Clinical challenges in bone tissue engineering - A narrative review

• Published in: Bone (New York, N.Y.) N.Y.), 2024-12, Vol.192, p.117363, Article 117363
• Main Authors: Hoveidaei, Amir Human, Sadat-Shojai, Mehdi, Nabavizadeh, Sara S., Niakan, Reza, Shirinezhad, Amirhosein, MosalamiAghili, SeyedArad, Tabaie, Sean
• Format: Article
• Language: English
• Subjects: Bone tissue engineering; Gene therapy; Growth factors; Inflammation; Mesenchymal stem cells; Scaffold design
• ISSN: 8756-3282; 1873-2763; 1873-2763
• DOI: 10.1016/j.bone.2024.117363

Bone tissue engineering (BTE) has emerged as a promising approach to address large bone defects caused by trauma, infections, congenital malformations, and tumors. This review focuses on scaffold design, cell sources, growth factors, and vascularization strategies, highlighting their roles in developing effective treatments. We explore the complexities of balancing mechanical properties, porosity, and biocompatibility in scaffold materials, alongside optimizing mesenchymal stem cell delivery methods. The critical role of growth factors in bone regeneration and the need for controlled release systems are discussed. Vascularization remains a significant hurdle, with strategies such as angiogenic factors, co-culture systems, and bioprinting under investigation. Mechanical challenges, tissue responses, and inflammation management are examined, alongside gene therapy's potential for enhancing osteogenesis and angiogenesis via both viral and non-viral delivery methods. The review emphasizes the impact of patient-specific factors on bone healing outcomes and the importance of personalized approaches. Future directions are described, emphasizing the necessity of interdisciplinary cooperation to advance the field of BTE and convert laboratory results into clinically feasible solutions. •Introduction of bone tissue engineering principles and its clinical relevance.•Overview of scaffold design and its role in mimicking natural bone structure.•Examination of cellular, molecular, and vascular factors in bone regeneration.•Discussion of challenges like inflammation, integration, and mechanical forces.•Future directions in personalized approaches and advanced manufacturing methods.