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  • Review Article
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Stem cell therapy for intervertebral disc regeneration: obstacles and solutions

Nature Reviews Rheumatology volume 11, pages 243–256 (2015)Cite this article

Subjects

Key Points

  • Intervertebral disc (IVD) degeneration is frequently associated with low back and neck pain

  • The avascularity of the IVD is an obstacle to intrinsic repair by exogenous cells

  • Tissue-specific progenitor cells have been identified in the IVD, and these cells could be targeted to promote intrinsic repair

  • Supplementation of functional cells from exogenous sources has IVD-regenerative effects in basic and preclinical studies

  • A growing number of clinical trials are assessing the effects of cell therapy for IVD disease

  • Despite promising results of cell therapy for IVD disease in preclinical studies, various obstacles remain to define its efficacy and target indications

Abstract

Intervertebral disc (IVD) degeneration is frequently associated with low back and neck pain, which accounts for disability worldwide. Despite the known outcomes of the IVD degeneration cascade, the treatment of IVD degeneration is limited in that available conservative and surgical treatments do not reverse the pathology or restore the IVD tissue. Regenerative medicine for IVD degeneration, by injection of IVD cells, chondrocytes or stem cells, has been extensively studied in the past decade in various animal models of induced IVD degeneration, and has progressed to clinical trials in the treatment of various spinal conditions. Despite preliminary results showing positive effects of cell-injection strategies for IVD regeneration, detailed basic research on IVD cells and their niche indicates that transplanted cells are unable to survive and adapt in the avascular niche of the IVD. For this therapeutic strategy to succeed, the indications for its use and the patients who would benefit need to be better defined. To surmount these obstacles, the solution will be identified only by focused research, both in the laboratory and in the clinic.

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Figure 1: Morphology of region-specific IVD cells.
Figure 2: Treatment options for IVD degeneration using cell therapy.
Figure 3: Cell-surface markers for NP cell differentiation.
Figure 4: The IVD-specific niche is an obstacle to successful IVD regeneration using cell therapy.
Figure 5: Post-surgical IVD degeneration is a potential indication for cell therapy.

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Acknowledgements

The authors are grateful to M. E. Lenz for her help in preparation of the manuscript. This work was supported in part by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, a grant from AO Spine International and a grant from AO Foundation (D.S.).

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  1. Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, 259-1193, Kanagawa, Japan

    Daisuke Sakai

  2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, 60612, IL, USA

    Gunnar B. J. Andersson

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  1. Daisuke Sakai
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Correspondence to Daisuke Sakai.

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Sakai, D., Andersson, G. Stem cell therapy for intervertebral disc regeneration: obstacles and solutions. Nat Rev Rheumatol 11, 243–256 (2015). https://doi.org/10.1038/nrrheum.2015.13

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