Bone morphogenetic proteins: from their discoveries till their clinical applications

Since their discovery 40 years ago by Urist M., several studies have been done on the bone morphogenetic proteins (BMP). They belong to the superfamily of TGF beta (Transforming Growth Factor) and are the only osteoinductive growth factors known until now. They are nowadays up to 20. After the fixation of these molecules on their receptors, intracellular cell reactions occur, inducing bone formation by the activation of genes responsible for cartilaginous formation and osteogenesis. In experimental studies on animal species, BMP showed their efficiency on the recovery of bone defects, on the acceleration of fractures consolidation or spine arthrodesis fusion or on pseudarthrodesis treatment. To be efficient, BMP must be used at the proper dose and delivered locally for a sufficient period by a biocompatible and biodegradable matrix, whose tridimensional structure allows its invasion by new bone and vascular cells. According to these data, clinical trials have been conducted on the human. Only rhBMP-2 and rhBMP-7 uses are validated for definite clinical applications (vertebral fusion, tibial pseudarthrosis and open leg fracture) by the results of randomized multicentric studies. Other clinical applications have been reported in the literature but large-scale studies are still necessary to confirm their results. Even if the clinical results are sometimes spectacular, and if the use of BMP, currently reserved because of their cost, in difficult situations give rise to big hopes, many questions remain unsolved. These questions will probably be dealt with in the future: stability of the new bone formation, eventual long-term adverse effects.