title: Intervertebral disk degeneration and emerging biologic treatments.
abstract: Although understanding of the biologic basis of intervertebral disk (IVD) degeneration is rapidly advancing, the unique IVD environment presents challenges to the development and delivery of biologic treatments. Acceleration of cellular senescence and apoptosis in degenerative IVDs and the depletion of matrix proteins have prompted the development of treatments based on replacing IVD cells using various cell sources. However, this strategy has not been tested in animal models. IVD degeneration and associated pain have led to interest in pathologic innervation of the IVD and ultimately to the development of percutaneous devices to ablate afferent nerve endings in the posterior annulus. Degeneration leads to changes in the expression of matrix protein, cytokines, and proteinases. Injection of growth factors and mitogens may help overcome these degenerative changes in IVD phenotype, and these potential treatments are being explored in animal studies. Gene therapy is an elegant method to address changes in protein expression, but efforts to apply this technology to IVD degeneration are still at early stages.
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Christopher K
authors: CK
authors: Kepler
authors: D Greg
authors: DG
authors: Anderson
authors: Chadi
authors: C
authors: Tannoury
authors: Ravi K
authors: RK
authors: Ponnappan
mesh_terms: D000818:Animals; D017209:Apoptosis; D001691:Biological Therapy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D016922:Cellular Senescence; D016207:Cytokines / Q000037:antagonists & inhibitors / Q000378:metabolism; D004599:Electric Stimulation Therapy / Q000379:methods; D005109:Extracellular Matrix / Q000378:metabolism / Q000473:pathology; D015316:Genetic Therapy / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007403:Intervertebral Disc / Q000294:innervation / Q000378:metabolism / Q000473:pathology; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000628:therapy*; D053657:Platelet-Rich Plasma; D011506:Proteins / Q000378:metabolism; D033581:Stem Cell Transplantation; D015854:Up-Regulation
chemical_list: D016207:Cytokines; D011506:Proteins