Η χρήση των οστικών μορφογενετικών Πρωτεϊνών (BMPs) στην Αποκατάσταση οστικών Ελλειμμάτων. Βιβλιογραφική Ανασκόπηση
Μαγόπουλος Χ.1, Δημητρακόπουλος Ι.2
Στοματική και ΓναΘοπροσωπική Χειρουργική Κλινική. Νοσοκομείο «Γ. Παπανικολάου» - Αριστοτέλειο Παν/μιο Θεσσαλονίκης.
(Διευθ.: Καθηγητής Ν. Λαζαρίδης)
1. Στοματικός και Γναθοπροσωπικός Χειρουργός.
2. Αναπληρωτής Καθηγητής Στοματικής και Γναθοπροσωπικής
Χειρουργικής.
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 7(2): 65-75, 2006
ΠΕΡΙΛΗΨΗ
Οι οστικές μορφογενετικές πρωτεΐνες ανήκουν στην υπερ-οικογένεια του Μεταμορφωτικού Αυξητικού Παράγοντα
-β (TGF-β) και περιλαμβάνουν αυξητικούς παράγοντες και παράγοντες διαφοροποίησης. Συμμετέχουν
τόσο στις διαδικασίες εμβρυϊκής ανάπτυξης του σκελετού και άλλων οργάνων, όσο και στην κυτταρική
αύξηση και διαφοροποίηση, στην απόπτωση και μορφογένεση των κυπάρων διαφορετικών ιστών, οργάνων
και συστημάτων, αλλά και στη διαδικασία της οστικής επαναδιαμόρφωσης του σκελετού του ενήλικα
(remodeling). Η χρήση τους κυρίως στην Ορθοπαιδική και στη Νευροχειρουργική, έχει επιφέρει τελευταία σημαντικές
βελτιώσεις στα αποτελέσματα των οστικών μεταμοσχεύσεων, ιδιαίτερα στην αντιμετώπιση οστικών ελλειμμάτων
μεγάλου μεγέθους.
Σκοπός της παρούσας μελέτης είναι να περιγράψει τη δομή και τη βιολογική δράση των οστικών μορφογενετικών
πρωτεϊνών, καθώς και να αναδείξει την κλινική αξία της χρήσης τους στην περιοχή της Στοματικής
και Γναθοπροσωπικής Χειρουργικής. Περιγράφονται επίσης οι νεότερες μέθοδοι εφαρμογής τους, που αφορούν
κυρίως στη γονιδιακή θεραπεία, ενώ τέλος παραθέτονται οι τοπικές και συστηματικές επιπλοκές που
έχουν αναφερθεί από τη χρήση τους.
Λέξεις κλειδιά: οστικές μορφογενετικές πρωτεΐνες, αυξητικοί παράγοντες, οστικά μοσχεύματα, γονιδιακή θεραπεία.
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Στοματική και ΓναΘοπροσωπική Χειρουργική Κλινική. Νοσοκομείο «Γ. Παπανικολάου» - Αριστοτέλειο Παν/μιο Θεσσαλονίκης.
(Διευθ.: Καθηγητής Ν. Λαζαρίδης)
1. Στοματικός και Γναθοπροσωπικός Χειρουργός.
2. Αναπληρωτής Καθηγητής Στοματικής και Γναθοπροσωπικής
Χειρουργικής.
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής 7(2): 65-75, 2006
ΠΕΡΙΛΗΨΗ
Οι οστικές μορφογενετικές πρωτεΐνες ανήκουν στην υπερ-οικογένεια του Μεταμορφωτικού Αυξητικού Παράγοντα
-β (TGF-β) και περιλαμβάνουν αυξητικούς παράγοντες και παράγοντες διαφοροποίησης. Συμμετέχουν
τόσο στις διαδικασίες εμβρυϊκής ανάπτυξης του σκελετού και άλλων οργάνων, όσο και στην κυτταρική
αύξηση και διαφοροποίηση, στην απόπτωση και μορφογένεση των κυπάρων διαφορετικών ιστών, οργάνων
και συστημάτων, αλλά και στη διαδικασία της οστικής επαναδιαμόρφωσης του σκελετού του ενήλικα
(remodeling). Η χρήση τους κυρίως στην Ορθοπαιδική και στη Νευροχειρουργική, έχει επιφέρει τελευταία σημαντικές
βελτιώσεις στα αποτελέσματα των οστικών μεταμοσχεύσεων, ιδιαίτερα στην αντιμετώπιση οστικών ελλειμμάτων
μεγάλου μεγέθους.
Σκοπός της παρούσας μελέτης είναι να περιγράψει τη δομή και τη βιολογική δράση των οστικών μορφογενετικών
πρωτεϊνών, καθώς και να αναδείξει την κλινική αξία της χρήσης τους στην περιοχή της Στοματικής
και Γναθοπροσωπικής Χειρουργικής. Περιγράφονται επίσης οι νεότερες μέθοδοι εφαρμογής τους, που αφορούν
κυρίως στη γονιδιακή θεραπεία, ενώ τέλος παραθέτονται οι τοπικές και συστηματικές επιπλοκές που
έχουν αναφερθεί από τη χρήση τους.
Λέξεις κλειδιά: οστικές μορφογενετικές πρωτεΐνες, αυξητικοί παράγοντες, οστικά μοσχεύματα, γονιδιακή θεραπεία.
REFERENCES
Alden TD, Pittman DD, Beres EJ, Hankins GR, Kailmes DF.
Wisotsky BM, et al: Percutaneous spinal fusion using bone
morphogenetic protein-2 gene therapy. J. Neurosurg. 90:109-
114, 1999.
Alden TD, Beres EJ, Laurent JS, Ength JA, Dos S, Jane JA, et al:
The use of bone morphogenetic protein, gene therapy in
craniofacial bone repair. J Craniofac Surg. ll(l):24-30, 2000.
Balemans W, Van Hul W.: Extracellular regulation of BMP signaling
in vertebrates: a cocktail of modulators. Dev Biol. 250:231-50,
2002.
Baltzer A, Lattermann C, Whalen JD, Wooley P, Weiss K, Grimm
M, etal: Genetic enhancement of fracture repair: Healing of an
experimental segmental defect by adenoviral transfer of the
BMP-2gene. Gene Ther. 7: 734-739, 2000.
Blokhuis TJ, den BoerFC, Bramer JA, JennerJM, BakkerFC, Patka
P, Haarman HJ: Biomechanical and histological aspects of
fracture healing stimulated with osteogenetic protein-1.
Biomaterials. 22:725-30, 2001.
Bobinac D, Marie I, Zoricic S, Spanjol J, Dordevic G, Mustac E,
Fuckar Z.: Expression of bone morphogenetic proteins in
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