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Osteoinduktion und- reparation

Osteoinduction and bone restoration

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Zusammenfassung

Traumen, Krankheiten, Entwicklungstörungen und Tumorresektionen führen häufig zu Knochendefekten und- atrophien. Prinzipiell existieren 3 unterschiedliche Mechanismen, durch welche eine knöcherne Reparation erzielt werden kann: die Osteogenese durch die Transplantation vitaler, knochenbildender Zellen, die Osteokonduktion (bzw. der schleichende Ersatz) und die Osteoinduktion. Unter letzterem Wirkungsmechanismus versteht man die Differenzierung pluripotenter mesenchymaler Zellen im ersatzstarken Implantatlager in knorpel- und knochenbildende Vorläuferzellen unter dem Einfluß von induktiv wirksamen Bone Morphogenetic Proteins (BMPs). Einige der bisher bekannten BMPs sind natürlicherweise in geringer Konzentration als organische Bestandteile im Knochengewebe enthalten. Aus demineralisierten Knochen-implantaten können sie in das Implantatbett diffundieren und dort eine Differenzierung in vitales Knochengewebe induzieren. Mittlerweile sind 9 verschiedene BMPs isoliert, charakterisiert und gentechnisch hergestellt worden. Einige dieser BMPs besitzen induktive Eigenschaften und sind in der Lage, selbständig eine Knochenneubildung im Muskelgewebe oder in Knochendefekten herbeizuführen. Durch die zukünftig unbegrenzte Verfügbarkeit gentechnisch hergestellter BMPs ergeben sich vollständig neue therapeutische Möglichkeiten in der rekonstruktiven Knochenchirurgie.

Summary

Traumata, diseases, developmental deformities, and tumor resections frequently cause bone defects and atrophies. In general, three different mechanisms exist by which bone restoration can be achieved: (1) osteogenesis initiated by vital, osteoblastic cells of autografts; (2) osteoconduction (or creeping substitution); and (3) osteoinduction. The latter mechanism means the differentiation of pluripotent, mesenchymal-type cells (located in a recipient bed with strong regenerative capacity) into cartilage- and bone-forming progenitor cells under the influence of inductive bone morphogenetic proteins (BMPs). Some BMPs are physiologically included in low concentrations as organic components in bone tissue. They can diffuse from demineralized bone implants into the recipient bed and induce a differentiation into new bone tissue. Nine different BMPs have been isolated, characterized, and cloned. Some of these possess inductive properties and can initiate new bone formation in muscle tissue or in bone defects. In the future recombinant BMPs will be available in unlimited quantities. This will lead to completely new therapeutic concepts in reconstructive bone surgery.

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    N. R. Kübler

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Kübler, N.R. Osteoinduktion und- reparation. Mund Kiefer GesichtsChir 1, 2–25 (1997). https://doi.org/10.1007/BF03043502

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