Abstract
Cell-based regenerative medicine therapies have been proposed for repairing the degenerated intervertebral disc (a major cause of back pain). However, for this approach to be successful, it is essential to characterise the phenotype of its native cells to guarantee that implanted cells differentiate and maintain the correct phenotype to ensure appropriate cell and tissue function. While recent studies have increased our knowledge of the human nucleus pulposus (NP) cell phenotype, their ontogeny is still unclear. The expression of notochordal markers by a subpopulation of adult NP cells suggests that, contrary to previous reports, notochord-derived cells are retained in the adult NP, possibly coexisting with a second population of cells originating from the annulus fibrosus or endplate. It is not known, however, how these two cell populations interact and their specific role(s) in disc homeostasis and disease. In particular, notochordal cells are proposed to display both anabolic and protective roles; therefore, they may be the ideal cells to repair the degenerate disc. Thus, understanding the ontogeny of the adult NP cells is paramount, as it will inform the medical and scientific communities as to the ideal phenotype to implant into the degenerate disc and the specific pathways involved in stem cell differentiation towards such a phenotype.
Highlights
Back pain is a major international health problem
While recent studies have increased our knowledge of the human nucleus pulposus (NP) cell phenotype, their ontogeny is still unclear
The expression of notochordal markers by a subpopulation of adult NP cells suggests that, contrary to previous reports, notochord-derived cells are retained in the adult NP, possibly coexisting with a second population of cells originating from the annulus fibrosus or endplate
Summary
Back pain is a major international health problem. It is estimated that approximately two-thirds of the world population will experience low back pain at some point in their lives [1], with its point and one-month prevalence being, 11.9 and 23.2 %, respectively [2]. The global number of people suffering from this condition will further increase. In the USA alone, between 1997 and 2005, the estimated number of people suffering from back pain increased by 20.7 % which was accompanied by a 65 % increase (adjusted for inflation) in the overall health expenditure to treat this condition [4]. This overwhelming investment, has had no significant clinical impact as, during the same period, self-reported measurements of. Research on the intervertebral disc (IVD) has shown that disc degeneration is associated in around 40 % of cases [6] and has a probable causal relationship with back pain [7]
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