How to enhance the ability of mesenchymal stem cells to alleviate intervertebral disc degeneration

Intervertebral disc (ID) degeneration (IDD) is one of the main causes of chronic low back pain, and degenerative lesions are usually caused by an imbalance between catabolic and anabolic processes in the ID. The environment in which the ID is located is harsh, with almost no vascular distribution within the disc, and the nutrient supply relies mainly on the diffusion of oxygen and nutrients from the blood vessels located under the endplate. The stability of its internal environment also plays an important role in preventing IDD. The main feature of disc degeneration is a decrease in the number of cells. Mesenchymal stem cells have been used in the treatment of disc lesions due to their ability to differentiate into nucleus pulposus cells in a nonspecific anti-inflammatory manner. The main purpose is to promote their regeneration. The current aim of stem cell therapy is to replace the aged and metamorphosed cells in the ID and to increase the content of the extracellular matrix. The treatment of disc degeneration with stem cells has achieved good efficacy, and the current challenge is how to improve this efficacy. Here, we reviewed current treatments for disc degeneration and summarize studies on stem cell vesicles, enhancement of therapeutic effects when stem cells are mixed with related substances, and improvements in the efficacy of stem cell therapy by adjuvants under adverse conditions. We reviewed the new approaches and ideas for stem cell treatment of disc degeneration in order to contribute to the development of new therapeutic approaches to meet current challenges.

Key Words: Mesenchymal stem cells, Intervertebral disc degeneration, Extracellular vesicles, Nucleus pulposus cells, Tissue regeneration

Core Tip: Mesenchymal stem cells have a strong self-renewal capacity and multidirectional differentiation potential, and their secreted vesicles promote regeneration of myeloid cells, increase extracellular matrix production, and alleviate inflammatory status. We reviewed the current relevant targets of stem cell exosomes for the treatment of intervertebral discs and the adjuvant tools used in conjunction with stem cell therapy. This will help to improve the therapeutic efficacy of stem cells and their exosomes, which will also contribute to development of more efficient treatment strategies and approaches for the restoration of disc degeneration.