Growth factors influencing bone development

Case report: Focal heterotopic ossification in paravertebral muscles as a cause of neurogenic lameness in a dog

This case report describes a 17-month-old Pudelpointer with recurring motor impairment localized to the left thoracic limb. A neurological exam highlighted lameness in that limb, accompanied by pre-scapular swelling. Radiographs and magnetic resonance imaging detected an osseous structure in soft tissues close to the fifth cervical vertebra, and subsequent surgery uncovered adjacent cervical spinal nerve impingement. Histology of the bony structure revealed heterotopic ossification in paravertebral muscles. Mild bone re-formation at the operating site was detected after a 2-year period, but the patient was asymptomatic. This article reports the first case of heterotopic ossification with spinal nerve entrapment in a dog and adds a new differential diagnosis to the causes of neurogenic lameness in dogs.

Exploring the growth trait molecular markers in two sheep breeds based on Genome-wide association analysis

Growth traits are quantitative traits controlled by multiple micro-effect genes. we identified molecular markers related to sheep growth traits, which formed the basis of molecular breeding. In this study, we randomly selected 100 Qira Black sheep and 84 German Merino sheep for the blood collection the jugular vein to genotype by using the Illumina Ovine SNP 50K Bead Chip. quality control criteria for statistical analysis were: rejection detection rate < 90% and minimum allele frequency (MAF) < 5%. Then, we performed Genome-wide association studies (GWAS) on sheep body weight, body height, body length, and chest circumference using mixed linear models. After getting 55 SNPs with significant correlation, they were annotated by reference genome of Ovis aries genome (Oar_v4.0) and We obtained a total of 84 candidate genes associated with production traits (BMPR1B, HSD17B3, TMEM63C, etc.). We selected BMPR1B for population validation and found a correlation between the FecB locus and body weight traits. Therefore, this study not only supplements the existing knowledge of molecular markers of sheep growth traits, but also has important theoretical significance and reference value for the mining of functional genes of sheep growth traits.

Characterization of bioactive substances involved in the induction of bone augmentation using demineralized bone sheets

PURPOSE

To investigate the bone augmentation ability of demineralized bone sheets mixed with allogeneic bone with protein fractions containing bioactive substances and the interaction between coexisting bioactive substances and proteins.

METHODS

Four types of demineralized bone sheets mixed with allogeneic bone in the presence or absence of bone proteins were created. Transplantation experiments using each demineralized bone sheet were performed in rats, and their ability to induce bone augmentation was analysed by microcomputed tomography images. Bioactive substances in bone proteins were isolated by heparin affinity chromatography and detected by the measurement of alkaline phosphatase activity in human periodontal ligament cells and dual luciferase assays. Noncollagenous proteins (NCPs) coexisting with the bioactive substances were identified by mass spectrometry, and their interaction with bioactive substances was investigated by in vitro binding experiments.

RESULTS

Demineralized bone sheets containing bone proteins possessed the ability to induce bone augmentation. Bone proteins were isolated into five fractions by heparin affinity chromatography, and transforming growth factor-beta (TGF-β) was detected in the third fraction (Hep-c). Dentin matrix protein 1 (DMP1), matrix extracellular phosphoglycoprotein (MEPE), and biglycan (BGN) also coexisted in Hep-c, and the binding of these proteins to TGF-β increased TGF-β activity by approximately 14.7% to 32.7%.

CONCLUSIONS

Demineralized bone sheets are capable of inducing bone augmentation, and this ability is mainly due to TGF-β in the bone protein mixed with the sheets. The activity of TGF-β is maintained when binding to bone NCPs such as DMP1, MEPE, and BGN in the sheets.

Dentin Matrix Protein 1 on Titanium Surface Facilitates Osteogenic Differentiation of Stem Cells

Dentin matrix protein 1 (DMP1) contains a large number of acidic domains, multiple phosphorylation sites, a functional arginine-glycine-aspartate (RGD) motif, and a DNA binding domain, and has been shown to play essential regulatory function in dentin and bone mineralization. DMP1 could also orchestrate bone matrix formation, but the ability of DMP1 on Ti to human mesenchymal stem cell (hMSC) conversion to osteoblasts has not been studied. There is importance to test if the DMP1 coated Ti surface would promote cell migration and attachment to the metal surface and promote the differentiation of the attached stem cells to an osteogenic lineage. This study aimed to study the human mesenchymal stem cells (hMSCs) attachment and proliferation on DMP1 coated titanium (Ti) disks compared to non-coated disks, and to assess possible osteoblastic differentiation of attached hMSCs. Sixty-eight Ti disks were divided into two groups. Group 1 disks were coated with dentin matrix protein 1 and group 2 disks served as control. Assessment with light microscopy was used to verify hMSC attachment and proliferation. Cell viability was confirmed through fluorescence microscopy and mitochondrial dehydrogenase activity. Real-time polymerase chain reaction analysis was done to study the gene expression. The proliferation assay showed significantly greater cell proliferation with DMP1 coated disks compared to the control group (p-value < 0.001). Cell vitality analysis showed a greater density of live cells on DMP1 coated disks compared to the control group. Alkaline phosphatase staining revealed higher enzyme activity on DMP1 coated disks and showed itself to be significantly higher than the control group (p-value < 0.001). von Kossa staining revealed higher positive areas for mineralized deposits on DMP1 coated disks than the control group (p-value < 0.05). Gene expression analysis confirmed upregulation of runt-related transcription factor 2, osteoprotegerin, osteocalcin, osteopontin, and alkaline phosphatase on DMP1 coated disks (p-value < 0.001). The dentin matrix protein promoted the adhesion, proliferation, facilitation differentiation of hMSC, and mineralized matrix formation.

A calcified chronic total occlusion preclinical model

OBJECTIVE

To create an experimental chronic total occlusion (CTO) model with calcification by dietary modification (cholesterol, calcium carbonate, vitamin D) and local injection of pro-calcification factors (dipotassium phosphate, calcium chloride, and bone morphogenetic protein-2 [BMP-2]).

BACKGROUND

Percutaneous revascularization of CTOs frequently fails in heavily calcified occlusions. Development of novel approaches requires a reproducible preclinical model of calcified CTO.

METHODS

CTOs were created in 18 femoral arteries of 9 New Zealand White rabbits using the thrombin injection model. Dietary interventions included a high cholesterol diet (0.5% or 0.25%), calcium carbonate (150 mg × 3-5 days/week), and vitamin D (50,000 U × 3-5 days/week). In selected animals, BMP-2 (1-4 μg), dipotassium phosphate, and calcium chloride were injected locally at the time of CTO creation. Animals were sacrificed at 2 weeks (n = 4 arteries), 6 weeks (n = 4 arteries), and 10-12 weeks (n = 14 arteries).

RESULTS

CTOs showed evidence of chronic lipid feeding (foam cells) and chronic inflammation (intimal/medial fibrosis and microvessels, inflammatory cells, internal elastic lamina disruption). In calcium/vitamin D supplemented rabbits, mineralization (calcification and/or ossification) was evident as early as 2 weeks post CTO creation, and in 78% of the overall arteries. Mineralization changes were not present in the absence of calcium/vitamin D dietary supplements. Mineralization occurred in 85% of BMP-treated arteries and 60% of arteries without BMP.

CONCLUSIONS

Complex mineralization occurs in preclinical CTO models with dietary supplementation of cholesterol with vitamin D and calcium.

A Statistical Model to Allow the Phasing Out of the Animal Testing of Demineralised Bone Matrix Products

Demineralised bone matrix (DBM) products are complex mixtures of proteins known to influence bone growth, turnover, and repair. They are used extensively in orthopaedic surgery, and are bioassayed in vivo prior to being used in clinical applications. Many factors contribute to the osteogenic potency of DBM, but the relative contributions of these factors, as well as the possibility of interactive effects, are not completely defined. The “gold standard” measure of the therapeutic value of DBM, the in vivo assay for ectopic bone formation, is costly, time-consuming, and involves the use of numerous animal subjects. We have measured the levels of five growth factors released by the collagenase digestion of DBM, and statistically related these levels with osteogenic potency as determined by a standard in vivo model, in order to determine which value or combination of values of growth factors best predict osteogenic activity. We conclude that the level of BMP-2 is the best single predictor of osteogenic potency, and that adding the values of other growth factors only minimally increases the predictive power of the BMP-2 measurement. A small, but significant, interactive effect between BMP-2 and BMP-7 was demonstrated. We present a statistical model based on growth factor (e.g. BMP-2) analysis that best predicts the in vivo assay score for DBM. This model allows the investigator to predict which lots of DBM are likely to exhibit in vivo bioactivity and which are not, thus reducing the need to conduct in vivo testing of insufficiently active lots of DBM. This model uses cut-point analysis to allow the user to assign an estimate of acceptable uncertainty with respect to the “gold standard” test. This procedure will significantly reduce the number of animal subjects used to test DBM products.

A Genome-Wide Association Study Reveals That Genes with Functions for Bone Development Are Associated with Body Conformation in Catfish

Body conformation is of great scientific and commercial interest for aquaculture fish species because it affects biological adaptation of the organism to environments, and is of economic importance to the aquaculture industry considering its direct effect on fillet yield. Catfish is the primary aquaculture species in the USA. Two major species used in the aquaculture industry, channel catfish and blue catfish, differ in body shape and therefore the backcross progenies serve as a good model for quantitative trait locus (QTL) analysis. Here, a genome-wide association study (GWAS) with hybrid catfish was conducted to identify the QTL for body conformation, including deheaded body length (DBL), body length (BL), body depth (BD), and body breadth (BB), which were all standardized by cubic root of body weight. Overall, the results indicate that the traits are polygenic. For DBL, linkage group (LG) 2 and LG 24 contain significant QTL, and LG 13 and LG 26 contain suggestively associated QTL (-log₁₀(P value) > 4.5). Compared with DBL, additional SNPs were identified to be associated with body length on LG 2, LG 7, and LG 18. Although no significant QTL for body depth was found, three suggestively associated QTLs were identified on LG 5, LG 13, and LG 14. No SNP for body breadth reached the threshold for suggestive association. Genes close to the associated SNPs were determined, many of which are known to be involved in bone development. This work therefore provides the basis for future identification of causal genes for the control of body conformation.

Bone augmentation around a dental implant using demineralized bone sheet containing biologically active substances

This study was designed to evaluate the volume of alveolar bone augmentation after immediate implant placement using demineralized bone. We examined the collagen matrix of demineralized bone and biologically active substances contained therein. Rat maxillary first molars were extracted, and the animals were divided into five groups as follows: tooth extraction only, implant into the mesial root socket, implant and other root sockets covered with demineralized bone sheet, implant and other root sockets filled with demineralized bone powder under the sheet, and implant and other root sockets covered with demineralized bone sheet from which proteins were extracted. We ascertained whether biologically active substances are contained in extracted proteins. Biologically active substances were detected in extracted proteins. Conditions using demineralized bone sheet with biologically active substances significantly augmented the height of the alveolar bone. Such resorbable membranes containing biologically active substances hold promise as clinical agents for bone augmentation upon implantation.

Evaluation of bone morphogenic proteins in periodontal practice

Forty years ago Marshal R. Urist discovered a substance in bone matrix that had inductive properties for the development of bone and cartilage, until date, at least 20 bone morphogenetic proteins (BMPs) have been identified, some of which have been shown in vitro to stimulate the process of stem cell differentiation into osteoblasts in human and animal models. The purpose of this paper is to give a brief overview of BMPs and to review critically the clinical data currently available on the use of BMPs in various periodontal applications. The literature on BMPs was reviewed. A comprehensive search was designed. The articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal applications were included. The available literature was analyzed and compiled. The analysis indicates BMPs to be a promising, as well as an effective novel approach to reconstruct and engineer the periodontal apparatus. Here, we represent several articles, as well as recent texts that make up a special and an in-depth review on the subject. On the basis of the data provided in the studies that were reviewed BMPs provide revolutionary therapies in periodontal practice.

A carboxy terminal BMP/TGF-β binding site in secreted phosphoprotein 24 kD independently affects BMP-2 activity

Secreted phosphoprotein 24 kD (spp24) is a bone matrix protein isolated during attempts to identify osteogenic proteins. It is not osteogenic but performs other important roles in the regulation of bone metabolism, at least in part, by binding to and affecting the activity of members of the BMP/TGF-β family of cytokines. Spp24 exists in a number of forms that preserve the N-terminus and are truncated at the C-terminus. The hypothesized cytokine binding domain is present within the cystatin domain which is preserved in all of the N-terminal products. In this report, we describe a C-terminal fragment that is distinct from the cystatin domain and which independently binds to BMP-2 and TGF-β. This fragment inhibited BMP-2 activity in an ectopic bone forming assay. A shorter C-terminal product did not inhibit BMP-2 activity but improved bone quality induced by BMP-2 and produced increased calcium deposition outside of bone. Spp24 has been used to develop several potential therapeutic proteins. These results provide more information on the function of spp24 and provide other materials that can be exploited for clinical interventions.

Bone morphogenetic proteins in tumour associated angiogenesis and implication in cancer therapies

Bone morphogenetic protein (BMP) belongs to transforming growth factor-β superfamily. To date, more than 20 BMPs have been identified in humans. BMPs play a critical role in embryonic and postnatal development, and also in maintaining homeostasis in different organs and tissues by regulating cell differentiation, proliferation, survival and motility. They play important roles in the development and progression of certain malignancies, including prostate cancer, breast cancer, lung cancer, etc. Recently, more evidence shows that BMPs are also involved in tumour associated angiogenesis. For example BMP can either directly regulate the functions of vascular endothelial cells or indirectly influence the angiogenesis via regulation of angiogenic factors, such as vascular endothelial growth factor (VEGF). Such crosstalk can also be reflected in the interaction with other angiogenic factors, like hepatocyte growth factor (HGF) and basic fibroblast growth factor (bFGF). All these factors are involved in the orchestration of the angiogenic process during tumour development and progression. Review of the relevant studies will provide a comprehensive prospective on current understanding and shed light on the corresponding therapeutic opportunity.

Myoconductive and osteoinductive free-standing polysaccharide membranes

Free-standing (FS) membranes have increasing applications in the biomedical field as drug delivery systems for wound healing and tissue engineering. Here, we studied the potential of free-standing membranes made by the layer-by-layer assembly of chitosan and alginate to be used as a simple biomimetic system of the periosteum. The design of a periosteum-like membrane implies the elaboration of a thick membrane suitable for both muscle and bone formation. Our aim was to produce well-defined ∼50 μm thick polysaccharide membranes that could be easily manipulated, were mechanically resistant, and would enable both myogenesis and osteogenesis in vitro and in vivo. The membranes were chemically crosslinked to improve their mechanical properties. Crosslinking chemistry was followed via Fourier transform infrared spectroscopy and the mechanical properties of the membranes were assessed using dynamic mechanical analysis. The loading and release of the potent osteoinductive growth factor bone morphogenetic protein 2 (BMP-2) inside and outside of the FS membrane was followed by fluorescence spectroscopy in a physiological buffer over 1 month. The myogenic and osteogenic potentials of the membranes in vitro were assessed using BMP-2-responsive skeletal myoblasts. Finally, their osteoinductive properties in vivo were studied in a preliminary experiment using a mouse ectopic model. Our results showed that the more crosslinked FS membranes enabled a more efficient myoblast differentiation in myotubes. In addition, we showed that a tunable amount of BMP-2 can be loaded into and subsequently released from the membranes, depending on the crosslinking degree and the initial BMP-2 concentration in solution. Only the more crosslinked membranes were found to be osteoinductive in vivo. These polysaccharide-based membranes have strong potential as a periosteum-mimetic scaffold for bone tissue regeneration.

Nanoenhanced hydrogel system with sustained release capabilities

An alginate/halloysite nanotube (HNT) nanocomposite was developed with sustained release of bone morphogenetic proteins (BMPs) at picogram low levels. BMP-2, 4, and 6 and osteoblasts were chosen as our model "growth factor" and "cell type" as the interaction of BMPs with osteoblasts is well known and thoroughly investigated. Alginate hydrogels with HNTs doped with BMP-2, 4, or 6 only or BMP-4 and 6 in combination. Osteoblasts were seeded within the hydrogels and studied for changes in cell proliferation, phenotypic expression, and mineralization over a 28-day experimental period. Osteoblast behavior was enhanced in BMP doped hydrogel/HNTs nanocomposites as compared with control groups. Release profiles showed that BMP-2 was released in a sustained fashion over a 7-day period and at picogram levels. Mineralization, as showed by Von Kossa staining, and protein synthesis peaked at 28 days, for all three growth factor combinations. BMP-4 provided a marked stimulus for osteoblast functionality base and was comparable to BMP-6 in terms of osteoblast differentiation and mineralization. BMP-4 and 6, in combination, showed a marked enhancement in osteoblast differentiation and functionality; however, the response seemed to be delayed when compared with BMP-4 and 6 release. Hydrogel surfaces had a complex surface topography and greater structural integrity with increased halloysite addition. The data suggest that these nanocomposites may provide a mechanism to enhance repair and regeneration in damaged or diseased tissues, reducing the need for more invasive treatment modalities.

Pharmacophysiology of bone and spinal fusion

BACKGROUND CONTEXT

In recent years, the number of complex spinal surgeries has increased significantly in the elderly population, where the prevalence of low bone density is highest. Consequently, spine surgeons often treat osteoporotic patients who are associated with higher rates of instrumentation failure. Therefore, establishing a successful fusion requires an appropriate substrate for bone formation and local bone remodeling. The fusion process can be supported by therapies that seek to shift the balance of bone homeostasis to increased formation and reduced resorption.

PURPOSE

Thorough understanding of the physiology of bone formation and adjunctive therapies can help improve fusion rates. Therefore, we present a thorough review of the latest pharmacologic agents used to enhance bone strength and surgical spinal fusion.

METHODS

Systematic review of literature.

RESULTS

Current knowledge on bone physiology has led to the development of several pharmacologic agents that enhance bone formation and strengthen the human skeleton. At present, natural supplements of vitamin D and calcium or synthetic medications like bisphosphonates are widely used before and after spine surgeries to enhance bone fusion. Additional physiologic agents, including testosterone, parathyroid hormone, calcitonin, and growth hormone, have been shown to improve bone mass density or spinal fusion in both animal and human studies. As in other medical fields, gene therapy has shown viability and promise with the use of both viral and nonviral vectors.

CONCLUSIONS

Through the understanding of bone physiology, numerous natural and synthetic pharmacologic agents have been developed to enhance the body's skeleton and to improve outcomes of spinal fusion surgery.

Risk factors for posttraumatic heterotopic ossification of the elbow: case-control study

PURPOSE

Heterotopic ossification (HO) is well-known after surgical repair of elbow fractures, but little is known about risk factors for its development in these patients. The purpose of this study was to define factors associated with development of HO.

METHODS

We used a prospective fracture registry collected in 2 Level I trauma centers and medical chart review to examine all elbow fractures treated surgically between 2002 and 2009. We determined which of these patients developed HO with an impact on range of motion (Hastings class II and III). We conducted a matched case-control study to examine factors associated with risk of HO. We used conditional logistic regression to compare occurrences of risk factors between cases and controls, matched by fracture type, age, and sex.

RESULTS

Our database contained 786 elbow fractures treated surgically. Of these, 55 developed clinically relevant HO. The risk of HO varied among types of elbow fractures, with combined olecranon and radial head fractures having no HO and floating elbows (fractures on both sides of the elbow joint) having the highest incidence of HO at 36%. In multiple conditional logistic regression, risk factors for the development of HO were days to surgery, with subjects waiting 8 or more days having 12 times the odds of HO than subjects having surgery within a day of injury, and time to postoperative mobilization, with subjects who had at least 15 days to mobilization having greater odds of HO than those who had less than 7 days to mobilization.

CONCLUSIONS

Heterotopic ossification of the elbow occurs frequently after surgical repair of elbow fractures, with an incidence of 7% in this registry. In the case-control sample, conditions associated with development of HO included longer time to surgery and longer time to mobilization after surgery.

Effect of recombinant human bone morphogenetic protein 2 associated with a variety of bone substitutes on vertical guided bone regeneration in rabbit calvarium

BACKGROUND

A major challenge for dental implantology is to consistently obtain appropriate bone augmentation before implant placement. The aim of this study is to evaluate the effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) associated with bone substitute materials beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), and bovine bone mineral on vertical guided bone regeneration (GBR) in rabbit calvarium.

METHODS

Four titanium cylinders were fixed to the calvarium of 22 rabbits. In group 1 (n = 10), three cylinders were randomly filled with one of the test materials, and one cylinder was filled with a blood clot (CL). In group 2 (n = 12), the cylinders were randomly assigned to the same materials and CL but with the addition of rhBMP-2. Bone labels were injected over the course of 13 weeks, and euthanasia was performed 14 weeks after surgery in both groups.

RESULTS

The mean volume and area of tissue growth was greater in group 2 (with rhBMP-2) than in group 1 (without rhBMP-2), irrespective of the material used (P <0.001). The mean volume of tissue growth in the CL cylinder was smaller than that observed with all other materials (P <0.001) in both groups. The mean area of regenerated bone in the CL cylinder was smaller than that observed in the β-TCP cylinder (P = 0.028). The histologic study revealed more lamellar bone in the rhBMP-2 group, with a greater level of biodegradation of all the bone substitute materials tested.

CONCLUSION

The use of rhBMP-2/absorbable collagen sponge (ACS) combined with all of the bone substitute materials tested resulted in a greater amount of bone formation than that produced with the bone substitute materials alone or rhBMP-2/(ACS) and CL using the rabbit calvarium GBR model.

Dental implants and the use of rhBMP-2

Tissue engineering is an emerging field of medicine and dentistry that combines the body's natural biologic response to tissue injury with engineering principles. The goal is to replicate or reconstruct the natural form and function of missing tissues and organs. Tissue-engineered bone with native qualities will be necessary for implantation or migration of engineered teeth in the future, and is currently required for the osseointegration of dental implants. This article addresses the role of bone morphogenetic proteins (BMP) in native bone healing for implant osseointegration and the application of BMP for de novo bone regeneration.

Hepatoregenerative role of bone morphogenetic protein-9

Bone morphogenetic protein-9 (BMP-9) is a member of the transforming growth factor beta (TGF-β) superfamily of cytokines, which regulate cell growth and differentiation during embryogenesis. Apart of that, the hypoglycemic potential of BMP-9 is of great interest. It has been confirmed that BMP-9, like insulin, improves glycemia in diabetic mice and regulates directional glucose metabolism in hepatocytes; therefore it is proposed to be a candidate hepatic insulin-sensitizing substance (HISS). In liver fibrosis, due to the portocaval shunt, insulin bypasses the organ and the liver undergoes atrophy. Parenteral administration of insulin reverses atrophy by stimulating mitogenic activity of the hepatocytes. Because BMP-9 has a signaling pathway similar to other BMPs and insulin, it is to be expected that BMP-9 has a certain regenerative role in the liver, supporting the above-mentioned is evidence of BMP-9 expression in Dissè's spaces and BMP-7's mitogenic activity in mucosal cells. However, further studies are needed to confirm the possible regenerative role of BMP-9.

Dental implants and the use of rhBMP-2

Tissue engineering is an emerging field of medicine and dentistry that combines the body's natural biologic response to tissue injury with engineering principles. The goal is to replicate or reconstruct the natural form and function of missing tissues and organs. Tissue-engineered bone with native qualities will be necessary for implantation or migration of engineered teeth in the future, and is currently required for the osseointegration of dental implants. This article addresses the role of bone morphogenetic proteins (BMP) in native bone healing for implant osseointegration and the application of BMP for de novo bone regeneration.

Alveolar cleft defect closure with iliac bone graft, rhBMP-2 and rhBMP-2 with zygoma shavings: Comparative study

Aim:

To present the outcome measures of the use of iliac bone graft, rhBMP-2 and rhBMP-2 with zygoma shavings in alveolar cleft defect closure.

Materials and Methods:

Retrospective analysis of details of treated alveolar defect cases (5-10 years during January 2008–December 2010) from records with 4 months follow-up in accordance with the inclusion criteria.

Predictor Variables:

Type of graft used (iliac crest graft/rhBMP-2/rhBMP-2 with zygoma shaving).

Outcome Variables:

Duration of the operation, blood loss, postoperative drugs used, donor site morbidity, efficiency of bone deposition (radiologically) at 4 months.

Statistics:

Descriptive statistics, one-way ANOVA. P < 0.05 was taken as significant.

Results:

Forty two cases met the inclusion criteria. Mean efficiency of bone deposition was 89.97 ± 4.79%. Mean efficiency of bone formation in rhBMP-2 (n=13), rhBMP-2 with zygoma shavings (n=9) and iliac crest graft (n=20) was 89.42%, 95.38% and 87.91%, respectively (P=0.000). Drugs usage and postoperative morbidity differed significantly between groups (P < 0.05).

Conclusion:

The use of rhBMP-2 evades the need for additional surgery and overcomes the postoperative morbidity that is associated with the conventional iliac grafting technique. The rhBMP-2 with zygoma shavings showed maximum benefits.

Bone regeneration by bioactive hybrid membrane containing FGF2 within rat calvarium

This study examined the bone regeneration potential of a novel hybrid membrane consisting of collagen and nano-bioactive glass (nBG) incorporating basic fibroblast growth factor (FGF2) for use in guided bone regeneration. nBG was added to a reconstitution of collagen at a concentration of 30%, and the hybrid was formulated into a thin membrane. FGF2 (50 microg/ml) was adsorbed to the hybrid membrane. This level of FGF2 was found to be the optimal concentration to stimulate osteoblastic differentiation in vitro. Three membrane groups, including pure collagen, collagen-nBG hybrid and its combination with FGF2 were implanted within a rat calvarium defect (phi = 5 mm) for a period of 3 weeks. Histomorphometric analysis was carried out to evaluate the bone regeneration within the defect. The results showed that the defect in the collagen-nBG-FGF2 membrane was recovered almost completely, while partial recovery was observed in the other membrane groups (collagen and collagen-BG). However, there was little defect recovery in the blank control. The new bone formation was as high as approximately 60, approximately 45, and approximately 30% of the defect treated with the collagen-nBG-FGF2, collagen-BG, and collagen, respectively, whilst only 4% of new bone was observed in the blank control. Overall, the nBG was shown to stimulate bone formation of the collagen membrane, and FGF2 synergistically accelerated the bone regeneration within a rat calvarium defect.

Bone morphogenetic protein binding peptide mechanism and enhancement of osteogenic protein-1 induced bone healing

STUDY DESIGN

In vitro and in vivo evaluation of BBP interactions with BMP.

OBJECTIVE

To explore bone morphogenetic protein-binding peptide (BBP)'s mechanism of action, investigate an extended repertoire for BBP applications, and evaluate the usefulness of BBP as a surgical adjuvant when used with recombinant human osteogenic protein-1 (rhOP-1).

SUMMARY OF BACKGROUND DATA

Bone morphogenetic proteins (BMPs) are osteoinductive proteins that provide a potential alternative to autograft. Their utility is limited by cost, and potential dose-dependent risks, such as local inflammatory reactions and ectopic bone formation. BBP, a cyclized synthetic peptide, avidly binds recombinant human BMP-2(rhBMP-2) and has been shown to accelerate and enhance its osteogenic qualities.

METHODS

BBP binding with 4 growth factors from the transforming growth factor -beta family were assessed using surface plasmon resonance. The in vivo retention of rhBMP-2 was quantified by comparing the percentage of retained [¹²⁵I]-labeled rhBMP-2 in absorbable collagen sponge implants with or without BBP at 1, 3, and 7 days postimplantation. The adjunctive effect of BBP with rhOP-1-induced bone growth was evaluated by comparing time to fusion and fusion rates in a rodent posterolateral fusion model with 2 different doses of rhOP-1 with or without BBP.

RESULTS

BBP bound all 4 growth factors with an intermediate affinity. The in vivo retention of rhBMP-2 alone ranged from about 40% on day 1 to about 30% on day 7, whereas, the retention of rhBMP-2 in the presence of BBP was about 85% on day 1 and about 55% on day 7. The addition of BBP to rhOP-1 resulted in significantly earlier and greater fusion rates than achieved with rhOP-1 alone.

CONCLUSION

The mechanism of the BBP enhanced osteoinductive properties of BMPs involves the binding and retention of the growth factor, resulting in a prolonged exposure of BMP to the desired fusion site. The use of BBP in conjunction with BMPs may prove to provide satisfactory fusion outcomes, while reducing the costs and side effects associated with BMP use.

Carboxy terminus of secreted phosphoprotein-24 kDa (spp24) is essential for full inhibition of BMP-2 activity

Secreted phosphoprotein-24 kDa (spp24) is a bone morphogenetic protein (BMP)-binding protein isolated from bone. It exists in a number of size forms and is hypothesized to function as a BMP latency protein and/or a "slow release" mechanism for BMPs involved in bone turnover and repair. We have examined the hypothesis that proteolytic modification of the C-terminus of spp24 affects its BMP-2-binding properties and bioactivity in the BMP-2-stimulated ectopic bone forming bioassay. Three different size forms of recombinant spp24 that correspond to predicted 18.1 kDa, 16.0 kDa, and 14.5 kDa proteolytic products were compared to full-length (fl) spp24. One of these forms (spp18.1) we hypothesize to be the protein which Urist initially, but apparently inaccurately, called "BMP." Only full-length spp24 completely inhibited BMP-2-induced bone formation. The 18.1 kDa truncated isoform of spp24 which we hypothesize to be Urist's protein did not. The inhibitory capacity of the proteins was correlated with their kinetic constants, assessed by surface plasmon resonance. At the highest, inhibitory, dose of spp24 and its derivatives, k(d) ("stability") best predicted the extent of ectopic bone formation whereas at the lowest dose, which was not inhibitory, k(a) ("recognition") best predicted the extent of ectopic bone formation. We conclude that proteolytic processing of spp24 affects the interaction of this protein with BMP-2 and this affects the function of the protein.

Graft options in posterolateral and posterior interbody lumbar fusion

STUDY DESIGN

Review article, review of literature.

OBJECTIVE

To review the bone graft options that exist for posterolateral and posterior interbody lumbar fusion.

SUMMARY OF BACKGROUND DATA

As the number of lumbar fusion surgeries has increased over the last decade, alternative methods of grafting have been developed. Iliac crest autograft bone has traditionally been used for lumbar fusion. The downside to this graft option, however, is donor site morbidity.

METHODS

The current literature on alternatives to iliac crest autograft bone for obtaining lumbar fusion was reviewed.

RESULTS

Platelet gels, demineralized bone matrix, synthetic bone graft, and bone morphogenetic protein are potential options for bone graft supplementation or substitution. In preclinical studies, platelet gels have been beneficial to bone growth when combined with autograft, but clinical studies do not support the use of platelet gel in posterolateral lumbar fusion. Preclinical studies of demineralized bone matrix have shown significant variability in the osteoinductive properties of the available products, and clinical data showing efficacy is limited. The use of synthetic bone graft material (ceramics) in lumbar fusion surgery is increasing. Calcium phosphate compounds (i.e., beta-tricalcium phosphate and hydroxyapetite) are most commonly used and are often combined with type I collagen to form a matrix. These materials provide an osteoconductive scaffold for bony ingrowth and can be combined with bone marrow aspirate or used as a carrier for osteogenic factors. Bone morphogenetic protein (rhBMP-2) has been shown to provide similar or even increased fusion rates over autograft iliac crest bone. There are, however, potential safety concerns associated with the use of bone morphogenetic protein that are not fully understood.

CONCLUSION

Several alternatives to iliac crest autograft bone provide promising early clinical results in achieving posterolateral and posterior interbody lumbar fusion.

Epidermal growth factor and bone morphogenetic proteins upregulate osteoblast proliferation and osteoblastic markers and inhibit bone nodule formation

OBJECTIVE

The aim of this study was to investigate the in vitro osteogenic activity of EGF in association with bone morphogenetic proteins BMP2 and BMP7.

METHODS

SaOS-2 (osteoblast-like cell line from human osteosarcoma) were cultured in the presence of EGF and BMPs for various culture periods to assess (a) cell proliferation by MTT assay, (b) Runx2, alkaline phosphatase (ALP) and osteocalcin (OC) mRNA expression using quantitative RT-PCR and ELISA, and (c) bone tissue mineralization using Alizarin Red staining.

RESULTS

EGF alone was able to stimulate osteoblast growth in a time-dependent manner. When mixed with BMP2, BMP7, and their combination, EGF greatly promoted osteoblast growth, compared to the BMP- and EGF-stimulated cells, suggesting a possible synergistic effect between EGF and BMPs on osteoblast growth. Stimulation with EGF, EGF/BMP2, and EGF/BMP2/BMP7 for 7 days upregulated Runx2 mRNA expression by the osteoblasts. EGF downregulated ALP mRNA expression, which was recovered when the BMP2/BMP7 combination was added to the osteoblast culture. Tested on OC mRNA expression, EGF had no effect and inhibited the enhancing effect of BMP2 and BMP7 on osteocalcin expression. The bone mineralization assay showed that EGF reduced both the number and size of the bone nodules. This reducing effect was observable even in the presence of BMP2 and BMP7.

CONCLUSION

This study demonstrated that EGF may act in the early phase to promote osteoblast growth and specific marker expression rather than the late phase involving cell differentiation/mineralization.

BMPs: Options, indications, and effectiveness

Alteration of the bone healing process with bone morphogenetic proteins offers a new perspective in orthopaedic surgery in those adverse situations that necessitate bone grafting. BMPs have been demonstrated to be effective and safe for human application and have an efficacy comparable with that of autologous bone grafting. Nevertheless, clinical trials with level 1 evidence are still limited in their ability to extrapolate robust and safe clinical conclusions for the possible indications mentioned in this article. Future research should refine issues regarding the relative effectiveness of bone morphogenetic proteins, the interaction between bone morphogenetic protein subtypes, and their specific effect on various target cell populations.

Use of recombinant human Bone Morphogenetic Protein (rhBMP-2) in reconstruction of maxillary alveolar clefts

BACKGROUND

Use of rhBMP2 has been demonstrated to be an ideal bone reconstructive material for alveolar clefts. There is a lack of such studies from Indian cleft patients.

AIM

To compare rhBMP2 alveolar cleft repair and iliac crest graft treated cases.

MATERIALS AND METHOD

Retrospective analysis of rhBMP2 alveolar cleft repair and iliac crest graft treated cases.

PREDICTOR VARIABLES

Gender, type of surgery and type of cleft

OUTCOME VARIABLES

Total surgery time, blood loss at surgical and harvest site, length of scar, number of days on antibiotics, serratiopeptidase and NSAIDS; sutured days, number of days to regain masticatory functions, pain VAS on 5th postoperative day and at harvest site on a scale of 10; duration of edema, number of working days lost, time until child could walk 'normally'; mean efficiency of bone deposition.

STATISTICS

Descriptive, paired 't' test, one way ANOVA RESULTS: Difference between rhBMP2 and iliac crest graft treated cases in terms of antibiotic use, serratopeptidase, NSAIDS, pain at surgical site, edema, number of working lost for attendees and number of days to walk unaided were statistically significant. The mean length of surgery for unilateral cases was 87.60 minutes whereas it was 108.75 minutes for bilateral cases (p=0.003). The mean efficiency of bone deposition as revealed loss in radiolucency for rhBMP2 treated cases was 91.74% whereas iliac crest graft cases showed a 87.96% (p=0.006).

DISCUSSION

It is evident that one has to reject null hypothesis in favor of the alternate hypothesis. The rhBMP2 is better than the conventional gold standard of iliac crest graft for restoration of maxillary alveolar clefts in terms of considered surgical, post surgical and radiographic planimetry parameters.

CONCLUSION

Sparing children from the procedure of iliac crest harvesting is by itself a compelling reason to favor rhBMP2 use. It avoids the unnecessary surgery, loss of blood and postoperative morbidity of iliac crest harvesting.

The location-specific healing response of damaged articular cartilage after ACL reconstruction: short-term follow-up

Although many different interventions have been proposed for treating cartilage lesions at the time of ACL reconstruction, the normal healing response of these injuries has not been well documented. To address this point, we compared the arthroscopic status of chondral lesions at the time of ACL reconstruction with that obtained at second-look arthroscopy. We hypothesized that there might be a location-specific difference in the healing response of damaged articular cartilage. Between September 1998 and March 2000, 383 patients underwent arthroscopically-assisted hamstring ACL reconstruction without any intervention to the articular cartilage. Among these patients, 84 patients underwent second-look arthroscopy (ranging from 6 to 52 months following initial surgery) and make up the population of the present study. Chondral injuries, left untreated at ACL reconstruction, were arthroscopically evaluated using the Outerbridge classification, and were again evaluated at second-look arthroscopy. At second-look arthroscopy, there was significant recovery of chondral lesions by Outerbridge grading on both the medial and lateral femoral condyles. Among the recovered chondral lesions, 69% of cases of the medial femoral condyle, 88% of cases of the lateral femoral condyle were partial thickness injuries (grade I and II). Conversely, there was no significant recovery of chondral lesions observed at the patello-femoral joint or tibial plateaus. Our study revealed that there was a location-specific difference in the natural healing response of chondral injury. Untreated cartilage lesions on the femoral condlyes had a superior healing response compared to those on the tibial plateaus, and in the patello-femoral joint.

Repair of large osteochondral defects with allogeneic cartilaginous aggregates formed from bone marrow-derived cells using RWV bioreactor

Our objective was to examine the technique of regenerating cartilage tissue from bone marrow-derived cells by three-dimensional (3D) culture using the rotating wall vessel (RWV) bioreactor. Three-dimensional and cylindrical aggregates of allogeneic cartilage with dimensions of 10 x 5 mm (height x diameter) formed by the RWV bioreactor were transplanted into osteochondral defects of Japanese white rabbits (Group T, n = 15). For the control, some osteochondral defects were left empty (Group C, n = 18). At 4, 8, and 12 weeks postimplantation, the reparative tissues were evaluated macroscopically, histologically, and biochemically. In Group T at as early as 4 weeks, histological observation, especially via safranin-O staining, suggested that the reparative tissues resembled hyaline cartilage. And we observed no fibrous tissues between reparative tissue and adjacent normal tissues. In the deeper portion of the bony compartment, the osseous tissues were well remodeled. At 4 and 8 weeks postimplantation, the mean histological score of Group T was significantly better than that of Group C (p < 0.05). The glycosaminoglycans (GAG)/DNA ratio in both groups increased gradually from 4 to 8 weeks and then decreased from 8 to 12 weeks. We herein report the first successful regeneration of cartilage in osteochondral defects in vivo using allogeneic cartilaginous aggregates derived from bone marrow-derived cells by 3D culture using the RWV bioreactor.

Bone repair in rat mandible by rhBMP-2 associated with two carriers

This study evaluated the quantity and quality of newly formed bone, stimulated by rhBMP-2 in combination with monoolein or chitosan gel as carriers, in critical bone defects created in 36 Wistar rat mandibles. Two weeks after surgery, the animals were anesthetized with 37.5% urethane submitted to perfusion and the hemi-mandibles removed for histological and histomorphometrical analysis. The results showed that there was a statistical difference between groups of animals receiving or not rhBMP-2 (p<0.05). Newly formed bone was more intense in the occlusal region, followed by the basal and middle regions, respectively. Both carriers, monoolein and chitosan gels were adequate for defect filling and control of protein release.

Articular chondrocyte culturing for cell-based cartilage repair: needs and perspectives

Articular cartilage displays a limited capacity of self-regeneration after injury. Thus, the biology of this tissue and its cellular components - the chondrocytes - has become the focus of several investigations, driven by tissue engineering and the basic and clinical research fields, aiming to ameliorate the present clinical approaches to cartilage repair. In this work, we present a brief recapitulation of the events that lead to cartilage development during the skeletal embryonal growth. The intrinsic phenotypic plasticity of the mesenchymal precursors and the adult chondrocytes is evaluated, dependent on the cell source, its physiopathological state, and as a function of the donor's age. The phenotypic changes induced by the basic culturing techniques are also taken into account, thus highlighting the phenotypic plasticity of the chondrocyte as the main property which could couple the differentiation process to the repair process. Chondrocyte proliferation and the contemporary maintenance of the chondrogenic differentiation potential are regarded as the two primary goals to be achieved in order to fulfill the quantitative needs of the clinical applications and the qualitative requirements of a properly repaired tissue. In this light, the effects of several growth factors and medium supplements are investigated. Finally, the latest improvements in culturing conditions and their possible clinical applications are presented as well.

Effect of Recombinant Human Bone Morphogenetic Protein-2 on Mandibular Distraction at Different Rates in a Rabbit Model

This study aims to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on mandibular distraction at routine and rapid distraction rates. Eighteen New Zealand white rabbits were assigned to 2 groups, 1 treated at a routine distraction rate (0.9 mm/d) and the other at a rapid distraction rate (2.7 mm/d). rhBMP-2 was injected into 1 side of the distraction regenerate at the end of the active distraction period; the contralateral side was used as a control. The distraction regenerates were analyzed by plain radiography, microcomputed tomography, and histologic examination. The results showed that rhBMP-2 can promote bone formation at both rapid and routine distraction rates, but no statistically significant difference was observed between the bone morphogenetic protein injection sides of the rapid and routine distraction groups. In conclusion, the study indicates that rhBMP-2 can enhance bone ossification at both routine and rapid distraction rates. The addition of rhBMP-2 seems to be able to compensate for the rapid distraction rate in mandibular distraction osteogenesis. Further longterm follow-up and mechanical strength test for the support of implants or conventional prostheses are necessary.

Expression profiling of transforming growth factor beta superfamily genes in developing orofacial tissue

BACKGROUND

Numerous signaling molecules have been shown to participate in the dynamic process of orofacial development. Among these signal mediators, members of the transforming growth factor beta (TGFbeta) superfamily have been shown to play critical roles. Developing orofacial tissue expresses TGFbeta and bone morphogenetic protein (BMP) mRNAs, their protein isoforms and TGFbeta- and BMP-specific receptors. All these molecules display unique temporospatial patterns of expression in embryonic orofacial tissue, suggesting functional roles in orofacial development. For example, the TGFbetas and BMPs regulate maxillary mesenchymal cell proliferation and extracellular matrix synthesis. This is particularly noteworthy in that perturbation of either process results in orofacial clefting. Although the cellular and phenotypic effects of the TGFbeta superfamily of growth factors on embryonic orofacial tissue have been extensively studied, the specific genes that function as effectors of these cytokines in orofacial development have not been well defined.

METHODS

In the present study, oligonucleotide-based microarray technology was utilized to provide a comprehensive analysis of the expression of the panoply of genes related to the TGFbeta superfamily, as well as those encoding diverse groups of proteins functionally associated with this superfamily, during orofacial ontogenesis.

RESULTS

Of the 7000 genes whose expression was detected in the developing orofacial region, 249 have been identified that encode proteins related to the TGFbeta superfamily. Expression of some (27) of these genes was temporally regulated. In addition, several candidate genes, whose precise role in orofacial development is still unknown, were also identified. Examples of genes constituting this cluster include: TGFbeta1-induced antiapoptotic factor-1 and -2, TGFbeta-induced factor 2, TGFbeta1 induced transcript-1 and -4, TGFbeta-inducible early growth response 1, follistatin-like 1, follistatin-like 3, transmembrane protein with EGF-like and two follistatin-like domains (Tmeff)-1 and -2, nodal modulator 1, various isoforms of signal transducers and activators of transcription (Stat), notch, and growth and differentiation factors.

CONCLUSIONS

Elucidation of the precise physiological roles of these proteins in orofacial ontogenesis should provide unique insights into the intricacies of the TGFbeta superfamily signal transduction pathways utilized during orofacial development.

Effect of distraction rates on expression of bone morphogenetic proteins in rabbit mandibular distraction osteogenesis

BACKGROUND

The expression of bone morphogenetic proteins can be regarded as an indicator for biological interaction in distraction osteogenesis. It was hypothesized that different distraction rates may produce different patterns of BMP expression.

MATERIAL AND METHODS

This study compared the expression of BMP-2, -4 and -7 at routine (0.9mm once daily) and rapid (2.7mm once daily) distraction rates using the rabbit mandibular lengthening model. Mandibular samples were harvested at days 1, 7 and 14 of consolidation.

RESULTS

The expression of BMP-2 and BMP-4 was found throughout the experiment, their expression intensity and location being essentially similar, whereas BMP-7 had not been expressed. Expression of BMP-2 and -4 was more intense at the routine distraction rate than at the rapid distraction rate.

CONCLUSIONS

BMP-7 had no expression during the consolidation period of mandibular distraction. The change in the mechanical environment created by different distraction rates led to different expression of BMP-2 and -4. In the early consolidation stage the biological environment for bone formation created by distraction at a routine rate was superior to that created by the rapid distraction rate.

Bone apposition to titanium implants biocoated with recombinant human bone morphogenetic protein-2 (rhBMP-2). A pilot study in dogs

The aim of the present study was to investigate bone formation to recombinant human bone morphogenetic protein-2 (rhBMP-2)-biocoated and rhBMP-2-nonbiocoated titanium implants after implantation in dogs. Implantation of sand-blasted and acid-etched (C), chromosulfuric acid surface-enhanced (CSA), and rhBMP-2-biocoated CSA [BMP-A: noncovalently immobilized rhBMP-2 (596 ng/cm²), BMP-B: covalently immobilized rhBMP-2 (819 ng/cm²)] implants was performed in both the mandible and tibia of dogs. After 4 weeks of healing, the percentage of direct bone to implant contact (BIC) and the induced bone density (BD) at a distance of less than and greater than 1 mm adjacent to each implant was assessed. Histomorphometric analysis of implants inserted in the mandible and tibia revealed that BIC values appeared to be highest in the BMP-B group, followed by BMP-A, CSA, and C. BD as measured at a distance of <1 mm revealed obvious differences between groups: BMP-B>BMP-A>CSA>C. However, no differences between groups were observed at a distance of >1 mm. Within the limits of the present study, it may be concluded that rhBMP-2 immobilized by covalent and noncovalent methods on CSA-treated implant surfaces seemed to be stable and promoted direct bone apposition in a concentration-dependant manner.

Effect of Recombinant Human Bone Morphogenetic Protein-2 on Mandibular Distraction at Different Rates in an Experimental Model

This study evaluates the effect of recombinant human (rh) bone morphogenetic protein (BMP)-2 on mandibular distraction at normal and rapid distraction rates. This study also determines the feasibility of compensating for the increased distraction rate by the addition of rhBMP-2 while maintaining the quality of the distraction regenerate. Twenty-four New Zealand white rabbits were divided into 2 groups, 1 treated at a normal distraction rate (0.9 mm/d) and the other at a rapid distraction rate (2.7 mm/d). At the end of the active distraction period, rhBMP-2 was injected into distraction regenerate, and the contralateral side was used as a control. The distraction regenerates were analyzed by plain radiography, microcomputed tomography, and mechanical testing. The results showed that rhBMP-2 can promote bone formation at both rapid and normal distraction rates. At week 2 and week 4 of consolidation, bone volumes in the BMP-injection sides were significantly higher than in the control sides, but no statistically significant difference was observed between the BMP-injection sides of the rapid and normal distraction groups. At week 8 of consolidation, mechanical testing demonstrated no significant difference of the failure load and stiffness between the BMP-injection and control sides. In conclusion, the study indicates that rhBMP-2 can enhance bone ossification at both normal and rapid distraction rates. The addition of rhBMP-2 can compensate for the rapid distraction rate in mandibular distraction osteogenesis. However, in the long term, the bone quality and stiffness of the distraction regeneration was not influenced by rhBMP-2.

Discovery and development of BMPs

In the early 1970s, the isolation and identification of bone morphogenetic proteins (BMPs) was a major breakthrough for the understanding of the distinct biological events occurring during bone formation. Not surprising, since their discovery, BMPs have been perhaps one of the most intensively studied group of factors in various physiological processes. The prompt development of recombinant BMPs and various delivery methods made BMPs currently available for clinical use. Research and clinical studies on BMPs are ongoing, aiming to refine further our understanding of their activities in vivo and to optimise and expand their clinical use in humans.

Evaluation of recombinant human bone morphogenetic protein-2 in mandibular distraction osteogenesis in rabbits: Effect of dosage and number of doses on formation of bone

We evaluated the dose- and time-dependent response of recombinant human bone morphogenetic protein-2 (rhBMP-2) to the formation of bone in mandibular distraction osteogenesis. Twenty-one adult white New Zealand rabbits (3.0-3.8 kg) were used to establish the mandibular distraction model, 18 of which completed the experiment. Eight rabbits were given rhBMP-2 360 microg and eight 1080 microg; two were given no rhBMP-2. The fluids were injected into the regenerating bone at three different time sequences (days 5, 8, and 11 of active distraction; days 5 and 11 of active distraction; and day 11 of active distraction alone). After four weeks of consolidation, the specimens were harvested and examined radiographically by micro-computed tomography (micro-CT), and histologically. The formation and remodelling of bone in distraction osteogenesis was significantly increased by the addition of rhBMP-2, and the increase was dose-dependent. There was no significant difference between different dosage regimens. A single injection of rhBMP-2 at the end of the distraction phase was as effective as multiple injections.

Heterotopic ossification: a review

Heterotopic ossification is the formation of bone in the soft tissues. Soft tissue bone deposition may range from the minimal and inconsequential to massive and clinically significant. In some clinical settings it is a predictable finding with an unpredictable course and in other settings it may be diagnostically confounding. Heterotopic ossification may be encountered in clinically disparate disease processes and circumstances. We review the genetic, neurogenic, post-traumatic, post-surgical and "reactive" causes of heterotopic ossification and discuss some current concepts of its pathogenesis.

Utilisation de facteurs de croissance pour la réparation osseuse

Osteoformation is induced by numerous growth factors that play an important role in bone repair such as fracture healing. They may serve as therapeutic agent in the treatment of squeletal injuries in the orthopeadic and maxillo-facial fields. Among these proteins, Bone Morphogenetic Proteins (BMP) are the only known osteoinductive growth factors. Unfortunately, they are highly susceptible to proteolysis in vivo and require a suitable delivery system to potentiate their biological activity in a local, controlled and durable manner. In this aim, three options are under investigations: (i) osteoinductive materials made of appropriate carrier to release the protein in situ, (ii) in vivo gene therapy in which the gene is directly transfected in cells of the patient or (iii) ex vivo gene therapy in which cells are harvested from the patient, transfected with DNA in culture and then implanted in the defect. These different kinds of BMP delivery will be discussed.

O papel da proteína morfogenética óssea na reparação do tecido ósseo

Este estudo de revisão da literatura aborda os avanços do uso da proteína morfogenética óssea (BMP) na reparação do tecido ósseo e seus mecanismos de ação no tecido lesionado. As BMPs são moléculas pleiotrópicas que são envolvidas na quimiotaxia, mitose e diferenciação de células mesenquimais no tecido ósseo.

Bone repair in the twenty-first century: biology, chemistry or engineering?

Increases in reconstructive orthopaedic surgery, such as total hip replacement and spinal fusion, resulting from advances in surgical practice and the ageing population, have lead to a demand for bone graft that far exceeds supply. Consequently, a number of synthetic bone-graft substitutes (BGSs) have been developed with mixed success and surgical acceptance. Skeletal tissue regeneration requires the interaction of three basic elements: cells, growth factors (GFs) and a permissive scaffold. This can be achieved by pre-loading a synthetic scaffold with GFs or pre-expanded cells; however, a 'simpler' approach is to design intrinsic 'osteoinductivity' into your BGS, i.e. the capability to recruit and stimulate the patient's own GFs and stem cells. Through investigation of the mechanisms controlling bone repair in BGSs, linking interactions between the local chemical and physical environment, scientists are currently developing osteoinductive materials that can stimulate bone regeneration through control of the scaffold chemistry and structure. Moreover, this body of research is providing the foundations for future generations of BGSs and bone-repair therapies and may ultimately contribute towards improving the quality of life through maintenance of the skeleton and reversal of disease states, as opposed to the mending of broken bones that we currently practice. Will we be able to grow our own bones in a bioreactor for use as autologous graft materials in the future? Could surgery be limited to accidental trauma cases, with greater restoration of function through biochemical or gene therapies? The technology and research probes necessary to this task are currently being developed with the advent of nanotechnology, genomics and proteomics: are we about to embark on a chemical revolution in medicine? This paper aims to discuss some of the current thinking on the mechanisms behind bioactivity and biocompatibility in bone and how a fuller understanding of the interactions between cells and the materials used today could bring about completely new approaches for the treatment of bone fracture and disease tomorrow.

Menin is required for bone morphogenetic protein 2- and transforming growth factor beta-regulated osteoblastic differentiation through interaction with Smads and Runx2

Menin, the product of the multiple endocrine neoplasia type 1 (MEN1) gene, is required for commitment of multipotential mesenchymal stem cells to the osteoblast lineage, however, it inhibits their later differentiation (Sowa, H., Kaji, H., Canaff, L., Hendy, G.N., Tsukamoto, T., Yamaguchi, T., Miyazono, K., Sugimoto, T., and Chihara, K. (2003) J. Biol. Chem. 278, 21058-21069). Here, we have examined the mechanism of action of menin in regulating osteoblast differentiation using the mouse bone marrow stromal ST2 and osteoblast MC3T3-E1 cell lines. In ST2 cells, reduced menin expression achieved by transfection of menin antisense DNA (AS) antagonized bone morphogenetic protein (BMP)-2-induced alkaline phosphatase activity and osteocalcin and Runx2 mRNA expression. Menin was co-immunoprecipitated with Smad1/5 in ST2 and MC3T3-E1 cells, and inactivation of menin antagonized BMP-2-induced transcriptional activity of Smad1/5 in ST2 cells, but not MC3T3-E1 cells. Menin was co-immunoprecipitated with the key osteoblast regulator, Runx2, and AS antagonized Runx2 transcriptional activity and the ability of Runx2 to stimulate alkaline phosphatase activity only in ST2 cells but not in MC3T3-E1 cells. In the osteoblast MC3T3-E1 cells, transforming growth factor-beta and its signaling molecule, Smad3, negatively regulated Runx2 transcriptional activity. Menin and Smad3 were co-immunoprecipitated, and combined menin and Smad3 overexpression antagonized, whereas menin and the dominant-negative Smad3DeltaC together enhanced BMP-2-induced transcriptional activity of Smad1/5 and Runx2. Smad3 alone had no effect. Therefore, menin interacts physically and functionally with Runx2 in uncommitted mesenchymal stem cells, but not in well differentiated osteoblasts. In osteoblasts the interaction of menin and the transforming growth factor-beta/Smad3 pathway negatively regulates the BMP-2/Smad1/5- and Runx2-induced transcriptional activities leading to inhibition of late-stage differentiation.