1
|
Zhu D, Chen S, Sheng P, Wang Z, Li Y, Kang X. POSTN promotes nucleus pulposus cell senescence and extracellular matrix metabolism via activing Wnt/β-catenin and NF-κB signal pathway in intervertebral disc degeneration. Cell Signal 2024; 121:111277. [PMID: 38944256 DOI: 10.1016/j.cellsig.2024.111277] [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: 04/23/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Intervertebral disc (IVD) degeneration (IVDD) is a prevalent condition contributing to back pain and disability. Periostin (POSTN) has emerged as a potential molecular marker and therapeutic target in IVDD, prompting further investigation into its role and mechanisms. METHODS This study employs bioinformatics analysis combined with experimental validation to explore the role of POSTN in IVDD. Gene expression datasets from the GEO database were analyzed to identify genes associated with IVDD, and the effects of POSTN on rat nucleus pulposus (NP) cells senescence and extracellular matrix (ECM) metabolism were assessed both in vitro and in vivo. RESULTS Elevated POSTN expression was observed in degenerated discs from IVDD patients, correlating with disease severity. In vitro experiments demonstrated that POSTN promotes NP cells senescence and ECM metabolism in a dose- and time-dependent manner. In vivo studies confirmed that POSTN inhibition can ameliorate the progression of IVDD. Further mechanistic insights revealed that POSTN may exert its effects by activating the NF-κB and Wnt/β-catenin signaling pathways. CONCLUSION POSTN plays a significant role in the pathogenesis of IVDD, with its upregulated expression closely linked to NP cells senescence and ECM metabolism. Targeting POSTN could offer a novel therapeutic strategy for IVDD. Additionally, the study predicts small molecules that may inhibit POSTN expression, providing potential candidates for the development of new drug treatments.
Collapse
Affiliation(s)
- Daxue Zhu
- Lanzhou University Second Hospital, 82 Cuiyingmen, Lanzhou 730030, PR China; Orthopaedics Key Laboratory of Gansu Province, Lanzhou 730030, PR China
| | - Shijie Chen
- Lanzhou University Second Hospital, 82 Cuiyingmen, Lanzhou 730030, PR China; Orthopaedics Key Laboratory of Gansu Province, Lanzhou 730030, PR China
| | - Pan Sheng
- The 947th Hospital of the People's Liberation Army Ground Force of Xinjiang Uygur Autonomous Region, Kashgar, PR China
| | - Zhaoheng Wang
- Lanzhou University Second Hospital, 82 Cuiyingmen, Lanzhou 730030, PR China; Orthopaedics Key Laboratory of Gansu Province, Lanzhou 730030, PR China
| | - Yanhu Li
- Lanzhou University Second Hospital, 82 Cuiyingmen, Lanzhou 730030, PR China; Orthopaedics Key Laboratory of Gansu Province, Lanzhou 730030, PR China
| | - Xuewen Kang
- Lanzhou University Second Hospital, 82 Cuiyingmen, Lanzhou 730030, PR China; Orthopaedics Key Laboratory of Gansu Province, Lanzhou 730030, PR China.
| |
Collapse
|
2
|
Xiang Z, Zhang P, Jia C, Xu R, Cao D, Xu Z, Lu T, Liu J, Wang X, Qiu C, Fu W, Li W, Cheng L, Yang Q, Feng S, Wang L, Zhao Y, Liu X. Piezo1 channel exaggerates ferroptosis of nucleus pulposus cells by mediating mechanical stress-induced iron influx. Bone Res 2024; 12:20. [PMID: 38553442 PMCID: PMC10980708 DOI: 10.1038/s41413-024-00317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/17/2023] [Accepted: 01/19/2024] [Indexed: 04/02/2024] Open
Abstract
To date, several molecules have been found to facilitate iron influx, while the types of iron influx channels remain to be elucidated. Here, Piezo1 channel was identified as a key iron transporter in response to mechanical stress. Piezo1-mediated iron overload disturbed iron metabolism and exaggerated ferroptosis in nucleus pulposus cells (NPCs). Importantly, Piezo1-induced iron influx was independent of the transferrin receptor (TFRC), a well-recognized iron gatekeeper. Furthermore, pharmacological inactivation of Piezo1 profoundly reduced iron accumulation, alleviated mitochondrial ROS, and suppressed ferroptotic alterations in stimulation of mechanical stress. Moreover, conditional knockout of Piezo1 (Col2a1-CreERT Piezo1flox/flox) attenuated the mechanical injury-induced intervertebral disc degeneration (IVDD). Notably, the protective effect of Piezo1 deficiency in IVDD was dampened in Piezo1/Gpx4 conditional double knockout (cDKO) mice (Col2a1-CreERT Piezo1flox/flox/Gpx4flox/flox). These findings suggest that Piezo1 is a potential determinant of iron influx, indicating that the Piezo1-iron-ferroptosis axis might shed light on the treatment of mechanical stress-induced diseases.
Collapse
Affiliation(s)
- Ziqian Xiang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
- University of Health and Rehabilitation Sciences, Qingdao, 226000, China
| | - Pengfei Zhang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Chunwang Jia
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Rongkun Xu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Dingren Cao
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Zhaoning Xu
- School of Nursing and Rehabilitation, Shandong University, Jinan, 250012, China
| | - Tingting Lu
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, 061011, China
| | - Jingwei Liu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xiaoxiong Wang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
- University of Health and Rehabilitation Sciences, Qingdao, 226000, China
| | - Cheng Qiu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Wenyang Fu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Weiwei Li
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lei Cheng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, 30021, China
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Lianlei Wang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Yunpeng Zhao
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Xinyu Liu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, 250012, China.
| |
Collapse
|
3
|
Cheng YK, Lin CL, Huang YC, Lin GS, Lian ZY, Chuang CH. Accurate Intervertebral Disc Segmentation Approach Based on Deep Learning. Diagnostics (Basel) 2024; 14:191. [PMID: 38248069 PMCID: PMC10814817 DOI: 10.3390/diagnostics14020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Automatically segmenting specific tissues or structures from medical images is a straightforward task for deep learning models. However, identifying a few specific objects from a group of similar targets can be a challenging task. This study focuses on the segmentation of certain specific intervertebral discs from lateral spine images acquired from an MRI scanner. In this research, an approach is proposed that utilizes MultiResUNet models and employs saliency maps for target intervertebral disc segmentation. First, a sub-image cropping method is used to separate the target discs. This method uses MultiResUNet to predict the saliency maps of target discs and crop sub-images for easier segmentation. Then, MultiResUNet is used to segment the target discs in these sub-images. The distance maps of the segmented discs are then calculated and combined with their original image for data augmentation to predict the remaining target discs. The training set and test set use 2674 and 308 MRI images, respectively. Experimental results demonstrate that the proposed method significantly enhances segmentation accuracy to about 98%. The performance of this approach highlights its effectiveness in segmenting specific intervertebral discs from closely similar discs.
Collapse
Affiliation(s)
- Yu-Kai Cheng
- Department of Neurosurgery, China Medical University Hospital, Taichung 404, Taiwan;
| | - Chih-Lung Lin
- Department of Neurosurgery, Asia University Hospital, Taichung 413, Taiwan;
- Department of Occupational Therapy, Asia University, Taichung 413, Taiwan
| | - Yi-Chi Huang
- Department of Radiology, Asia University Hospital, Taichung 413, Taiwan;
| | - Guo-Shiang Lin
- Department of Computer Science and Information Engineering, National Chin-Yi University of Technology, Taichung 411, Taiwan;
| | - Zhen-You Lian
- Department of Artificial Intelligence and Computer Engineering, National Chin-Yi University of Technology, Taichung 411, Taiwan;
| | - Cheng-Hung Chuang
- Department of Artificial Intelligence and Computer Engineering, National Chin-Yi University of Technology, Taichung 411, Taiwan;
| |
Collapse
|
4
|
Sun J, Tan Y, Su J, Mikhail H, Pavel V, Deng Z, Li Y. Role and molecular mechanism of ghrelin in degenerative musculoskeletal disorders. J Cell Mol Med 2023; 27:3681-3691. [PMID: 37661635 PMCID: PMC10718156 DOI: 10.1111/jcmm.17944] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/19/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
Ghrelin is a brain-gut peptide, and the first 28-peptide that was found in the gastric mucosa. It has a growth hormone (GH)-releasing hormone-like effect and can potently promote the release of GH from pituitary GH cells; however, it is unable to stimulate GH synthesis. Therefore, ghrelin is believed to play a role in promoting bone growth and development. The correlation between ghrelin and some degenerative diseases of the musculoskeletal system has been reported recently, and ghrelin may be one of the factors influencing degenerative pathologies, such as osteoporosis, osteoarthritis, sarcopenia and intervertebral disc degeneration. With population ageing, the risk of health problems caused by degenerative diseases of the musculoskeletal system gradually increases. In this article, the roles of ghrelin in musculoskeletal disorders are summarized to reveal the potential effects of ghrelin as a key target in the treatment of related bone and muscle diseases and the need for further research.
Collapse
Affiliation(s)
- Jianfeng Sun
- Deparment of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina
- Xiangya School of Medicine, Central South UniversityChangshaHunanChina
| | - Yibo Tan
- Deparment of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina
- Xiangya School of Medicine, Central South UniversityChangshaHunanChina
| | - Jingyue Su
- Department of Sports MedicineThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenGuangdongChina
| | - Herasimenka Mikhail
- Republican Scientific and Practical Center of Traumatology and OrthopedicsMinskBelarus
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and OrthopedicsMinskBelarus
| | - Zhenhan Deng
- Department of Sports MedicineThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenGuangdongChina
| | - Yusheng Li
- Deparment of OrthopedicsXiangya Hospital, Central South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaHunanChina
| |
Collapse
|
5
|
Kuhn A, Riegger J, Teixeira GQ, Huber-Lang M, Lambris JD, Neidlinger-Wilke C, Brenner RE. Terminal Complement Activation Is Induced by Factors Released from Endplate Tissue of Disc Degeneration Patients and Stimulates Expression of Catabolic Enzymes in Annulus Fibrosus Cells. Cells 2023; 12:cells12060887. [PMID: 36980228 PMCID: PMC10047197 DOI: 10.3390/cells12060887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Terminal complement complex (TCC) deposition was identified in human degenerated discs. To clarify the role of terminal complement activation in disc degeneration (DD), we investigated respective activating mechanisms and cellular effects in annulus fibrosus (AF) cells. Isolated cells from human AF, nucleus pulposus (NP), and endplate (EP) were stimulated with human serum alone or with zymosan and treated with either the C3 inhibitor Cp40 or the C5 antibody eculizumab. Complement activation was determined via anaphylatoxin generation and TCC deposition detection. Thereby, induced catabolic effects were evaluated in cultured AF cells. Moreover, C5 cleavage under degenerative conditions in the presence of AF cells was assessed. Zymosan-induced anaphylatoxin generation and TCC deposition was significantly suppressed by both complement inhibitors. Zymosan induced gene expression of ADAMTS4, MMP1, and COX2. Whereas the C3 blockade attenuated the expression of ADAMTS4, the C5 blockade reduced the expression of ADAMTS4, MMP1, and COX2. Direct C5 cleavage was significantly enhanced by EP conditioned medium from DD patients and CTSD. These results indicate that terminal complement activation might be functionally involved in the progression of DD. Moreover, we found evidence that soluble factors secreted by degenerated EP tissue can mediate direct C5 cleavage, thereby contributing to complement activation in degenerated discs.
Collapse
Affiliation(s)
- Amelie Kuhn
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Ulm University, 89081 Ulm, Germany
| | - Jana Riegger
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Ulm University, 89081 Ulm, Germany
| | - Graciosa Q. Teixeira
- Institute of Orthopedic Research and Biomechanics, Trauma Research Centre, Ulm University, 89081 Ulm, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, 89081 Ulm, Germany
| | - John D. Lambris
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cornelia Neidlinger-Wilke
- Institute of Orthopedic Research and Biomechanics, Trauma Research Centre, Ulm University, 89081 Ulm, Germany
| | - Rolf E. Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Ulm University, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-(0)731-500-63280
| |
Collapse
|
6
|
Liawrungrueang W, Kim P, Kotheeranurak V, Jitpakdee K, Sarasombath P. Automatic Detection, Classification, and Grading of Lumbar Intervertebral Disc Degeneration Using an Artificial Neural Network Model. Diagnostics (Basel) 2023; 13:diagnostics13040663. [PMID: 36832151 PMCID: PMC9955414 DOI: 10.3390/diagnostics13040663] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intervertebral disc degeneration (IDD) is a common cause of symptomatic axial low back pain. Magnetic resonance imaging (MRI) is currently the standard for the investigation and diagnosis of IDD. Deep learning artificial intelligence models represent a potential tool for rapidly and automatically detecting and visualizing IDD. This study investigated the use of deep convolutional neural networks (CNNs) for the detection, classification, and grading of IDD. METHODS Sagittal images of 1000 IDD T2-weighted MRI images from 515 adult patients with symptomatic low back pain were separated into 800 MRI images using annotation techniques to create a training dataset (80%) and 200 MRI images to create a test dataset (20%). The training dataset was cleaned, labeled, and annotated by a radiologist. All lumbar discs were classified for disc degeneration based on the Pfirrmann grading system. The deep learning CNN model was used for training in detecting and grading IDD. The results of the training with the CNN model were verified by testing the grading of the dataset using an automatic model. RESULTS The training dataset of the sagittal intervertebral disc lumbar MRI images found 220 IDDs of grade I, 530 of grade II, 170 of grade III, 160 of grade IV, and 20 of grade V. The deep CNN model was able to detect and classify lumbar IDD with an accuracy of more than 95%. CONCLUSION The deep CNN model can reliably automatically grade routine T2-weighted MRIs using the Pfirrmann grading system, providing a quick and efficient method for lumbar IDD classification.
Collapse
Affiliation(s)
| | - Pyeoungkee Kim
- Department of Computer Engineering, Silla University, Busan 46958, Republic of Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok 10330, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi 20110, Thailand
| | - Peem Sarasombath
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-8164-0444-5
| |
Collapse
|
7
|
Lin M, Hu Y, An H, Guo T, Gao Y, Peng K, Zhao M, Zhang X, Zhou H. Silk fibroin-based biomaterials for disc tissue engineering. Biomater Sci 2023; 11:749-776. [PMID: 36537344 DOI: 10.1039/d2bm01343f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Low back pain is the major cause of disability worldwide, and intervertebral disc degeneration (IVDD) is one of the most important causes of low back pain. Currently, there is no method to treat IVDD that can reverse or regenerate intervertebral disc (IVD) tissue, but the recent development of disc tissue engineering (DTE) offers a new means of addressing these disadvantages. Among numerous biomaterials for tissue engineering, silk fibroin (SF) is widely used due to its easy availability and excellent physical/chemical properties. SF is usually used in combination with other materials to construct biological scaffolds or bioactive substance delivery systems, or it can be used alone. The present article first briefly outlines the anatomical and physiological features of IVD, the associated etiology and current treatment modalities of IVDD, and the current status of DTE. Then, it highlights the characteristics of SF biomaterials and their latest research advances in DTE and discusses the prospects and challenges in the application of SF in DTE, with a view to facilitating the clinical process of developing interventions related to IVD-derived low back pain caused by IVDD.
Collapse
Affiliation(s)
- Maoqiang Lin
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Yicun Hu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Haiying An
- Department of Laboratory Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430000, Hubei, China
| | - Taowen Guo
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Yanbing Gao
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Kaichen Peng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Meiling Zhao
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| | - Xiaobo Zhang
- Department of Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China.
| | - Haiyu Zhou
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, Gansu, China. .,Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou 730030, Gansu, China
| |
Collapse
|
8
|
Velnar T, Gradisnik L. Endplate role in the degenerative disc disease: A brief review. World J Clin Cases 2023; 11:17-29. [PMID: 36687189 PMCID: PMC9846967 DOI: 10.12998/wjcc.v11.i1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/19/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023] Open
Abstract
The degenerative disease of the intervertebral disc is nowadays an important health problem, which has still not been understood and solved adequately. The vertebral endplate is regarded as one of the vital elements in the structure of the intervertebral disc. Its constituent cells, the chondrocytes in the endplate, may also be involved in the process of the intervertebral disc degeneration and their role is central both under physiological and pathological conditions. They main functions include a role in homeostasis of the extracellular environment of the intervertebral disc, metabolic support and nutrition of the discal nucleus and annulus beneath and the preservation of the extracellular matrix. Therefore, it is understandable that the cells in the endplate have been in the centre of research from several viewpoints, such as development, degeneration and growth, reparation and remodelling, as well as treatment strategies. In this article, we briefly review the importance of vertebral endplate, which are often overlooked, in the intervertebral disc degeneration.
Collapse
Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Alma Mater Europaea Maribor, Maribor 2000, Slovenia
| | - Lidija Gradisnik
- Alma Mater Europaea Maribor, Maribor 2000, Slovenia
- Institute of Biomedical Sciences, University of Maribor, University of Maribor, Maribor 2000, Slovenia
| |
Collapse
|
9
|
Kopec JA, Sayre EC, Cibere J, Li LC, Wong H, Okhmatovskaia A, Esdaile JM. Reducing the burden of low back pain: results from a new microsimulation model. BMC Musculoskelet Disord 2022; 23:804. [PMID: 35996103 PMCID: PMC9396830 DOI: 10.1186/s12891-022-05747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Low back pain (LBP) causes the highest morbidity burden globally. The purpose of the present study was to project and compare the impact of three strategies for reducing the population health burden of LBP: weight loss, ergonomic interventions, and an exercise program. Methods We have developed a microsimulation model of LBP in Canada using a new modeling platform called SimYouLate. The initial population was derived from Cycle 1 (2001) of the Canadian Community Health Survey (CCHS). We modeled an open population 20 years of age and older. Key variables included age, sex, education, body mass index (BMI), type of work, having back problems, pain level in persons with back problems, and exercise participation. The effects of interventions on the risk of LBP were obtained from the CCHS for the effect of BMI, the Global Burden of Disease Study for occupational risks, and a published meta-analysis for the effect of exercise. All interventions lasted from 2021 to 2040. The population health impact of the interventions was calculated as a difference in years lived with disability (YLDs) between the base-case scenario and each intervention scenario, and expressed as YLDs averted per intervention unit or a proportion (%) of total LBP-related YLDs. Results In the base-case scenario, LBP in 2020 was responsible for 424,900 YLDs in Canada and the amount increased to 460,312 YLDs in 2040. The effects of the interventions were as follows: 27,993 (95% CI 23,373, 32,614) YLDs averted over 20 years per 0.1 unit change in log-transformed BMI (9.5% change in BMI) among individuals who were overweight and those with obesity, 19,416 (16,275, 22,557) YLDs per 1% reduction in the proportion of workers exposed to occupational risks, and 26,058 (22,455, 29,661) YLDs averted per 1% increase in the proportion of eligible patients with back problems participating in an exercise program. Conclusions The study provides new data on the relationship between three types of interventions and the resultant reductions in LBP burden in Canada. According to our model, each of the interventions studied could potentially result in a substantial reduction in LBP-related disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05747-2.
Collapse
Affiliation(s)
- Jacek A Kopec
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. .,Arthritis Research Canada, Vancouver, BC, Canada.
| | - Eric C Sayre
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Anya Okhmatovskaia
- McGill Clinical and Health Informatics, McGill University, Montreal, QC, Canada
| | - John M Esdaile
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
10
|
Identification of miRNA-mRNA Pairs in Relation to TNF-α/IL-1β Induced Inflammatory Response in Intervertebral Disc Degeneration. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3374091. [PMID: 35990856 PMCID: PMC9391105 DOI: 10.1155/2022/3374091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Abstract
Objective The determination of miRNA-mRNA pairs for intervertebral disc degeneration (IVDD) regulated by pro-inflammatory cytokines were investigated. Methods Two dataset (accession number GSE27494 and GSE41883 from platform GPL1352) of expression profiling was downloaded from Gene Expression Omnibus (GEO). The annulus cells were isolated from annulus fibrosus in patients with degenerative disc disease. The cells were then cultured in a three-dimensional (3D) collagen containing with/without proinflammatory cytokines (tumor necrosis factor alpha (TNF-α) or interleukin beta (IL-1β)). After being cultured for 14 days, the isolated total RNA was analyzed via microarray, and the expression array data were obtained using BRB-Array Tools followed by analyzing the differentially expressed genes (DEGs) and the prediction of potential miRNA targets of hub genes through online database. Results Firstly, 52 and 296 DEGs were found in IL-1β- and TNF-α-induced annulus cells, respectively, of these there had 42 common DEGs (co-DEGs) with 34 increased transcripts and 8 reduced ones. Based on the GO and KEGG software, these co-DEGs were mainly enriched in the response to lipopolysaccharide (LPS) and molecule of bacterial origin, the regulation of receptor ligand activity and signaling receptor activator activity, as well as the following signaling pathways, including TNF signaling pathway, IL-17 signaling pathway, and NF-κB signaling pathway. Top hub genes (CXCL1, CXCL2, CXCL8, IL1Β and PTGS2) regulated by several potential microRNAs were involved in TNF-α/IL-1β treated annulus cells. Conclusions Several candidate genes regulated by miRNAs caused by TNF-α/IL-1β in the annulus cells were found, which will guide diagnosis and treatment for degenerative disc disease.
Collapse
|
11
|
Zhu D, Wang Z, Zhang G, Ma C, Qiu X, Wang Y, Liu M, Guo X, Chen H, Deng Q, Kang X. Periostin promotes nucleus pulposus cells apoptosis by activating the Wnt/β-catenin signaling pathway. FASEB J 2022; 36:e22369. [PMID: 35747912 DOI: 10.1096/fj.202200123r] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022]
Abstract
Intervertebral disc (IVD) degeneration (IVDD) is closely linked to degenerative spinal disease, resulting in disability, poor quality of life, and financial burden. Apoptosis of nucleus pulposus (NP) cells (NPCs) is a key pathological basis of IVDD. Periostin (POSTN), an extracellular matrix protein, is expressed in many tissues, whereas its abnormal expression is associated with IVDD. The conventional Wnt/β-catenin pathway is also involved in IVDD and contributes to NPCs apoptosis. However, research on the mechanisms of POSTN in IVDD is lacking. This study investigated the relationship between POSTN and β-catenin expression in degenerated IVDs. We detected the expression of POSTN, β-catenin, and cleaved-caspase-3 (C-caspase3) in degenerated and non-degenerated IVD tissues of different grades (n = 8) using RT-qPCR, immunohistochemical staining, and western blotting analysis. Next, we explored the effects of recombinant periostin (rPOSTN) and isoquercitrin (Iso), an inhibitor of the Wnt/β-catenin pathway, on NPCs apoptosis. Finally, we inhibited the expression of POSTN in degenerated NPCs in vivo and investigated the anti-apoptotic effect. The expression of β-catenin, POSTN, and C-caspase3 in severe degenerative IVDs was significantly higher than that in mild degenerative IVDs. These findings were confirmed in rat and cell-based degenerative models. When treated with rPOSTN, the Wnt/β-catenin pathway activity and cell apoptosis were time- and dose-dependent. However, rPOSTN-induced NPCs apoptosis decreased after iso-induced inhibition of the Wnt/β-catenin pathway. POSTN inhibition reduced apoptosis but was restored by rPOSTN re-addition. Lastly, POSTN inhibition ameliorated puncture-induced IVDD in vivo. Overall, our study demonstrated that POSTN promotes NPCs apoptosis and aggravates degeneration by activating the Wnt/β-catenin pathway.
Collapse
Affiliation(s)
- Daxue Zhu
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Zhaoheng Wang
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Guangzhi Zhang
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Congwen Ma
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Xiaoming Qiu
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Yidian Wang
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Mingqiang Liu
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Xudong Guo
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Haiwei Chen
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| | - Qiang Deng
- Gansu Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Xuewen Kang
- Lanzhou University Second Hospital, Lanzhou, PR China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou, PR China
| |
Collapse
|
12
|
Romaniyanto, Mahyudin F, Prakoeswa CRS, Notobroto HB, Tinduh D, Ausrin R, Rantam FA, Suroto H, Utomo DN, Rhatomy S. Hypoxia Effects in Intervertebral Disc-Derived Stem Cells and Discus Secretomes: An in vitro Study. Stem Cells Cloning 2022; 15:21-28. [PMID: 35655962 PMCID: PMC9153942 DOI: 10.2147/sccaa.s363951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 12/17/2022] Open
Abstract
Background This study aimed to investigate the effects of hypoxia and normoxia preconditioning in rabbit intervertebral disc-derived stem cells (IVDSCs) and discus-derived conditioned medium (DD-CM)/secretomes in vitro. Transforming growth factor (TGF)-β1, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) have a role in the proliferation, development, differentiation, and migration of MSCs. Materials and Methods Intervertebral discs were isolated from rabbit and incubated in normoxia and hypoxia 1%, 3%, and 5% (hypoxia groups) condition. Cell counting was performed after 24 hours of manipulation, then analyzed using one-way ANOVA. TGF-β1, PDGF, FGF, and VEGF were measured using the ELISA. Results The highest number of cells was in the hypoxia 3% preconditioning compared to the normoxia, hypoxia 1%, and hypoxia 5% groups. Hypoxia 3% also had the highest increase in PDGF protein production compared to normoxia, with hypoxia 1% and 5%. Among hypoxia groups, the highest secretions of VEGF and FGF proteins were in the hypoxia 3% group. Based on TGF-β1 protein measurement, the hypoxia 1% group was the highest increase in this protein compared to other groups. Conclusion Oxygen level in hypoxia preconditioning has a role in the preparation of IVDSCs and secretome preparation in vitro. The highest cell numbers were found in the treatment group with 3% hypoxia, and 3% hypoxia was significantly related to support IVDSCs preparation. Preconditioning with 3% hypoxia had higher PDGF and VEGF levels than other hypoxia groups.
Collapse
Affiliation(s)
- Romaniyanto
- Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Dermatology and Venereology, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | | | - Damayanti Tinduh
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Physical Medicine and Medical Rehabilitation, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ryan Ausrin
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia.,Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia
| | - Heri Suroto
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
13
|
Zhang XB, Xu SQ, Hui YG, Zhou HY, Hu YC, Zhang RH, Gao XD, Zheng CM. Lactotransferrin promotes intervertebral disc degeneration by regulating Fas and inhibiting human nucleus pulposus cell apoptosis. Aging (Albany NY) 2022; 14:4572-4585. [PMID: 35613904 PMCID: PMC9186764 DOI: 10.18632/aging.204100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Background: In recent years, intervertebral disc (IVD) degeneration (IDD) has increased in age. There is still a lack of effective treatment in clinics, which cannot improve the condition of IDD at the level of etiology. Objective: To explore IDD pathogenesis at the cellular and gene levels and investigate lactotransferrin (LTF) expression in IDD patients and its possible mechanism. Methods: We downloaded the IDD data set from the Gene Expression Omnibus (GEO) database, screened the differentially expressed genes (DEGs) and hub genes and performed Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to construct a protein–protein interaction (PPI) network. Subsequently, we verified LTF's regulatory mechanism through cell experiments. IL-1β was used to intervene in nucleus pulposus cells (NPCs) to construct the IDD cell model, and LTF and Fas expression was detected by qRT–PCR. LTF inhibitor, Fas inhibitor, LTF mimic, and Fas mimic were used to intervene in each group. Western blotting was used to detect Fas, Caspase-3, Bax, and Bcl-2 expression. Results: A total of 131 DEGs and 10 hub genes were screened. LTF mRNA in the IDD model was significantly higher than that in the control group, while Fas' mRNA was significantly lower. When LTF was upregulated or downregulated in NPCs, apoptosis marker expression showed the opposite trend. The rescue test showed that LTF and Fas' overexpression greatly enhanced NPC apoptosis. Conclusion: LTF promotes IDD progression by regulating Fas in NPCs, and it may be an effective gene therapy target.
Collapse
Affiliation(s)
- Xiao-Bo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an, Shanxi 710000, PR China
| | - Si-Qi Xu
- Department of Spine Surgery, Honghui Hospital, Xi'an, Shanxi 710000, PR China
| | - Yi-Geng Hui
- Department of Spine Surgery, Honghui Hospital, Xi'an, Shanxi 710000, PR China
| | - Hai-Yu Zhou
- Department of Spine Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730000, PR China
| | - Yi-Cun Hu
- Department of Spine Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730000, PR China
| | - Rui-Hao Zhang
- Department of Spine Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730000, PR China
| | - Xi-Dan Gao
- Department of Spine Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730000, PR China
| | - Chang-Ming Zheng
- Department of Spine Surgery, Honghui Hospital, Xi'an, Shanxi 710000, PR China
| |
Collapse
|
14
|
Feng X, Li Y, Su Q, Tan J. Degenerative Nucleus Pulposus Cells Derived Exosomes Promoted Cartilage Endplate Cells Apoptosis and Aggravated Intervertebral Disc Degeneration. Front Mol Biosci 2022; 9:835976. [PMID: 35359595 PMCID: PMC8963919 DOI: 10.3389/fmolb.2022.835976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 01/07/2023] Open
Abstract
Intervertebral disc (IVD) degeneration is a complex multifactorial disease model, which pathogenesis has not been fully defined. There are few studies on the information interaction between nucleus pulposus (NP) cells and cartilage endplate (CEP) cells. Exosomes, as a carrier of information communication between cells, have become a research hotspot recently. The purpose of this study was to explore whether degenerative NP cells-derived exosomes promoted CEP cells apoptosis and aggravated IVD degeneration. The degenerative NP cells model was induced by TNFα. NPC exosomes were isolated from the supernatant of the NP cell culture medium. The viability of NP cells and CEP cells was examined by CCK-8 assays. The exosomes were identified by TEM, NTA, and western blot. Extracellular matrix (ECM) metabolism was measured by cellular immunofluorescence and qRT-PCR. Apoptosis was detected by flow cytometry and TUNEL. X-ray and magnetic resonance imaging (MRI), as well as hematoxylin-eosin (H&E), Safranine O-Green staining was adopted to evaluate IVD degeneration grades. TNFα had a minor impact on NPC viability but inhibited ECM synthesis and promoted ECM degradation. TNFα-NPC-Exo had less effect on CEPC proliferation but promoted CEPC apoptosis and affect ECM metabolism, inhibiting aggrecan and collagen II expression and enhancing MMP-3 expression. TNFα-NPC-Exo aggravates IVD degeneration in a rat model and promoted CEPC apoptosis. In conclusion, this study demonstrated that degenerated NPC-exosome could induce apoptosis of CEPCs, inhibit ECM synthesis, and promote ECM degradation. In addition, it was proved that degenerated NPC-exosome aggravates IVD degeneration.
Collapse
Affiliation(s)
- Xiaofei Feng
- School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Xiaofei Feng,
| | - Yongchao Li
- School of Medicine, Tongji University, Shanghai, China
| | - Qihang Su
- School of Medicine, Tongji University, Shanghai, China
- Department of Orthopedics, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Jun Tan
- School of Medicine, Tongji University, Shanghai, China
- Department of Spinal Surgery, Shanghai East Hospital, Shanghai, China
| |
Collapse
|
15
|
Ling Z, Liu Y, Wang Z, Zhang Z, Chen B, Yang J, Zeng B, Gao Y, Jiang C, Huang Y, Zou X, Wang X, Wei F. Single-Cell RNA-Seq Analysis Reveals Macrophage Involved in the Progression of Human Intervertebral Disc Degeneration. Front Cell Dev Biol 2022; 9:833420. [PMID: 35295968 PMCID: PMC8918513 DOI: 10.3389/fcell.2021.833420] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
Intervertebral disc degeneration (IDD) has been considered as the primary pathological mechanism that underlies low back pain. Understanding the molecular mechanisms underlying human IDD is imperative for making strategies to treat IDD-related diseases. Herein, we report the molecular programs, lineage progression patterns, and paths of cellular communications during the progression of IDD using single-cell RNA sequencing (scRNA-seq) on nucleus pulposus (NP) cells from patients with different grades of IDD undergoing discectomy. New subtypes of cells and cell-type-specific gene signatures of the metabolic homeostatic NP cells (Met NPC), adhesive NP cells (Adh NPC), inflammatory response NP cells (IR NPC), endoplasmic reticulum stress NP cells (ERS NPC), fibrocartilaginous NP cells (Fc NPC), and CD70 and CD82+ progenitor NP cells (Pro NPC) were identified. In the late stage of IDD, the IR NPC and Fc NPC account for a large proportion of NPC. Importantly, immune cells including macrophages, T cells, myeloid progenitors, and neutrophils were also identified, and further analysis showed that significant intercellular interaction between macrophages and Pro NPC occurred via MIF (macrophage migration inhibitory factor) and NF-kB signaling pathways during the progression of IDD. In addition, dynamic polarization of macrophage M1 and M2 cell subtypes was found in the progression of IDD, and gene set functional enrichment analysis suggested a significant role of the macrophage polarization in regulating cell metabolism, especially the Pro NPC. Finally, we found that the NP cells in the late degenerative stage were mainly composed of the cell types related to inflammatory and endoplasmic reticulum (ER) response, and fibrocartilaginous activity. Our results provided new insights into the identification of NP cell populations at single-cell resolution and at the relatively whole-transcriptome scale, accompanied by cellular communications between immune cells and NP cells, and discriminative markers in relation to specific cell subsets. These new findings present clues for effective and functional manipulation of human IDD-related bioremediation and healthcare.
Collapse
Affiliation(s)
- Zemin Ling
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Liu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhe Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziji Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bolin Chen
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiaming Yang
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Baozhu Zeng
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yu Gao
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chang Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yulin Huang
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiuhui Wang
- Department of Orthopaedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- *Correspondence: Fuxin Wei, ; Xiuhui Wang,
| | - Fuxin Wei
- Department of Orthopedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- *Correspondence: Fuxin Wei, ; Xiuhui Wang,
| |
Collapse
|
16
|
Lewkowicz D, Wohlbrandt AM, Bottinger E. Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis. JMIR Mhealth Uhealth 2022; 10:e35042. [PMID: 35129454 PMCID: PMC8861873 DOI: 10.2196/35042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Digital therapeutic care apps provide a new effective and scalable approach for people with nonspecific low back pain (LBP). Digital therapeutic care apps are also driven by personalized decision-support interventions that support the user in self-managing LBP, and may induce prolonged behavior change to reduce the frequency and intensity of pain episodes. However, these therapeutic apps are associated with high attrition rates, and the initial prescription cost is higher than that of face-to-face physiotherapy. In Germany, digital therapeutic care apps are now being reimbursed by statutory health insurance; however, price targets and cost-driving factors for the formation of the reimbursement rate remain unexplored. OBJECTIVE The aim of this study was to evaluate the cost-effectiveness of a digital therapeutic care app compared to treatment as usual (TAU) in Germany. We further aimed to explore under which circumstances the reimbursement rate could be modified to consider value-based pricing. METHODS We developed a state-transition Markov model based on a best-practice analysis of prior LBP-related decision-analytic models, and evaluated the cost utility of a digital therapeutic care app compared to TAU in Germany. Based on a 3-year time horizon, we simulated the incremental cost and quality-adjusted life years (QALYs) for people with nonacute LBP from the societal perspective. In the deterministic sensitivity and scenario analyses, we focused on diverging attrition rates and app cost to assess our model's robustness and conditions for changing the reimbursement rate. All costs are reported in Euro (€1=US $1.12). RESULTS Our base case results indicated that the digital therapeutic care strategy led to an incremental cost of €121.59, but also generated 0.0221 additional QALYs compared to the TAU strategy, with an estimated incremental cost-effectiveness ratio (ICER) of €5486 per QALY. The sensitivity analysis revealed that the reimbursement rate and the capability of digital therapeutic care to prevent reoccurring LBP episodes have a significant impact on the ICER. At the same time, the other parameters remained unaffected and thus supported the robustness of our model. In the scenario analysis, the different model time horizons and attrition rates strongly influenced the economic outcome. Reducing the cost of the app to €99 per 3 months or decreasing the app's attrition rate resulted in digital therapeutic care being significantly less costly with more generated QALYs, and is thus considered to be the dominant strategy over TAU. CONCLUSIONS The current reimbursement rate for a digital therapeutic care app in the statutory health insurance can be considered a cost-effective measure compared to TAU. The app's attrition rate and effect on the patient's prolonged behavior change essentially influence the settlement of an appropriate reimbursement rate. Future value-based pricing targets should focus on additional outcome parameters besides pain intensity and functional disability by including attrition rates and the app's long-term effect on quality of life.
Collapse
Affiliation(s)
- Daniel Lewkowicz
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Attila M Wohlbrandt
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Erwin Bottinger
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany.,Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| |
Collapse
|
17
|
Zhang W, Wang H, Yuan Z, Chu G, Sun H, Yu Z, Liang H, Liu T, Zhou F, Li B. Moderate mechanical stimulation rescues degenerative annulus fibrosus by suppressing caveolin-1 mediated pro-inflammatory signaling pathway. Int J Biol Sci 2021; 17:1395-1412. [PMID: 33867854 PMCID: PMC8040478 DOI: 10.7150/ijbs.57774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 12/29/2022] Open
Abstract
Mechanical loading can induce or antagonize the extracellular matrix (ECM) synthesis, proliferation, migration, and inflammatory responses of annulus fibrosus cells (AFCs), depending on the loading mode and level. Caveolin-1 (Cav1), the core protein of caveolae, plays an important role in cellular mechanotransduction and inflammatory responses. In the present study, we presented that AFCs demonstrated different behaviors when subjected to cyclic tensile strain (CTS) for 24 h at a magnitude of 0%, 2%, 5% and 12%, respectively. It was found that 5% CTS had positive effects on cell proliferation, migration and anabolism, while 12% CTS had the opposite effects. Besides, cells exposed to interleukin-1β stimulus exhibited an increase expression in inflammatory genes, and the expression of these genes decreased after exposure to moderate mechanical loading with 5% CTS. In addition, 5% CTS decreased the level of Cav1 and integrin β1 and exhibited anti-inflammatory effects. Moreover, the expression of integrin β1 and p-p65 increased in AFCs transfected with Cav1 plasmids. In vivo results revealed that moderate mechanical stimulation could recover the water content and morphology of the discs. In conclusion, moderate mechanical stimulation restrained Cav1-mediated signaling pathway and exhibited anti-inflammatory effects on AFCs. Together with in vivo results, this study expounds the underlying molecular mechanisms on the effect of moderate mechanical stimulation on intervertebral discs (IVDs) and may provide a new therapeutic strategy for the treatment of IVD degeneration.
Collapse
Affiliation(s)
- Weidong Zhang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Wang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zhangqin Yuan
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Heng Sun
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zilin Yu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Huan Liang
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Bin Li
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China.,China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, Zhejiang, China
| |
Collapse
|
18
|
Wilby MJ, Best A, Wood E, Burnside G, Bedson E, Short H, Wheatley D, Hill-McManus D, Sharma M, Clark S, Bostock J, Hay S, Baranidharan G, Price C, Mannion R, Hutchinson PJ, Hughes DA, Marson A, Williamson PR. Microdiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by prolapsed intervertebral disc: the NERVES RCT. Health Technol Assess 2021; 25:1-86. [PMID: 33845941 DOI: 10.3310/hta25240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of microdiscectomy with transforaminal epidural steroid injection for the management of radicular pain secondary to lumbar prolapsed intervertebral disc for non-emergency presentation of sciatica of < 12 months' duration. INTERVENTIONS Patients were randomised to either (1) microdiscectomy or (2) transforaminal epidural steroid injection. DESIGN A pragmatic, multicentre, randomised prospective trial comparing microdiscectomy with transforaminal epidural steroid injection for sciatica due to prolapsed intervertebral disc with < 1 year symptom duration. SETTING NHS services providing secondary spinal surgical care within the UK. PARTICIPANTS A total of 163 participants (aged 16-65 years) were recruited from 11 UK NHS outpatient clinics. MAIN OUTCOME MEASURES The primary outcome was participant-completed Oswestry Disability Questionnaire score at 18 weeks post randomisation. Secondary outcomes were visual analogue scores for leg pain and back pain; modified Roland-Morris score (for sciatica), Core Outcome Measures Index score and participant satisfaction at 12-weekly intervals. Cost-effectiveness and quality of life were assessed using the EuroQol-5 Dimensions, five-level version; Hospital Episode Statistics data; medication usage; and self-reported cost data at 12-weekly intervals. Adverse event data were collected. The economic outcome was incremental cost per quality-adjusted life-year gained from the perspective of the NHS in England. RESULTS Eighty-three participants were allocated to transforaminal epidural steroid injection and 80 participants were allocated to microdiscectomy, using an online randomisation system. At week 18, Oswestry Disability Questionnaire scores had decreased, relative to baseline, by 26.7 points in the microdiscectomy group and by 24.5 points in the transforaminal epidural steroid injection. The difference between the treatments was not statistically significant (estimated treatment effect -4.25 points, 95% confidence interval -11.09 to 2.59 points). Nor were there significant differences between treatments in any of the secondary outcomes: Oswestry Disability Questionnaire scores, visual analogue scores for leg pain and back pain, modified Roland-Morris score and Core Outcome Measures Index score up to 54 weeks. There were four (3.8%) serious adverse events in the microdiscectomy group, including one nerve palsy (foot drop), and none in the transforaminal epidural steroid injection group. Compared with transforaminal epidural steroid injection, microdiscectomy had an incremental cost-effectiveness ratio of £38,737 per quality-adjusted life-year gained and a probability of 0.17 of being cost-effective at a willingness to pay threshold of £20,000 per quality-adjusted life-year. LIMITATIONS Primary outcome data was invalid or incomplete for 24% of participants. Sensitivity analyses demonstrated robustness to assumptions made regarding missing data. Eighteen per cent of participants in the transforaminal epidural steroid injection group subsequently received microdiscectomy prior to their primary outcome assessment. CONCLUSIONS To the best of our knowledge, the NErve Root Block VErsus Surgery trial is the first trial to evaluate the comparative clinical effectiveness and cost-effectiveness of microdiscectomy and transforaminal epidural steroid injection. No statistically significant difference was found between the two treatments for the primary outcome. It is unlikely that microdiscectomy is cost-effective compared with transforaminal epidural steroid injection at a threshold of £20,000 per quality-adjusted life-year for sciatica secondary to prolapsed intervertebral disc. FUTURE WORK These results will lead to further studies in the streamlining and earlier management of discogenic sciatica. TRIAL REGISTRATION Current Controlled Trials ISRCTN04820368 and EudraCT 2014-002751-25. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 24. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Martin J Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust (member of Liverpool Health Partners), Liverpool, UK
| | - Ashley Best
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girvan Burnside
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Emma Bedson
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Hannah Short
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Dianne Wheatley
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Manohar Sharma
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust (member of Liverpool Health Partners), Liverpool, UK
| | | | - Sally Hay
- Patient and public involvement representative, Norfolk, UK
| | | | - Cathy Price
- Pain Clinic, Solent NHS Trust, Southampton, UK
| | | | - Peter J Hutchinson
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| |
Collapse
|
19
|
Hall JA, Jowett S, Lewis M, Oppong R, Konstantinou K. The STarT Back stratified care model for nonspecific low back pain: a model-based evaluation of long-term cost-effectiveness. Pain 2021; 162:702-710. [PMID: 32868748 DOI: 10.1097/j.pain.0000000000002057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT The STarT Back approach comprises subgrouping patients with low back pain (LBP) according to the risk of persistent LBP-related disability, with appropriate matched treatments. In a 12-month clinical trial and implementation study, this stratified care approach was clinically and cost-effective compared with usual, nonstratified care. Despite the chronic nature of LBP and associated economic burden, model-based economic evaluations in LBP are rare and have shortcomings. This study therefore produces a de novo decision model of this stratified care approach for LBP management to estimate the long-term cost-effectiveness and address methodological concerns in LBP modelling. A cost-utility analysis from the National Health Service perspective compared stratified care with usual care in patients consulting in primary care with nonspecific LBP. A Markov state-transition model was constructed where patient prognosis over 10 years was dependent on physical function achieved at 12 months. Data from the clinical trial and implementation study provided short-term model parameters, with extrapolation using 2 cohort studies of usual care in LBP. Base-case results indicate this model of stratified care is cost-effective, delivering 0.14 additional quality-adjusted life years at a cost saving of £135.19 per patient over a time horizon of 10 years. Sensitivity analyses indicate the approach is likely to be cost-effective in all scenarios and cost saving in most. It is likely this stratified care model will help reduce unnecessary healthcare usage while improving the patient's quality of life. Although decision-analytic modelling is used in many conditions, its use has been underexplored in LBP, and this study also addresses associated methodological challenges.
Collapse
Affiliation(s)
- James A Hall
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Martyn Lewis
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Biostatistics Group, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Raymond Oppong
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Kika Konstantinou
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Haywood Hospital, Midlands Partnership Foundation NHS Trust, Staffordshire, United Kingdom
| |
Collapse
|
20
|
A New Hope in Spinal Degenerative Diseases: Piezo1. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6645193. [PMID: 33575334 PMCID: PMC7857891 DOI: 10.1155/2021/6645193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
As a newly discovered mechanosensitive ion channel protein, the piezo1 protein participates in the transmission of mechanical signals on the cell membrane and plays a vital role in mammalian biomechanics. Piezo1 has attracted widespread attention since it was discovered in 2010. In recent years, studies on piezo1 have gradually increased and deepened. In addition to the discovery that piezo1 is expressed in the respiratory, cardiovascular, gastrointestinal, and urinary systems, it is also stably expressed in cells such as mesenchymal stem cells (MSCs), osteoblasts, osteoclasts, chondrocytes, and nucleus pulposus cells that constitute vertebral bodies and intervertebral discs. They can all receive external mechanical stimulation through the piezo1 protein channel to affect cell proliferation, differentiation, migration, and apoptosis to promote the occurrence and development of lumbar degenerative diseases. Through reviewing the relevant literature of piezo1 in the abovementioned cells, this paper discusses the effect of piezo1 protein expression under mechanical stress stimuli on spinal degenerative disease, providing the molecular basis for the pathological mechanism of spinal degenerative disease and also a new basis, ideas, and methods for the prevention and treatment of this degenerative disease.
Collapse
|
21
|
Pereira M, Roios E, Leite Â, Pereira MG. Subjective suffering in patients with low back pain. Int J Rheum Dis 2020; 23:1379-1387. [PMID: 32869482 DOI: 10.1111/1756-185x.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
AIM Low back pain (LPB) is a prevalent rheumatic and musculoskeletal disease and patients often experience physical discomfort and functional limitations. This study aimed to evaluate how subjective suffering relates to illness perceptions, pain intensity and psychological morbidity as well as to understand the mediator (direct and indirect) effects on functional disability. METHODS A cross-sectional study with 125 patients who received physiotherapy and answered the following instruments: Illness Perception Questionnaire-Revised; Illness Subjective Suffering Inventory; Hospital Anxiety and Depression Scale and the Oswestry LBP Incapacity Questionnaire. RESULTS In the structural equation modeling analysis, subjective suffering totally mediated the relationship between both emotional response (estimate = 0.068, 95% highest posterior density interval [HPDI] = [0.017, 0.133]), consequences (estimate = 0.118, 95% HPDI = [0.035, 0.211]) and functional disability. The relationship between coherence and disability was partially mediated by subjective suffering (estimate = -0.067, 95% HPDI = [-0.134, -0.016]). Only identity and pain intensity showed direct effects on functional disability. CONCLUSION Intervention in patients with LBP should focus on subjective suffering to reduce functional disability, providing information and promoting the acceptance of disease and pain.
Collapse
Affiliation(s)
- Marta Pereira
- School of Psychology, Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Edite Roios
- School of Psychology, Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Ângela Leite
- School of Psychology, Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - M Graça Pereira
- School of Psychology, Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| |
Collapse
|
22
|
Abstract
Introduction: The degenerative processes of the intervertebral disc represent an important cause of morbidity in everyday clinical practice, exerting burden on patients and clinicians treating them. Numerous factors may initiate degenerative processes, which most commonly affect the nucleus pulposus and ultimately influence the biomechanics of the whole spine. Aim: This paper provides an overview from the literature about the process, causes and mechanisms of disc degeneration and the associated factors. Methods: The scientific literature was reviewed through PubMed, Medline and Science Direct. The articles were chosen in correlation with the study objective and their scientific relevance. Results: Many mechanical factors, such as mechanical, traumatic, genetic and nutritional, may affect the integrity of the intervertebral disc. The degenerative processes involve the structural damage of the intervertebral disc and the changes in number and composition of cells. The main factor in the degeneration of the intervertebral disc is the loss of proteoglycans. Degenerative changes of the disc are connected to damage of adjacent structures, leading to functional changes, higher susceptibility to injuries and clinical signs and symptoms. Conclusions: Degenerative disease of the intervertebral disc remains a significant health problem. Besides standard conservative and surgical treatment, techniques of regenerative therapy are becoming very promising, although still in the experimental phase.
Collapse
Affiliation(s)
- Natasa Kos
- Department of Medical Rehabilitation, University Medical Centre Ljubljana, Slovenia.,AMEU-ECM Maribor, Slovenia
| | - Lidija Gradisnik
- AMEU-ECM Maribor, Slovenia.,Institute of Biomedical Sciences, Medical Faculty Maribor, Slovenia
| | - Tomaz Velnar
- AMEU-ECM Maribor, Slovenia.,Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| |
Collapse
|