Pure platelet-rich plasma delays spinal disc degeneration by activating SIRT1-mediated autophagy in nucleus pulposus cells & improving mitochondrial homeostasis.

Pure platelet-rich plasma (P-PRP) delays intervertebral disc degeneration, air condition that ultimately leads to spinal arthritis and often chronic pain.

An August 2025 study by the Journal of Orthopaedic Surgical Research recently looked into the beneficial treatment of platelet conentrate PRP injection therapy for intervertebral disc degeneration.

Intervertebral disc degeneration is characterised by the inner nucleus pulposus cells to suffer apoptosis and extracellular matrix (ECM) degradation. Impaired autophagy and mitochondrial dysfunction further leads to acceleration of spinal disc degeneration.

Pure platelet-rich plasma (P-PRP), enriched in growth factors and low in pro-inflammatory mediators, has shown pain inflammatory reduction and regenerative potential. However, its mechanism of action, particularly the role of the autophagy-related SIRT1 pathway and mitochondrial homeostasis, remains to further be investigated.

P-PRP protected against degenerative properties by activating functional capacities and restoring mitochondrial function via the SIRT1 signalling axis. These findings provide novel mechanistic insight into PRP-based therapies and identify SIRT1 as a promising therapy for the treatment of interconvertible disc degenerative disease .

Ultimately, degenerative disc disease is characterised by loss of nucleus pulposus hydration, annular tears in the outer portion of the discs, inflammation, nerve ingrowth, and matrix breakdown. This leads to pain and progressive structural decline.

PRP injections, into or around the affected disc (intradiscal, intraligamentous, or peridiscal), has the therapeutic potential to slow down the degenerative process by:

1. Delivering High Concentrations of Growth Factors

   
   

   PRP releases TGF-β, PDGF, IGF-1, VEGF, and FGF, which stimulate disc cell activity and promote extracellular matrix production (proteoglycans, collagen type II). This supports hydration and biomechanical integrity of the disc.

2. Enhancing Disc Cell Viability

   PRP provides signals that help maintain nucleus pulposus and annulus fibrosus cell survival.

   It reduces apoptosis (cell death) of disc cells, which is a key factor in disc degeneration.

3. Slowing Matrix Degradation

   PRP suppresses matrix metalloproteinases (MMPs) and aggrecanases, enzymes that break down disc collagen and proteoglycans.

   This helps preserve the structural integrity of the disc tissue.

4. Supporting Nerve Healing and Reducing Pain

   PRP can reduce abnormal nerve ingrowth into the disc (a source of chronic pain).

   It also decreases local inflammatory sensitisation of nociceptors, helping reduce discogenic pain.

   
   

🔹How PRP Biologically Reduces Inflammation in Disc Degeneration

PRP can help to rebalance the catabolic (destructive) vs anabolic (healing) processes in the disc environment:

• Downregulates Pro-inflammatory Cytokines:

  Suppresses IL-1β, TNF-α, and IL-6, which are strongly implicated in disc degeneration, nerve irritation, and chronic pain.

  
  

• Reduces COX-2 and Prostaglandin E2 (PGE2):

  Lowers key mediators of pain and inflammation in the disc environment.

  
  

• Suppresses NF-κB Signalling Pathway:

  This is the central pathway that drives inflammation and catabolism in DDD.

  
  

• Promotes Anti-inflammatory Cytokines:

  Enhances production of IL-10 and TGF-β, shifting the environment towards repair.

  
  

• Stabilises the Peridiscal Microenvironment:

  Improves nutrient exchange and reduces chronic low-grade inflammation in surrounding tissues.

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