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Fontana, G,See, E,Pandit, A
2015
April
Current trends in biologics delivery to restore intervertebral disc anabolism
Published
1
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Inflammation Intervertebral disc Nucleus pulposus Annulus fibrosus Growth factors Gene therapy Cell therapy Biomaterials MESENCHYMAL STEM-CELLS NUCLEUS PULPOSUS CELLS VERTEBRAL END-PLATE LOW-BACK-PAIN NECROSIS-FACTOR-ALPHA DORSAL-ROOT GANGLIA NERVE GROWTH-FACTOR GENE-THERAPY IN-VIVO ANNULUS FIBROSUS
Low back pain is generally attributed to intervertebral disc (IVD) degeneration. This is a multifactorial disease induced by genetic and environmental factors and that progresses with aging. Disc degeneration is characterized by a limited ability of IVD cells to produce functional matrix while producing abnormal amounts of matrix-degrading enzymes. The prolonged imbalance between anabolism and catabolism in degenerative discs alters their composition and hydration. In turn, this results in increased angiogenesis and the loss of the disc's ability to maintain its aneural condition. Inflammation in the IVD, in particular the presence of pro-inflammatory cytokines, was found to favor innervation and also sensitization of the nociceptive pathways, thereby exacerbating degenerative symptoms. In this review, we discuss anti-inflammatory approaches to encounter disc catabolism, potential treatments to lower discogenic pain and pro-anabolic approaches in the form of protein delivery, gene therapy and cell delivery, to trigger regeneration in the IVD. (C) 2014 Elsevier B.V. All rights reserved.
146
158
10.1016/j.addr.2014.08.008
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