Abstract
Intervertebral disc (IVD) degeneration can cause chronic lower back pain (LBP), leading to disability. Despite significant advances in the treatment of discogenic LBP, the limitations of current treatments have sparked interest in biological approaches, including growth factor and stem cell injection, as new treatment options for patients with chronic LBP due to IVD degeneration (IVDD). Gene therapy represents exciting new possibilities for IVDD treatment, but treatment is still in its infancy. Literature searches were conducted using PubMed and Google Scholar to provide an overview of the principles and current state of gene therapy for IVDD. Gene transfer to degenerated disc cells in vitro and in animal models is reviewed. In addition, this review describes the use of gene silencing by RNA interference (RNAi) and gene editing by the clustered regularly interspaced short palindromic repeats (CRISPR) system, as well as the mammalian target of rapamycin (mTOR) signaling in vitro and in animal models. Significant technological advances in recent years have opened the door to a new generation of intradiscal gene therapy for the treatment of chronic discogenic LBP.
Highlights
Basic Anatomy of Intervertebral DiscThe intervertebral disc (IVD) is made of fibrous cartilage and is the most important functional part of the spine, presenting in between the vertebral bones providing flexibility to the vertebrae
Current treatments for chronic lower back pain (LBP) caused by IVD degeneration (IVDD) include physiotherapy, medication, and surgery [30,31]
There is a need for the development of new biological treatments that can be clinically applied for the purpose of inhibiting underlying disc degeneration, protecting degenerated discs, or regenerating the discs
Summary
The intervertebral disc (IVD) is made of fibrous cartilage and is the most important functional part of the spine, presenting in between the vertebral bones providing flexibility to the vertebrae. It consists of the nucleus pulposus (NP), surrounded by the annulus fibrosus (AF), and the cartilaginous endplate [1,2,3,4,5,6,7]. AF consists of collagen fibers lying parallel with the lamellae, whereas the cartilaginous endplate is made up of a thin layer of hyaline All these tissues being sandwiched together yields important functional properties to the disc [4,8,9]. Results in chronic lower back pain (LBP), which is a global concern, and causes more dysfunction than any other medical situation [10]
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