ACAN and intervertebral disk degenerative disorder: 2019). Therefore, the balance between growth and apoptosis of NPCs is the key to ECM balance and IDD. In addition, the increased expression of proinflammatory cytokines and inflammatory mediators, including IL-1, IL-6, IL-12, IL-17, TNF-α, and TNF-γ, is another feature of the IDD microenvironment (Penolazzi et al. 2019). Studies have shown that inflammatory cytokines such as IL-1β and TNFα increase the expression of MMP13, decrease the expression of collagen II and aggrecan, and induce NPCs apoptosis contributing to the degeneration of IVD (Hamamura et al. 2013; Lian et al. 2017).