Clinical Advances in Bone Regeneration

Abstract

Understanding of the biology of bone regeneration has been increasing rapidly, with greater appreciation for the importance of biochemical aspects as well as the mechanical requirements for bone to heal. There are a number of situations where there is difficulty in bone healing such as fracture non-union; or growth such as osteogenesis imperfecta; or a requirement for surplus bone to reconstruct defects such as following surgery for tumour excision or limb lengthening. There is a greater understanding of the complex interplay between osteoblasts and osteoclasts, and the chemical mediators that provide signalling along complex pathways. Although we have known about substances such as Bone Morphogenic Proteins and Growth Hormones for some time, their application in clinical practice is still not widespread, and we need to study them more to understand their role in bone healing. With newer technologies such as stem cells and gene therapy being developed there is the potential for vast improvement in bone regenerative techniques, although we are not at a stage where we can be confident that these techniques will work. In this review article we discuss the basic healing process of bone and how our understanding of this has led to improved techniques as well as the potential for future developments in new technologies.

EPO Promotes Bone Repair through Enhanced Cartilaginous Callus Formation and Angiogenesis

“…These conditions include delayed fracture union or non-union, osteoporotic fracture healing, impaired bone repair associated with diabetes, and large bone defects caused by trauma or surgical treatments [3], [4], [5], [6]. Hallmarks of impaired bone repair in patients and animal models include the deficiency in vascular supply and cartilaginous callus formation at the site of injury, suggesting that impaired angiogenic and chondrogenic responses are major contributors to the pathology [7], [8].…”

Bone regeneration in critical bone defects using three‐dimensionally printed β‐tricalcium phosphate/hydroxyapatite scaffolds is enhanced by coating scaffolds with either dipyridamole or BMP‐2

“…The materials used in bone grafting can be divided into several major categories, including autografts, allografts, and xenografts; autografts remain the ‘gold standard’ in reconstructing small bone defects and have strong osteogenic characteristics relevant to bone healing, modeling, and remodeling [3] The regeneration and repair of bone requires a source of mesenchymal stem cells that can differentiate into bone-forming osteoblasts.. Like autografts, bioresorbable scaffolds can direct the migration of these stem cells into the defected area and can promote the formation of a vascular network capable of supporting the bone. Thus, when autografts are not practical bioresorbable scaffolds can be used to enhance bone regeneration [4]. …”

Effect of Dual Treatment with SDF-1 and BMP-2 on Ectopic and Orthotopic Bone Formation

“…Pluripotent MSCs make up only a small fraction of the host marrow [2] and increasing cell numbers by ex vivo cell culture can change the cell characteristics and increase the risk of contamination [3]. The application of cytokines or growth factors at the site of bone healing and regeneration has been suggested as a means of overcoming the shortcomings of cell therapy [4]. …”