Current and future clinical applications of bone morphogenetic proteins in orthopaedic trauma surgery

Forty years after the discovery by Marshal R. Urist of a substance in bone matrix that has inductive properties for the development of bone and cartilage, there are now 15 individual human bone morphogenetic proteins (BMPs) that possess varying degrees of inductive activities. Two of these, BMP-2 and BMP-7, have become the subject of extensive research aimed at developing therapeutic strategies for the restoration and treatment of skeletal conditions. This has led to three different therapeutic preparations, each for a distinct clinical application. Non-union, open tibial fractures and spinal fusions are the three conditions for which there is clinical approval for use of BMPs. This article reviews the evidence supporting the therapeutic applications of BMPs as they are presently available and suggests future applications based on current research. Among the future directions discussed are percutaneous injections, protein carriers, advances in gene transfer technology and the use of BMPs to engineer the regeneration of skeletal parts.