title: Treatment of nonunions with nonglycosylated recombinant human bone morphogenetic protein-2 delivered from a fibrin matrix.
abstract: OBJECTIVE
  To report the results of the treatment of nonunions with nonglycosylated recombinant human bone morphogenetic protein-2 (nglBMP-2) delivered from a designed fibrin matrix.
  
  
  METHODS
  Experimental trial in rodents and prospective clinical study in dogs and cats with nonunion fractures.
  
  
  METHODS
  Twenty adult female, albino, Sprague-Dawley rats; 8 client-owned cats and dogs.
  
  
  METHODS
  After development of a fibrin matrix and evaluation of nglBMP-2 in a rodent femoral defect model, 8 consecutive long bone nonunion fractures (no progression in healing in > or = 3 months), were treated using 300 microg nglBMP-2 in a liquid fibrin precursor, injected into the defect gap after fracture revision and stabilization, or through a stab incision into the fracture site. The fibrin matrix was designed to clot in the wound after 60 seconds and to release the nglBMP-2 continuously over several days.
  
  
  RESULTS
  Using only fibrin gel, 7% of the rat femoral defect was filled with new formed bone compared with 79% defect filling using 2 microg nglBMP-2 (P=.006). Five and 10 microg nglBMP in fibrin resulted in union of all femoral defects with complete filling of the gap with new bone. Bony bridging and clinical healing was achieved in 7 patients within 24 weeks of administration of nglBMP-2.
  
  
  CONCLUSIONS
  Application of nglBMP-2 in a functional matrix can induce bone healing. Controlled release of nglBMP-2 from a fibrin matrix mimics the natural fracture hematoma.
  
  
  CONCLUSIONS
  nglBMP-2/fibrin can successfully replace a cancellous bone autograft in fracture treatment with an associated reduction in graft donor site morbidity and surgical time.
authors.affiliation: Department of Clinical Veterinary Medicine, University of Berne, Switzerland. hugo.schmoekel@kkh.unibe.ch
authors.forename: Hugo G
authors.initials: HG
authors.lastname: Schmökel
authors.forename: Franz E
authors.initials: FE
authors.lastname: Weber
authors.forename: Gabriela
authors.initials: G
authors.lastname: Seiler
authors.forename: Brigitte
authors.initials: B
authors.lastname: von Rechenberg
authors.forename: Jason C
authors.initials: JC
authors.lastname: Schense
authors.forename: Peter
authors.initials: P
authors.lastname: Schawalder
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hubbell
mesh_terms: D000818:Animals; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage*; D018786:Bone Substitutes; D002415:Cats / Q000293:injuries*; D004285:Dogs / Q000293:injuries*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000628:therapy / Q000662:veterinary; D005337:Fibrin; D005592:Fracture Fixation / Q000379:methods / Q000662:veterinary*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy / Q000662:veterinary*; D008297:Male; D008663:Metacarpus / Q000293:injuries; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000628:therapy / Q000662:veterinary; D051381:Rats; D017207:Rats, Sprague-Dawley; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000628:therapy / Q000662:veterinary; D016212:Transforming Growth Factor beta; D016896:Treatment Outcome
chemical_list: C525718:BMP2 protein, human; C525720:Bmp2 protein, rat; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D016212:Transforming Growth Factor beta; D005337:Fibrin