Extracellular Matrix and Amniotic Derivatives in Bone and Nerve Repair: A Narrative Review of Mechanisms and Their Preclinical and Clinical Applications.

Extracellular matrix (ECM) and amniotic derivatives have emerged as promising biomaterials in regenerative medicine, particularly for bone and nerve repair. These biologic scaffolds provide structural and biochemical cues that support cellular migration, proliferation, and differentiation, thereby facilitating tissue regeneration. ECM-based therapies leverage native bioactive components to modulate immune responses and enhance healing, while perinatal derivatives, including amniotic membrane, umbilical cord, and placental tissue, offer a rich source of growth factors, cytokines, and stem cells that promote neurogenesis and osteogenesis. This literature review explores the mechanistic underpinnings of ECM and perinatal derivatives in bone and nerve repair, detailing their role in cellular signaling, inflammation modulation, and extracellular microenvironment remodeling. Furthermore, we discuss current preclinical and clinical applications, evaluating their efficacy in enhancing functional recovery in orthopedic and neurosurgical contexts. While these therapies hold immense potential, challenges like standardization, immunogenicity, and clinical translation remain key areas for future research. By integrating ECM and perinatal-based approaches, regenerative medicine can advance toward more effective, biologically driven solutions for complex bone and nerve injuries.