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. 2023 May;41(5):1115-1122.
doi: 10.1002/jor.25437. Epub 2022 Sep 14.

Role of C-reactive protein in the bone marrow of Modic type 1 changes

Stefan Dudli  1   2   3 , Irina Heggli  1   3 , Christoph J Laux  4 , José M Spirig  4 , Florian Wanivenhaus  4 , Michael Betz  4 , Christoph Germann  5 , Nadja A Farshad-Amacker  5 , Nick Herger  1   3 , Tamara Mengis  1   3 , Florian Brunner  3 , Mazda Farshad  4 , Oliver Distler  1   3
Affiliations

Role of C-reactive protein in the bone marrow of Modic type 1 changes

Stefan Dudli et al. J Orthop Res. 2023 May.

Abstract

Modic type 1 changes (MC1) are vertebral bone marrow lesions and associate with low back pain. Increased serum C-reactive protein (CRP) has inconsistently been associated with MC1. We aimed to provide evidence for the role of CRP in the tissue pathophysiology of MC1 bone marrow. From 13 MC1 patients undergoing spinal fusion at MC1 levels, vertebral bone marrow aspirates from MC1 and intrapatient control bone marrow were taken. Bone marrow CRP, interleukin (IL)-1, and IL-6 were measured with enzyme-linked immunosorbent assays; lactate dehydrogenase (LDH) was measured with a colorimetric assay. CRP, IL-1, and IL-6 were compared between MC1 and control bone marrow. Bone marrow CRP was correlated with blood CRP and with bone marrow IL-1, IL-6, and LDH. CRP expression by marrow cells was measured with a polymerase chain reaction. Increased CRP in MC1 bone marrow (mean difference: +0.22 mg CRP/g, 95% confidence interval [CI] [-0.04, 0.47], p = 0.088) correlated with blood CRP (r = 0.69, p = 0.018), with bone marrow IL-1β (ρ = 0.52, p = 0.029) and IL-6 (ρ = 0.51, p = 0.031). Marrow cells did not express CRP. Increased LDH in MC1 bone marrow (143.1%, 95% CI [110.7%, 175.4%], p = 0.014) indicated necrosis. A blood CRP threshold of 3.2 mg/L detected with 100% accuracy increased CRP in MC1 bone marrow. In conclusion, the association of CRP with inflammatory and necrotic changes in MC1 bone marrow provides evidence for a pathophysiological role of CRP in MC1 bone marrow.

Keywords: C-reactive protein; Modic changes; biomarker; low back pain.

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Figures

FIGURE 1
FIGURE 1
Blood and bone marrow CRP concentrations in MC1 patients. (A) CRP concentration is higher in Modic type 1 change bone marrow compared to intrapatient control bone marrow. CRP concentrations normalized to total protein concentrations are indicated. (B) Blood CRP concentration correlates with bone marrow CRP. (C) Blood CRP concentration correlates with increased CRP in Modic type 1 change bone marrow plasma. Gray shadow indicates 95% confidence interval. A blood CRP threshold of 3.2–3.8 mg/L (red line) detects with 100% accuracy increased CRP concentrations in MC1 bone marrow. CRP, C-reactive protein; MC1, Modic type 1 change.
FIGURE 2
FIGURE 2
Correlation of bone marrow CRP with bone marrow (A) IL- 1β and (B) IL-6. Gray areas indicate 95% confidence intervals. CRP, C-reactive protein; IL, interleukin.
See this image and copyright information in PMC

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