Melatonin and the intervertebral disc: a potential intervention for lower back pain?

Melatonin and the intervertebral disc

  • Christopher File John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
  • Ramaswamy Sharma School of Osteopathic Medicine, University of the Incarnate Word, 7615 Kennedy Hill Drive, San Antonio, TX 78235, USA
Keywords: Melatonon, Intervertebral disc, reactive oxygen species, senescence, inflammation

Abstract

Lower back pain is a common disability associated with aging that continues to carry a huge economic and health burden globally. Importantly, lower back pain is strongly associated with diseases involving intervertebral discs (IVDs), and many of the treatment options for the repair and maintenance of the IVDs are insufficient. Being a well-tolerated and endogenously produced molecule, melatonin is a suitable candidate for the treatment and prevention of a wide variety of skeletal conditions. In this review, we have evaluated current updates regarding melatonin’s activities in IVD degenerative disease and discuss multiple mechanisms related to its effects on inflammation, oxidative stress, autophagy and senescence that contribute towards its support of the IVDs as well as its benefits in the treatment of IVD disease.


References

1. Wu A, et al. (2020) Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann. Transl. Med. 8: 299.
2. Chen S, et al. (2021) Global, regional and national burden of low back pain 1990–2019: A systematic analysis of the Global Burden of Disease study 2019. J. Orthop. Translat. 32: 49-58.
3. Dieleman JL, et al. (2020) US health care spending by payer and health condition, 1996-2016. JAMA 323: 863.
4. Dutmer AL, et al. (2019) Personal and societal impact of low back pain: The groningen spine cohort. Spine 44: E1443.
5. Brinjikji W, et al. (2015) MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. AJNR Am. J. Neuroradiol. 36: 2394-2399.
6. Mohd IIL, et al. (2023) Discogenic low back pain: anatomy, pathophysiology and treatments of intervertebral disc degeneration. Int. J. of Mol. Sci. 24: 208.
7. Lu X, et al. (2021) Insight into the roles of melatonin in bone tissue and bone‑related diseases (Review). Int. J. Mol. Med. 47: 82.
8. Reiter RJ, et al. (2019) Melatonin: Protection of the Intervertebral Disc. Melatonin Res. 2: 1-9.
9. Xie W, et al. (2021) Melatonin: Effects on cartilage homeostasis and therapeutic prospects in cartilage-related diseases. Aging Dis. 12: 297-307.
10. Alonso F, et al. (2014) "Intervertebral Disk" in Encyclopedia of the Neurological Sciences (Second Edition), Aminoff MJ, Daroff RB, Eds. (Academic Press, Oxford, 2014), https://doi.org/10.1016/B978-0-12-385157-4.01154-4, pp. 724-729.
11. Sharabi M (2022) Structural mechanisms in soft fibrous tissues: A review. Front. Materi. 8: 1-28.
12. Clouet J, et al. (2009) The intervertebral disc: From pathophysiology to tissue engineering. Joint, bone, spine 76: 614-618.
13. Singh K, et al. (2009) Age-related changes in the extracellular matrix of nucleus pulposus and anulus fibrosus of human intervertebral disc. Spine (Phila Pa 1976) 34: 10-16.
14. Iatridis JC, et al. (2005) Mechanical damage to the intervertebral disc annulus fibrosus subjected to tensile loading. J. Biomech. 38: 557-565.
15. Urban JPG, et al. (2003) Degeneration of the intervertebral disc. Arthritis Res. Ther. 5: 120.
16. Fields AJ, et al. (2018) Contribution of the endplates to disc degeneration. Cur.Mol. Biol. Rep: 4: 151-160.
17. Nerlich AG, et al. (2007) Temporo-spatial distribution of blood vessels in human lumbar intervertebral discs. Eur. Spine J. 16: 547-555.
18. Bernick S, et al. (1982) Vertebral end-plate changes with aging of human vertebrae. Spine 7: 97-102.
19. Dudek M, et al. (2017) The intervertebral disc contains intrinsic circadian clocks that are regulated by age and cytokines and linked to degeneration. Ann. Rheum. Dis. 76: 576-584.
20. Newell N, et al. (2017) Biomechanics of the human intervertebral disc: A review of testing techniques and results. J. Mech. Behav. Biomed. Mater. 69: 420-434.
21. Zhang T, et al. (2020) The circadian rhythm in intervertebral disc degeneration: an autophagy connection. Exp. Mol. Med. 52: 31-40.
22. Turgut M, et al. (2006) Surgical pinealectomy accelerates intervertebral disc degeneration process in chicken. Eur. Spine J. 15: 605-612.
23. Bian Q, et al. (2017) Mechanosignaling activation of TGFβ maintains intervertebral disc homeostasis. Bone Res. 5: 17008.
24. Latorre A, et al. (1998) Experimental model of multidirectional disc hernia in rats. Int. Orthop. 22: 44-48.
25. Turgut M, et al. (2006) The effect of exogenous melatonin administration on trabecular width, ligament thickness and TGF-β1 expression in degenerated intervertebral disk tissue in the rat. J. Clin. Neurosci. 13: 357-363.
26. Shen C, et al. (2020) Melatonin prevents the binding of vascular endothelial growth factor to its receptor and promotes the expression of extracellular matrix-associated genes in nucleus pulposus cells. Exp. Ther. Med. 20: 106.
27. Oh C, et al. (2016) SOX9 directly Regulates CTGF/CCN2 transcription in growth plate chondrocytes and in nucleus pulposus cells of intervertebral disc. Sci. Rep. 6: 29916.
28. Wang S. et al. (2013) Effects of TGF-β1 and IL-1β on expression of ADAMTS enzymes and TIMP-3 in human intervertebral disc degeneration. Exp. Ther. Med. 6: 1522-1526.
29. Yang H, et al. (2015) TGF-βl suppresses inflammation in cell therapy for intervertebral disc degeneration. Sci. Rep. 5: 13254.
30. Yang H, et al. (2015) TGF- β 1 antagonizes TNF- α induced up-regulation of matrix metalloproteinase 3 in nucleus pulposus cells: role of the ERK1/2 pathway. Connect. Tissue Res. 56: 461-468.
31. Ge J, et al. (2019) Melatonin protects intervertebral disc from degeneration by improving cell survival and function via activation of the ERK1/2 signaling pathway. Oxid. Med. Cell. Longev. 2019: 5120275.
32. Dou X, et al. (2023) Therapeutic potential of melatonin in the intervertebral disc degeneration through inhibiting the ferroptosis of nucleus pulpous cells. J. Cell. Mol. Med. 27: 2340-2353.
33. Feng C, et al. (2016) Disc cell senescence in intervertebral disc degeneration: Causes and molecular pathways. Cell Cycle 15: 1674-1684.
34. Roberts S, et al. (2006) Histology and pathology of the human intervertebral disc. J. Bone Joint Surg. Am. 88 Suppl 2: 10-14.
35. Li Z. et al. (2017) Melatonin inhibits nucleus pulposus (NP) cell proliferation and extracellular matrix (ECM) remodeling via the melatonin membrane receptors mediated PI3K-Akt pathway. J. Pineal Res. 63: e12435.
36. Qiu X. et al. (2022) Melatonin reverses tumor necrosis factor-alpha-induced metabolic disturbance of human nucleus pulposus cells via MTNR1B/Gαi2/YAP signaling. Int. J. Biol. Sci. 18: 2202-2219.
37. Zhao B, et al. (2010) A coordinated phosphorylation by Lats and CK1 regulates YAP stability through SCFβ-TRCP. Genes Dev. 24: 72-85.
38. Chen F, et al. (2020) Melatonin activates autophagy via the NF-κB signaling pathway to prevent extracellular matrix degeneration in intervertebral disc. Osteoarthritis Cartilage 28: 1121-1132.
39. Oktem G, et al. (2006) Evaluation of the relationship between inducible nitric oxide synthase (iNOS) activity and effects of melatonin in experimental osteoporosis in the rat. Surg. Radiol. Anat. 28: 157-162.
40. Simon PS, et al. (2015) The NF-κB p65 and p50 homodimer cooperate with IRF8 to activate iNOS transcription. BMC Cancer 15: 770.
41. Ma H, et al. (2021) ROR: Nuclear receptor for melatonin or not? Molecules 26 (9): 2693.
42. Liang T, et al. (2021) Inverse agonist of retinoid-related orphan receptor-alpha prevents apoptosis and degeneration in nucleus pulposus cells via upregulation of YAP. Mediators Inflamm. 2021: 9954909.
43. Wang Y, et al. (2020) The role of IL-1β and TNF-α in intervertebral disc degeneration. Biomed. Pharmacother. 131: 110660.
44. Zhang Y, et al. (2019) Melatonin modulates IL-1β-induced extracellular matrix remodeling in human nucleus pulposus cells and attenuates rat intervertebral disc degeneration and inflammation. Aging 11: 10499-10512.
45. Chen F, et al. (2020) Melatonin alleviates intervertebral disc degeneration by disrupting the IL-1β/NF-κB-NLRP3 inflammasome positive feedback loop. Bone Res. 8: 10.
46. Le MCL, et al. (2005) The role of interleukin-1 in the pathogenesis of human intervertebral disc degeneration. Arthritis Res. Ther. 7: R732.
47. Huang Y, et al. (2020) Nicotinamide phosphoribosyl transferase controls NLRP3 inflammasome activity through MAPK and NF-κB signaling in nucleus pulposus cells, as suppressed by melatonin. Inflammation 43: 796-809.
48. Shi C, et al. (2018) Nicotinamide phosphoribosyltransferase inhibitor APO866 prevents IL-1β-induced human nucleus pulposus cell degeneration via autophagy. Cell. Physiol. Biochem. 49: 2463-2482.
49. Tian Y, et al. (2021) Lower plasma melatonin in the intervertebral disk degeneration patients was associated with increased proinflammatory cytokines. Clin. Interv. Aging 16: 215-224.
50. Dou X, (2023) et al. Medical prospect of melatonin in the intervertebral disc degeneration through inhibiting M1-type macrophage polarization via SIRT1/notch signaling pathway. Biomedicines 11 (6): 1615.
51. Chen Y, et al. (2019) Melatonin ameliorates intervertebral disc degeneration via the potential mechanisms of mitophagy induction and apoptosis inhibition. J. Cell. Mol. Med. 23: 2136-2148.
52. Risbud MV, et al. (2014) Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat. Rev. Rheumatol. 10: 44-56.
53. O’Brien WT, et al. (2020) The NLRP3 inflammasome in traumatic brain injury: potential as a biomarker and therapeutic target. J. Neuroinflammation 17: 104.
54. Bai Z, et al. (2023) Melatonin protects human nucleus pulposus cells from pyroptosis by regulating Nrf2 via melatonin membrane receptors. Bone Joint Res. 12: 202-211.
55. Zhang C, et al. (2023) The long non-coding RNA maternally expressed 3-micorRNA-15a-5p axis is modulated by melatonin and prevents nucleus pulposus cell inflammation and apoptosis. Basic. Clin. Pharmacol. Toxicol. 133: 603-619.
56. He R, et al. (2018) Melatonin resists oxidative stress-induced apoptosis in nucleus pulposus cells. Life Sci. 199: 122-130.
57. Huang ZN, et al. (2023) Melatonin alleviates oxidative stress-induced injury to nucleus pulposus-derived mesenchymal stem cells through activating PI3K/Akt pathway. J. Orthop. Translat. 43: 66-84.
58. Li J, et al. (2021) Melatonin suppresses apoptosis of nucleus pulposus cells through inhibiting autophagy via the PI3K/Akt pathway in a high-glucose culture. Biomed. Res. Int. 2021: 4604258.
59. Xie L, et al. (2021) Melatonin alleviates radiculopathy against apoptosis and NLRP3 inflammasomes via the parkin-mediated mitophagy pathway. Spine 46: E859-E868.
60. Xiao B, et al. (2017) Reactive oxygen species trigger Parkin/PINK1 pathway–dependent mitophagy by inducing mitochondrial recruitment of Parkin. J. Biol. Chem. 292: 16697-16708.
61. Kubli DA, et al. (2012) Mitochondria and mitophagy: The Yin and Yang of cell death control. Cir. Res. 111: 1208-1221.
62. Fu S, et al. (2019) Circadian production of melatonin in cartilage modifies rhythmic gene expression. J. Endocrinol. 241: 161-173.
63. Reiter RJ, et al. (2018) Melatonin mitigates mitochondrial meltdown: Interactions with SIRT3. Int. J. Mol. Sci. 19: 2439.
64. Zhang GZ, et al. (2020) Sirtuins and intervertebral disc degeneration: Roles in inflammation, oxidative stress, and mitochondrial function. Clin. Chim. Acta 508: 33-42.
65. Yuan Y, et al. (2016) Regulation of SIRT1 in aging: Roles in mitochondrial function and biogenesis. Mech. Ageing Develop. 155: 10-21.
66. Favero G, et al. (2020) Sirtuin1 role in the melatonin protective effects against obesity-related heart injury. Front. Physiol. 11: 103.
67. Lim Hm et al. (2012) Cytoprotective and anti-inflammatory effects of melatonin in hydrogen peroxide-stimulated CHON-001 human chondrocyte cell line and rabbit model of osteoarthritis via the SIRT1 pathway. J. Pineal Res. 53: 225-237.
68. Peng Z, et al. (2018) Melatonin attenuates airway inflammation via SIRT1 dependent inhibition of NLRP3 inflammasome and IL-1β in rats with COPD. Int. Immunopharmacol. 62: 23-28.
69. Xu S, et al. (2021) Melatonin attenuates sepsis-induced small-intestine injury by upregulating sirt3-mediated oxidative-stress inhibition, mitochondrial protection, and autophagy induction. Front. Immunol. 12: 625627.
70. Ma Z, et al. (2022) SIRT1 alleviates IL-1β induced nucleus pulposus cells pyroptosis via mitophagy in intervertebral disc degeneration. Int. Immunopharmacol. 107: 108671.
71. Zhou T-Y, et al. (2019) SIRT3 retards intervertebral disc degeneration by anti-oxidative stress by activating the SIRT3/FOXO3/SOD2 signaling pathway. Eur. Rev. Med. Pharmacol. Sci. 23: 9180-9188.
72. Song Y, et al. (2018) Sirtuin 3-dependent mitochondrial redox homeostasis protects against AGEs-induced intervertebral disc degeneration. Redox. Biol. 19: 339-353.
73. Lin J, et al. (2021) SIRT3 mitigates intervertebral disc degeneration by delaying oxidative stress‐induced senescence of nucleus pulposus cells. J. Cell. Physiol. 236: 6441-6456.
74. Reiter RJ, et al. (2020) Melatonin in mitochondria: mitigating clear and present dangers. Physiology 35: 86-95.
75. Li J, et al. (2019) Melatonin attenuates renal fibrosis in diabetic mice by activating the AMPK/PGC1α signaling pathway and rescuing mitochondrial function. Mol. Med. Rep. 19: 1318-1330.
76. Liu D, et al. (2018) AMPK/PGC1α activation by melatonin attenuates acute doxorubicin cardiotoxicity via alleviating mitochondrial oxidative damage and apoptosis. Free Radic. Biol. Med. 129: 59-72.
77. Lee JM, et al. (2011) Interleukin-1β induces angiogenesis and innervation in human intervertebral disc degeneration. J. Orthop. Res. 29: 265-269.
78. Rätsep T, et al. (2013) Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs. Eur. Spine J. 22: 2474-2480.
79. Cerezo AB, et al. (2017) Inhibition of VEGF-induced VEGFR-2 activation and HUVEC migration by melatonin and other bioactive indolic compounds. Nutrients 9: 249.
80. Liu S-C, et al. (2022) Melatonin abolished proinflammatory factor expression and antagonized osteoarthritis progression in vivo. Cell Death Dis. 13: 1-10.
81. Ma Z, et al. (2019) Deletion of clock gene Bmal1 impaired the chondrocyte function due to disruption of the HIF1α-VEGF signaling pathway. Cell Cycle 18: 1473-1489.
82. Sun X, et al. (2022) Melatonin promotes antler growth by accelerating MT1-mediated mesenchymal cell differentiation and inhibiting VEGF-induced degeneration of chondrocytes. Int. J. Mol. Sci. 23: 759.
83. He M, et al. (2020) Overexpression of TIMP3 inhibits discogenic pain by suppressing angiogenesis and the expression of substance P in nucleus pulposus. Mol. Med. Rep. 21: 1163-1171.
84. Ruggiero G, et al. (2021) Period 2: A regulator of multiple tissue-specific circadian functions. Front. Mol. Neurosci. 14: 718387.
85. Wang D, et al. (2022) Restoring the dampened expression of the core clock molecule BMAL1 protects against compression-induced intervertebral disc degeneration. Bone Res. 10: 1-13.
86. Ertosun MG, et al. (2019) The regulation of circadian clock by tumor necrosis factor alpha. Cytokine Growth Factor Rev 46: 10-16.
87. Bisla RS, et al. (1976) Auto-immunological basis of disk degeneration. Clin. Orthop. Relat. Res. 121: 205-211.
88. Naylor A (1971) The biochemical changes in the human intervertebral disc in degeneration and nuclear prolapse. Orthop. Clin. North Am. 2: 343-358.
89. Wang J, et al. (2007) The expression of Fas ligand on normal and stabbed-disc cells in a rabbit model of intervertebral disc degeneration: a possible pathogenesis. J. Neurosurg. Spine 6: 425-430.
90. Capossela S, et al. (2014) Degenerated human intervertebral discs contain autoantibodies against extracellular matrix proteins. Eur. Cell. Mater. 27: 251-263.
91. Lin GJ, et al. (2013) Modulation by melatonin of the pathogenesis of inflammatory autoimmune diseases. Int. J. Mol. Sci. 14: 11742-11766.
92. Lardone PJ, et al. (2011) Melatonin synthesized by T lymphocytes as a ligand of the retinoic acid-related orphan receptor. J. Pineal Res. 51: 454-462.
93. Cheng L, et al. (2013) Th17 lymphocyte levels are higher in patients with ruptured than non-ruptured lumbar discs, and are correlated with pain intensity. Injury 44: 1805-1810.
94. Karchevskaya AE, et al. (2023) Understanding intervertebral disc degeneration: background factors and the role of initial injury. Biomedicines 11 (10): 2714.
95. Dudek M, et al. (2016) The chondrocyte clock gene Bmal1 controls cartilage homeostasis and integrity. J. Clin. Invest. 126: 365-376.
96. Song X, et al. (2021) chronic circadian rhythm disturbance accelerates knee cartilage degeneration in rats accompanied by the activation of the canonical Wnt/β-catenin signaling pathway. Front. Pharmacol. 12: 760988.
97. Alhilali M, et al. (2021) IL-1β induces changes in expression of core circadian clock components PER2 and BMAL1 in primary human chondrocytes through the NMDA receptor/CREB and NF-κB signalling pathways. Cell. Signal. 87: 110143.
98. Huang C-C, et al. (2019) Melatonin attenuates TNF-α and IL-1β expression in synovial fibroblasts and diminishes cartilage degradation: Implications for the treatment of rheumatoid arthritis. J. Pineal Res. 66: e12560.
99. Chen K, et al. (2017) Autophagy is a protective response to the oxidative damage to endplate chondrocytes in intervertebral disc: Implications for the treatment of degenerative lumbar disc. Oxid. Med. Cell. Longev. 2017: 4041768.
100. Chen Z, et al. (2021) Anti-apoptosis and autophagy effects of melatonin protect rat chondrocytes against oxidative stress via regulation of AMPK/Foxo3 pathways. Cartilage 13: 1041S-1053S.
101. Zhang Z, et al. (2019) Melatonin protects vertebral endplate chondrocytes against apoptosis and calcification via the Sirt1-autophagy pathway. J. Cell. Mol. Med. 23: 177-193.
102. Liao FX, et al. (2021) The new role of sirtuin1 in human osteoarthritis chondrocytes by regulating autophagy. Cartilage 13: 1237S-1248S.
103. Pintor JJ, et al. (2019) Melatonin stimulates extracellular matrix formation in human articular cartilage chondrocytes. Melatonin Res. 2: 106-114.
104. Wu X, et al. (2021) Melatonin attenuates intervertebral disk degeneration via maintaining cartilaginous endplate integrity in rats. Front. Physiol. 12: 672572.
105. Gao W, et al. (2014) Melatonin enhances chondrogenic differentiation of human mesenchymal stem cells. J. Pineal Res. 56: 62-70.
106. Liu X, et al. (2014) Rescue of proinflammatory cytokine-inhibited chondrogenesis by the antiarthritic effect of melatonin in synovium mesenchymal stem cells via suppression of reactive oxygen species and matrix metalloproteinases. Free Radic. Biol. Med. 68: 234-246.
107. Gao B, et al. (2018) Melatonin rescued interleukin 1β-impaired chondrogenesis of human mesenchymal stem cells. Stem Cell Res.Ther. 9: 162.
108. Wu Z, et al. (2018) Melatonin-mediated miR-526b-3p and miR-590-5p upregulation promotes chondrogenic differentiation of human mesenchymal stem cells. J. Pineal Res. 65: e12483.
109. Shen C, et al. (2011) Autophagy in rat annulus fibrosus cells: evidence and possible implications. Arthritis Res. Ther. 13: R132.
110. Hai B, et al. (2019) Melatonin benefits to the growth of human annulus fibrosus cells through inhibiting miR-106a-5p/ATG7 signaling pathway. Clin. Interv. Aging 14: 621-630.
111. Li J, et al. (2021) Melatonin inhibits annulus fibrosus cell senescence through regulating the ROS/NF-κB pathway in an inflammatory environment. BioMed. Res. Int. 2021: 3456321.
112. Hu X, et al. (2023) Melatonin-loaded self-healing hydrogel targets mitochondrial energy metabolism and promotes annulus fibrosus regeneration. Mater. Today Bio. 23: 100811.
113. Wu R, et al. (2023) Injectable mesoporous bioactive glass/sodium alginate hydrogel loaded with melatonin for intervertebral disc regeneration. Mater. Today Bio. 22, 100731.
114. Lyu F-J, et al. (2021) Painful intervertebral disc degeneration and inflammation: from laboratory evidence to clinical interventions. Bone Res. 9: 1-14.
115. Cheng Z, et al. (2021) The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review. Ageing Res. Rev. 70: 101394.
Published
2024-04-30
How to Cite
[1]
File, C. and Sharma, R. 2024. Melatonin and the intervertebral disc: a potential intervention for lower back pain?. Melatonin Research. 7, 1 (Apr. 2024), 84-102. DOI:https://doi.org/https://doi.org/10.32794/mr112500169.