Claudia Siverino, Shorouk Fahmy-Garcia, Viktoria Niklaus, Nicole Kops, Laura Dolcini, Massimiliano Maraglino Misciagna, Yanto Ridwan, Eric Farrell, Gerjo J. V. M. van Osch, Joachim Nickel

• Highlights • Despite not being crucial for bone development BMP9 can induce bone growth in vivo. • BMP9 induced bone formation is strongly enhanced by introduced heparin binding sites. • BMP9s bone forming capabilities are triggered by extracellular matrix binding. • Heparin binding BMP9 (BMP9 HB) can improve the current therapies in treating bone fractures. Abstract Bone Morphogenetic proteins (BMPs) like BMP2 and BMP7 have shown great potential in the treatment of severe bone defects. In recent in vitro studies, BMP9 revealed theHighlights • Despite not being crucial for bone development BMP9 can induce bone growth in vivo. • BMP9 induced bone formation is strongly enhanced by introduced heparin binding sites. • BMP9s bone forming capabilities are triggered by extracellular matrix binding. • Heparin binding BMP9 (BMP9 HB) can improve the current therapies in treating bone fractures. Abstract Bone Morphogenetic proteins (BMPs) like BMP2 and BMP7 have shown great potential in the treatment of severe bone defects. In recent in vitro studies, BMP9 revealed the highest osteogenic potential compared to other BMPs, possibly due to its unique signaling pathways that differs from other osteogenic BMPs. However, in vivo the bone forming capacity of BMP9-adsorbed scaffolds is not superior to BMP2 or BMP7. In silico analysis of the BMP9 protein sequence revealed that BMP9, in contrast to other osteogenic BMPs such as BMP2, completely lacks so-called heparin binding motifs that enable extracellular matrix (ECM) interactions which in general might be essential for the BMPs' osteogenic function. Therefore, we genetically engineered a new BMP9 variant by adding BMP2-derived heparin binding motifs to the N-terminal segment of BMP9′s mature part. The resulting protein (BMP9 HB) showed higher heparin binding affinity than BMP2, similar osteogenic activity in vitro and comparable binding affinities to BMPR-II and ALK1 compared to BMP9. However, remarkable differences were observed when BMP9 HB was adsorbed to collagen scaffolds and implanted subcutaneously in the dorsum of rats, showing a consistent and significant increase in bone volume and density compared to BMP2 and BMP9. Even at 10-fold lower BMP9 HB doses bone tissue formation was observed. This innovative approach of significantly enhancing the osteogenic properties of BMP9 simply by addition of ECM binding motifs, could constitute a valuable replacement to the commonly used BMPs. The possibility to use lower protein doses demonstrates BMP9 HB's high translational potential.…