Low back pain patients with Modic type 1 changes exhibit distinct bacterial and non-bacterial subtypes
I Heggli1,2, T Mengis1,2, C J Laux3
1Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Osteoarthritis and Cartilage Open
|February 7, 2024
Summary
Modic type 1 changes in chronic low back pain may have two subtypes: bacterial, indicated by high Cutibacterium acnes, and non-bacterial, with low C. acnes. This discovery suggests distinct treatment approaches are needed for these chronic low back pain subtypes.
Area of Science:
- Spinal imaging and pathology
- Microbiology of bone marrow lesions
- Immunology of chronic pain
Background:
- Modic type 1 changes (MC1) are bone marrow lesions in chronic low back pain (CLBP) patients with unknown causes.
- Current treatments for MC1 do not address underlying pathomechanisms.
- A hypothesis suggests two biological subtypes of MC1 exist: bacterial and non-bacterial.
Purpose of the Study:
- To investigate the potential existence of bacterial and non-bacterial subtypes within Modic type 1 changes.
- To determine if Cutibacterium acnes (C. acnes) is associated with different immune responses in MC1 lesions.
- To inform the development of targeted treatments for CLBP patients with MC1.
Main Methods:
- Quantification of C. acnes genome copy numbers (GCNs) in intervertebral disc (IVD) tissues adjacent to MC1 and control vertebrae using 16S qPCR.
- Transcriptomic and cytokine profile analysis of bone marrow (BM) in MC1 and control groups via RNA sequencing and immunoassay.
- Assessment of the association between C. acnes GCNs and blood plasma cytokine levels.
Main Results:
- MC1-adjacent IVD tissues exhibited either low (<870) or high (>870) C. acnes GCNs.
- MC1 patients with high C. acnes showed upregulated innate immune signatures and pro-inflammatory cytokines in BM.
- MC1 patients with low C. acnes displayed increased adaptive immune signatures and elevated IL-13 in blood plasma.
Conclusions:
- This study provides the first evidence for distinct bacterial (C. acnes high) and non-bacterial (C. acnes low) subtypes in Modic type 1 changes in CLBP patients.
- The findings support the hypothesis of two MC1 subtypes, each associated with different immune responses.
- Differentiation of MC1 subtypes is crucial for developing targeted and effective treatment strategies for chronic low back pain.
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