In a preliminary study, the recurrent presence of nervous terminations was demonstrated with optical microscopy in several slides of degenerative lumbar facet joints and surrounding soft tissues. The purpose of this study was to prove the presence of
NGF (
nerve growth factor) and its
receptor TrkA (
tyrosine kinase receptor) with immunofluorescence. The peri/articular tissues were harvested from the lumbar facet joints of ten patients surgically treated for degenerative diseases. There were seven females (one bilateral) and two males whose mean age at surgery was 72 years (range, 67-80 years). The affected levels were L3-L4 in two cases and L4-L5 in seven cases (one bilateral). All specimens were fixed in
formalin, dehydrated and enclosed in
paraffin. From each specimen, four slides were obtained. Two slides were employed for the search of
NGF: one was treated with specific
antibodies and marked with
FITC (
fluorescein isothiocyanate conjugated), and the second slide was for control purposes. It was exposed to
FITC, but without prior exposure to the specific antibody. The same procedure was repeated to obtain on two more slides, to repeat the search for Trka with specific
antibodies. All the slides were finally studied on a fluoromicroscope. The analysis of these specimens revealed the presence of the
neurotrophin (
NGF) and its own
receptor (TrkA) in all cases: the immunohistochemical reaction between the specimens and the specific
antibodies marked with
FITC was seen under fluoromicroscopy, but in none of the control cases treated with
FITC only.
NGF is released by mastocytes, fibroblasts and other cell types involved in the inflammatory processes. The level of peripheral
NGF is increased in inflammatory processes, while the administration of exogenous
NGF has a hyperalgesic effect on rats and produces muscular
pain in humans. Furthermore,
NGF produces hypersensitization to heat stimulation in humans and mammals in general. There is considerable evidence showing that the system constituted by the
NGF and its high-affinity
receptor TrkA plays a fundamental role in the molecular processes underlying the main forms of "persistent"
pain. This indicates a possible therapeutic area for the
antibodies that could block the
NGF/TrkA system, in order to modulate the frequency and the duration of the action potential of nociceptive neurons during chronic
inflammation. This study demonstrated the presence of
NGF and TrkA in specimens collected from degenerative facet joints, suggesting that specific molecules could be used in order to modulate
chronic pain in patients with degenerative lumbar spine.