What does Propionibacterium do to living tissue?

Propionibacterium acnes induces intervertebral disc degeneration by promoting nucleus pulposus cell apoptosis via the TLR2/JNK/mitochondrial-mediated pathway

These authors point out the evidence that intervertebral disc degeneration can be induced by Propionibacterium acnes (P. acnes).

They analyzed the pathological changes in degenerated human intervertebral discs infected with P. acnes, finding that compared with P. acnes-negative samples, P. acnes-positive discs showed increased apoptosis of nucleus pulposus cells concomitant with severe intervertebral disc degeneration. 

They then established a P. acnes inoculated intervertebral disc degeneration animal model, finding that severe intervertebral disc degeneration was induced by P. acnes infection by promoting nucleus pulposus cell apoptosis. 

Their results suggested that P.acnes-induced apoptosis of nucleus pulposus cells via the Toll-like receptor 2 (TLR2)/c-Jun N terminal kinase (JNK) pathway and mitochondrial-mediated cell death. 

Furthermore P. acnes was found to activate autophagy (the orderly degradation and recycling of cellular components), which likely plays a role in apoptosis of nucleus pulposus cells

Overall, these findings further validated the involvement of P. acnes in the pathology of intervertebral disc degeneration and provided evidence that P. acnes-induced apoptosis of nucleus pulposus cells via the TLR2/JNK pathway is likely responsible for the pathology of intervertebral disc degeneration

Comment: While this study concerns intervertebral disc degeneration caused by Propionibacterium, it elucidates the mechanism by which this bacteria can destroy tissue. This same mechanism may be involved in the destruction of bone and soft tissue by this organism in failed arthroplasty and cuff repair.

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Herniated lumbar discs are often culture positive for Propionibacterium

Modic changes in the adjacent vertebrae due to disc material infection with Propionibacterium acnes in patients with lumbar disc herniation

Modic changes (MC) are pathological changes in the vertebrae. These changes are situated in both the body of the vertebrae and in the end plate of the neighboring disc. These authors sought to  evaluate the MCs seen on MRI in patients with disc herniation and positive for P. acnes.

They enrolled a total of 120 patients (69 male and 51 female with mean age of 43.15 ± 12.62 ) with disc herniation surgery, culturing the tissue excised during discectomy in both anaerobic and aerobic media. Cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction (PCR). MCs of baseline MRI were evaluated.

60 disc samples and 8 muscle samples were positive for microorganisms. 36 of 46 patients with P. acnes in their sample had MCs.

They concluded that P. acnes can lead to edema on the vertebrae endplates near to infected area.

Comment: In this study the association of Propionibacterium culture positive disc material and modic changes is striking (see Table below). This is important because it demonstrates a correlation between two distinct objectively determined findings.

For those of us in the shoulder world, this is additionally interesting because the Propionibacterium appear to have colonized the disc material without being iatrogenically introduced. We must wonder if the seeding of the disc material was hematogenous or if it resulted from bacteria moving from the dermis to the deeper tissues.

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