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椎间盘（IVD）退变是一种常见的病理状态，保守治疗往往失败，IVD变性的患者最后往往需要手术干预。已经提出的几种治疗方案中，只有椎间盘切除术和关节融合术被证明可以达到预料的效果。生物治疗的目的是预防和控制椎间盘变性，改善椎间盘的功能、髓核和纤维环细胞的合成代谢和修复能力，并抑制基质降解。目前，临床应用仍处于起步阶段。间充质干细胞和基因治疗在预防和治疗IVD变性的作用还需要进一步的研究。最近的研究向我们展示了一种新的保护椎间盘的结构和功能的治疗策略：间充质干细胞（MSCs）移植，尤其是骨髓间充质干细胞（BM-MSCs）。而了解MSCs是否可以以及如何在有排拆性的退化的椎间盘中存活并繁殖是十分重要的。因此，本文着重讨论内源性蛋白酶、细胞因子、低氧、低营养、机械负荷及渗透压的调节对移植的 MSCs的影响。

英文摘要:

Intervertebral disc degeneration (IVD) is a frequent pathological condition. Conservative management often fails, and patients with IVD degeneration may require surgical intervention. Several treatment strategies have been proposed, although only surgical discectomy and arthrodesis have been proved to be predictably effective. The aim of biological strategies is to prevent and manage IVD degeneration, improve the function, the anabolic and reparative capabilities of the nucleus pulposus and annulus fibrosus cells, and inhibit matrix degradation. At present, clinical applications are still in their infancy. Further studies are required to clarify the role of mesenchymal stem cells and gene therapy for the prevention and treatment of IVD degeneration. Recent studies have demonstrated new therapeutic strategy using transplantation of mesenchymal stem cells (MSCs), especially bone marrow-derived MSCs (BM-MSCs), to preserve intervertebral disc (IVD) structure and functions. It is important to understand whether and how the MSCs survive and thrive in the hostile microenvironment of the degenerated IVD. Therefore, this reviewmajorly examines cytokines, endogenous proteinases, hypoxia, low nutrition, mechanical loading and osmotic conditions regulate the behavior of the exogenous MSCs.

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