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Madariaga MC, O'Malley NA, Groff H, Alben M, Papalia A, Fogel J, Thompson J, Apazidis A. Does hydrogen peroxide help mitigate the incidence of Cutibacterium acnes in cervical spine surgeries? NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100514. [PMID: 39175928 PMCID: PMC11339044 DOI: 10.1016/j.xnsj.2024.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 08/24/2024]
Abstract
Background Surgical site infection (SSI) is a common yet serious complication of cervical spine surgery. While initially thought to be clinically insignificant, Cutibacterium acnes (C. acnes) is an important cause of infection. The purpose of this study was to investigate the ability of a hydrogen peroxide (H2O2) application during standard presurgical skin preparation to reduce the burden of C. acnes in patients undergoing cervical spine surgery. Methods This was a retrospective review of prospectively collected data. Subjects were randomly assigned to either standard surgical preparation plus H2O2 (experimental) or without H2O2 (control). Prescrub, postscrub, and dermal cultures were obtained to assess the C. acnes burden after cultures on an aerobic and anaerobic growth medium were held for 21 days. Multivariate analysis was conducted to determine factors associated with presence of C. acnes. Outcome measures included the results of intraoperative cultures and the development of a SSI within 90 days postoperatively. Results Patients (n=86) undergoing elective 2- or 3-level fusion via anterior approach were included. Prior to application of the antiseptic solution, 65% (28/43) of the experimental cohort and 77% (33/43) of the control cohort had positive C. acnes cultures (p=.34). Following application of antiseptic solution, there were no differences in positive C. acnes culture rates between the experimental and control cohorts in the epidermal (30% vs. 28%, p=1.00) or dermal (40% vs. 42%, p=1.00) cultures. No differences in the rates of C. acnes eradication from preantiseptic to postantiseptic application occurred for epidermal (p=1.00) or dermal (p=1.00) skin layers. None of the factors were associated with positive C. acnes epidermal cultures on multivariable logistic regression analysis (p>.05). Conclusions While there is potential for H2O2 to reduce the positive culture rate of C. acnes in cervical spine patients, no difference was seen when compared to standard surgical skin preparation.
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Affiliation(s)
| | - Nicholas A. O'Malley
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY 11554
| | - Hannah Groff
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY 11554
| | - Matthew Alben
- State University at Buffalo, Department of Orthopedic Surgery, Buffalo, NY
| | - Aidan Papalia
- Geisnger Health, Department of Orthopedic Surgery, Danville, PA
| | - Joshua Fogel
- Department of Biostatistics, Nassau University Medical Center, East Meadow, NY 11554
| | - Jeffrey Thompson
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY 11554
| | - Alexios Apazidis
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY 11554
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Mengis T, Bernhard L, Nüesch A, Heggli I, Herger N, Devan J, Marcus R, Laux CJ, Brunner F, Farshad M, Distler O, Le Maitre CL, Dudli S. The Expression of Toll-like Receptors in Cartilage Endplate Cells: A Role of Toll-like Receptor 2 in Pro-Inflammatory and Pro-Catabolic Gene Expression. Cells 2024; 13:1402. [PMID: 39272974 PMCID: PMC11394474 DOI: 10.3390/cells13171402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/14/2024] [Accepted: 08/21/2024] [Indexed: 09/15/2024] Open
Abstract
INTRODUCTION The vertebral cartilage endplate (CEP), crucial for intervertebral disc health, is prone to degeneration linked to chronic low back pain, disc degeneration, and Modic changes (MC). While it is known that disc cells express toll-like receptors (TLRs) that recognize pathogen- and damage-associated molecular patterns (PAMPs and DAMPs), it is unclear if CEP cells (CEPCs) share this trait. The CEP has a higher cell density than the disc, making CEPCs an important contributor. This study aimed to identify TLRs on CEPCs and their role in pro-inflammatory and catabolic gene expression. METHODS Gene expression of TLR1-10 was measured in human CEPs and expanded CEPCs using quantitative polymerase chain reaction. Additionally, surface TLR expression was measured in CEPs grouped into non-MC and MC. CEPCs were stimulated with tumor necrosis factor alpha, interleukin 1 beta, small-molecule TLR agonists, or the 30 kDa N-terminal fibronectin fragment. TLR2 signaling was inhibited with TL2-C29, and TLR2 protein expression was measured with flow cytometry. RESULTS Ex vivo analysis found all 10 TLRs expressed, while cultured CEPCs lost TLR8 and TLR9 expression. TLR2 expression was significantly increased in MC1 CEPCs, and its expression increased significantly after pro-inflammatory stimulation. Stimulation of the TLR2/6 heterodimer upregulated TLR2 protein expression. The TLR2/1 and TLR2/6 ligands upregulated pro-inflammatory genes and matrix metalloproteases (MMP1, MMP3, and MMP13), and TLR2 inhibition inhibited their upregulation. Endplate resorptive capacity of TLR2 activation was confirmed in a CEP explant model. CONCLUSIONS The expression of TLR1-10 in CEPCs suggests that the CEP is susceptible to PAMP and DAMP stimulation. Enhanced TLR2 expression in MC1, and generally in CEPCs under inflammatory conditions, has pro-inflammatory and pro-catabolic effects, suggesting a potential role in disc degeneration and MC.
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Affiliation(s)
- Tamara Mengis
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Laura Bernhard
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Andrea Nüesch
- School of Medicine and Population Health, University of Sheffield, Sheffield S10 2RX, UK
| | - Irina Heggli
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai New York, New York, NY 10029, USA
| | - Nick Herger
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jan Devan
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Roy Marcus
- Department of Radiology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Christoph J Laux
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Christine L Le Maitre
- School of Medicine and Population Health, University of Sheffield, Sheffield S10 2RX, UK
| | - Stefan Dudli
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Jia Y, Chen H, Huang S, Huo Z, Xu B. Causal effects of skin microbiota on intervertebral disk degeneration, low back pain and sciatica: a two-sample Mendelian randomization study. J Orthop Surg Res 2024; 19:476. [PMID: 39138503 PMCID: PMC11321032 DOI: 10.1186/s13018-024-04980-w] [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: 06/26/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE The purpose of this study is to use two-sample Mendelian randomization (MR) to investigate the causal relationship between skin microbiota, especially Propionibacterium acnes, and intervertebral disc degeneration (IVDD), low back pain (LBP) and sciatica. METHODS We conducted a two-sample MR using the aggregated data from the whole genome-wide association studies (GWAS). 150 skin microbiota were derived from the GWAS catalog and IVDD, LBP and sciatica were obtained from the IEU Open GWAS project. Inverse-variance weighted (IVW) was the primary research method, with MR-Egger and Weighted median as supplementary methods. Perform sensitivity analysis and reverse MR analysis on all MR results and use multivariate MR to adjust for confounding factors. RESULTS MR revealed five skin microbiota associated with IVDD, four associated with LBP, and two with sciatica. Specifically, P.acnes in sebaceous skin environments were associated with reduced risk of IVDD; IVDD was found to increase the abundance of P.acnes in moist skin. Furthermore, ASV010 [Staphylococcus (unc.)] from dry skin was a risk factor for LBP and sciatica; ASV045 [Acinetobacter (unc.)] from dry skin and Genus Rothia from dry skin exhibited potential protective effects against LBP; ASV065 [Finegoldia (unc.)] from dry skin was a protective factor for IVDD and LBP. ASV054 [Enhydrobacter (unc.)] from moist skin, Genus Bacteroides from dry skin and Genus Kocuria from dry skin were identified as being associated with an increased risk of IVDD. Genus Streptococcus from moist skin was considered to be associated with an increased risk of sciatica. CONCLUSIONS This study identified a potential causal relationship between skin microbiota and IVDD, LBP, and sciatica. No evidence suggests skin-derived P.acnes is a risk factor for IVDD, LBP and sciatica. At the same time, IVDD can potentially cause an increase in P.acnes abundance, which supports the contamination theory.
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Affiliation(s)
- Yuchao Jia
- Department of Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Houcong Chen
- Department of Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Shengbo Huang
- Department of Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Zhenxin Huo
- Department of Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Baoshan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, 300211, China.
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Deng S, Xie J, Niu T, Wang J, Han G, Xu J, Liu H, Li Z. Association of modic changes and postoperative surgical site infection after posterior lumbar spinal fusion. 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 2024; 33:3165-3174. [PMID: 38816538 DOI: 10.1007/s00586-024-08329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/21/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies have reported Modic changes (MC) represent a subclinical infection. This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery. METHODS We retrospectively reviewed the records of 424 patients who received posterior lumbar fusion. Preoperative clinical and radiological parameters were recorded. Primary outcome was the rate of postoperative surgical site infection. Covariates included age, body mass index (BMI), sex, hypertension, diabetes mellitus, chronic heart failure, Pfirrmann classification, fused levels, and operation duration. The presence of Modic changes was used as an exposition variable, and adjusted for other risk factors in multivariate analyses. RESULTS Of the 424 patients, 30 (7%) developed an acute surgical site infection. Infection had no relation to age, sex, BMI, and comorbidities. There were 212 (50%) patients with MC, and 23 (10.8%) had a surgical site infection, compared to 212 (50%) patients without MC in which there were 7 (3.3%) surgical site infections. MC was associated with surgical site infection in univariate analysis (odds ratio [OR] = 3.56, 95% confidence interval [CI]: 1.49-8.50, p = 0.004) and multivariate logistic regression analysis (OR = 3.05, 95% CI: 1.26-7.37, p = 0.013). There was statistically significant between specific type (p = 0.035) and grade of MCs (p = 0.0187) and SSI. CONCLUSIONS MCs may be a potential risk factor for SSI following posterior lumbar spinal intervertebral fusion. Type I and grade C MCs showed a higher infection rate compared with other MC types and grades.
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Affiliation(s)
- Siping Deng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiahua Xie
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Department of Spine Surgery, The Seventh Affiliated Hospital of Southern Medical University, Foshan, 528244, China
| | - Tianzuo Niu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Guowei Han
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghui Xu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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Rolfsen MP, Gammelsrud KW, Espeland A, Bråten LC, Mjønes SB, Austevoll I, Dolatowski FC, Årrestad MB, Toppe MK, Orlien IE, Holberg-Petersen M, Fagerland M, Zwart JA, Storheim K, Hellum C. Bacterial growth in patients with low back pain and Modic changes: protocol of a multicentre, case-control biopsy study. BMJ Open 2024; 14:e082244. [PMID: 38719329 PMCID: PMC11086543 DOI: 10.1136/bmjopen-2023-082244] [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: 11/17/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Bacterial infection and Modic changes (MCs) as causes of low back pain (LBP) are debated. Results diverged between two randomised controlled trials examining the effect of amoxicillin with and without clavulanic acid versus placebo on patients with chronic LBP (cLBP) and MCs. Previous biopsy studies have been criticised with regard to methods, few patients and controls, and insufficient measures to minimise perioperative contamination. In this study, we minimise contamination risk, include a control group and optimise statistical power. The main aim is to compare bacterial growth between patients with and without MCs. METHODS AND ANALYSIS This multicentre, case-control study examines disc and vertebral body biopsies of patients with cLBP. Cases have MCs at the level of tissue sampling, controls do not. Previously operated patients are included as a subgroup. Tissue is sampled before antibiotic prophylaxis with separate instruments. We will apply microbiological methods and histology on biopsies, and predefine criteria for significant bacterial growth, possible contamination and no growth. Microbiologists, surgeons and pathologist are blinded to allocation of case or control. Primary analysis assesses significant growth in MC1 versus controls and MC2 versus controls separately. Bacterial disc growth in previously operated patients, patients with large MCs and growth from the vertebral body in the fusion group are all considered exploratory analyses. ETHICS AND DISSEMINATION The Regional Committees for Medical and Health Research Ethics in Norway (REC South East, reference number 2015/697) has approved the study. Study participation requires written informed consent. The study is registered at ClinicalTrials.gov (NCT03406624). Results will be disseminated in peer-reviewed journals, scientific conferences and patient fora. TRIAL REGISTRATION NUMBER NCT03406624.
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Affiliation(s)
- Mads Peder Rolfsen
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Karianne Wiger Gammelsrud
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo Faculty of Medicine, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | | | | | - Ivar Austevoll
- Kysthospitalet in Hagavik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | | | | | | | - Ingvild Elise Orlien
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Holberg-Petersen
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Fagerland
- Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Christian Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
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Crump KB, Alminnawi A, Bermudez‐Lekerika P, Compte R, Gualdi F, McSweeney T, Muñoz‐Moya E, Nüesch A, Geris L, Dudli S, Karppinen J, Noailly J, Le Maitre C, Gantenbein B. Cartilaginous endplates: A comprehensive review on a neglected structure in intervertebral disc research. JOR Spine 2023; 6:e1294. [PMID: 38156054 PMCID: PMC10751983 DOI: 10.1002/jsp2.1294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 12/30/2023] Open
Abstract
The cartilaginous endplates (CEP) are key components of the intervertebral disc (IVD) necessary for sustaining the nutrition of the disc while distributing mechanical loads and preventing the disc from bulging into the adjacent vertebral body. The size, shape, and composition of the CEP are essential in maintaining its function, and degeneration of the CEP is considered a contributor to early IVD degeneration. In addition, the CEP is implicated in Modic changes, which are often associated with low back pain. This review aims to tackle the current knowledge of the CEP regarding its structure, composition, permeability, and mechanical role in a healthy disc, how they change with degeneration, and how they connect to IVD degeneration and low back pain. Additionally, the authors suggest a standardized naming convention regarding the CEP and bony endplate and suggest avoiding the term vertebral endplate. Currently, there is limited data on the CEP itself as reported data is often a combination of CEP and bony endplate, or the CEP is considered as articular cartilage. However, it is clear the CEP is a unique tissue type that differs from articular cartilage, bony endplate, and other IVD tissues. Thus, future research should investigate the CEP separately to fully understand its role in healthy and degenerated IVDs. Further, most IVD regeneration therapies in development failed to address, or even considered the CEP, despite its key role in nutrition and mechanical stability within the IVD. Thus, the CEP should be considered and potentially targeted for future sustainable treatments.
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Affiliation(s)
- Katherine B. Crump
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
- Graduate School for Cellular and Biomedical Sciences (GCB)University of BernBernSwitzerland
| | - Ahmad Alminnawi
- GIGA In Silico MedicineUniversity of LiègeLiègeBelgium
- Skeletal Biology and Engineering Research Center, KU LeuvenLeuvenBelgium
- Biomechanics Research Unit, KU LeuvenLeuvenBelgium
| | - Paola Bermudez‐Lekerika
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
- Graduate School for Cellular and Biomedical Sciences (GCB)University of BernBernSwitzerland
| | - Roger Compte
- Twin Research & Genetic EpidemiologySt. Thomas' Hospital, King's College LondonLondonUK
| | - Francesco Gualdi
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)BarcelonaSpain
| | - Terence McSweeney
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
| | - Estefano Muñoz‐Moya
- BCN MedTech, Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | - Andrea Nüesch
- Division of Clinical Medicine, School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Liesbet Geris
- GIGA In Silico MedicineUniversity of LiègeLiègeBelgium
- Skeletal Biology and Engineering Research Center, KU LeuvenLeuvenBelgium
- Biomechanics Research Unit, KU LeuvenLeuvenBelgium
| | - Stefan Dudli
- Center of Experimental RheumatologyDepartment of Rheumatology, University Hospital Zurich, University of ZurichZurichSwitzerland
- Department of Physical Medicine and RheumatologyBalgrist University Hospital, Balgrist Campus, University of ZurichZurichSwitzerland
| | - Jaro Karppinen
- Research Unit of Health Sciences and TechnologyUniversity of OuluOuluFinland
- Finnish Institute of Occupational HealthOuluFinland
- Rehabilitation Services of South Karelia Social and Health Care DistrictLappeenrantaFinland
| | - Jérôme Noailly
- BCN MedTech, Department of Information and Communication TechnologiesUniversitat Pompeu FabraBarcelonaSpain
| | - Christine Le Maitre
- Division of Clinical Medicine, School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical FacultyUniversity of BernBernSwitzerland
- Department of Orthopaedic Surgery and Traumatology, InselspitalBern University Hospital, Medical Faculty, University of BernBernSwitzerland
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Aboushaala K, Wong AYL, Barajas JN, Lim P, Al-Harthi L, Chee A, Forsyth CB, Oh CD, Toro SJ, Williams FMK, An HS, Samartzis D. The Human Microbiome and Its Role in Musculoskeletal Disorders. Genes (Basel) 2023; 14:1937. [PMID: 37895286 PMCID: PMC10606932 DOI: 10.3390/genes14101937] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Musculoskeletal diseases (MSDs) are characterized as injuries and illnesses that affect the musculoskeletal system. MSDs affect every population worldwide and are associated with substantial global burden. Variations in the makeup of the gut microbiota may be related to chronic MSDs. There is growing interest in exploring potential connections between chronic MSDs and variations in the composition of gut microbiota. The human microbiota is a complex community consisting of viruses, archaea, bacteria, and eukaryotes, both inside and outside of the human body. These microorganisms play crucial roles in influencing human physiology, impacting metabolic and immunological systems in health and disease. Different body areas host specific types of microorganisms, with facultative anaerobes dominating the gastrointestinal tract (able to thrive with or without oxygen), while strict aerobes prevail in the nasal cavity, respiratory tract, and skin surfaces (requiring oxygen for development). Together with the immune system, these bacteria have coevolved throughout time, forming complex biological relationships. Changes in the microbial ecology of the gut may have a big impact on health and can help illnesses develop. These changes are frequently impacted by lifestyle choices and underlying medical disorders. The potential for safety, expenses, and efficacy of microbiota-based medicines, even with occasional delivery, has attracted interest. They are, therefore, a desirable candidate for treating MSDs that are chronic and that may have variable progression patterns. As such, the following is a narrative review to address the role of the human microbiome as it relates to MSDs.
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Affiliation(s)
- Khaled Aboushaala
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Juan Nicolas Barajas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Perry Lim
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Ana Chee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Christopher B. Forsyth
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Chun-do Oh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sheila J. Toro
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Howard S. An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
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Gualdi F, Smith IG, Boixader RC, Williams FMK. Modic change is associated with increased BMI but not autoimmune diseases in TwinsUK. 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 2023; 32:3379-3386. [PMID: 37555954 DOI: 10.1007/s00586-023-07870-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/24/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the largest causes of morbidity worldwide. The aetiology of LBP is complex, and many factors contribute to the onset. Bone marrow lesions within the vertebra adjacent to an intervertebral degenerate disc named Modic change (MC) have been suggested as a diagnostic subgroup of LBP. Autoimmune response has been proposed to be one of the causes that promote the development of MC. The aim of the current investigation is to assess prevalence and severity of MC and LBP in participants with an autoimmune disease diagnosis in a well-documented cohort of adult twin volunteers. METHODS Multivariate generalized mixed linear models (GLMM) were implemented in order to calculate the association between having an autoimmune disorder and MC prevalence, width and severe and disabling LBP. The model was corrected for family structure as well as for covariates such as age, BMI and smoking. RESULTS No association was found between diagnosis of autoimmune disorder and MC. Interestingly, BMI was independently associated with MC width but not to MC prevalence. These results help to shed light on the relationship between MC and autoimmunity as well as the role of BMI in the development of the lesions. CONCLUSION This study is the first to examine autoimmune disorders and MC prevalence in a large, population-based female cohort. The study was well powered to detect a small effect. No association was found between having a diagnosis of one or more autoimmune conditions and MC prevalence, width or LBP.
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Affiliation(s)
- Francesco Gualdi
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Pompeu Fabra University (UPF), Barcelona, Spain.
- Structural Bioinformatics Lab (GRIB-IMIM), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Catalonia, Spain.
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Isabelle Granville Smith
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Roger Compte Boixader
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Frances M K Williams
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Chen X, Lu S, Chopra N, Cui P, Zhang S, Narulla R, Diwan AD. The association between low virulence organisms in different locations and intervertebral disc structural failure: A meta-analysis and systematic review. JOR Spine 2023; 6:e1244. [PMID: 37361324 PMCID: PMC10285758 DOI: 10.1002/jsp2.1244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 06/28/2023] Open
Abstract
Many factors may trigger intervertebral disc (IVD) structural failure (intervertebral disc degeneration (IDD) and endplate changes), including inflammation, infection, dysbiosis, and the downstream effects of chemical factors. Of these, microbial diversity in the IVD and elsewhere in the body has been considered as one of the potential reasons for disc structural failure. The exact relationships between microbial colonization and IVD structural failure are not well understood. This meta-analysis aimed to investigate the impact of microbial colonization and its location (such as skin, IVD, muscle, soft tissues, and blood) on IVD structural failure and corresponding low back pain (LBP) if any. We searched four online databases for potential studies. The potential relationships between microbial colonization in different sample sources (such as skin, IVD, muscle, soft tissues, and blood) and IDD and endplate change were considered as primary outcomes. Odds ratio (OR) and 95% confidence intervals (CI) for direct comparisons were reported. Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale was used to assess the quality of evidence. Twenty-five cohort studies met the selection criteria. Overall pooled prevalence of microbial colonization in 2419 patients with LBP was 33.2% (23.6%-43.6%). The pooled prevalence of microbial colonization in 2901 samples was 29.6% (21.0%-38.9%). Compared with the patients without endplate change, the patients with endplate changes had higher rates of microbial colonization of disc (OR = 2.83; 95% CI = 1.93-4.14; I 2 = 37.6%; p = 0.108). The primary pathogen was Cutibacterium acnes which was present in 22.2% of cases (95% CI = 13.3%-32.5%; I 2 = 96.6%; p = 0.000). This meta-analysis and systematic review found low-quality grade evidence for an association between microbial colonization of disc with endplate changes. The primary pathogen was C. acnes. Due to lack of enough high-quality studies and methodological limitations of this review, further studies are required to improve our understanding of the potential relationships and mechanisms of microbiota, dysbiosis, IVD colonization and IVD structural failure.
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Affiliation(s)
- Xiaolong Chen
- Spine Labs, St. George & Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- Department of OrthopaedicsXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Shibao Lu
- Department of OrthopaedicsXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Neha Chopra
- Spine Labs, St. George & Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- Spine Service, Department of Orthopaedic SurgerySt. George Hospital CampusSydneyNew South WalesAustralia
| | - Peng Cui
- Department of OrthopaedicsXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Sitao Zhang
- Department of OrthopaedicsXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Rajpal Narulla
- Spine Labs, St. George & Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - Ashish D. Diwan
- Spine Labs, St. George & Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- Spine Service, Department of Orthopaedic SurgerySt. George Hospital CampusSydneyNew South WalesAustralia
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10
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Bråten LCH, Gjefsen E, Gervin K, Pripp AH, Skouen JS, Schistad E, Pedersen LM, Wigemyr M, Selmer KK, Aass HCD, Goll G, Brox JI, Espeland A, Grøvle L, Zwart JA, Storheim K. Cytokine Patterns as Predictors of Antibiotic Treatment Effect in Chronic Low Back Pain with Modic Changes: Subgroup Analyses of a Randomized Trial (AIM Study). J Pain Res 2023; 16:1713-1724. [PMID: 37252109 PMCID: PMC10224727 DOI: 10.2147/jpr.s406079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Randomized trials testing the effect of antibiotics for chronic low back pain (LBP) with vertebral bone marrow changes on MRI (Modic changes) report inconsistent results. A proposed explanation is subgroups with low grade discitis where antibiotics are effective, but there is currently no method to identify such subgroups. The objective of the present study was to evaluate whether distinct patterns of serum cytokine levels predict any treatment effect of oral amoxicillin at one-year follow-up in patients with chronic low back pain and Modic changes at the level of a previous lumbar disc herniation. Design We used data from an overpowered, randomized, placebo-controlled trial (the AIM study) that tested 100 days of oral 750 mg amoxicillin vs placebo three times daily in hospital outpatients with chronic (>6 months) LBP with pain intensity ≥5 on a 0-10 numerical rating scale and Modic changes type 1 (oedema type) or 2 (fatty type). We measured serum levels of 40 inflammatory cytokines at baseline and analysed six predefined potential predictors of treatment effect based on cytokine patterns in 78 randomized patients; three analyses with recursive partitioning, one based on cluster analysis and two based on principal component analyses. The primary outcome was the Roland-Morris Disability Questionnaire score at one-year follow-up in the intention to treat population. The methodology and overall results of the AIM study were published previously. Results The 78 patients were 25-62 years old and 47 (60%) were women. None of the three recursive partitioning analyses resulted in any suggested subgroups. Of all main analyses, the largest effect estimate (mean difference between antibiotic and placebo groups) was seen in a subgroup not predefined as of main interest (Cluster category 3+4; -2.0, 95% CI: -5.2-1.3, RMDQ points; p-value for interaction 0.54). Conclusion Patterns of inflammatory serum cytokine levels did not predict treatment effect of amoxicillin in patients with chronic LBP and Modic changes. Clinical Trial Registration Number ClinicalTrials.gov (identifier: NCT02323412).
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Affiliation(s)
- Lars Christian Haugli Bråten
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
| | - Elisabeth Gjefsen
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina Gervin
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital Ulleval, Oslo, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Elina Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
| | - Linda Margareth Pedersen
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
| | - Monica Wigemyr
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
| | - Kaja Kristine Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
| | | | - Guro Goll
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Oslo, Norway
- Oslo Metropolitan University, Department of Physiotherapy, Oslo, Norway
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11
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He S, Zhou X, Yang G, Zhou Z, Zhang Y, Shao X, Liang T, Lv N, Chen J, Qian Z. Proteomic comparison between physiological degeneration and needle puncture model of disc generation 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 2022; 31:2920-2934. [PMID: 35842490 DOI: 10.1007/s00586-022-07284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The completeness of the intervertebral disc proteome is fundamental to the integrity and functionality of the intervertebral disc. METHODS The 20 experimental rats were placed into two groups randomly, normal group (NG) and acupuncture pathological degeneration group-2 weeks (APDG-2w). The ten 24-month-old rats were grouped into physiological degeneration group (PDG). Magnetic resonance imaging, X-ray examination, histological staining (hematoxylin & eosin, safranin-O cartilage, and alcian blue staining), and immunohistochemical examination were carried out for assessing the degree of disc degradation. Intervertebral disc was collected, and protein composition was determined by LC- MS, followed by bioinformatic analysis including significance analysis, subcellular localization prediction, protein domain prediction, GO function and KEGG pathway analysis, and protein interaction network construction. LC-PRM was done for protein quantification. RESULTS Physiological degeneration and especially needle puncture decreased T2 signal intensity and intervertebral disc height. Results from hematoxylin & eosin, safranin-O, and alcian blue staining revealed that the annulus fibrosus apparently showed the wavy and collapsed fibrocartilage lamellas in APDG-2w and PDG groups. The contents of the nucleus pulposus were decreased in physiological degeneration group and APDG-2w group compared with NG. Results from immunohistochemical analysis suggested the degeneration of intervertebral disc and inflammation in APDG-2w and PDG groups. The protein composition and expression between needle puncture rat models and the physiological degeneration group showed significant difference. CONCLUSIONS Our studies produced point-reference datasets of normal rats, physiological degeneration rats, and needle puncture rat models, which is beneficial to subsequent pathological studies. There is differential expression of protein expression in degenerative discs with aging and acupuncture, which may be used as a potential discriminating index for different intervertebral degenerations.
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Affiliation(s)
- Shuangjun He
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, The People's Hospital of Danyang, Xinmin Road 2, Danyang, Zhenjiang, 212300, Jiangsu, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Xinfeng Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Guotao Yang
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, The People's Hospital of Danyang, Xinmin Road 2, Danyang, Zhenjiang, 212300, Jiangsu, China
| | - Zhangzhe Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Yijian Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Xiaofeng Shao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Ting Liang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, 41 Hailian Street, Lianyungang, Jiangsu, China.
| | - Jianhong Chen
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, The People's Hospital of Danyang, Xinmin Road 2, Danyang, Zhenjiang, 212300, Jiangsu, China.
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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12
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Schweizer TA, Andreoni F, Acevedo C, Scheier TC, Heggli I, Maggio EM, Eberhard N, Brugger SD, Dudli S, Zinkernagel AS. Intervertebral disc cell chondroptosis elicits neutrophil response in Staphylococcus aureus spondylodiscitis. Front Immunol 2022; 13:908211. [PMID: 35967370 PMCID: PMC9366608 DOI: 10.3389/fimmu.2022.908211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
To understand the pathophysiology of spondylodiscitis due to Staphylococcus aureus, an emerging infectious disease of the intervertebral disc (IVD) and vertebral body with a high complication rate, we combined clinical insights and experimental approaches. Clinical data and histological material of nine patients suffering from S. aureus spondylodiscitis were retrospectively collected at a single center. To mirror the clinical findings experimentally, we developed a novel porcine ex vivo model mimicking acute S. aureus spondylodiscitis and assessed the interaction between S. aureus and IVD cells within their native environment. In addition, the inflammatory features underlying this interaction were assessed in primary human IVD cells. Finally, mirroring the clinical findings, we assessed primary human neutrophils for their ability to respond to secreted inflammatory modulators of IVD cells upon the S. aureus challenge. Acute S. aureus spondylodiscitis in patients was characterized by tissue necrosis and neutrophil infiltration. Additionally, the presence of empty IVD cells’ lacunae was observed. This was mirrored in the ex vivo porcine model, where S. aureus induced extensive IVD cell death, leading to empty lacunae. Concomitant engagement of the apoptotic and pyroptotic cell death pathways was observed in primary human IVD cells, resulting in cytokine release. Among the released cytokines, functionally intact neutrophil-priming as well as broad pro- and anti-inflammatory cytokines which are known for their involvement in IVD degeneration were found. In patients as well as ex vivo in a novel porcine model, S. aureus IVD infection caused IVD cell death, resulting in empty lacunae, which was accompanied by the release of inflammatory markers and recruitment of neutrophils. These findings offer valuable insights into the important role of inflammatory IVD cell death during spondylodiscitis and potential future therapeutic approaches.
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Affiliation(s)
- Tiziano A. Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Andreoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C. Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irina Heggli
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Physical Medicine and Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ewerton Marques Maggio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadia Eberhard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D. Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Dudli
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- *Correspondence: Annelies S. Zinkernagel,
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Jha SC, Sairyo K. The role of Propionibacterium acnes in and Modic type 1 changes : A literature review. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 67:21-26. [PMID: 32378611 DOI: 10.2152/jmi.67.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Propionibacterium acnes (P. acnes) is part of the normal flora of human skin, oral cavity, intestinal tract and external ear canal. However, breach in the mucosa as well as ruptured annulus fibrosus provide favorable pathway for P. acnes to nucleus pulposus where it can proliferate under anaerobic condition. In past two decades many authors have identified P. acnes in routine culture of discs. There studies showed that almost 50% of discs cultured were positive for various organism, and in vast majority of culture positive disc, P. acnes was the primary organism isolated. However, there are few studies that refute the hypothesis that P. acnes has a role in pathogenesis of Modic type 1 changes. Identification of P. acnes in culture indicates the infective patho-mechanism in the pathogenesis of Modic type 1 changes, which may be ameable to antibiotic treatment. However, it is still difficult to identify which subset of these patients (patients with low back pain with type 1 Modic change) are infective in nature. Further investigation and more clinical trails will be required for clear identification of the infective subgroup among low back patient in general. J. Med. Invest. 67 : 21-26, February, 2020.
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Affiliation(s)
- Subash Chandra Jha
- Department of Orthopedics, Birat Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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14
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Manniche C, Hall GM. Chronic low back pain, Modic changes and low-grade virulent infection: efficacy of antibiotic treatment. Future Sci OA 2021; 7:FSO703. [PMID: 34046205 PMCID: PMC8147823 DOI: 10.2144/fsoa-2021-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Chronic low back pain (CLBP) has consistently been associated with the longest number of years lived with a disability in global studies, while commonly used treatments for CLBP are largely ineffective. In 2013 a randomized, double-blind, controlled study demonstrated significant improvements in CLBP patients demonstrating Modic changes type 1 on their MRI scans and undergoing long-term oral antibiotic treatment (100 days). Much of the ensuing debate has focused on whether this was a true infection or contamination. Newer and more advanced technologies clearly point to an ongoing low-grade infection. We have reviewed all of the clinical trials published in the recent past and conclude that there is compelling evidence for the effect of long-term oral antibiotic treatment for this patient group.
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Affiliation(s)
- Claus Manniche
- Department of Occupational & Environmental Medicine, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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15
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Sheep as a Potential Model of Intradiscal Infection by the Bacterium Cutibacterium acnes. Vet Sci 2021; 8:vetsci8030048. [PMID: 33809558 PMCID: PMC8002071 DOI: 10.3390/vetsci8030048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022] Open
Abstract
The anaerobic bacterium Cutibacterium acnes has been increasingly linked to the development of degenerative disc disease (DDD), although causality is yet to be conclusively proven. To better study how this organism could contribute to the aetiology of DDD, improved animal models that are more reflective of human disc anatomy, biology and mechanical properties are required. Against this background, our proof-of concept study aimed to be the first demonstration that C. acnes could be safely administered percutaneously into sheep intervertebral discs (IVDs) for in vivo study. Following our protocol, two sheep were successfully injected with a strain of C. acnes (8.3 × 106 CFU/disc) previously recovered from a human degenerative disc. No adverse reactions were noted, and at one-month post inoculation all triplicate infected discs in our first animal grew C. acnes, albeit at a reduced load (5.12 × 104 to 6.67 × 104 CFU/disc). At six months, no growth was detected in discs from our second animal indicating bacterial clearance. This pilot study has demonstrated the feasibility of safe percutaneous injection of C. acnes into sheep IVDs under fluoroscopic guidance. The design of follow-up sheep studies to investigate the potential of C. acnes to drive pathological changes within infected discs should now be pursued.
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16
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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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Tang G, Han X, Lin Z, Qian H, Chen B, Zhou C, Chen Y, Jiang W. Propionibacterium acnes Accelerates Intervertebral Disc Degeneration by Inducing Pyroptosis of Nucleus Pulposus Cells via the ROS-NLRP3 Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:4657014. [PMID: 33603947 PMCID: PMC7870295 DOI: 10.1155/2021/4657014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
Our previous study verified the occurrence of Propionibacterium acnes (P. acnes), a low-virulence anaerobic bacterium, latently residing in degenerated intervertebral discs (IVDs), and the infection had a strong association with IVD degeneration. We explored whether P. acnes induces nucleus pulposus cell (NPC) pyroptosis, a more dangerous cell death process than apoptosis, and accelerates IVD degeneration via the pyroptotic products interleukin- (IL-) 1β and IL-18. After coculturing with P. acnes, human NPCs showed significant upregulation of NOD-like receptor 3 (NLRP3), cleaved IL-1β, cleaved caspase-1, and cleaved gasdermin D in response to the overexpression of IL-1β and IL-18 in a time- and dose-dependent manner. In addition, the gene expression of inflammatory factors and catabolic enzymes significantly increased in normal NPCs when cocultured with pyroptotic NPCs in a transwell system, and the adverse effects were inhibited when NPC pyroptosis was suppressed. Furthermore, inoculation of P. acnes into the IVDs of rats caused significant pyroptosis of NPCs and remarkable IVD degeneration. Finally, coculture of NPCs with P. acnes induced the overexpression of reactive oxygen species (ROS) and NLRP3, while inhibition of both factors reduced NPC pyroptosis. Therefore, P. acnes induces NPC pyroptosis via the ROS-NLRP3 signaling pathway, and the pyroptotic NPCs cause an IVD degeneration cascade. Targeting the P. acnes-induced pyroptosis of NPCs may become an alternative treatment strategy for IVD degeneration in the future.
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Affiliation(s)
- Guoqing Tang
- Orthopedic Center, The First Affiliated Hospital of Soochow University, Suzhou 215000, China
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
| | - Xiaoguang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhijie Lin
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
- Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou 225001, China
| | - Hongbin Qian
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
| | - Bing Chen
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
| | - Chengliang Zhou
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
| | - Yong Chen
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225001, China
| | - Weimin Jiang
- Orthopedic Center, The First Affiliated Hospital of Soochow University, Suzhou 215000, China
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18
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Bråten LCH, Grøvle L, Espeland A, Pripp AH, Grotle M, Helllum C, Haugen AJ, Froholdt A, Rolfsen MP, Nygaard ØP, Lutro O, Kristoffersen PM, Anke A, Schistad EI, Skouen JS, Brox JI, Zwart JA, Storheim K. Clinical effect modifiers of antibiotic treatment in patients with chronic low back pain and Modic changes - secondary analyses of a randomised, placebo-controlled trial (the AIM study). BMC Musculoskelet Disord 2020; 21:458. [PMID: 32660517 PMCID: PMC7359501 DOI: 10.1186/s12891-020-03422-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 01/13/2023] Open
Abstract
Background Randomised trials on antibiotic treatment for patients with chronic low back pain and vertebral endplate changes visible on MRI (Modic changes) have shown mixed results. A possible explanation might be a real treatment effect in subgroups of the study populations. The purpose of the present study was to explore potential clinical effect modifiers of 3-months oral amoxicillin treatment in patients with chronic low back pain and type I or II Modic changes at the level of a previous lumbar disc herniation. Methods We performed analyses of effect modifiers on data from AIM, a double-blind parallel-group multicentre trial. One hundred eighty patients with chronic low back pain, previous disc herniation, Modic change type I (n = 118) or type II (n = 62) were randomised to 3-months oral treatment with 750 mg amoxicillin (n = 89) or placebo (n = 91) three times daily. The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (possible values 0–24) at 1-year follow-up in the intention-to-treat population. The predefined minimal clinically important between-group mean difference was 4 RMDQ points (not reached in the primary analysis of AIM). Predefined baseline characteristics were analysed as potential effect modifiers, four primary (type I Modic changes, previous disc surgery, positive pain provocation test, high CRP) and five exploratory (disturbed sleep, constant low back pain, short duration of low back pain, younger age, and male) using ANCOVA with interaction terms. Results None of the four primary potential effect modifiers had strong evidence of modifying the treatment effect. In patients younger than 40 years the difference in mean RMDQ score between the treatment groups was − 4.0 (95%CI, − 6.9 to − 1.2), compared to − 0.5 (95%CI, − 2.3 to 1.3) in patients 40 years or older, both in favour of amoxicillin treatment (exploratory analysis). Conclusions We did not find evidence for convincing clinical effect modifiers of antibiotic treatment in patients with chronic low back pain and Modic changes. Our results for younger age in these explorative analyses should not affect clinical treatment decisions without confirmation in future studies. Trial registration ClinicalTrials.gov NCT02323412, First registered 23 December 2014.
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Affiliation(s)
- Lars Christian Haugli Bråten
- FORMI, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, PO BOX 1078 Blindern, 0316, Oslo, Norway.
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Klinisk institutt 1, Postboks 7804, NO-5020, Bergen, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Postbox 4950 Nydalen, 0424, Oslo, Norway
| | - Margreth Grotle
- FORMI, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - Christian Helllum
- Department of Orthopaedic surgery, Oslo University Hospital, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - Anne Julsrud Haugen
- Department of Rheumatology, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway
| | - Anne Froholdt
- Department of Physical Medicine and Rehabilitation, Drammen Hospital, Vestre Viken Hospital Trust Drammen, Postboks 800, 3004, Drammen, Norway
| | - Mads Peder Rolfsen
- Faculty of Medicine, University of Oslo, PO BOX 1078 Blindern, 0316, Oslo, Norway.,Department of Orthopaedic surgery, Oslo University Hospital, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - Øystein Petter Nygaard
- Department of Neurosurgery, St. Olavs University Hospital, Postbox 3250 Torgarden, NO-7006, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway.,National Advisory Unit on Spinal Surgery, St Olavs Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway
| | - Olav Lutro
- Stavanger University Hospital, Helse Stavanger HF, Postboks 8100, 4068, Stavanger, Norway
| | - Per Martin Kristoffersen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Klinisk institutt 1, Postboks 7804, NO-5020, Bergen, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Postboks 100, 9038, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Elina Iordanova Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ulleval, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Helse Bergen HF, Box 1, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, NO-5020, Bergen, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, PO BOX 1078 Blindern, 0316, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ulleval, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - John-Anker Zwart
- FORMI, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, PO BOX 1078 Blindern, 0316, Oslo, Norway
| | - Kjersti Storheim
- FORMI, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130, Oslo, Norway
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Hashemi M, Dadkhah P, Taheri M, Katibeh P, Asadi S. Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel ®) versus percutaneous laser disc decompression in patients with chronic radicular low back pain. Korean J Pain 2020; 33:66-72. [PMID: 31888320 PMCID: PMC6944373 DOI: 10.3344/kjp.2020.33.1.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/07/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel®). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. Methods Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions Both techniques were equivalent in pain reduction but DiscoGel® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.
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Affiliation(s)
- Masoud Hashemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Dadkhah
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Taheri
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Katibeh
- Department of Pediatric Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Asadi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Liu J, Wei X, Huang B, Wu H, Zhang X, Chen J, Shan Z, Fan S, Zhao F. Lubricin expression in the lumbar endplate and its association with Modic changes. J Orthop Translat 2019; 22:124-131. [PMID: 32440508 PMCID: PMC7231957 DOI: 10.1016/j.jot.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the expression of lubricin in the lumbar endplate and its association with Modic changes (MCs). Methods Human endplate specimens harvested from patients undergoing surgery for thoracolumbar spine fractures or lumbar interbody fusion were divided into two groups: MCs group and normal group. Lubricin expression was examined by immunohistochemistry, and differences between the groups were analysed using quantitative polymerase chain reaction (qPCR). Lubricin expression and differences between endplates with MCs and normal endplates were confirmed using a rabbit model. In a final experiment, rabbit endplate chondrocytes were cocultured with Propionibacteria acnes (P. acnes) supernatant, and the expression of lubricin and endplate degeneration related genes were evaluated. In addition, the expression of matrix metalloproteinase 1(MMP-1), A disintegrin-like and metalloproteinase with thrombospondin type 5 motif (ADAMTS5) and inflammatory factors (Interleukin- 1β (IL-1β) and Interleukin-6 (IL-6)) were evaluated after lubricin overexpression. Results Lubricin was found in human lumbar endplates and its expression was lower in the MCs group compared to the normal group. In the rabbit model, lubricin was also found in the endplate. In rabbits injected with P. acnes (the MCs group), lubricin expression of endplate decreased compared to the normal group. In the culture of rabbit endplate chondrocytes with P. acnes supernatant, the expression of lubricin, aggrecan, sox9 and collagen type-II decreased significantly, while that of MMP-1 and ADAMTS5 increased significantly. Moreover, lubricin overexpression could downregulate the expression of MMP-1, ADAMTS5 and inflammatory factors (IL-1β and IL-6) compared to negative control. Conclusion Lubricin is present in the lumbar endplate where it may have an anti-inflammatory role. P. acnes infection inhibits lubricin expression by cartilage endplate cells and this may facilitate the progression of MCs and endplate degeneration. The translational potential of this article Lubricin may have an anti-inflammatory role. P. acnes infection inhibits lubricin expression by cartilage endplate cells and this may facilitate the progression of MCs and endplate degeneration.
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Affiliation(s)
- Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Xiaoan Wei
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Bao Huang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Hao Wu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, PR China
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21
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Bråten LCH, Rolfsen MP, Espeland A, Wigemyr M, Aßmus J, Froholdt A, Haugen AJ, Marchand GH, Kristoffersen PM, Lutro O, Randen S, Wilhelmsen M, Winsvold BS, Kadar TI, Holmgard TE, Vigeland MD, Vetti N, Nygaard ØP, Lie BA, Hellum C, Anke A, Grotle M, Schistad EI, Skouen JS, Grøvle L, Brox JI, Zwart JA, Storheim K. Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial. BMJ 2019; 367:l5654. [PMID: 31619437 PMCID: PMC6812614 DOI: 10.1136/bmj.l5654] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN Double blind, parallel group, placebo controlled, multicentre trial. SETTING Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION ClinicalTrials.gov NCT02323412.
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Affiliation(s)
- Lars Christian Haugli Bråten
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mads Peder Rolfsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Wigemyr
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Anne Froholdt
- Department of Physical Medicine and Rehabilitation, Drammen Hospital, Drammen, Norway
| | | | - Gunn Hege Marchand
- Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Martin Kristoffersen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Lutro
- Stavanger University Hospital, Stavanger, Norway
| | - Sigrun Randen
- Department of Physical Medicine and Rehabilitation, Drammen Hospital, Drammen, Norway
| | - Maja Wilhelmsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Thomas Istvan Kadar
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | | | - Maria Dehli Vigeland
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Vetti
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øystein Petter Nygaard
- Department of Neurosurgery, St Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St Olavs Hospital, Trondheim, Norway
| | - Benedicte Alexandra Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Christian Hellum
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
| | - John-Anker Zwart
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health(FORMI), Oslo University Hospital HF, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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22
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Establishment and Initial Testing of a Medium-Sized, Surgically Feasible Animal Model for Brucellar Spondylodiscitis: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7368627. [PMID: 31662995 PMCID: PMC6791230 DOI: 10.1155/2019/7368627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/04/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
Brucellar spondylodiscitis, the most prevalent and significant osteoarticular presentation of human Brucellosis, is difficult to diagnose and usually yields irreversible neurologic deficits and spinal deformities. However, no animal models of Brucellar spondylodiscitis exist, allowing for preclinical investigations. The present study investigated whether intraosseous injection of attenuated Brucella melitensis vaccine into rabbits' lumbar vertebrae imitates the radiographic and histopathological characteristics of human Brucellar spondylodiscitis. Radiographic and histopathological analyses at 8 weeks postoperatively revealed radiographic changes within vertebral bodies and intervertebral discs, abscesses formation within the paravertebral soft tissue, and typical prominent inflammation response without caseous necrosis, which were largely comparable to human Brucellar spondylodiscitis. Such a medium-sized, surgically feasible rabbit model provides a promising in vivo setting for further preclinical investigation of Brucellar spondylodiscitis.
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23
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Tang G, Chen Y, Chen J, Wang Z, Jiang W. Higher proportion of low-virulence anaerobic bacterial infection in young patients with intervertebral disc herniation. Exp Ther Med 2019; 18:3085-3089. [PMID: 31572548 PMCID: PMC6755454 DOI: 10.3892/etm.2019.7910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration caused by the latent infection of low-virulence anaerobic bacteria (LVAB) is a hot research topic. The present study analyzed and compared the positive rate of LVAB within IVDs of patients of different ages. IVD samples were intraoperatively retrieved from 176zpatients with disc herniation and subjected to microbiological culture. Subsequently, all the patients were classified into 3 groups based on their ages as follows: Group A (age <30 years), group B (age from 30 to 50 years) and group C (age >50 years) and the positive rates of LVAB were compared among the three groups. The severity of IVD degeneration was also assessed by measuring intervertebral height. Of the 176 cultured discs, 39 samples had bacterial growth, while 6 of them were suspiciously contaminated. Follwoing the exclusion of the 6 suspicious samples, 31 samples were Propionibacterium acnes and 2 samples were coagulase-negative Staphylococci of the remaining 33 samples, The bacterial positive rates were significantly higher in younger patients, with 34.4% (11/32), 25.5% (13/51) and 10.3% (9/87) in group A, B and C, respectively. More importantly, the bacterial-positive samples had a significantly lower disc height compared with the negative samples in groups A and B. Therefore, it can be reasonably concluded that younger patients have a much higher prevalence of LVAB infection in herniated IVDs and a greater severity of IVD degeneration when infected by bacteria. The LVAB may have a strong association with IVD degeneration, particularly in young patients.
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Affiliation(s)
- Guoqing Tang
- Orthopedic Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China.,Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215300, P.R. China
| | - Yong Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215300, P.R. China.,Department of Orthopaedics, The Second Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215008, P.R. China
| | - Ji Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215300, P.R. China
| | - Zhuo Wang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215300, P.R. China
| | - Weimin Jiang
- Orthopedic Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
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Jiao Y, Lin Y, Zheng Y, Yuan Y, Chen Z, Cao P. The bacteria-positive proportion in the disc tissue samples from surgery: a systematic review and meta-analysis. 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 2019; 28:2941-2950. [PMID: 31312913 DOI: 10.1007/s00586-019-06062-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/08/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The role of bacteria, especially Propionibacterium acnes (P. acnes), in human intervertebral disc diseases has raised attention in recent years. However, limited sample size of these studies and diverse bacteria-positive proportion made this topic still controversial. We aimed to review related articles and summarize the bacteria-positive proportion in these studies. METHODS We searched the PubMed, Cochrane Library, Embase for related literature from January 2001 to May 2018, and the reference articles were also searched. The random effects or fixed effects meta-analysis was used to pool the overall positive proportion or odds ratio of these studies. RESULTS We found 16 relevant articles and 2084 cases of the bacteria culture from surgery. Within the 16 included studies, 12 studies' results supported the infection in the discs. The pooled bacterial infection rate was 25.3%. The pooled P. acnes infection rate was 15.5%. The overall pooled P. acnes proportion in bacteria-positive discs was 56.4%. We also found that the presence of bacteria may contribute to the development of Modic change with the odds ratio as 1.27 (95% CI: 0.44-3.64), but this result is not significant due to heterogeneity, so further study is needed. CONCLUSION The existence of bacteria in the intervertebral discs was proved by many studies. However, the variety in sample collecting and culture methods is still obvious and the positive rate also fluctuated within the studies. Standardized and reliable methods should be taken to promote the study in the future. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Yucheng Jiao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Yazhou Lin
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Yuehuan Zheng
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, 201800, China
| | - Ye Yuan
- Department of Orthopaedics, Chang Gung Hospital, Tsinghua University, Beijing, 102202, China
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Peng Cao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Manniche C, O'Neill S. New insights link low-virulent disc infections to the etiology of severe disc degeneration and Modic changes. Future Sci OA 2019; 5:FSO389. [PMID: 31245043 PMCID: PMC6554696 DOI: 10.2144/fsoa-2019-0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022] Open
Abstract
Within the last 5 years, international research collaborations including those of several research groups skilled in microbiology, immunology and pathophysiology, have identified a low-virulent intradiscal infection with the ability to provoke gradual and progressive disc degeneration, end-plate disruption, Modic changes and persistent clinical lower-back pain. Certain strains of the Propionibacterium acne bacterium seem able to invade, colonize and develop a protective biofilm inside the disc. The interaction of P. acne, disc tissues and mononuclear cells of the bone marrow are shown to trigger a relevant immunological response and an ensuing destructive inflammation of the disc and adjacent vertebrae. This process presents on MRI as Modic changes. Recent proof-of-concept data provide compelling evidence for this bacterial disc infection hypothesis.
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Affiliation(s)
- Claus Manniche
- Department of Occupational & Environmental Medicine, Odense University Hospital & Institute of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark.,Department of Occupational & Environmental Medicine, Odense University Hospital & Institute of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark
| | - Søren O'Neill
- Spinecenter of Southern Denmark, Lillebaelt Hospital, Institute of Regional Health Research, University of Southern Denmark, 5230 Odense M, Denmark.,Spinecenter of Southern Denmark, Lillebaelt Hospital, Institute of Regional Health Research, University of Southern Denmark, 5230 Odense M, Denmark
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26
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Tang G, Wang Z, Chen J, Zhang Z, Qian H, Chen Y. Latent infection of low-virulence anaerobic bacteria in degenerated lumbar intervertebral discs. BMC Musculoskelet Disord 2018; 19:445. [PMID: 30572849 PMCID: PMC6302300 DOI: 10.1186/s12891-018-2373-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023] Open
Abstract
Background The existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. In this study, the prevalence of low-virulence anaerobic bacteria in degenerated IVDs was examined, and the correlation between bacterial infection and clinical symptoms was analysed. Methods Eighty patients with disc herniation who underwent discectomy were included in this study. Under a stringent protocol to ensure sterile conditions, 80 disc samples were intraoperatively retrieved and subjected to microbiological culture. Meanwhile, tissue samples from the surrounding muscle and ligaments were harvested and cultured as contamination markers. The severity of IVD degeneration and the prevalence of Modic changes (MCs) were assessed according to preoperative MRI analysis. Results Of the 80 cultured discs, 54 were sterile, and 26 showed the presence of bacteria: Propionibacterium acnes (21 cases) and coagulase-negative staphylococci (5 cases). MRI revealed that the presence of bacteria was significantly associated with MCs (P<0.001). However, there was no significant association between bacterial infection and the severity of IVD degeneration (P = 0.162). Conclusions Our findings further validated the presence of low-virulence anaerobic bacteria in degenerated IVDs, and P. acnes was the most frequent bacterium. In addition, the latent infection of bacteria in IVDs was associated with Modic changes. Therefore, low-virulence anaerobic bacteria may play a crucial role in the pathophysiology of MCs and lumbar disc herniation.
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Affiliation(s)
- Guoqing Tang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China
| | - Zhuo Wang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China
| | - Ji Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China
| | - Zhengshi Zhang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China
| | - Hongbin Qian
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China
| | - Yong Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Suzhou, 215000, China.
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27
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Jiao Y, Yuan Y, Lin Y, Zhou Z, Zheng Y, Wu W, Tang G, Chen Y, Xiao J, Li C, Chen Z, Cao P. Propionibacterium acnes induces discogenic low back pain via stimulating nucleus pulposus cells to secrete pro-algesic factor of IL-8/CINC-1 through TLR2-NF-κB p65 pathway. J Mol Med (Berl) 2018; 97:25-35. [PMID: 30397790 DOI: 10.1007/s00109-018-1712-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/13/2018] [Accepted: 10/28/2018] [Indexed: 12/19/2022]
Abstract
Latent infection of Propionibacterium acnes was considered as a new pathogeny for low back pain (LBP); however, there is no credible animal evidence or mechanism hypothesis. This study proved that P. acnes is a causative pathogen of bacteria-induced LBP and investigated its underlying mechanism. For this, P. acnes was firstly identified in patients' degenerated intervertebral disc (IVDs) samples. The results of patients' Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores indicated that P. acnes-positive patients showed more severe LBP and physical disability. Then, a P. acnes-inoculated lumbar IVDs model was established in rats. The results of paw/foot withdrawal threshold and qRT-PCR indicated that P. acnes-inoculated rats had obvious LBP in behavioral evaluation and over-expression of substance P (SP) and calcitonin gene-related peptide (CGRP) in IVDs. Subsequently, enzyme-linked immunosorbent assay (ELISA) results demonstrated that increased expression of IL-8 or CINC-1 (the homolog of IL-8 in rats) in the P. acnes-positive IVDs of human and rats. The CINC-1 injected animal model proved that the cytokines were able to induce LBP. Finally, the co-culture experiments showed that nucleus pulposus cells (NPCs) were able to respond to P. acnes and secreted IL-8/CINC-1 via TLR-2/NF-κB p65 pathway. In conclusion, P. acnes had strong association with LBP by stimulating NPCs to secrete pro-algesic factor of IL-8/CINC-1 via TLR2/NF-κBp65 pathway. The finding may provide a promising alternative therapy strategy for LBP in clinical. KEY MESSAGES: Patients with P. acnes-positive IVDs tended to have more severe LBP, physical disability, and increased IL-8 expressions. P. acnes can induce LBP via IL-8/CINC-1 in IVDs. P. acnes stimulate the NPCs to secrete pro-algesic factor of IL-8/CINC-1 via TLR2/NF-κBp65 pathway.
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Affiliation(s)
- Yucheng Jiao
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ye Yuan
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Yazhou Lin
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zezhu Zhou
- Department of Orthopedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Yuehuan Zheng
- Department of Orthopedics, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, 201800, China
| | - Wenjian Wu
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Guoqing Tang
- Kunshan Hospital of Traditional Chinese medicine, Kunshan, 215300, China
| | - Yong Chen
- Kunshan Hospital of Traditional Chinese medicine, Kunshan, 215300, China
| | - Jiaqi Xiao
- Department of Medical Microbiology and Parasitology, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Changwei Li
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Peng Cao
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
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Abstract
Purpose of review The endplates form the interface between the rigid vertebral bodies and compliant intervertebral discs. Proper endplate function involves a balance between conflicting biomechanical and nutritional demands. This review summarizes recent data that highlight the importance of proper endplate function and the relationships between endplate dysfunction, adjacent disc degeneration, and axial low back pain. Recent findings Changes to endplate morphology and composition that impair its permeability associate with disc degeneration. Endplate damage also associates with disc degeneration, and the progression of degeneration may be accelerated and the chronicity of symptoms heightened when damage coincides with evidence of adjacent bone marrow lesions. Summary The endplate plays a key role in the development of disc degeneration and low back pain. Clarification of the mechanisms governing endplate degeneration and developments in clinical imaging that enable precise evaluation of endplate function and dysfunction will distinguish the correlative vs. causative nature of endplate damage and motivate new treatments that target pathologic endplate function.
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Propionibacterium acnes Induces Intervertebral Disc Degeneration by Promoting iNOS/NO and COX-2/PGE 2 Activation via the ROS-Dependent NF- κB Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3692752. [PMID: 30210652 PMCID: PMC6120277 DOI: 10.1155/2018/3692752] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/09/2018] [Accepted: 06/20/2018] [Indexed: 01/05/2023]
Abstract
Accumulating evidence suggests that Propionibacterium acnes (P. acnes) is a novel pathogenic factor promoting intervertebral disc degeneration (IVDD). However, the underlying mechanisms by which P. acnes induces IVDD have been unclear. In this study, we quantified the severity of IVDD, as well as the expressions of inducible nitric oxide synthase (iNOS)/nitric oxide (NO) and cyclooxygenase (COX-2)/prostaglandin (PGE2) in human intervertebral discs (IVDs) infected with P. acnes. Compared with P. acnes-negative IVDs, P. acnes-positive IVDs showed increased iNOS/NO and COX-2/PGE2 activity concomitant with more severe IVDD. In order to detect the potential correlation between iNOS/NO expression, COX-2/PGE2 expression, and IVDD, we developed a P. acnes-induced IVDD rat model and found that the upregulation of iNOS/NO and COX-2/PGE2 was essential to the occurrence of P. acnes-induced IVDD. This finding was supported by the fact that the inhibition of iNOS/NO and COX-2/PGE2 activity ameliorated IVDD significantly, as evidenced by restored aggrecan and collagen II expression both in vivo and in vitro. Mechanistically, we found that P. acnes induced iNOS/NO and COX-2/PGE2 expressions via a reactive oxygen species- (ROS-) dependent NF-κB cascade. Furthermore, NADPH oxidase participated in P. acnes-induced ROS, iNOS/NO, and COX-2/PGE2 expressions. Overall, these findings further validated the involvement of P. acnes in the pathology of IVDD and provided evidence that P. acnes-induced iNOS/NO and COX-2/PGE2 activation via the ROS-dependent NF-κB pathway is likely responsible for the pathology of IVDD.
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30
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Zheng Y, Lin Y, Chen Z, Jiao Y, Yuan Y, Li C, Xu X, Cao P. Propionibacterium acnes induces intervertebral discs degeneration by increasing MMP-1 and inhibiting TIMP-1 expression via the NF-κB pathway. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:3445-3453. [PMID: 31949722 PMCID: PMC6962859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/23/2018] [Indexed: 06/10/2023]
Abstract
Emerging evidence suggests that Propionibacterium acnes (P. acnes) may be a new pathogen implicated in intervertebral disc degeneration (IVDD), although the underlying mechanisms are unclear. Since the most significant biochemical change of IVDD is inability of the extracellular matrix (ECM) synthesis by nucleus pulposus cells, we first analyzed the expression of aggrecan and collagen II in nucleus pulposus tissues of IVDD patients with or without P. acnes infection. Compared with the P. acnes-negative controls, the expression levels of aggrecan and collagen II were significantly dampened in nucleus pulposus tissues with P. acnes infection. Interestingly, we found that P. acnes infection strongly increased matrix-degrading metalloproteinase-1 (MMP-1) expression but decreased that of tissue inhibitor of metalloproteinase-1 (TIMP1). Furthermore, the dampened aggrecan and collagen II synthesis concomitant with the increased MMP-1 and decreased TIMP-1 expression seen in P. acnes-induced IVDD were confirmed by a rat model. Mechanistically, P. acnes infection increased MMP-1 levels, while decreasing TIMP-1 expression via the NF-κB pathway. Overall, these findings reveal that P. acnes infection dampens aggrecan and collagen II synthesis in nucleus pulposus cells by increasing MMP-1 and inhibiting TIMP-1 expression via the NF-κB pathway, which may ultimately lead to IVDD.
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Affiliation(s)
- Yuehuan Zheng
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Yazhou Lin
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Yucheng Jiao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Ye Yuan
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Changwei Li
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Xiangyang Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
| | - Peng Cao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, China
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Lin Y, Jiao Y, Yuan Y, Zhou Z, Zheng Y, Xiao J, Li C, Chen Z, Cao P. Propionibacterium acnes induces intervertebral disc degeneration by promoting nucleus pulposus cell apoptosis via the TLR2/JNK/mitochondrial-mediated pathway. Emerg Microbes Infect 2018; 7:1. [PMID: 29323102 PMCID: PMC5837142 DOI: 10.1038/s41426-017-0002-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/22/2017] [Accepted: 10/31/2017] [Indexed: 01/07/2023]
Abstract
Evidence suggests that intervertebral disc degeneration (IVDD) can be induced by Propionibacterium acnes (P. acnes), although the underlying mechanisms are unclear. In this study, we analyzed the pathological changes in degenerated human intervertebral discs (IVDs) infected with P. acnes. Compared with P. acnes-negative samples, P. acnes-positive IVDs showed increased apoptosis of nucleus pulposus cells (NPCs) concomitant with severe IVDD. Then, a P. acnes-inoculated IVD animal model was established, and severe IVDD was induced by P. acnes infection by promoting NPC apoptosis. The results suggested that P.acnes-induced apoptosis of NPCs via the Toll-like receptor 2 (TLR2)/c-Jun N-terminal kinase (JNK) pathway and mitochondrial-mediated cell death. In addition, P. acnes was found to activate autophagy, which likely plays a role in apoptosis of NPCs. Overall, these findings further validated the involvement of P. acnes in the pathology of IVDD and provided evidence that P. acnes-induced apoptosis of NPCs via the TLR2/JNK pathway is likely responsible for the pathology of IVDD.
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Affiliation(s)
- Yazhou Lin
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China ,0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Yucheng Jiao
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China ,0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Ye Yuan
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China ,0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Zezhu Zhou
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Yuehuan Zheng
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Jiaqi Xiao
- 0000 0004 0368 8293grid.16821.3cDepartment of Medical Microbiology and Parasitology, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Changwei Li
- 0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Zhe Chen
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China ,0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
| | - Peng Cao
- 0000 0004 0368 8293grid.16821.3cDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China ,0000 0004 0368 8293grid.16821.3cShanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000 China
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Abstract
PURPOSE OF REVIEW Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. RECENT FINDINGS There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
- Johns Hopkins Orthopaedic and Spine Surgery, 601 N. Caroline Street #5241, Baltimore, MD, 21287, USA.
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Yuan Y, Chen Y, Zhou Z, Jiao Y, Li C, Zheng Y, Lin Y, Xiao J, Chen Z, Cao P. Association between chronic inflammation and latent infection of Propionibacterium acnes in non-pyogenic degenerated intervertebral discs: a pilot study. 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 2017; 27:2506-2517. [PMID: 29086028 DOI: 10.1007/s00586-017-5363-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Propionibacterium acnes may be considered a new pathogeny for disc degeneration, but its pathological role has remained unclear. This study was designed to determine whether the latent infection of P. acnes was associated with chronic inflammation in degenerated intervertebral discs via quantification of the levels of a series of cytokines and neutrophils. METHODS Here, 76 degenerated intervertebral discs were harvested from patients with lower back pain and/or sciatica. Discs with and without P. acnes infection were distinguished and identified using anaerobic culture combined with 16S rDNA PCR and histological examination. Then, cytokines of TNF-α, IL-1β, IL-6, IL-8, MCP-1, MIP-1α, and IP-10, and the numbers of neutrophils were quantified and compared. The severity of disc degeneration and the prevalence of Modic changes were also evaluated between discs with and without P. acnes. RESULTS After anaerobic culture and PCR examination, 15 intervertebral discs were placed in the P. acnes-positive group. Another 15 discs were selected from the remaining bacteria-free samples and formed a matched P. acnes-negative group. IL-8, MIP-1α, MCP-1, IP-10, TNF-α, and neutrophils were much higher in P. acnes-positive group than that in the matched P. acnes-negative group. However, only IL-8, MIP-1α, and neutrophils were statistically significant. Furthermore, 7 of 15 P. acnes-positive samples were histologically positive and a subgroup analysis suggested that both histological and PCR-positive samples had the highest concentrations of cytokines of IL-8, MIP-1α, TNF-α, and MCP-1 and the greatest numbers of neutrophils. PCR-positive but histologically negative samples showed the second-greatest, and matched P. acnes-negative samples showed the fewest. However, the difference was only statistically significant between samples found positive under both histology and PCR and samples found negative for P. acnes. Finally, P. acnes-positive group had significantly lower height of intervertebral discs and there was a trend with higher proportion of Modic changes in P. acnes-positive group, but without statistical results. CONCLUSIONS Latent P. acnes infection was associated with chronic inflammation in degenerated intervertebral discs, especially in the samples with visible bacteria in histology, which manifested as increased numbers of cytokines and neutrophils. Discs with P. acnes infection had much severer disc degeneration and P. acnes-associated chronic inflammation may be the reason.
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Affiliation(s)
- Ye Yuan
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Chen
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Zezhu Zhou
- Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yucheng Jiao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Changwei Li
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuehuan Zheng
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yazhou Lin
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaqi Xiao
- Department of Medical Microbiology and Parasitology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Peng Cao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Capoor MN, Ruzicka F, Schmitz JE, James GA, Machackova T, Jancalek R, Smrcka M, Lipina R, Ahmed FS, Alamin TF, Anand N, Baird JC, Bhatia N, Demir-Deviren S, Eastlack RK, Fisher S, Garfin SR, Gogia JS, Gokaslan ZL, Kuo CC, Lee YP, Mavrommatis K, Michu E, Noskova H, Raz A, Sana J, Shamie AN, Stewart PS, Stonemetz JL, Wang JC, Witham TF, Coscia MF, Birkenmaier C, Fischetti VA, Slaby O. Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy. PLoS One 2017; 12:e0174518. [PMID: 28369127 PMCID: PMC5378350 DOI: 10.1371/journal.pone.0174518] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/10/2017] [Indexed: 01/31/2023] Open
Abstract
Background In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. Methods Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. Results Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). Conclusions This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.
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Affiliation(s)
- Manu N Capoor
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, United States of America.,Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Filip Ruzicka
- Department of Microbiology, Faculty of Medicine, Masaryk university, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - Jonathan E Schmitz
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Garth A James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, United States of America
| | - Tana Machackova
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Martin Smrcka
- Department of Neurosurgery, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava University, Ostrava, Czech Republic
| | - Fahad S Ahmed
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Todd F Alamin
- Department of Orthopedic Surgery, Stanford University Medical Center, Stanford University, Stanford, California, United States of America
| | - Neel Anand
- Cedars-Sinai Institute for Spinal Disorders, Los Angeles, California, United States of America
| | - John C Baird
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine, School of Medicine, Irvine, California, United States of America
| | - Sibel Demir-Deviren
- Spine Center, UCSF Medical Center, San Francisco, California, United States of America
| | - Robert K Eastlack
- Scripps Clinic Division of Orthopedic Surgery, San Diego, California, United States of America
| | - Steve Fisher
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, United States of America
| | - Steven R Garfin
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, United States of America
| | - Jaspaul S Gogia
- Department of Orthopedic Surgery, Kaiser Permanente-San Jose Medical Center, San Jose, California, United States of America
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Calvin C Kuo
- Department of Orthopedic Surgery, Kaiser Permanente-Oakland Medical Center, Oakland, California, United States of America
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine, School of Medicine, Irvine, California, United States of America
| | - Konstantinos Mavrommatis
- Celgene Corporation, Information Knowledge and Utilization, San Francisco, California, United States of America
| | - Elleni Michu
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Hana Noskova
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - Assaf Raz
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, United States of America
| | - Jiri Sana
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
| | - A Nick Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Philip S Stewart
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, United States of America
| | - Jerry L Stonemetz
- Department of Anesthesia, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, University Southern California, Los Angeles, California, United States of America
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Michael F Coscia
- Department of Orthopedic Surgery, OrthoIndy Hospital, Indianapolis, Indiana, United States of America
| | - Christof Birkenmaier
- Department of Orthopedics, Physical Medicine & Rehabilitation, University of Munich (LMU), Munich, Germany
| | - Vincent A Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, New York, United States of America
| | - Ondrej Slaby
- Department of Molecular Oncology, Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
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Histological Identification of Propionibacterium acnes in Nonpyogenic Degenerated Intervertebral Discs. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6192935. [PMID: 28401158 PMCID: PMC5376442 DOI: 10.1155/2017/6192935] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 11/18/2022]
Abstract
Purpose. Low-virulence anaerobic bacteria, especially the Propionibacterium acnes (P. acnes), have been thought to be a new pathogeny for a series of disc diseases. However, until now, there has been no histological evidence to confirm this link. The purpose of this study was to confirm the presence of P. acnes in nonpyogenic intervertebral discs via histological observation. Method. Degenerated intervertebral discs were harvested from 76 patients with low back pain and/or sciatica but without any symptoms of discitis or spondylodiscitis. The samples were cultured under anaerobic conditions and then examined using 16S rDNA PCR to screen for P. acnes. Samples found to be positive for P. acnes were stained with hematoxylin-eosin (HE) and modified Brown-Brenn staining and observed under a microscope. Results. Here, 16 intervertebral discs were found to be positive for P. acnes via 16S rDNA PCR and the prevalence was 21.05% (16/76). Among them, 7 samples had visible microbes stained with HE and modified Brown-Brenn staining. Morphological examination showed the bacteria to be Gram-positive and rod-shaped, so they were considered P. acnes. Conclusion. P. acnes is capable of colonizing some degenerated intervertebral discs without causing discitis, and its presence could be further confirmed by histological evidence. Targeting these bacteria may be a promising therapy method for some disc diseases.
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Aghazadeh J, Salehpour F, Ziaeii E, Javanshir N, Samadi A, Sadeghi J, Mirzaei F, Naseri Alavi SA. Modic changes in the adjacent vertebrae due to disc material infection with Propionibacterium acnes in patients with lumbar disc herniation. 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 2016; 26:3129-3134. [PMID: 27885471 DOI: 10.1007/s00586-016-4887-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/27/2016] [Accepted: 11/14/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Modic changes (MCs) in vertebral bones are induced by two mechanisms of mechanical factors and infection. As Propionibacterium acnes (P. acnes) have been reported to be associated with LBP. The aim of this study is to evaluate the MCs in patients with disc herniation and positive for P. acnes. METHODS AND MATERIAL A total of 120 patients with disc herniation surgery were enrolled into the study. The samples were excised during discectomy and then cultured in both anaerobic and aerobic incubations. Gram staining was employed for investigation of all colonies. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction (PCR). MCs of baseline MRI were evaluated. RESULTS In this study, 120 subjects (69 male and 51 female) with mean age of 43.15 ± 12.62 years were investigated. Sixty disc samples and eight muscle samples were positive for microorganisms. Moreover, 16S rDNA gene was identified in 46 (38.3%) disc samples. Moreover, 36/46 patients with P. acnes in their sample had MCs. CONCLUSION According to the results and presence of 36/46 MCs in patients with lumbar disc herniation, positive for P. acnes suggests that P. acnes can lead to edema on the vertebrae endplates near to infected area.
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Affiliation(s)
- Javad Aghazadeh
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Firooz Salehpour
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Ziaeii
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naghme Javanshir
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Samadi
- Department of Medical Biotechnology, Faculty of Medicine, Hacettepe University of Medical Sciences, Ankara, Turkey
| | - Javid Sadeghi
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Letter to the Editor concerning “Prospective study using anterior approach did not show association between Modic 1 changes and low-grade infection in lumbar spine” by Rigal J, Thelen T, Byrne F, Cogniet A, Boissière L, Aunoble S, Le Huec JC (Eur Spine J [2016]; 25(4):1000–5. doi: 10.1007/s00586-016-4396-5). 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 2016; 25:3379-3380. [DOI: 10.1007/s00586-016-4751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/20/2016] [Indexed: 11/27/2022]
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Prevalence of Propionibacterium acnes in Intervertebral Discs of Patients Undergoing Lumbar Microdiscectomy: A Prospective Cross-Sectional Study. PLoS One 2016; 11:e0161676. [PMID: 27536784 PMCID: PMC4990245 DOI: 10.1371/journal.pone.0161676] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background The relationship between intervertebral disc degeneration and chronic infection by Propionibacterium acnes is controversial with contradictory evidence available in the literature. Previous studies investigating these relationships were under-powered and fraught with methodical differences; moreover, they have not taken into consideration P. acnes’ ability to form biofilms or attempted to quantitate the bioburden with regard to determining bacterial counts/genome equivalents as criteria to differentiate true infection from contamination. The aim of this prospective cross-sectional study was to determine the prevalence of P. acnes in patients undergoing lumbar disc microdiscectomy. Methods and Findings The sample consisted of 290 adult patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation. An intraoperative biopsy and pre-operative clinical data were taken in all cases. One biopsy fragment was homogenized and used for quantitative anaerobic culture and a second was frozen and used for real-time PCR-based quantification of P. acnes genomes. P. acnes was identified in 115 cases (40%), coagulase-negative staphylococci in 31 cases (11%) and alpha-hemolytic streptococci in 8 cases (3%). P. acnes counts ranged from 100 to 9000 CFU/ml with a median of 400 CFU/ml. The prevalence of intervertebral discs with abundant P. acnes (≥ 1x103 CFU/ml) was 11% (39 cases). There was significant correlation between the bacterial counts obtained by culture and the number of P. acnes genomes detected by real-time PCR (r = 0.4363, p<0.0001). Conclusions In a large series of patients, the prevalence of discs with abundant P. acnes was 11%. We believe, disc tissue homogenization releases P. acnes from the biofilm so that they can then potentially be cultured, reducing the rate of false-negative cultures. Further, quantification study revealing significant bioburden based on both culture and real-time PCR minimize the likelihood that observed findings are due to contamination and supports the hypothesis P. acnes acts as a pathogen in these cases of degenerative disc disease.
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Dudli S, Liebenberg E, Magnitsky S, Miller S, Demir-Deviren S, Lotz JC. Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes. J Orthop Res 2016; 34:1447-55. [PMID: 27101067 DOI: 10.1002/jor.23265] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/14/2016] [Indexed: 02/04/2023]
Abstract
Modic type I change (MC1) are vertebral bone marrow lesions adjacent to degenerated discs that are specific for discogenic low back pain. The etiopathogenesis is unknown, but occult discitis, in particular with Propionibacteria acnes (P. acnes), has been suggested as a possible etiology. If true, antibiotic therapy should be considered for patients with MC1. However, this hypothesis is controversial. While some studies report up to 40% infection rate in herniated discs, others fail to detect infected discs and attribute reports of positive cultures to contamination during sampling procedure. Irrespective of the clinical controversy, whether it is biologically plausible for P. acnes to cause MC1 has never been investigated. Therefore, the objective of this study was to test if P. acnes can proliferate within discs and cause reactive changes in the adjacent bone marrow. P. acnes was aseptically isolated from a symptomatic human L4/5 disc with MC1 and injected into rat tail discs. We demonstrate proliferation of P. acnes and up-regulation of IL-1 and IL-6 within three days of inoculation. At day-7, disc degeneration was apparent along with fibrotic endplate erosion. TNF-α immunoreactivity was enhanced within the effected endplates along with cellular infiltrates. The bone marrow appeared normal. At day-14, endplates and trabecular bone close to the disc were almost completely resorbed and fibrotic tissue extended into the bone marrow. T-cells and TNF-α immunoreactivity were identified at the disc/marrow junction. On MRI, bone marrow showed MC1-like changes. In conclusion, P. acnes proliferate within the disc, induce degeneration, and cause MC1-like changes in the adjacent bone marrow. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1447-1455, 2016.
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Affiliation(s)
- Stefan Dudli
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Avenue, Suite-1164, San Francisco, 94143, California
| | - Ellen Liebenberg
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Avenue, Suite-1164, San Francisco, 94143, California
| | - Sergey Magnitsky
- Department of Radiology, University of California San Francisco, 185 Berry St., Suite 350, San Francisco, 94107, California
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, 185 Berry St., Suite 290, San Francisco 94107, California
| | - Sibel Demir-Deviren
- Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens St., San Francisco, 94158, California
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Avenue, Suite-1164, San Francisco, 94143, California
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The NLRP3/Caspase-1/Interleukin-1β Axis Is Active in Human Lumbar Cartilaginous Endplate Degeneration. Clin Orthop Relat Res 2016; 474:1818-26. [PMID: 27146654 PMCID: PMC4925417 DOI: 10.1007/s11999-016-4866-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Modic changes are the MRI signal changes of degenerative lumbar vertebral endplate and which lead to or accelerate intervertebral disc degeneration. NLRP3, caspase-1, and interleukin-1β (IL-1β) play a pivotal role in the pathogenesis of many inflammatory diseases, such as osteoarthritis. However, the roles of IL-1β and its activators caspase-1 and NLRP3 are unclear in the degenerative endplate. QUESTIONS/PURPOSES We asked: (1) What are the degenerative changes of the histologic features and chondrogenic markers' gene expressions between the cartilaginous endplates of patients with Modic changes and trauma (control)? (2) How does the NLRP3/caspase-1/IL-1β axis in the cartilaginous endplates of patients with Modic changes compare with control (trauma) specimens? METHODS Surgical specimens of cartilaginous endplates were divided into Modic changes (n = 56) and the trauma control (n = 16) groups. Hematoxylin and eosin and safranin O staining of cartilaginous endplate tissues were done to evaluate the extracellular matrix. Reverse transcription-polymerase chain reaction was performed on these tissues to investigate mRNA expression of type II collagen (Col II), SOX-9, matrix metalloproteinase-3, and a disintegrin like and metalloproteinase thrombospondin type I motifs-5. NLRP3, caspase-1, and IL-1β were evaluated by reverse transcription-polymerase chain reaction and immunohistochemistry. RESULTS Hematoxylin and eosin and safranin O staining showed the extracellular matrix degraded in the cartilaginous endplates of patients with Modic changes but not in the control cartilaginous endplates. Chondrogenic Col II (p = 0.024) and SOX9 (p = 0.053) were downregulated in the Modic changes group compared with the control group. In contrast to the control group, the transcriptional levels of NLRP3 (p < 0.001), caspase-1 (p = 0.054), and IL-1β (p = 0.001) were all upregulated in the Modic changes group. CONCLUSIONS The expression of NLRP3, caspase-1, and IL-1β was upregulated in the patients with low back pain and Modic changes on MRI compared with patients with vertebral burst fracture without degenerative changes on MRI. The data suggest the NLRP3/caspase-1/IL-1β axis may be implicated in lumbar cartilaginous endplate degeneration. CLINICAL RELEVANCE The NLRP3/caspase-1/IL-1β axis is active in cartilaginous endplates of patients with Modic changes and inflammatory cascades can exacerbate the cartilaginous endplate degeneration which may act as a trigger for intervertebral disc degeneration and low back pain. If these findings can be confirmed by others, we hope that new and effective therapy could be developed directed against this target.
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10 years of research: from ignoring Modic changes to considerations regarding treatment and prevention of low-grade disc infections. Future Sci OA 2016; 2:FSO117. [PMID: 28031964 PMCID: PMC5137919 DOI: 10.4155/fsoa-2016-0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 01/21/2023] Open
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