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World J Stem Cells. Nov 26, 2023; 15(11): 989-998
Published online Nov 26, 2023. doi: 10.4252/wjsc.v15.i11.989
How to enhance the ability of mesenchymal stem cells to alleviate intervertebral disc degeneration
Qing-Xiang Zhang, Min Cui
Qing-Xiang Zhang, Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Qing-Xiang Zhang, Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430048, Hubei Province, China
Min Cui, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Zhang QX wrote the manuscript and collected the data; Cui M revised and approved the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82202766; Natural Science Foundation of Hubei Province of China, No. 2022CFB686; Science Foundation of Union Hospital, No. 2021xhyn102; Scientific Research Training Program for Young Talents in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
Conflict-of-interest statement: There is no conflict of interest associated with this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Cui, MD, PhD, Associate Chief Physician, Associate Professor, Doctor, Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. cm95588@hust.edu.cn
Received: July 17, 2023
Peer-review started: July 17, 2023
First decision: August 22, 2023
Revised: September 14, 2023
Accepted: November 16, 2023
Article in press: November 16, 2023
Published online: November 26, 2023
Processing time: 129 Days and 10.8 Hours
Abstract

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.

Keywords: 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.