ArticleResearch square2026
Blood immune profiles in chronic low back pain patients with type 1 Modic changes are associated with intradiscal propionic acid levels.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Background: Modic type 1 changes (MC1) are vertebral endplate bone marrow lesions associated with chronic low back pain (CLBP), but their underlying pathobiology remains unclear. Disc-bone marrow crosstalk that includes Methods: In a prospective analysis of patients from the UCSF comeBACK cohort, we quantified intradiscal propionic acid (PA) - a metabolic product of Results: High intradiscal PA was associated with distinct systemic immune responses in patients with MC1 but not in patients with Modic type 2 changes or without Modic changes. Transcriptomic analysis revealed enrichment of adaptive immune pathways and B cell activation signatures in PA-high MC1. Flow cytometry identified the expansion of immunosuppressive ectonucleotidases CD39 and CD73-expressing B cells in PA-high MC1 patients. Finally, intradiscal PA levels were correlated with circulating B cells and serum cytokine concentrations. Conclusions: Intradiscal PA levels measured by MRS associate with biologically distinct blood profiles characterised by systemic B cell activation in patients with MC1. These findings suggest a systemic immune component in the pathobiology of MC1 and highlight the potential of MRS-derived intradiscal PA levels to stratify patients with MC1-related chronic low back pain into biologically distinct subgroups.
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