Regulating the fate of stem cells for regenerating the intervertebral disc degeneration

Lower back pain is a leading cause of disability and is one of the reasons for the substantial socioeconomic burden. The etiology of intervertebral disc (IVD) degeneration is complicated, and its mechanism is still not completely understood.Factors such as aging, systemic inflammation, biochemical mediators,toxic environmental factors, physical injuries, and genetic factors are involved inthe progression of its pathophysiology. Currently, no therapy for restoringdegenerated IVD is available except pain management, reduced physicalactivities, and surgical intervention. Therefore, it is imperative to establishregenerative medicine-based approaches to heal and repair the injured disc,repopulate the cell types to retain water content, synthesize extracellular matrix,and strengthen the disc to restore normal spine flexion. Cellular therapy hasgained attention for IVD management as an alternative therapeutic option. In thisreview, we present an overview of the anatomical and molecular structure andthe surrounding pathophysiology of the IVD. Modern therapeutic approaches,including proteins and growth factors, cellular and gene therapy, and cell fateregulators are reviewed.