Abstract
Disc degeneration is the most common cause of back pain in adults and has enormous socioeconomic implications. Conservative management is ineffective in most cases, and results of surgical treatment have not yet reached desirable standards. Biologic treatment options are an alternative to the above conventional management and have become very attractive in recent years. The present review highlights the currently available biologic treatment options in mild and moderate disc degeneration, where a potential for regeneration still exists. Biologic treatment options include protein-based and cell-based therapies. Protein-based therapies involve administration of biologic factors into the intervertebral disc to enhance matrix synthesis, delay degeneration or impede inflammation. These factors can be delivered by an intradiscal injection, alone or in combination with cells or tissue scaffolds and by gene therapy. Cell-based therapies comprise treatment strategies that aim to either replace necrotic or apoptotic cells, or minimize cell death. Cell-based therapies are more appropriate in moderate stages of degenerated disc disease, when cell population is diminished; therefore, the effect of administration of growth factors would be insufficient. Although clinical application of biologic treatments is far from being an everyday practice, the existing studies demonstrate promising results that will allow the future design of more sophisticated methods of biologic intervention to treat intervertebral disc degeneration.
Highlights
The spinal column sustains continuous movements in different directions to provide the vital flexibility of the human body
PROTEIN-BASED THERAPIES Protein-based therapies include all treatment strategies that involve administration of biologic factors into the intervertebral disc to enhance matrix synthesis, delay degeneration or stop inflammation. These factors can be delivered by an intradiscal injection, alone or in combination with cells or tissue scaffolds as well as by gene therapy
Transfection of degenerated human intervertebral disc cells with an adenovirus vector expressing SOX9 resulted in increased synthesis of collagen type II [44], restored the height of the degenerative rabbit intervertebral disc and promoted the expression of proteoglycan and collagen type II when administered with osteogenic protein-1 (OP-1) as a dual gene therapy [45]
Summary
Elias S Vasiliadis, Spyros G Pneumaticos, Demitrios S Evangelopoulos, and Athanasios G Papavassiliou. Biologic treatment options are an alternative to the above conventional management and have become very attractive in recent years. The present review highlights the currently available biologic treatment options in mild and moderate disc degeneration, where a potential for regeneration still exists. Biologic treatment options include protein-based and cell-based therapies. Proteinbased therapies involve administration of biologic factors into the intervertebral disc to enhance matrix synthesis, delay degeneration or impede inflammation. These factors can be delivered by an intradiscal injection, alone or in combination with cells or tissue scaffolds and by gene therapy. Cell-based therapies are more appropriate in moderate stages of degenerated disc disease, when cell population is diminished; the effect of administration of growth factors would be insufficient.
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