Kemik grefti yerine geçen substratlar ve etki mekanizmaları

BMP and TGFβ use and release in bone regeneration

“…Trauma, tumor resection, degeneration, deformation may cause bone defects in which the healing process is controlled by cytokines as bone morphogenetic proteins (BMP) or transforming growth factor beta (TGFβ), are a great challenge for regeneration studies [1,2,3,4]. Bone loss is frequently difficult to reconstruct due to limitations in autografts, allografts, natural or synthetic composites [1]. In 2015 Sheikh et al [5] mentioned that about 5% to 10% of all the procedures related with impaired healing are due to physiological stress and they cause morbidity in patients while a significant economic loss is recorded.…”

“…Autografts, standard in treatment of bone defects, are the most commonly used grafts because of their osteoinductivity, osteoconductivity and being nonimmunogenic; however, they have disadvantages as increased surgical time and donor site morbidity [1,2,4,6,7]. On the other hand, allografts are also osteoconductive and slightly osteoinductive and do not have complications as donor site morbidity but have the probability of disease transmission or rejection by the immune system and their bone repair capability is half of the autografts, with higher price [1,4,8,9]. Together with these disadvantages, the collected tissue for regeneration may not always be sufficient enough to fill the defect [10,11].…”

“…In the process of regeneration, cell migration to damaged areas, angiogenesis, fibrosis, chemokine secretions and differentiation of stem cells are especially important [15]. Thus, osteogenic growth factors or cytokines are generally used in bone tissue engineering due to their osteoinductive abilities because they are able to attract the progenitor cells to the defect area and promote the cell proliferation, migration and endogenous repair mechanisms [1,10]. Their effects on the mechanism of bone regeneration via migration, proliferation, differentiation and reconstruction of the extracellular matrix are in time dependent manner [1,4].…”

“…Throughout these cytokines, bone morphogenetic proteins (BMPs), as being the biggest subfamily of TGFβ superfamily, are the most commonly used growth factors because they are already present in bone tissue and reported to be necessary for fetal tissue development and fracture repair [1,2,4,6,10,16]. TGFβ, itself, is also known as an important growth factor in regulation of osteoblast and osteoclast activities which is an important process for bone homeostasis and remodeling [17,18].…”

“…The use of BMP-2 in spine for anterior lumbar spinal fusion has approved by FDA (US Food and Drug Administration), yet the excess amount of BMP, leakage or uncontrolled burst release can cause inflammation, edema, nerve root compression and seroma formation, radiculitis, ectopic bone formation, immune response, osteolysis, cervical and soft tissue edema, osteoclast mediated bone resorption, wound complications, urogenital disorders, inappropriate adipogenesis and heterotrophic bone formation [1,2,11,19,20]. Although BMPs are known as key factors in the commitment of stem cells to osteoprogenitor lineage, especially in the spinal applications, the excess amount of BMP is reported to cause cancer [11].…”