Controversies in regenerative medicine: Should intervertebral disc degeneration be treated with mesenchymal stem cells?. Issue 1 (1st March 2019)

• Record Type: Journal Article
• Authors: Loibl, Markus; Wuertz‐Kozak, Karin; Vadala, Gianluca; Lang, Siegmund; Fairbank, Jeremy; Urban, Jill P.
• Is Part Of: JOR spine. Volume 2:Issue 1(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-03-01
• Subjects: degenerate disc disease -- inflammation -- intervertebral disc degeneration -- mesenchymal stem cells -- microenvironment -- regeneration; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Electronic journal; Periodicals; 616.73005
• DOI: 10.1002/jsp2.1043
• Languages: English
• ISSNs: 2572-1143

Abstract

Abstract : Low back pain (LBP) can significantly reduce the quality of life of patients, and has a considerable economic and social impact worldwide. It is commonly associated with disc degeneration, even though many people with degenerate discs are asymptomatic. Degenerate disc disease (DDD), is thus a common term for intervertebral disc (IVD) degeneration associated with LBP. Degeneration is thought to lead to LBP because of nerve ingrowth into the degenerate disc, inflammation, or because degradation of extracellular matrix (ECM) alters spinal biomechanics inappropriately. Thus, while the objectives of some interventions for LBP are to control pain intensity, other interventions aim to deal with the consequences of disc degeneration through stabilizing the disc surgically, by inserting artificial discs or by repairing the disc biologically and preventing progressive IVD degeneration. Despite tremendous research efforts, treatment of LBP through the use of regenerative interventions aiming to repair the IVD is still controversial. The use of mesenchymal stem cells for IVD regeneration in a patient‐based case will be discussed by an ensemble of clinicians and researchers. Abstract : This T2‐weighted magnetic resonance imaging reveals single‐level intervertebral disc (IVD) degeneration at the L4/5. The 22‐year‐old patient has been complaining about low back pain for 8 months despite conservative treatment. Mesenchymal stem cells (MSCs) as a regenerative treatment option have been tested as a feasible injection therapy for degenerate disc disease. Despite promising preclinical trials, clinical results are insufficient and multicenter, prospective, randomized trials remain to be conducted. Nevertheless, MSCs hold great regenerative potential due to their proliferation characteristics, their anabolic functionality and inflammation‐modulatory properties. The main challenge for a successful cell‐based IVD therapy can be seen in the harsh microenvironment of the degenerated IVDs that limits the viability and functionality of injected MSCs. However, preconditioning approaches including new emerging techniques in genomics have the potential to prepare MSCs for the survival in IVDs and to take MSCs therapies to the next step..