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Ozden M, Silav ZK. Correlations of Disc Tissue Pathological Changes With Pfirrmann Grade in Patients With Disc Herniation Treated With Microdiscectomy. Cureus 2023; 15:e37913. [PMID: 37220462 PMCID: PMC10200016 DOI: 10.7759/cureus.37913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND To reveal whether pathological disc changes (vascularization, inflammation, disc aging and senescence as assessed with immunohistopathological CD34, CD68, brachyury and P53 staining densities respectively) are associated with the extent of disease (Pfirrmann grade) and lumbar radicular pain in patients with lumbar disc herniation. We selectively included a homogenous group of 32 patients (16 males and 16 females) with single-level sequestered discs who had disease stages between Pfirrmann grades I to IV and excluded patients with the complete collapse of the disc space to determine histopathological correlations of the disease more precisely. MATERIALS AND METHODS Pathological assessments were performed on surgically excised disc specimens stored in a -80°C refrigerator. Preoperative and postoperative pain intensities were determined with visual analog scales (VASs). Pfirrmann disc degeneration grades were determined on routine T2-weighted magnetic resonance imaging (MRI). RESULTS Stainings were especially observed with CD34 and CD68, which positively correlated with each other and Pfirrmann grading but not with VAS scores or patients' age. Weak nuclear staining with brachyury was observed in 50% of patients and did not correlate with disease features. Focal weak staining with P53 was only seen in the disc specimen of two patients. CONCLUSIONS In the pathogenesis of disc disease, inflammation may trigger angiogenesis. The subsequent aberrant increase of oxygen perfusion in the disc cartilage may cause further damage, as the disc tissue is adapted to hypoxia. This vicious cycle of inflammation and angiogenesis may be a future innovative therapeutic target for chronic degenerative disc disease.
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Affiliation(s)
- Mahmut Ozden
- Neurosurgery, Memorial Bahcelievler Hospital, Istanbul, TUR
| | - Zuhal K Silav
- Pathology, Sadi Konuk Education and Research Hospital, Bakirkoy, TUR
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Feng P, Che Y, Gao C, Zhu L, Gao J, Vo NV. Immune exposure: how macrophages interact with the nucleus pulposus. Front Immunol 2023; 14:1155746. [PMID: 37122738 PMCID: PMC10140429 DOI: 10.3389/fimmu.2023.1155746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Intervertebral disc degeneration (IDD) is a primary contributor to low back pain. Immune cells play an extremely important role in modulating the progression of IDD by interacting with disc nucleus pulposus (NP) cells and extracellular matrix (ECM). Encased within the annulus fibrosus, healthy NP is an avascular and immune-privileged tissue that does not normally interact with macrophages. However, under pathological conditions in which neovascularization is established in the damaged disc, NP establishes extensive crosstalk with macrophages, leading to different outcomes depending on the different microenvironmental stimuli. M1 macrophages are a class of immune cells that are predominantly pro-inflammatory and promote inflammation and ECM degradation in the NP, creating a vicious cycle of matrix catabolism that drives IDD. In contrast, NP cells interacting with M2 macrophages promote disc tissue ECM remodeling and repair as M2 macrophages are primarily involved in anti-inflammatory cellular responses. Hence, depending on the crosstalk between NP and the type of immune cells (M1 vs. M2), the overall effects on IDD could be detrimental or regenerative. Drug or surgical treatment of IDD can modulate this crosstalk and hence the different treatment outcomes. This review comprehensively summarizes the interaction between macrophages and NP, aiming to highlight the important role of immunology in disc degeneration.
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Affiliation(s)
- Peng Feng
- School of Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Che
- School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunyu Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghua Gao
- Department of Spine, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
| | - Nam V. Vo
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Jinghua Gao, ; Nam V. Vo,
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Höflsauer S, Bonnaire FC, Bamberger CE, Danalache M, Feierabend M, Hofmann UK. Changes in stiffness of the extracellular and pericellular matrix in the anulus fibrosus of lumbar intervertebral discs over the course of degeneration. Front Bioeng Biotechnol 2022; 10:1006615. [PMID: 36619385 PMCID: PMC9816436 DOI: 10.3389/fbioe.2022.1006615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Analogous to articular cartilage, changes in spatial chondrocyte organisation have been proposed to be a strong indicator for local tissue degeneration in the intervertebral disc (IVD). While a progressive structural and functional degradation of the extracellular (ECM) and pericellular (PCM) matrix occurs in osteoarthritic cartilage, these processes have not yet been biomechanically elucidated in the IVD. We aimed to evaluate the local stiffness of the ECM and PCM in the anulus fibrosus of the IVD on the basis of local chondrocyte spatial organisation. Using atomic force microscopy, we measured the Young's modulus of the local ECM and PCM in human and bovine disc samples using the spatial chondrocyte patterns as an image-based biomarker. By measuring tissue from 31 patients and six bovine samples, we found a significant difference in the elastic moduli (E) of the PCM in clusters when compared to the healthy patterns single cells (p = 0.029), pairs (p = 0.016), and string-formations (p = 0.010). The ECM/PCM ratio ranged from 0.62-0.89. Interestingly, in the bovine IVD, the ECM/PCM ratio of the E significantly varied (p = 0.002) depending on the tissue origin. Overall the reduced E in clusters demonstrates that cluster formation is not only a morphological phenomenon describing disc degeneration, but it marks a compromised biomechanical functioning. Immunohistochemical analyses indicate that collagen type III degradation might be involved. This study is the first to describe and quantify the differences in the E of the ECM in relation to the PCM in the anulus fibrosus of the IVD by means of atomic force microscopy on the basis of spatial chondrocyte organisation.
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Affiliation(s)
- Sebastian Höflsauer
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany,Medical Faculty of the University of Tübingen, Tübingen, Germany
| | - Florian Christof Bonnaire
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany,Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Charlotte Emma Bamberger
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany,Medical Faculty of the University of Tübingen, Tübingen, Germany
| | - Marina Danalache
- Laboratory of Cell Biology, Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany,Medical Faculty of the University of Tübingen, Tübingen, Germany
| | - Martina Feierabend
- Institute for Bioinformatics and Medical Informatics, Faculty of Science of the University of Tübingen, Tübingen, Germany,*Correspondence: Martina Feierabend,
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital of Tübingen, Tübingen, Germany,Department of Orthopaedic Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Chen Q, Wang J, Xia Q, Wu L, Chen F, Li L, Zhu C, He M, Jiang Y, Huang Y, Ding H, Wu R, Zhang L, Song Y, Liu L. Treatment outcomes of injectable thermosensitive hydrogel containing bevacizumab in intervertebral disc degeneration. Front Bioeng Biotechnol 2022; 10:976706. [PMID: 36213074 PMCID: PMC9533143 DOI: 10.3389/fbioe.2022.976706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 01/08/2023] Open
Abstract
Intervertebral disc (IVD) degeneration (IDD) is a common musculoskeletal disease and its treatment remains a clinical challenge. It is characterised by reduced cell numbers and degeneration of the extracellular matrix (ECM). Nucleus pulposus (NP) cells play a crucial role in this process. The purpose of this study is to explore the role of bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, in the treatment of IDD through local drug delivery. High expression of VEGF was observed in degenerating human and rat IVDs. We demonstrated that MMP3 expression was decreased and COL II synthesis was promoted, when VEGF expression was inhibited by bevacizumab, thereby improving the degree of disc degeneration. Thus, these findings provide strong evidence that inhibition of VEGF expression by local delivery of bevacizumab is safe and effective in ameliorating disc degeneration in rats. The injectable thermosensitive PLGA-PEG-PLGA hydrogels loaded with bevacizumab is a potential therapeutic option for disc degeneration.
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Affiliation(s)
- Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lei Wu
- Histology and Imaging Platform, Core Facilities of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fei Chen
- The Institute of Clinic Pathology, Sichuan University, Chengdu, China
| | - Li Li
- The Institute of Clinic Pathology, Sichuan University, Chengdu, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miaomiao He
- Analytical and Testing Center, Sichuan University, Chengdu, Sichuan, China
| | - Yulin Jiang
- Analytical and Testing Center, Sichuan University, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruibang Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Analytical and Testing Center, Sichuan University, Chengdu, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liming Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Liming Liu,
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