ABSTRACT
Director of Bone Biology, Orthopaedic Research Institute, University of New South Wales, Sydney, Australia, Address: PO Box 541, Kogarah 1485, Australia,
Email: a.diwan@spine-service.org Departmental Contact: Level 2, Education and Research Building,
St George Hospital, 4-10 South Street, Kogarah NSW 2217 Sydney, Australia
Programmed cell death aff ects many diff erent aspects of the musculoskeletal system both during development and in adult tissue maintenance. Intervertebral discs, the shock absorbing cushion between the vertebrae in the spinal column, can be damaged through trauma and deteriorate with age, conditions that can result in chronic back pain. Healthy disc tissue normally expresses Fas Ligand and exhibits reduced apoptosis. However discs that have been subjected to prolonged mechanical stress, severe trauma or aging exhibit signs of increased cell death such as caspase degradation pathway protein activation and TNFα upregulation. Th us there appears to be a fi ne balance in the intervertebral disc, between protein synthesis and breakdown, and between cell death and cell regeneration. Exploration of this complex area of biology may provide alternative avenues for therapeutic intervention in chronic back pain as a result of disc degeneration. BMP-7 has shown promise in blocking apoptosis in disc cells in vitro. Th is
approach may tip the balance towards regeneration early in the deterioration process, avoiding the loss of valuable anabolic cells. Th is chapter discusses apoptosis in the spinal disc, and explores the potential for therapeutic intervention.
