“…Therapeutic regeneration strategies aim to abrogate this proinflammatory, catabolic positive feedback loop through the implantation of healthy cells and/or signalling molecules to instruct correct ECM production, particularly in the NP. One growth factor recently proposed for NP regeneration is growth differentiation factor 6 (GDF6), a member of the bone morphogenetic protein (BMP) family that plays important developmental roles in the formation of cartilaginous tissues, including the IVD (Clendenning & Mortlock, 2012;Settle et al, 2003;Tassabehji et al, 2008;Wei et al, 2016). GDF6 expression has been linked to anti-ageing effects in multiple tissues (Hisamatsu, Ohno-Oishi, Nakamura, Mabuchi, & Naka-Kaneda, 2016) and, whereas studies conducted in our laboratory and others do not suggest GDF6 expression decreases with degeneration (Gulati, Chung, Wei, & Diwan, 2015; Le Maitre, Freemont, & Hoyland, 2009), preclinical studies have demonstrated that injection of GDF6 into experimentally induced rabbit and ovine annular puncture models attenuates pro-inflammatory molecular changes and prevents progression of IVD degeneration (Miyazaki et al, 2018;Shen et al, 2009).…”