Growth factors in orthopaedic surgery: demineralized bone matrix versus recombinant bone morphogenetic proteins

Abstract

During recent decades the utilisation of growth factors, especially BMPs, has received an increasing interest in orthopaedic surgery. For clinical implantation the two main options are demineralised bone matrix (DBM) and recombinant bone morphogenetic proteins (rhBMP). Many clinical studies agree on an equivalent osteoinductive effect between DBM, BMPs and autologous bone graft; however, the different origins and processing of DBM and rhBMP may introduce some fluctuations. Their respective characteristics are reviewed and possible interactions with their effectiveness are analysed. The main difference concerns the concentration of BMPs, which varies to an order of magnitude of 106 between DBM and rhBMPs. This may explain the variability in efficiency of some products and the adverse effects. Currently, considering osteoinductive properties, safety and availability, the DBM seems to offer several advantages. However, if DBM and rhBMPs are useful in some indications, their effectiveness and safety can be improved and more evidence-based studies are needed to better define the indications.

Osseointegration effect of biomimetic intrafibrillarly mineralized collagen applied simultaneously with titanium implant: A pilot in vivo study

“…These findings are also consistent with the increased skeletogenesis‐related gene expression reported in bone fracture healing (Bais et al, ) and guided bone regeneration (Al‐Kattan et al, ; Donos, Retzepi, et al, ) in a rat model as well as during osseointegration in humans (Donos, Hamlet, et al, ; Ivanovski, Hamlet, Salvi, et al, ) at the 14‐day time point. Additionally, signaling pathways related to the upregulation of osteogenesis‐related genes included the Tgf‐β/Bmp, Wnt, and Notch pathways, which have been demonstrated to be involved in bone regeneration as well as in mesenchymal stem cell and osteoblast differentiation (Argintar, Edwards, & Delahay, ; Canalis, Parker, Feng, & Zanotti, ; Chen & Alman, ; Hinsenkamp & Collard, ; Olivares‐Navarrete, Hyzy, Wieland, Boyan, & Schwartz, ; Zanotti & Canalis, ). Furthermore, research has shown that activation of Wnt and Tgf‐β/Bmp signaling pathways can promote the osteogenic differentiation of mesenchymal stem cells and osteoblasts on the SLActive dental implant surface (Olivares‐Navarrete et al, ; Vlacic‐Zischke, Hamlet, Friis, Tonetti, & Ivanovski, ).…”

BMPER Enhances Bone Formation by Promoting the Osteogenesis-Angiogenesis Coupling Process in Mesenchymal Stem Cells

“…BMP-2, BMP-4, BMP-6, BMP-7 and BMP-9 induce osteogenic differentiation of MSCs in vitro and in vivo [4, 5]. By binding type I and II receptors to form complexes on the cell surface, BMPs exert their biological function through the activation of Smad signaling pathways, which regulate osteogenic-related gene expression [6, 7]. Meanwhile, BMPs are functionally modulated by a class of intracellular and extracellular BMP-binding proteins, termed BMP antagonists [2, 8].…”

Bone morphogenetic protein use in spine surgery—complications and outcomes: a systematic review

“…Hinsenkamp and Collard [56] recently reported the importance of concentration of rhBMP that may introduce some interactions with the effectiveness. The difference in concentration between DBM (demineralised bone matrix) and BMPs can vary to a magnitude order of 10 6 , and this may explain the variability in efficiency and the adverse effects.…”