Identification of Biomarkers and Molecular Targets Involved on Intervertebral Disc Degeneration and Discogenic Pain

Development of New Diagnostic, Prognostic and Therapeutic Strategies in the Field of Degenerative Disc Disease: Identification of Biomarkers and Molecular Targets Involved in Discogenic Pain and Neuroinflammation

Low back pain, associated with intrinsic disorders of the spine, is a very frequent clinical condition that is accompanied by high morbidity with effects both on psychosocial aspects, and health care system. It occurs in approximately 80% of the population throughout their lives. Most low back pain is associated with intervertebral disc degeneration (IDD) associated with neuroinflammation and pain. In this context, the study of sphingolipid metabolism can play an important role in the identification of new molecules responsible for the degenerative process. Sphingolipids, in fact, are a class of molecules that are implicated in multiple signal pathways, such as proliferation, degradation of the extracellular matrix, inflammatory state, apoptosis and migration. In particular, sphingosine-1-phosphate (S1P), an intermediate of sphingolipid metabolism, acts as a pro-inflammatory mediator, predominantly in the extracellular environment, regulating important cellular properties related to inflammatory potential and pain. The objective of this study is to characterize the degenerative process in cells isolated from degenerated human intervertebral discs from both at cellular and molecular levels in order to identify new targets implicated in degenerative processes, including sphingolipid signaling pathway.

Study Overview

• Status: Recruiting
• Conditions: Intervertebral Disc Degeneration; Discogenic Pain; Discogenic Disease
• Intervention / Treatment: Other: cell isolation from intervertebral disc tissue and biomarker investigation

Detailed Description

Low back pain (LBP) is a serious public health problem and has been identified as the most widespread cause of disability worldwide by the 2013 Global Burden of Disease Study. It is estimated that in the Western world the annual incidence of acute low back pain is 5% in adults and that the lifetime prevalence is 80%. Although different anatomical structures can be implicated in the generation of LBP, in many cases this is associated with the degeneration of the intervertebral disc (IVD). IVD degeneration (IDD) represents a chronic age-related process, characterized by a progressive reduction in the content of proteoglycans and water in the nucleus pulposus (NP) with the subsequent loss of the ability of the disc to respond to compressive forces with the possible appearance of instability. Furthermore, this degenerative process is accompanied by the development of a highly inflammatory microenvironment which contributes to exacerbating the degenerative process, leading to the progressive structural failure of the disc itself and in most cases, to pain. From these premises, arises the need to better investigate all the cell-mediated mechanisms underlying IDD, to identify and develop new therapies aimed at recovering the IVD and reducing pain.

In this context, sphingolipids, a class of molecules responsible for multiple signal pathways such as proliferation, migration, apoptosis and angiogenesis, appear to play a key role in exacerbating the inflammatory process and degradation of the extracellular matrix in conditions of IDD. Sphingosine-1-phosphate (S1P) is an intermediate of sphingolipid metabolism, formed from sphingosine through the action of sphingosine kinases (SphK1, SphK2). Increasing evidence suggests that S1P acts as a pro-inflammatory signal, predominantly in the extracellular environment, regulating important cellular properties correlated with the inflammatory potential on chondrocyte-like cells. It has been reported that an alteration in the production and secretion of these molecules is capable of increasing the inflammatory and degenerative condition in various pathologies related to neuroinflammation and pain. The aim of the project is to define new disease biomarkers and characterize the degenerative process in cells isolated from degenerated human intervertebral discs from both at cellular and molecular levels in order to identify new targets implicated in degenerative processes, including sphingolipid signaling pathway. Secondary objective is the analysis of the effectiveness of the modulation of sphingolipid metabolism and the in vitro testing of molecules with therapeutic potential.

A greater understanding of the events implicated in the pathogenesis of IDD both at macroscopic and microscopic levels, is of fundamental importance for the development of new diagnostic tools, to be combined with current therapeutic strategies.

• Study Type: Observational
• Enrollment (Estimated): 160

Contacts and Locations

• Study Contact: Name: Giovanni Marfia, MD, PhD; Phone Number: +39 0255034268; Email: giovanni.marfia@policlinico.mi.it
• Study Contact Backup: Name: Stefania Navone, PhD; Phone Number: +39 0255034268; Email: stefania.navone@policlinico.mi.it

Study Locations

• Italy
  • Milan, Italy, 20122
    • Recruiting
    • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
    • Contact: Giovanni Marfia, MD, Phd; Phone Number: +39 0255035502; Email: giovanni.marfia@policlinico.mi.it
    • Contact: Stefania E Navone, PhD; Phone Number: +39 0255034268; Email: stefania.navone@policlinico.mi.it
    • Principal Investigator: Mauro Pluderi, MD
    • Sub-Investigator: Giovanni Marfia, MD, PhD
    • Sub-Investigator: Stefania E Navone, PhD
    • Sub-Investigator: Laura Guarnaccia, PhD
    • Sub-Investigator: Laura Begani, MSc
    • Sub-Investigator: Marco Locatelli, Md, PhD
    • Sub-Investigator: Stefano Borsa, MD
    • Sub-Investigator: Giulio Bertani, MD
    • Sub-Investigator: Claudia Fanizzi, MD
    • Sub-Investigator: Giorgio Fiore, MD
    • Sub-Investigator: Luigi Schisano, MD
    • Sub-Investigator: Manuela Caroli, MD
    • Sub-Investigator: Antonella Ampollini, MD
    • Sub-Investigator: Elena Pirola, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients who underwent the surgery of discectomy for the degenerative disc.

Description

Inclusion Criteria:

• Patients with disc degeneration for spondylolisthesis, herniated intervertebral disc, and other causes of disc degeneration

Exclusion Criteria:

• Spinal infection

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Characterization of degenerated intervertebral disc cells	Determination of a panel of inflammatory and degenerated markers related to components of the extracellular matrix and mediators linked to inflammatory/degenerative processes, hyperinnervation and sphingolipid metabolism.	through study completion, an average of 3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Development of cellular model platform	Creation of a cellular platform based on patient-derived intervertebral disc cells; assessment of inflammatory and degenerative markers linked to alteration of sphingolipid metabolism; determination of a panel of inflammatory cytokines related to degenerative process, neuro-inflammation and pain; evaluation of prognostic and predictive markers related to disc degeneration.	through study completion, an average of 3 years

Collaborators and Investigators

• Sponsor: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
• Investigators: Study Director: Marco Locatelli, MD, PhD, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurosurgery Unit; Principal Investigator: Mauro Pluderi, MD, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Neurosurgery Unit; Study Chair: Giovanni Marfia, MD, PhD, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Neurosurgery Unit, Istituto di Medicina Aerospaziale di Milano, CeMATA - Aeronautica Militare

Publications and helpful links

General Publications

• Marfia G, Guarnaccia L, Navone SE, Ampollini A, Balsamo M, Benelli F, Gaudino C, Garzia E, Fratocchi C, Di Murro C, Ligarotti GK, Campanella C, Landolfi A, Perelli P, Locatelli M, Ciniglio Appiani G. Microgravity and the intervertebral disc: The impact of space conditions on the biomechanics of the spine. Front Physiol. 2023 Mar 14;14:1124991. doi: 10.3389/fphys.2023.1124991. eCollection 2023.
• Navone SE, Campanella R, Guarnaccia L, Ouellet JA, Locatelli M, Cordiglieri C, Gualtierotti R, Gaudino C, Ciniglio Appiani G, Luzzi S, Borsa S, Rampini P, Pluderi M, Haglund L, Riboni L, Alini M, Marfia G. Inflammatory interactions between degenerated intervertebral discs and microglia: Implication of sphingosine-1-phosphate signaling. J Orthop Res. 2021 Jul;39(7):1479-1495. doi: 10.1002/jor.24827. Epub 2020 Aug 24.
• Navone SE, Peroglio M, Guarnaccia L, Beretta M, Grad S, Paroni M, Cordiglieri C, Locatelli M, Pluderi M, Rampini P, Campanella R, Alini M, Marfia G. Mechanical loading of intervertebral disc modulates microglia proliferation, activation, and chemotaxis. Osteoarthritis Cartilage. 2018 Jul;26(7):978-987. doi: 10.1016/j.joca.2018.04.013. Epub 2018 May 1.
• Navone SE, Marfia G, Giannoni A, Beretta M, Guarnaccia L, Gualtierotti R, Nicoli D, Rampini P, Campanella R. Inflammatory mediators and signalling pathways controlling intervertebral disc degeneration. Histol Histopathol. 2017 Jun;32(6):523-542. doi: 10.14670/HH-11-846. Epub 2016 Nov 16.
• Marfia G, Campanella R, Navone SE, Zucca I, Scotti A, Figini M, Di Vito C, Alessandri G, Riboni L, Parati E. Potential use of human adipose mesenchymal stromal cells for intervertebral disc regeneration: a preliminary study on biglycan-deficient murine model of chronic disc degeneration. Arthritis Res Ther. 2014 Oct 8;16(5):457. doi: 10.1186/s13075-014-0457-5.
• Marfia G, Navone SE, Di Vito C, Tabano S, Giammattei L, Di Cristofori A, Gualtierotti R, Tremolada C, Zavanone M, Caroli M, Torchia F, Miozzo M, Rampini P, Riboni L, Campanella R. Gene expression profile analysis of human mesenchymal stem cells from herniated and degenerated intervertebral discs reveals different expression of osteopontin. Stem Cells Dev. 2015 Feb 1;24(3):320-8. doi: 10.1089/scd.2014.0282. Epub 2014 Oct 29.

Helpful Links

• website Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Study record dates

Study Major Dates

• Study Start (Actual): May 22, 2018
• Primary Completion (Estimated): May 21, 2025
• Study Completion (Estimated): May 21, 2025

Study Registration Dates

• First Submitted: March 21, 2024
• First Submitted That Met QC Criteria: March 29, 2024
• First Posted (Actual): April 5, 2024

Study Record Updates

• Last Update Posted (Actual): April 5, 2024
• Last Update Submitted That Met QC Criteria: March 29, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: biomarkers; neuroinflammation; discogenic pain; sphingolipids; intervertebral disc degeneration; iperinnervation; sphingosine-1 phosphate
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Spinal Diseases; Bone Diseases; Intervertebral Disc Degeneration
• Other Study ID Numbers: DISCOLAB

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No