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Narita A, Nakano Y, Okada H, Yamamoto T, Matsunaga N, Ikeda S, Izumi Y, Kitagawa A, Ota T, Suzuki K. In Vitro Characterization of Drug-Loaded Superabsorbent Polymer Microspheres: Absorption and Release Capacity of Contrast Material, Antibiotics and Analgesics. Cardiovasc Intervent Radiol 2023; 46:1632-1640. [PMID: 37759091 DOI: 10.1007/s00270-023-03559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To examine the characteristics of drug-loaded superabsorbent polymer microspheres (SAP-MS) such as drug absorption, drug release, diameter, and visibility. MATERIALS AND METHODS SAP-MS (HepaSphere150-200 µm; Merit Medical, South Jordan, UT, USA) were suspended in drug solutions: (a) cefazolin, (b) lidocaine, (c) iopamidol and cefazolin, (d) iopamidol and lidocaine, and (e) iopamidol, cefazolin, and lidocaine. The concentrations of drugs were measured, and the amount of each drug absorbed was calculated. Filtered drug-loaded SAP-MS were mixed with saline, and the drug release rates were calculated. The diameter changes of SAP-MS during absorption were observed. Radiography of drug-loaded SAP-MS was evaluated as radiopacity by contrast-to-noise ratio (CNR). RESULTS The drug concentration did not change during absorption. The release rates increased for 10 min and then came to an equilibrium. The mean amounts of drug absorbed at 180 min and mean release rates at 24 h were (a) cefazolin: 265.4 mg, 64.2%; (b) lidocaine: 19.6 mg, 75.6%; (c) iopamidol: 830.2 mg, 22.5%; cefazolin: 137.6 mg, 21.2%; (d) iopamidol: 1620.6 mg, 78.5%; lidocaine: 13.5 mg, 81.4%; and (e) iopamidol: 643.7 mg, 52.9%; cefazolin: 194.0 mg, 51.6%; lidocaine: 5.3 mg, 58.4%. The diameter of SAP-MS increased for approximately 15 min. Finally, the diameters of SAP-MS were (a) 3.9 times, (b) 5.0 times, (c) 2.2 times, (d) 5.5 times, and (e) 3.6 times larger than the original size. Drug-loaded SAP-MS containing iopamidol were visible under X-ray imaging, with CNRs of (c) 3.0, (d) 9.0, and (e) 4.5. CONCLUSION SAP-MS can absorb and release iopamidol, cefazolin, and lidocaine.
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Affiliation(s)
- Akiko Narita
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan.
| | - Yuta Nakano
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Hiroaki Okada
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Akira Kitagawa
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, Japan
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Pett TB, Petry B, Martyn T, Grainger MNC, Baker JF. Plasma concentration of prophylactic cefazolin best correlates with lean body mass measured by bioimpedance analysis in lumbar spine surgery: Results of a pilot study. J Clin Neurosci 2023; 116:55-59. [PMID: 37625221 DOI: 10.1016/j.jocn.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
The aim of this study was to determine the association between measures of body composition and the concentration of plasma and paraspinal muscle cefazolin. Secondly, we aimed to confirm the efficacy of our hospital dosing regimen in achieving the minimum inhibitory concentration (MIC) at the surgical site. Patients undergoing posterior-based lumbar spine surgery had body composition analysed using bioimpedance analysis. All received 2 g of cefazolin at anaesthetic induction in line with hospital guidelines. Cefazolin concentration was measured in plasma (30-minites) and muscle (30- and 60-minuites) using high-performance liquid chromatography. 20 patients were recruited (mean age 61.5 years; 12 female). Mean plasma cefazolin concentrations were 34.1 +/- 10.2 mg/L; mean muscle concentrations 44.4 +/- 18.6 mg/kg and 43.8 +/- 20.4 mg/kg at 30- and 60-minutes respectively. Univariate analysis showed significant correlation between plasma cefazolin concentration and lean mass weight, absolute body weight, height, dry lean mass, total water, total body water, extracellular and intracellular water volume. Linear regression analysis showed lean mass weight the best predictor of plasma cefazolin concentration. Muscle cefazolin concentration was dependent on the plasma concentration. Using a MIC of 2 mg/L and 2 mg/kg for Staphylococcus aureus, MIC was achieved in all samples. In summary, plasma cefazolin concentration was best predicted by lean body mass. Further work should consider the influence of body composition on antibiotic delivery in extremes of body mass index. Local hospital guidelines are effective at achieving MIC against S. aureus.
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Affiliation(s)
- Thomas B Pett
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Benjamin Petry
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Tanushk Martyn
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | | | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand.
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Issa TZ, Lambrechts MJ, Toci GR, Brush PL, Schilken MM, Torregrossa F, Grasso G, Vaccaro AR, Canseco JA. Evaluating Nonoperative Treatment for Low Back Pain in the Presence of Modic Changes: A Systematic Review. World Neurosurg 2023; 171:e108-e119. [PMID: 36442780 DOI: 10.1016/j.wneu.2022.11.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to summarize and assess the current literature evaluating nonoperative treatments for patients with Modic changes (MCs) and low back pain (LBP). METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed database was searched from its inception until May 1, 2022 for studies evaluating MC and clinical outcomes. Key findings, treatment details, and patient information were extracted from included studies. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Eighteen studies were included in this review, encompassing a total of 2452 patients, 1713 of whom displayed baseline MC. Seventy-eight percent of studies were high quality. Of included studies, 2 evaluated antibiotics, 5 evaluated steroid injections, 6 evaluated conservative therapies, and 5 evaluated other treatment modalities. Antibiotics and bisphosphonates improved treatment in patients with MC. Patients with MC without disc herniation benefited from conservative therapy, while those with Type I Modic changes and disc herniation experienced poorer improvement. Significant variability exists in reported outcomes following steroid injections. CONCLUSIONS Nonoperative therapy may provide patients with MC with significant benefits. Patients may benefit from therapies not traditionally utilized for LBP such as antibiotics or bisphosphonates, but conservative therapy is not recommended for patients with concomitant MC and disc herniation. The large variation in follow-up times and outcome measures contributes to significant heterogeneity in studies and inability to predict long-term patient outcomes. More long-term studies are needed to assess nonoperative treatments for LBP in patients with MC.
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Affiliation(s)
- Tariq Z Issa
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Parker L Brush
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meghan M Schilken
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Alexander R Vaccaro
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Rothman Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Magno da Rocha V, Lima COGX, Ferreira EDO, de Farias GC, Nogueira FCS, Martha Antunes LC, Cassiano KM, Fiorelli RKA. Colonization of intervertebral discs by Cutibacterium acnes in patients with low back pain: Protocol for an analytical study with microbiological, phenotypic, genotypic, and multiomic techniques. PLoS One 2023; 18:e0271773. [PMID: 36848344 PMCID: PMC9970075 DOI: 10.1371/journal.pone.0271773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/15/2022] [Indexed: 03/01/2023] Open
Abstract
Lumbar disc degeneration (LDD) and low back pain (LBP) are two conditions that are closely related. Several studies have shown Cutibacterium acnes colonization of degenerated discs, but whether and how these finding correlates with LBP is unknown. A prospective study was planned to identify molecules present in lumbar intervertebral discs (LLIVD) colonized by C. acnes in patients with LDD and LBP and correlate them with their clinical, radiological, and demographic profiles. The clinical manifestations, risk factors, and demographic characteristics of participants undergoing surgical microdiscectomy will be tracked. Samples will be isolated and pathogens found in LLIVD will be characterized phenotypically and genotypically. Whole genome sequencing (WGS) of isolated species will be used to phylotype and detect genes associated with virulence, resistance, and oxidative stress. Multiomic analyses of LLIVD colonized and non-colonized will be carried out to explain not only the pathogen's role in LDD, but also its involvement in the pathophysiology of LBP. This study was approved by the Institutional Review Board (CAAE 50077521.0.0000.5258). All patients who agree to participate in the study will sign an informed consent form. Regardless of the study's findings, the results will be published in a peer-reviewed medical journal. Trials registration number NCT05090553; pre-results.
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Affiliation(s)
- Vinícius Magno da Rocha
- Departamento de Cirurgia geral e especializada, Escola de Medicina, Universidade Federal do Estado do Rio de Janeiro (UniRio), Rio de Janeiro- RJ, Brazil
| | - Carla Ormundo Gonçalves Ximenes Lima
- Departamento de Microbiologia Médica, Institito de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | - Eliane de Oliveira Ferreira
- Departamento de Microbiologia Médica, Institito de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
- * E-mail:
| | | | | | | | - Keila Mara Cassiano
- Departamento de Estatística, Instituto de Matemática, Universidade Federal Fluminense (UFF), Niterói- RJ, Brazil
| | - Rossano Kepler Alvim Fiorelli
- Departamento de Cirurgia geral e especializada, Escola de Medicina, Universidade Federal do Estado do Rio de Janeiro (UniRio), Rio de Janeiro- RJ, Brazil
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Koch BCP, Zhao Q, Oosterhoff M, van Oldenrijk J, Abdulla A, de Winter BCM, Bos K, Muller AE. The mysteries of target site concentrations of antibiotics in bone and joint infections: what is known? A narrative review. Expert Opin Drug Metab Toxicol 2022; 18:587-600. [PMID: 36008360 DOI: 10.1080/17425255.2022.2117607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Currently, antibiotic treatment is often a standard dosing regimen in bone and joint infections (BJI). However, it remains unknown if exposure at the target-site is adequate. The aim of this review is to gain more insight in the relationship between the target site concentration of antibiotic and the minimal inhibitory concentration to target the bacteria in bone and joint infections (BJI). AREAS COVERED A literature search was performed by Erasmus MC Medical library. Bone, bone tissue and synovial concentration of antibiotics were covered in humans. In addition, we reported number of patients, dose, sampling method, analytical method and tissue and plasma concentrations. We used the epidemiological cut-off value (ECOFF) values of the targeted micro-organisms. If more than 3 publications were available on the antibiotic, we graphically presented ECOFFS values against reported antibiotic concentrations. EXPERT OPINION For most antibiotics the literature is sparse. In addition, a lot of variable and total antibiotic concentrations are published. Ciprofloxacin, cefazolin, cefuroxime, vancomycin and linezolid seem to have adequate average exposure if correlating total concentration to ECOFF, when standard dosing is used. With regards to other antibiotics, results are inconclusive. More extensive pharmacokinetic/pharmacodynamic modeling in BJI is needed.
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Affiliation(s)
- Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Qiaolin Zhao
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rotterdam Clinical Pharmacometrics Group
| | - Maartje Oosterhoff
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Koen Bos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anouk E Muller
- CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Medical Microbiology, Haaglanden Medisch Centrum, The Hague, the Netherlands
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6
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Alawamry A, Makia MA, Samir MA. Role of intra-discal Vancomycin instillation in prevention post-operative discitis. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Post discectomy discitis is regarded as the most disabling cause of failed back surgery. Value of local intra-operative application of antibiotics in prevention of such complication has been a matter of debate. We evaluate the role of intraoperative intra-discal vancomycin powder instillation as a prophylaxis in prevention of postoperative discitis in patients undergoing microscopic discectomy. We allocated 100 patients undergoing discectomy equally into two groups. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted.
Results
The postoperative discitis was reported in 6 cases; of them, two patients were in the Vancomycin group (4%), while four patients were in the non-Vancomycin group (8%).
Conclusions
We concluded that the intra-operative prophylaxis, with intra-discal Vancomycin, decreased the incidence of postoperative discitis but without significant statistical difference. We advocate using local vancomycin especially in high risk patients for prevention of post discectomy discitis.
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7
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Gilligan CJ, Cohen SP, Fischetti VA, Hirsch JA, Czaplewski LG. Chronic low back pain, bacterial infection and treatment with antibiotics. Spine J 2021; 21:903-914. [PMID: 33610802 DOI: 10.1016/j.spinee.2021.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023]
Abstract
The contribution of bacterial infection to chronic low back pain and its treatment with antibiotics have generated considerable controversy in literature. If efficacious, antibiotics have the potential to transform the treatment of chronic low back pain in a significant subset of patients. Some microbiology studies of disc tissue from patients with CLBP have shown that bacteria are present, most likely due to infection, while others conclude they are absent or if found, it is due to surgical contamination. Clinical studies testing the efficacy of oral antibiotics to treat CLBP have either shown that the treatment is efficacious leading to significantly reduced pain and disability or that their effect is modest and not clinically significant. Critical review of the literature on CLBP, bacterial infection and treatment with antibiotics identified five well-designed and executed microbiology studies characterizing bacteria in disc samples that demonstrate that bacteria do infect herniated disc tissue, but that the bacterial burden is low and may be below the limits of detection in some studies. Two randomized, controlled clinical trials evaluating oral antibiotics in patients with CLBP indicate that for certain subsets of patients, the reduction in pain and disability achieved with antibiotic therapy may be significant. In patients for whom other therapies have failed, and who might otherwise progress to disc replacement or fusion surgery, antibiotic therapy may well be an attractive option to reduce the individual suffering associated with this debilitating condition. Additional clinical research is recommended to refine the selection of patients with CLBP caused or complicated by bacterial infection and most likely to respond to antibiotics, to optimize antibiotic therapy to maximize patient benefit, to minimize and manage side effects, and to address legitimate concerns about antibiotic stewardship.
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Affiliation(s)
- Christopher J Gilligan
- Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA, USA
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 550 N. Broadway, Ste 301, Baltimore, MD 21029, USA; Department of Anesthesiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
| | - Vincent A Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, New York
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Lloyd G Czaplewski
- Persica Pharmaceuticals Ltd, 7 Denne Hill Business Centre, Womenswold, Canterbury, Kent, CT4 6HD, UK.
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8
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Capoor MN, Konieczna A, McDowell A, Ruzicka F, Smrcka M, Jancalek R, Maca K, Lujc M, Ahmed FS, Birkenmaier C, Dudli S, Slaby O. Pro-Inflammatory and Neurotrophic Factor Responses of Cells Derived from Degenerative Human Intervertebral Discs to the Opportunistic Pathogen Cutibacterium acnes. Int J Mol Sci 2021; 22:ijms22052347. [PMID: 33652921 PMCID: PMC7956678 DOI: 10.3390/ijms22052347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 12/20/2022] Open
Abstract
Previously, we proposed the hypothesis that similarities in the inflammatory response observed in acne vulgaris and degenerative disc disease (DDD), especially the central role of interleukin (IL)-1β, may be further evidence of the role of the anaerobic bacterium Cutibacterium (previously Propionibacterium) acnes in the underlying aetiology of disc degeneration. To investigate this, we examined the upregulation of IL-1β, and other known IL-1β-induced inflammatory markers and neurotrophic factors, from nucleus-pulposus-derived disc cells infected in vitro with C. acnes for up to 48 h. Upon infection, significant upregulation of IL-1β, alongside IL-6, IL-8, chemokine (C-C motif) ligand 3 (CCL3), chemokine (C-C motif) ligand 4 (CCL4), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), was observed with cells isolated from the degenerative discs of eight patients versus non-infected controls. Expression levels did, however, depend on gene target, multiplicity and period of infection and, notably, donor response. Pre-treatment of cells with clindamycin prior to infection significantly reduced the production of pro-inflammatory mediators. This study confirms that C. acnes can stimulate the expression of IL-1β and other host molecules previously associated with pathological changes in disc tissue, including neo-innervation. While still controversial, the role of C. acnes in DDD remains biologically credible, and its ability to cause disease likely reflects a combination of factors, particularly individualised response to infection.
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Affiliation(s)
- Manu N. Capoor
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
- Correspondence: (M.N.C.); (O.S.)
| | - Anna Konieczna
- Central European Institute of Technology (CEITEC), Masaryk University, 625 00 Brno, Czech Republic; (A.K.); (F.S.A.)
| | - Andrew McDowell
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK;
| | - Filip Ruzicka
- Department of Microbiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, 656 91 Brno, Czech Republic;
| | - Martin Smrcka
- Department of Neurosurgery, University Hospital Brno, Masaryk University, 625 00 Brno, Czech Republic; (M.S.); (K.M.)
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne’s University Hospital, Masaryk University, 656 91 Brno, Czech Republic;
| | - Karel Maca
- Department of Neurosurgery, University Hospital Brno, Masaryk University, 625 00 Brno, Czech Republic; (M.S.); (K.M.)
| | - Michael Lujc
- Department of Orthopaedic Surgery, University Hospital Brno, Masaryk University, 625 00 Brno, Czech Republic;
| | - Fahad S. Ahmed
- Central European Institute of Technology (CEITEC), Masaryk University, 625 00 Brno, Czech Republic; (A.K.); (F.S.A.)
| | - Christof Birkenmaier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich, 80331 Munich, Germany;
| | - Stefan Dudli
- Centre of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8091 Zurich, Switzerland;
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8091 Zurich, Switzerland
| | - Ondrej Slaby
- Central European Institute of Technology (CEITEC), Masaryk University, 625 00 Brno, Czech Republic; (A.K.); (F.S.A.)
- Department of Biology, Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
- Correspondence: (M.N.C.); (O.S.)
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9
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Gushcha AO, Yusupova AR. [Modern concepts of intervertebral disc degeneration]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:112-117. [PMID: 33306308 DOI: 10.17116/neiro202084061112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The widespread prevalence of degenerative spine diseases and achievements in the treatment of these lesions have not yet led to an answer the main question: «What is the etiology of spine degeneration?» Treatment will remain symptomatic if primary cause of disease will be unclear. However, improvement of genetic and molecular survey gradually clarifies the mechanisms underlying degenerative processes. The latest knowledge in regenerative medicine seem promising. Nevertheless, further advances in understanding the fundamental processes in human organism are followed by additional questions and unsolved problems. The authors analyzed the best-studied modern theories of degeneration in this brief review devoted to current concepts of intervertebral disc degeneration.
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Affiliation(s)
- A O Gushcha
- Neurology Research Center, Moscow, Russia.,Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
| | - A R Yusupova
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
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Rajasekaran S, Soundararajan DCR, Tangavel C, Muthurajan R, Sri Vijay Anand KS, Matchado MS, Nayagam SM, Shetty AP, Kanna RM, Dharmalingam K. Human intervertebral discs harbour a unique microbiome and dysbiosis determines health and disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1621-1640. [PMID: 32409889 DOI: 10.1007/s00586-020-06446-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/04/2020] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To document the role of sub-clinical infections in disc disorders and investigate the existence of microbiome in intervertebral discs (IVD). METHODS Genomic DNA from 24 lumbar IVDs [8-MRI normal discs (ND) from brain dead yet alive organ donors, 8-disc herniation (DH), 8-disc degeneration (DD)] was subjected to 16SrRNA sequencing for profiling the diversity of human disc microbiome in health and disease. The disc microbiome was further compared to established human gut and skin microbiomes. RESULTS All healthy MRI normal discs from brain dead yet alive organ donors also had a rich bacterial presence. A total of 424 different species (355-ND, 346-DD, and 322-DH) were detected, with 42.75% OTUs being classified at kingdom level, 44% at the phylum level, 22.62% at genus level, and 5.5% at species level. Varying biodiversity and abundance between healthy and diseased discs were documented with protective bacteria being abundant in normal discs, and putative pathogens abundant in DD and DH. Propionibacterium acnes had a similar but lower abundance to other pathogens in all three groups ND (3.07%), DD (3.88%), DH (1.56%). Fifty-eight bacteria were common between gut and IVD microbiomes, 29 between skin and IVD microbiomes, and six common to gut/skin/IVD. CONCLUSION Our study challenges the hitherto concept of sterility in healthy IVD and documented a microbiome even in MRI normal healthy discs. The varying abundance of bacteria between ND, DD, and DH documents 'dysbiosis' as a possible etiology of DD. Many known pathogens were identified in greater abundance than Propionibacterium acnes, and there was evidence for the presence of the gut/skin/spine microbiome axis.
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Affiliation(s)
| | | | - Chitraa Tangavel
- Ganga Research Centre, No 91, Mettupalayam Road, Coimbatore, 641030, India
| | - Raveendran Muthurajan
- Department of Plant Biotechnology, Tamil Nadu Agricultural University, Coimbatore, 641003, India
| | - K S Sri Vijay Anand
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | | | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - K Dharmalingam
- Aravind Medical Research Foundation, Madurai, 625020, India
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Prysak MH, Lutz CG, Zukofsky TA, Katz JM, Everts PA, Lutz GE. Optimizing the safety of intradiscal platelet-rich plasma: an in vitro study with Cutibacterium acnes. Regen Med 2019; 14:955-967. [PMID: 31587600 DOI: 10.2217/rme-2019-0098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: The most common risk associated with intradiscal injection of platelet-rich plasma (PRP) is discitis with Cutibacterium acnes. It is hypothesized that antimicrobial activity of PRP can be enhanced through inclusion of leukocytes or antibiotics in the injectate. Materials & methods: Multiple PRP preparations of varying platelet and leukocyte counts were co-cultured with C. acnes with or without cefazolin, with viable bacterial colony counts being recovered at 0, 4, 24 and 48 hours post-inoculation. Results: A direct correlation between C. acnes recovery and granulocyte counts were observed. Conclusion: We observed the greatest antimicrobial activity with the leukocyte-rich, high platelet PRP preparation combined with an antibiotic in the injectate. However, cefazolin did not completely clear the bacteria in this assay.
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Affiliation(s)
- Meredith H Prysak
- Orthobond Corporation, 671 Suite B, US 1 North, North Brunswick, NJ 08902, USA
| | - Cole G Lutz
- Regenerative SportsCare Institute, 62 East 88th Street, New York, NY 10128, USA
| | - Tyler A Zukofsky
- Orthobond Corporation, 671 Suite B, US 1 North, North Brunswick, NJ 08902, USA
| | - Jordan M Katz
- Orthobond Corporation, 671 Suite B, US 1 North, North Brunswick, NJ 08902, USA
| | - Peter A Everts
- Gulf Coast Biologics, 4331 Veronica S Shoemaker Blvd. #4 Fort Myers, FL 33916, USA
| | - Gregory E Lutz
- Regenerative SportsCare Institute, 62 East 88th Street, New York, NY 10128, USA
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