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BMP-9 is a circulating dimeric protein cytokine of the transforming growth factor β (TGF-β) superfamily, also known as growth differentiation factor 2, that is predominantly produced by the liver and signals through activin receptor-like kinase 1 (ALK1), endoglin, and related receptors on endothelial and other cells to activate SMAD1/5/8 pathways and downstream signaling including crosstalk with SMAD2/3 and JNK pathways.[1][2][3][6][19] It is one of the most osteogenic BMPs, potently inducing osteogenic differentiation and bone formation from mesenchymal stem cells and periodontal ligament stem cells, and has broader roles in angiogenesis, lymphatic vessel maturation and valve formation, vascular homeostasis, glucose and lipid metabolism, neurogenesis, and tumor biology.[1][2][4][5][11] Recombinant BMP-9 has shown preclinical therapeutic activity in models of bone regeneration, nonalcoholic fatty liver disease, sepsis, and pulmonary hypertension, where it improves macrophage recruitment and bacterial clearance, attenuates vascular remodeling, and modulates metabolic and inflammatory gene expression, making it a candidate host-directed biologic therapy and prognostic biomarker, although it is not yet an approved pharmaceutical product.[1][3][5][7][10][16]
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