Future perspectives of cell-based therapy for intervertebral disc disease

Abstract

Intervertebral disc degeneration is a primary cause of low back pain and has a high societal cost. Research on cell-based therapies for intervertebral disc disease is emerging, along with the interest in biological therapy to treat disc disease without reducing the mobility of the spinal motion segment. Results from animal models have shown promising results under limited conditions; however, future studies are needed to optimise efficacy, methodology, and safety. To advance research on cell-based therapy for intervertebral disc disease, a better understanding of the phenotype and differentiation of disc cells and of their microenvironment is essential. This article reviews current concepts in cell-based therapy for intervertebral disc disease, with updates on potential cell sources tested primarily using animal models, and discusses the hurdles to clinical application. Future perspectives for cell-based therapies for intervertebral disc disease are also discussed.

Fig. 1

Time-course pattern of normal ageing versus pathological disc degeneration. Biological therapies (drugs, protein injections, gene therapy, and cell therapy) may have potential to reverse the progression of degeneration by the appropriate timing of intervention. Chronic back pain may be associated to period where pathological disc degeneration progresses from moderate to severe. In the severe period, secondary spinal deformity, and neural compressive manifestations are manifested

Fig. 2

Therapeutic scenario for the use of cells to treat disc disease. Pathological disc degeneration due to disc herniations, etc. will most likely progress after surgical intervention. The rescue of viable cells by supplementing various donor cells using in vitro culture techniques may help delay or regenerate the progressive degeneration process

Fig. 3

Macroscopic evaluation and T2 weighted magnetic resonance images (MRI) of undamaged intervertebral disc (IVD)(normal control), IVD degeneration induced by nucleotomy (degeneration model) and mesenchymal stem cell (MSC) transplantation (stem cell transplanted). Note that the structure of the nucleus pulposus (NP) is better retained and MRI signal intensity has increased in the stem cell-transplanted IVD, suggesting positive effect of the procedure in delaying the progression of IVD dgeneration