The Use of Growth Factors and Mesenchymal Stem Cells in Orthopaedics: In particular, their use in Fractures and Non-Unions: A Systematic Review.
OBJECTIVE
The aim was to look at current evidence for treating non-unions or delayed fracture healing in regard to novel methods applying mesenchymal stem cells (MSCs) and growth factors (GF).


METHODS
Pre-clinical and clinical trials focusing on the use of Mesenchymal Stem Cells and Growth Factors for fracture healing were included in this review. Published articles were identified using specific search terms in Medline, Cochrane Library, PubMed, Scopus and Web of Science.


RESULTS
Of the 580 articles found, 82 met my selection criteria and were included, with 39 papers involving trials on the effects of GFs and MSCs on non-unions or bone repair. These included 11 articles on MSCs, 10 on Bone Morphogenetic Proteins, 2 on Vascular-Endothelial GF, 5 on Insulin like-GF, 4 on Transforming-GF-β, 4 on Platelet-Rich Plasma, 1 on Platelet Derived-GF and 2 on Fibroblast-GF, with the other articles included qualitatively. Overall results were positive with the addition of MSCs, Bone Morphogenetic Proteins, VEGF, IGF and TGF-β in aiding fracture healing compared to controls, with mixed results for other factors.


CONCLUSIONS
Overall this review shows promising results regarding the use of MSCs and various Growth factors in the treatment of fractures and non-unions, as well as synergistic effects observed when combined together. However more research is indicated as these methods are still in the early stages of development.
The Hull York Medical School, Heslington, York, North Yorkshire YO10 5DD, United Kingdom.
Katherine L
KL
Sinclair
Whipps Cross University Hospital. Barts Health NHS Trust, Whipps Cross Rd, Leytonstone, London E11 1NR, United Kingdom.
Pouya
P
Mafi
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, United Kingdom.
Reza
R
Mafi
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge CB2 0QQ, United Kingdom.
Wasim S
WS
Khan
D000818:Animals; D001861:Bone Regeneration / Q000187:drug effects / Q000502:physiology*; D002454:Cell Differentiation / Q000187:drug effects; D017102:Fracture Healing / Q000187:drug effects / Q000502:physiology*; D050723:Fractures, Bone / Q000473:pathology / Q000628:therapy*; D048091:Guided Tissue Regeneration / Q000379:methods; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000494:pharmacology* / Q000627:therapeutic use; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000187:drug effects / Q000502:physiology*; D009985:Orthopedics / Q000379:methods*
D036341:Intercellular Signaling Peptides and Proteins
Bone morphogenetic proteins; fracture; growth factor; mesenchymal stem cells; non-union; orthopaedics; vascular
endothelial growth factor