Abstract
Intervertebral disc degeneration (IVDD) has been reported to be the most prevalent contributor to low back pain, posing a significant strain on the healthcare systems on a global scale. Currently, there are no approved therapies available for the prevention of the progressive degeneration of intervertebral disc (IVD); however, emerging regenerative strategies that aim to restore the normal structure of the disc have been fundamentally promising. In the last decade, mesenchymal stem cells (MSCs) have received a significant deal of interest for the treatment of IVDD due to their differentiation potential, immunoregulatory capabilities, and capability to be cultured and regulated in a favorable environment. Recent investigations show that the pleiotropic impacts of MSCs are regulated by the production of soluble paracrine factors. Exosomes play an important role in regulating such effects. In this review, we have summarized the current treatments for disc degenerative diseases and their limitations and highlighted the therapeutic role and its underlying mechanism of MSC-derived exosomes in IVDD, as well as the possible future developments for exosomes.
Highlights
Low back pain (LBP) is a widespread health concern in modern society, resulting in high socioeconomic consequences (Katz, 2006; Kague et al, 2021)
The aim is to develop therapies that prevent LBP by delaying the intervertebral disc (IVD) deterioration and promoting its repair. These strategies can be roughly split into two groups: cell-based and cell-free therapies (DiStefano et al, 2021); among the cell-free systems, exosomes have received a great deal of interest as a potentially effective therapeutic approach for Intervertebral disc degeneration (IVDD) in recent years
In order to produce safer and more effective functionalized exosomes on a large scale to cater to the needs of clinical research, the selection of appropriate culture conditions is critical to the development of exosome-based treatments for IVDD in the future
Summary
Low back pain (LBP) is a widespread health concern in modern society, resulting in high socioeconomic consequences (Katz, 2006; Kague et al, 2021). The clinical treatment for LBP mainly includes bed rest, administration of non-steroid anti-inflammatory drugs (NSAIDs) and analgesics, lumbar discectomy, and interbody fusion (Binch et al, 2021). These approaches only focus on temporarily alleviating the symptoms rather than targeting the pathogenesis, and as such the progression of IVDD is neither delayed nor reversed (Hu et al, 2020; DiStefano et al, 2021). It was thought that the injected MSCs could phenotypically differentiate into nucleus pulposus-like cells to replace the damaged tissue (Risbud et al, 2004a; Risbud et al, 2004b; Steck et al, 2005) This hypothesis was later challenged by the findings from numerous studies in the last decade. We focused on the potential mechanisms of MSC-derived exosomes for IVDD treatment
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