1
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Chae JS, Im J, Choi YJ, Lee HJ, Kim WJ. Comparison of the Severity of Zoster-Associated Pain and Incidence of Postherpetic Neuralgia in Patients with and without Pre-Existing Spinal Disorders at the Same Spinal Nerve Level: A Retrospective Multicenter Study. J Pers Med 2023; 13:1286. [PMID: 37763054 PMCID: PMC10532827 DOI: 10.3390/jpm13091286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
The incidences of herpes zoster (HZ) and postherpetic neuralgia (PHN) are significantly influenced by age. As individuals age, the occurrence of spinal disorders increases, thereby raising the likelihood of HZ and PHN coexistence. Considering this, our study aimed to explore the potential impact of pre-existing spinal disorders at the nerve level where HZ developed, on the severity of zoster-associated pain (ZAP) and the incidence of PHN. For our investigation, we retrospectively analyzed a total of 237 patients who presented with HZ and ZAP at various sensory levels (cervical, thoracic, lumbar, and sacral) with or without pre-existing spinal disorders. The presence or absence of spinal disorders at the sensory level affected by HZ was determined using computed tomography or magnetic resonance imaging. Our study results revealed that the group with spinal disorders at the sensory level where HZ developed did not exhibit an increased incidence of PHN. However, 3-6 months after HZ onset, this same group showed significantly higher ZAP scores compared to the group without spinal disorders. It implies a need for heightened pain management, as the coexistence of these conditions can increase pain severity. This study furnishes an initial standpoint to delve into intricate interactions between two diseases.
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Affiliation(s)
| | | | | | | | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea; (J.S.C.)
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2
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Marfia G, Guarnaccia L, Navone SE, Ampollini A, Balsamo M, Benelli F, Gaudino C, Garzia E, Fratocchi C, Di Murro C, Ligarotti GK, Campanella C, Landolfi A, Perelli P, Locatelli M, Ciniglio Appiani G. Microgravity and the intervertebral disc: The impact of space conditions on the biomechanics of the spine. Front Physiol 2023; 14:1124991. [PMID: 36998982 PMCID: PMC10043412 DOI: 10.3389/fphys.2023.1124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
The environmental conditions to which astronauts and other military pilots are subjected represent a unique example for understanding and studying the biomechanical events that regulate the functioning of the human body. In particular, microgravity has shown a significant impact on various biological systems, such as the cardiovascular system, immune system, endocrine system, and, last but not least, musculoskeletal system. Among the potential risks of flying, low back pain (LBP) has a high incidence among astronauts and military pilots, and it is often associated with intervertebral disc degeneration events. The mechanisms of degeneration determine the loss of structural and functional integrity and are accompanied by the aberrant production of pro-inflammatory mediators that exacerbate the degenerative environment, contributing to the onset of pain. In the present work, the mechanisms of disc degeneration, the conditions of microgravity, and their association have been discussed in order to identify possible molecular mechanisms underlying disc degeneration and the related clinical manifestations in order to develop a model of prevention to maintain health and performance of air- and space-travelers. The focus on microgravity also allows the development of new proofs of concept with potential therapeutic implications.
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Affiliation(s)
- Giovanni Marfia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
- *Correspondence: Giovanni Marfia,
| | - Laura Guarnaccia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Elena Navone
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Ampollini
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Balsamo
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Benelli
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Gaudino
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Emanuele Garzia
- Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | - Claudia Fratocchi
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | - Claudia Di Murro
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | | | - Carmelo Campanella
- Istituto di Medicina Aerospaziale “Aldo Di Loreto”, Aeronautica Militare, Rome, Italy
| | | | | | - Marco Locatelli
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
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3
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Sidiropoulos K, Christofilos SI, Tsikopoulos K, Kitridis D, Drago L, Meroni G, Romanò CL, Kavarthapu V. Viral infections in orthopedics: A systematic review and classification proposal. World J Orthop 2022; 13:1015-1028. [PMID: 36439372 PMCID: PMC9685635 DOI: 10.5312/wjo.v13.i11.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/01/2021] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might have been underestimated.
AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.
METHODS We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Reference Citation Analysis (RCA), and Scopus for completed studies published before January 30, 2021, to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries. Quality assessment was performed using SYRCLE's risk of bias tool for animal studies, Moga score for case series, Wylde score for registry studies, and Newcastle-Ottawa Scale for case-control studies.
RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis. Hepatitis C virus was implicated in several peri- and post-operative complications in patients without cirrhosis after major orthopedic surgery. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.
CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis. Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms. Therefore, based on our literature search, the proposed clinical and pathogenetic classification scheme is as follows: (1) Viral infections of bone or joint; (2) Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues; and (3) Viral infection as a risk factor for post-surgical bacterial infection.
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Affiliation(s)
| | - Savvas Ilias Christofilos
- Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, United Kingdom
| | | | - Dimitrios Kitridis
- the First Department of Orthopaedics, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health and Microbiome, University of Milan, Milan 20133, Italy
| | - Gabriele Meroni
- Department of Biomedical, Surgical, and Dental Sciences, One Health Unit, University of Milan, Milan 20133, Italy
| | - Carlo Luca Romanò
- Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, Milan 20100, Italy
| | - Venu Kavarthapu
- Trauma, and Orthopaedics, Kings College Hospital London, Denmark Hill, London SE59RS, United Kingdom
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4
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Senker W, Aspalter S, Radl C, Pichler J, Doppler S, Weis S, Webersinke C, Wagner H, Hermann P, Aichholzer M, Aufschnaiter-Hießböck K, Thomae W, Stroh N, Hauser T, Gruber A. Frequency and characteristics of bacterial and viral low-grade infections of the intervertebral discs: a prospective, observational study. J Orthop Traumatol 2022; 23:15. [PMID: 35303173 PMCID: PMC8933588 DOI: 10.1186/s10195-022-00633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Study design Monocentric, prospective, observational study. Objective The clinical relevance of bacterial colonization of intervertebral discs is controversial. This study aimed to determine a possible relationship between bacterial and viral colonization and low-grade infection of the discs. Methods We investigated 447 disc samples from 392 patients. Microbiological culture was used to examine the samples for bacterial growth, polymerase chain reaction (PCR) was used for detection of herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and Cytomegalovirus (CMV), and histopathological analysis was used to detect signs of inflammation. The results were compared between subgroups organized according to gender, age, location of the samples, surgical approach, preoperative C-reactive protein (CRP), preoperative and 6 months postoperative Oswestry Disability Index (ODI) and Neck Disability Index (NDI), and Modic changes (MC) of the corresponding endplates. Also, we assessed the occurrence of postoperative infections within 6 months. Results Microbiological culture was positive in 38.78% of the analyzed intervertebral discs. Altogether, 180 bacteria were isolated. Coagulase-negative staphylococci (CONS) (23.41%) and Cutibacterium acnes (18.05%) were the most frequently detected microorganisms. None of HSV-1, HSV-2, or CMV were detected. Male patients (p = 0.00036) and cervical segments (p = 0.00001) showed higher rates of positive culture results. Ventral surgical approaches ( p < 0.001) and Type 2 MC (p = 0.0127) were significantly associated with a positive microbiological result ( p< 0.001). Neither pre- nor postoperative ODI and NDI are associated with positive culture results. In 4 (1.02%) patients, postoperative spondylodiscitis occurred. Conclusions With 447 segments from 392 patients, we present one of the largest studies to date. While disc degeneration caused by HSV-1, HSV-2, and CMV seems unlikely, we found positive microbiological culture results in 38.78% of all discs. The role of local skin flora and sample contamination should be the focus of further investigations. Level of Evidence III. Trial registration: The study was registered at ClinicalTrials.gov (ID: NCT04712487, https://www.clinicaltrials.gov/ct2/show/study/NCT04712487). Supplementary Information The online version contains supplementary material available at 10.1186/s10195-022-00633-y.
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Affiliation(s)
- Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Stefan Aspalter
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria.
| | - Christian Radl
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Josef Pichler
- Department of Internal Medicine, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Stefan Doppler
- Institute of Pathology and Microbiology, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 9, 4021, Linz, Austria
| | - Serge Weis
- Institute of Pathology and Neuropathology, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Christine Webersinke
- Institute of Pathology and Neuropathology, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Helga Wagner
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Huemerstrasse 3-5, 4020, Linz, Austria.,Department of Medical Statistics and Biometry, Institute of Applied Statistics, Johannes Kepler University, Altenberger Strasse 69, 4040, Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University, Huemerstrasse 3-5, 4020, Linz, Austria
| | - Martin Aichholzer
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Kathrin Aufschnaiter-Hießböck
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Wolfgang Thomae
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Thomas Hauser
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria
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5
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Molladavoodi S, DeWitte‐Orr SJ, Gregory DE. An in vitro
3D
annulus fibrosus cell culture model with type I collagen: An examination of
cell–matrix
interactions. JOR Spine 2022; 5:e1193. [PMID: 35386752 PMCID: PMC8966884 DOI: 10.1002/jsp2.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sara Molladavoodi
- Department of Kinesiology and Physical Education Wilfrid Laurier University Waterloo Ontario Canada
| | - Stephanie J. DeWitte‐Orr
- Department of Health Sciences Wilfrid Laurier University Waterloo Ontario Canada
- Department of Biology Wilfrid Laurier University Waterloo Ontario Canada
| | - Diane E. Gregory
- Department of Kinesiology and Physical Education Wilfrid Laurier University Waterloo Ontario Canada
- Department of Health Sciences Wilfrid Laurier University Waterloo Ontario Canada
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6
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Slanted slot was the most resistant to failure of ventral slot techniques tested in rabbit cervical vertebrae. ACTA VET BRNO 2022. [DOI: 10.2754/avb202291010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The ventral slot technique is used to relieve neural compression secondary to intervertebral disc degeneration or disease. In the present study, the biomechanical properties of three different ventral surgical procedures in the rabbit C6–C7 vertebral motion unit (VMU) were assessed and compared with the intact C6–C7 VMU. The ventral slot procedure (slanted, full, or mini; n = 8/group) was performed on these cervical vertebrae. Normal spine torsion and flexion values were compared to those of spines subjected to slanted, full, and mini slot surgery. The slanted slot spines were the most stable, maintaining 70% of normal cervical spine strength, compared to 26% with the full slot and 30% with the mini slot. Regarding torsion, slanted slot spines showed 74% stability compared to the normal cervical spine, while the full slot and mini slot spines showed 58% and 62% stability, respectively. Flexion values were lower after all versions of the ventral slot procedure than in the normal spine, with the greatest flexion difference occurring after the full slot procedure (21% of the normal flexion value). The flexion values also differed significantly between the slanted and full spine groups, and all operated spines showing roughly 60% torsion rates compared with normal spines. The slanted slot maintains more stability in rabbit cervical spine than the other procedures. To our knowledge, this was the first study to examine biomechanical failure differences between the distinct versions of this ventral slot procedure.
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7
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Walker BF, Armson AJ, O'Dea MA, White JR, Lind CRP, Woodland PR. Are viruses associated with disc herniation? A clinical case series. BMC Musculoskelet Disord 2020; 21:27. [PMID: 31937280 PMCID: PMC6961364 DOI: 10.1186/s12891-020-3052-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is some limited evidence for the presence of viruses in herniated disc material including a previous case series that claimed to provide “unequivocal evidence of the presence of herpes virus DNA in intervertebral disc specimens of patients with lumbar disc herniation suggesting the potential role of herpes viruses as a contributing factor to the pathogenesis of degenerative disc disease”. This study has not been replicated. The objective of our study was to determine if viruses were present in herniated disc fragments in participants with a prior history of back pain. Methods We recruited fifteen participants with a history of prior low-back pain prior to undergoing disc herniation surgery in the lumbar spine. Harvested disc samples were subject to next generation sequencing for detection of both RNA and DNA viral pathogens. Additionally, samples were analysed by a broadly reactive PCR targeting herpesviral DNA. Ethics approval was granted by the Human Research Ethics Committees of both Murdoch University, and St John of God Hospital, Western Australia. Results Of the fifteen research participants, 8 were female. Mean age was 49.4 years (SD 14.5 yrs) with a range of 24–70 years. All participants had prior back pain with mean time since first ever attack being 8.8 years (SD 8.8 yrs). No samples contained significant DNA sequences relating to known human viral agents. Inconsequential retroviral sequences were commonly found and were a mixture of putative animal and human retroviral protein coding segments. All samples were negative for herpesvirus DNA when analysed by pan-herpesvirus PCR. Conclusions This study found no viral pathogens in any intervertebral disc fragments of patients who had previous back pain and underwent discectomy for disc herniation and thus it is unlikely that viruses are associated with disc herniation, however given the contradiction between key studies enhanced replication of this experiment is recommended.
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Affiliation(s)
- B F Walker
- Discipline of Psychology, Counselling, Exercise Science and Chiropractic, Murdoch University, Murdoch, Western 90 South Street, Murdoch, 6150, Australia.
| | - A J Armson
- Discipline of Psychology, Counselling, Exercise Science and Chiropractic, Murdoch University, Murdoch, Western 90 South Street, Murdoch, 6150, Australia
| | - M A O'Dea
- Veterinary Virology, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia
| | - J R White
- Australian Animal Health Laboratory, CSIRO, Geelong, Victoria, Australia
| | - C R P Lind
- Neurospinal Department, St. John of God Hospital, Subiaco, Western Australia.,Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Medical School, University of Western Australia, Nedlands, Western Australia
| | - P R Woodland
- Neurospinal Department, St. John of God Hospital, Subiaco, Western Australia.,Spinal Service, Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia
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8
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Rajasekaran S, Tangavel C, K S SVA, Soundararajan DCR, Nayagam SM, Matchado MS, Raveendran M, Shetty AP, Kanna RM, Dharmalingam K. Inflammaging determines health and disease in lumbar discs-evidence from differing proteomic signatures of healthy, aging, and degenerating discs. Spine J 2020; 20:48-59. [PMID: 31125691 DOI: 10.1016/j.spinee.2019.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The true understanding of aging and disc degeneration (DD) is still elusive. MRI has not helped our attempts to understand the health and disease status of the discs as it reflects mainly the end morphologic changes and not the changes at a molecular level. Understanding degeneration at a molecular level through proteomics might allow differentiation from normal aging and also aid in the development of biomarkers for early diagnosis and preventive therapies. PURPOSE To utilize proteomics to understand the molecular basis of healthy, aging, and degenerating discs and conclusively differentiate normal aging and degeneration. STUDY DESIGN Proteomic analysis of human intervertebral disc samples. METHODS L4-L5 disc samples from three groups were acquired and subjected to proteomic analysis. Samples from individuals aged in the second, third, and fourth decades were used to represent young healthy discs (Group A). Those from MRI normal donors aged in the fifth, sixth, and seventh decades represented normal aging (Group B). Five degenerated discs obtained from patients at surgery represented degeneration (Group C). The entire proteome map and alteration in protein expressions were further analyzed using bioinformatics analysis. This was a self-funded project. RESULTS There were 84 common proteins. Specific proteins numbered 225 in A, 315 in B, and 283 in C. By gene ontology biological process identification, Group A predominated with extracellular matrix organization, cytoskeletal structural and normal metabolic proteins. Group B differed in having additional basal expression of immune response, complement inhibitors, and senescence proteins. Group C was different, with upregulation of proteins associated with oxidative stress response, positive regulators of apoptosis, innate immune response, complement activation and defense response to gram positive bacteria indicating ongoing inflammaging. CONCLUSIONS Our study documented diverse proteome signatures between the young, aging and degenerating discs. Inflammaging was the main differentiator between normal biological aging and DD. CLINICAL SIGNIFICANCE Multiple inflammatory molecules unique to DD were identified, allowing the possibility of developing specific biomarkers for early diagnosis and thereby provide evidence-based metrics for preventive measures rather than surgical intervention and also to monitor progress of the disease.
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Affiliation(s)
- S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India.
| | - Chitraa Tangavel
- Ganga Research Centre, No 91, Mettupalayam Rd, Coimbatore 641030, India
| | - Sri Vijay Anand K S
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | | | | | | | - M Raveendran
- Department of Plant Biotechnology, Tamil Nadu Agricultural University, Coimbatore 641003, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore, India
| | - K Dharmalingam
- Aravind Medical Research Foundation, Madurai 625020, India
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9
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Sorokin YN. [Back pain and intervertebral disc degeneration in the International Classification of Diseases 11th revision]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:153-159. [PMID: 31626184 DOI: 10.17116/jnevro2019119081153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2018, the World Health Organization introduced a new version of the International Classification of Diseases (ICD-11), which is preliminary and introductory in nature and will come into force on 1 January 2022. One of the most changed sections compared to ICD-10 is the section characterizing the spine pain syndrome and other manifestations of discogenic pathology. The article describes the terms and codes for the degenerative lesion of the intervertebral disk (IVD) in accordance with the requirements of ICD-11, which also agree with the definitions of the 2nd revision of the nomenclature and classification of the pathology of the lumbar IVD from 2014. The basic concepts of IVD degenerative changes are also revealed. The need to create a new revision of the domestic clinical classification of vertebrogenic neurologic pathology adapted to ICD-11 codes is underlined.
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Affiliation(s)
- Yu N Sorokin
- Rostov State Medical University, Rostov-on-Don, Russia
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10
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Alpantaki K, Zafiropoulos A, Tseliou M, Vasarmidi E, Sourvinos G. Herpes simplex virus type-1 infection affects the expression of extracellular matrix components in human nucleus pulposus cells. Virus Res 2018; 259:10-17. [PMID: 30339788 DOI: 10.1016/j.virusres.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
Intervertebral disc (IVD) degeneration has a complex multifactorial origin and it is tightly associated with changes in the secretion of proteoglycans and collagen of the Nucleus Pulposus (NP) extracellular matrix. Chronic infection by Herpes virus has been previously associated with disc degeneration after detection of Herpes Simplex Virus type-1 (HSV-1) and CMV DNA in human excised disc samples. The aim of the present study was to assess the effect of HSV-1 infection on proteoglycan synthesis employing human Nucleus Pulposus (HNPCs) cells as a model of intervertebral disc degeneration. During lytic HSV-1 infection, a significant reduction of Decorin expression was observed 8 h post infection (h.p.i) which furthered deteriorated at 24 h.p.i. Biglycan was also reduced but only 24 h.p.i. Collagen type II, although demonstrated a downward trend, it was not statistically significant, whereas both Versican and Aggrecan showed a substantial decrease at 24 h.p.i. Hyaluronan production was not significantly affected. In a non-productive HSV-1 infection, a substantial reduction of Decorin, Biglycan, Versican and Aggrecan expression was found, similarly to our findings from the lytic infection. Furthermore, collagen type II expression was completely abolished. HAS1 expression was not affected, whereas HAS 2 and 3 were found to be significantly reduced. These results indicate that HSV-1 infection of human NP cells yields a complex effect on host extracellular cell function. The viral-induced changes in proteoglycan and collagen type II concentration may affect cell-matrix interactions and lead to a dysfunctional intervertebral disc which may trigger or promote the degeneration process.
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Affiliation(s)
- Kalliopi Alpantaki
- Laboratory of Clinical Virology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Alexandros Zafiropoulos
- Laboratory of Clinical Virology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Melpomeni Tseliou
- Laboratory of Clinical Virology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Laboratory of Clinical Virology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - George Sourvinos
- Laboratory of Clinical Virology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
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11
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Dhillon RS, Smith PD. Diskogenic Reactivation of Herpes Zoster. World Neurosurg 2017; 109:138-139. [PMID: 28962964 DOI: 10.1016/j.wneu.2017.09.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022]
Abstract
Varicella zoster virus remains dormant in the dorsal root ganglia after childhood exposure to chickenpox. Its reactivation results in herpes zoster, otherwise known as shingles, which is a painful vesicular rash in a dermatomal distribution. We present a case of foraminal disk extrusion that resulted in radicular pain in a dermatomal distribution. The resultant inflammatory response around the dorsal root ganglion triggered an episode of shingles, which elegantly highlights the pathophysiology of this condition at a gross anatomic level.
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Affiliation(s)
- Rana S Dhillon
- Department of Neurosurgery, St. Vincent's Hospital, Melbourne, Australia; Centre for Clinical Neuroscience and Neurological Research, Melbourne, Australia.
| | - Paul D Smith
- Department of Neurosurgery, St. Vincent's Hospital, Melbourne, Australia; Centre for Clinical Neuroscience and Neurological Research, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
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12
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Abstract
Spondylodiscitis is a severe infectious disease of the intervertebral discs and of the adjacent parts of the vertebral bodies, culminating in destruction of the mobile segment. It is accompanied by a mortality rate of approximately 15%. Severe courses of the disease can also lead to abscess formation and dispersal of sepsis. Malpositioning of the axis organ and deficits in neurological function up to paraplegia are also possible complications. Timely diagnostics and targeted therapy contribute to minimizing the risk of significant health disorders. This review article gives a summary of important algorithms in the diagnostics and treatment and discusses them against the background of currently available literature. According to the current state of knowledge the surgical treatment of spondylodiscitis provides many advantages and is therefore the method choice, even if a conservative approach can be successful in selected cases. The endpoints of treatment are cleansing of the infection with normalization of laboratory parameters of inflammation and the osseous fusion of the mobile segment.
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Kondo M, Goto H, Yamamoto S. Case of lumbar disc hernia caused in the left L4 and L5 dermatomes after herpes zoster infection in the right L2 and L3 dermatomes. J Dermatol 2016; 43:977-8. [DOI: 10.1111/1346-8138.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Makoto Kondo
- Department of Dermatology; Yokkaichi Municipal Hospital; Yokkaichi Japan
| | - Hiroyuki Goto
- Department of Dermatology; Yokkaichi Municipal Hospital; Yokkaichi Japan
| | - Shinya Yamamoto
- Department of Dermatology; Yokkaichi Municipal Hospital; Yokkaichi Japan
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Rigal J, Thelen T, Byrne F, Cogniet A, Boissière L, Aunoble S, Le Huec JC. Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1000-5. [PMID: 26818032 DOI: 10.1007/s00586-016-4396-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The modern literature is producing a rapidly growing number of articles which highlight the relationship between infection and lumbar disc degeneration. However, the means by which samples are collected is questionable. Posterior approach surgery is not free from skin contamination. The possibility of intraoperative contamination of disc biopsies cannot be excluded. OBJECTIVE The objective of this study was to determine if an association existed between lumbar disc degeneration and chronic infection of the intervertebral disc. MATERIALS AND METHODS 313 patients (186/127, F/M) with chronic low back pain secondary to degenerative disc disease which was resistant to medical treatment were included in a single-centre prospective study. All underwent a lumbar anterior video-assisted minimally invasive fusion or disc prosthesis in L4-L5 and/or L5-S1 via an anterior retroperitoneal approach. The patients MRI scans demonstrated in Pfirrmann's classification grade IV or V disc degeneration; 385 disc drives were taken. In terms of Modic changes, 303 Modic 1, 58 Modic II and 24 absence of Modic change, respectively. All underwent intraoperative biopsy, performed according to a strict aseptic protocol. The biopsies were then cultured for 4 weeks with specialised enrichment cultures and subjected to histopathological analysis. RESULTS The mean age was 47 ± 8.6 years sterile cultures were obtained in 379 samples (98.4%) and 6 were positive (1.6%). The cultured bacteria were: Propionibacterium acnes (n:2), Staphylococcus epidermidis (n:2), Citrobacter freundii (n:1), and Saccharopolyspora hirsuta (n:1). Histopathological analysis did not demonstrate any evidence of a neutrophilia. There were no delayed or secondary infections. DISCUSSION AND CONCLUSION Unlike the posterior approach where contamination is common, the anterior video-assisted approach allows a biopsy without skin contact. This approach to the spine is the most effective way to eliminate the risk of contamination. Our results confirm the absence of any relationship between infection and disc degeneration. We suggest that the 6 positive samples in our study may be related to contamination. The absence of infection at 1-year followup is an additional argument in favour of our results. In conclusion, our study shows no association between infection and disc degeneration. The pathophysiology of disc degeneration is complex, but the current literature opens new perspectives.
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Affiliation(s)
- Julien Rigal
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
| | - Thomas Thelen
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
| | - Fergus Byrne
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
| | - Arnaud Cogniet
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
| | - Louis Boissière
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
| | - Stephane Aunoble
- Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France
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15
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Mechanics and biology in intervertebral disc degeneration: a vicious circle. Osteoarthritis Cartilage 2015; 23:1057-70. [PMID: 25827971 DOI: 10.1016/j.joca.2015.03.028] [Citation(s) in RCA: 539] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 02/02/2023]
Abstract
Intervertebral disc degeneration is a major cause of low back pain. Despite its long history and large socio-economical impact in western societies, the initiation and progress of disc degeneration is not well understood and a generic disease model is lacking. In literature, mechanics and biology have both been implicated as the predominant inductive cause; here we argue that they are interconnected and amplify each other. This view is supported by the growing awareness that cellular physiology is strongly affected by mechanical loading. We propose a vicious circle of mechanical overloading, catabolic cell response, and degeneration of the water-binding extracellular matrix. Rather than simplifying the disease, the model illustrates the complexity of disc degeneration, because all factors are interrelated. It may however solve some of the controversy in the field, because the vicious circle can be entered at any point, eventually leading to the same pathology. The proposed disease model explains the comparable efficacy of very different animal models of disc degeneration, but also helps to consider the consequences of therapeutic interventions, either at the cellular, material or mechanical level.
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Kelekis A, Filippiadis DK. Percutaneous treatment of cervical and lumbar herniated disc. Eur J Radiol 2014; 84:771-6. [PMID: 24673977 DOI: 10.1016/j.ejrad.2014.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 12/27/2022]
Abstract
Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.
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Affiliation(s)
- A Kelekis
- University of Athens, 2nd Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str , 12462 Haidari/Athens, Greece.
| | - D K Filippiadis
- University of Athens, 2nd Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str , 12462 Haidari/Athens, Greece.
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Birkenmaier C. Should we start treating chronic low back pain with antibiotics rather than with pain medications? Korean J Pain 2013; 26:327-35. [PMID: 24155998 PMCID: PMC3800704 DOI: 10.3344/kjp.2013.26.4.327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 01/29/2023] Open
Abstract
For those of us who have read the 2 recently published articles by a Danish - British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in consequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results.
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Affiliation(s)
- Christof Birkenmaier
- Department of Orthopaedics, Ludwig-Maximilian-University Munich, Grosshadern Campus, Munich, Germany
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Salzberg LD, Manusov EG. Management options for patients with chronic back pain without an etiology. Health Serv Insights 2013; 6:33-8. [PMID: 25114558 PMCID: PMC4089831 DOI: 10.4137/hsi.s10469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The treatment and management of low back pain is complex when there is no specific etiology such as cancer, fracture, or herniated disc. An organized approach to management that follows evidence based guidelines will facilitate care in a problem that reflects a lifetime prevalence of over 70 percent. The purpose of this review is to present a guideline to care for a common disabling process with a very heterogeneous etiology.
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Affiliation(s)
- Lenny D Salzberg
- Faculty Development Fellowship, Duke/SR-AHEC Family Medicine Residency, 1601 Owen Drive, Fayetteville NC 28304
| | - Eron G Manusov
- Vice President CEAS, Program Director, Duke/SR-AHEC Family Medicine Residency, 1601 Owen Drive, Fayetteville NC 28304
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Hughes SPF, Freemont AJ, Hukins DWL, McGregor AH, Roberts S. The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. ACTA ACUST UNITED AC 2012; 94:1298-304. [DOI: 10.1302/0301-620x.94b10.28986] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article reviews the current knowledge of the intervertebral disc (IVD) and its association with low back pain (LBP). The normal IVD is a largely avascular and aneural structure with a high water content, its nutrients mainly diffusing through the end plates. IVD degeneration occurs when its cells die or become dysfunctional, notably in an acidic environment. In the process of degeneration, the IVD becomes dehydrated and vascularised, and there is an ingrowth of nerves. Although not universally the case, the altered physiology of the IVD is believed to precede or be associated with many clinical symptoms or conditions including low back and/or lower limb pain, paraesthesia, spinal stenosis and disc herniation. New treatment options have been developed in recent years. These include biological therapies and novel surgical techniques (such as total disc replacement), although many of these are still in their experimental phase. Central to developing further methods of treatment is the need for effective ways in which to assess patients and measure their outcomes. However, significant difficulties remain and it is therefore an appropriate time to be further investigating the scientific basis of and treatment of LBP.
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Affiliation(s)
- S. P. F. Hughes
- Imperial College London, South
Kensington Campus, London SW7 2AZ, UK
| | - A. J. Freemont
- University of Manchester, Oxford
Road, Manchester M13 9PL, UK
| | | | - A. H. McGregor
- Imperial College London, South
Kensington Campus, London SW7 2AZ, UK
| | - S. Roberts
- Robert Jones and Agnes Hunt Orthopaedic
Hospital NHS Foundation Trust, and ISTM,
Keele University, Oswestry, Shropshire SY10
7AG, UK
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Tsyba L, Rynditch AV, Boeri E, Jabbari K, Bernardi G. Distribution of HIV-1 in the genomes of AIDS patients. Cell Mol Life Sci 2004; 61:721-6. [PMID: 15052414 PMCID: PMC11138794 DOI: 10.1007/s00018-003-3436-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
The localization of HIV-1 proviruses in compositional DNA fractions from 27 AIDS patients during the chronic phase of the disease with depletion of CD4+ and different levels of viremia showed the following. (1) At low viremia, proviruses are predominantly localized in the GC-richest isochores, which are characterized by an open chromatin structure; this result mimics findings on HIV-1 integration in early infected cells in culture. (2) At higher viremia, an increased distribution of proviruses in GC-poor isochores (which match the GC poorness of HIV-1) was found; this suggests a selection of cells in which the 'isopycnic' localization leads to a higher expression of proviruses and, in turn, to higher viremia. (3) At the highest viremia, integrations in GC-rich isochores are often predominant again, but generally not at the same level as in (1); this may be the consequence of new integrations from the extremely abundant RNA copies.
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Affiliation(s)
- L. Tsyba
- Laboratoire de Génétique Moléculaire, Institut Jacques Monod, 2 place Jussieu, 75005 Paris, France
- Institute of Molecular Biology and Genetics, Ukrainian Academy of Sciences, 150 Zabolotnogo str., 03143 Kiev, Ukraine
| | - A. V. Rynditch
- Laboratoire de Génétique Moléculaire, Institut Jacques Monod, 2 place Jussieu, 75005 Paris, France
- Institute of Molecular Biology and Genetics, Ukrainian Academy of Sciences, 150 Zabolotnogo str., 03143 Kiev, Ukraine
| | - E. Boeri
- Diagnostica e Ricerca San Raffaele, I.R.C.C.S. Istituto Scientifico San Raffaele, Via Stamira di Ancona 22, 20127 Milan, Italy
| | - K. Jabbari
- Laboratoire de Génétique Moléculaire, Institut Jacques Monod, 2 place Jussieu, 75005 Paris, France
| | - G. Bernardi
- Laboratoire de Génétique Moléculaire, Institut Jacques Monod, 2 place Jussieu, 75005 Paris, France
- Laboratorio di Evoluzione Molecolare, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Naples, Italy
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