Targeting the extracellular matrix: Matricellular proteins regulate cell–extracellular matrix communication within distinct niches of the intervertebral disc

The so-called “matricellular” proteins have recently emerged as important regulators of cell–extracellular matrix (ECM) interactions. These proteins modulate a variety of cell functions through a range of interactions with cell-surface receptors, hormones, proteases and structural components of the ECM. As such, matricellular proteins are crucial regulators of cell phenotype, and consequently tissue function. The distinct cell types and microenvironments that together form the IVD provide an excellent paradigm to study how matricellular proteins mediate communication within and between adjacent tissue types. In recent years, the role of several matricellular proteins in the intervertebral disc has been explored in vivo using mutant mouse models in which the expression of target matricellular proteins was deleted from either one or all compartments of the intervertebral disc. The current review outlines what is presently known about the roles of the matricellular proteins belonging to the CCN family, SPARC (Secreted Protein, Acidic, and Rich in Cysteine), and thrombospondin (TSP) 2 in regulating intervertebral disc cell–ECM interactions, ECM synthesis and disc tissue homeostasis using genetically modified mouse models. Furthermore, we provide a brief overview of recent preliminary studies of other matricellular proteins including, periostin (POSTN) and tenascin (TN). Each specific tissue type of the IVD contains a different matricellular protein signature, which varies based on the specific stage of development, maturity or disease. A growing body of direct genetic evidence links IVD development, maintenance and repair to the coordinate interaction of matricellular proteins within their respective niches and suggests that several of these signaling modulators hold promise in the development of diagnostics and/or therapeutics targeting intervertebral disc aging and/or degeneration.     

Analysis of nonlinear coupled diffusion of oxygen and lactic acid in intervertebral discs

The transport of oxygen and lactate (i.e., lactic acid) in the human intervertebral disc was investigated accounting for the measured coupling between species via the pH level in the tissue. Uncoupled cases were also analyzed to identify the extent of the effect of such coupling on the solute gradients across the disc. Moreover, nonlinear lactic production rate versus lactic concentration and oxygen consumption rate versus oxygen concentration were considered. The nonlinear coupled diffusion equations were solved using an in-house finite element program and an axisymmetric model of the disc with distinct nucleus and anulus regions. A pseudotransient approach with a backward integration scheme was employed to improve convergence. Coupled simulations influenced the oxygen concentration and lactic acid concentration throughout the disc, in particular the gradient of concentrations along the disc mid-height to the nucleus-anulus boundary where the solutes reached their most critical values; minimum for the oxygen tension and maximum for the lactate. Results suggest that for realistic estimates of nutrient and metabolite gradients across the disc, it could be important to take into account the coupling between the rates of synthesis and overall local metabolite/nutrient concentration.     

Sox9治疗兔椎间盘退变的效果及机制研究

目的:探究Sox9用于治疗椎间盘退变的效果及调控机制。方法:将Ad-sox9和Ad-GFP各20μL分别转染至椎间盘退变兔的髓核组织中,转染后3、7、30、60天取材,采用免疫组化、免疫荧光和MRI等研究方法检测椎间盘髓核组织中II型胶原、蛋白多糖的表达情况,并分析对椎间盘退变的改善情况。结果:免疫组化染色显示sox9组中椎间盘髓核组织中II型胶原、蛋白多糖的表达明显升高,MRI显示sox9组椎间盘T2像信号有明显改善(P<0.05)。结论:体内转染腺病毒介导的sox9基因能够增加椎间盘内II型胶原和蛋白多糖的表达,并抑制椎间盘的退变进程。     

Nutrient distribution and metabolism in the intervertebral disc in the unloaded state: A parametric study

A 2-D finite element model for the intervertebral disc in which quadriphasic theory is coupled to the transport of solutes involved in cellular nutrition was developed for investigating the main factors contributing to disc degeneration. Degeneration is generally considered to result from chronic disc cell nutrition insufficiency, which prevents the cells from renewing the extracellular matrix and thus leads to the loss of proteoglycans. Hence, the osmotic power of the disc is decreased, causing osmomechanical impairments. Cellular metabolism depends strongly on the oxygen, lactate and glucose concentrations and on pH in the disc. To study the diffusion of these solutes in a mechanically or osmotically loaded disc, the osmomechanical and diffusive effects have to be coupled. The intervertebral disc is modeled here using a plane strain formulation at the equilibrium state under physiological conditions after a long rest period (called unloaded state). The correlations between solute distribution and various properties of healthy and degenerated discs are investigated. The numerical simulation shows that solute distribution in the disc depends very little on the elastic modulus or the proteoglycan concentration but greatly on the porosity, diffusion coefficient and endplate diffusion area. This coupled model therefore opens new perspectives for investigating intervertebral disc degeneration mechanisms.     

Gene expression profile analysis of human intervertebral disc degeneration

In this study, we used microarray analysis to investigate the biogenesis and progression of intervertebral disc degeneration. The gene expression profiles of 37 disc tissue samples obtained from patients with herniated discs and degenerative disc disease collected by the National Cancer Institute Cooperative Tissue Network were analyzed. Differentially expressed genes between more and less degenerated discs were identified by significant analysis of microarray. A total of 555 genes were significantly overexpressed in more degenerated discs with a false discovery rate of < 3%. Functional annotation showed that these genes were significantly associated with membrane-bound vesicles, calcium ion binding and extracellular matrix. Protein-protein interaction analysis showed that these genes, including previously reported genes such as fibronectin, COL2A1 and β-catenin, may play key roles in disc degeneration. Unsupervised clustering indicated that the widely used morphology-based Thompson grading system was only marginally associated with the molecular classification of intervertebral disc degeneration. These findings indicate that detailed, systematic gene analysis may be a useful way of studying the biology of intervertebral disc degeneration.     

Protective Effects of Cannabidiol on Lesion-Induced Intervertebral Disc Degeneration

Disc degeneration is a multifactorial process that involves hypoxia, inflammation, neoinnervation, accelerated catabolism, and reduction in water and glycosaminoglycan content. Cannabidiol is the main non-psychotropic component of the Cannabis sativa with protective and anti-inflammatory properties. However, possible therapeutic effects of cannabidiol on intervertebral disc degeneration have not been investigated yet. The present study investigated the effects of cannabidiol intradiscal injection in the coccygeal intervertebral disc degeneration induced by the needle puncture model using magnetic resonance imaging (MRI) and histological analyses. Disc injury was induced in the tail of male Wistar rats via a single needle puncture. The discs selected for injury were punctured percutaneously using a 21-gauge needle. MRI and histological evaluation were employed to assess the results. The effects of intradiscal injection of cannabidiol (30, 60 or 120 nmol) injected immediately after lesion were analyzed acutely (2 days) by MRI. The experimental group that received cannabidiol 120 nmol was resubmitted to MRI examination and then to histological analyses 15 days after lesion/cannabidiol injection. The needle puncture produced a significant disc injury detected both by MRI and histological analyses. Cannabidiol significantly attenuated the effects of disc injury induced by the needle puncture. Considering that cannabidiol presents an extremely safe profile and is currently being used clinically, these results suggest that this compound could be useful in the treatment of intervertebral disc degeneration.     

Immunolocalization of type X collagen in human lumbar intervertebral discs during ageing and degeneration

 Type X collagen has so far not been reported to occur in human intervertebral discs. The objective of this study was therefore to investigate the occurrence of type X collagen in human lumbar intervertebral discs during ageing and degeneration. Ninety intervertebral discs with adjacent endplates were excised in toto from individuals (0–86 years) without known spinal disease and were processed for routine decalcified histology. Appropriate slices of each disc were processed for immunohistochemistry using a type-spec ific, monoclonal antibody raised against human type X collagen. Each intervertebral disc was examined for macroscopic and histomorphological features of disc degeneration. Immunohistochemically, a positive specific type X staining was observed in the hypertrophic zone of the growth plate and only in the interstitial matrix of juvenile (<2 years) nucleus pulposus. In adult discs, type X collagen could be localized in conjunction with advanced disc degeneration and first occurred in the disc matrix (i.e., pericellular region) of a 47-year-old specimen. Positive type X staining of the disc matrix was more frequently found in senile (>70 years) discs with end stages of disc degeneration. This study provides the first evidence for the occurrence of type X collagen in human lumbar intervertebral discs and it appears that type X collagen is re-expressed in late stages of disc degeneration. Accepted: 24 April 1997     

Is post-contrast MRI a valuable method for the study of the nutrition of the intervertebral disc?

Decreased nutrition has been proposed as a potential mechanism leading to intervertebral disc degeneration. A method to investigate it in vivo is the MRI evaluation of the transport of a paramagnetic contrast agent, which is assumed to diffuse through the endplate to the disc using the same mechanisms as the cell nutrients. However, previous numerical studies questioned the value of this method as a model to investigate disc nutrition. To assess its validity, a parametric osmoporoelastic finite element model of a lumbar intervertebral disc incorporating diffusion and convection of a solute (representing the contrast agent) was developed. A Taguchi sensitivity analysis was performed in order to assess the relevance of various parameters which influence the solute transport. Subsequently, a full-factorial sensitivity analysis was used to investigate specifically the diffusion coefficients of the contrast agent. The most important parameters in determining the results were the disc height, the diffusion coefficients and the pharmacokinetic of the contrast agent. However, diffusion coefficients values as measured in in vitro studies would lead to insubstantial enhancement of the MRI signal. Thus, transport mechanisms other than pure diffusion should be active in in vivo transport of the contrast agent. In conclusion, the study showed that post-contrast MRI may not be suited for a quantitative analysis, but only for a qualitative examination aimed for example to detect endplate lesions. Open questions remain on the use of post-contrast MRI for the investigation of the relevance of reduced nutrition as a trigger to disc degeneration.     

Modeling The Nutrientsbehavior in Intervertebral Discs: A Boundary Integral Simulation

It is a well-known fact that computational biomechanics and mechanobiology have deserved great attention by the numerical-methods community. Many efforts and works can be found in technical literature. This work deals with the modeling of nutrients and their effects on the behavior of intervertebral discs. The numerical modeling was carried out using the Boundary ELement Method (BEM) and an axisymmetric model of the disc. Concentration and production of lactate and oxygen are modeled with the BEM. Results agree well enough with those obtained using finite elements. The numerical efforts in the domain and boundary discretizations are minimized using the BEM. Also, the effect of the calcification of the disc that causes the vascularization loss has been studied. The glucose, oxygen and lactate components behavior has been analyzed applying a mixed loading-unloading process, then allowing the study of the disc-height variations due to the degradation of the disc.     

Genetic and Functional Studies of the Intervertebral Disc: A Novel Murine Intervertebral Disc Model

Intervertebral disc (IVD) homeostasis is mediated through a combination of micro-environmental and biomechanical factors, all of which are subject to genetic influences. The aim of this study is to develop and characterize a genetically tractable, ex vivo organ culture model that can be used to further elucidate mechanisms of intervertebral disc disease. Specifically, we demonstrate that IVD disc explants (1) maintain their native phenotype in prolonged culture, (2) are responsive to exogenous stimuli, and (3) that relevant homeostatic regulatory mechanisms can be modulated through ex-vivo genetic recombination. We present a novel technique for isolation of murine IVD explants with demonstration of explant viability (CMFDA/propidium iodide staining), disc anatomy (H&E), maintenance of extracellular matrix (ECM) (Alcian Blue staining), and native expression profile (qRT-PCR) as well as ex vivo genetic recombination (mT/mG reporter mice; AdCre) following 14 days of culture in DMEM media containing 10% fetal bovine serum, 1% L-glutamine, and 1% penicillin/streptomycin. IVD explants maintained their micro-anatomic integrity, ECM proteoglycan content, viability, and gene expression profile consistent with a homeostatic drive in culture. Treatment of genetically engineered explants with cre-expressing adenovirus efficaciously induced ex vivo genetic recombination in a variety of genetically engineered mouse models. Exogenous administration of IL-1ß and TGF-ß3 resulted in predicted catabolic and anabolic responses, respectively. Genetic recombination of TGFBR1^fl/fl explants resulted in constitutively active TGF-ß signaling that matched that of exogenously administered TGF-ß3. Our results illustrate the utility of the murine intervertebral disc explant to investigate mechanisms of intervertebral disc degeneration.     

正常椎间盘胶原的研究

腰椎间盘突出症是引起腰腿痛常见的原因。胶原作为椎间盘结构的主要成分,构成椎间盘的纤维框架,其类型与分布直接决定着椎间盘结构的强度和功能的稳定。本文利用溴化氰消化椎间盘胶原产生多肽,借助于梯度层析。SDS-PAGE及光密度定量扫描等对正常人椎间盘胶原进行了研究。结果表明:正常人椎间盘含Ⅰ型及Ⅱ型两种胶原,它们的分布呈明显而特征性的移行性变化:纤维环外层边缘以Ⅰ型胶原为主(83％),由外向内Ⅰ型胶原逐渐移行为Ⅱ型胶原,靠近髓核处以Ⅱ型胶原为主(72％);髓核中心含有Ⅱ型胶原。此为椎间盘的一个结构特性,以满足椎间盘的特殊功能的需要。     

TGF-β synergizes with ML264 to block IL-1β-induced matrix degradation mediated by Krüppel-like factor 5 in the nucleus pulposus

Intervertebral disc degeneration causes low back pain.Interleukin-1β (IL-1β) is a well-known inflammatory mediator that is involved in disc degeneration but its molecular mechanisms on catabolic and anabolic events in nucleus pulposus (NP) cells remain unclear. Krüppel-like factor 5 (KLF5) is associated with inflammation and was previously shown to cause cartilage degradation. In this study, we revealed that KLF5 is involved in IL-1β activated NF-kB cascade by enhancing both p65 phosphorylation and p65 acetylation. Moreover, the catabolic effect of KLF5 can be abolished by transforming growth factor-β (TGF-β) via promoting the proteasomal degradation of KLF5. Therefore, a KLF5 inhibitor ML264 was further proved to synergize with TGF-β to attenuate IL-1β-induced intervertebral disc degeneration. These results indicate the critical role of KLF5 in regulating intervertebral disc metabolism and suggest KLF5 inhibitor such as ML264 as potential compound for treatment of degenerative disc disease.     

CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels

BackgroundRecognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. As such, it is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI).MethodsA total of 30 adult cadavers were studied by sectional anatomic dissection, and 60 patients were examined using CT (16 slices, 3-mm thickness, 3-mm intersection gap, n = 30) and MRI (3.0T, T2-WI, 5-mm thickness, 1-mm intersection gap, n = 30). The distances between the midline and the superficial points of the intermuscular spaces at different intervertebral disc levels were measured.ResultsBased on study of our cadavers, the mean distances from the midline to the intermuscular space between multifidus and longissimus, from intervertebral disc levels L1–L2 to L5–S1, were 0.9, 1.1, 1.7, 3.0, and 3.5 cm, respectively. Compared with the upper levels (L1–L3), the superficial location at the lower level (L4–S1) is more laterally to the midline (P<0.05). The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4–S1. The intermuscular spaces in patients also varied at different levels of the lumbar spine showing a low discontinuous density in CT and a high signal in MRI. There were no significant differences between the observations in cadavers and those made using CT and MRI.ConclusionThe intermuscular spaces within the paraspinal muscles vary at different intervertebral disc levels. Preoperative CT and MRI can facilitate selection of the muscle-splitting approach to the lumbar spine. This paper demonstrates the efficacy of medical imaging techniques in surgical planning.     

Effect of age on pyridinoline and pentosidine matrix cross-links in the desert sand rat intervertebral disc

Spondylosis in the desert sand rat (Psammomys obesus) has been studied as a model for intervertebral disc degeneration. Reducing sugars, which react with protein amino groups to form a diverse group of moieties with fluorescence and cross-linking properties, have been implicated in the structural and functional alterations of proteins that occur during aging and long-term diabetes. This study was undertaken to determine the changes in two matrix cross-links of the intervertebral disc and to study their association with aging. Two types of cross-links were studied: the physiological cross-link, pyridinoline, which is initiated by lysyl oxidase; and the non-enzymatically initiated cross-link, pentosidine. A significant increase in pentosidine, but not pyridinoline, was observed in the intervertebral disc with aging. Radiological, histological and biochemical findings support a hypothesis that subchondral bone responses, marked by increased bone density, contribute to alterations in the intervertebral disc. Cross-link changes in the structural proteins of the disc may contribute to the progressive fibrocartilage degradation typical of intervertebral disc disease as an effect of age.     

退行性腰椎滑脱临近节段椎间盘退变和关节突关节角度相关研究

目的:探讨退行性腰椎滑脱(DLS)临近节段椎间盘退变程度和关节突关节角度之间的关系。方法:选取我院2012年6月至2016年6月收治的120例DLS患者作为DLS组,另外选取来我院接受体检的健康者120例作为对照组,选择CT进行关节突关节角和腰椎滑脱度的测量,使用MRI的T2像对椎间盘进行Pfirrmann退变分级。结果:DLS组的各节段关节突关节角度均小于对照组(P0.05);DLS组不同滑脱程度的L2/3、L3/4、L5/S1节段关节突关节角度的比较,差异无统计学意义(P0.05);DLS组L2/3、L3/4、L5/S1节段不同椎间盘退变等级间的滑脱程度无显著性差异(P0.05)。L2/3和L3/4节段不同椎间盘退变程度间关节突关节角度差无显著性差异(P0.05),L5/S1节段不同椎间盘退变程度间关节突关节角度差有统计学差异(P0.05)。结论:退行性腰椎滑脱临近节段关节突关节角度明显小于正常人,且临近节段关节突关节的角度并未随着腰椎滑脱程度的加重而改变,退行性腰椎滑脱患者滑脱临近节段椎间盘退变与关节突关节的矢状化程度无关,但L5/S1关节突关节角度不对称性会影响到同节段椎间盘退变程度。     

Is the sheep a suitable model to study the mechanical alterations of disc degeneration in humans? A probabilistic finite element model study

Intervertebral disc degeneration is one major source of low back pain, which because of its complex multifactorial nature renders the treatment challenging and thus necessitates extensive research. Experimental animal models have proven valuable in improving our understanding of degenerative processes and potentially promising therapies. Currently, the sheep is the most frequently used large animal in vivo model in intervertebral disc research. However, despite its undoubted value for investigations of the complex biological and cellular aspects, to date, it is unclear whether the sheep is also suited to study the mechanical aspects of disc degeneration in humans.A parametric finite element (FE) model of the L4–5 spinal motion segment was developed. Using this model, the geometry and the material properties of both the human and the ovine spinal segment as well as different appearances of disc degeneration can be depicted. Under pure and combined loads, it was investigated whether degenerative changes to both the human and the ovine model equivalent caused the same mechanical response.Different patterns of degeneration resulted in large variations in the ranges of motion, intradiscal pressure, ligament and facet loads. In the human, but not in the ovine model, all these results differed significantly between different degrees of degeneration.This FE model study highlighted possible differences in the mechanical response to disc degeneration between human and ovine intervertebral discs and indicates the necessity of further, more detailed, investigations.     

Temporal changes of mechanical signals and extracellular composition in human intervertebral disc during degenerative progression

In this study, a three-dimensional finite element model was used to investigate the changes in tissue composition and mechanical signals within human lumbar intervertebral disc during the degenerative progression. This model was developed based on the cell-activity coupled mechano-electrochemical mixture theory. The disc degeneration was simulated by lowering nutrition levels at disc boundaries, and the temporal and spatial distributions of the fixed charge density, water content, fluid pressure, Von Mises stress, and disc deformation were analyzed. Results showed that fixed charge density, fluid pressure, and water content decreased significantly in the nucleus pulposus (NP) and the inner to middle annulus fibrosus (AF) regions of the degenerative disc. It was found that, with degenerative progression, the Von Mises stress (relative to that at healthy state) increased within the disc, with a larger increase in the outer AF region. Both the disc volume and height decreased with the degenerative progression. The predicted results of fluid pressure change in the NP were consistent with experimental findings in the literature. The knowledge of the variations of temporal and spatial distributions of composition and mechanical signals within the human IVDs provide a better understanding of the progression of disc degeneration.