Yonsei Med J.  2007 Oct;48(5):839-846. 10.3349/ymj.2007.48.5.839.

The Association of the Activation-Inducible Tumor Necrosis Factor Receptor and Ligand with Lumbar Disc Herniation

  • 1Department of Orthopaedic Surgery, 1Hallym University College of Medicine, Seoul, Korea. amhangpark@yahoo.co.kr
  • 2Yonsei University College of Medicine, Seoul, Korea.
  • 3Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
  • 4Immunomodulation Research Center, Ulsan University, Ulsan, Korea.
  • 5Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, MO, USA.


PURPOSE: Herniated nucleus pulposus fragments are recognized by the immune system as a foreign-body, which results in an autoimmune reaction. Human activation-inducible tumor necrosis factor receptor (AITR) and its ligand, AITRL, are important costimulatory molecules in the pathogenesis of autoimmune diseases. Despite the importance of these costimulatory molecules in autoimmune disease, their role in the autoimmune reaction to herniated disc fragments has yet to be explored. The purpose of the present study is to investigate whether the overexpression of AITR and AITRL might be associated with lumbar disc herniation. MATERIALS AND METHODS: The study population consisted of 20 symptomatic lumbar disc herniation patients. Ten macroscopically normal control discs were obtained from patients with spinal fractures managed with anterior procedures that involved a discectomy. Peripheral blood samples from both the study patients and controls were collected. The expression levels of AITR and AITRL were investigated by flow cytometric analysis, confocal laser scanning microscopy, immunohistochemistry and by reverse transcriptase-polymerase chain reaction (RT-PCR). The soluble AITR and AITRL serum levels were measured by an enzyme-linked immunosorbent assay. RESULTS: Flow cytometric analysis revealed significantly higher levels of both AITR and AITRL in the lumbar disc herniation patients than in the controls. The AITRL expression levels were also increased in patients with lumbar disc herniation, shown by using confocal laser scanning microscopy, immunohisto-chemistry, and RT-PCR. Finally, soluble AITR and AITRL were elevated in the patients with lumbar disc herniations. CONCLUSION: The AITR and AITRL are increased in both the herniated disc tissue and the peripheral blood of patients with lumbar disc herniation.


Lumbar disc herniation; costimulatory molecule

MeSH Terms

Flow Cytometry
Intervertebral Disk Displacement/*immunology
*Lumbar Vertebrae
Microscopy, Confocal
Middle Aged
Receptors, Nerve Growth Factor/*blood
Receptors, Tumor Necrosis Factor/*blood
Reverse Transcriptase Polymerase Chain Reaction
Tumor Necrosis Factor-alpha/blood
Tumor Necrosis Factors/*blood
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