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Association between chronic inflammation and latent infection of Propionibacterium acnes in non-pyogenic degenerated intervertebral discs: a pilot study

European Spine Journal volume 27, pages 2506–2517 (2018)Cite this article

Abstract

Purpose

Propionibacterium acnes may be considered a new pathogeny for disc degeneration, but its pathological role has remained unclear. This study was designed to determine whether the latent infection of P. acnes was associated with chronic inflammation in degenerated intervertebral discs via quantification of the levels of a series of cytokines and neutrophils.

Methods

Here, 76 degenerated intervertebral discs were harvested from patients with lower back pain and/or sciatica. Discs with and without P. acnes infection were distinguished and identified using anaerobic culture combined with 16S rDNA PCR and histological examination. Then, cytokines of TNF-α, IL-1β, IL-6, IL-8, MCP-1, MIP-1α, and IP-10, and the numbers of neutrophils were quantified and compared. The severity of disc degeneration and the prevalence of Modic changes were also evaluated between discs with and without P. acnes.

Results

After anaerobic culture and PCR examination, 15 intervertebral discs were placed in the P. acnes-positive group. Another 15 discs were selected from the remaining bacteria-free samples and formed a matched P. acnes-negative group. IL-8, MIP-1α, MCP-1, IP-10, TNF-α, and neutrophils were much higher in P. acnes-positive group than that in the matched P. acnes-negative group. However, only IL-8, MIP-1α, and neutrophils were statistically significant. Furthermore, 7 of 15 P. acnes-positive samples were histologically positive and a subgroup analysis suggested that both histological and PCR-positive samples had the highest concentrations of cytokines of IL-8, MIP-1α, TNF-α, and MCP-1 and the greatest numbers of neutrophils. PCR-positive but histologically negative samples showed the second-greatest, and matched P. acnes-negative samples showed the fewest. However, the difference was only statistically significant between samples found positive under both histology and PCR and samples found negative for P. acnes. Finally, P. acnes-positive group had significantly lower height of intervertebral discs and there was a trend with higher proportion of Modic changes in P. acnes-positive group, but without statistical results.

Conclusions

Latent P. acnes infection was associated with chronic inflammation in degenerated intervertebral discs, especially in the samples with visible bacteria in histology, which manifested as increased numbers of cytokines and neutrophils. Discs with P. acnes infection had much severer disc degeneration and P. acnes-associated chronic inflammation may be the reason.

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Author information

Author notes

  1. Ye Yuan and Yong Chen have contributed equally.

Authors and Affiliations

  1. Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

    Ye Yuan, Yucheng Jiao, Yazhou Lin, Zhe Chen & Peng Cao

  2. Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Ye Yuan, Yucheng Jiao, Changwei Li, Yazhou Lin, Zhe Chen & Peng Cao

  3. Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China

    Yong Chen

  4. Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Zezhu Zhou

  5. Department of Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yuehuan Zheng

  6. Department of Medical Microbiology and Parasitology, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Jiaqi Xiao

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  1. Ye Yuan
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Correspondence to Zhe Chen or Peng Cao.

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Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The institution of the authors (YY, ZZZ, JYC, ZYH, LYZ, CZ, and CP) received, during the study period, funding from the Science and Technology Commission of Shanghai Municipality, Shanghai, China (No. 13430722100 and No. 15DZ1942604) and grants from the Shanghai Bureau of Health, Shanghai, China (No. XBR2011024). The institution of the author Y Chen received during the study period, funding from the Science and Technology Bureau of Kunshan, Kunshan, China (No. KS1547).

Ethical review committee statement

The study was approved by the Institutional Review Board of Ruijin Hospital.

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Yuan, Y., Chen, Y., Zhou, Z. et al. Association between chronic inflammation and latent infection of Propionibacterium acnes in non-pyogenic degenerated intervertebral discs: a pilot study. Eur Spine J 27, 2506–2517 (2018). https://doi.org/10.1007/s00586-017-5363-5

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Keywords

  • P. acnes
  • Intervertebral discs
  • Chronic inflammation
  • Cytokines
  • Neutrophils
  • Disc degeneration
  • Modic changes