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Heterotopic Ossification Following Traumatic Blast Injury

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Cardiovascular Calcification and Bone Mineralization

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

The incidence of blast injuries is increasing, in both the civilian and combat settings. Heterotopic ossification (HO), the aberrant growth of bone outside of the skeleton, is a common complication as a consequence of these injuries. HO can cause chronic pain and skin ulceration and prevent prosthetic limb fitting, significantly delaying rehabilitation in these patients. Current preventions, which were developed for HO formed following hip surgery, show inconsistent efficacy and side effects that make them intolerable for patients with high-energy injuries. This leaves surgical excision as the only available treatment. The biological processes behind HO are complex, with several cell types able to differentiate down HO tissue lineages, and it is likely that several pathways exist concurrently. However, as the biological mechanisms are becoming clearer, new targets are being identified and novel drugs developed for HO prophylaxis. The goal of these advances is to provide new therapies to prevent HO and improve the quality of life for blast-injured patients.

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Abbreviations

AHO:

Albright hereditary osteodystrophy

ALK:

Activin receptor-like kinase

ALP:

Alkaline phosphatase

ATP:

Adenosine triphosphate

BMP:

Bone morphogenetic protein

BNB:

Blood-nerve barrier

cAMP:

Cyclic adenosine monophosphate

CGRP:

Calcitonin gene-related peptide

CNS:

Central nervous system

COX:

Cyclooxygenase

CT:

Computed tomography

FDA:

Food and Drug Administration

FOP:

Fibrodysplasia ossificans progressiva

HIF:

Hypoxia-inducible transcription factor

HO:

Heterotopic ossification

IED:

Improvised explosive device

IGF:

Insulin-like growth factor

IL:

Interleukin

IP:

Interferon gamma-induced protein

MCP:

Monocyte chemoattractant protein

MIP:

Macrophage inflammatory protein

MMP:

Matrix metalloprotein

MRSA:

Methicillin-resistant Staphylococcus aureus

MSC:

Mesenchymal stem cell

NSAID:

Non-steroidal anti-inflammatory drug

POH:

Progressive osseous heteroplasia

RAR:

Retinoic acid receptor

SCI:

Spinal cord injury

SP:

Substance P

TBI:

Traumatic brain injury

TGF:

Transforming growth factor

TNF:

Tumour necrosis factor

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, UK

    Thomas E. Robinson, Sophie C. Cox & Liam M. Grover

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    Elena Aikawa

  2. Department of Biomedical Engineering, Florida International University, Miami, FL, USA

    Joshua D. Hutcheson

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Robinson, T.E., Cox, S.C., Grover, L.M. (2020). Heterotopic Ossification Following Traumatic Blast Injury. In: Aikawa, E., Hutcheson, J. (eds) Cardiovascular Calcification and Bone Mineralization. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-46725-8_14

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