eCM (Eur Cell Mater / e Cells & Materials) Not-for-Profit Open Access
Created by Scientists, for Scientists
 ISSN:1473-2262         NLM:100973416 (link)         DOI:10.22203/eCM

2021   Volume No 41 – pages 355-369

Title: For whom the disc tolls: intervertebral disc degeneration, back pain and toll-like receptors

Authors: DG Bisson, M Mannarino, R Racine, L Haglund

Address: The Orthopaedic Research Laboratory, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Room C10.148.2, Montreal, QC, H3G 1A4, Canada

E-mail: lisbet.haglund at

Abstract: Intervertebral disc (IVD) degeneration is characterised by catabolic and inflammatory processes that contribute largely to tissue degradation and chronic back pain. The disc cells are responsible for the pathological production of pro-inflammatory cytokines and catabolic enzymes leading to degeneration. However, this phenotypical change is poorly understood. Growing evidence in animal and human studies implicates Toll-like receptors (TLR) and their activation through danger-associated alarmins, found increasingly in degenerating IVDs. TLR signalling results in the release of pro-inflammatory cytokines and proteolytic enzymes that can directly cause IVD degeneration and back pain. This review aims to summarise the current literature on TLR activation in IVD degeneration and discuss potential treatment modalities to alleviate the inflammatory phenotype of disc cells in order to arrest IVD degeneration and back pain.

Key Words: Inflammation, proteases, catabolism, alarmins, pain, innervation.

Publication date: March 19th 2021

Article download: Pages 355-369 (PDF file)

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