As NP cells express αv and multiple β integrin subunits, integrin-mediated activation of TGFβ may play a critical role in IVDs.25 In addition, active TGFβ is known to act upstream of connective tissue growth factor (CTGF/CCN2) and aggrecan, both of which are involved in DDD development.26,27 Thus, we sought to understand the role of TGFβ in IVD homeostasis. This evidence concerns the gene CCN2 and Dowling-Degos disease 1.