Emerging tissue engineering strategies for annulus fibrosus therapy

Low back pain is a major public health concern experienced by 80% of the world's population during their lifetime, which is closely associated with intervertebral disc (IVD) herniation. IVD herniation manifests as the nucleus pulposus (NP) protruding beyond the boundaries of the intervertebral disc due to disruption of the annulus fibrosus (AF). With a deepening understanding of the importance of the AF structure in the pathogenesis of intervertebral disc degeneration, numerous advanced therapeutic strategies for AF based on tissue engineering, cellular regeneration, and gene therapy have emerged. However, there is still no consensus concerning the optimal approach for AF regeneration. In this review, we summarized strategies in the field of AF repair and highlighted ideal cell types and pro-differentiation targeting ap-proaches for AF repair, and discussed the prospects and difficulties of implant systems combining cells and biomaterials to guide future research directions. Statement of significance Low back pain is a major public health concern experienced by 80% of the world's population during their lifetime, which is closely associated with intervertebral disc (IVD) herniation. However, there is still no consensus concerning the optimal approach for annulus fibrosus (AF) regeneration. In this review, we summarized strategies in the field of AF repair and highlighted ideal cell types and pro-differentiation targeting approaches for AF repair, and discussed the prospects and difficulties of implant systems com-bining cells and biomaterials to guide future research directions. & COPY; 2023 The Authors. Published by Elsevier Ltd on behalf of Acta Materialia Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

Low back pain is a common issue affecting 80% of the global population, often caused by intervertebral disc herniation. There is no consensus on the best approach for annulus fibrosus (AF) regeneration. This review summarizes strategies for AF repair, including ideal cell types and pro-differentiation targeting approaches, and discusses the prospects and challenges of implant systems combining cells and biomaterials for guiding future research directions.