Abstract
Bone reconstruction techniques are mainly based on the use of tissue grafts and artificial scaffolds. The former presents well-known limitations, such as restricted graft availability and donor site morbidity, while the latter commonly results in poor graft integration and fixation in the bone, which leads to the unbalanced distribution of loads, impaired bone formation, increased pain perception, and risk of fracture, ultimately leading to recurrent surgeries. In the past decade, research efforts have been focused on the development of innovative bone substitutes that not only provide immediate mechanical support, but also ensure appropriate graft anchoring by, for example, promoting de novo bone tissue formation. From the countless studies that aimed in this direction, only few have made the big jump from the benchtop to the bedside, whilst most have perished along the challenging path of clinical translation. Herein, we describe some clinically successful cases of bone device development, including biological glues, stem cell-seeded scaffolds, and gene-functionalized bone substitutes. We also discuss the ventures that these technologies went through, the hindrances they faced and the common grounds among them, which might have been key for their success. The ultimate objective of this perspective article is to highlight the important aspects of the clinical translation of an innovative idea in the field of bone grafting, with the aim of commercially and clinically informing new research approaches in the sector.
Highlights
Bone’s extraordinary healing capacity can be challenged by complex fractures or health conditions, resulting in nonunion fractures that can lead to long-term disability and pain (Keating et al, 2005)
Bone repair interventions are based on autografts, allografts, xenografts, and artificial scaffolds
In a recent clinical trial, a combination product based on a collagen-hydroxyapatite medical device and a plasmid DNA encoding for vascular endothelial growth factorA (VEGF-A), showed to promote bone ingrowth in maxillofacial bone defects without causing adverse effects (Bozo et al, 2016)
Summary
Bone’s extraordinary healing capacity can be challenged by complex fractures (i.e., injuries above critical size) or health conditions (i.e., diabetes, genetic factors, poor lifestyle), resulting in nonunion fractures that can lead to long-term disability and pain (Keating et al, 2005). This manuscript covers the use of glues, cements, tissue grafts, biohybrid scaffolds, bioactive matrices, and stem cell-loaded constructs in reported clinical trials or in well-settled clinical practices.
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