Importance of Propionibacterium acnes hemolytic activity in human intervertebral discs: A microbiological study

Abstract

Most patients with chronic lower back pain (CLBP) exhibit degenerative disc disease. Disc specimens obtained during initial therapeutic discectomies are often infected/colonized with Propionibacterium acnes, a Gram-positive commensal of the human skin. Although pain associated with infection is typically ascribed to the body’s inflammatory response, the Gram-positive bacterium Staphylococcus aureus was recently observed to directly activate nociceptors by secreting pore-forming α-hemolysins that disrupt neuronal cell membranes. The hemolytic activity of P. acnes in cultured disc specimens obtained during routine therapeutic discectomies was assessed through incubation on sheep-blood agar. The β-hemolysis pattern displayed by P. acnes on sheep-blood agar was variable and phylogroup-dependent. Their molecular phylogroups were correlated with their hemolytic patterns. Our findings raise the possibility that pore-forming proteins contribute to the pathogenesis and/or symptomology of chronic P. acnes disc infections and CLBP, at least in a subset of cases.

Colonization of intervertebral discs by Cutibacterium acnes in patients with low back pain: Protocol for an analytical study with microbiological, phenotypic, genotypic, and multiomic techniques

“…Colonization of LIVD by C . acnes in patients with LDD supports the bacterial hypothesis of LBP [ 4 , 8 , 29 , 45 – 47 ]. The determination of a molecular profile for these patients will not only contribute to a better understanding of the pathophysiological basis of LBP associated with LDD [ 41 – 43 ], but it will also positively interfere in the clinical management of this common condition, rationalizing its treatment and optimizing its costs.…”

Colonization of intervertebral discs byCutibacterium acnesin patients with low back pain: protocol for an analytical study with microbiological, phenotypic, genotypic, and multiomic techniques

“…Colonization of LIVD by C. acnes in patients with LDD supports the bacterial hypothesis of LBP (4,8,29,(45)(46)(47). The determination of a molecular profile for these patients will not only contribute to a better understanding of the pathophysiological (41)(42)(43), but it will also positively interfere in the clinical management of this common condition, rationalizing its treatment and optimizing its costs.…”

Bacterial toxins in musculoskeletal infections

“…There is a possibility that pore‐forming toxin, like the α‐hemolysin of S. aureus , contributes to the pathogenesis and/or symptomatology of chronic C. acnes vertebral disc infections. Hyperhemolysis on blood agar has been proposed as a microbiological marker for MSKIs 58‐61 …”