Non-unions treated with bone morphogenic protein 7: introducing the quantitative measurement of human serum cytokine levels as promising tool in evaluation of adjunct non-union therapy

Abstract

BackgroundIn this study we sought to determine if application of bone morphogenic protein 7 (BMP-7) promotes physiological bone healing of non-unions and to investigate if serum cytokine analysis may serve as a promising tool in the analysis of adjunct non-union therapy. Therefore we analyzed the influence of BMP-7 application on the serum cytokine expression patterns on patients with impaired bone healing compared to patients that showed proper bone healing.MethodsOur study involved analyzing blood samples from 208 patients with long bone fractures together with patients that subsequently developed non-unions. From this large pool, 15 patients with atrophic non-union were matched to 15 patients with atrophic non-union treated with local application of BMP-7 as well as normal bone healing. Changes in the cytokine expression patterns were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd week. The patients were followed both clinically and radiologically for the entire duration of the study. Serum cytokine expression levels of transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) were analyzed and compared.ResultsSerum expression of TGF-β were nearly parallel in all three groups, however serum concentrations were significantly higher in patients with proper bone healing and those treated with BMP-7 than in patients with non-unions (p < 0.05). bFGF serum concentrations increased initially in patients with proper bone healing and in those treated with BMP-7. Afterwards, values decreased; bFGF serum concentrations in the BMP-7 group were significantly higher than in the other groups (p < 0.05). PDGF serum concentration levels were nearly parallel in all groups, serum concentrations were significantly higher in patients with proper bone healing and those treated with BMP-7 than in patients with non-unions (p < 0.05).ConclusionTreatment with BMP-7 in patients with former non-unions led to similar cytokine expression patterns after treatment as those found in patients with proper bone healing. Our results suggest that treatment with BMP-7 promote healing of non-unions. Furthermore, quantitative measurement of serum cytokine expression is a promising tool for evaluating the effectiveness of additional non-union therapies such as adjunct application of growth factors.

Low intensity pulsed ultrasound in the treatment of long bone nonunions: Evaluation of cytokine expression as a tool for objectifying nonunion therapy

“…The strengths of this study are its prospective approach, the well-established study protocol, 8,9,17 and the use of one product brand, which allowed us to eliminate technical factors that could bias the evaluation. Furthermore, two different orthopedic surgeons determined the indication for LIPUS therapy and analyzed the data, which also minimized bias.…”

“…8 In previous studies, we have described several cytokine expression patterns in regular and failed bone healing, which showed significant differences in expression patterns at certain time points depending upon if fracture healing was delayed or failed. [8][9][10][11] We concluded from these results that measuring serum cytokine expression over a standardized follow-up scheme is a valid instrument for the evaluation of bone healing.…”

“…1). 9,17 Blood was drawn between 8 and 11 AM from patients on an empty stomach to avoid intraday measurement bias. 18,19 Within 2 h after collection, the samples were centrifuged (1000 rpm, 10 min, 21 8C) and serum was stored at À80 8C.…”

Osteopathia striata with cranial sclerosis (OSCS): review of the literature and case report demonstrating challenges of spinal fusion after trauma

“…2). The area of the fracture was covered with an extra small piece of BMP after decortication to aid in bone healing [11]. Two crosslink connectors linked the rods on both sides, and were secured in place.…”

Platelet-Rich Fibrin and Its Usage in Orthopaedic Surgery: Review

“…Bu riskleri en aza indirmek için kemik grefti yerine geçen alternatif arayışlar hâlen devam etmektedir. [7][8][9][10][11] Bu çalışmada, kemik iyileş-mesinin hızlandırılması amacıyla kemik grefti yerine kullanılabilen ve ikinci kuşak trombosit konsantrasyonu olan trombositten zengin fibrin (TZF)'nin özellikleri, yapısında bulundurduğu bü-yüme faktörleri ve konu ile ilgili çalışmalar hakkında bilgi verilmesi amaçlanmıştır.…”