Biological approaches in degenerative disc disease. Where are we now

Intervertebral disc (IVD) disease consists one of the main chronic- age related diseases mostly in patients over 60 years old. IVD degeneration is considered a multifactorial process with interaction of genetic, nutritional and environmental factors. Any nutritional and compositional imbalance leads to disturbance in biochemical and structural integrity. Unfortunately common therapeutic methods- conservative and surgical- focus mainly on the patients and rather to the pathology of disc degeneration. Biological treatment strategies approach the condition at a molecular level and according with the stage of degeneration are classified into biomolecular therapy, cell therapy and tissue-engineering (TE) therapy. During the first stage of the disease, where there is damage to biomolecules, biomoleucular therapy is suitable for promoting extracellular matrix (ECM) synthesis. This is achieved through injection of protein solutions (bone morphogenic proteins, osteogenic protein-1, transforming growth factor superfamily), platelet-rich-plasma and gene therapy injection (viral or non-viral vectors). In the midstage of disease, with cell amount reduction, cell therapy through mesenchymal stem cells and chondrocyte transplantation forms the best option for production- differentiation of ECM components and disc repair. Lastly, as degeneration reaches the final stage, implantation of TE disc-like constructs is considered the most optional reconstruction therapy for disc repair. Biological therapeutic strategies in IVD disease consists a revolutionary method, address not to symptoms but to pathophysiology of the degeneration with purpose to improve population’s quality life