Structural bone allografts are used to reconstruct large skeletal defects after tumor surgery. Although allograft-related
complications are declining, the use of perioperative radiation therapy is associated with a poorer outcome. Recently, BMP-2
levels in the host bed were reportedly diminished after exposure to radiation doses consistent with those used perioperatively
to treat musculoskeletal sarcoma. Reintroduction of this osteogenic protein may circumvent the deleterious effects of preoperative
radiation on allograft incorporation. We introduced a novel polymeric BMP-2 gene delivery system into the host-allograft junctions
at the time of transplantation in an ovine tibial defect model with or without preoperative exposure to 50 Gy radiation. After
4 months, we noted no radiographic or histologic improvements in allograft incorporation after preoperative radiation and
BMP-2 reintroduction; however, 50 Gy radiation was associated with increased porosity in the interface regions and poorer
radiographic healing. We identified no BMP2-expressing cells or protein in the interface at the study end point, suggesting
the polymeric gene delivery system was unable to promote extended expression of the protein or induce a healing response.
Although gene therapy may hold promise as a novel technique to improve allograft incorporation, our data do not support that
contention with the current approach.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. This
work was made possible through financial assistance provided by the Musculoskeletal Transplant Foundation.
Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations
were conducted in conformity with ethical principles of research.