To document the role of sub-clinical infections in disc disorders and investigate the existence of microbiome in intervertebral discs (IVD).
Genomic DNA from 24 lumbar IVDs [8—MRI normal discs (ND) from brain dead yet alive organ donors, 8—disc herniation (DH), 8—disc degeneration (DD)] was subjected to 16SrRNA sequencing for profiling the diversity of human disc microbiome in health and disease. The disc microbiome was further compared to established human gut and skin microbiomes.
All healthy MRI normal discs from brain dead yet alive organ donors also had a rich bacterial presence. A total of 424 different species (355-ND, 346-DD, and 322-DH) were detected, with 42.75% OTUs being classified at kingdom level, 44% at the phylum level, 22.62% at genus level, and 5.5% at species level. Varying biodiversity and abundance between healthy and diseased discs were documented with protective bacteria being abundant in normal discs, and putative pathogens abundant in DD and DH. Propionibacterium acnes had a similar but lower abundance to other pathogens in all three groups ND (3.07%), DD (3.88%), DH (1.56%). Fifty-eight bacteria were common between gut and IVD microbiomes, 29 between skin and IVD microbiomes, and six common to gut/skin/IVD.
Our study challenges the hitherto concept of sterility in healthy IVD and documented a microbiome even in MRI normal healthy discs. The varying abundance of bacteria between ND, DD, and DH documents ‘dysbiosis’ as a possible etiology of DD. Many known pathogens were identified in greater abundance than Propionibacterium acnes, and there was evidence for the presence of the gut/skin/spine microbiome axis.
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- 16S rRNA:
16 (Svedberg) ribosomal ribonucleic acid
Ribosomal subunit contains 16S rRNA
Data analysis decision and action
Deoxyribose nucleic acid
Green GENES database version 138
Intuitional Review Board
Low back pain
Software search engine to identify proteins uses MOWSE algorithm
Magnetic resonance imaging
Tandem mass spectrometry
- MW test:
Operational taxonomic unit
Phylogenetic investigation of communities by reconstruction of unobserved states
Quantitative insights into microbial ecology
- R packages:
Statistical tool designed by Ross Ihaka and Robert gentleman
- Sequest HT:
Tandem mass spectrometric data analysis program used for protein identification
Statistical analysis of taxonomic and functional profiles
Testing hypotheses on the mean of the normal distribution
Nine hypervariable regions
Transplant authority government of Tamil Nadu, India
Revolutions per minute
Sodium dodecyl sulphate polyacrylamide gel electrophoresis
Statistical package for the social sciences
Parts per million
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The corresponding author has full access to the data analysed in this study and holds all responsibilities towards the submission of this article. We acknowledge the receipt of grants from the Ganga Orthopaedic Research & Education Foundation (GOREF 2018-08) and AO Spine (AOSIN(R) 2017-04). All authors contributed equally to the preparation of this manuscript. We acknowledge the efforts taken by all the authors equally in preparing this manuscript and also thank GOREF for funding the project.
The project was mainly funded by Ganga Orthopaedic Research & Education Foundation (GOREF 2018-08) and partially by the AO Spine (AOSIN(R) 2017-04).
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The authors declare that they have no conflict of interest.
The study was performed only after approval of the IRB committee.
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Rajasekaran, S., Soundararajan, D.C.R., Tangavel, C. et al. Human intervertebral discs harbour a unique microbiome and dysbiosis determines health and disease. Eur Spine J 29, 1621–1640 (2020). https://doi.org/10.1007/s00586-020-06446-z
- Disc degeneration
- Sub-clinical infection