Update on Biologics in Orthopedic Sportsmedicine对骨科运动医学生物制品的更新.pptVIP

Update on Biologics in Orthopedic SportsmedicineCells and Growth Factors William F Bennett MD Injured Tissue-The Basics of HealingRequires Cells and Growth Factors Tissue repair relies on vascularity and cellular migration Blood escapes, hematoma Platelets, pluripotential stem cells form scaffold for neocellular proliferation Cells respond to Growth Factors(Bioactive agents) Some cells respond different to growth factors based upon tissue Growth Factors/Bioactive Agents At the time of injury released, Gfs bind to receptors and effect cellular function. Part of inflammatory response. Proteins Anabolic/catabolic Cytokines-extracellular proteins Effect cell to cell mediation Examples- Interferon/interleukin/tumor necrosis factor Growth Factors Transforming Growth factor-beta(TGFB)-Largest group Over 100 members Anabolic effect on all components of Musculoskeletal tissue Common Types of TGF-Beta Bone Morphogenic proteins-BMP’s Osteoprogenitor derived cells-promote bone growth Platelet Derived Growth Factor-PDGF From platelets and stimulates angiogenesis, chemotactic influence and mitogenic Insulinlike Growth Factor-IGF-1 From variable cells, broad anabolic effect Fibroblast Growth factor-bFGF Early differentiation of cells and tissue and in repair process Common Types of TGF-Betacont’d Epidermal Derived Growth Factor-EGF Proliferates ectoderm and mesoderm Growth and differentiation Factor-GDF-5 Chondrocyte, fibroblast and mesenchymal cell expansion Bone Healing Two clinically available BMP’s-stimulates bone growth rhBMP2-Recombinant BMP- (Infuse, Medtronic Sofamor Danek, Minneapolis, Mn.) BMP 7-(osteogenic protein-1- OP1) Stryker, Biotech, Hopkinton, Ma, LMP1-Lyophilized Mineral protein Stimulates BMP PDGF and Platelet Rich Plasma may interfere with bone healing BMPs help reduce non-union rate, spinal fusion rate and possibly open wedge osteotomy non-healing Bone To Tendon Healing BMP2 and OP1 have been shown to aid in the tendon to bone healing Although the ex