European Spine Journal

, Volume 23, Supplement 3, pp 364–374

Cell sources for nucleus pulposus regeneration


    • Educell Ltd.
    • Faculty for Health Sciences Novo mesto
  • Jill Urban
    • Department of Physiology, Anatomy and GeneticsUniversity of Oxford
  • Mirjam Fröhlich
    • Educell Ltd.
  • Cornelia Neidlinger-Wilke
    • Institute of Orthopaedic Research and BiomechanicsUniversity of Ulm
  • Dimitris Kletsas
    • Laboratory of Cell Proliferation and Ageing Institute of Biology NCSR “Demokritos”
  • Urska Potocar
    • Educell Ltd.
  • Sarah Turner
    • Spinal Studies, Robert Jones and Agnes Hunt Orthopaedic Hospital and ISTMKeele University
  • Sally Roberts
    • Spinal Studies, Robert Jones and Agnes Hunt Orthopaedic Hospital and ISTMKeele University
Review article

DOI: 10.1007/s00586-013-3106-9

Cite this article as:
Kregar Velikonja, N., Urban, J., Fröhlich, M. et al. Eur Spine J (2014) 23: 364. doi:10.1007/s00586-013-3106-9



There is increasing interest in the development of cell therapy as a possible approach for the treatment of degenerative disc disease. To regenerate nucleus pulposus tissue, the cells must produce an appropriate proteoglycan-rich matrix, as this is essential for the functioning of the intervertebral disc. The natural environment within the disc is very challenging to implanted cells, particularly if they have been subcultured in normal laboratory conditions. The purpose of this work is to discuss parameters relevant to translating different proposed cell therapies of IVD into clinical use.


Several sources of cells have been proposed, including nucleus pulposus cells, chondrocytes and mesenchymal stem cells derived from bone marrow or adipose tissue. There are some clinical trials and reports of attempts to regenerate nucleus pulposus utilising either autologous or allogenic cells. While the published results of clinical applications of these cell therapies do not indicate any safety issues, additional evidence will be needed to prove their long-term efficacy.


This article discusses parameters relevant for successful translation of research on different cell sources into clinically applicable cell therapies: the influence of the intervertebral disc microenvironment on the cell phenotype, issues associated with cell culture and technical preparation of cell products, as well as discussing current regulatory requirements. There are advantages and disadvantages of each proposed cell type, but no strong evidence to favour any one particular cell source at the moment.


Intervertebral disc regenerationCell implantationDifferentiationMicroenvironmental factorsCell productsRegulatory and governance issues

Copyright information

© Springer-Verlag Berlin Heidelberg 2013