European Spine Journal

, Volume 23, Supplement 3, pp 364–374

Cell sources for nucleus pulposus regeneration

  • Nevenka Kregar Velikonja
  • Jill Urban
  • Mirjam Fröhlich
  • Cornelia Neidlinger-Wilke
  • Dimitris Kletsas
  • Urska Potocar
  • Sarah Turner
  • Sally Roberts
Review article



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 regeneration Cell implantation Differentiation Microenvironmental factors Cell products Regulatory and governance issues 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nevenka Kregar Velikonja
    • 1
    • 6
  • Jill Urban
    • 2
  • Mirjam Fröhlich
    • 1
  • Cornelia Neidlinger-Wilke
    • 3
  • Dimitris Kletsas
    • 4
  • Urska Potocar
    • 1
  • Sarah Turner
    • 5
  • Sally Roberts
    • 5
  1. 1.Educell Ltd.TrzinSlovenia
  2. 2.Department of Physiology, Anatomy and GeneticsUniversity of OxfordOxfordUK
  3. 3.Institute of Orthopaedic Research and BiomechanicsUniversity of UlmUlmGermany
  4. 4.Laboratory of Cell Proliferation and Ageing Institute of Biology NCSR “Demokritos”AthensGreece
  5. 5.Spinal Studies, Robert Jones and Agnes Hunt Orthopaedic Hospital and ISTMKeele UniversityShropshireUK
  6. 6.Faculty for Health Sciences Novo mestoNovo mestoSlovenia

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