Geiss Andrea, Sobottke Rolf, Delank Karl Stefan, Eysel Peer
Department of Psychology, Biological Psychology, University of Cologne, Bernhard-Feilchenfeld-Straße 11, 50969, Cologne, Germany.
Department of Orthopaedic Surgery, Medizinisches Zentrum StädteRegion Aachen, Mauerfeldchen 25, 52146, Würselen, Germany.
Eur Spine J. 2016 May;25(5):1417-1427. doi: 10.1007/s00586-015-4325-z. Epub 2016 Feb 23.
Herniated nucleus pulposus has been considered to induce an adaptive immune response. Antigen recognition by antigen-presenting-cells (APCs) represents an important step within manifestation of an adaptive immune response. Macrophages have been assumed to function as APC, while importance of plasmacytoid dendritic cells for initiation of an immune response directed towards herniated nucleus pulposus has never been examined. The aim of the present study was to assess importance of plasmacytoid dendritic cells for initiation of immune response directed towards herniated discs.
Fifteen patients with true sequestrations and three patients with subligamentous sequestrations underwent surgery after their neurological examinations. Disc material was harvested, weighted and digested for 90 min. Separated single cells were counted, stained for plasmacytoid dendritic cells (CD123(+)CD4(+)), macrophages (CD14(+)CD11c(+)) and memory T cells (CD4(+)CD45RO(+)) and analysed by flow cytometry. Both patient groups were compared in cell proportions. Furthermore, patients with true sequestrations (TRUE patients) were subdivided into subgroups based on severity of muscle weakness and results in straight leg raising (SLR) test. Subgroups were compared in cell proportions.
Plasmacytoid dendritic cells and memory T cells infiltrated true sequestrations stronger than the subligamentous sequestration and plasmacytoid dendritic cells predominated over macrophages in true sequestrations. Highest proportions of plasmacytoid dendritic cells were detected in infiltrates of patients having true sequestrations, severe muscle weakness and negative result in SLR test.
The findings of the present study indicate that plasmacytoid dendritic cells are involved in initiation of an immune response directed towards herniated nucleus pulposus, while macrophages may reinforce the manifested immune response and mediate disc resorption.
髓核突出被认为可引发适应性免疫反应。抗原呈递细胞（APC）对抗原的识别是适应性免疫反应表现过程中的重要一步。巨噬细胞被假定发挥抗原呈递细胞的作用，而浆细胞样树突状细胞在引发针对髓核突出的免疫反应中的重要性从未被研究过。本研究的目的是评估浆细胞样树突状细胞在引发针对椎间盘突出的免疫反应中的重要性。
15例真性游离型和3例韧带下游离型患者在进行神经学检查后接受手术。采集椎间盘组织，称重并消化90分钟。对分离出的单个细胞进行计数，用浆细胞样树突状细胞（CD123(+)CD4(+)）、巨噬细胞（CD14(+)CD11c(+)）和记忆T细胞（CD4(+)CD45RO(+)）进行染色，然后通过流式细胞术进行分析。比较两组患者的细胞比例。此外，将真性游离型患者（真性患者）根据肌肉无力的严重程度和直腿抬高（SLR）试验结果分为亚组。比较各亚组的细胞比例。
浆细胞样树突状细胞和记忆T细胞在真性游离型中的浸润程度强于韧带下游离型，且在真性游离型中浆细胞样树突状细胞多于巨噬细胞。在真性游离型、肌肉无力严重且SLR试验结果为阴性的患者浸润物中检测到最高比例的浆细胞样树突状细胞。
本研究结果表明，浆细胞样树突状细胞参与了针对髓核突出的免疫反应的启动，而巨噬细胞可能增强已表现出的免疫反应并介导椎间盘吸收。
