Since the pioneering work of Marshall Urist, who was able to identify a family of proteins that have the property of osteoinduction, investigators in many laboratories have shown that bone morphogenetic proteins (BMPs) will elicit the differentiation of non-committed stem cells along the line leading to the formation of bone. Not only are the BMPs able to stimulate progenitor cells to differentiate and form bone, but in appropriate environments, they can produce cartilage, tendon, or ligament. Recent data suggest that certain BMPs may even lead to the partial repair of nerve and kidney. Recombinant forms of BMPs, particularly BMP2, 4, and 7, have the capability of healing critical-sized bone defects in rodents, dogs, sheep, and primates when combined with a carrier of collagen, guanidine-extracted demineralized bone matrix, hydroxyapatite, or biodegradable polymers. Clinical trials using a highly concentrated human extract of BMP have shown promise for the treatment of established non-unions and spine fusion. Johnson et al. reported in a series of publications that a combination of internal fixation and implants containing human BMP could lead to successful union in more than 90% of patients with established non-unions1. In five patients with established posterior spinal pseudarthrosis who underwent posterior spinal fusion with autogenous bone graft augmented with BMP, four went on to fusion.
Comprehensive clinical trials of recombinant BMIP2 and BMIP7 are currently underway in Europe and the United States in the areas of anterior spine …
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