Intervertebral disc degeneration and associated lower back pain is one of the leading musculoskeletal disorders confronting our health system with 15%–20% of the population experiencing lower back pain annually [1–4]. It has been shown that early in disc degeneration, the extracellular matrix of the nucleus pulposus is depleted of the proteoglycan aggrecan, resulting in loss of disc hydration, osmotic pressure and mechanical stability which leads to lower back pain [2, 5]. Early-stage restoration of the proteoglycan content within normal levels with natural aggrecan may help to restore disc functionality but it is cost prohibitive. We propose a new strategy to restore the extracellular matrix of the degenerated disc and mitigate lower back pain by molecularly engineering the disc matrix with an injection of a biomimetic aggrecan (BA) novel class of molecules that mimics the 3D bottle brush structure and physical properties of natural aggrecan.

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