Abstract
Low back pain (LBP) is one of the most frequent symptoms associated with intervertebral disc degeneration (IDD) and affects more than 80% of the population, with strong psychosocial and economic impacts. The main cause of IDD is a reduction in the proteoglycan content within the nucleus pulposus (NP), eventually leading to the loss of disc hydration, microarchitecture, biochemical and mechanical properties. The use of mesenchymal stem cells (MSCs) has recently arisen as a promising therapy for IDD. According to numerous reports, MSCs mediate their regenerative and immunomodulatory effects mainly through paracrine mechanisms. Recent studies have suggested that extracellular vesicles (EVs) extracted from MSCs may be a promising alternative to cell therapy in regenerative medicine. EVs, including exosomes and microvesicles, are secreted by almost all cell types and have a fundamental role in intercellular communication. Early results have demonstrated the therapeutic potential of MSCs-derived EVs for the treatment of IDD through the promotion of tissue regeneration, cell proliferation, reduction in apoptosis and modulation of the inflammatory response. The aim of this review is to focus on the biological properties, function, and regulatory properties of different signaling pathways of MSCs-derived exosomes, highlighting their potential applicability as an alternative cell-free therapy for IDD.
Highlights
Low back pain (LBP) is one of the most common musculoskeletal symptoms affecting up to 80% of adults aged between 40–80 years
Low back pain (LBP) is one of the most frequent symptoms associated with intervertebral disc degeneration (IDD) and affects more than 80% of the population, with strong psychosocial and economic impacts
The aim of this review is to focus on the biological properties, function, and regulatory properties of different signaling pathways of mesenchymal stem cells (MSCs)-derived exosomes, highlighting their potential applicability as an alternative cell-free therapy for IDD
Summary
Low back pain (LBP) is one of the most common musculoskeletal symptoms affecting up to 80% of adults aged between 40–80 years. The financial burden of LBP in the United States is estimated to exceed $100 billion per year, depending on the inevitable effect of changes in work status, prolonged hospitalization, and increased outpatient visits [2,3,4]. The majority of LBP episodes are associated with intervertebral disc degeneration (IDD). The intervertebral disc (IVD) acts as a shock absorber between the vertebrae while allowing for flexion–extension, lateral flexion, and rotation movements. IDD is an age-related disease and is mainly linked to loss of NP hydration and reduction in the proteoglycan content [9]. Current approaches to treat IDD are based on conservative or surgical procedures that aim to relieve the symptoms; they are not able to change the natural history of the disease [10]
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