Pulsed Electromagnetic Field (PEMF) plus BMP-2 upregulates intervertebral disc-cell matrix synthesis more than either BMP-2 alone or PEMF alone.

Study Design: An in vitro study using human intervertebral disc (IVD) cells.

Objectives: To determine if pulsed electromagnetic field (PEMF) plus bone morphogenetic protein (BMP)-2 could upregulate IVD-cell matrix synthesis more than either BMP-2 alone or PEMF alone.

Summary Of Background Data: BMP-7 and BMP-2 can both upregulate IVD-cell matrix synthesis. There are problems associated with using either BMP-2 or BMP-7. They can diffuse away rather quickly after injection into the IVD space, they cost a lot, and they have side effects such as soft-tissue inflammation and swelling. PEMF has been reported to stimulate various types of cells. PEMF is safe, inexpensive, and noninvasive, thus multiple use is possible. However, PEMF alone has a rather weak effect on disc cells. We decided to carry out an experiment whereby we combined PEMF with BMP-2. Our thoughts were that BMP-2 plus PEMF could be better than either alone.

Methods: The PEMF signal used was similar to that used in the clinical treatment of fracture nonunions or delayed fracture healing. Human disc cells were treated with BMP-2 alone or PEMF alone or PEMF plus BMP-2. Quantitative real-time PCR was performed to determine mRNA expression levels of aggrecan, collagen-2, transforming growth factor (TGF)-β, BMP-2, and BMP-7. Sulfated glycosaminoglycansynthesis was analyzed using the dimethylmethylene blue method. Western blot analysis was performed to determine the protein levels of TGF-β, BMP-2, and BMP-7.

Results: PEMF plus BMP-2 upregulates IVD-cell matrix synthesis more than BMP-2 alone or PEMF alone, and the effect seems to be synergistic. Also, PEMF plus BMP-2 induces more endogenous BMP-7 and BMP-2 mRNA levels as well as protein levels, as compared with either PEMF alone or BMP-2 alone.

Conclusions: PEMF plus BMP-2 acts in synergy to upregulate intervertebral disc-cell matrix synthesis more than either BMP-2 alone or PEMF alone.