Advances in the use of growth factors for treatment of disorders of soft tissues.
Repair and healing of injured and diseased tendons have been traditionally fraught with apprehension and difficulties, and often lead to rather unsatisfactory results. The burgeoning research field of growth factors has opened new venues for treatment of tendon disorders and injuries, and possibly for treatment of disorders of the aorta and major arteries as well. Several chapters in this volume elucidate the role of transforming growth factor β in pathogenesis of several heritable disorders affecting soft tissues, such as aorta, cardiac valves, and tendons and ligaments. Several members of the bone morphogenetic group either have been approved by the FDA for treatment of non-healing fractures or have been undergoing intensive clinical and experimental testing for use in healing of bone fractures and tendon injuries. Because FGFs are involved in embryonic development of tendons and muscles among other tissues and organs the hope is that their testing would lead to the development of some new treatment strategies providing that we can control angiogenicity of these growth factors. The problem, or rather question regarding practical use of IGF-I in tendon repair is whether IGF-I acts independently or under the guidance of growth hormone. FGF2 or PDGF alone or in combination with IGF-I stimulated regeneration of periodontal ligament, a matter of importance in Marfan patients with periodontitis. In contrast, VEGF appears to have rather deleterious effect on experimental tendon healing, perhaps because of its angiogenic activity and stimulation of matrix metalloproteinases, proteases whose increased expression has been documented in a variety of ruptured tendons. Other modalities, such as local administration of platelet-rich plasma (PRP) and/or of mesenchymal stem cells have been explored extensively in tendon healing. Though treatment with PRP and mesenchymal stem cells has met with some success in horses (who experience a lot of tendon injuries and other tendon problems), the use of PRP and mesenchymal stem cells in people has been more problematic and requires more studies before PRP and mesenchymal stem cells can become reliable tools in management of soft tissue injuries and disorders.
Department of Pathology, College of Veterinary Medicine and Medical Partnership, The University of Georgia, Athens, GA, 30602-7388, USA, jhalper@uga.edu.
Jaroslava
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Halper
D000818:Animals; D001011:Aorta / Q000187:drug effects / Q000473:pathology; D001158:Arteries / Q000187:drug effects / Q000473:pathology; D019485:Bone Morphogenetic Proteins / Q000378:metabolism / Q000627:therapeutic use; D016222:Fibroblast Growth Factor 2 / Q000378:metabolism / Q000627:therapeutic use*; D006351:Heart Valves / Q000187:drug effects / Q000473:pathology; D006736:Horses; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism / Q000627:therapeutic use*; D008022:Ligaments / Q000187:drug effects / Q000293:injuries; D045164:Mesenchymal Stem Cell Transplantation; D010982:Platelet-Derived Growth Factor / Q000378:metabolism / Q000627:therapeutic use*; D053657:Platelet-Rich Plasma / Q000502:physiology; D017695:Soft Tissue Injuries / Q000628:therapy*; D013708:Tendon Injuries / Q000628:therapy*; D013710:Tendons / Q000187:drug effects / Q000473:pathology
D019485:Bone Morphogenetic Proteins; D010982:Platelet-Derived Growth Factor; D016222:Fibroblast Growth Factor 2; D007334:Insulin-Like Growth Factor I