Morphologic and molecular evidence for gap junctions and connexin 43 and 45 expression in annulus fibrosus cells from the human intervertebral disc

Integrated proteome sequencing, bulk RNA sequencing and single-cell RNA sequencing to identify potential biomarkers in different grades of intervertebral disc degeneration

Low back pain (LBP) is a prevalent health problem worldwide that affects over 80% of adults during their lifetime. Intervertebral disc degeneration (IDD) is a well-recognized leading cause of LBP. IDD is classified into five grades according to the Pfirrmann classification system. The purpose of this study was to identify potential biomarkers in different IDD grades through an integrated analysis of proteome sequencing (PRO-seq), bulk RNA sequencing (bRNA-seq) and single-cell RNA sequencing (scRNA-seq) data. Eight cases of grade I-IV IDD were obtained. Grades I and II were considered non-degenerative discs (relatively normal), whereas grades III and IV were considered degenerative discs. PRO-seq analysis was performed to identify differentially expressed proteins (DEPs) in various IDD grades. Variation analysis was performed on bRNA-seq data to differentiate expressed genes (DEGs) in normal and degenerated discs. In addition, scRNA-seq was performed to validate DEGs in degenerated and non-degenerated nucleus pulposus (NP). Machine learning (ML) algorithms were used to screen hub genes. The receiver operating characteristic (ROC) curve was used to validate the efficiency of the screened hub genes to predict IDD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to analyze function enrichment and signaling pathways. Protein-protein interaction (PPI) network was used to prioritize disease-related proteins. SERPINA1, ORM2, FGG and COL1A1 were identified through PRO-seq as the hub proteins involved in regulating IDD. ML algorithms selected ten hub genes, including IBSP, COL6A2, MMP2, SERPINA1, ACAN, FBLN7, LAMB2, TTLL7, COL9A3, and THBS4 in bRNA-seq. Since serine protease inhibitor clade A member 1 (SERPINA1) was the only common gene, its accuracy in degenerated and non-degenerated NP cells was validated using scRNA-seq. Then, the rat degeneration model of caudal vertebra was established. The expression of SERPINA1 and ORM2 was detected using immunohistochemical staining of human and rat intervertebral discs. The results showed that SERPINA1 was poorly expressed in the degenerative group. We further explored the potential function of SERPINA1 by Gene Set Enrichment Analysis (GSEA) and cell-cell communication. Therefore, SERPINA1 can be used as a biomarker to regulate or predict the progress of disc degeneration.

Joint diseases: from connexins to gap junctions

Connexons form the basis of hemichannels and gap junctions. They are composed of six tetraspan proteins called connexins. Connexons can function as individual hemichannels, releasing cytosolic factors (such as ATP) into the pericellular environment. Alternatively, two hemichannel connexons from neighbouring cells can come together to form gap junctions, membrane-spanning channels that facilitate cell-cell communication by enabling signalling molecules of approximately 1 kDa to pass from one cell to an adjacent cell. Connexins are expressed in joint tissues including bone, cartilage, skeletal muscle and the synovium. Indicative of their importance as gap junction components, connexins are also known as gap junction proteins, but individual connexin proteins are gaining recognition for their channel-independent roles, which include scaffolding and signalling functions. Considerable evidence indicates that connexons contribute to the function of bone and muscle, but less is known about the function of connexons in other joint tissues. However, the implication that connexins and gap junctional channels might be involved in joint disease, including age-related bone loss, osteoarthritis and rheumatoid arthritis, emphasizes the need for further research into these areas and highlights the therapeutic potential of connexins.

Surgical anatomy, radiological features, and molecular biology of the lumbar intervertebral discs

The intervertebral disc (IVD) is a joint unique in structure and functions. Lying between adjacent vertebrae, it provides both the primary support and the elasticity required for the spine to move stably. Various aspects of the IVD have long been studied by researchers seeking a better understanding of its dynamics, aging, and subsequent disorders. In this article, we review the surgical anatomy, imaging modalities, and molecular biology of the lumbar IVD. Clin. Anat. 30:251-266, 2017. © 2017 Wiley Periodicals, Inc.

Decoding the intervertebral disc: Unravelling the complexities of cell phenotypes and pathways associated with degeneration and mechanotransduction

Back pain is the most common cause of pain and disability worldwide. While its etiology remains unknown, it is typically associated with intervertebral disc (IVD) degeneration. Despite the prevalence of back pain, relatively little is known about the specific cellular pathways and mechanisms that contribute to the development, function and degeneration of the IVD. Consequently, current treatments for back pain are largely limited to symptomatic interventions. However, major progress is being made in multiple research directions to unravel the biology and pathology of the IVD, raising hope that effective disease-modifying interventions will soon be developed. In this review, we will discuss our current knowledge and gaps in knowledge on the developmental origin of the IVD, the phenotype of the distinct cell types found within the IVD tissues, molecular targets in IVD degeneration identified using bioinformatics strategies, and mechanotransduction pathways that influence IVD cell fate and function.

Repair, regenerative and supportive therapies of the annulus fibrosus: achievements and challenges

Lumbar discectomy is a very effective therapy for neurological decompression in patients suffering from sciatica due to hernia nuclei pulposus. However, high recurrence rates and persisting post-operative low back pain in these patients require serious attention. In the past decade, tissue engineering strategies have been developed mainly targeted to the regeneration of the nucleus pulposus (NP) of the intervertebral disc. Accompanying techniques that deal with the damaged annulus fibrous are now increasingly recognised as mandatory in order to prevent re-herniation to increase the potential of NP repair and to confine NP replacement therapies. In the current review, the requirements, achievements and challenges in this quickly emerging field of research are discussed.

Gene expression of types I, II, and VI collagen, aggrecan, and chondroitin-6-sulfotransferase in the human annulus: in situ hybridization findings

BACKGROUND CONTEXT

Within each lamellar bundle in the annulus, disc cells produce a complex and sophisticated architectural organization which acts to meet the unique biomechanical needs of the disc. How cells coordinate expression of genes throughout the disc is an important but as yet poorly understood process. For the annulus, such coordination probably involves cell-cell communication as well as growth factor and mechanoreceptor signaling to appropriately maintain the disc extracellular matrix (ECM) for the prevention of annular tears.

PURPOSE

To determine the percentage and patterns of gene expression for types I, II, and VI collagen, aggrecan, and chondroitin-6-sulfotransferase in the human annulus.

STUDY DESIGN/SETTING

Human annulus specimens were obtained from surgical subjects and a control donor in a study approved by the authors' Human Subjects Institutional Review Board.

PATIENT SAMPLE

Four Thompson grade II, three grade III, and four grade IV annulus specimens were evaluated with in situ hybridization to determine gene expression.

OUTCOME MEASURES

The percentages of cells in the human annulus expressing type I, II, and VI collagen, aggrecan, and chondroitin-6-sulfotransferase.

METHODS

In situ hybridization, a technique with high temporal and spatial resolution, was used to detect gene expression of types I, II, and VI collagen, aggrecan, and chondroitin-6 sulfotransferase in cells in adjacent sections of annulus from discs with Thompson grades of II, III, and IV.

RESULTS

Overall, 30.8% of cells expressed aggrecan, 38.4% type I collagen, 45.6% type II collagen, 48.1% type VI collagen, and 57.7% chondroitin-6-sulfotransferase. An important finding was that adjacent cells could be expressing, or not expressing, the gene of interest. These data could not have been gained from other global molecular techniques such as microarray analysis or reverse transcription polymerase chain reaction (RT-PCR). Information on gene expression by individual disc cells is important to better understand disc matrix homeostasis, the pathogenesis of disc degeneration, and to formulate potential biologic therapies for disc degeneration.

CONCLUSIONS

This in situ hybridization study revealed the important finding that adjacent cells differ in their gene expression patterns for specific genes. Factors that could contribute to this difference in adjacent cell gene expression include cellular heterogeneity within the annulus, the presence of senescent cells with altered gene expression, and/or loss of coordinated disc cell function as a result of disruption of cell-cell communication.

Analysis of cell death and vertebral end plate bone mineral density in the annulus of the aging sand rat

BACKGROUND CONTEXT

The relationship between disc degeneration and end plate sclerosis is poorly understood. The sand rat is an excellent, economical small-animal model in which disc degeneration is age related, spontaneous, reliable, and well characterized. This model is used here to evaluate disc degeneration, disc cell viability, and vertebral end plate bone mineral density (BMD) in lumbar sites.

PURPOSE

To determine the proportion of live and dead cells and end plate bone mineral density in the aging sand rat annulus.

STUDY DESIGN

Young and old sand rats were used in work approved by the Institutional Animal Care and Use Committee. Outcome measures were the percentage of live/dead annulus cells in the disc and the BMD of cranial and caudal end plates of lumbar vertebrae.

METHODS

Bone densitometry was used to obtain endplate BMD on lumbar spines of 16 young sand rats aged 2 to 6 months and 26 older animals aged 22 to 46 months. X-ray films were analyzed for wedging, end plate calcification, and disc-space narrowing. Additional discs were also harvested and incubated with fluorochromes, and the percentage of live or dead cells were determined for the outer, inner annulus, and entire annulus.

RESULTS

Radiographically old animals had significantly greater incidence of lumbar wedging (p<0.004) and a significantly greater incidence of end plate calcification and disc-space narrowing (p<0.01). In the live-dead study, the mean percentage of dead annulus cells for the three age groups were significantly different for the outer annulus (p<0.001), inner annulus (p=0.005), and total annulus (p<0.0001). The percentages of dead cells for the entire annulus were 46.14%+/-7.99% (age 2-6 months), 48.13%+/-17.32% (age, 13-19 months), and 76.80%+/-7.27% (age 26-38 months). The percentage of dead disc cells correlated significantly with age for outer annulus, inner annulus, and total annulus (p<0.006). The percentage of dead cells in the entire annulus and the inner annulus correlated significantly with end plate BMD (p<0.02).

CONCLUSIONS

Data are novel and show that in very aged sand rats, end plate BMD is significantly greater than that of young animals. Live/dead cell analyses showed increasing cell death in both outer and inner annulus, which correlated significantly with age and with end plate BMD.

Senescence in cells of the aging and degenerating intervertebral disc: immunolocalization of senescence-associated beta-galactosidase in human and sand rat discs

STUDY DESIGN

Human intervertebral disc anulus tissue was obtained in a prospective study of cell senescence. Localization of the senescence biomarker beta-galactosidase (senescence associated beta-galactosidase, SA-beta-gal) was used for quantitative determination of the % senescent cells. Discs were obtained from surgical specimens or control donors. Discs were also studied from the lumbar spine of the sand rat. Experimental studies were approved by the authors' Human Subjects Institutional Review Board and animal use committee.

OBJECTIVES

To determine the incidence of cell senescence in human discs with Thompson Grades I through V using immunocytochemistry to quantify the percentage of cells positive for the senescence biomarker SA-beta-gal.

SUMMARY OF BACKGROUND DATA

Cell senescence has been recognized as a potential factor playing a role age-related disc degeneration. Senescent cells are viable but have lost the ability to divide. Senescence cells, however, are metabolically active.

METHODS

Fifty-seven discs specimens from 54 subjects were examined with immunocytochemistry for anti-SA-beta-gal immunocytochemical localization to identify senescent cells. The fraction of positive cells was determined with quantitative histomorphometry.

RESULTS

Quantitative histomorphometry of human discs show an overall incidence of SA-beta-gal-positive cells of 29.9% (+/-24.8, SD), with a range from 0 to 92.01%. Analysis by ANOVA of the % senescent cells grouped by Thompson grade showed significant increases in senescence with increasing disc degeneration (P < 0.0001). Further analysis with Tukey's test showed significant differences between the % senescent cells in Grades I/II versus IV, and versus V. SA-beta-gal-positive cells were also present in discs of the aging sand rat spine.

CONCLUSIONS

Quantitative analysis of immunohistochemical localization of SA-beta-gal identified a sizeable population of senescent cells in the aging/degenerating disc. It is important to discover more about the senescent disc cell population because these cells persist and accumulate over time within the disc. Since senescent cells cannot divide, senescence may reduce the disc's ability to generate new cells to replace existing ones lost to necrosis or apoptosis.

Connexin 32 and 43 gap junctions differentially modulate tenocyte response to cyclic mechanical load

Gap junctions allow rapid exchange of ions and small metabolites between cells. They can occur between connective tissue cells, and in tendons there are two prominent types, composed of connexin 32 or 43. These form distinct networks - tenocyte rows are linked by both longitudinally, but only by connexin 43 laterally. We hypothesised that the junctions had different roles in cell response to mechanical loading, and measured the effects of inhibitors of gap junction function on secretion of collagen by tenocyte cultures exposed to mechanical strain. Chicken tendon fibroblasts were exposed to cyclic tensile loading in the presence or absence of general gap junction inhibitors (halothane or the biomimetic peptide gap27), or antisense oligonucleotides to chicken connexin 32 or 43. Untreated cultures increased collagen secretion by around 25% under load. Halothane eliminated this response but caused cell damage. Gap27 peptide reduced secretion but maintained loading effects - strained cultures secreting more collagen than unstrained. Antisense downregulation showed major differences between connexins: antisense 32 reduced, and antisense 43 increased, collagen secretion. In both cases loading effects were maintained. This shows that (i) gap junctional integration of signals is important in load response of tenocyte populations - mechanotransduction occurs in individual cells but integration of signals markedly enhances it and (ii) communication via connexin 32 and 43 have differential effects on the load response, with connexin 32 being stimulatory and connexin 43 being inhibitory. Cells coordinate and control their response to mechanical signals at least in part by differential actions of these two types of gap junction.

The SOX9 transcription factor in the human disc: decreased immunolocalization with age and disc degeneration

STUDY DESIGN

Human intervertebral disc anulus tissue was obtained in a prospective study of immunolocalization of SOX9, a protein that plays a role in chondrogenesis and Type II collagen expression. The Human Subjects Institutional Review Board approved experimental studies. Discs were obtained from surgical specimens and from control donors.

OBJECTIVES

To determine whether SOX9 could be detected in discs of Thompson Grades I-IV using immunohistochemistry and to quantify the percentage of cells with SOX9 expression.

SUMMARY OF BACKGROUND DATA

SOX9 is involved with cell-specific activation of COL2A1 in chondrocytes. Recent studies have used adenoviral delivery vectors expressing SOX9 to infect a chondroblastic cell line and human disc cells; SOX9 and Type II collagen production increased. The AdSOX9 virus has also been injected directly into rabbit discs in which disc architecture was preserved for 5 weeks. Despite current interest in SOX9 for gene therapy, there have been few studies of SOX9 in normal or degenerated discs.

METHODS

Discs from 12 normal donors and 25 surgical subjects 15-76 years old were examined for SOX9 immunolocalization. Eight Thompson Grade I discs, 7 Grade II discs, 10 Grade III discs, and 12 Grade IV discs were studied.

RESULTS

In Thompson Grade I discs, SOX9 was uniformly localized throughout the anulus and in some cells of the nucleus. However, in discs from adult donors, anulus cells were present that showed no SOX9 localization, although neighboring cells might be positive. Mean percent localization was 74% for Grade II discs, 69% for Grade III, and 71.6% for Grade IV. Cervical sites showed significantly greater localization than lumbar sites.

CONCLUSIONS

Findings showed a uniform expression of SOX9 in the newborn healthy anulus. With aging and disc degeneration, some anulus cells no longer express this transcription product. These observations suggest that the loss of expression of SOX9 in some disc cells may play a role indisc aging and disc degeneration by resulting in decreased expression and production of Type II collagen.

ISSLS prize winner: A study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs

STUDY DESIGN

An in vivo serial magnetic resonance imaging study of diffusion characteristics in human lumbar discs over 24 hours in healthy volunteers and patients with low back pain.

OBJECTIVES

To document the temporal pattern of diffusion in normal human lumbar discs and to study the influence of the vascularity of bone and the status of endplate on diffusion in the normal and degenerate discs.

SUMMARY OF BACKGROUND DATA

Diffusion is the only source of nutrition to the discs, but no firm data are available on pattern of diffusion in humans. More data on this important subject are required to improve our understanding of disc degeneration and to probe research possibilities for preventing the same.

METHODS

The diffusion pattern over 24 hours following gadodiamide injection was studied in 150 discs (96 normal and 54 degenerate). Signal intensity values for three regions of interest in bone (i.e., vertebral body, subchondral bone, and endplate zone) and seven in the disc were calculated, and normal percentiles of diffusion were derived for these regions. Enhancement percentage for each time period, peak enhancement percentage for each region, and the time taken to achieve peak enhancement percentage (Tmax) were used to define and compare diffusion characteristics and plot a time-intensity curve to document the 24-hour temporal pattern. The correlation of blood flow of the bone as measured by peak enhancement percentage of vertebral body, the status of the endplate zone as measured by the peak enhancement percentage, and Tmax of the endplate zone were correlated with the diffusion of the disc.Univariate analysis of variance, multiple comparisons, appropriate tests for significance, and stepwise linear regression analysis were used for analysis of the data using SPSS software.

RESULTS

In normal discs, a "diffusion march" from the vertebral body to the center of disc was noted with the SImax being observed at 5 min in the vertebral body and subchondral bone, at 2 hours in the endplate zone, and at 6 hours in the nucleus pulposus. A significant difference in mean peak enhancement percentage was observed between that of the body and the discs in those less than 10 years and those above the age of 20 years (P < 0.001). Alterations in endplate zone produced distinct magnetic resonance imaging signs of disturbance in diffusion, which offered a reliable noninvasive method of identifying endplate cartilage damage. Stepwise linear regression analysis showed that the significant variable influencing diffusion to the center of the nucleus pulposus of the total sample was peak enhancement percentage of endplate zone (R2 = 0.216; P < 0.001), that of degenerate discs was peak enhancement percentage of endplate zone (R2 = 0.322; P < 0.001), and that of normal discs (R2 = 0.324; P < 0.001) was age.

CONCLUSIONS

Serial postcontrast magnetic resonance imaging studies offer a reliable method of assessing the diffusion of the discs and the functional status of the endplate cartilage. Endplate cartilage damage increases with age and produces considerable changes in diffusion. The present study has described reliable signs by which these damages can be identified in vivo. Aging and degeneration have been shown to be two separate processes by documenting clear-cut differences in diffusion. The present data encourage use of diffusion studies as a noninvasive method to assess the physiologic status of the disc and endplate and to study the effect of drugs, smoking, mechanical loading, exercises, etc. on the physiology of the disc.

Cell-based tissue engineering for the intervertebral disc: in vitro studies of human disc cell gene expression and matrix production within selected cell carriers

BACKGROUND CONTEXT

Little is known about how disc cells attach, proliferate and form extracellular matrix (ECM) within carrier materials. Such information is needed to help formulate criteria for successful cell-carrier interactions in tissue engineering.

PURPOSE

To compare proliferation, ECM production and gene expression in annulus cells cultured in a variety of cell carrier materials with potential application in tissue engineering of the disc.

STUDY DESIGN

Human intervertebral disc cells from the annulus were used in a prospective study of proliferation, ECM production and gene expression within selected cell carriers.

METHODS

Annulus cells from discs of 29 individuals were tested in collagen sponge, collagen gel, agarose, alginate or fibrin gel formulations. In situ hybridization assessed ECM gene expression of Types I and II collagen, aggrecan and chondroitin-6 sulfotransferase. Cell proliferation, cell shape, attachment and ECM production were evaluated.

RESULTS

Collagen sponges provided the best microenvironment for disc cell ECM production and gene expression. Although collagen gels often could support good cell growth, such constructs did not result in either abundant ECM production or ECM gene expression, as shown by in situ hybridization. Growth and ECM production and gene expression in alginate, agarose and fibrin microenvironments were inferior.

CONCLUSIONS

Tissue engineering techniques open new therapeutic possibilities for use of autologous disc cells, but fundamental questions on how these cells interact with cell carriers are unexplored. Results provide novel data on disc cell gene expression within diverse microenvironments. The collagen sponge proved to be a superior microenvironment.

The molecular basis of intervertebral disk degeneration

At present, the molecular evidence involved in the degeneration of the IVD is still in its primitive stage. In general, however, intrinsic, extrinsic, and generic factors all have shown a contribution to the initiation of degeneration. These factors may stimulate cytokines and directly or indirectly generate the cellular events thus far detected and observed. Such changes discussed have been the cellularity, matrix degradation, matrix quality, and synthesis of enzymes involved in the breakdown of the matrix, including fibronectin fragments of the degraded matrix which can contribute to further degradation. The involvement of cytokines and other inflammatory mediators in the generation of vascularization and stimulation of pain receptors are still controversial but may reveal the pathway to the symptomatic conditions of IVD degeneration.

Recent advances in disc cell biology

STUDY DESIGN

There have been many advances over the past decade in understanding and experimentally modulating biologic aspects of intervertebral disc cell function. An overview of the current state of this biologic research is presented.

OBJECTIVES

To provide clinicians with a review of important recent advances in biologic studies of the disc and their implications for potential disc therapies.

SUMMARY OF BACKGROUND DATA

Historically, anatomic, biochemical, radiologic, and biomechanical studies of the intervertebral disc formed the foundation on which our understanding of disc function was built. Magnetic resonance imaging techniques that allowed viewing of soft tissue components of the disc further advanced imaging capabilities.

METHODS

Recent publications are reviewed.

RESULTS

Experimental approaches over the past decade have enabled researchers to look more critically at disc cell function. This is important because disc cell function produces the extracellular matrix components of the disc, which, in turn, shape the disc's subsequent physiologic and biomechanical functions. New approaches to the study of disc cell function, methods to manipulate disc cells, studies of intact discs and disc nutrition, vertebral endplate structure and function, tissue engineering, gene therapy, and the potential of stem cells in disc therapy are reviewed and discussed.

CONCLUSIONS

Many believe that disc degeneration has a cellular basis. New research is helping us better understand healthy, aging, and degenerating discs. Modern methods to manipulate and modulate disc cell function open exciting and challenging new therapeutic possibilities for future biologic treatments of disc degeneration.

Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science

STUDY DESIGN

A histologic study on age-related changes of the human lumbar intervertebral disc was conducted.

OBJECTIVES

To investigate comprehensively age-related temporospatial histologic changes in human lumbar intervertebral disc, and to develop a practicable and reliable classification system for age-related histologic disc alteration.

SUMMARY OF THE BACKGROUND DATA

No comprehensive microscopic analysis of age-related disc changes is available. There is no conceptual morphologic framework for classifying age-related disc changes as a reference basis for more sophisticated molecular biologic analyses of the causative factors of disc aging or premature aging (degeneration).

METHODS

A total of 180 complete sagittal lumbar motion segment slices obtained from 44 deceased individuals (fetal to 88 years of age) were analyzed with regard to 11 histologic variables for the intervertebral disc and endplate, respectively. In addition, 30 surgical specimens (3 regions each) were investigated with regard to five histologic variables. Based on the semiquantitative analyses of 20,250 histologic variable assessments, a classification system was developed and tested in terms of validity, practicability, and reliability. The classification system was applied to cadaveric and surgical disc specimens not included in the development of the classification system, and the scores were assessed by two additional independent raters.

RESULTS

A semiquantitative analyses provided clear histologic evidence for the detrimental effect of a diminished blood supply on the endplate, resulting in the tissue breakdown beginning in the nucleus pulposus and starting in the second life decade. Significant temporospatial variations in the presence and abundance of histologic disc alterations were observed across levels, regions, macroscopic degeneration grades, and age groups. A practicable classification system for age-related histologic disc alterations was developed, resulting in moderate to excellent reliability (kappa values, 0.49-0.98) depending on the histologic variable. Application of the classification system to cadaveric and surgical specimens demonstrated a significant correlation with age ( < 0.0001) and macroscopic grade of degeneration ( < 0001). However, substantial data scatter caution against reliance on traditional macroscopic disc grading and favor a histology-based classification system as a reference standard.

CONCLUSIONS

Histologic disc alterations can reliably be graded based on the proposed classification system providing a morphologic framework for more sophisticated molecular biologic analyses of factors leading to age-related disc changes. Diminished blood supply to the intervertebral disc in the first half of the second life decade appears to initiate tissue breakdown.

Regional variations in the cellular matrix of the annulus fibrosus of the intervertebral disc

The three-dimensional architecture of cells in the annulus fibrosus was studied by a systematic, histological examination using antibodies to cytoskeletal components, in conjunction with confocal microscopy. Variations in cell shape, arrangement of cellular processes and cytoskeletal architecture were found both within and between the defined zones of the outer and inner annulus. The morphology of three, novel annulus fibrosus cells is described: extended cordlike cells that form an interconnected network at the periphery of the disc; cells with extensive, sinuous processes in the inner region of the annulus fibrosus; and cells with broad, branching processes specific to the interlamellar septae of the outer annulus. The complex, yet seemingly deliberate arrangement of various cell shapes and their processes suggests multiple functional roles. Regional variations in the organization of the actin and vimentin cytoskeletal networks is reported across all regions of the annulus. Most notable is the continuous, strand arrangement of the actin label at the disc's periphery in contrast to its punctate appearance in all other regions. The gap junction protein connexin 43 was found within cells from all regions of the annulus, including those which did not form physical connections with surrounding cells. These observations of the cellular matrix in the healthy intervertebral disc should contribute to a better understanding of site-specific changes in tissue architecture, biochemistry and mechanical properties during degeneration, injury and healing.