title: Risk of prion disease transmission through bovine-derived bone substitutes: a systematic review.
abstract: BACKGROUND
  Despite the causal association between variant Creutzfeldt - Jakob disease and bovine spongiform encephalopathy (BSE), bovine origin graft materials are widely used during dental surgical procedures. The aim of this study was to assess the risk of BSE transmission through anorganic bovine bone substitutes.
  
  
  METHODS
  Electronic database of MEDLINE was searched to identify relevant studies regarding our focused questions, presence of BSE prion infectivity in raw bovine bone, BSE prion inactivation by bone substitute manufacturing process, protein contents in anorganic bovine bone substitutes, and validity of current BSE diagnostic methods. Search terms yielded 1,704 titles. After title/abstract screening and duplicates removal, 36 full-text articles were screened for inclusion.
  
  
  RESULTS
  A total of 16 studies were included in the final analysis. No eligible studies were identified regarding the efficacy of BSE prion inactivation by the treatments used for anorganic bovine bone manufacturing. BSE infectivity and PrP(Sc) , pathological prion, were detected in bovine bone marrow and serum samples. Proteins were detected in Tutoplast® (bovine), Bio-Oss®, and tibia samples treated at the similar condition for Bio-Oss deproteinization. Inconsistent results of different BSE diagnostic tests were not unusual findings (Iwata et al. 2006; Arnold et al. 2007; Murayama et al. 2010), and a study by Balkema-Buschmann and colleagues showed an apparent discrepancy between BSE infectivity and detection of PrP(27-30), the current surrogate marker for prion disease infectivity.
  
  
  CONCLUSIONS
  This review indicates that bovine-derived graft biomaterials may carry a risk of prion transmission to patients.
authors.affiliation: Resident, Advanced Education in Periodontics Program, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA professor, Clinical Dentistry and director, Advanced Education in Periodontics Program, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA associate professor, Advanced Education in Periodontics Program, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
authors.forename: Yeoungsug
authors.initials: Y
authors.lastname: Kim
authors.forename: Hessam
authors.initials: H
authors.lastname: Nowzari
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Rich
mesh_terms: D000818:Animals; D018786:Bone Substitutes; D002417:Cattle; D016643:Encephalopathy, Bovine Spongiform / Q000635:transmission*; D012307:Risk Factors
chemical_list: D018786:Bone Substitutes