Bone Morphogenetic Protein-2 (BMP-2) in the Treatment of Pyogenic Vertebral Osteomyelitis

Allen, R. T.; Lee, Yu-Po; Stimson, Elizabeth; Garfin, Steven R.

doi:10.1097/brs.0b013e31815cde3e

Cited by 54 publications

(28 citation statements)

References 39 publications

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“…We selected the W-20-17 cell line because it has been used for an ASTM (F2131) standard test for in vitro biological activity of BMP-2. S. aureus was chosen for both its clinical origin and its high prevalence in bone graft failures (2,4,19,29). If desired, modification of the system we establish here could accommodate testing of other antibiotic or growth factor compounds across a wide array of mammalian/bacterial cell cocultures.…”

Section: Discussionmentioning

confidence: 99%

Effect of Coadministration of Vancomycin and BMP-2 on Cocultured Staphylococcus aureus and W-20-17 Mouse Bone Marrow Stromal Cells In Vitro

Nguyen

Kim

Maloney

et al. 2012

Antimicrob Agents Chemother

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ABSTRACTIn this study, we aimed to establish anin vitrobacterium/bone cell coculture model system and to use this model for dose dependence studies of dual administration of antibiotics and growth factorsin vitro. We examined the effect of single or dual administration of the antibiotic vancomycin (VAN) at 0 to 16 μg/ml and bone morphogenetic protein-2 (BMP-2) at 0 or 100 ng/ml on both methicillin-sensitiveStaphylococcus aureusand mouse bone marrow stromal cells (W-20-17) under both mono- and coculture conditions. Cell metabolic activity, Live/Dead staining, double-stranded DNA (dsDNA) amounts, and alkaline phosphatase activity were measured to assess cell viability, proliferation, and differentiation. An interleukin-6 (IL-6) enzyme-linked immunosorbent assay (ELISA) kit was used to test the bone cell inflammation response in the presence of bacteria. Our results suggest that, when delivered together in coculture, VAN and BMP-2 maintain their primary functions as an antibiotic and a growth factor, respectively. Most interestingly, this dual-delivery type of approach has shown itself to be effective at lower concentrations of VAN than those required for an approach relying strictly on the antibiotic. It may be that BMP-2 enhances cell proliferation and differentiation before the cells become infected. In coculture, a dosage of VAN higher than that used for treatment in monoculture may be necessary to effectively inhibit growth ofStaphylococcus aureus. This could mean that the coculture environment may be limiting the efficacy of VAN, possibly by way of bacterial invasion of the bone cells. This report of a coculture study demonstrates a potential beneficial effect of the coadministration of antibiotics and growth factors compared to treatment with antibiotic alone.

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Section: Discussionmentioning

confidence: 99%

Effect of Coadministration of Vancomycin and BMP-2 on Cocultured Staphylococcus aureus and W-20-17 Mouse Bone Marrow Stromal Cells In Vitro

Nguyen

Kim

Maloney

et al. 2012

Antimicrob Agents Chemother

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“…Anterior fusion with rhBMP-2 inserted in structural allograft or titanium cylindrical cages, followed by posterior instrumented fusion with autogenous iliac crest graft has been claimed to have good results after a range of 11-30 months follow-up [1]. However, since infection relapse and structural allograft failure may appear after very long follow-up, more studies with longer follow-up are needed.…”

Section: Bmpsmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

183

130

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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“…Pyogenic vertebral osteomyelitis is one of less common complications after spinal fusion, present late or in patients with multiple medical morbidities such as diabetes, HIV or rheumatoid conditions; the use of BMPs to correct this hostile environment of pyogenic infection it is proven effective managed by circumferential instrumented fusion in combination with antibiotics, according to Allen et al 13 it has good evidence of bony fusion, no infection recurrence and the patients had clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

The use of bone morphogenetic proteins (BMP) and pseudarthrosis, a literature review

Oliveira

Martins

Lima

et al. 2017

Revista Brasileira de Ortopedia (English Edition)

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Bone morphogenetic proteins (BMP) are multi-functional growth factors to promote bone healing with the proposal of less morbidity compared to the usual methods of bone graft harvest. Pseudoarthrosis occur when the fusion attempt fails, a solid fusion is not achieved, or there is motion across the segment leading to it, and it can be clinically symptomatic as pain, deformity, neurocompression, or hardware failure. BMPs are used at spinal fusion as a tool for the treatment of degenerative, traumatic, neoplastic and infectious conditions of the spine. This review shows that the use of BMPS is effective and secure when compared with iliac crest bone graft (ICGB); however, depending of the location of usage (cervical spine, lumbar spine or sacrum) and the medical status of the patient (presence of comorbidities, tobacco usage), it is more likely to exhibit complications. Therefore, the use of these proteins must be an informed decision of patient and physician preferences.

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Bone Morphogenetic Protein-2 (BMP-2) in the Treatment of Pyogenic Vertebral Osteomyelitis

Abstract: rhBMP-2 use, in combination with antibiotics and circumferential instrumented fusion, provides a safe and successful surgical treatment of medically nonresponsive PVO, with solid fusions obtained, good clinical results, and no adverse side effects from the BMP.

Cited by 54 publications

References 39 publications

Effect of Coadministration of Vancomycin and BMP-2 on Cocultured Staphylococcus aureus and W-20-17 Mouse Bone Marrow Stromal Cells In Vitro

Effect of Coadministration of Vancomycin and BMP-2 on Cocultured Staphylococcus aureus and W-20-17 Mouse Bone Marrow Stromal Cells In Vitro

Surgical treatment of spondylodiscitis. An update

The use of bone morphogenetic proteins (BMP) and pseudarthrosis, a literature review

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