469 DOI: 10.3389/fsurg.2020.00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Spinal epidural abscess (SEA) incidence is rising. However, most series do not differentiate between SEAs associated with pyogenic infectious spondylodiscitis (PS) and SEAs limited to the epidural space. Methods: We retrospectively reviewed the records and radiological images of all patients admitted to our institutions with a diagnosis of SEA not associated with PS between January 2013 and December 2018. Results: We found three males and four females; five of the seven were intravenous drug users. All patients presented with pain: in six, it was associated with acute motor and sensory deficits, while one had only pain and paresthesias. Staphylococcus aureus was cultured from abscesses and/or from multiple blood cultures in four patients. Abscesses were localized to the cervical spine in one patient, thoracic in three, lumbar in one, and in two, the SEAs involved multiple segments. All patients but one underwent urgent open surgery. This patient had a multisegmental abscess and was successfully treated by percutaneous aspiration when pain became intractable. After abscess evacuation, the neurological deficits improved in all patients except one. The patients that were treated without spine instrumentation did not develop delayed kyphosis or instability at follow-up. Conclusion: Patients with SEAs not associated with PS are likely to present with pain and motor deficits, appear to benefit from urgent abscess evacuation, and seem to be less dependent on spine instrumentation to avoid delayed spinal deformities compared to SEA associated with PS. Finally, the lack of initial involvement of bone and intervertebral disks may suggest that at least some of the SEAs without PS originate from infection of epidural lymphatic vessels that are not present inside those structures.
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Affiliation(s)
- Lorenzo Magrassi
- Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Mussa
- Unit of Infectious and Tropical Diseases, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Andrea Montalbetti
- Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Neurosurgery Pope John XXIII Hospital, Bergamo, Italy
| | - Marta Colaneri
- Unit of Infectious and Tropical Diseases, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Angela di Matteo
- Unit of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo Hospital Foundation, Pavia, Italy
| | - Antonello Malfitano
- Unit of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo Hospital Foundation, Pavia, Italy
| | - Anna Maria Simoncelli
- Diagnostic Radiology, Interventional Radiology and Neuroradiology Unit, IRCCS Policlinico San Matteo Hospital Foundation, Pavia, Italy
| | | | | | - Enrico Brunetti
- Unit of Infectious and Tropical Diseases, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Ghannam M, Jumah F, Mansour S, Samara A, Alkhdour S, Alzuabi MA, Aker L, Adeeb N, Massengale J, Oskouian RJ, Tubbs RS. Surgical anatomy, radiological features, and molecular biology of the lumbar intervertebral discs. Clin Anat 2017; 30:251-266. [PMID: 27997062 DOI: 10.1002/ca.22822] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 01/07/2023]
Abstract
The intervertebral disc (IVD) is a joint unique in structure and functions. Lying between adjacent vertebrae, it provides both the primary support and the elasticity required for the spine to move stably. Various aspects of the IVD have long been studied by researchers seeking a better understanding of its dynamics, aging, and subsequent disorders. In this article, we review the surgical anatomy, imaging modalities, and molecular biology of the lumbar IVD. Clin. Anat. 30:251-266, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Malik Ghannam
- An-Najah National University Hospital, Nablus, Palestine
| | - Fareed Jumah
- An-Najah National University Hospital, Nablus, Palestine
| | - Shaden Mansour
- An-Najah National University Hospital, Nablus, Palestine
| | - Amjad Samara
- An-Najah National University Hospital, Nablus, Palestine
| | - Saja Alkhdour
- An-Najah National University Hospital, Nablus, Palestine
| | | | - Loai Aker
- An-Najah National University Hospital, Nablus, Palestine
| | - Nimer Adeeb
- Department of Neurosurgery, Boston Medical Center, Boston University, Massachusetts
| | - Justin Massengale
- Department of Neurosurgery, Boston Medical Center, Boston University, Massachusetts
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada.,Seattle Science Foundation, Seattle, Washington
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Berthelot JM, Claudepierre P. Trafficking of antigens from gut to sacroiliac joints and spine in reactive arthritis and spondyloarthropathies: Mainly through lymphatics? Joint Bone Spine 2016; 83:485-90. [DOI: 10.1016/j.jbspin.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022]
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Woon JT, Stringer MD. Clinical anatomy of the coccyx: A systematic review. Clin Anat 2011; 25:158-67. [DOI: 10.1002/ca.21216] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 04/30/2011] [Accepted: 05/13/2011] [Indexed: 12/13/2022]
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Abstract
STUDY DESIGN Analysis of lymphatic vessels in childhood and adult normal and pathological vertebral bone and intervertebral disc tissue. OBJECTIVE To determine whether lymphatic vessels are present in spinal vertebrae and intervertebral discs in normal children and adults (4-30 years) as well as in pathological lesions of the spine. SUMMARY OF BACKGROUND DATA There is uncertainty regarding the presence or absence of lymphatic vessels in normal intervertebral discs and the role of lymphatics in the pathobiology of disc degeneration and infective, neoplastic, and other spinal pathology. METHODS The presence of the specific lymphatic endothelial cell markers, podoplanin, and LYVE-1 was determined immuno-histochemically in normal cervical, thoracic, and lumbar disc and vertebral tissues of adults and children, as well as in a wide range of spinal disorders. RESULTS Lymphatics were not found in intact normal intervertebral discs or within spinal vertebrae of children or adults. Lymphatics were present in the outer periosteum and paraspinal ligaments and surrounding connective tissue. Lymphatic vessels were seen in infected and displaced degenerate disc tissue. Lymphatic vessels in vertebral bone were seen only when neoplastic and non-neoplastic lesions of the spine were associated with vertebral destruction and the lesion extending through the bone cortex into surrounding connective tissue. CONCLUSION Lymphatics are not found in intact normal spinal vertebrae or the intervertebral discs of children or adults. Lymphatics in vertebral bone are found in pathological lesions of the spine when these have extended beyond the normal anatomical confines of the vertebra or intervertebral disc; this most likely occurs by ingrowth of lymphatics from surrounding connective tissues. These findings strongly suggest that metastatic tumor spread to the spine does not occur by lymphatics and that lymph node involvement of primary malignant spinal tumors occurs only after extraosseous spread.
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Difference in Energy Metabolism of Annulus Fibrosus and Nucleus Pulposus Cells of the Intervertebral Disc. Cell Mol Bioeng 2011; 4:302-310. [PMID: 21625336 DOI: 10.1007/s12195-011-0164-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Low back pain is associated with intervertebral disc degeneration. One of the main signs of degeneration is the inability to maintain extracellular matrix integrity. Extracellular matrix synthesis is closely related to production of adenosine triphosphate (i.e. energy) of the cells. The intervertebral disc is composed of two major anatomical regions: annulus fibrosus and nucleus pulposus, which are structurally and compositionally different, indicating that their cellular metabolisms may also be distinct. The objective of this study was to investigate energy metabolism of annulus fibrosus and nucleus pulposus cells with and without dynamic compression, and examine differences between the two cell types. Porcine annulus and nucleus tissues were harvested and enzymatically digested. Cells were isolated and embedded into agarose constructs. Dynamically loaded samples were subjected to a sinusoidal displacement at 2 Hz and 15% strain for 4 h. Energy metabolism of cells was analyzed by measuring adenosine triphosphate content and release, glucose consumption, and lactate/nitric oxide production. A comparison of those measurements between annulus and nucleus cells was conducted. Annulus and nucleus cells exhibited different metabolic pathways. Nucleus cells had higher adenosine triphosphate content with and without dynamic loading, while annulus cells had higher lactate production and glucose consumption. Compression increased adenosine triphosphate release from both cell types and increased energy production of annulus cells. Dynamic loading affected energy metabolism of intervertebral disc cells, with the effect being greater in annulus cells.
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