Bone repair: new developments in growth factor delivery systems and their mathematical modeling.

More and more of our aging populations will suffer from large bone defects in the next few years. But the growth factor (GF) delivery systems (DSs) currently under investigation will help overcome the limitations of the bone grafts presently used. Some GFDSs accredited by the Food and Drug Administration (FDA) are commercially available, but they have mechanical, structural and GF retention weaknesses. New studies focus on polymers and the composition of GFs in order to mimic as closely as possible the physiological environment of healing bone. This review first summarizes the process of endochondral bone healing and the major cytokines involved. We then review the latest GFDSs, with their combinations of organic, inorganic, natural and synthetic biomaterials, the kinetics of GF release and their biological effects. We will explore new research avenues such as the use of peptides derived from bone morphogenetic proteins, including our own results, and the sequential release of bone-inducing GFs. We then review the latest mathematical models of drug delivery systems (DDSs) for several transport phenomena that may be encountered when using GFDS. The final section discusses new improvements for GFDS modeling.