La médecine régénératrice du disque intervertébral : panacée ou illusion ?

Abstract

Recent improvements of our understanding of the physiopathological processes of disc degeneration has made possible to consider with interest the regenerative medicine strategies to restore the intervertebral disc (IVD) function. These strategies include cell therapy and tissue engineering that could repair disc integrity by appropriate cells associated or not with a scaffolding biomaterials. Several options can be considered concerning cell types but also biomaterials. Studies in animal and human seem to confirm the feasibility of such an approach. However, unresolved issues remain including cell and biomaterial types to restore a functional nucleopulpogenic extracellular matrix (ECM). To date, stem cells (MSC and induced pluripotent stem cells iPS) and hydrogel family are well acknowledged as the ideal candidates regarding their ability to differentiate into an appropriate cell type and their hyperhydration composition similar to that of intervertebral disc ECM, respectively. Future work should allow to consider regenerative medicine as a breakthrough innovation in the management of low back pain patients. After a brief reminder of the general principles of regenerative medicine and its relevance to treat degenerative disc disease, cell therapy and tissue engineering are discussed. A state of the art is then given before discussing the remaining challenges prior to the transposition to humans.