Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review.
This systematic review examined the existing literature on BPC-157 (Body Protection Compound-157), a naturally occurring gastric pentadecapeptide, specifically through the lens of orthopedic sports medicine. Researchers searched PubMed, Cochrane, and Embase for English-language studies published from database inception through June 2024. Of 544 identified articles, 36 met inclusion criteria — 35 preclinical studies and only 1 clinical study. Preclinical findings suggested BPC-157 may enhance growth hormone receptor expression, promote angiogenesis, stimulate cell growth pathways, and reduce inflammatory cytokines, with improved functional, structural, and biomechanical outcomes reported across muscle, tendon, ligament, and bone injury models. The sole clinical study was a retrospective case series in which 7 of 12 patients reported musculoskeletal pain relief lasting more than 6 months following intraarticular injection for chronic knee pain. The compound was found to be hepatically metabolized with a half-life under 30 minutes and renally cleared. Preclinical safety data showed no adverse effects across multiple organ systems; no clinical safety data were identified. The authors note that BPC-157 lacks FDA approval and is banned in professional sports, and caution about risks from unregulated manufacturing. The review is limited almost entirely to preclinical evidence, leaving significant gaps in human safety and efficacy data.
Why this grade: The review is based on 35 preclinical studies and only a single small retrospective clinical case series (n=12), providing insufficient human evidence to draw reliable clinical conclusions.
Background: Body protection compound-157 (BPC-157) is a naturally occurring gastric peptide that promotes mucosal integrity and homeostasis. Preclinical studies show its potential for promoting healing in musculoskeletal injuries such as fractures, tendon ruptures, ligament tears, and muscle injuries. Despite lacking US Food and Drug Administration approval and its use being banned in professional sports, it is increasingly used by clinicians and athletes. Purpose: We sought to (1) provide a comprehensive synthesis of the BPC-157 literature from an orthopedic sports medicine perspective and (2) elucidate the mechanism of action, musculoskeletal effects, metabolism, and safety profile. Methods. We conducted a systematic review of English-language literature, published from database inception to June 3, 2024, from PubMed, Cochrane, and Embase. We searched PROSPERO to identify any current or unpublished reviews. Studies reporting BPC-157's mechanism, musculoskeletal outcomes, metabolism, and safety were included. Articles were screened in 3 phases by 2 reviewers. In cases of a disagreement between the 2 reviewers, blinding was removed, and eligibility was determined by group consensus, with a third author making the final decision. Results. A total of 544 articles from 1993 to 2024 were identified. After duplicates were removed, 36 studies were included (35 preclinical studies, 1 clinical study). The studies suggest that BPC-157 enhances growth hormone receptor expression and several pathways involved in cell growth and angiogenesis, while reducing inflammatory cytokines. In preclinical models, BPC-157 improved functional, structural, and biomechanical outcomes in muscle, tendon, ligament, and bony injuries. In a retrospective study of musculoskeletal pain following intraarticular injection of BPC-157 for unspecified chronic knee pain, 7 of 12 patients reported relief for >6 months. BPC-157 is metabolized in the liver, with a half-life of less than 30 minutes, and is cleared by the kidneys. Preclinical safety studies showed no adverse effects across several organ systems. No clinical safety data were found. Conclusion: This systematic review of level IV and level V studies suggests that BPC-157 shows promise for promoting recovery from musculoskeletal injuries. Adverse effects are possible due to unregulated manufacturing, contamination, or unknown clinical safety. We recommend that clinicians counsel athletes to understand their organizations' rules to remain compliant with medication/supplement safety and testing standards.
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