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      Influence of macrophage polarization in herniated nucleus pulposus tissue on clinical efficacy after lumbar discectomy

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          Abstract

          Background

          Low back pain or sciatic pain because of lumbar intervertebral disc herniation (LDH) is caused by mechanical compression and/or an inflammatory component on the nerve root. However, it is difficult to define to what extent each component contributes to the pain. This study attempted to explore the effects of macrophage polarization on clinical symptoms in patients experiencing LDH after surgery, and investigated the association between macrophage cell percentages and clinical efficacy.

          Methods

          This study retrospectively harvested nucleus pulposus (NP) tissue samples from 117 patients. Clinical symptoms and efficacy using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated at different time points preoperatively and postoperatively. CD68, CCR7, CD163, and CD206 were selected as macrophage phenotypic markers.

          Results

          Seventy‐six samples showed positive expression of macrophage markers in NP samples of patients with LDH, whereas 41 patients displayed negative results. No significant differences were detected between the two groups, involvement of several demographic data, and preoperative clinical findings. With respect to the macrophage‐positive group, no significant correlation was detected between the positive rate of the four markers and the VAS score or ODI after surgery. However, patients with NP samples positive for CD68 and CCR7 expression showed significantly lower VAS scores 1 week after surgery compared with those in the negative group. Moreover, the improvement in VAS score showed a strong positive correlation with CD68‐ and CCR7‐positive cell percentages.

          Conclusions

          Our results indicated that pro‐inflammatory M1 macrophages may be associated with the reduction of chronic pain after surgery. Therefore, these findings contribute to better personalized pharmacological interventions for patients with LDH, considering the heterogeneity of pain.

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          The Oswestry Disability Index.

          Jeremy C. T. Fairbank, Paul B Pynsent (2000)
          The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.
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            Proinflammatory cytokine expression profile in degenerated and herniated human intervertebral disc tissues.

            Robert E. Isaacs, Alykhan Shamji, Jason W Jarvis … (2010)
            Prior reports document macrophage and lymphocyte infiltration with proinflammatory cytokine expression in pathologic intervertebral disc (IVD) tissues. Nevertheless, the role of the Th17 lymphocyte lineage in mediating disc disease remains uninvestigated. We undertook this study to evaluate the immunophenotype of pathologic IVD specimens, including interleukin-17 (IL-17) expression, from surgically obtained IVD tissue and from nondegenerated autopsy control tissue. Surgical IVD tissues were procured from patients with degenerative disc disease (n = 25) or herniated IVDs (n = 12); nondegenerated autopsy control tissue was also obtained (n = 8) from the anulus fibrosus and nucleus pulposus regions. Immunohistochemistry was performed for cell surface antigens (CD68 for macrophages, CD4 for lymphocytes) and various cytokines, with differences in cellularity and target immunoreactivity scores analyzed between surgical tissue groups and between autopsy control tissue regions. Immunoreactivity for IL-4, IL-6, IL-12, and interferon-gamma (IFNgamma) was modest in surgical IVD tissue, although expression was higher in herniated IVD samples and virtually nonexistent in control samples. The Th17 lymphocyte product IL-17 was present in >70% of surgical tissue fields, and among control samples was detected rarely in anulus fibrosus regions and modestly in nucleus pulposus regions. Macrophages were prevalent in surgical tissues, particularly herniated IVD samples, and lymphocytes were expectedly scarce. Control tissue revealed lesser infiltration by macrophages and a near absence of lymphocytes. Greater IFNgamma positivity, macrophage presence, and cellularity in herniated IVDs suggests a pattern of Th1 lymphocyte activation in this pathology. Remarkable pathologic IVD tissue expression of IL-17 is a novel finding that contrasts markedly with low levels of IL-17 in autopsy control tissue. These findings suggest involvement of Th17 lymphocytes in the pathomechanism of disc degeneration.
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              Macrophages regulate the progression of osteoarthritis

              H. Zhang, D Cai, X Bai (2020)
              Article 0 comments Cited 145 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Mao‐Sheng Wang: lixcgzph@163.com
                Xiao‐Chun Bai:
                ORCID: https://orcid.org/0000-0001-9087-1376
                baixiaochunnfy@163.com
                Journal
                Journal ID (nlm-ta): JOR Spine
                Journal ID (iso-abbrev): JOR Spine
                Journal ID (doi): 10.1002/(ISSN)2572-1143
                Journal ID (publisher-id): JSP2
                Title: JOR Spine
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Electronic): 2572-1143
                Publication date (Electronic): 26 January 2023
                Publication date Collection: June 2023
                Volume: 6
                Issue: 2 ( doiID: 10.1002/jsp2.v6.2 )
                Electronic Location Identifier: e1249
                Affiliations
                [ 1 ] Department of Cell Biology, School of Basic Medical Sciences Southern Medical University Guangzhou Guangdong China
                [ 2 ] Postdoctoral Innovation Practice Base of Gaozhou People's Hospital Maoming Guangdong China
                [ 3 ] Department of Orthopaedic Surgery, Gaozhou People's Hospital Maoming Guangdong China
                [ 4 ] Graduate School of Guangdong Medical University Zhanjiang Guangdong China
                Author notes
                [*] [* ] Correspondence

                Mao‐Sheng Wang and Xiao‐Chun Bai, Postdoctoral Innovation Practice Base of Gaozhou People's Hospital, Maoming, Guangdong 525200, China.

                Email: lixcgzph@ 123456163.com and baixiaochunnfy@ 123456163.com

                Author information
                https://orcid.org/0000-0001-9087-1376
                Article
                Publisher ID: JSP21249
                DOI: 10.1002/jsp2.1249
                PMC ID: 10285759
                PubMed ID: 37361327
                SO-VID: f621d14e-0688-4856-b097-69792dff9a2f
                Copyright © © 2023 The Authors. JOR Spine published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 10 January 2023
                Date received : 24 September 2022
                Date accepted : 15 January 2023
                Page count
                Figures: 6, Tables: 5, Pages: 12, Words: 6913
                Funding
                Funded by: China Postdoctoral Science Foundation , doi 10.13039/501100002858;
                Award ID: 2018M630968
                Funded by: National Natural Science Foundation of China , doi 10.13039/501100001809;
                Award ID: 81802130
                Funded by: Natural Science Foundation of Guangdong Province , doi 10.13039/501100003453;
                Award ID: 2018A030310462
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date June 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.9 mode:remove_FC converted:22.06.2023

                Keywords: inflammation,intervertebral disc,low back pain,osteoarthritis,spinal surgery
                Data availability:
                Keywords: inflammation, intervertebral disc, low back pain, osteoarthritis, spinal surgery

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