Intervertebral disc degeneration (IDD) is a common degenerative disease of the musculoskeletal system and is also the main cause of chronic low back pain (LBP), which seriously affects the quality of life of patients and places a huge economic burden on families and society. [1][2][3] It is estimated that about 20% of adolescents have mild IDD and 80% of the general population will experience back pain symptoms during their lifetime. 4 However, the specific pathogenesis of IDD is still not fully understood. At present, IDD is believed to be a complex cell-mediated process that ultimately leads to changes in intervertebral disc (IVD) structure and function. 5

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Intervertebral disc degeneration (IDD) is the most common chronic skeletal muscle degeneration disease. Although the underlying mechanisms remain unclear, nucleus pulposus (NP) autophagy, senescence, and apoptosis are known to play a critical role in this process. Previous studies suggest that bromodomain-containing protein 4 (BRD4) promotes senescent and apoptotic effects in several age-related degenerative diseases. It is not known, however, if BRD4 inhibition is protective in IDD. In this study, we explored whether BRD4 influenced IDD. In human clinical specimens, the BRD4 level was markedly increased with the increasing Pfirrmann grade. At the cellular level, BRD4 inhibition prevented IL-1β-induced senescence and apoptosis of NP cells and activated autophagy via the AMPK/mTOR/ULK1 signaling pathway. Inhibition of autophagy by 3-methyladenine (3-MA) partially reversed the antisenescence and antiapoptotic effects of BRD4. In vivo, BRD4 inhibition attenuated IDD. Taken together, the results of this study showed that BRD4 inhibition reduced NP cell senescence and apoptosis by induced autophagy, which ultimately alleviated IDD. Therefore, BRD4 may serve as a novel potential therapeutic target for the treatment of IDD.

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