Expression of degenerative markers in intervertebral discs of young and elderly asymptomatic individuals.

Intervertebral disc (IVD) degeneration is a remodeling process mediated by several growth factors and cytokines. This process has been extensively studied in vitro and with pathologic specimens obtained during surgery for scoliosis or back pain. However, the occurrence and temporal evolution of these molecules during normal aging, particularly in the cervical segment, is not known. Our objective was to study and compare the presence of putative mediators in the IVD of young (<35 years, G1) and elderly (>65 years, G2) presumably asymptomatic individuals. Thirty C4-5 and C5-6 discs and thirty L4-5 and L5-S1 discs per group were collected during the autopsy of individuals whose family members denied a history of neck or back pain. Discs were divided into anterior, central (lumbar only) and posterior sectors for analysis. Immunohistochemistry for TNF-α, IL-1ß, VEGF, NGF-ß, BDNF, TIMP-1, MMP-1, -2 and -3 was performed and reactivity compared between groups and sectors. All of these molecules were detected in every disc sector of both G1 and G2. Most statistical comparisons (25/45, 55.6%) revealed an increase in mediator expression in G2 in relation to G1. Regional differences in the expression of remodeling enzymes were rare; NGF-ß and BDNF had slightly higher expression in the cervical segment of elderly individuals. A senescent profile with elevated VEGF, MMP-2 and MMP-3 was observed across most G2 disc regions and were generally elevated from G1. In conclusion, the mere presence of any of the studied molecules inside the IVD cannot be considered pathologic. Expression of remodeling enzymes and inflammatory mediators is relatively similar across different vertebral segments and disc regions leading to a common degenerated pattern, while neurotrophins have slightly higher expression in cervical discs. These findings support the concept that disc remodeling in different segments follows a similar pathway that can be potentially mediated to avoid structural failure.

Normal aging in human lumbar discs: An ultrastructural comparison.

The normal aging of the extracellular matrix and collagen content of the human lumbar intervertebral disc (IVD) remains relatively unknown despite vast amounts of basic science research, partly because of the use of inadequate surrogates for a truly normal, human IVD. Our objective in this study was to describe and compare the morphology and ultrastructure of lumbar IVDs in 2 groups of young (G1-<35 years) and elderly (G2->65 years). Thirty L4-5 and L5-S1 discs per group were obtained during autopsies of presumably-asymptomatic individuals and analyzed with magnetic resonance imaging (MRI), a morphological grading scale, light microscopy, scanning electron microscopy (SEM) and immunohistochemistry (IHC) for collagen types I, II, III, IV, V, VI, IX and X. As expected, a mild to moderate degree of degeneration was present in G1 discs and significantly more advanced in G2. The extracellular matrix of G2 discs was significantly more compact with an increase of cartilaginous features such as large chondrocyte clusters. Elastic fibers were abundant in G1 specimens and their presence correlated more with age than with degeneration grade, being very rare in G2. SEM demonstrated persistence of basic structural characteristics such as denser lamellae with Sharpey-type insertions into the endplates despite advanced age or degeneration grades. Immunohistochemistry revealed type II collagen to be the most abundant type followed by collagen IV. All collagen types were detected in every disc sector except for type X collagen. Statistical analysis demonstrated a general decrease in collagen expression from G1 to G2 with an annular- and another nuclear-specific pattern. These results suggest modifications of IVD morphology do not differ between the anterior or posterior annulus but are more advanced or happen earlier in the posterior areas of the disc. This study finally describes the process of extracellular matrix modification during disc degeneration in an unselected, general population and demonstrates it is similar to the same process in the cervical spine as published previously.

Desafio anatômico: uma metodologia capaz de auxiliar no aprendizado de anatomia humana / Anatomical challenge: a methodology able to assist in learning human anatomy

Em 2007 a cidade de Cajazeiras-PB recebeu a implantação do curso de Medicina pela Universidade Federal de Campina Grande. Neste processo, os docentes se depararam com várias dificuldades. Para propor melhoras e até, suplementação da carga de conceitos em Anatomia Humana, foi criada uma atividade didática chamada “Desafio Anatômico”, no qual os discentes eram instruídos a confeccionar modelos anatômicos que fossem didáticos a ponto de serem usados nas aulas, auxiliando o conteúdoda disciplina. Após a apresentação dos trabalhos, os discentes mostraram-se satisfeitos com os resultados, sobretudo sob o ponto de vista de transmissão de conhecimento e absorção de conteúdo. Desta maneira, esta experiência mostrou-se positiva e singular para o processo de ensino-aprendizagem da anatomia no curso médico, pois a mesma estimulou de diversas formas a criatividade, memória etrabalho em grupo dos participantes.

In 2007 the city of Cajazeiras-PB received the implantation of the School of Medicine from Federal University of Campina Grande. In this process professors were faced with several difficulties. To propose improvements and even supplementation in Anatomy concepts, they created a didactic activity called“Anatomical Challenge” in which the students were instructed to fabricate didactical anatomical models to be used in classrooms, helping the content of the discipline. After work, the students were satisfied with the results, especially from the point of view of knowledge transmission and absorption of content.Thus, this experience was positive and unique to the process of teaching and learning of anatomy inmedical school, because it stimulated creativity in many ways, memory and group working by the participants.