Use of bone morphogenetic proteins for treatment of non-unions and future perspectives

Schmidmaier, Gerhard; Schwabe, Philipp; Wildemann, Britt; Haas, Norbert

doi:10.1016/s0020-1383(08)70007-x

Cited by 93 publications

(62 citation statements)

References 53 publications

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“…Although they have not been tested in atrophic non-unions where natural osteogenesis is impaired, osteoinductive CaP may hold promise in these applications similar to BMPs that are currently used in conjunction with autograft (Schmidmaier et al, 2007; additional reference) because they exert similar bone-inductive effects. Currently, these materials are used clinically for (posterolateral) spine fusion and the treatment of craniomaxillofacial defects (e.g.…”

Section: Brennanmentioning

confidence: 99%

Submicron-scale surface architecture of tricalcium phosphate directs osteogenesis in vitro and in vivo

Davison

Luo²,

Schoenmaker³

et al. 2014

eCM

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A current challenge of synthetic bone graft substitute design is to induce bone formation at a similar rate to its biological resorption, matching bone's intrinsic osteoinductivity and capacity for remodelling. We hypothesise that both osteoinduction and resorption can be achieved by altering surface microstructure of beta-tricalcium phosphate (TCP). To test this, two TCP ceramics are engineered with equivalent chemistry and macrostructure but with either submicron-or micron-scale surface architecture. In vitro, submicron-scale surface architecture differentiates larger, more active osteoclasts -a cell type shown to be important for both TCP resorption and osteogenesis -and enhances their secretion of osteogenic factors to induce osteoblast differentiation of human mesenchymal stem cells. In an intramuscular model, submicrostructured TCP forms 20 % bone in the free space, is resorbed by 24 %, and is densely populated by multinucleated osteoclast-like cells after 12 weeks; however, TCP with micron-scale surface architecture forms no bone, is essentially not resorbed, and contains scarce osteoclast-like cells. Thus, a novel submicron-structured TCP induces substantial bone formation and is resorbed at an equivalent rate, potentially through the control of osteoclast-like cells.

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Section: Brennanmentioning

confidence: 99%

Submicron-scale surface architecture of tricalcium phosphate directs osteogenesis in vitro and in vivo

Davison

Luo²,

Schoenmaker³

et al. 2014

eCM

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“…In general, non-union as a complication of fracture healing occurs in 5% -10% of cases (1) and can be as high as 30% in high-risk groups (2)(3)(4)(5).…”

Section: Epidemiologymentioning

confidence: 99%

Non-Union Current Treatment Concept

2016

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Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of nonunions according to the principles of 'diamond concept' and aspects that have to be attended. Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept. Results: If an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required. Conclusions: By using the 'diamond concept' as a complex concept, non-unions can be treated in different stages in a targeted manner.

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“…Issues regarding method of delivery, choice of target cell and cost, still need to be clarified before clinical application of these products is possible. 10 Recombinant growth factors, such as rBMPs, have been the most rapidly emerging therapeutic agent in bone regeneration studies. rBMPs act to stimulate differentiation of mesenchymal cells to osteoblasts and induce new bone formation.…”

Section: Basic Principles Of Bone Biologymentioning

confidence: 99%

Tissue‐engineered vascularized bone grafts: Basic science and clinical relevance to trauma and reconstructive microsurgery

2011

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Bone grafts are an important part of orthopaedic surgeon's armamentarium. Despite well-established bone-grafting techniques, large bone defects still represent a challenge. Efforts have therefore been made to develop osteoconductive, osteoinductive, and osteogenic bone-replacement systems. The long-term clinical goal in bone tissue engineering is to reconstruct bony tissue in an anatomically functional three-dimensional morphology. Current bone tissue engineering strategies take into account that bone is known for its ability to regenerate following injury, and for its intrinsic capability to re-establish a complex hierarchical structure during regeneration. Although the tissue engineering of bone for the reconstruction of small to moderate sized bone defects technically feasible, the reconstruction of large defects remains a daunting challenge. The essential steps towards optimized clinical application of tissue-engineered bone are dependent upon recent advances in the area of neovascularization of the engineered construct. Despite these recent advances, however, a gap from bench to bedside remains; this may ultimately be bridged by a closer collaboration between basic scientists and reconstructive surgeons. The aim of this review is to introduce the basic principles of tissue engineering of bone, outline the relevant bone physiology, and discuss the recent concepts for the induction of vascularization in engineered bone tissue.

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Use of bone morphogenetic proteins for treatment of non-unions and future perspectives

Cited by 93 publications

References 53 publications

Submicron-scale surface architecture of tricalcium phosphate directs osteogenesis in vitro and in vivo

Submicron-scale surface architecture of tricalcium phosphate directs osteogenesis in vitro and in vivo

Non-Union Current Treatment Concept

Tissue‐engineered vascularized bone grafts: Basic science and clinical relevance to trauma and reconstructive microsurgery

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