Stem Cells and Exosomes: New Therapies for Intervertebral Disc Degeneration

Abstract

Intervertebral disc degeneration (IVDD) occurs as a result of an imbalance of the anabolic and catabolic processes in the intervertebral disc, leading to an alteration in the composition of the extracellular matrix (ECM), loss of nucleus pulposus (NP) cells, excessive oxidative stress and inflammation. Degeneration of the IVD occurs naturally with age, but mechanical trauma, lifestyle factors and certain genetic abnormalities can increase the likelihood of symptomatic disease progression. IVDD, often referred to as degenerative disc disease (DDD), poses an increasingly substantial financial burden due to the aging population and increasing incidence of obesity in the United States. Current treatments for IVDD include pharmacological and surgical interventions, but these lack the ability to stop the progression of disease and restore the functionality of the IVD. Biological therapies have been evaluated but show varying degrees of efficacy in reversing disc degeneration long-term. Stem cell-based therapies have shown promising results in the regeneration of the IVD, but face both biological and ethical limitations. Exosomes play an important role in intercellular communication, and stem cell-derived exosomes have been shown to maintain the therapeutic benefit of their origin cells without the associated risks. This review highlights the current state of research on the use of stem-cell derived exosomes in the treatment of IVDD.

Mechanism of Action of Mesenchymal Stem Cell-Derived Exosomes in the Intervertebral Disc Degeneration Treatment and Bone Repair and Regeneration

“…Studies have shown that MSC-Exos could prevent IDD by inhibiting apoptosis and promoting the proliferation of NPCs, inhibiting ECM degradation, alleviating inflammatory response and oxidative stress, promoting chondrogenic differentiation, and protecting endplate chondrocytes and annulus fibrosus. Therefore, MSC-Exos may be a promising option to delay or even reverse IDD (Hu et al, 2020;Krut et al, 2021). The related…”

Mesenchymal Stem Cell-Derived Exosomes and Intervertebral Disc Regeneration: Review

“…Therefore, interest in the use of exosomes for disc regeneration is increasing [160]. In the present scenario, for treating IVDD, only one clinical trial (phase 1) is being conducted in India; this trial involves using intradiscal injections of platelet-rich plasma that is enriched with exosomes in 30 participants [161]. Despite being a promising way of treating IVDD, various drawbacks and challenges still exist.…”

Regenerating and repairing degenerative intervertebral discs by regulating the micro/nano environment of degenerative bony endplates based on low-tension mechanics

“…Loss of proteoglycans is one of the primary manifestations of intervertebral disc degeneration. Therefore, restoration of proteoglycan content is required for degenerative disc repair [ 45 – 47 ]. This study showed that in the case of disc space recovery, the recovery of proteoglycan content was significant in LTT compared with HTT, with the LTT-4w groups scoring better than the LTT-2w groups.…”