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2015 ; 473
(6
): 1903-12
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Molecular basis of intervertebral disc degeneration and herniations: what are the
important translational questions?
#MMPMID25024024
Kadow T
; Sowa G
; Vo N
; Kang JD
Clin Orthop Relat Res
2015[Jun]; 473
(6
): 1903-12
PMID25024024
show ga
BACKGROUND: Intervertebral disc degeneration is a common condition with few
inexpensive and effective modes of treatment, but current investigations seek to
clarify the underlying process and offer new treatment options. It will be
important for physicians to understand the molecular basis for the pathology and
how it translates to developing clinical treatments for disc degeneration. In
this review, we sought to summarize for clinicians what is known about the
molecular processes that causes disc degeneration. RESULTS: A healthy disc
requires maintenance of a homeostatic environment, and when disrupted, a
catabolic cascade of events occurs on a molecular level resulting in upregulation
of proinflammatory cytokines, increased degradative enzymes, and a loss of matrix
proteins. This promotes degenerative changes and occasional neurovascular
ingrowth potentially contributing to the development of pain. Research
demonstrates the molecular changes underlying the harmful effects of aging,
smoking, and obesity seen clinically while demonstrating the variable influence
of exercise. Finally, oral medications, supplements, biologic treatments, gene
therapy, and stem cells hold great promise but require cautious application until
their safety profiles are better outlined. CONCLUSIONS: Intervertebral disc
degeneration occurs where there is a loss of homeostatic balance with a
predominantly catabolic metabolic profile. A basic understanding of the molecular
changes occurring in the degenerating disc is important for practicing clinicians
because it may help them to inform patients to alter lifestyle choices, identify
beneficial or harmful supplements, or offer new biologic, genetic, or stem cell
therapies.