Clinical applications of BMPs
Section snippets
Clinical applications
Bone morphogenetic proteins (BMPs) are probably the most important growth factors in bone formation and healing.13 They share action with a number of other molecules, all members of the TGF-β superfamily, but their effects seems to be superior and more specific and have been extensively proved in several clinical trials.4, 5 The purpose of this brief manuscript is to evaluate the efficacy of BMP's in clinical trials of prospective randomised nature.
Spinal applications
Johnsson et al.10 demonstrated high fusion rates in non-instrumented posterolateral spinal fusions with the application of BMP's. They randomised 20 patients to fusion with either OP-1 implant or autograft bone from the iliac crest (10 patients in each group). The lumbar spine was immobilised post-operatively with a soft lumbar brace. At surgery 0.8 mm metallic markers were positioned in L5 and the sacrum, enabling radiostereometric follow-up analysis after a period of 12 months. The
Non-union of fractures
Friedlaender et al.8 enrolled 122 patients (124 tibial non-unions) in a controlled, prospective, randomised, partially blinded, multi-center clinical trial and followed them at frequent intervals over 24 months. Each patient was treated by insertion of an intramedullary rod, accompanied by rhOP-1 in a type I collagen carrier or by fresh bone autograft. Assessment criteria included the severity of pain at the fracture site, the ability to walk with full weight bearing, the need for surgical
Conclusion
The available level I evidence with regard to the application of BMP's in clinical practice is promising. However, often too many variables are present that can influence the end result. Delivery methods of BMP or other growth factors are currently under investigation. Recent studies by Wildemann et al.15 have tested the possibility of coating osteosynthesis devices with growth factors and showed the efficacy of this technique, introducing new concepts of growth factors (GFs) delivery in
References (15)
- et al.
Effect of recombinant human osteogenic protein-1 on the healing of a freshly closed diaphyseal fracture
Bone
(2002) - et al.
Local delivery of growth factors from coated titanium plates increases osteotomy healing in rats
Bone
(2004) - et al.
The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report
Spine
(2000) - et al.
Potential role of bone morphogenetic proteins in fracture healing
Clin Orthop
(1998) - et al.
Radiographic assessment of interbody fusion using recombinant human bone morphogenetic protein type 2
Spine
(2003) - et al.
Failure of growth hormone to alter the biomechanics of fracture-healing in a rabbit model
J Bone Joint Surg Am
(1992) - et al.
Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs)
J Bone Joint Surg Am
(2003)