The anaerobic bacterium Cutibacterium acnes has been increasingly linked to the development of degenerative disc disease (DDD), although causality is yet to be conclusively proven. To better study how this organism could contribute to the aetiology of DDD, improved animal models that are more reflective of human disc anatomy, biology and mechanical properties are required. Against this background, our proof-of concept study aimed to be the first demonstration that C. acnes could be safely administered percutaneously into sheep intervertebral discs (IVDs) for in vivo study. Following our protocol, two sheep were successfully injected with a strain of C. acnes (8.3 × 106 CFU/disc) previously recovered from a human degenerative disc. No adverse reactions were noted, and at one-month post inoculation all triplicate infected discs in our first animal grew C. acnes, albeit at a reduced load (5.12 × 104 to 6.67 × 104 CFU/disc). At six months, no growth was detected in discs from our second animal indicating bacterial clearance. This pilot study has demonstrated the feasibility of safe percutaneous injection of C. acnes into sheep IVDs under fluoroscopic guidance. The design of follow-up sheep studies to investigate the potential of C. acnes to drive pathological changes within infected discs should now be pursued.

Center for Comparative Translational Research Purdue University 625 Harrison Street West Lafayette IN 47907 USA

Center for Diagnostic Imaging Carmel IN 46032 USA

Central European Institute of Technology Masaryk University 625 00 Brno Czech Republic

College of Osteopathic Medicine Marian University Indianapolis IN 46222 USA

Department of Biomedical Sciences and Pathobiology Virginia Maryland College of Veterinary Medicine Virginia Polytechnic Institute and State University Blacksburg VA 24061 USA

Department of Comparative Pathobiology College of Veterinary Medicine Purdue University West Lafayette IN 47907 USA

Laboratory of Bacterial Pathogenesis and Immunology Rockefeller University 1230 York Avenue New York NY 10065 USA

Nutrition Innovation Centre for Food and Health School of Biomedical Sciences Ulster University Coleraine BT52 1SA UK

OrthoIndy 8450 Northwest Blvd Indianapolis IN 46278 USA

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