Exclusion criteria included manuscripts in languages other than English and those with incomplete documentation. All studies that did not fulfil all eligibility criteria were excluded from further analysis. Studies selected were original articles publishing results on the effect of different peptides on osteoblasts and osteoprogenitor cells as well as in vivo studies on bone healing. Publications from January 1980 to date were included. This review was conducted in accordance to the PRISMA guidelines. The aim of this study is to identify the currently existing osteogenic peptides, other than those derived from BMPs and to investigate their impact in the upregulation of bone healing and bone regeneration. Although BMP-derived peptides are the most studied, other peptides also exist. To date, a number of peptides have been engineered to upregulate the osteogenic response. In general, they exert their effect through binding to specific high-affinity receptors on the respective target cell receptors. Proteins usually refer to denote an entire biological molecule in a stable conformation, while peptides refer to short amino acid oligomers most commonly lacking a stable 3-dimensional structure. The terms protein, polypeptide, oligopeptide and peptide are rather ambiguous and overlapping in their meaning. Recombinant DNA technologies have simplified the production of these molecules and the discovery of a variety of osteogenic peptides has emerged. However, the high cost derived from the purification techniques and the high doses required due to the instability of these molecules in vivo are the two most significant points of concern. Several other proteins have shown to upregulate the osteogenic bone healing process. Bone morphogenetic proteins (BMPs) are the most representative example, which have been granted US Food and Drug Administration (FDA) approval for clinical applications in recalcitrant long bone non-unions, lumbar fusion and open tibial shaft fractures. The intense research in this field seen over the last few decades, has resulted in the discovery of several proteins that can upregulate the bone healing response. It is estimated that 1.5 million bone grafting procedures are performed annually in the USA and this figure is rapidly increasing due to population ageing. In established non-unions and bone defects, bone grafting is a common procedure. Fracture non-union often results in devastating outcomes for the patient and the surgeon, requiring a complex, long-lasting and expensive treatment, and a variable degree of morbidity is often a common finding. Approximately 5 % to 10 % of the fractures occurring are associated with impaired healing, including delayed union or non-union. Unfortunately, this process is not always successful. With further advances in the field of biomimetic materials and scaffolds, new treatment modalities for bone repair will emerge.Īfter a traumatic insult to the bone, the musculoskeletal system mounts both local and systemic reactions facilitating the prompt restoration of the continuity of bone and normal function. ![]() Conclusionįurther research is desirable to shed more light into the processes governing the osteoprogenitor cellular responses. However, from the available peptides that reached the level of clinical trials, the presented results are limited. Several peptides were found to upregulate the bone healing response in experimental models and could act as potential candidates for future clinical applications. Resultsīased on the available literature, a significant amount of experimental in vitro and in vivo evidence exists. Articles presenting peptides capable of exerting an upregulatory effect on osteoprogenitor cells and bone healing were included in the study. MethodsĪ systematic review according to PRISMA guidelines was conducted. The aim of this comprehensive review is to present the clinical and experimental studies analysing the potential role of peptides for bone healing and bone regeneration. ![]() Several peptides have been shown to support and stimulate the bone healing response and have been proposed as therapeutic vehicles for clinical use. Bone tissue engineering and the research surrounding peptides has expanded significantly over the last few decades.
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