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18 KitamuraS.MatsudaF.TohgeT.Yonekura-SakakibaraK.YamazakiM.SaitoK.et al (2010)

358 Senescent chondrocytes induce senescence in other chondrocytes in cartilage by releasing SASP factors, such as IL-6, IL-1, and MCP1

However, as it sounds like you agree, it's pretty clear that as insulin levels go down IGFBP-3 goes up...sorry, as IGF binding protein 3 goes up...maybe it's worth me taking a moment why that matters

Simultaneously, the mechanical properties of the ECM change significantly: the shear stiffness of the human nucleus pulposus increases from 12.5 kPa in Pfirrmann grade 116.5 kPa in grade V (Walter et al., 2017), collagen fibers thicken and become disorganized (Wuertz et al., 2007) (Table 1)

"I assume they considered everything before they went forward with that as they did and they would take advice from whoever was doing the legal work