Preclinical and clinical studies on the use of growth factors for bone repair: a systematic review.

BACKGROUND: Bone healing is a complex process. Whilst the majority of fractures heal with conventional treatment, open fractures, large bone defects and non unions still provide great challenges to Orthopaedic Surgeons. Whilst autologous bone graft is seen as the gold standard, the use of growth factors is a growing area of research to find an effective alternative with lower side effects such as donor site morbidity and the finite amount available. OBJECTIVES: This systematic review aims to summarize the pre clinical in-vivo studies and examine the clinical studies on the use of growth factors in bone healing. DATA SOURCES: Databases: PubMed, Medline, OVID, and Cochrane library. The following key words and search terms were used: Growth Factors, Bone Healing, Bone Morphogenic Protein, Transforming Growth Factor Beta, Insulin Like Growth Factor, Platelet Derived Growth Factor, Fracture. METHODS: All articles were screened based on title with abstracts and full text articles reviewed as appropriate. Reference lists were reviewed from relevant articles to ensure comprehensive and systematic review. RESULTS: Three tables of studies were constructed focussing on Bone Morphogenic Proteins, Platelet Rich Plasma and Growth Factors and Tissue Engineering. CONCLUSIONS: Bone Morphogenic Proteins and Platelet Rich Plasma, which contains multiple growth factors, have been shown in preclinical and clinical trials to be an effective alternative to autologous bone graft. Bone Morphogenic Proteins have been shown to be effective in fracture non union, and in open tibial fractures. Platelet Rich Plasma has shown promise in preclinical trials and some small clinical trials, however numbers are limited. Bone Morphogenic Proteins have been shown to be superior to Platelet Rich Protein in one trial. Combining these growth factors with tissue engineering techniques is the focus of ongoing research, and through further clinical trials the most effective techniques for enhancing bone healing will be revealed.

A systematic review on preclinical and clinical studies on the use of scaffolds for bone repair in skeletal defects.

BACKGROUND: The management and treatment of bone defects caused by trauma, non-union, tumors and disease poses a major clinical problem. Limitations with autograft and allograft have led to research into tissue engineering of bone graft using scaffolds and mesenchymal stem cells. OBJECTIVES: This systematic review aims to examine and summarize the pre clinical in-vivo studies and the limited clinical studies on the use of scaffolds in the treatment of critical size bony defects. DATA SOURCES: Databases: PubMed, Medline, OVID, Scopus and Cochrane library. The following key words and search terms were used: scaffolds, bone repair, bone regeneration, mesenchymal stem cells, and tissue engineering and musculo skeletal. METHODS: A total of 503 articles were reviewed. 23 articles were identified as relevant for the purpose of this systematic literature review. RESULTS: Three tables of studies were constructed: pre clinical biological scaffolds, pre clinical synthetic scaffolds and clinical scaffolds. CONCLUSIONS: There is a lot of pre clinical evidence that the use of scaffold combined with mesenchymal stem cells enhances osteogenesis when treating bone defects. There is limited clinical evidence at this early stage that scaffolds can be used safely and effectively in tissue engineered grafts to repair bone defects with no RCTs as yet having been conducted.The limited clinical series reported have however produced promising results.