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Zhang K, Li M, Yao W, Wan L. Cytotoxicity of Local Anesthetics on Bone, Joint, and Muscle Tissues: A Narrative Review of the Current Literature. J Pain Res 2023; 16:611-621. [PMID: 36875687 PMCID: PMC9983438 DOI: 10.2147/jpr.s398329] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
Background Local anesthetics are commonly used in surgical procedures to control pain in patients. Whilst the cardiotoxicity and neurotoxicity of local anesthetics have received much attention, the cytotoxicity they exert against bone, joint, and muscle tissues has yet to be well recognized. Objective This review aimed to raise awareness regarding how local anesthetics may cause tissue damage and provide a deeper understanding of the mechanisms of local anesthetic-induced cytotoxicity. We summarized the latest progress on the cytotoxicity of local anesthetics and the underlying mechanisms and discussed potential strategies to reduce it. Findings We found that the toxic effects of local anesthetics on bone, joint, and muscle tissues were time- and concentration-dependent in vitro. Local anesthetics induced apoptosis, necrosis, and autophagy through specific cellular pathways. Altogether, this review indicates that toxicity of local anesthetics may be avoided by rationally selecting the appropriate anesthetic, limiting the total amount, and determining the lowest effective concentration and duration.
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Affiliation(s)
- Kaiwen Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Meihong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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2
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Zhang A, Chang Chien GC. Effects of Local Anesthetics and Contrast Agents on Regenerative Medicine Procedures. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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3
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Duan L, Zhang JY, Zhang JH, Kang JY, Zhou HC. Effect of intradiscal local anesthetic injection on intraoperative pain during percutaneous transforaminal endoscopic discectomy: A retrospective study. Asian J Surg 2022:S1015-9584(22)01434-8. [DOI: 10.1016/j.asjsur.2022.09.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022] Open
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4
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Zhang A, Wang D, Diwan S, Lin CP, Calodney A, Rosenthal R, Chang Chien GC. Effects of local anesthetics and contrast agents on musculoskeletal regenerative medicine procedures. Regen Med 2022; 17:845-853. [PMID: 36069006 DOI: 10.2217/rme-2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In regenerative medicine, cells, tissues and organs are often replaced, engineered or regrown in order to restore their function after they have been damaged or lost. Local anesthetics, corticosteroids and contrast agents are commonly employed for both diagnostic and therapeutic objectives in interventional pain and musculoskeletal treatments for regenerative medicine. There is growing evidence that routine injectables promote catabolism and disease processes. Thus, understanding the effects of these compounds on regenerative medicine injectates and target tissues such as tenocytes, chondrocytes, nucleus pulposus and ligamentous tissue is critical. This review includes the current research on the effects of local anesthetics and contrast agents, as well as their use and recommendations in regenerative medicine operations.
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Affiliation(s)
- Allan Zhang
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - Daniel Wang
- Kansas City University, Kansas City, MO 64106, USA
| | | | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, 10048, Taiwan
| | | | | | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA 93003, USA.,GCC Institute Regenerative Medicine, Newport Beach, CA 92606, USA
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5
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Steverink JG, Piluso S, Malda J, Verlaan JJ. Comparison of in vitro and in vivo Toxicity of Bupivacaine in Musculoskeletal Applications. FRONTIERS IN PAIN RESEARCH 2022; 2:723883. [PMID: 35295435 PMCID: PMC8915669 DOI: 10.3389/fpain.2021.723883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
The recent societal debate on opioid use in treating postoperative pain has sparked the development of long-acting, opioid-free analgesic alternatives, often using the amino-amide local anesthetic bupivacaine as active pharmaceutical ingredient. A potential application is musculoskeletal surgeries, as these interventions rank amongst the most painful overall. Current literature showed that bupivacaine induced dose-dependent myo-, chondro-, and neurotoxicity, as well as delayed osteogenesis and disturbed wound healing in vitro. These observations did not translate to animal and clinical research, where toxic phenomena were seldom reported. An exception was bupivacaine-induced chondrotoxicity, which can mainly occur during continuous joint infusion. To decrease opioid consumption and provide sustained pain relief following musculoskeletal surgery, new strategies incorporating high concentrations of bupivacaine in drug delivery carriers are currently being developed. Local toxicity of these high concentrations is an area of further research. This review appraises relevant in vitro, animal and clinical studies on musculoskeletal local toxicity of bupivacaine.
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Affiliation(s)
- Jasper G Steverink
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Regenerative Medicine Utrecht, Utrecht University, Utrecht, Netherlands
| | - Susanna Piluso
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Regenerative Medicine Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Developmental BioEngineering, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jos Malda
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Regenerative Medicine Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Regenerative Medicine Utrecht, Utrecht University, Utrecht, Netherlands
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6
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Intradiscal glucocorticoids injection in chronic low back pain with active discopathy: A randomized controlled study. Ann Phys Rehabil Med 2020; 64:101396. [PMID: 32461125 DOI: 10.1016/j.rehab.2020.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of an intradiscal injection of corticosteroids for low back pain with active discopathy is not totally resolved. OBJECTIVE The objective of this study was to estimate the clinical efficacy of an intradiscal injection of glucocorticoids versus lidocaine in patients with low back pain and active discopathy (Modic 1 changes). METHODS A prospective, single-blind, randomized controlled study was conducted in 2 tertiary care centers with spine units. We enrolled 50 patients (mean age 50 years; 46% women) with lumbar active discopathy on MRI and failure of medical treatment for more than 6 weeks. Participants were randomly assigned to receive an intradiscal injection of glucocorticoids [50mg prednisolone acetate (GC group), n=24] or lidocaine [40mg (L group), n=26] by senior radiologists. Outcome measures were low back pain in the previous 8 days (10-point visual analog scale), Dallas Pain Questionnaire, Oswestry Disability Index, analgesic treatment and work status at 1, 3 and 6 months as well as pain at 1, 2 and 3 weeks. The primary outcome was change in pain between baseline and 1 month. RESULTS Data for 39 patients (78%; 17 in the GC group, 22 in the L group) were analyzed for the primary outcome. Pain intensity was significantly reduced at 1 month in the GC versus L group [mean (SD) -2.7 (2.3) and +0.1 (2.0), P<0.001] but not at 3 and 6 months. At 1 and 3 months, the groups significantly differed in daily activities of the Dallas Pain Questionnaire in favour of the GC group. The groups did not differ in consumption of analgesics or professional condition at any time. No serious intervention-related adverse events occurred. Study limitations included patients lost to the study because of injection-related technical issues in the L5/S1 disc and short time of follow-up. CONCLUSION As compared with intradiscal injection of lidocaine, intradiscal injection of prednisolone acetate for low back pain with active discopathy may reduce pain intensity at 1 month but not at 3 and 6 months.
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Ura K, Sudo H, Iwasaki K, Tsujimoto T, Ukeba D, Iwasaki N. Effects of Intradiscal Injection of Local Anesthetics on Intervertebral Disc Degeneration in Rabbit Degenerated Intervertebral Disc. J Orthop Res 2019; 37:1963-1971. [PMID: 31106893 DOI: 10.1002/jor.24347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Analgesic discoblock is widely used for the diagnosis or treatment of discogenic low back pain by injecting local anesthetics. The purpose of this study was to investigate the deleterious effects of local anesthetics on degenerated rabbit intervertebral disks (IVDs) using an organotypic culture model and in vivo long-term follow-up model. To induce IVD degeneration, a rabbit annular puncture model was used. For the organotypic culture model, degenerated IVDs were harvested 1 month after the initial annular puncture and cultured for 3 or 7 days after intradiscal injection of local anesthetics (1% lidocaine and 0.5% bupivacaine). To perform in vivo analysis, local anesthetics were injected into degenerated IVDs, and IVDs were prepared for histological analysis after 6 or 12 months. In the organotypic model, terminal deoxynucleotidyl transferase dUTP nick end labeling-positive nucleus pulposus (NP) cells were significantly increased in the bupivacaine group compared with the other groups. In the in vivo study, the number of NP cells was significantly decreased in the saline and local anesthetics groups compared with the untreated control and puncture-only groups. However, there was no significant difference among the saline, lidocaine, and bupivacaine groups. In addition, histological analysis showed no significant difference of IVD degeneration among the puncture-only, saline, lidocaine, and bupivacaine groups. Although bupivacaine induced apoptotic NP cell death in the organotypic culture model, in vivo observations did not show any definitive proof to suggest that local anesthetics were capable of promoting degeneration in the degenerated IVD, except for pressurized injection-induced damage. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1963-1971, 2019.
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Affiliation(s)
- Katsuro Ura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15, West-7, Sapporo, 060-8638, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeru Tsujimoto
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Ukeba
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Yang G, Li Z, Mei H, Ye W, Huang S, Liu K, Tan Q. Bupivacaine at clinically relevant concentrations induces toxicity in human intervertebral disc cells via the induction of autophagy in vitro. Mol Med Rep 2019; 20:837-843. [PMID: 31180558 DOI: 10.3892/mmr.2019.10279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/17/2019] [Indexed: 11/06/2022] Open
Abstract
It has been reported that bupivacaine, the most widely used local anesthetic to relieve discogenic back pain in clinical settings, is cytotoxic to intervertebral disc (IVD) cells in vitro; however, the precise mechanisms of cytotoxicity induced by bupivacaine remain unclear. Autophagy is an intracellular lysosomal degradation process that is important for cellular survival. The present study investigated the role of autophagy in the survival of IVD cells subjected to bupivacaine treatment. Human nucleus pulposus (NP) cells isolated from IVD cells were exposed to various concentrations of bupivacaine for 2, 6 and 12 h, and analyzed for cellular viability using MTT assay and western blotting. Additionally, autophagosome formation and autophagy‑associated biomarkers were evaluated by electron microscopy and western blotting to determine the autophagic activity and signaling alterations in NP cells under bupivacaine treatment. Furthermore, autophagic activity was inhibited in vitro using 3‑methyladenine to further analyze the association between autophagy and apoptosis in bupivacaine‑treated NP cells. Bupivacaine exhibited time‑ and dose‑dependent cytotoxic effects on human IVD cells at clinically relevant concentrations. Bupivacaine increased autophagic activity by promoting autophagosome formation, and LC3‑II and Beclin‑1 production. Additionally, bupivacaine inhibited protein kinase B (Akt)/mammalian target of rapamycin (mTOR)/S6 kinase (S6K) signaling, which is a negative regulator of autophagic activity. Of note, pharmacological inhibition of autophagy alleviated bupivacaine‑induced cytotoxicity of IVD cells. The findings indicated that application of clinically relevant concentrations of bupivacaine upregulated autophagic activity via inhibition of Akt/mTOR/S6K signaling. In addition, the inhibition of autophagic activation served as a protective mechanism against bupivacaine‑induced cytotoxicity. Collectively, these findings may provide novel insight into the mechanisms underlying cytotoxicity induced by bupivacaine when controlling spine‑associated pain.
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Affiliation(s)
- Ge Yang
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
| | - Zhuoyang Li
- Department of Orthopedics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Haibo Mei
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
| | - Weihua Ye
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
| | - Shengxiang Huang
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
| | - Kun Liu
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
| | - Qian Tan
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha, Hunan 410007, P.R. China
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9
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Tsujimoto T, Sudo H, Todoh M, Yamada K, Iwasaki K, Ohnishi T, Hirohama N, Nonoyama T, Ukeba D, Ura K, Ito YM, Iwasaki N. An acellular bioresorbable ultra-purified alginate gel promotes intervertebral disc repair: A preclinical proof-of-concept study. EBioMedicine 2018; 37:521-534. [PMID: 30389504 PMCID: PMC6286260 DOI: 10.1016/j.ebiom.2018.10.055] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background The current surgical procedure of choice for lumbar intervertebral disc (IVD) herniation is discectomy. However, defects within IVD produced upon discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration. This study aimed to investigate whether the use of an acellular bioresorbable ultra-purified alginate (UPAL) gel implantation system is safe and effective as a reparative therapeutic strategy after lumbar discectomy. Methods Human IVD cells were cultured in a three-dimensional system in UPAL gel. In addition, lumbar spines of sheep were used for mechanical analysis. Finally, the gel was implanted into IVD after discectomy in rabbits and sheep in vivo. Findings The UPAL gel was biocompatible with human IVD cells and promoted extracellular matrix production after discectomy, demonstrating sufficient biomechanical characteristics without material protrusion. Interpretation The present results indicate the safety and efficacy of UPAL gels in a large animal model and suggest that these gels represent a novel therapeutic strategy after discectomy in cases of lumbar IVD herniation. Fund Grant-in-Aid for the Ministry of Education, Culture, Sports, Science, and Technology of Japan, Japan Agency for Medical Research and Development, and the Mochida Pharmaceutical Co., Ltd.
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Affiliation(s)
- Takeru Tsujimoto
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Hideki Sudo
- Faculty of Medicine and Graduate of Medicine, Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University, N15W7, Sapporo 060-8638, Hokkaido, Japan.
| | - Masahiro Todoh
- Faculty of Engineering, Division of Human Mechanical Systems and Design, Hokkaido University, N13W8, Sapporo, Hokkaido 060-8628, Japan
| | - Katsuhisa Yamada
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Koji Iwasaki
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Takashi Ohnishi
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Naoki Hirohama
- Faculty of Engineering, Division of Human Mechanical Systems and Design, Hokkaido University, N13W8, Sapporo, Hokkaido 060-8628, Japan
| | - Takayuki Nonoyama
- Faculty of Advanced Life Science, Division of Advanced Transdisciplinary Sciences, Hokkaido University, N21W11, Sapporo, Hokkaido 001-0021, Japan
| | - Daisuke Ukeba
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Katsuro Ura
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
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Mascarinas A, Harrison J, Boachie-Adjei K, Lutz G. Regenerative Treatments for Spinal Conditions. Phys Med Rehabil Clin N Am 2018; 27:1003-1017. [PMID: 27788898 DOI: 10.1016/j.pmr.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A literature review of clinical and translational studies was performed to provide an overview of current concepts on regenerative treatments for spinal conditions, including platelet rich plasma and stem cell treatments to treat low back pain.
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Affiliation(s)
- Angelie Mascarinas
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Julian Harrison
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Kwadwo Boachie-Adjei
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Gregory Lutz
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA.
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11
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Abstract
Degenerative disc disease is a progressive, chronic disorder with strong association to pain, where the dysregulated tissue environment signals disc cells, thereby leading to a low inflammatory process and slow extracellular matrix degradation and fibrosis in a perpetual vicious cycle, generating a structural and functional failure of intervertebral disc joint (IVDJ). Among current biologic therapies, there is an emerging minimally invasive strategy that consists of infiltrating plasma rich in growth factors, a safe and efficacious therapeutic approach for other musculoskeletal degenerative conditions. This review summarizes the homeostasis and degeneration of IVDJ, discusses some results on basic science and therapeutic use of platelet-rich plasma products and advances an alternative minimally invasive biologic therapy in IVDJ degeneration and chronic back pain.
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Affiliation(s)
- Eduardo Anitua
- BTI - Biotechnology Institute, Laboratory of Regenerative Medicine, Jose Maria Cagigal Kalea, 19, 01007 Vitoria-Gasteiz, Álava, Spain.,University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), C/Jacinto Quincoces, 39,01007 Vitoria-Gasteiz, Álava, Spain
| | - Sabino Padilla
- BTI - Biotechnology Institute, Laboratory of Regenerative Medicine, Jose Maria Cagigal Kalea, 19, 01007 Vitoria-Gasteiz, Álava, Spain.,University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), C/Jacinto Quincoces, 39,01007 Vitoria-Gasteiz, Álava, Spain
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12
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Bentov I, Damodarasamy M, Spiekerman C, Reed MJ. Lidocaine Impairs Proliferative and Biosynthetic Functions of Aged Human Dermal Fibroblasts. Anesth Analg 2017; 123:616-23. [PMID: 27537755 DOI: 10.1213/ane.0000000000001422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aged are at increased risk of postoperative wound healing complications. Because local anesthetics are infiltrated commonly into the dermis of surgical wounds, we sought to determine whether local anesthetics adversely affect proliferative and biosynthetic functions of dermal fibroblasts. We also evaluated the effect of local anesthetics on insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1), growth factors that are important regulators of wound healing. METHODS Human dermal fibroblasts (HFB) from aged and young donors were exposed to local anesthetic agents at clinically relevant concentrations. We screened the effects of lidocaine, bupivacaine, mepivacaine, and ropivacaine on proliferation of HFB. Lidocaine was most detrimental to proliferation in HFB. We then evaluated the effect of lidocaine on expression and function of the growth factors, IGF-1 and TGF-β1. Lastly, concurrent exposure to lidocaine and IGF-1 or TGF-β1 was evaluated for their effects on proliferation and expression of dermal collagens, respectively. RESULTS Lidocaine and mepivacaine inhibited proliferation in aged HFB (for lidocaine 88% of control, 95% confidence interval [CI], 80%-98%, P = .009 and for mepivacaine 90% of control, 95% CI, 81%-99%, P = .032) but not in young HFB. Ropivacaine and bupivacaine did not inhibit proliferation. Because of the clinical utility of lidocaine relative to mepivacaine, we focused on lidocaine. Lidocaine decreased proliferation in aged HFB, which was abrogated by IGF-1. Lidocaine inhibited transcripts for IGF-1 and insulin-like growth factor-1 receptor (IGF1R) in fibroblasts from aged donors (IGF-1, log2 fold-change -1.25 [42% of control, 95% CI, 19%-92%, P = .035] and IGF1R, log2 fold-change -1.00 [50% of control, 95% CI, 31%-81%, P = .014]). In contrast, lidocaine did not affect the expression of IGF-1 or IGF1R transcripts in the young HFB. Transcripts for collagen III were decreased after lidocaine exposure in aged and young HFB (log2 fold-change -1.28 [41% of control, 95% CI, 20%-83%, P = .022] in aged HFB and log2 fold-change -1.60 [33% of control, 95% CI, 15%-73%, P = .019] in young HFB). Transcripts for collagen I were decreased in aged HFB (log2 fold-change -1.82 [28% of control, 95% CI, 14%-58%, P = .006]) but not in the young HFB. Similar to the transcripts, lidocaine also inhibited the protein expression of collagen III in young and aged HFB (log2 fold-change -1.79 [29% of control, 95% CI, 18%-47%, P = .003] in young HFB and log2 fold-change -1.76 [30% of control, 95% CI, 9%-93%, P = .043] in aged HFB). The effect of lidocaine on the expression of collagen III protein was obviated by TGF-β1 in both young and aged HFB. CONCLUSIONS Our results show that lidocaine inhibits processes relevant to dermal repair in aged HFB. The detrimental responses to lidocaine are due, in part, to interactions with IGF-1 and TGF-β1.
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Affiliation(s)
- Itay Bentov
- From the *Department of Anesthesiology and Pain Medicine and †Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington; and ‡Center for Biomedical Statistics, Institute for Translational Health Sciences, University of Washington, Seattle, Washington
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13
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Lee YJ, Kim SA, Lee SH. Hyaluronan suppresses lidocaine-induced apoptosis of human chondrocytes in vitro by inhibiting the p53-dependent mitochondrial apoptotic pathway. Acta Pharmacol Sin 2016; 37:664-73. [PMID: 27041463 DOI: 10.1038/aps.2015.151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/20/2015] [Indexed: 11/09/2022] Open
Abstract
AIM Intra-articular injection of local anesthetics (LAs) is a common procedure for therapeutic purposes. However, LAs have been found toxic to articular cartilage, and hyaluronan may attenuate this toxicity. In this study we investigated whether hyaluronan attenuated lidocaine-induced chondrotoxicity, and if so, to elucidate the underlying mechanisms. METHODS Human chondrocyte cell line SW1353 and newly isolated murine chondrocytes were incubated in culture medium containing hyaluronan and/or lidocaine for 72 h. Cell viability was evaluated using MTT assay. Cell apoptosis was detected with DAPI staining, caspase 3/7 activity assay and flow cytometry. Cell cycle distributions, ROS levels and mitochondrial membrane potential (ΔΨm) were determined using flow cytometry. The expression of p53 and p53-regulated gene products was measured with Western blotting. RESULTS Lidocaine (0.005%-0.03%) dose-dependently decreased the viability of SW1353 cells. This local anesthetic (0.015%, 0.025%) induced apoptosis, G2/M phase arrest and loss of ΔΨm, and markedly increased ROS production in SW1353 cells. Hyaluronan (50-800 μg/mL) alone did not affect the cell viability, but co-treatment with hyaluronan (200 μg/mL) significantly attenuated lidocaine-induced apoptosis and other abnormalities in SW1353 cells. Furthermore, co-treatment with lidocaine and hyaluronan significantly decreased the levels of p53 and its transcription targets Bax and p21 in SW1353 cells, although treatment with lidocaine alone did not significantly change these proteins. Similar results were obtained in ex vivo cultured murine chondrocytes. CONCLUSION Hyaluronan suppresses lidocaine-induced apoptosis of human chondrocytes in vitro through inhibiting the p53-dependent mitochondrial apoptotic pathway.
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14
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In vivo effects of bupivacaine and gadobutrol on the intervertebral disc following discoblock and discography: a histological analysis. Eur Radiol 2016; 27:149-156. [PMID: 27085700 DOI: 10.1007/s00330-016-4358-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/24/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the present study was to histologically compare chondrotoxicity in surgically harvested intervertebral discs (IVDs) of patients following discoblock, discography, or no preoperative intervention. METHODS Thirty patients (IVD degeneration Modic ≥ 2°, Pfirrmann 3° or 4°) at L4/5 or L5/S1 who were planned for anterior lumbar interbody fusion were randomly assigned to three groups (open MRI: group DG - discography with gadobutrol; group DB - discoblock with bupivacaine at 4 weeks prior to surgery; group C - no intervention). The intervertebral discs were histologically evaluated and compared using ANOVA and Bonferroni tests for cell count, apoptosis, and proliferation. RESULTS A reduced cell count (groups DG vs. DB vs. C: 14.9 ± 7.1, 9.2 ± 3.8, and 16.6 ± 5.2 cells/mm2, respectively; p ANOVA = 0.016), increased apoptosis (groups DG vs. DB vs. C: 34.9 ± 10.2, 47.4 ± 16.3, 32.6 ± 12.2 %, respectively; p ANOVA = 0.039) and increased cell proliferation (post hoc pDB vs. DG or C p < 0.001; for 3-7 cell monoclonal cell nests: groups DG vs. DB vs. C: 2.4 ± 1, 3.9 ± 1, 2.2 ± 1.1, respectively; p interventionx nest size = 0.006) were found in the IVDs of patients in group DB. CONCLUSIONS This in vivo study suggests that chondrotoxic effects occur in IVD cells after the intradiscal injection of bupivacaine but not after gadobutrol administration. KEY POINTS • Local bupivacaine administration to intervertebral discs leads to cell toxicity and proliferation. • Gadobutrol demonstrated no significant effect on cell count, apoptosis, or cell proliferation. • In vivo cytotoxicity was demonstrated histologically in humans for the first time. • Addition/administration of bupivacaine during discographies must be judged critically.
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Levi D, Horn S, Tyszko S, Levin J, Hecht-Leavitt C, Walko E. Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. PAIN MEDICINE 2015; 17:1010-22. [DOI: 10.1093/pm/pnv053] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/17/2015] [Indexed: 12/21/2022]
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Li K, Han X. Endoplasmic reticulum stress is involved in the lidocaine-induced apoptosis in SH-SY5Y neuroblastoma cells. J Mol Neurosci 2014; 56:122-30. [PMID: 25522790 DOI: 10.1007/s12031-014-0473-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/18/2014] [Indexed: 01/20/2023]
Abstract
Lidocaine has been indicated to promote apoptosis and to promote endoplasmic reticulum (ER) stress. However, the mechanism underlining ER stress-mediated apoptosis is unclear. In the present study, we investigated the promotion to ER stress in the lidocaine-induced apoptosis in human neuroblastoma SH-SY5Y cells. Firstly, we confirmed that lidocaine treatment induced apoptosis in SH-SY5Y cells, time-dependently and dose-dependently, via MTT cell viability assay and annexin V/FITC apoptosis detection with a FACScan flow cytometer. And the anti-apoptosis Bcl-2 and Bcl-xL were downregulated, whereas the apoptosis-executive caspase 3 was promoted through Western blot assay and caspase 3 activity assay. Moreover, the ER stress-associated binding immunoglobulin protein (BiP), PKR-like ER kinase (PERK), activating transcription factor 4 (ATF4) and CCAAT/enhancer-binding protein homologous protein (CHOP) were also upregulated at both mRNA and protein levels by lidocaine treatment. On the other hand, downregulation of the ER stress-associated BiP by RNAi method not only blocked the lidocaine-promoted ER stress but also attenuated the lidocaine-induced SH-SY5Y cell apoptosis. In conclusion, the present study confirmed the involvement of ER stress in the lidocaine-induced apoptosis in human neuroblastoma SH-SY5Y cells. Our study provides a better understanding on the mechanism of lidocaine's neurovirulence.
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Affiliation(s)
- Kehan Li
- Department of Anesthesiology, The First Affiliated Hospital of Henan Science and Technology University, No. 24 Jinghua Road, Jianxi District, 471003, Luoyang, China,
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Iwasaki K, Sudo H, Yamada K, Higashi H, Ohnishi T, Tsujimoto T, Iwasaki N. Effects of single injection of local anesthetic agents on intervertebral disc degeneration: ex vivo and long-term in vivo experimental study. PLoS One 2014; 9:e109851. [PMID: 25286407 PMCID: PMC4186881 DOI: 10.1371/journal.pone.0109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Analgesic discography (discoblock) can be used to diagnose or treat discogenic low back pain by injecting a small amount of local anesthetics. However, recent in vitro studies have revealed cytotoxic effects of local anesthetics on intervertebral disc (IVD) cells. Here we aimed to investigate the deteriorative effects of lidocaine and bupivacaine on rabbit IVDs using an organotypic culture model and an in vivo long-term follow-up model. METHODS For the organotypic culture model, rabbit IVDs were harvested and cultured for 3 or 7 days after intradiscal injection of local anesthetics (1% lidocaine or 0.5% bupivacaine). Nucleus pulposus (NP) cell death was measured using confocal microscopy. Histological and TUNEL assays were performed. For in vivo study, each local anesthetic was injected into rabbit lumbar IVDs under a fluoroscope. Six or 12 months after the injection, each IVD was prepared for magnetic resonance imaging (MRI) and histological analysis. RESULTS In the organotypic culture model, both anesthetic agents induced time-dependent NP cell death; when compared with injected saline solution, significant effects were detected within 7 days. Compared with the saline group, TUNEL-positive NP cells were significantly increased in the bupivacaine group. In the in vivo study, MRI analysis did not show any significant difference. Histological analysis revealed that IVD degeneration occurred to a significantly level in the saline- and local anesthetics-injected groups compared with the untreated control or puncture-only groups. However, there was no significant difference between the saline and anesthetic agents groups. CONCLUSIONS/SIGNIFICANCE In the in vivo model using healthy IVDs, there was no strong evidence to suggest that discoblock with local anesthetics has the potential of inducing IVD degeneration other than the initial mechanical damage of the pressurized injection. Further studies should be performed to investigate the deteriorative effects of the local injection of analgesic agents on degenerated IVDs.
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Affiliation(s)
- Koji Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideaki Higashi
- Division of Infection and Immunity, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Takashi Ohnishi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeru Tsujimoto
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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