Clinical applications of BMP-7/OP-1 in fractures, nonunions and spinal fusion.
Since the identification of the osteogenic protein-1 (OP-1) gene, also called bone morphogenetic protein-7 (BMP-7), almost 20 years ago, OP-1 has become one of the most characteristic members of the BMP family. The biological activity of recombinant human OP-1 has been defined using a variety of animal models. These studies have demonstrated that local implantation of OP-1 in combination with a collagen matrix results in the repair of critical size defects in long bones and in craniofacial bones and the formation of bony fusion masses in spinal fusions. Clinical trials investigating long bone applications have provided supportive evidence for the use of OP-1 in the treatment of open tibial fractures, distal tibial fractures, tibial nonunions, scaphoid nonunions and atrophic long bone nonunions. Clinical studies investigating spinal fusion applications have provided supportive evidence for the use of OP-1 in posterolateral lumbar models and compromised patients as an adjunct or as a replacement for autograft. Both long bone repair and spinal fusion studies have demonstrated the efficacy and safety of OP-1 by clinical outcomes and radiographic measures. Future clinical investigations will be needed to better define variables, such as dose, scaffold and route of administration. Clearly the use of BMPs in orthopaedics is still in its formative stage, but the data suggest an exciting and promising future for the development of new therapeutic applications.
White
Andrew P
AP
Carl J. Shapiro Department of Orthopaedics, Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Stoneman 10, 330 Brookline Ave, Boston, MA, 02215, USA, apw.spine@gmail.com
Vaccaro
Alexander R
AR
Hall
Jeremy A
JA
Whang
Peter G
PG
Friel
Brian C
BC
McKee
Michael D
MD
D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods; D050723:Fractures, Bone / Q000188:drug therapy*; D005599:Fractures, Ununited / Q000188:drug therapy*; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods; D013123:Spinal Fusion / Q000379:methods; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*
C525819:BMP7 protein, human; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins; D016212:Transforming Growth Factor beta