Neurophysiological and transcriptomic predictors of chronic low back pain: towards precision pain management (NEAT Study)

项目摘要 最常见和最昂贵的慢性疼痛条件之一是腰痛（LBP），它产生更多的全球性疼痛。 比任何其他条件的残疾。高达39%的急性LBP发作患者报告慢性LBP（疼痛） 持续3个月以上）和2年或更长时间的长期残疾。增加对机械的理解 从急性LBP过渡到慢性LBP将使我们能够在过渡期早期识别生物标志物， 治疗目标在关键的机会窗口，以预防和/或更好地管理慢性LBP。在本研究中， 我们将检验神经生理学和基因表达差异可以用来建立 一个预测模型，将定义慢性LBP表型和转录组，并确定这些LBP 将从急性疼痛表型转变为慢性疼痛表型的患者。我们将前瞻性地跟踪一组 380名LBP患者和40名健康对照（用于与LBP患者比较并追踪基因表达稳定性 随着时间的推移），在首次门诊就诊报告LBP后两年。我们将严格地对 参与者，包括测量神经生理学因素，并分析基线时的基因表达， 第一年以及18个月和24个月定期进行。我们将通过以下两个具体措施来实现这些目标： 目的：目的1：检查神经生理学预测从急性到慢性疼痛的转变， 基线和初始诊所访视后随时间推移的LBP报告。我们将在以下时间招募参与者： 初始LBP和随访6、8、10、12、16、20、24和52周，以及发病后18和24个月。在 在与RNA-seq抽血相对应的时间点，我们将进行神经生理学测试， 表征外周感觉神经功能、时间总和（结束）和条件性疼痛调制 （下行抑制性疼痛调节系统的完整性）。在其他时间点，参与者将填写 关于疼痛和心理社会结构的在线问卷。目的2：检验差异性 MHC基因座基因在基线和随时间的表达将与慢性疾病的风险相关。 疼痛，而已知的疼痛基因的差异表达将定义慢性LBP转录组。在这 为了达到这个目的，我们将从全血中分离总RNA，用于基线和6、12、24、52周和2年时的测序。 我们将研究三组（n=20名健康人）在极端表型中基因表达的变化如何不同 参与者，n=50例急性LBP，n=50例慢性LBP）。除了生物标志物 为了进一步鉴定，我们将对差异表达基因进行无偏途径分析， 对慢性疼痛预防和/或管理的潜在新治疗靶点的机制性洞察。这 这项研究与NINR的战略计划和使命、国家疼痛战略、IOM报告和 美国国立卫生研究院的HEAL倡议，以确定慢性疼痛和治疗疼痛的目标风险的生物标志物。

PROJECT SUMMARY One of the most common and costly chronic pain conditions is low back pain (LBP), which produces more global disability than any other condition. Up to 39% of patients with an acute LBP episode report chronic LBP (pain lasting >3 months) and long-term disability for 2 years or longer. Increased mechanistic understanding of the transition from acute to chronic LBP will enable us to identify biomarkers early in the transition period and new therapeutic targets at critical windows of opportunity to prevent and/or better manage chronic LBP. In this study, we will test the hypothesis that neurophysiological and gene expression differences can be used to build a predictive model that will define the chronic LBP phenotype and transcriptome and identify those LBP patients who will transition from acute to chronic pain phenotypes. We will prospectively follow a cohort of 380 LBP patients and 40 healthy controls (for comparison with LBP patients and to track gene expression stability over time) for two years following the initial clinic visit for report of LBP. We will rigorously phenotype the participants, including measurement of neurophysiological factors, and analyze gene expression at baseline and regular intervals during the first year and at 18 and 24 months. We will accomplish these goals via two specific aims: Aim 1: To examine neurophysiological predictors of the transition from acute to chronic pain at baseline and over time following initial clinic visit for report of LBP. We will enroll participants at time of initial LBP and follow them 6, 8, 10, 12, 16, 20, 24, and 52 weeks, as well as 18 and 24 months’ post onset. At timepoints that correspond with blood draws for RNA-seq we will conduct neurophysiological testing to characterize peripheral sensory nerve function, temporal summation (wind up) and conditioned pain modulation (intactness of the descending inhibitory pain modulatory system). At other timepoints, participants will fill out online questionnaires about pain and psychosocial constructs. Aim 2: To test the hypothesis that differential expression of MHC locus genes at baseline and over time will be associated with the risk for chronic pain, while differential expression of known pain genes will define the chronic LBP transcriptome. In this aim, we will isolate total RNA from whole blood for sequencing at baseline and 6, 12, 24, 52 weeks, and 2 years. We will examine how changes in gene expression differs in extreme phenotypes from three groups (n=20 healthy participants, n=50 acute LBP, n=50 chronic LBP) at each of the six timepoints. In addition to biomarker identification, we will conduct non-biased pathway analysis of the differentially expressed genes to gain mechanistic insight into potential novel therapeutic targets for chronic pain prevention and/or management. This study is highly aligned with NINR’s strategic plan and mission, the National Pain Strategy, IOM report, and the NIH’s HEAL Initiative to identify biomarkers of the risk for chronic pain and therapeutic pain targets.