Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions

Calori, G.M.; Tagliabue, L.; Gala, Luca; d’Imporzano, M.; Peretti, Giuseppe M.; Albisetti, W.

doi:10.1016/j.injury.2008.08.011

Cited by 179 publications

(104 citation statements)

References 66 publications

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“…Preliminary results showed that rhBMP-7 seemed to be more effective, with higher healing rate and lower failure rate. These results were later confirmed in 2008 during the final analysis of this study [13] on a large cohort of 120 patients: 60 patients in each group. Clinical and radiological unions were superior in the rhBMP-7 group, also showing a lower radiographic healing time.…”

Section: Rhbmp-7 and Non-unionssupporting

confidence: 57%

“…Among RCTs and comparative studies, all 6 papers reported superior results with rhBMPs, in terms of clinical outcome, radiographic consolidation, and healing time acceleration [13,14,36,42,48,54]. Moreover, rhBMPs provided comparable results to ABG treatment [14,48,54] with shorter operative time, reduced operative blood loss, and avoiding donor site morbidity [14,36].…”

Section: Discussionmentioning

confidence: 97%

“…Currently, there are two commercially available BMPs, recombinant human rh BMP-2 and rhBMP-7. They have been tested in several preclinical studies showing the ability to induce bone regeneration [9][10][11], and evaluated in clinical trials to treat various bone disorders such as non-unions, open fractures, and osteonecrosis [12][13][14][15][16][17]. The successful application of BMPs led, in July 2002, to the approval by the European Medicines Agency (EMA) of rhBMP-2 (InductOs®) for the treatment of single-level lumbar spine fusion and for acute tibial fractures in adults [18].…”

Section: Introductionmentioning

confidence: 99%

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Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Krishnakumar

Roffi

Reale

et al. 2017

International Orthopaedics (SICOT)

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Purpose This paper documents the existing evidence on bone morphogenetic proteins (BMPs) use for the treatment of bone fractures, non-union, and osteonecrosis, through a review of the clinical literature, underlying potential and limitations in terms of cost effectiveness and risk of complications. Methods A systematic review was performed on the PubMed database using the following string: (bone morphogenetic proteins OR BMPs) and (bone repair OR bone regeneration) including papers from 2000 to 2016. The search focused on clinical trials dealing with BMPs application to favor bone regeneration in bone fractures, non-union, and osteonecrosis, in English language, with level of evidence I, II, III, and IV. Relevant data (type of study, number of patients, BMPs delivery material, dose, site, follow-up, outcome, and adverse events) were extracted and analyzed. Results Forty-four articles met the inclusion criteria: 10 randomized controlled trials (RCTs), 7 comparative studies, 18 case series, and 9 case reports. rhBMP-2 was documented mainly for the treatment of fractures, and rhBMP-7 mainly for non-unions and osteonecrosis. Mixed results were found among RCTs and comparative papers: 11 reported positive results for BMPs augmentation, 3 obtained no significant effects, and 2 showed negative results. The only study comparing the two BMPs showed a better outcome with rhBMP-2 for non-union treatment. Conclusion Clinical evidence on BMPs use for the treatment of fractures, non-union, and osteonecrosis is still controversial, with the few available reports being mainly of low quality. While positive findings have been described in many studies, mixed results are still present in the literature in terms of efficacy and adverse events. The difficulties in drawing clear conclusions are also due to the studies heterogeneity, mainly in terms of different BMPs applied, with different concomitant treatments for each bone pathology. Therefore, further research with well-designed studies is needed in order to understand the real potential of this biological approach to favour bone healing.

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Section: Rhbmp-7 and Non-unionssupporting

confidence: 57%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Krishnakumar

Roffi

Reale

et al. 2017

International Orthopaedics (SICOT)

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“…Laboratory data on the use of PRP advocates that it promotes cell proliferation and increases the extracellular matrix [35]. Clinical data is still controversial and based on case series where PRP is used either alone or associated with bone grafts or bone substitutes [37,38]. To date, there is no evidence sustaining the use of PRP as a supporting aid in bone regeneration [39][40][41].…”

Section: Platelet Derived Growth Factormentioning

confidence: 99%

Updates in biological therapies for knee injuries: bone

Kfuri

Freitas

Batista

et al. 2014

Curr Rev Musculoskelet Med

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Bone is a unique tissue because of its mechanical properties, ability for self-repair, and enrollment in different metabolic processes such as calcium homeostasis and hematopoietic cell production. Bone barely tolerates deformation and tends to fail when overloaded. Fracture healing is a complex process that in particular cases is impaired. Osteoprogenitor cells proliferation, growth factors, and a sound tridimensional scaffold at fracture site are key elements for new bone formation and deposition. Mechanical stability and ample vascularity are also of great importance on providing a proper environment for bone healing. From mesenchymal stem cells delivery to custom-made synthetic scaffolds, many are the biological attempts to enhance bone healing. Impaired fracture healing represents a real burden to contemporary society. Sound basic science knowledge has contributed to newer approaches aimed to accelerate and improve the quality of bone healing.

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“…295,297,298 Clinical studies comparing the role of approved BMPs and PRP on bone healing have been done. 299 Calori et al 299 reported a clinical report regarding the positive role of both BMP-7 and PRP on treatment of long-bone nonunions, with BMP-7 promoting a slightly better healing response in the treated patients. Preclinical evidence has demonstrated that PRP enhances osteoprogenitor cell proliferation, promotes angiogenesis, and enhanced fracture healing and bone regeneration.…”

mentioning

confidence: 99%

Controlled Release Strategies for Bone, Cartilage, and Osteochondral Engineering—Part II: Challenges on the Evolution from Single to Multiple Bioactive Factor Delivery

Santo

Gomes²,

Mano³

et al. 2013

Tissue Engineering Part B: Reviews

102

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The development of controlled release systems for the regeneration of bone, cartilage, and osteochondral interface is one of the hot topics in the field of tissue engineering and regenerative medicine. However, the majority of the developed systems consider only the release of a single growth factor, which is a limiting step for the success of the therapy. More recent studies have been focused on the design and tailoring of appropriate combinations of bioactive factors to match the desired goals regarding tissue regeneration. In fact, considering the complexity of extracellular matrix and the diversity of growth factors and cytokines involved in each biological response, it is expected that an appropriate combination of bioactive factors could lead to more successful outcomes in tissue regeneration. In this review, the evolution on the development of dual and multiple bioactive factor release systems for bone, cartilage, and osteochondral interface is overviewed, specifically the relevance of parameters such as dosage and spatiotemporal distribution of bioactive factors. A comprehensive collection of studies focused on the delivery of bioactive factors is also presented while highlighting the increasing impact of platelet-rich plasma as an autologous source of multiple growth factors.

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Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions

Cited by 179 publications

References 66 publications

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Updates in biological therapies for knee injuries: bone

Controlled Release Strategies for Bone, Cartilage, and Osteochondral Engineering—Part II: Challenges on the Evolution from Single to Multiple Bioactive Factor Delivery

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