1. Severity of intervertebral disc herniation regulates cytokine and chemokine levels in patients with chronic radicular back pain
- Author
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Aysha N. Khan, Hayley E. Jacobsen, Nadeen O. Chahine, Christopher G. Filippi, and Mitchell Levine
- Subjects
Male ,0301 basic medicine ,Chemokine CXCL1 ,medicine.medical_treatment ,Becaplermin ,Systemic inflammation ,Severity of Illness Index ,Gastroenterology ,Body Mass Index ,0302 clinical medicine ,Back pain ,Medicine ,Orthopedics and Sports Medicine ,HMGB1 Protein ,Radiculopathy ,Chemokine CCL3 ,Pain Measurement ,Lumbar Vertebrae ,Age Factors ,Chronic pain ,Middle Aged ,Acute Pain ,Magnetic Resonance Imaging ,Low back pain ,CXCL1 ,Cytokine ,Cytokines ,Female ,Chemokines ,Chronic Pain ,medicine.symptom ,Intervertebral Disc Displacement ,Adult ,Chemokine CCL11 ,medicine.medical_specialty ,Biomedical Engineering ,Article ,Proinflammatory cytokine ,03 medical and health sciences ,Sex Factors ,Rheumatology ,Internal medicine ,Humans ,CXCL10 ,Macrophage Migration-Inhibitory Factors ,030203 arthritis & rheumatology ,business.industry ,Interleukin-9 ,medicine.disease ,Chemokine CXCL10 ,030104 developmental biology ,business ,Low Back Pain - Abstract
Summary Objective The contributions of intervertebral disc disease and subject-specific covariates to systemic inflammation in low back pain are unknown. We examined the effects of symptomatic disc herniation (DH) and MRI herniation severity on serum cytokine levels in clinical subjects. Design Cytokine levels from lumbar DH subjects (N = 78) were compared to control subjects (N = 57) accounting for effects of DH, age, body mass index (BMI) and gender. Effect of DH severity on cytokine levels was analyzed on subsets of subjects with acute or chronic pain. Serum cytokines were also analyzed in a subset of patients between pre- and 3 months post-surgery. Results Cytokine levels were elevated in the serum of patients with symptomatic DH, and the covariates age, BMI and gender significantly contributed to levels of some cytokines. Severity of herniation was a significant contributor to pain intensity (VAS), serum levels of HMGB1, PDGFbb, and IL-9. The relationship between DH severity and cytokine levels was confirmed in subjects with chronic, but not acute symptoms. Serum levels of macrophage migration inhibitory factor (MIF) decreased, whereas levels of CCL3, CCL11, CXCL1, and CXCL10 were significantly elevated post surgery. Conclusions This study is the first to show that DH severity is coordinately associated with changes in serum levels of inflammatory cytokines in chronic pain subjects. HMGB1, PDGFbb and IL-9 are novel mediators of increasing DH severity, indicative of cellular damage, neuro-inflammation and angiogenesis. Resolution of inflammation was observed with decrease in MIF post surgery. However, elevated chemokine levels indicate ongoing remodeling and wound healing at 3-month time point.
- Published
- 2020