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Abstract
Chronic low back pain (LBP) remains a challenging condition to treat, and especially to cure. If conservative treatment approaches fail, the current “gold standard” for intervertebral disc degeneration (IDD)-provoked back pain is spinal fusion. However, due to its invasive and destructive nature, the focus of orthopedic research related to the intervertebral disc (IVD) has shifted more towards cell-based therapeutic approaches. They aim to reduce or even reverse the degenerative cascade by mimicking the human body’s physiological healing system. The implementation of progenitor and/or stem cells and, in particular, the delivery of mesenchymal stromal cells (MSCs) has revealed significant potential to cure the degenerated/injured IVD. Over the past decade, many research groups have invested efforts to find ways to utilize these cells as efficiently and sustainably as possible. This narrative literature review presents a summary of achievements made with the application of MSCs for the regeneration of the IVD in recent years, including their preclinical and clinical applications. Moreover, this review presents state-of-the-art strategies on how the homing capabilities of MSCs can be utilized to repair damaged or degenerated IVDs, as well as their current limitations and future perspectives.
Highlights
The Burden of Low Back Pain and Its Association with Intervertebral Disc DegenerationBeing the leading cause of disability worldwide, low back pain (LBP) provokes agony in up to 637 million people worldwide [1]; it accounts for more lost workdays than any other musculoskeletal disorder in the USA, and in Europe, LBP is the most prevalent reason for premature retirement and medically certified sick leave [2,3,4]
In order to understand the possible correlations between intervertebral disc degeneration (IDD) and LBP, one should consider the general structure of a healthy intervertebral disc (IVD) and how a pathophysiological development of the IVD can potentially lead to this disease
Thereby, the application of mesenchymal stromal cell (MSC)-based therapies has been placed into the spotlight
Summary
The Burden of Low Back Pain and Its Association with Intervertebral Disc Degeneration. A lack of nutrients can be responsible for changes in the IVDs catabolic and anabolic turnover, cause dehydration, and lead to an aberrant production of pro-inflammatory cytokines [19,20] As a result, these cytokines can initiate inflammation, promote vascular and nerve ingrowth into the IVD, induce pain, or even increase the risk of herniation (Figure 1) [20,21,22,23]. The application of mesenchymal stromal cells (MSCs) has been studied most extensively with regard to IVD regeneration [36,39,40,41] For this reason, the purpose of this narrative literature review is to show the achievements and progress made on MSC-based therapy with the eventual aim to regenerate damaged and/or degenerated IVDs. A particular focus of this review is targeted on the state-of-the-art strategies of MSC homing into IVDs, their potential, and their current limitations for cell-based therapies
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