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Additional RCTs are required to ascertain the efficacy of combined therapeutic approaches, such as immunomodulatory compounds, intravesical injection or instillation with BTX or HA, or HA and CS and diet modification

Our data further suggest that autologous fibroblasts can induce native NP cells in degenerative IVDs to adopt a fibrotic phenotype via the activation of TGF/Smad signaling in order to enhance the reparative fibrosis and healing process (Fig

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