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BMPs in Orthopaedic Medicine: Promises and Challenges

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Bone Morphogenetic Proteins: Systems Biology Regulators

Part of the book series: Progress in Inflammation Research ((PIR))

Abstract

Over the last 50 years the concept of inducing bone formation, using biologically active signalling molecules, has evolved significantly. The most potent of these osteoinductive molecules remain the Bone Morphogenetic Proteins, with established role on the chemotaxis, proliferation and differentiation of mesenchymal progenitor cells to form cartilage and bone.

The initial enthusiasm following the synthetic production of BMP2 and BMP7 using recombinant gene technology, was followed by an expansion of their use “in-” and “off-label” in clinical practice, on parallel to a large number of basic science and translational medicine studies attempting to define further their effect.

The key role of BMPs in bone repair stimulated their widespread use in the orthopaedic discipline including the management of delayed union and non-union of fractures, bone defects, open fractures, fusion of joints, spinal fusions, as well as treatment of osteoarthritis and intervertebral disc cartilage degeneration. It is quite evident that rhBMPs in humans have a different dose–response relationship in comparison to animal species, as well as that the final outcome of their use is also relevant to the specifics of their carrier and delivery system, their containment, the timing of their application, as well as the state of the recipient host local environment. The different effect of different BMPs, and their variable interaction with inhibiting molecules and negative feedback mechanisms, are nowadays better understood, widening further the horizon of contemporary research of bone, as well as of cartilage regeneration.

The reputation of BMPs has been negatively affected lately due to the recent redraw from the market of their recombinant synthetic forms, which is however attributed mostly to strategic commercial planning rather than their performance. New osteoinductive molecules emerge attempting to fill in the gap, whilst the challenge of evidence based clinical practice remains.

This article presents the contemporary understanding, as well as a summary of selected published evidence on the roles of the BMPs in bone and cartilage regeneration.

Conflict of Interest

No funds were received in support of this study. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article

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Authors and Affiliations

  1. Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK

    Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng) & Nikolaos K. Kanakaris

  2. NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, Leeds, UK

    Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng)

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  1. Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng)
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  2. Nikolaos K. Kanakaris
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Correspondence to Peter V. Giannoudis MB, BSc, MD, FACS, FRCS (Eng) .

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  1. School of Medicine, University of Zagreb, Zagreb, Croatia

    Slobodan Vukicevic

  2. perForm Biologics Inc, Holliston, Massachusetts, USA

    Kuber T. Sampath

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Giannoudis, P.V., Kanakaris, N.K. (2017). BMPs in Orthopaedic Medicine: Promises and Challenges. In: Vukicevic, S., Sampath, K. (eds) Bone Morphogenetic Proteins: Systems Biology Regulators. Progress in Inflammation Research. Springer, Cham. https://doi.org/10.1007/978-3-319-47507-3_8

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