TY - JOUR
T1 - Immune-inflammatory and hypothalamic-pituitary-adrenal axis biomarkers are altered in patients with non-specific low back pain
T2 - A systematic review
AU - Sanabria-Mazo, Juan P.
AU - Colomer-Carbonell, Ariadna
AU - Carmona-Cervelló, Meritxell
AU - Feliu-Soler, Albert
AU - Borràs, Xavier
AU - Grasa, Mar
AU - Esteve, Montserrat
AU - Maes, Michael
AU - Edo, Sílvia
AU - Sanz, Antoni
AU - Luciano, Juan V.
N1 - Funding Information:
This work was supported by the Institute of Health Carlos III (ISCIII; PI19/00112) cofinanced with European Union ERDF funds. JS-M has a PFIS predoctoral contract from the ISCIII (FI20/00034). AC-C has a FI predoctoral contract from AGAUR (FI_B/00216). AF-S acknowledges the funding from the Serra Húnter program (Generalitat de Catalunya; reference number UAB-LE-8015). The funding sources and sponsors had no influence on the design of the study, data collection and analysis, or the writing of the manuscript.
Publisher Copyright:
Copyright © 2022 Sanabria-Mazo, Colomer-Carbonell, Carmona-Cervelló, Feliu-Soler, Borràs, Grasa, Esteve, Maes, Edo, Sanz and Luciano.
PY - 2022/9/2
Y1 - 2022/9/2
N2 - This systematic review aimed to investigate immune-inflammatory and hypothalamic-pituitary-adrenal (HPA) axis biomarkers in individuals with non-specific low back pain (NSLBP) compared to healthy control. The search was performed in five databases until 4 November 2021. Two reviewers independently conducted screenings, data extraction, risk of bias, and methodological quality assessment of 14 unique studies. All studies reported the source of the fluid analyzed: nine studies used serum, two used plasma, one used serum and plasma, and two studies used salivary cortisol. We found preliminary and limited evidence (only one study for each biomarker) of increased levels in growth differentiation factor 15 (GDF-15), interleukin-23 (IL-23), transforming growth factor–beta (TGF-β), and soluble tumor necrosis factor receptor 1 (sTNF-R1) in NSLBP. Inconsistent and limited evidence was identified for interleukin-10 (IL-10). Although C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor–alpha (TNF-α) levels appear to increase in NSLBP, only one study per each biomarker reported statistically significant differences. Interleukin-1 beta (IL-1β), interleukin-17 (IL-17), interferon gamma (IFN-γ), and high-sensitivity CRP (hsCRP) showed no significant differences. Regarding cortisol, one study showed a significant increase and another a significant decrease. More robust evidence between GDF-15, IL-23, TGF-β, and sTNF-R1 with NSLBP is needed. Moreover, contrary to the findings reported in previous studies, when comparing results exclusively with healthy control, insufficient robust evidence for IL-6, TNF-α, and CRP was found in NSLBP. In addition, cortisol response (HPA-related biomarker) showed a dysregulated functioning in NSLBP, with incongruent evidence regarding its directionality. Therefore, our effort is to find adjusted evidence to conclude which immune-inflammatory and HPA axis biomarkers are altered in NSLBP and how much their levels are affected. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176153, identifier CRD42020176153.
AB - This systematic review aimed to investigate immune-inflammatory and hypothalamic-pituitary-adrenal (HPA) axis biomarkers in individuals with non-specific low back pain (NSLBP) compared to healthy control. The search was performed in five databases until 4 November 2021. Two reviewers independently conducted screenings, data extraction, risk of bias, and methodological quality assessment of 14 unique studies. All studies reported the source of the fluid analyzed: nine studies used serum, two used plasma, one used serum and plasma, and two studies used salivary cortisol. We found preliminary and limited evidence (only one study for each biomarker) of increased levels in growth differentiation factor 15 (GDF-15), interleukin-23 (IL-23), transforming growth factor–beta (TGF-β), and soluble tumor necrosis factor receptor 1 (sTNF-R1) in NSLBP. Inconsistent and limited evidence was identified for interleukin-10 (IL-10). Although C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor–alpha (TNF-α) levels appear to increase in NSLBP, only one study per each biomarker reported statistically significant differences. Interleukin-1 beta (IL-1β), interleukin-17 (IL-17), interferon gamma (IFN-γ), and high-sensitivity CRP (hsCRP) showed no significant differences. Regarding cortisol, one study showed a significant increase and another a significant decrease. More robust evidence between GDF-15, IL-23, TGF-β, and sTNF-R1 with NSLBP is needed. Moreover, contrary to the findings reported in previous studies, when comparing results exclusively with healthy control, insufficient robust evidence for IL-6, TNF-α, and CRP was found in NSLBP. In addition, cortisol response (HPA-related biomarker) showed a dysregulated functioning in NSLBP, with incongruent evidence regarding its directionality. Therefore, our effort is to find adjusted evidence to conclude which immune-inflammatory and HPA axis biomarkers are altered in NSLBP and how much their levels are affected. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176153, identifier CRD42020176153.
KW - cortisol
KW - cytokines
KW - hypothalamic-pituitary-adrenal axis
KW - immune-inflammatory biomarkers
KW - non-specific low back pain
UR - http://www.scopus.com/inward/record.url?scp=85138160327&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fimmu.2022.945513
DO - https://doi.org/10.3389/fimmu.2022.945513
M3 - Review article
C2 - 36119028
AN - SCOPUS:85138160327
SN - 1664-3224
VL - 13
SP - 1
EP - 14
JO - Frontiers in immunology
JF - Frontiers in immunology
M1 - 945513
ER -