title: Commentary on research of bone morphogenetic protein discussed in review article: Genetic advances in the regeneration of the intervertebral disc.
abstract: BACKGROUND
  In Maerz, Herkowitz and Baker's review, Molecular and Genetic Advances in the Regeneration of the Intervertebral Disc, they also included an assessment of both in vivo and in vitro complications attributed to Bone Morphogenetic Protein ((BMP): BMP-2, BMP-7). This topic is of particular interest to spinal surgeons, as INFUSE/BMP (Medtronic, Memphis, TN, USA) is utilized, mostly off-label in the cervical, thoracic, and lumbar spine, where it has been associated with significant perioperative and postoperative complications.
  
  
  METHODS
  BMP-2 and BMP-7 are the only human recombinant growth factors approved by the Food and Drug Administration (FDA) for anterior lumbar interbody fusion (ALIF) in combination with the Lumbar Tapered Fusion Device (LT Cage: Medtronic, Memphis, TN, USA). BMP, however, is more typically utilized "off-label" in many other areas of the spine, where it has been associated with numerous complications.
  
  
  RESULTS
  Maerz, et al. documented multiple in vivo and in vitro laboratory-based animal studies dating back to the early 2000's in which BMP (INFUSE is the clinically available product: Medtronic, Memphis, TN) contributed to multiple complications, especially when utilized at higher doses. These complications included; inflammation/inflammatory processes, increased vascularity, fibroblastic proliferation, and catabolism.
  
  
  CONCLUSIONS
  Maerz, et al. reviewed the increased risks associated with utilizing high dose BMP=INFUSE in spinal surgery, particularly when utilized "off-label". The authors clearly indicate that BMP/INFUSE should be further investigated (based on the old and new findings) to better determine/confirm its safety, efficacy, and dosing.
authors: Department of Neurosurgery, The Albert Einstein College of Medicine, Bronx, New York, 10461, and Chief of Neurosurgical Spine/Education; Department of Neuroscience, Winthrop University Hospital, Mineola, NY 11501, USA.
authors: Nancy E
authors: NE
authors: Epstein
keywords: Animal laboratory studies; bone morphogenetic protein; clinical; infuse; intervertebral disc; regeneration; spinal surgery
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