慢性椎间盘源性下腰痛的生物分子疗法:一项叙述性综述。
Biomolecular therapies for chronic discogenic low back pain: A narrative review.
作者信息
Rudnik-Jansen Imke, van Kruining Kodele Sanda, Creemers Laura, Joosten Bert
机构信息
Department of Anesthesiology and Pain Management Maastricht University Medical Center (MUMC+) Maastricht the Netherlands.
Department of Translational Neuroscience, School of Mental Health and Neuroscience (MHeNs) University of Maastricht Maastricht the Netherlands.
出版信息
JOR Spine. 2024 Aug 6;7(3):e1345. doi: 10.1002/jsp2.1345. eCollection 2024 Sep.
Chronic low back pain caused by intervertebral disc (IVD) degeneration, also termed chronic discogenic low back pain (CD-LBP), is one of the most prevalent musculoskeletal diseases. Degenerative processes in the IVD, such as inflammation and extra-cellular matrix breakdown, result in neurotrophin release. Local elevated neurotrophin levels will stimulate sprouting and innervation of sensory neurons. Furthermore, sprouted sensory nerves that are directly connected to adjacent dorsal root ganglia have shown to increase microglia activation, contributing to the maintenance and chronification of pain. Current pain treatments have shown to be insufficient or inadequate for long-term usage. Furthermore, most therapeutic approaches aimed to target the underlying pathogenesis of disc degeneration focus on repair and regeneration and neglect chronic pain. How biomolecular therapies influence the degenerative IVD environment, pain signaling cascades, and innervation and excitability of the sensory neurons often remains unclear. This review addresses the relatively underexplored area of chronic pain treatment for CD-LBP and summarizes effects of therapies aimed for CD-LBP with special emphasis on chronic pain. Approaches based on blocking pro-inflammatory mediators or neurotrophin activity have been shown to hamper neuronal ingrowth into the disc. Furthermore, the tissue regenerative and neuro inhibitory properties of extracellular matrix components or transplanted mesenchymal stem cells are potentially interesting biomolecular approaches to not only block IVD degeneration but also impede pain sensitization. At present, most biomolecular therapies are based on acute IVD degeneration models and thus do not reflect the real clinical chronic pain situation in CD-LBP patients. Future studies should aim at investigating the effects of therapeutic interventions applied in chronic degenerated discs containing established sensory nerve ingrowth. The in-depth understanding of the ramifications from biomolecular therapies on pain (chronification) pathways and pain relief in CD-LBP could help narrow the gap between the pre-clinical bench and clinical bedside for novel CD-LBP therapeutics and optimize pain treatment.
由椎间盘(IVD)退变引起的慢性下腰痛,也称为慢性盘源性下腰痛(CD-LBP),是最常见的肌肉骨骼疾病之一。IVD中的退变过程,如炎症和细胞外基质分解,会导致神经营养因子释放。局部神经营养因子水平升高会刺激感觉神经元的发芽和神经支配。此外,直接连接到相邻背根神经节的发芽感觉神经已显示会增加小胶质细胞的激活,从而导致疼痛的维持和慢性化。目前的疼痛治疗方法已证明长期使用不足或不充分。此外,大多数旨在针对椎间盘退变潜在发病机制的治疗方法都侧重于修复和再生,而忽视了慢性疼痛。生物分子疗法如何影响退变的IVD环境、疼痛信号级联以及感觉神经元的神经支配和兴奋性往往仍不清楚。本综述探讨了CD-LBP慢性疼痛治疗中相对未被充分探索的领域,并总结了针对CD-LBP的治疗效果,特别强调慢性疼痛。基于阻断促炎介质或神经营养因子活性的方法已显示会阻碍神经元长入椎间盘。此外,细胞外基质成分或移植的间充质干细胞的组织再生和神经抑制特性是潜在有趣的生物分子方法,不仅可以阻止IVD退变,还可以阻碍疼痛致敏。目前,大多数生物分子疗法基于急性IVD退变模型,因此不能反映CD-LBP患者实际的临床慢性疼痛情况。未来的研究应旨在研究在含有已建立感觉神经长入的慢性退变椎间盘中应用治疗干预的效果。深入了解生物分子疗法对CD-LBP疼痛(慢性化)途径和疼痛缓解的影响,有助于缩小新型CD-LBP治疗方法在临床前实验台和临床床边之间的差距,并优化疼痛治疗。