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Kang X, Qian M, Qin T, Liu M, Xu H, Xu B. Increased Expression of Inflammatory Cytokines and Discogenic Neck Pain. Orthop Surg 2024; 16:227-233. [PMID: 38097400 PMCID: PMC10782267 DOI: 10.1111/os.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Although neck pain has become a serious economic and social problem worldwide, the etiology remains poorly understood. The aim of current study is to explore the possible pathogenesis of discogenic neck pain by analyzing the relationship between inflammatory cytokines and discogenic neck pain and provide a valuable reference for the prevention and treatment of discogenic neck pain. METHODS A total of 111 cervical disc samples were collected between October 1, 2021, and October 1, 2022: 38 samples from the discogenic neck pain group, 41 samples from the symptomatic control group, and 32 samples from the normal control group. The concentration of nitric oxide (NO), interleukin (IL)-1, interleukin (IL)-6, and tumor necrosis factor alpha (TNF-α) was determined using the enzyme-linked immunosorbent assay in each sample, and the degeneration degree of the target discs were evaluated using T2-weighted sagittal magnetic resonance imaging (MRI) according to the Miyazaki disc degeneration grading system. Whether the differences among the three groups were statistically significant was tested using one-way analysis of variance and an unpaired t-test, respectively. RESULTS The differences of the baseline characteristics were not statistically significant between the discogenic neck pain group and the symptomatic control group (p > 0.05). The expression of inflammatory cytokines in disc samples from the discogenic neck pain group (NO: 9.89 ± 1.75, IL-1β: 10.74 ± 1.92, IL-6:31.65 ± 2.46, and TNF-α: 5.96 ± 1.91) was increased in comparison with the disc samples from both the symptomatic control group (NO: 7.15 ± 2.78, IL-1β: 8.03 ± 1.87, IL-6: 25.79 ± 2.12, and TNF-α: 4.18 ± 2.87) and the normal control group (NO: 6.11 ± 1.37, IL-1β: 5.84 ± 2.25, IL-6: 20.65 ± 1.26, and TNF-α: 2.05 ± 0.58). The differences were statistically significant (p < 0.001). Further, there were no statistical differences in the degree of degeneration between discogenic neck pain group and symptomatic control group. CONCLUSIONS The increased expression of inflammatory cytokines in diseased cervical intervertebral discs might play a key role in the pathogenesis of discogenic neck pain. Although inflammation is involved in intervertebral disc degeneration, there is no linear positive correlation between the concentration of inflammatory cytokines and the degree of disc degeneration.
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Affiliation(s)
- Xinjian Kang
- Graduate SchoolTianjin Medical UniversityTianjinChina
- Department of OrthopedicsTraditional Chinese Medicine Hospital of QinhuangdaoQinhuangdaoChina
| | - Man Qian
- Department of Refractive SurgeryQinhuangdao Aier Ophthalmic HospitalQinhuangdaoChina
| | - Tao Qin
- Department of ImagingQinhuangdao Worker's HospitalQinhuangdaoChina
| | - Mingli Liu
- Graduate SchoolTianjin Medical UniversityTianjinChina
| | - Haiwei Xu
- Department of Minimally Invasive Spine SurgeryTianjin HospitalTianjinChina
| | - Baoshan Xu
- Department of Minimally Invasive Spine SurgeryTianjin HospitalTianjinChina
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2
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Ying Y, Cai K, Cai X, Zhang K, Qiu R, Jiang G, Luo K. Recent advances in the repair of degenerative intervertebral disc for preclinical applications. Front Bioeng Biotechnol 2023; 11:1259731. [PMID: 37811372 PMCID: PMC10557490 DOI: 10.3389/fbioe.2023.1259731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients' quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.
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Affiliation(s)
- Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xiongxiong Cai
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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3
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Stover JD, Trone MA, Lawrence B, Bowles RD. Multiplex epigenome editing of ion channel expression in nociceptive neurons abolished degenerative IVD-conditioned media-induced mechanical sensitivity. JOR Spine 2023; 6:e1253. [PMID: 37361323 PMCID: PMC10285767 DOI: 10.1002/jsp2.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/15/2023] [Accepted: 02/27/2023] [Indexed: 06/28/2023] Open
Abstract
Background Low back pain is a major contributor to disability worldwide and generates a tremendous socioeconomic impact. The degenerative intervertebral disc (IVD) has been hypothesized to contribute to discogenic pain by sensitizing nociceptive neurons innervating the disc to stimuli that is nonpainful in healthy patients. Previously, we demonstrated the ability of degenerative IVDs to sensitize neurons to mechanical stimuli; however, elucidation of degenerative IVDs discogenic pain mechanisms is required to develop therapeutic strategies that directly target these mechanisms. Aims In this study, we utilized CRISPR epigenome editing of nociceptive neurons to identify mechanisms of degenerative IVD-induced changes to mechanical nociception and demonstrated the ability of multiplex CRISPR epigenome editing of nociceptive neurons to modulate inflammation-induced mechanical nociception. Methods and Results Utilizing an in vitro model, we demonstrated degenerative IVD-produced IL-6-induced increases in nociceptive neuron activity in response to mechanical stimuli, mediated by TRPA1, ASIC3, and Piezo2 ion channel activity. Once these ion channels were identified as mediators of degenerative IVD-induced mechanical nociception, we developed singleplex and multiplex CRISPR epigenome editing vectors that modulate endogenous expression of TRPA1, ASIC3, and Piezo2 via targeted gene promoter histone methylation. When delivered to nociceptive neurons, the multiplex CRISPR epigenome editing vectors abolished degenerative IVD-induced mechanical nociception while preserving nonpathologic neuron activity. Conclusion This work demonstrates the potential of multiplex CRISPR epigenome editing as a highly targeted gene-based neuromodulation strategy for the treatment of discogenic pain, specifically; and, for the treatment of inflammatory chronic pain conditions, more broadly.
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Affiliation(s)
- Joshua D. Stover
- Department of BioengineeringUniversity of UtahSalt Lake CityUtahUSA
| | - Matthew A. Trone
- Department of BioengineeringUniversity of UtahSalt Lake CityUtahUSA
| | - Brandon Lawrence
- Department of OrthopaedicsUniversity of UtahSalt Lake CityUtahUSA
| | - Robby D. Bowles
- Department of BioengineeringUniversity of UtahSalt Lake CityUtahUSA
- Department of OrthopaedicsUniversity of UtahSalt Lake CityUtahUSA
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4
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Yamada K, Iwasaki N, Sudo H. Biomaterials and Cell-Based Regenerative Therapies for Intervertebral Disc Degeneration with a Focus on Biological and Biomechanical Functional Repair: Targeting Treatments for Disc Herniation. Cells 2022; 11:cells11040602. [PMID: 35203253 PMCID: PMC8870062 DOI: 10.3390/cells11040602] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a common cause of low back pain and most spinal disorders. As IVD degeneration is a major obstacle to the healthy life of so many individuals, it is a major issue that needs to be overcome. Currently, there is no clinical treatment for the regeneration of degenerated IVDs. However, recent advances in regenerative medicine and tissue engineering suggest the potential of cell-based and/or biomaterial-based IVD regeneration therapies. These treatments may be indicated for patients with IVDs in the intermediate degenerative stage, a point where the number of viable cells decreases, and the structural integrity of the disc begins to collapse. However, there are many biological, biomechanical, and clinical challenges that must be overcome before the clinical application of these IVD regeneration therapies can be realized. This review summarizes the basic research and clinical trials literature on cell-based and biomaterial-based IVD regenerative therapies and outlines the important role of these strategies in regenerative treatment for IVD degenerative diseases, especially disc herniation.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
- Correspondence:
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CGRP Regulates Nucleus Pulposus Cell Apoptosis and Inflammation via the MAPK/NF- κB Signaling Pathways during Intervertebral Disc Degeneration. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2021:2958584. [PMID: 34987701 PMCID: PMC8720589 DOI: 10.1155/2021/2958584] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 12/22/2022]
Abstract
Chronic low back pain (CLBP) has been proved to be the dominating cause of disability in patients with lumbar degenerative diseases. Of the various etiological factors, intervertebral disc degeneration (IVDD) has been the dominating cause. In the past few decades, the role and changes of nerve systems, especially the peripheral sensory fibers and their neurotransmitters, in the induction and progression of IVDD have attracted growing concerns. The expression of many neuropeptides, such as SP, NPY, and CGRP, in the nociceptive pathways is increased during the progression of IVDD and responsible for the discogenic pain. Here, the role of CGRP in the progression of IVDD was firstly investigated both in vitro and in vivo. Firstly, we confirmed that human degenerated intervertebral disc tissue exhibited elevated expression of CGRP and its receptor. Secondly, in vitro experiments suggested that CGRP could inhibit the proliferation and induce apoptosis in human nucleus pulposus (NP) cells, as well as promote inflammation and degenerated phenotypes through activating NF-κB and MAPK signaling pathways. Thirdly, CGRP receptor antagonist, Rimegepant, can ameliorate the adverse effects of CGRP imposed on NP cells, which were confirmed in vitro and in vivo. Our results will bring about a brand-new insight into the roles of neuromodulation in IVDD and related therapeutic attempts.
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Marshall SL, Jacobsen TD, Emsbo E, Murali A, Anton K, Liu JZ, Lu HH, Chahine NO. Three-Dimensional-Printed Flexible Scaffolds Have Tunable Biomimetic Mechanical Properties for Intervertebral Disc Tissue Engineering. ACS Biomater Sci Eng 2021; 7:5836-5849. [PMID: 34843224 DOI: 10.1021/acsbiomaterials.1c01326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The intervertebral disc (IVD) exhibits complex structure and biomechanical function, which supports the weight of the body and permits motion. Surgical treatments for IVD degeneration (e.g., lumbar fusion, disc replacement) often disrupt the mechanical environment of the spine which lead to adjacent segment disease. Alternatively, disc tissue engineering strategies, where cell-seeded hydrogels or fibrous biomaterials are cultured in vitro to promote matrix deposition, do not recapitulate the complex IVD mechanical properties. In this study, we use 3D printing of flexible polylactic acid (FPLA) to fabricate a viscoelastic scaffold with tunable biomimetic mechanics for whole spine motion segment applications. We optimized the mechanical properties of the scaffolds for equilibrium and dynamic moduli in compression and tension by varying fiber spacing or porosity, generating scaffolds with de novo mechanical properties within the physiological range of spine motion segments. The biodegradation analysis of the 3D printed scaffolds showed that FPLA exhibits lower degradation rate and thus has longer mechanical stability than standard PLA. FPLA scaffolds were biocompatible, supporting viability of nucleus pulposus (NP) cells in 2D and in FPLA+hydrogel composites. Composite scaffolds cultured with NP cells maintained baseline physiological mechanical properties and promoted matrix deposition up to 8 weeks in culture. Mesenchymal stromal cells (MSCs) cultured on FPLA adhered to the scaffold and exhibited fibrocartilaginous differentiation. These results demonstrate for the first time that 3D printed FPLA scaffolds have de novo viscoelastic mechanical properties that match the native IVD motion segment in both tension and compression and have the potential to be used as a mechanically stable and biocompatible biomaterial for engineered disc replacement.
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Affiliation(s)
- Samantha L Marshall
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Timothy D Jacobsen
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States.,Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Erik Emsbo
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Archana Murali
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Kevin Anton
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Jessica Z Liu
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Helen H Lu
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States.,Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
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7
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A comparative study of mesenchymal stem cell transplantation and NTG-101 molecular therapy to treat degenerative disc disease. Sci Rep 2021; 11:14804. [PMID: 34285277 PMCID: PMC8292352 DOI: 10.1038/s41598-021-94173-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Cellular replacement therapy using mesenchymal stem cells (MSCs) and/or the delivery of growth factors are at the forefront of minimally invasive biological treatment options for Degenerative Disc Disease (DDD). In this study, we compared the therapeutic potential of a novel drug candidate, NTG-101 to MSCs, including rat cartilage derived stem cells (rCDSCs), bone marrow stem cells (rBMSCs) and human Umbilical Cord Derived Mesenchymal Stem Cells (hUCMSCs) for the treatment of DDD. We induced DDD using a validated image-guided needle puncture injury in rat-tail IVDs. Ten weeks post-injury, animals were randomized and injected with MSCs, NTG-101 or vehicle. At the end of the study, histological analysis of the IVD-Nucleus Pulposus (NPs) injected with NTG-101 or rCDSCs showed a healthy or mild degenerative phenotype in comparison to vehicle controls. Immunohistochemical analysis revealed strong expression of aggrecan, collagen 2, brachyury and Oct4 in IVD-NPs injected with NTG-101. Our results also demonstrated suppression of inflammation induced p38 and NFκB resulting in inhibition of catabolic genes, but activation of Smad-2/3, Erk-1/2 and Akt-dependent signaling inducing anabolic genes in IVD-NP on treatment with NTG-101. In conclusion, a single injection of NTG-101 into the degenerative disc demonstrated superior benefits compared to stem cell transplantation.
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8
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Stover JD, Lawrence B, Bowles RD. Degenerative IVD conditioned media and acidic pH sensitize sensory neurons to cyclic tensile strain. J Orthop Res 2021; 39:1192-1203. [PMID: 32255531 PMCID: PMC9265139 DOI: 10.1002/jor.24682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
Low back pain is among the leading causes of disability worldwide. The degenerative intervertebral disc (IVD) environment contains pathologically high levels of inflammatory cytokines and acidic pH hypothesized to contribute to back pain by sensitizing nociceptive neurons to stimuli that would not be painful in healthy patients. We hypothesized that the degenerative IVD environment drives discogenic pain by sensitizing nociceptive neurons to mechanical loading. To test this hypothesis, we developed an in vitro model that facilitated the investigation of interactions between the degenerative IVD environment, nociceptive neurons innervating the IVD and mechanical loading of the disc; and, the identification of the underlying mechanism of degenerative IVD induced nociceptive neuron sensitization. In our model, rat dorsal root ganglia (DRG) neurons were seeding onto bovine annulus fibrosus tissue, exposed to degenerative IVD conditioned media and/or acidic pH, and subjected to cyclic tensile strain (1 Hz; 1%-6% strain) during measurement of DRG sensory neuron activity via calcium imaging. Using this model, we demonstrated that both degenerative IVD conditioned media and degenerative IVD acidic pH levels induced elevated nociceptive neuron activation in response to physiologic levels of mechanical strain. In addition, interleukin 6 (IL-6) was demonstrated to mediate degenerative IVD conditioned media induced elevated nociceptive neuron activation. These results demonstrate IL-6 mediates degenerative IVD induced neuron sensitization to mechanical loading and further establishes IL-6 as a potential therapeutic target for the treatment of discogenic pain. Data further suggests the degenerative IVD environment contains multiple neuron sensitization pathways (IL-6, pH) that may contribute to discogenic pain.
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Affiliation(s)
- Joshua D. Stover
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Brandon Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Robby D. Bowles
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah,Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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9
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Barrett JM, Fewster KM, Gruevski KM, Callaghan JP. A novel least-squares method to characterize in-vivo joint functional passive regional stiffness zones. Hum Mov Sci 2021; 76:102765. [PMID: 33497869 DOI: 10.1016/j.humov.2021.102765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To present and evaluate a method to objectively quantify the functional regions of joint lumped passive stiffness. BACKGROUND Joint passive stiffness has an important clinical role in constraining the degrees of freedom at a given joint. Links between passive stiffness and injury, pathology and function may be better understood if joint passive stiffness can be accurately quantified. Thus, a technique was developed to objectively partition passive stiffness curves into 3 linear regions (low, transition and high stiffness). METHODS The passive stiffness of the lumbar spine is presented as an example. Simulated data was used to determine the sensitivity of the method to Gaussian white noise in force measurements. An experimentally determined lumbar passive flexion curve was used to demonstrate the technique on human data. Breakpoint analysis was employed on the resulting moment-angle cures to partition the curve into low, transition and high stiffness zones. RESULTS The proposed method was successful at discriminating between the three stiffness zones and quantifying the passive stiffness within each zone. The algorithm had difficulty determining parameters in the low-stiffness zone in the presence of noise. CONCLUSIONS The proposed method can be used as an objective method to investigate passive stiffness. Breakpoint Analysis can identify the three functional linear zones of passive stiffness. The slopes of these linear regions are then used as a measure of passive stiffness, which have applications in clinical populations and research studies, to assess time varying responses, or changes in stiffness following an intervention.
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Affiliation(s)
- Jeff M Barrett
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Kayla M Fewster
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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Ura K, Yamada K, Tsujimoto T, Ukeba D, Iwasaki N, Sudo H. Ultra-purified alginate gel implantation decreases inflammatory cytokine levels, prevents intervertebral disc degeneration, and reduces acute pain after discectomy. Sci Rep 2021; 11:638. [PMID: 33436742 PMCID: PMC7804289 DOI: 10.1038/s41598-020-79958-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Abstract
Lumbar intervertebral disc (IVD) herniation causes severe low back pain (LBP), which results in substantial financial and emotional strains. Despite the effectiveness of discectomy, there is no existing treatment for post-operative LBP induced by progressive IVD degeneration. Two key factors of LBP are intradiscal inflammation, indicated by tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), and sensory nerve ingrowth into the inner layer of the annulus fibrosus, triggered by nerve growth factor/high-affinity tyrosine kinase A (TrkA) signalling. In an animal models of discectomy, the bioresorbable ultra-purified alginate (UPAL) gel with an extremely low-toxicity has been effective in acellular tissue repair. We aimed to investigate whether UPAL gel can alleviate LBP using a rat nucleus pulposus (NP) punch model and a rabbit NP aspirate model. In both models, we assessed TNF-α and IL-6 production and TrkA expression within the IVD by immunohistochemistry. Further, histological analysis and behavioural nociception assay were conducted in the rat model. UPAL gel implantation suppressed TNF-α and IL-6 production, downregulated TrkA expression, inhibited IVD degeneration, and reduced nociceptive behaviour. Our results suggest the potential of UPAL gel implantation as an innovative treatment for IVD herniation by reducing LBP and preventing IVD degeneration after discectomy.
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Affiliation(s)
- Katsuro Ura
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Katsuhisa Yamada
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Takeru Tsujimoto
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Ukeba
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan.
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11
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Newton MD, Marek AA, Planalp M, Park DK, Baker KC, Maerz T. Longitudinal characterization of intervertebral disc remodeling following acute annular injury in a rat model of degenerative disc disease. Connect Tissue Res 2020; 61:568-576. [PMID: 31232119 DOI: 10.1080/03008207.2019.1635589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Characterize 3D remodeling of the rat intervertebral disc (IVD) following acute annular injury via in vivo micro-computed tomography (µCT), ex vivo contrast-enhanced (CE)-µCT, and histology. Design: Female Lewis rats (N = 4/group) underwent either sham surgery or anterior annular puncture to L3-L4 and L5-L6 (n = 8 IVDs/group) to induce IVD degeneration. Rats were allowed ad libidum cage activity before and after surgery and underwent in vivo µCT scanning at baseline and every 2 weeks post-op for 12 weeks to characterize longitudinal changes in IVD height. At 12 weeks, lumbar spines were dissected and underwent CE-µCT scanning to characterize endpoint glycosaminoglycan distribution and nucleus pulposus (NP) volume ratio. Spines were processed for safranin-O-stained sagittal histology, and IVD degeneration was graded via the Rutges scale. Results: Puncture IVDs exhibited loss of IVD height at all time points from 4 weeks onward compared to Sham-the most severe height loss occurred posteriorly, with significant changes also occurring in the NP and laterally. Puncture IVDs exhibited higher CE-µCT attenuation, indicative of lower glycosaminoglycan content, and reduced NP volume ratio compared to Sham. Histologically, Puncture IVDs had higher Rutges damage scores and exhibited reduced NP cellularity and hydration, disorganized annulus fibrosus (AF) lamellae with evidence of the stab tract, and indistinct AF-NP border compared to Sham. Conclusions: Characterization of the complex, 3D alterations involved in the onset and early progression of IVD degeneration can foster greater understanding of the pathoetiology of IVD degeneration and may inform future studies assessing more sensitive diagnostic techniques or novel therapies.
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Affiliation(s)
- Michael D Newton
- Orthopaedic Research Laboratories, Beaumont Health , Royal Oak, MI, USA
| | - Abigail A Marek
- Orthopaedic Research Laboratories, Beaumont Health , Royal Oak, MI, USA
| | - Michael Planalp
- Department of Orthopaedic Surgery, Beaumont Health , Royal Oak, MI, USA
| | - Daniel K Park
- Department of Orthopaedic Surgery, Beaumont Health , Royal Oak, MI, USA
| | - Kevin C Baker
- Orthopaedic Research Laboratories, Beaumont Health , Royal Oak, MI, USA
| | - Tristan Maerz
- Orthopaedic Research Laboratories, Beaumont Health , Royal Oak, MI, USA.,Department of Orthopaedic Surgery, University of Michigan , Ann Arbor, MI, USA
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12
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Xu L, Zhang Y, Min X, Li L, Ling Q, Xu S, Liu L, Cao P, Wang L, Wang J, Du G. Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment. World J Urol 2020; 39:1597-1605. [PMID: 32613324 DOI: 10.1007/s00345-020-03330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Refractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH. METHODS A retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes. RESULTS In group A, following treatment, the maximum flow rate (Qmax) increased by 3.92 ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09 ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784). CONCLUSIONS LUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.
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Affiliation(s)
- Lei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yong Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Lina Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Shengfei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Libo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Peng Cao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Jianming Wang
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Guanghui Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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Involvement of the G-Protein-Coupled Receptor 4 in the Increased Expression of RANK/RANKL/OPG System and Neurotrophins by Nucleus Pulposus Cells under the Degenerated Intervertebral Disc-Like Acidic Microenvironment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1328436. [PMID: 32566653 PMCID: PMC7277045 DOI: 10.1155/2020/1328436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 12/05/2022]
Abstract
Intervertebral disc (IVD) degeneration is associated with local inflammation and increased expression of neurotrophins. Acidic microenvironment is believed to cause the progression of IVD degeneration. However, there is a paucity of information regarding the relationship between acidic microenvironment and the inflammation and expression of neurotrophins in IVD. G-protein-coupled receptor 4 (GPR4) is a pH-sensing receptor, which can activate the inflammation and increase the expression levels of nerve growth factor in acidic microenvironment. In this study, culture media with pH 7.2 (representing the normal IVD-like acidic condition) and pH 6.5 (degenerated IVD-like acidic condition) were prepared. The gene and protein expression levels of GPR4 in SD rat nucleus pulposus cells were determined under the acidic conditions. And cyclic AMP (cAMP), the second messenger of GPR4, was assayed. Furthermore, the expression levels of receptor activator of nuclear factor κ B (RANK), RANKL ligand (RANKL), osteoprotegerin (OPG), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) were also determined. To clarify the involvement of GPR4 in the upregulation of the expression of RANK/RANKL/OPG system and neurotrophins, gene knockdown and forced expression of GPR4 and inhibiting its downstream cAMP accumulation and Ca2+ mobilization were performed. The alternation of the expression levels of matrix metalloproteinase-3 (MMP-3), MMP-13, and aggrecanase-2 (ADAMTS-5) were evaluated by RT-PCR and western blot. The results showed that GPR4 was expressed in rat nucleus pulposus cells, and the expression was upregulated under the degenerated IVD-like acidic microenvironment. cAMP accumulation levels were increased under the degenerated IVD-like acidic culture conditions. The expression levels of RANK, RANKL, OPG, NGF, and BNDF were significantly upregulated under the degenerated IVD-like acidic microenvironment. GPR4 knockdown and reduction of cAMP by the inhibitor SQ22536 abolished the upregulation of the expression of RANK, RANKL, OPG, NGF, and BNDF under the degenerated IVD-like acidic microenvironment. On the opposite, acidosis-induced cAMP accumulation and upregulation of RANK, RANKL, OPG, NGF, and BNDF were further promoted by GPR4 overexpression. The expression levels of MMP-3, MMP-13, and ADAMTS-5 were upregulated under the degenerated IVD-like acidic condition, which can be promoted or attenuated by GPR4 overexpression or knockdown, respectively. We concluded that GPR4-mediated cAMP accumulation was involved in the increased expression of RANK/RANKL/OPG system and neurotrophins by nucleus pulposus cells under the degenerated IVD-like acidic microenvironment.
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14
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Dombrowski ME, Olsen AS, Vaudreuil N, Couch BK, Dong Q, Tucci M, Lee JY, Vo NV, Sowa G. Rabbit Annulus Fibrosus Cells Express Neuropeptide Y, Which Is Influenced by Mechanical and Inflammatory Stress. Neurospine 2020; 17:69-76. [PMID: 32252156 PMCID: PMC7136102 DOI: 10.14245/ns.2040046.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Rabbit annulus fibrosus (AF) cells were exposed to isolated or combined mechanical and inflammatory stress to examine the expression of neuropeptide Y (NPY). This study aims to explore the ability of AF cells to produce NPY in response to mechanical and inflammatory stress.
Methods Lumbar AF cells of 6- to 8-month-old female New Zealand white rabbits were harvested and exposed to combinations of inflammatory (interleukin-1β) and mechanical (6% or 18%) tensile stress using the Flexcell System. NPY concentrations were measured in the media via enzyme-linked immunosorbent assay. The presence of NPY receptor-type 1 (NPY-1R) in AF cells of rabbit intervertebral discs was also analyzed via immunohistochemistry and immunofluorescence.
Results Exposure to inflammatory stimuli showed a significant increase in the amount of NPY expression compared to control AF cells. Mechanical strain alone did not result in a significant difference in NPY expression. While combined inflammatory and mechanical stress did not demonstrate an increase in NPY expression at low (6%) levels of strain, at 18% strain, there was a large—though not statistically significant—increase in NPY expression under conditions of inflammatory stress. Lastly, immunofluorescence and immunohistochemistry of AF cells and tissue, respectively, demonstrated the presence of NPY-1R.
Conclusion These findings demonstrate that rabbit AF cells are capable of expressing NPY, and expression is enhanced in response to inflammatory and mechanical stress. Because both inflammatory and mechanical stress contribute to intervertebral disc degeneration (IDD), this observation raises the potential of a mechanistic link between low back pain and IDD.
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Affiliation(s)
- Malcolm E Dombrowski
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam S Olsen
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Vaudreuil
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon K Couch
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qing Dong
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Tucci
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nam V Vo
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gwendolyn Sowa
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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15
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Chan AK, Tang X, Mummaneni NV, Coughlin D, Liebenberg E, Ouyang A, Dudli S, Lauricella M, Zhang N, Waldorff EI, Ryaby JT, Lotz JC. Pulsed electromagnetic fields reduce acute inflammation in the injured rat-tail intervertebral disc. JOR Spine 2019; 2:e1069. [PMID: 31891118 PMCID: PMC6920683 DOI: 10.1002/jsp2.1069] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/03/2019] [Accepted: 10/19/2019] [Indexed: 01/07/2023] Open
Abstract
Pro-inflammatory cytokines are recognized contributors to intervertebral disc (IVD) degeneration and discogenic pain. We have recently reported the anti-inflammatory effect of pulsed electromagnetic fields (PEMF) on IVD cells in vitro. Whether these potentially therapeutic effects are sufficiently potent to influence disc health in vivo has not been demonstrated. We report here the effect of PEMF on acute inflammation arising from a rat-tail IVD injury model. Disc degeneration was induced by percutaneously stabbing the Co6-7, Co7-8, and Co8-9 levels using a 20-gauge needle. Seventy-two (72) rats were divided into three groups: sham control, needle stab, needle stab+PEMF. Treated rats were exposed to PEMF immediately following surgery and for either 4 or 7 days (4 hr/d). Stab and PEMF effects were evaluated by measuring inflammatory cytokine gene expression (RT-PCR) and protein levels (ELISA assay), anabolic and catabolic gene expression (RT-PCR), and histologic changes. We observed in untreated animals that at day 7 after injury, inflammatory cytokines (interleukin [IL]-6, tumor necrosis factor α, and IL-1β) were significantly increased at both gene and protein levels (P < .05). Similarly, catabolic factors (MMP [metalloproteinases]-2, MMP-13 and the transcriptional factor NF-kβ gene expression) were significantly increased (P < .05). At day 7, PEMF treatment significantly inhibited inflammatory cytokine gene and protein expression induced by needle stab injury (P < .05). At day 4, PEMF downregulated FGF-1 and upregulated MMP-2 compared to the stab-only group. These data demonstrate that previously reported anti-inflammatory effects of PEMF on disc cells carry over to the in vivo situation, suggesting potential therapeutic benefits. Though we observed an inhibitory effect of PEMF on acute inflammatory cytokine expression, a consistent effect was not observed for acute changes in disc histology and anabolic and catabolic factor expression. Therefore, these findings should be further investigated in studies of longer duration following needle-stab injury.
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Affiliation(s)
- Andrew K. Chan
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCalifornia
| | - Xinyan Tang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Nikhil V. Mummaneni
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Dezba Coughlin
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Ellen Liebenberg
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Annie Ouyang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Stefan Dudli
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Michael Lauricella
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | | | | | | | - Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
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16
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Aberrant mechanosensing in injured intervertebral discs as a result of boundary-constraint disruption and residual-strain loss. Nat Biomed Eng 2019; 3:998-1008. [PMID: 31611678 PMCID: PMC6899202 DOI: 10.1038/s41551-019-0458-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Abstract
In fibrous tissues, pre-stressed boundary constraints at bone interfaces instil residual strain throughout the tissue, even when unloaded. For example, internal swelling pressures in the central nucleus pulposus of the intervertebral disc generate pre-strain in the outer annulus fibrosus. With injury and depressurization, these residual strains are lost. Here, we show that the loss of residual strains in the intervertebral disc alters the microenvironment and instigates aberrant tissue remodelling and the adoption of atypical cellular phenotypes. By using puncture surgery of the annulus fibrosus in rabbits, ex vivo puncture experiments, and electrospun nanofibrous scaffolds recapitulating evolving boundary constraints, we show that the loss of residual strain promotes short-term apoptosis and the emergence of a fibrotic phenotype, that local fibre organization and cellular contractility mediate this process, and that the aberrant cellular changes could be abrogated by targeting the cell-mechanosensing machinery with small molecules. Our findings indicate that injury to dense connective tissues under pre-strain alters boundary constraints and residual strain, leading to aberrant mechanosensing, which in turn promotes disease progression.
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17
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Stover JD, Farhang N, Lawrence B, Bowles RD. Multiplex Epigenome Editing of Dorsal Root Ganglion Neuron Receptors Abolishes Redundant Interleukin 6, Tumor Necrosis Factor Alpha, and Interleukin 1β Signaling by the Degenerative Intervertebral Disc. Hum Gene Ther 2019; 30:1147-1160. [PMID: 31056946 PMCID: PMC6761584 DOI: 10.1089/hum.2019.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/27/2019] [Indexed: 01/07/2023] Open
Abstract
Back pain is the leading cause of disability worldwide and contributes to significant socioeconomic impacts. It has been hypothesized that the degenerative intervertebral disc (IVD) contributes to back pain by sensitizing nociceptive neurons innervating the IVD to stimuli that would not be painful to healthy patients. However, the inflammatory signaling networks mediating this sensitization remain poorly understood. A better understanding of the underlying mechanisms of degenerative IVD-induced changes in nociception is required to improve the understanding and treatment of back pain. Toward these ends, a novel in vitro model was developed to investigate degenerative IVD-induced changes in dorsal root ganglion (DRG) neuron activation by measuring DRG neuron activity following neuron seeding on human degenerative IVD tissue collected from patients undergoing surgical treatment for back pain. Lentiviral clustered regularly interspaced palindromic repeat (CRISPR) epigenome editing vectors were built to downregulate the inflammatory receptors TNFR1, IL1R1, and IL6st in DRG neurons in single- and multiplex. Multiplex CRISPR epigenome editing of inflammatory receptors demonstrated that degenerative IVD tissue drives thermal sensitization through the simultaneous and redundant signaling of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), and IL-1β. This work elucidates redundant signaling pathways in neuron interactions with the degenerative IVD and suggests the need for multiplex targeting of IL-6, TNF-α, and IL-1β for pain modulation in the degenerative IVD.
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Affiliation(s)
- Joshua D. Stover
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Niloofar Farhang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Brandon Lawrence
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Robby D. Bowles
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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18
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The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain. Pain Res Manag 2019; 2019:8957847. [PMID: 31511784 PMCID: PMC6714323 DOI: 10.1155/2019/8957847] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/06/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
Chronic nonspecific low back pain (CNLBP) is defined as pain or discomfort originating from the waist, which lasts for at least 12 weeks, but no radiculopathy or specific spinal diseases. CNLBP is a complicated medical problem and places a huge burden on healthcare systems. Clinical manifestation of CNLBP includes discogenic LBP, zygapophyseal joint pain, sacroiliac joint pain, and lumbar muscle strain. Further evaluation should be completed to confirm the diagnosis including auxiliary examination, functional assessment, and clinical assessment. The principle of the management is to relieve pain, restore function, and avoid recurrence. Treatment includes conservative treatment, minimally invasive treatment, and rehabilitation. Pharmacologic therapy is the first-line treatment of nonspecific LBP, and it is most widely used in clinical practice. Interventional therapy should be considered only after failure of medication and physical therapy. Multidisciplinary rehabilitation can improve physical function and alleviate short-term and long-term pain. The emphasis should be put on the prevention of NLBP and reducing relevant risk factors.
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19
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Vincent K, Mohanty S, Pinelli R, Bonavita R, Pricop P, Albert TJ, Dahia CL. Aging of mouse intervertebral disc and association with back pain. Bone 2019; 123:246-259. [PMID: 30936040 PMCID: PMC6549718 DOI: 10.1016/j.bone.2019.03.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/26/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
With the increased burden of low back pain (LBP) in our globally aging population there is a need to develop preclinical models of LBP that capture clinically relevant features of physiological aging, degeneration, and disability. Here we assess the validity of using a mouse model system for age-related LBP by characterizing aging mice for features of intervertebral disc (IVD) degeneration, molecular markers of peripheral sensitization, and behavioral signs of pain. Compared to three-month-old and one-year-old mice, two-year-old mice show features typical of IVD degeneration including loss of disc height, bulging, innervation and vascularization in the caudal lumbar IVDs. Aging is also associated with the loss of whole-body bone mineral density in both male and female mice, but not associated with percent lean mass or body fat. Additionally, two-year-old mice have an accumulation of TRPA1 channels and sodium channels NaV1.8 and NaV1.9 in the L4 and L5 lumbar dorsal root ganglia consistent with changes in nociceptive signaling. Lastly, the effect of age, sex, and weight on mobility, axial stretching and radiating pain measures was assessed in male and female mice ranging from two months to two years in a general linear model. The model revealed that regardless of sex or weight, increased age was a predictor of greater reluctance to perform axial stretching and sensitivity to cold, but not heat in mice.
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Affiliation(s)
| | | | | | | | - Paul Pricop
- Hospital for Special Surgery, New York, NY 10021, USA
| | - Todd J Albert
- Hospital for Special Surgery, New York, NY 10021, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Chitra Lekha Dahia
- Hospital for Special Surgery, New York, NY 10021, USA; Department of Cell and Developmental Biology, Weill Cornell Medicine, Graduate School of Medical Science, New York, NY 10065, USA.
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20
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Zhang L, Chen Q, Wang H, Yang J, Sheng S. Andrographolide mitigates IL‑1β‑induced human nucleus pulposus cells degeneration through the TLR4/MyD88/NF‑κB signaling pathway. Mol Med Rep 2018; 18:5427-5436. [PMID: 30365119 PMCID: PMC6236278 DOI: 10.3892/mmr.2018.9599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/19/2018] [Indexed: 12/26/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a multifactorial disease with few efficacious clinical drugs, which has been demonstrated to be associated with nucleus pulposus (NP) cells apoptosis and degeneration of the extracellular matrix (ECM). Interleukin (IL)-1β, a common proinflammatory cytokine, is considered to be one of key regulators in IDD development. Andrographolide (AG), extracted from Andrographis paniculata, has been suggested to possess marked anti-inflammatory properties. However, the effects of AG on IDD has not been well explored. The present study aimed to investigate the effects and the mechanisms of AG on IDD in human NP cells. NP cells were treated with IL-1β in the absence or presence of AG to investigate the effects on cell viability, cellular apoptosis, production of ECM and matrix metalloproteinase (MMP)-3, MMP-9 and MMP-13, and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4 and ADAMTS-5. It was identified that IL-1β-induced NP cellular apoptosis was significantly inhibited by AG treatment. Furthermore, AG mitigated the IL-1β-induced degeneration of the ECM, which was paralleled by a decrease in MMPs and ADAMTS levels. In addition, AG exhibited marked inhibitory properties against the activation of Toll-like receptors (TLRs), Myeloid differentiation factor 88 (MyD88) and the nuclear translocation of Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB). Taken together, these results demonstrated that AG treatment mitigated IL-1β-induced NP cells degeneration through the TLR4/MyD88/NF-κB signaling pathway, and suggested that AG may be a potential agent for IDD prevention and therapy.
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Affiliation(s)
- Lilian Zhang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Qi Chen
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Haoli Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Jian Yang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Sunren Sheng
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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21
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Rider SM, Mizuno S, Kang JD. Molecular Mechanisms of Intervertebral Disc Degeneration. Spine Surg Relat Res 2018; 3:1-11. [PMID: 31435545 PMCID: PMC6690117 DOI: 10.22603/ssrr.2017-0095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/24/2018] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration is a well-known cause of disability, the result of which includes neck and back pain with associated mobility limitations. The purpose of this article is to provide an overview of the known molecular mechanisms through which intervertebral disc degeneration occurs as a result of complex interactions of exogenous and endogenous stressors. This review will focus on some of the identified molecular changes leading to the deterioration of the extracellular matrix of both the annulus fibrosus and nucleus pulposus. In addition, we will provide a summation of our current knowledge supporting the role of associated DNA and intracellular damage, cellular senescence's catabolic effects, oxidative stress, and the cell's inappropriate response to damage in contributing to intervertebral disc degeneration. Our current understanding of the molecular mechanisms through which intervertebral disc degeneration occurs provides us with abundant insight into how physical and chemical changes exacerbate the degenerative process of the entire spine. Furthermore, we will describe some of the related molecular targets and therapies that may contribute to intervertebral repair and regeneration.
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Affiliation(s)
- Sean M Rider
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shuichi Mizuno
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Kang
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Ohtori S, Miyagi M, Inoue G. Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review. Spine Surg Relat Res 2018; 2:11-17. [PMID: 31440640 PMCID: PMC6698542 DOI: 10.22603/ssrr.2016-0018] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/30/2017] [Indexed: 01/07/2023] Open
Abstract
Introduction Many patients suffer from discogenic low back pain. However, the mechanisms, diagnosistic strategy, and treatment of discogenic low back pain all remain controversial. The purpose of this paper was to review the pathological mechanisms of discogenic low back pain. Methods Many authors have investigated the pathological mechanisms of discogenic low back pain using animal models and examining human patients. Central to most investigations is understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators. We discuss three pathological mechanisms of discogenic low back pain: innervation, inflammation, and mechanical hypermobility of the intervertebral disc. Results Sensory nerve fibers include C-fibers and A delta-fibers, which relay pain signals from the innervated outer layers of the intervertebral disc under normal conditions. However, ingrowth of these sensory nerve fibers into the inner layers of intervertebral disc occurs under disease conditions. Levels of neurotrophic factors and some cytokines are significantly higher in diseased discs than in normal discs. Stablization of the segmental hypermobility, which can be induced by intervertebral disc degeneration, suppresses inflammation and prevents sensitization of sensory nerve fibers innervating the disc. Conclusions Pathological mechanisms of discogenic low back pain include sensory nerve ingrowth into inner layers of the intervertebral disc, upregulation of neurotrophic factors and cytokines, and instability. Inhibition of these mechanisms is important in the treatment of discogenic low back pain.
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Affiliation(s)
- Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
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23
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Han YC, Ma B, Guo S, Yang M, Li LJ, Wang SJ, Tan J. Leptin regulates disc cartilage endplate degeneration and ossification through activation of the MAPK-ERK signalling pathway in vivo and in vitro. J Cell Mol Med 2018; 22:2098-2109. [PMID: 29372627 PMCID: PMC5867127 DOI: 10.1111/jcmm.13398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 08/22/2017] [Indexed: 12/23/2022] Open
Abstract
Recent findings demonstrate that leptin plays a significant role in chondrocyte and osteoblast differentiation. However, the mechanisms by which leptin acts on cartilage endplate (CEP) cells to give rise to calcification are still unclear. The aim of this study was to evaluate the effects of leptin that induced mineralization of CEP cells in vitro and in vivo. We constructed a rat model of lumbar disc degeneration and determined that leptin was highly expressed in the presence of CEP calcification. Rat CEP cells treated with or without leptin were used for in vitro analysis using RT‐PCR and Western blotting to examine the expression of osteocalcin (OCN) and runt‐related transcription factor 2 (Runx2). Both OCN and Runx2 expression levels were significantly increased in a dose‐ and time‐dependent manner. Leptin activated ERK1/2 and STAT3 phosphorylation in a time‐dependent manner. Inhibition of phosphorylated ERK1/2 using targeted siRNA suppressed leptin‐induced OCN and Runx2 expression and blocked the formation of mineralized nodules in CEP cells. We further demonstrated that exogenous leptin induced matrix mineralization of CEP cells in vivo. We suggest that leptin promotes the osteoblastic differentiation of CEP cells via the MAPK/ERK signal transduction pathway and may be used to investigate the mechanisms of disc degeneration.
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Affiliation(s)
- Ying-Chao Han
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Ma
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Song Guo
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingjie Yang
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Jun Li
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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24
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Sloan SR, Lintz M, Hussain I, Hartl R, Bonassar LJ. Biologic Annulus Fibrosus Repair: A Review of Preclinical In Vivo Investigations. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:179-190. [PMID: 29105592 DOI: 10.1089/ten.teb.2017.0351] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lower back pain, the leading cause of workplace absences and disability, is often attributed to intervertebral disc degeneration, in which nucleus pulposus (NP) herniates through lesions in the annulus fibrosus (AF) and impinges on the spinal cord and surrounding nerves. Surgeons remove extruded NP via discectomy when indicated by local/radicular pain supported by radiographic evidence; however, current interventions do not alter the underlying disease or seal the AF. The reported rates of recurrent herniation or pain following discectomy cases range from 5% to 25%, which has pushed spine research in recent years toward annular repair and closure strategies. Synthetic implants designed to mechanically seal the AF have been subject to large animal and clinical trials, with limited success in preventing recurrent herniation. Like gold standard interventions, purely mechanical devices fail to promote tissue integration, long-term healing, or restore native biomechanical function to the spine. Biological repair strategies utilizing principles of tissue engineering have demonstrated success in overcoming the inadequacies of current interventions and mechanical implants, yet, none has reached clinical or proof-of-concept trials in humans. In this review, we will discuss annular repair strategies promoting biological healing that have been implemented in small and large animal models in vivo, and ways to enhance the efficacy of these treatments.
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Affiliation(s)
- Stephen R Sloan
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| | - Marianne Lintz
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| | - Ibrahim Hussain
- 2 Department of Neurological Surgery, Weill Cornell Brain and Spine Center , New York-Presbyterian Hospital, New York, New York
| | - Roger Hartl
- 2 Department of Neurological Surgery, Weill Cornell Brain and Spine Center , New York-Presbyterian Hospital, New York, New York
| | - Lawrence J Bonassar
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York.,3 Sibley School of Mechanical and Aerospace Engineering, Cornell University , Ithaca, New York
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25
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Stress enhances gait disturbance induced by lumbar disc degeneration in rat. 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; 27:205-213. [DOI: 10.1007/s00586-017-5243-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/16/2017] [Accepted: 07/26/2017] [Indexed: 12/27/2022]
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CRISPR Epigenome Editing of AKAP150 in DRG Neurons Abolishes Degenerative IVD-Induced Neuronal Activation. Mol Ther 2017; 25:2014-2027. [PMID: 28676344 DOI: 10.1016/j.ymthe.2017.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/07/2023] Open
Abstract
Back pain is a major contributor to disability and has significant socioeconomic impacts worldwide. The degenerative intervertebral disc (IVD) has been hypothesized to contribute to back pain, but a better understanding of the interactions between the degenerative IVD and nociceptive neurons innervating the disc and treatment strategies that directly target these interactions is needed to improve our understanding and treatment of back pain. We investigated degenerative IVD-induced changes to dorsal root ganglion (DRG) neuron activity and utilized CRISPR epigenome editing as a neuromodulation strategy. By exposing DRG neurons to degenerative IVD-conditioned media under both normal and pathological IVD pH levels, we demonstrate that degenerative IVDs trigger interleukin (IL)-6-induced increases in neuron activity to thermal stimuli, which is directly mediated by AKAP and enhanced by acidic pH. Utilizing this novel information on AKAP-mediated increases in nociceptive neuron activity, we developed lentiviral CRISPR epigenome editing vectors that modulate endogenous expression of AKAP150 by targeted promoter histone methylation. When delivered to DRG neurons, these epigenome-modifying vectors abolished degenerative IVD-induced DRG-elevated neuron activity while preserving non-pathologic neuron activity. This work elucidates the potential for CRISPR epigenome editing as a targeted gene-based pain neuromodulation strategy.
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27
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Song J, Wang HL, Ma XS, Xia XL, Lu FZ, Zheng CJ, Jiang JY. The value of radiographic indexes in the diagnosis of discogenic low back pain: a retrospective analysis of imaging results. Oncotarget 2017; 8:60558-60567. [PMID: 28947993 PMCID: PMC5601161 DOI: 10.18632/oncotarget.18652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/23/2017] [Indexed: 01/01/2023] Open
Abstract
To explore value of different radiographic indexes in the diagnosis of discogenic low back pain (LBP). A total number of 120 cases (60 patients diagnosed with discogenic LBP and 60 healthy people) were retrospectively analysed to identify factors in the diagnosis of discogenic LBP by using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve was drew to show the predictive accuracy of the finally enrolled factors. Among all the included patients, 60 were strictly admitted in the discogenic LBP group while the other 60 were enrolled in the control group. Five results shows significant differences between discogenic LBP and control groups, including Cobb angle, lumbar stability, height of the disc, Modic change and High intense zone (HIZ) based on the results of univariate analysis; lumbar stability, Modic change and HIZ show high value in the diagnosis of lumbar discogenic pain based on the multivariate logistic analysis. The ROC curve shows that good diagnostic accuracy was obtained from the enrolled diagnostic factors including lumbar stability (Angular motion, more than 14.35°), Modic change and HIZ.
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Affiliation(s)
- Jian Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Hong-Li Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiao-Sheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xin-Lei Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Fei-Zhou Lu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Chao-Jun Zheng
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jian-Yuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
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28
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Jin L, Balian G, Li XJ. Animal models for disc degeneration-an update. Histol Histopathol 2017; 33:543-554. [PMID: 28580566 DOI: 10.14670/hh-11-910] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intervertebral disc degeneration is considered a major cause of back pain that places a heavy burden on society, both because of its effect on the physiology of individuals and its consequences on the world economy. During the past few decades, research findings in the pre-clinical setting have led to a significant increase in the understanding of intervertebral disc degeneration, although many aspects of the disease remain unclear. The goal of this review is to summarize existing animal models for disc degeneration studies and the difficulties that are associated with the use of such models. A firm understanding of the cellular and molecular events that ensue as a result of injuries, as well as environmental factors, could be instrumental in the development of targeted therapies for the treatment of intervertebral disc degeneration.
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Affiliation(s)
- Li Jin
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gary Balian
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Xudong Joshua Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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29
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Xu H, Gao Z, Ma M, Xu J, Xiao L, Wang H, Zhang T, Liu X, Xu Y, Zhang X. P120‐Catenin Mediates Intermittent Cyclic Mechanical Tension‐Induced Inflammation in Chondrocytes. J Cell Biochem 2017; 118:4508-4516. [DOI: 10.1002/jcb.26108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/01/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Hong‐guang Xu
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Zhi Gao
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Ming‐ming Ma
- Department of Orthopedic SurgeryFirst People's Hospital of FuyangFuyang 236000AnhuiChina
| | - Jia‐jia Xu
- The Key Laboratory of Stem Cell BiologyInstitute of Health SciencesShanghai Institutes for Biological Sciences (SIBS)Chinese Academy of Sciences (CAS)University of Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine (SJTUSM)Shanghai200031China
| | - Liang Xiao
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Hong Wang
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Tao Zhang
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Xiang Liu
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Yong‐ming Xu
- Department of Orthopedic SurgeryWannan Medical CollegeYijishan HospitalWuhu 241001AnhuiChina
| | - Xiao‐ling Zhang
- The Key Laboratory of Stem Cell BiologyInstitute of Health SciencesShanghai Institutes for Biological Sciences (SIBS)Chinese Academy of Sciences (CAS)University of Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine (SJTUSM)Shanghai200031China
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's HospitalSJTUSMShanghai200011China
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30
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Bowles RD, Setton LA. Biomaterials for intervertebral disc regeneration and repair. Biomaterials 2017; 129:54-67. [PMID: 28324865 DOI: 10.1016/j.biomaterials.2017.03.013] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/05/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022]
Abstract
The intervertebral disc contributes to motion, weight bearing, and flexibility of the spine, but is susceptible to damage and morphological changes that contribute to pathology with age and injury. Engineering strategies that rely upon synthetic materials or composite implants that do not interface with the biological components of the disc have not met with widespread use or desirable outcomes in the treatment of intervertebral disc pathology. Here we review bioengineering advances to treat disc disorders, using cell-supplemented materials, or acellular, biologically based materials, that provide opportunity for cell-material interactions and remodeling in the treatment of intervertebral disc disorders. While a field still in early development, bioengineering-based strategies employing novel biomaterials are emerging as promising alternatives for clinical treatment of intervertebral disc disorders.
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Affiliation(s)
- Robert D Bowles
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Lori A Setton
- Department of Biomedical Engineering & Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA.
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31
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Gullbrand SE, Malhotra NR, Schaer TP, Zawacki Z, Martin JT, Bendigo JR, Milby AH, Dodge GR, Vresilovic EJ, Elliott DM, Mauck RL, Smith LJ. A large animal model that recapitulates the spectrum of human intervertebral disc degeneration. Osteoarthritis Cartilage 2017; 25:146-156. [PMID: 27568573 PMCID: PMC5182186 DOI: 10.1016/j.joca.2016.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/01/2016] [Accepted: 08/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to establish a large animal model that recapitulates the spectrum of intervertebral disc degeneration that occurs in humans and which is suitable for pre-clinical evaluation of a wide range of experimental therapeutics. DESIGN Degeneration was induced in the lumbar intervertebral discs of large frame goats by either intradiscal injection of chondroitinase ABC (ChABC) over a range of dosages (0.1U, 1U or 5U) or subtotal nucleotomy. Radiographs were used to assess disc height changes over 12 weeks. Degenerative changes to the discs and endplates were assessed via magnetic resonance imaging (MRI), semi-quantitative histological grading, microcomputed tomography (μCT), and measurement of disc biomechanical properties. RESULTS Degenerative changes were observed for all interventions that ranged from mild (0.1U ChABC) to moderate (1U ChABC and nucleotomy) to severe (5U ChABC). All groups showed progressive reductions in disc height over 12 weeks. Histological scores were significantly increased in the 1U and 5U ChABC groups. Reductions in T2 and T1ρ, and increased Pfirrmann grade were observed on MRI. Resorption and remodeling of the cortical boney endplate adjacent to ChABC-injected discs also occurred. Spine segment range of motion (ROM) was greater and compressive modulus was lower in 1U ChABC and nucleotomy discs compared to intact. CONCLUSIONS A large animal model of disc degeneration was established that recapitulates the spectrum of structural, compositional and biomechanical features of human disc degeneration. This model may serve as a robust platform for evaluating the efficacy of therapeutics targeted towards varying degrees of disc degeneration.
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Affiliation(s)
- S E Gullbrand
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - N R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - T P Schaer
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - Z Zawacki
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - J T Martin
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - J R Bendigo
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - A H Milby
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - G R Dodge
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - E J Vresilovic
- Penn State Hershey Bone and Joint Institute, Pennsylvania State University, Hershey, PA, United States
| | - D M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - R L Mauck
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - L J Smith
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States.
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32
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Nakai T, Sakai D, Nakamura Y, Nukaga T, Grad S, Li Z, Alini M, Chan D, Masuda K, Ando K, Mochida J, Watanabe M. CD146 defines commitment of cultured annulus fibrosus cells to express a contractile phenotype. J Orthop Res 2016; 34:1361-72. [PMID: 27273299 DOI: 10.1002/jor.23326] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/27/2016] [Indexed: 02/04/2023]
Abstract
Characterization of cells is important for facilitating cell-based therapies for degenerative diseases of intervertebral discs. For this purpose, we analyzed mouse annulus fibrosus cells by flowcytometory to detect phenotypic change in their primary cultures. After examination of sixteen cell surface proteins, we focused on CD146 that solely increased during culture expansion. CD146 is known to be a marker for mesenchymal stem cells and for their vascular smooth muscle commitment with expression of contractile phenotype enhanced by SM22α. We sorted CD146+ cells to elucidate their characteristics and the key factors that play a role in this change. Whole cell cultures showed the ability for tripotent differentiation toward mesenchymal lineages, whereas sorted CD146+ cells did not. Expression of CD146 was elevated by addition of transforming growth factor β1, and sorted CD146+ cells expressed higher levels of mRNA for SM22α and Elastin than did CD146- cells. Morphologically, CD146+ cells more broadly deposited extracellular type I collagen than CD146- cells and showed filamentous actin bundles traversing their cytoplasm and cell-cell junctions. Moreover, CD146+ cells demonstrated significantly higher gel contraction properties than CD146- cells when they were embedded in collagen gels. Human annulus fibrosus CD146+ cells also showed higher contractility. Immunohistochemistry determined CD146+ cells localized to the outermost annulus layers of mouse intervertebral disc tissue with co-expression of SM22α. These results suggest that increment of CD146 expression indicates gradual change of cultured annulus fibrosus cells to express a contractile phenotype and that transforming growth factor β1 enhances this cellular commitment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1361-1372, 2016.
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Affiliation(s)
- Tomoko Nakai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, 259-1143, Japan
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, 259-1143, Japan.,Research Center for Regenerative Medicine and Cancer Stem Cell, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan.,AO Spine Research Network, AO Spine International, Davos, Switzerland
| | - Yoshihiko Nakamura
- Research Center for Regenerative Medicine and Cancer Stem Cell, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Tadashi Nukaga
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, 259-1143, Japan
| | - Sibylle Grad
- AO Spine Research Network, AO Spine International, Davos, Switzerland.,AO Research Institute Davos, Davos, Switzerland
| | - Zhen Li
- AO Spine Research Network, AO Spine International, Davos, Switzerland.,AO Research Institute Davos, Davos, Switzerland
| | - Mauro Alini
- AO Spine Research Network, AO Spine International, Davos, Switzerland.,AO Research Institute Davos, Davos, Switzerland
| | - Danny Chan
- AO Spine Research Network, AO Spine International, Davos, Switzerland.,School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California, San Diego, La Jolla, California, 90293-0863
| | - Kiyoshi Ando
- Research Center for Regenerative Medicine and Cancer Stem Cell, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Joji Mochida
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, 259-1143, Japan.,Research Center for Regenerative Medicine and Cancer Stem Cell, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, 259-1143, Japan
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33
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Do Physical Symptoms Predict the Outcome of Surgical Fusion in Patients with Discogenic Low Back Pain? Asian Spine J 2016; 10:509-15. [PMID: 27340531 PMCID: PMC4917770 DOI: 10.4184/asj.2016.10.3.509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/04/2015] [Indexed: 12/30/2022] Open
Abstract
Study Design Retrospective case series. Purpose To determine whether symptoms predict surgical outcomes for patients with discogenic low back pain (DLBP). Overview of Literature Specific diagnosis of DLBP remains difficult. Worsening of pain on flexion is a reported symptom of DLBP. This study sought to determine whether symptoms predict surgical outcomes for patients with DLBP. Methods We investigated 127 patients with low back pain (LBP) and no dominant radicular pain. Magnetic resonance imaging was used to select patients with disc degeneration at only one level. If pain was provoked during discography, we performed fusion surgery (87 patients). Visual analogue scale score and responses to a questionnaire regarding symptoms including worsening of pain on flexion or extension were assessed. Symptom sites before surgery were categorized into LBP alone, or LBP plus referred inguinal or leg pain. We followed 77 patients (average 3.0 years) and compared symptoms before surgery with surgical outcome. Results Sixty-three patients with a good outcome showed postsurgical pain relief (≥60% pain relief) and 14 patients with a poor outcome did not (<60% pain relief). In patients with good outcomes, worsening of LBP was evident in 65% of cases on flexion and in 35% on extension. However, these findings were not significantly different from those in patients with poor outcomes. The percentage of patients with LBP alone was significantly lower and the percentage of patients with LBP plus referred inguinal or leg pain was significantly higher in the group with good surgical outcome compared with patients in the group with poor surgical outcome (p<0.05). Conclusions Worsening of pain on extension may be a symptom of DLBP. Surgical outcomes were superior in patients with both LBP and either referred inguinal or leg pain compared with those having LBP alone.
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34
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Wu Y, Cisewski SE, Wegner N, Zhao S, Pellegrini VD, Slate EH, Yao H. Region and strain-dependent diffusivities of glucose and lactate in healthy human cartilage endplate. J Biomech 2016; 49:2756-2762. [PMID: 27338525 DOI: 10.1016/j.jbiomech.2016.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/20/2023]
Abstract
The cartilage endplate (CEP) is implicated as the main pathway of nutrient supply to the healthy human intervertebral disc (IVD). In this study, the diffusivities of nutrient/metabolite solutes in healthy CEP were assessed, and further correlated with tissue biochemical composition and structure. The CEPs from non-degenerated human IVD were divided into four regions: central, lateral, anterior, and posterior. The diffusivities of glucose and lactate were measured with a custom diffusion cell apparatus under 0%, 10%, and 20% compressive strains. Biochemical assays were conducted to quantify the water and glycosaminoglycan (GAG) contents. The Safranin-O and Ehrlich׳s hematoxylin and eosin staining and scanning electron microscopy (SEM) were performed to reveal the tissue structure of the CEP. Average diffusivities of glucose and lactate in healthy CEP were 2.68±0.93×10-7cm2/s and 4.52±1.47×10-7cm2/s, respectively. Solute diffusivities were region-dependent (p<0.0001) with the highest values in the central region, and mechanical strains impeded solute diffusion in the CEP (p<0.0001). The solute diffusivities were significantly correlated with the tissue porosities (glucose: p<0.0001, r=0.581; lactate: p<0.0001, r=0.534). Histological and SEM studies further revealed that the collagen fibers in healthy CEP are more compacted than those in the nucleus pulposus (NP) and annulus fibrosus (AF) and show no clear orientation. Compared to human AF and NP, much smaller solute diffusivities in human CEP suggested that it acts as a gateway for solute diffusion through the disc, maintaining the balance of nutritional environment in healthy human disc under mechanical loading and preventing the progression of disc degeneration.
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Affiliation(s)
- Yongren Wu
- Department of Bioengineering, Clemson University, Clemson, SC, United States; Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Sarah E Cisewski
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Nicholas Wegner
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Shichang Zhao
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Vincent D Pellegrini
- Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Elizabeth H Slate
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, United States; Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States.
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35
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Matrix stiffness promotes cartilage endplate chondrocyte calcification in disc degeneration via miR-20a targeting ANKH expression. Sci Rep 2016; 6:25401. [PMID: 27142968 PMCID: PMC4855171 DOI: 10.1038/srep25401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/18/2016] [Indexed: 01/22/2023] Open
Abstract
The mechanical environment is crucial for intervertebral disc degeneration (IDD). However, the mechanisms underlying the regulation of cartilage endplate (CEP) calcification by altered matrix stiffness remain unclear. In this study, we found that matrix stiffness of CEP was positively correlated with the degree of IDD, and stiff matrix, which mimicked the severe degeneration of CEP, promoted inorganic phosphate-induced calcification in CEP chondrocytes. Co-expression analysis of the miRNA and mRNA profiles showed that increasing stiffness resulted in up-regulation of miR-20a and down-regulation of decreased ankylosis protein homolog (ANKH) during inorganic phosphate-induced calcification in CEP chondrocytes. Through a dual luciferase reporter assay, we confirmed that miR-20a directly targets 3'-untranslated regions of ANKH. The inhibition of miR-20a attenuated the calcium deposition and calcification-related gene expression, whereas the overexpression of miR-20a enhanced calcification in CEP chondrocytes on stiff matrix. The rescue of ANKH expression restored the decreased pyrophosphate efflux and inhibited calcification. In clinical samples, the levels of ANKH expression were inversely associated with the degeneration degree of CEP. Thus, our findings demonstrate that the miR-20a/ANKH axis mediates the stiff matrix- promoted CEP calcification, suggesting that miR-20a and ANKH are potential targets in restraining the progression of IDD.
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NF-κB Signaling Pathway in Controlling Intervertebral Disk Cell Response to Inflammatory and Mechanical Stressors. Phys Ther 2016; 96:704-11. [PMID: 26893504 PMCID: PMC4858661 DOI: 10.2522/ptj.20150045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intervertebral disk degeneration (IDD) has a greater than 90% lifetime incidence and is one of the leading causes of chronic back pain in the United States. Despite the high societal cost of IDD, there is limited understanding of the biological effects of mechanical overloading on further degeneration. The transcription factor NF-κB (nuclear factor κB) has been implicated as a key mediator of disk cell response to inflammatory and mechanical stresses and represents a potential control point. OBJECTIVE The study objective was to measure the effect of NF-κB signaling pathway inhibition on annulus fibrosus (AF) cell matrix synthesis and gene expression under conditions of combined inflammatory and mechanical stimulation. METHODS Annulus fibrosus cells were harvested from rabbit intervertebral disks and grown in vitro on flexible plates. The cells were exposed to inflammatory and mechanical stimulation for 24 hours with and without NF-κB inhibition. Nuclear translocation of NF-κB was measured via immunofluorescent staining. Intervertebral disk cell homeostasis was assessed via inflammatory, anabolic, and catabolic gene expression and via matrix synthetic ability. RESULTS NF-κB nuclear translocation in response to interleukin-1 beta (IL-1β) was reversed with exposure to NF-κB inhibition. NF-κB inhibition decreased matrix metalloproteinase-3, inducible nitric oxide synthase, and cyclooxygenase-2 gene expression and prostaglandin E2 production response to combined inflammatory and mechanical stimulation. Proteoglycan and collagen synthesis were decreased by combined stimulation, but this effect was not reversed by NF-κB inhibition. LIMITATIONS In vitro modeling of conditions within the disk may not fully reflect the response that AF cells have in native matrix. CONCLUSIONS NF-κB signaling mediates catabolic and inflammatory responses to inflammatory and mechanical stimulation but does not mediate the decrease in matrix synthesis under combined harmful stimulation. Identification of key control points in the cellular responses to inflammatory and mechanical stimuli will facilitate rational design of exercise-based therapies and facilitate synergistic treatments of novel biochemical treatments with rehabilitation regimens.
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Nojima D, Inage K, Sakuma Y, Sato J, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kuniyoshi K, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Sainoh T, Fujimoto K, Shiga Y, Abe K, Kanamoto H, Inoue G, Takahashi K, Ohtori S. Efficacy of Anti-NaV1.7 Antibody on the Sensory Nervous System in a Rat Model of Lumbar Intervertebral Disc Injury. Yonsei Med J 2016; 57:748-53. [PMID: 26996577 PMCID: PMC4800367 DOI: 10.3349/ymj.2016.57.3.748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/15/2015] [Accepted: 08/26/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The pathophysiology of discogenic low back pain is not fully understood. Tetrodotoxin-sensitive voltage-gated sodium (NaV) channels are associated with primary sensory nerve transmission, and the NaV1.7 channel has emerged as an analgesic target. Previously, we found increased NaV1.7 expression in dorsal root ganglion (DRG) neurons innervating injured discs. This study aimed to examine the effect of blocking NaV1.7 on sensory nerves after disc injury. MATERIALS AND METHODS Rat DRG neurons innervating the L5/6 disc were labeled with Fluoro-Gold (FG) neurotracer. Twenty-four rats underwent intervertebral disc puncture (puncture group) and 12 rats underwent sham surgery (non-puncture group). The injury group was divided into a saline infusion group (puncture+saline group) and a NaV1.7 inhibition group, injected with anti-NaV1.7 antibody (puncture+anti-NaV1.7 group); n=12 per group. Seven and 14 days post-surgery, L1 to L6 DRGs were harvested and immunostained for calcitonin gene-related peptide (CGRP) (an inflammatory pain marker), and the proportion of CGRP-immunoreactive (IR) DRG neurons of all FG-positive neurons was evaluated. RESULTS The ratio of CGRP-IR DRG neurons to total FG-labeled neurons in the puncture+saline group significantly increased at 7 and 14 days, compared with the non-puncture group, respectively (p<0.05). Application of anti-NaV1.7 into the disc significantly decreased the ratio of CGRP-IR DRG neurons to total FG-labeled neurons after disc puncture at 7 and 14 days (40% and 37%, respectively; p<0.05). CONCLUSION NaV1.7 antibody suppressed CGRP expression in disc DRG neurons. Anti-NaV1.7 antibody is a potential therapeutic target for pain control in patients with lumbar disc degeneration.
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Affiliation(s)
- Daisuke Nojima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiro Sakuma
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gou Kubota
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Sainoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
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A New CT Method for Assessing 3D Movements in Lumbar Facet Joints and Vertebrae in Patients before and after TDR. BIOMED RESEARCH INTERNATIONAL 2015; 2015:260703. [PMID: 26587533 PMCID: PMC4637432 DOI: 10.1155/2015/260703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Abstract
This study describes a 3D-CT method for analyzing facet joint motion and vertebral rotation in the lumbar spine after TDR. Ten patients were examined before and then three years after surgery, each time with two CT scans: provoked flexion and provoked extension. After 3D registration, the facet joint 3D translation and segmental vertebral 3D rotation were analyzed at the operated level (L5-S1) and adjacent level (L4-L5). Pain was evaluated using VAS. The median (±SD) 3D movement in the operated level for the left facet joint was 3.2 mm (±1.9 mm) before and 3.5 mm (±1.7 mm) after surgery and for the right facet joint was 3.0 mm (±1.0 mm) before and 3.6 mm (±1.4 mm) after surgery. The median vertebral rotation in the sagittal plane at the operated level was 5.4° (±2.3°) before surgery and 6.8° (±1.7°) after surgery and in the adjacent level was 7.7° (±4.0°) before and 9.2° (±2.7°) after surgery. The median VAS was reduced from 6 (range 5–8) to 3 (range 2–8) in extension and from 4 (range 2–6) to 2 (range 1–3) in flexion.
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Molinos M, Almeida CR, Caldeira J, Cunha C, Gonçalves RM, Barbosa MA. Inflammation in intervertebral disc degeneration and regeneration. J R Soc Interface 2015; 12:20141191. [PMID: 25673296 DOI: 10.1098/rsif.2014.1191] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain and hernia regression remains controversial. The inflammatory response may be involved in the onset of disease, but it is also crucial in maintaining tissue homeostasis. Furthermore, if properly balanced it may contribute to tissue repair/regeneration as has already been demonstrated in other tissues. In this review, we focus on how inflammation has been associated with IVD degeneration by describing observational and in vitro studies as well as in vivo animal models. Finally, we provide an overview of IVD regenerative therapies that target key inflammatory players.
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Affiliation(s)
- Maria Molinos
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Ciências Biomédicas Abel Salazar-ICBAS, Universidade do Porto, Porto, Portugal
| | - Catarina R Almeida
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Joana Caldeira
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia-IPATIMUP, Universidade do Porto, Porto, Portugal
| | - Carla Cunha
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Raquel M Gonçalves
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Mário A Barbosa
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Ciências Biomédicas Abel Salazar-ICBAS, Universidade do Porto, Porto, Portugal
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Lin HA, Gupta MS, Varma DM, Gilchrist ML, Nicoll SB. Lower crosslinking density enhances functional nucleus pulposus-like matrix elaboration by human mesenchymal stem cells in carboxymethylcellulose hydrogels. J Biomed Mater Res A 2015; 104:165-77. [DOI: 10.1002/jbm.a.35552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/20/2015] [Accepted: 08/07/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Huizi A. Lin
- Department of Biomedical Engineering; The City College of New York; New York New York
| | - Michelle S. Gupta
- Department of Biomedical Engineering; The City College of New York; New York New York
| | - Devika M. Varma
- Department of Biomedical Engineering; The City College of New York; New York New York
| | - M. Lane Gilchrist
- Department of Chemical Engineering; The City College of New York; New York City New York
| | - Steven B. Nicoll
- Department of Biomedical Engineering; The City College of New York; New York New York
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Wu Y, Cisewski SE, Sachs BL, Pellegrini VD, Kern MJ, Slate EH, Yao H. The region-dependent biomechanical and biochemical properties of bovine cartilaginous endplate. J Biomech 2015. [PMID: 26209084 DOI: 10.1016/j.jbiomech.2015.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Regional biomechanical and biochemical properties of bovine cartilaginous endplate (CEP) and its role in disc mechanics and nutrition were determined. The equilibrium aggregate modulus and hydraulic permeability between the central and lateral regions were examined by confined compression testing. Biochemical assays were conducted to quantify the amount of water, collagen, and glycosaminoglycan (GAG). The equilibrium aggregate modulus of the CEP in the central region (0.23 ± 0.15 MPa) was significantly lower than for the lateral region (0.83 ± 0. 26 MPa). No significant regional difference was found for the permeability of the CEP (central region: 0.13 ± 0.07×10(-15)m(4)/Ns and lateral region: 0.09 ± 0.03 × 10(-15)m(4)/Ns). CEPs were an average of 75.6% water by wet weight, 41.1% collagen, and 20.4% GAG by dry weight in the central region, as well as an average of 70.2% water by wet weight, 73.8% collagen, and 11.7% GAG by dry weight in the lateral region. Regional differences observed for the equilibrium aggregate modulus were likely due to the regional variation in biochemical composition. The lateral bovine endplate is much stiffer and may share a greater portion of the load. Compared with the nucleus pulposus (NP) and annulus fibrosus (AF), a smaller hydraulic permeability was found for the CEP in both the central and lateral regions, which could be due to its lower water content and higher collagen content. Our results suggest that the CEP may block rapid fluid exchange and solute convection, allow pressurization of the interstitial fluid, and play a significant role in nutrient supply in response to loading.
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Affiliation(s)
- Yongren Wu
- Department of Bioengineering, Clemson University, Clemson, SC, United States; Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Sarah E Cisewski
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Barton L Sachs
- Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Vincent D Pellegrini
- Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Michael J Kern
- Department of Regenerative Medicine and Cell Biology, MUSC, Charleston, SC, United States
| | - Elizabeth H Slate
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, United States; Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, United States.
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Sato M, Inage K, Sakuma Y, Sato J, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kuniyoshi K, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Sainoh T, Fujimoto K, Shiga Y, Abe K, Kanamoto H, Inoue G, Takahashi K, Ohtori S. Anti-RANKL antibodies decrease CGRP expression in dorsal root ganglion neurons innervating injured lumbar intervertebral discs in rats. 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 2015; 24:2017-22. [PMID: 26071945 DOI: 10.1007/s00586-015-4058-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/26/2015] [Accepted: 06/07/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Nuclear factor-κB (NF-κB), receptor activator of NF-κB (RANK), and RANK ligand (RANKL) are transcriptional regulators of inflammatory cytokines. RANKL expression in dorsal root ganglion (DRG) neurons is elevated in animal models of pain or intervertebral disc herniation. We sought to evaluate the effect of anti-RANKL antibodies on sensory nerves innervating injured intervertebral discs. METHOD We labeled DRG neurons innervating L5-6 discs with FluoroGold (FG). The L5-6 discs of 36 rats were punctured using a 23-gage needle and 18 rats underwent sham surgery without disc puncture. The puncture group was evenly subdivided into a group in which 10 μl saline was administered to the injured disc and a group in which 10 μl of anti-RANKL antibody was administered. Seven and 14 days postsurgery, DRGs at L2 level were harvested, sectioned, and immunostained for calcitonin gene-related peptide (CGRP). The proportion of CGRP-immunoreactive (IR) DRG neurons of all FG-positive neurons was determined. Amount of tumor necrosis factor (TNF)-α and interleukin(IL)-6 was measured within the intervertebral discs in each group at 7 and 14 days after surgery using an enzyme-linked immunosorbent assay (ELISA). RESULTS The proportion of CGRP-IR DRG neurons to total FG-labeled neurons innervating injured intervertebral discs and amount of TNF-α and IL-6 in the injured discs in the saline control group was significantly increased compared with that found in rats from the sham surgery group (P < 0.05). However, application of anti-RANKL antibody to the injured discs significantly decreased the proportion of CGRP-IR DRG neurons to total FG-labeled neurons and amount of TNF-α and IL-6 in the injured discs (P < 0.05). CONCLUSIONS TNF-α and IL-6 in the injured discs increased and CGRP expression increased in DRG neurons innervating injured discs, and antibodies to RANKL could suppress this increased TNF-α, IL-6, and CGRP expression. RANKL may be a therapeutic target for pain control in patients with lumbar disc degeneration.
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Affiliation(s)
- Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Pathomechanisms of discogenic low back pain in humans and animal models. Spine J 2015; 15:1347-55. [PMID: 24657737 DOI: 10.1016/j.spinee.2013.07.490] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 02/10/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although explored in humans and animal models, the pathomechanisms of discogenic low back pain (LBP) remain unknown. PURPOSE The aim of this study was to review the literature about the pathomechanisms of discogenic LBP. METHODS Animal models of discogenic pain and specimens from degenerated human intervertebral discs (IVDs) have provided clues about the pathomechanisms of discogenic LBP. Painful discs are characterized by a confluence of innervation, inflammation, and mechanical hypermobility. These three possible mechanisms are discussed in this review. RESULTS Animal models and specimens from humans have revealed sensory innervation of lumbar IVDs and sensory nerve ingrowth into the inner layer of IVDs. Cytokines such as tumor necrosis factor-α and interleukins induce this ingrowth. Nerve growth factor has also been recently identified as an inducer of ingrowth. Finally, disc degeneration induces several collagenases; their action results in hypermobility and pain. CONCLUSIONS To treat discogenic LBP, it is important to prevent sensitization of sensory nerve fibers innervating the IVD, to suppress pathogenic increases of cytokines, and to decrease disc hypermobility.
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Analgesic therapy for major spine surgery. Neurosurg Rev 2015; 38:407-18; discussion 419. [DOI: 10.1007/s10143-015-0605-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/13/2014] [Accepted: 11/16/2014] [Indexed: 12/11/2022]
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Han C, Ma XL, Wang T, Ma JX, Tian P, Zang JC, Kong JB, Li XD. Low magnitude of tensile stress represses the inflammatory response at intervertebral disc in rats. J Orthop Surg Res 2015; 10:26. [PMID: 25886263 PMCID: PMC4333165 DOI: 10.1186/s13018-015-0159-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to determine if the involvement of tensile stress affects the expressions of inflammatory cytokines interleukin-17(IL-17), interleukin-1β (IL-1β), and inducible nitric oxide synthase (iNOS) at intervertebral discs in vivo. Material and method Sixty-four female Sprague–Dawley rats were randomly divided into four groups: sham, tail-suspended (TS), tail-suspended with needle puncture (TSNP), and single-needle puncture (SNP) groups. A tail-suspension device provides low magnitude of tensile stress (2.45 Newton (N)), and aseptic needle puncture on the tail disc induces inflammatory response. After 4 weeks, the treated discs were harvested for histologic analysis, quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). Result Pathological examination demonstrated that compared to the sham group, the morphologies of nucleus pulposus (NP) and anulus fibrosus (AF) in TS, SNP, and TSNP groups displayed degenerative changes in varying degrees. Results from RT-qPCR showed that IL-17 and iNOS mRNA expression levels were significantly higher in both TSNP and SNP groups than those in the sham groups. Expression of IL-17 and iNOS are not significantly different between the sham and TS groups (P > 0.05). Compared with the SNP group, the mRNA expression of IL-17 and iNOS in the TSNP groups were markedly decreased (P < 0.05). The regulation of IL-1β and IL-17 detected by ELISA was coincident with the qRT-PCR results. Conclusion The results from this study suggested that relatively low magnitude tensile stress might play an essential role in the anti-inflammatory process and the relief of low-back pain (LBP).
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Affiliation(s)
- Chao Han
- Department of Orthopaedics, Tianjin Medical University General Hospital, No.154 Anshan Road, Heping District, Tianjin City, 300052, PR China. .,Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Xin-Long Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, No.154 Anshan Road, Heping District, Tianjin City, 300052, PR China. .,Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Tao Wang
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jian-Xiong Ma
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Peng Tian
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jia-Cheng Zang
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Jing-Bo Kong
- Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin City, 300211, PR China.
| | - Xiao-Dan Li
- Department of Anesthesiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin City, 300192, PR China.
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Kuelling FA, Foley KT, Liu JJ, Liebenberg E, Sin AH, Matsukawa A, Lotz JC. The anabolic effect of plasma-mediated ablation on the intervertebral disc: stimulation of proteoglycan and interleukin-8 production. Spine J 2014; 14:2479-87. [PMID: 24747799 DOI: 10.1016/j.spinee.2014.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 08/05/2013] [Accepted: 04/10/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Plasma-mediated radiofrequency-based ablation (coblation) is an electrosurgical technique currently used for tissue removal in a wide range of surgical applications, including lumbar microdiscectomy. In vitro and in vivo studies have shown the technique to alter the expression of inflammatory cytokines in the disc, increasing the levels of interleukin-8 (IL-8), which may promote maturation and remodeling of the disc matrix. PURPOSE To better understand the effect of coblation treatment, this study characterizes the temporal and spatial pattern of healing after stab injury to the rabbit intervertebral disc, with and without plasma-mediated radiofrequency treatment. PATIENT SAMPLE A total of 23 New Zealand white rabbits. STUDY DESIGN Annular and nuclear stab injuries. OUTCOME MEASURES Sandwich enzyme-linked immunosorbent assay evaluated the concentrations of cytokines tumor necrosis factor-α, IL-1β, and IL-8. Histopathologic evaluations were performed on whole discs and end plates. Tissue sections were stained with Safranin-O to evaluate nucleus pulposus and annulus fibrosus proteoglycan content and with Alcian blue for extracellular proteoglycan content. Intradiscal leakage pressure was evaluated by injecting methylene blue dye into the nucleus. METHODS Animals underwent annular and nuclear stab injuries on three consecutive lumbar discs (L2-L3 to L4-L5). The three levels were randomly assigned into one of the three groups for treatment with a plasma-mediated radiofrequency ablation device (TOPAZ; ArthroCare Corp., Austin, TX, USA): active treatment of the nucleus only (SN); active treatment of both nucleus and annulus (SNA); sham treatment. Unstabbed/untreated discs from L5-L6 (n=5) served as normal controls. Animals were euthanized at 4, 8, and 28 days postsurgery. RESULTS Tumor necrosis factor-α was detected in sham discs at 4 and 8 days, but not in coblation groups (SN or SNA); IL-1β was below detection in all three treatment groups. Interleukin-8 levels increased in all treatment groups at 4 and 8 days compared with normal control, peaking at 4th day for sham and SN groups and 8th day (p>.3) for the SNA group (a 2.5-fold increase). Pressure measurements revealed higher leakage in the SN group, but no statistically significant differences. Histopathology showed higher proteoglycan production by 28 days in the SNA and SN groups compared with sham. All three treatment groups showed ruptured annular fibers from the stab injury, but maintained the overall architecture. Remnants of notochordal tissue within the nucleus were evident in all treatment groups at 4 and 8 days, but were only found in sham group by 28 days. At this time, unlike the normal or sham controls, the nucleus of SN and SNA discs had fibrocartilaginous tissue with chondrocyte-like cells. Significant differences in the disc architecture grade were only noted when comparing normal controls with other groups by 28 days (p<.001). CONCLUSIONS Plasma-mediated radiofrequency ablation appears to have an anabolic effect on disc cells, stimulating proteoglycan and IL-8 production and maintaining annulus architecture. Coblation treatment appears to reduce cellular response to proinflammatory stimuli and restore overall disc architecture that may prove beneficial in a number of degenerative disc paradigms. Further studies are encouraged to investigate the therapeutic effect of the technique.
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Affiliation(s)
- Fabrice A Kuelling
- Orthopaedic Bioengineering Laboratory, Department of Orthopaedic Surgery, 513 Parnassus Ave, Box 0514, University of California, San Francisco, CA 94143, USA
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee, 427 Johnson Building, Memphis, TN 38119, USA
| | - Jane J Liu
- Orthopaedic Bioengineering Laboratory, Department of Orthopaedic Surgery, 513 Parnassus Ave, Box 0514, University of California, San Francisco, CA 94143, USA
| | - Ellen Liebenberg
- Orthopaedic Bioengineering Laboratory, Department of Orthopaedic Surgery, 513 Parnassus Ave, Box 0514, University of California, San Francisco, CA 94143, USA
| | - Anthony H Sin
- Department of Neurosurgery, University of Tennessee, 427 Johnson Building, Memphis, TN 38119, USA
| | - Akihiro Matsukawa
- Department of Pathology and Experimental Medicine, Okayama University School of Medicine, 2-5-1, Shikata, Okayama 700-8558, Japan
| | - Jeffrey C Lotz
- Orthopaedic Bioengineering Laboratory, Department of Orthopaedic Surgery, 513 Parnassus Ave, Box 0514, University of California, San Francisco, CA 94143, USA.
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Abstract
STUDY DESIGN Animal study. OBJECTIVE To investigate pain-related expression of NaV1.7 in dorsal root ganglia (DRG) innervating intervertebral discs. SUMMARY OF BACKGROUND DATA The pathophysiology of discogenic low back pain is not fully understood. Prostaglandins and cytokines produced by degenerated discs can cause pain, but nonsteroidal anti-inflammatory and steroid medications are often ineffective at pain reduction. Tetrodotoxin-sensitive, voltage-gated sodium (NaV) channels are associated with sensory transmission in primary sensory nerves, and the NaV1.7 channel has emerged as an attractive analgesic target. The purpose of this study was to investigate pain-related expression of NaV1.7 in DRG innervating intervertebral discs. METHODS Using a rodent model of disc puncture, we labeled DRG neurons innervating L5-L6 discs with FluoroGold neurotracer (n = 20). Half of the rats (n = 10) underwent intervertebral disc puncture using a 23-gauge needle (puncture group), and the other half underwent non-puncture sham surgery (non-puncture group). Seven and 14 days after surgery, DRGs from the L1 to L6 levels were harvested, sectioned, and immunostained for NaV1.7, and the proportion of NaV1.7-immunoreactive DRG neurons was evaluated. RESULTS NaV1.7 was expressed in DRG neurons innervating intervertebral discs from L1 to L5. The ratio of NaV1.7-expressing DRG neurons to total FG-labeled neurons was 7.2% and 7.6% at 1 and 2 weeks after surgery, respectively, in the non-puncture group and 16.2% and 16.3% at 1 and 2 weeks, respectively, in the puncture group. The upregulation of NaV1.7 after puncture was significant at both 1 and 2 weeks after surgery (P < 0.01). CONCLUSION We found that disc injury increases NaV1.7 expression in DRG neurons innervating injured discs. NaV1.7 may be a therapeutic target for pain control in patients with lumbar disc degeneration.
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Gawri R, Rosenzweig DH, Krock E, Ouellet JA, Stone LS, Quinn TM, Haglund L. High mechanical strain of primary intervertebral disc cells promotes secretion of inflammatory factors associated with disc degeneration and pain. Arthritis Res Ther 2014; 16:R21. [PMID: 24457003 PMCID: PMC3979109 DOI: 10.1186/ar4449] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 01/13/2014] [Indexed: 02/02/2023] Open
Abstract
Introduction Excessive mechanical loading of intervertebral discs (IVDs) is thought to alter matrix properties and influence disc cell metabolism, contributing to degenerative disc disease and development of discogenic pain. However, little is known about how mechanical strain induces these changes. This study investigated the cellular and molecular changes as well as which inflammatory receptors and cytokines were upregulated in human intervertebral disc cells exposed to high mechanical strain (HMS) at low frequency. The impact of these metabolic changes on neuronal differentiation was also explored to determine a role in the development of disc degeneration and discogenic pain. Methods Isolated human annulus fibrosus (AF) and nucleus pulposus (NP) cells were exposed to HMS (20% cyclical stretch at 0.001 Hz) on high-extension silicone rubber dishes coupled to a mechanical stretching apparatus and compared to static control cultures. Gene expression of Toll-like receptors (TLRs), neuronal growth factor (NGF) and tumour necrosis factor α (TNFα) was assessed. Collected conditioned media were analysed for cytokine content and applied to rat pheocromocytoma PC12 cells for neuronal differentiation assessment. Results HMS caused upregulation of TLR2, TLR4, NGF and TNFα gene expression in IVD cells. Medium from HMS cultures contained elevated levels of growth-related oncogene, interleukin 6 (IL-6), IL-8, IL-15, monocyte chemoattractant protein 1 (MCP-1), MCP-3, monokine induced by γ interferon, transforming growth factor β1, TNFα and NGF. Exposure of PC12 cells to HMS-conditioned media resulted in both increased neurite sprouting and cell death. Conclusions HMS culture of IVD cells in vitro drives cytokine and inflammatory responses associated with degenerative disc disease and low-back pain. This study provides evidence for a direct link between cellular strain, secretory factors, neoinnervation and potential degeneration and discogenic pain in vivo.
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Fielding LC, Alamin TF, Voronov LI, Carandang G, Havey RM, Patwardhan AG. Parametric and cadaveric models of lumbar flexion instability and flexion restricting dynamic stabilization system. 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 2013; 22:2710-8. [PMID: 23955312 PMCID: PMC3843799 DOI: 10.1007/s00586-013-2934-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 06/17/2013] [Accepted: 07/25/2013] [Indexed: 11/05/2022]
Abstract
PURPOSE Development of a dynamic stabilization system often involves costly and time-consuming design iterations, testing and computational modeling. The aims of this study were (1) develop a simple parametric model of lumbar flexion instability and use this model to identify the appropriate stiffness of a flexion restricting stabilization system (FRSS), and (2) in a cadaveric experiment, validate the predictive value of the parametric model. METHODS Literature was surveyed for typical parameters of intact and destabilized spines: stiffness in the high flexibility zone (HFZ) and high stiffness zone, and size of the HFZ. These values were used to construct a bilinear parametric model of flexion kinematics of intact and destabilized lumbar spines. FRSS implantation was modeled by iteratively superimposing constant flexion stiffnesses onto the parametric model. Five cadaveric lumbar spines were tested intact; after L4-L5 destabilization (nucleotomy, midline decompression); and after FRSS implantation. Specimens were loaded in flexion/extension (8 Nm/6 Nm) with 400 N follower load to characterize kinematics for comparison with the parametric model. RESULTS To accomplish the goal of reducing ROM to intact levels and increasing stiffness to approximately 50 % greater than intact levels, flexion stiffness contributed by the FRSS was determined to be 0.5 Nm/deg using the parametric model. In biomechanical testing, the FRSS restored ROM of the destabilized segment from 146 ± 13 to 105 ± 21 % of intact, and stiffness in the HFZ from 41 ± 7 to 135 ± 38 % of intact. CONCLUSIONS Testing demonstrated excellent predictive value of the parametric model, and that the FRSS attained the desired biomechanical performance developed with the model. A simple parametric model may allow efficient optimization of kinematic design parameters.
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Affiliation(s)
| | - Todd F. Alamin
- Department of Orthopaedic Surgery, Stanford University School of Medicine, San Carlos, CA USA
| | - Leonard I. Voronov
- Musculoskeletal Biomechanics Research Laboratory, Loyola University Chicago and Edward Hines Jr. VA Hospital, Fifth Avenue & Roosevelt Road, Hines, IL 60141 USA
| | - Gerard Carandang
- Musculoskeletal Biomechanics Research Laboratory, Loyola University Chicago and Edward Hines Jr. VA Hospital, Fifth Avenue & Roosevelt Road, Hines, IL 60141 USA
| | - Robert M. Havey
- Musculoskeletal Biomechanics Research Laboratory, Loyola University Chicago and Edward Hines Jr. VA Hospital, Fifth Avenue & Roosevelt Road, Hines, IL 60141 USA
| | - Avinash G. Patwardhan
- Musculoskeletal Biomechanics Research Laboratory, Loyola University Chicago and Edward Hines Jr. VA Hospital, Fifth Avenue & Roosevelt Road, Hines, IL 60141 USA
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Effects of unilateral facet fixation and facetectomy on muscle spindle responsiveness during simulated spinal manipulation in an animal model. J Manipulative Physiol Ther 2013; 36:585-94. [PMID: 24161386 DOI: 10.1016/j.jmpt.2013.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Manual therapy practitioners commonly assess lumbar intervertebral mobility before deciding treatment regimens. Changes in mechanoreceptor activity during the manipulative thrust are theorized to be an underlying mechanism of spinal manipulation (SM) efficacy. The objective of this study was to determine if facet fixation or facetectomy at a single lumbar level alters muscle spindle activity during 5 SM thrust durations in an animal model. METHODS Spinal stiffness was determined using the slope of a force-displacement curve. Changes in the mean instantaneous frequency of spindle discharge were measured during simulated SM of the L6 vertebra in the same 20 afferents for laminectomy-only and 19 laminectomy and facet screw conditions; only 5 also had data for the laminectomy and facetectomy condition. Neural responses were compared across conditions and 5 thrust durations (≤ 250 milliseconds) using linear-mixed models. RESULTS Significant decreases in afferent activity between the laminectomy-only and laminectomy and facet screw conditions were seen during 75-millisecond (P < .001), 100-millisecond (P = .04), and 150-millisecond (P = .02) SM thrust durations. Significant increases in spindle activity between the laminectomy-only and laminectomy and facetectomy conditions were seen during the 75-millisecond (P < .001) and 100-millisecond (P < .001) thrust durations. CONCLUSION Intervertebral mobility at a single segmental level alters paraspinal sensory response during clinically relevant high-velocity, low-amplitude SM thrust durations (≤ 150 milliseconds). The relationship between intervertebral joint mobility and alterations of primary afferent activity during and after various manual therapy interventions may be used to help to identify patient subpopulations who respond to different types of manual therapy and better inform practitioners (eg, chiropractic and osteopathic) delivering the therapeutic intervention.
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