Biological treatment strategies for disc degeneration: potentials and shortcomings

Abstract

Recent advances in molecular biology, cell biology and material sciences have opened a new emerging field of techniques for the treatment of musculoskeletal disorders. These new treatment modalities aim for biological repair of the affected tissues by introducing cell-based tissue replacements, genetic modifications of resident cells or a combination thereof. So far, these techniques have been successfully applied to various tissues such as bone and cartilage. However, application of these treatment modalities to cure intervertebral disc degeneration is in its very early stages and mostly limited to experimental studies in vitro or in animal studies. We will discuss the potential and possible shortcomings of current approaches to biologically cure disc degeneration by gene therapy or tissue engineering. Despite the increasing number of studies examining the therapeutic potential of biological treatment strategies, a practicable solution to routinely cure disc degeneration might not be available in the near future. However, knowledge gained from these attempts might be applied in a foreseeable future to cure the low back pain that often accompanies disc degeneration and therefore be beneficial for the patient.

Mesenchymal progenitor cells combined with pentosan polysulfate mediating disc regeneration at the time of microdiscectomy: a preliminary study in an ovine model

“…1,2,10,16,20,22,25,[30][31][32][34][35][36][37][38]46,48,49,53,54,56,57,60,62,[64][65][66][67]69,73,83,90 The EuroDISC study, by Meisel and colleagues, 49 investigated the percutaneous transplantation of autologous disc chondrocytes. Following microdiscectomy, disc chondrocytes were harvested and expanded in vitro and were subsequently injected into the NP 3 months postoperatively.…”

Scaffolding in tissue engineering: general approaches and tissue-specific considerations

“…Extensive efforts have been made to search for biological therapeutics for disc degeneration of different severity [48,103]. Readers are directed to excellent reviews on structural functional relationship and pathophysiological aspects of IVD [1,12,116] and excellent reviews on potential biological therapies including growth factor, cell and tissue engineering approaches [3,6,37,43,88]. In this review, existing scaffolding approaches for disc regeneration and their insufficiencies, the unique considerations of intervertebral disc and the future directions of scaffolding in IVD tissue engineering will be reviewed (Table 3).…”

Human mesenchymal stem cell co-culture modulates the immunological properties of human intervertebral disc tissue fragments in vitro

“…The local production of matrix-degrading enzymes is a key event leading to degeneration, but it must be also considered in the context of the upstream molecules, such as cytokines, which regulate enzyme synthesis. IVD cells have a capacity to express a range of cytokines [6,7], including pro-inflammatory molecules, such as both isoforms of interleukin-1, alpha (IL-1a) and beta (IL-1b) [8] and tumor necrosis factor alpha (TNF-a) [9]. It has been proposed that IL-1 can regulate IVD cell expression of key matrixdegrading enzymes in vitro [10] and in vivo [11], placing this cytokine as a main factor inducing degeneration.…”