Recombinant Human Bone Morphogenetic Protein-2: Use in Spinal Fusion Applications

H. Sandhu, Safdar N. Khan
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引用次数: 41

Abstract

It has been several decades since Marshall Urist's discovery of osteoinductive activity within demineralized bone protein extracts. Initially described in Science in 1965 1, Dr. Urist's remarkable discovery, an unexpected byproduct of intended research on the competitive binding of radionucleotides during bone mineralization, suggested that morphogenetic activity resides among certain bone-matrix-derived proteins; this work continued with Urist's later identification of the active molecules as bone morphogenetic proteins 2,3. This was followed, in 1988, by the isolation of an individual protein, BMP-2, from a purified extract and its recombinant production 4. The long-awaited clinical use and commercial availability of bone morphogenetic proteins (BMPs) have only recently approached reality. Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been tested for use in spinal fusion in several completed prospective, randomized clinical trials, beginning in 1997. After rhBMP-2 was demonstrated to be equivalent to autogenous iliac bone graft with regard to both fusion rate and clinical outcome 5, a scientific advisory panel convened by the Food and Drug Administration (FDA) advised that rhBMP-2 be approved as the first complete bone-graft substitute for spinal fusion. At this time, rhBMP-2 carried on a type-I collagen sponge is approved for use in conjunction with a tapered, threaded intervertebral fusion cage (LT-Cage; Medtronic Sofamor Danek, Minneapolis, Minnesota) for the clinical treatment of degenerative lumbar disc disease. Preclinical proof-of-concept, feasibility, and efficacy studies laid the groundwork that established certain parameters for the clinical use of rhBMP-2. Each successive spinal fusion study contributed to the evolution of the design and dose of the carrier/protein combination. The site-specific characteristics of spinal fusion led to the development of specific carrier/rhBMP-2 combinations. This paper documents the preclinical and clinical progress of the development of rhBMP-2 as a viable complete bone-graft substitute and is a tribute to the pioneering …
重组人骨形态发生蛋白-2:在脊柱融合中的应用
自从Marshall Urist发现脱矿骨蛋白提取物中的骨诱导活性以来,已经过去了几十年。Urist博士的惊人发现最初于1965年发表在《科学》杂志上,这是对骨矿化过程中放射性核苷酸竞争性结合的研究的意外副产品,表明形态发生活动存在于某些骨基质衍生的蛋白质中;这项工作随着Urist后来鉴定出骨形态发生蛋白2,3的活性分子而继续。随后,在1988年,从纯化的提取物中分离出单个蛋白质BMP-2及其重组产物4。期待已久的骨形态发生蛋白(BMPs)的临床应用和商业可用性直到最近才接近现实。重组人骨形态发生蛋白-2 (rhBMP-2)从1997年开始在几个已完成的前瞻性随机临床试验中用于脊柱融合术。在rhBMP-2被证明在融合率和临床结果方面与自体髂骨移植物相当后,由美国食品和药物管理局(FDA)召集的一个科学咨询小组建议,批准rhBMP-2作为第一个完全的脊柱融合骨移植物替代品。此时,i型胶原海绵携带的rhBMP-2被批准与锥形螺纹椎间融合器(LT-Cage;Medtronic Sofamor Danek, Minneapolis, Minnesota)用于退行性腰椎间盘疾病的临床治疗。临床前概念验证、可行性和疗效研究为rhBMP-2的临床应用奠定了一定的参数基础。每次后续的脊柱融合研究都有助于载体/蛋白质组合的设计和剂量的演变。脊柱融合的部位特异性特征导致了特异性载体/rhBMP-2组合的发展。本文记录了rhBMP-2作为一种可行的完全骨移植替代物的临床前和临床进展,是对开创性…
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