Elsevier

Injury

Volume 36, Issue 3, Supplement, November 2005, Pages S43-S46
Injury

Clinical applications of BMPs

https://doi.org/10.1016/j.injury.2005.07.034Get rights and content

Summary

Bone morphogenetic proteins (BMPs) are polypeptides discovered by Marshall Urist in 1965 and later defined by his co-workers as multifunctional cytokines involved in osteoinduction. They are members of the transforming growth factor-β superfamily with the exception of the BMP-1. Till now at least 20 BMPs have been identified and studied, but only BMP 2, 4 and 7 have been able in vitro to stimulate the entire process of stem cell differentiation into osteoblastic mature cells. After in vitro studies BMPs have been tested in preclinical and clinical studies, showing their definite potential in osteoinduction and have been approved for clinical use in open fracture of long bones, non-unions and vertebral arthrodesis. But more clinical use of these molecules is under investigation and the possibility of using gene therapy in selected pathologies seems the most appealing.

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

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