Pain-OMICS

Multi-dimensional omics approach to stratification patients with low back pain

St. Catherine Hospital is a part of colaborative scientific project "Multi-dimensional omics approach to stratification patients with low back pain" or "Pain-OMICS", founded by European Comission 7th framework programme (Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities) theme Health, dedicated to pain (Health. 2013.2.2.1-5 Understanding and controlling pain) in period 2013 - 2018. Pain-OMICS project involves 11 leading scientific and clinical centers across Europe, US and Australia and in Croatia partners are Specialty Hospital St. Catherine and Genos Ltd.

Low back pain as extremely prevalent disorder in western countries causing increasing disabilities, work absenteeism and lost productivity and inflicts substantial direct and indirect costs. Pain-OMICS project aims to identify new diagnostic and prognostic biomarkers to predict the transition from acute to chronic pain as well as molecular target sites for therapeutic interventions. In Europe, the incidence of low back pain varies between 5-11 %, while more than 40% of adults suffer from at least one episode of low back pain, causing beside clinical also socio-economical problem. Addressing the problem, Pain-OMICS group aims to find new way to characterize pathophysiology and identify new therapeutic targets of low back pain using complex system biology approaches– genomic, epigenomic, glycomic and activomic in the aim of trying to clarify the doubts in the chronic low back pain syndrome such as diagnosing complex physiological processes on the molecular level including disc pain, facet pain (pain that occur as a consequence of  small joint changes), sacroiliac pain, radicular pain and pain caused by congenital spinal stenosis. Therefore, a paper was published which shows the changes in glycosylation that follow chronic inflammation which happens during low back pain, as well as using „omics“ in conditions of chronic pain and searching for a new therapeutic solutions (1-3). The more, the study has been launched with 12,000 people who suffer from low back pain in the email identifying genetic variants associated with low back pain (4). Glycomics, activomics and biomarkers for low back pain will be used in the aim of a quality understanding of this frequent consition (5).

Pain-OMICS consortium consisted of leading international clinical centers and laboratories, coupled with research-intensive SMEs is in unique position to achieve this ambitious program, providing not only insight into molecular mechanisms of low back pain and discovery of predictive biomarkers, but also striving to transfer the knowledge for direct benefits for patients and provide more personalized approach. The project lead to numerous scientific research and papers, presentations on conferences and collaboration which all ensure quality research in the future. One of the most important ways of treating pain is a personalized approach to every patient that suffers from it. In our recently published paper, results show that treatment with nonsteroidal anti-inflammatory drugs and opioids, which make up a big percentage of analgesic drugs, in as many as 50% of patients cause side effects or inadequate decrease of pain (6,7). Therefore, pharmacodynamic testing, i.e. finding the right drive for the right patient at the right time depending on his or her genome is one of the fundamentals of the personalized approach which is routinely used in clinical practice in St. Catherine Specialty Hospital.

References:

1. 1. Trbojević-Akmačić I, Vučković F, Vilaj M, Skelin A, Karssen LC, Krištić J et at. Plasma N-glycome composition associates with chronic low back pain. Biochim Biophys Acta Gen Subj. 2018 Oct;1862(10):2124-2133.
2. 6. Bach-Rojecky L, Vađunec D, Žunić K, Kurija J, Šipicki S, Gregg R et al. Continuing war on pain: a personalized approach to the therapy with nonsteroidal anti-inflammatory drugs and opioids. Per Med. 2019 Mar;16(2):171-184

1. Freidin MB, Lauc G, Allegri M, Primorac D, Williams FM. Using omics in chronic pain conditions to delineate mechanisms and provide new therapeutic strategies. Pain Management. 2016;6(3):211-5.
2. Compagnone C, Schatman ME, Rauck RL, Van Zundert J, Kraus M, Primorac D, Williams F, Allegri M, Saccani Jordi G, Fanelli G; Pain-Omics Group. Past, Present, and Future of informed consent in pain and genomics research: Challenges facing Global Medical Community. Pain Practice. 2016. Aug 26. doi: 10.1111/papr.12485.
3. Allegri M, De Gregori M, Minella CE, Klersy C, Wang W, Sim M, Gieger C, Manz J, Pemberton IK, MacDougall J, Williams FM, Van Zundert J, Buyse K, Lauc G, Gudelj I, Primorac D, Skelin A, Aulchenko YS, Karssen LC, Kapural L, Rauck R, Fanelli G; PainOMICS Group. “Omics” biomarkers associated with chronic low back pain: Protocol and retrospective longitudinal study. BMJ Open. 2016 Oct 19;6(10):e012070. doi: 10.1136/bmjopen-2016-012070.
4. Dagostino C, De Gregori M, Gieger C, Manz J, Gudelj I, Lauc G, Divizia L, Wang W, Sim M, Pemberton IK, MacDougall J, Williams F, Van Zundert J, Primorac D, Aulchenko Y, Kapural L, Allegri M; PainOmics Group. Validation of standard operating procedures in a multicenter retrospective study to identify -omics biomarkers for chronic low back pain. PLoS One. 2017 May 1;12(5):e0176372. doi: 10.1371/journal.pone.0176372.

1. Primorac D & Bach-Rojecky L. Could a Personalized Approach to Therapy End the war on Pain? Practical Pain Management. 2019;19(3):50-53.