Scavenger receptor AI/II truncation, lung function and COPD: a large population-based study

OBJECTIVES

The scavenger receptor A-I/II (SRA-I/II) on alveolar macrophages is involved in recognition and clearance of modified lipids and inhaled particulates. A rare variant of the SRA-I/II gene, Arg293X, truncates the distal collagen-like domain, which is essential for ligand recognition. We tested whether the Arg293X variant is associated with reduced lung function and risk of chronic obstructive pulmonary disease (COPD) in the general population.

METHODS

We genotyped 48,741 individuals from the adult Danish general population for Arg293X, and recorded lung function and spirometry-defined COPD.

RESULTS

Arg293X homozygotes (n = 5) and heterozygotes (n = 587), compared with noncarriers (n = 48,149), had a 6% and 1% reduction in predicted percentage of forced vital capacity (FVC % predicted) (P = 0.05) and a nonsignificant 7% and 1% reduction in predicted percentage of forced expiratory volume in one second (FEV(1) % predicted) (P = 0.06), respectively. The Arg293X genotype interacted with gender (P = 0.004) and α(1) -antitrypsin MZ heterozygosity (P = 0.049), but not with superoxide dismutase-3 E1I1 heterozygosity (P = 0.11) in determining FEV(1) % predicted. Amongst men, FEV(1) % predicted and FVC % predicted were both reduced by 4% (P = 0.0004 and P = 0.0003, respectively) in Arg293X heterozygotes compared with noncarriers. Corresponding values were 14% (P = 0.03) and 11% (P = 0.04) amongst MZ heterozygotes, and 9% (P = 0.03) and 8% (P = 0.04) amongst E1I1 heterozygotes, compared with noncarriers. Lung function did not differ between Arg293X heterozygotes and noncarriers amongst females or individuals without MZ and E1I1. Arg293X heterozygosity was associated with spirometry-defined COPD amongst men [odds ratio (95% confidence interval): 1.7 (1.1-2.4)], but not with COPD in the whole cohort or in any other subgroup.

CONCLUSIONS

SRAI/II Arg293X heterozygotes have reduced lung function and increased COPD risk amongst men. They also have reduced lung function amongst individuals heterozygous for the α(1)-antitrypsin MZ and superoxide dismutase-3 E1I1 genotypes.

[Revision hip stems: an analysis of the fixation]

BACKGROUND

Revision hip replacements are complicated surgeries because the femoral quality is often reduced by large substance losses. Stem fixation in terms of sufficient primary stability is therefore a great challenge for the orthopaedic surgeon.

AIM

The aim of the present study was to examine two currently used prostheses in Germany (MHP and MRP) concerning their ability to securely bridge femoral defects.

RESULTS

Up to a segmental metaphyseal defect, both stems showed sufficient fixation in our experimental setup. However, because of its predominantly distal fixation, the MRP stem would unnecessarily bridge proximal bone areas still capable of load bearing. In the presence of a transfemoral approach, the surgeon should favour the distal fixation mode because in this situation the proximal fixation option is absent. Therefore, the isthmus takes a key role for both stem designs.

HLA class I antibodies provoke graft arteriosclerosis in human arteries transplanted into SCID/beige mice

Antibodies toward HLA class I and/or MICA are commonly observed in transplanted patients suffering from allograft arteriosclerosis, also called chronic vascular rejection (CVR). The relative importance of cellular versus humoral alloreactivity for CVR is still disputed. We demonstrate that antibodies toward HLA class I provoke lesions typical for CVR in human arteries in vivo in the absence of cellular immunity. To show this, we grafted segments of human mesenteric arteries from 8 deceased organ donors into 36 immunodeficient SCID/beige mice in the infrarenal aortic position. Three mice died postoperatively. The remaining 33 mice received weekly i.v. injections of either a monoclonal antibody toward HLA class I, toward MICA or an irrelevant monoclonal antibody. At sacrifice after 6 weeks, mice receiving the HLA antibody showed a significant neointimal thickening in the grafted artery due to smooth muscle cell (SMC) proliferation while control mice receiving anti-MICA or irrelevant antibody showed little or no thickening. Whereas antibodies toward HLA class I were mitogenic to SMC in vitro, those directed toward MICA did not have any effect. Humoral alloreactivity toward HLA may thus play a causal role for the development of CVR and this opens new possibilities for the treatment of CVR.

[Metal sensitivity in patients with joint replacement arthroplasties before and after surgery]

The object of the present study was to determine the incidence of metal sensitivity in patients with joint replacement arthroplasties before and after surgery and whether this is of significance as regards the final outcome of the operative procedure. A questionnaire-based survey involved 1,335 patients with an average age of 61 years and joint replacement arthroplasties before and after surgery. A history of dermal sensitivity to metal was given in 99 (7%) patients with almost equal frequency in the pre- and postoperative groups (7.6 vs 7.2%). In only 27 of 99 cases was the metal sensitivity recorded in the patient chart. In 46 cases investigation was done after knee or hip replacement arthroplasty with an average implant time in situ of 68 months. In 32 of 46 patients a sensitivity to the implanted material was known and they did not show any complications related to the metal sensitivity.It is currently unclear whether metal sensitivity could be induced by joint replacement arthroplasties and it remains uncertain whether loosening or infection causes the sensitization as a consequence of increased release of metal ions or vice versa. To draw further conclusions considerably more detailed studies involving more patients are clearly indicated.

Correlation between HLA-D/DR associated primed lymphocyte typing (PLT) defined DP-antigens, HLA-D and HLA-DR antigens

A panel of 79 individuals were typed for HLA-D/DR associated Primed Lymphocyte Typing (PLT) defined "DP"-antigens, HLA-D and HLA-DR antigens. Typing for DP-antigens was carried out with local PLT-cells. HLA-D and -DR typing was performed with all homozygous typing cells and all DR-antisera included in the 8th International Histocompatibility Workshop. Assignments of DP-, HLA-D- and HLA-DR-antigens were done independently and the correlations between DP/D/DR1-8 were analyzed. The panel included random unrelated individuals, and individuals previously found to have one or no identifiable HLA-D antigen (B). In the random group, 80% of the individuals were assigned to possess the same antigen with the 3 techniques, while this was only the case in 46% of B-group individuals. The overall correlation coefficients, r, for the antigens HLA-Dw/-DR/DP1-8 were 0.95 (DP/D), 0.94 (DP/DR), and 0.89 (D/DR). There is a remarkably strong correlation between HLA-D and -DR typing results concerning D/DR1-8, in particular in random individuals. It is possible to select PLT-cells that give typing results which are almost identical to those of HLA-D and -DR typing. When discrepant results were seen, HLA-DR was in general "broader" than DP which in turn was broader than HLA-D, indicating that it may be possible to split HLA-DR/DP1-8 into more "narrow" specificities.

HLA-A, B, C, D, DR antigens and primed lymphocyte typing (PLT) defined DP-antigens in juvenile chronic arthritis

A total of 48 patients with juvenile chronic arthritis (JCA) were typed for HLA-A, -B, -C, -D and -DR antigens and 36 patients were also typed for HLA-D/DR associated "DR"-antigens with the primed lymphocyte typing technique. In the total group of patients, we found increased frequencies of HLA-B27, HLA-Dw/DP5 and HLA-Dw/DP8, and decreased frequencies of HLA-Dw/-DR/DP2. The increased frequencies of HLA-Dw/DP8 and the decreased frequencies of HLA-Dw/-DR/DP2 were primarily found among patients with persistent pauciarticular arthritis. The frequencies of HLA-Dw/-DR/DP4 were increased in patients with polyarticular arthritis. The frequencies of HLA-B27 and -Dw/DP5 were increased in both pauciarticular and polyarticular arthritis. The results indicate (i) that genetic factors controlled by HLA confer susceptibility and/or resistance to JCA, and (ii) that the clinical subdivision of JCA into pauciarticular and polyarticular JCA can be supported by the presence of different genetic markers (HLA-antigens) in the two groups of JCA-patients. If these data can be confirmed HLA-D, -DR or DP typing may be of value in the prognostic evaluation of patients with pauciarticular onset JCA.

Design Modifications and Optimization of a Commercially Available Knee Simulator

To determine the wear behavior of knee endoprostheses, implants are tested in knee simulators before being introduced to the market. Implants may undergo mechanical failure and wear debris is generated. The magnitude and morphology of this debris are determined to gain information about its biological reactivity. In this study, we describe the modifications made to the AMTI multistation knee simulator. The simulator is not capable to ensure a medially biased load distribution as required per ISO 14243, and therefore the usage of the simulator is limited. Thus, simulator modifications were made to implement a wear test as outlined in ISO 14243, and to improve both user-friendliness of operation and cost of simulation. In particular, this involved modifying the implant holders and controlling implant kinematics during the simulation. For component design, a 3D computer-aided design software was used. After the manufacturing of all components had been completed, the redesigned system was put into operation. In a final wear test, functionality and conformance with the ISO standard were tested for the modified simulator. After implementation of design modifications, it is possible to run wear tests with a medially biased load distribution according to ISO 14243.

Nomenclature for HLA microsatellites

A proposal for a standardized nomenclature for human leukocyte antigen (HLA) microsatellites is presented. It provides recommendations for Microsatellites as regards to locus name, primer names, and denominations for alleles.

Compliance with continuous passive movement is low after surgical treatment of idiopathic club foot in infants

Treatment by continuous passive movement at home is an alternative to immobilisation in a cast after surgery for club foot. Compliance with the recommended treatment, of at least four hours daily, is unknown. The duration of treatment was measured in 24 of 27 consecutive children with a mean age of 24 months (5 to 75) following posteromedial release for idiopathic club foot. Only 21% (5) of the children used the continuous passive movement machine as recommended. The mean duration of treatment at home each day was 126 minutes (11 to 496). The mean range of movement for plantar flexion improved from 15.2° (10.0° to 20.6°) to 18.7° (10.0° to 33.0°) and for dorsiflexion from 12.3° (7.4° to 19.4°) to 18.9° (10.0° to 24.1°) (both, p = 0.0001) when the first third of therapy was compared with the last third.

A low level of patient compliance must be considered when the outcome after treatment at home is interpreted.

[Allergy towards bone cement]

Bone cements based on polymethylmethacrylate are typically used for fixation of artificial joints. Intolerance reactions to endoprostheses not explained by infection or mechanical failure may lead to allergological diagnostics, which mostly focuses on metal allergy. However, also bone cement components may provoke hypersensitivity reactions leading to eczema, implant loosening, or fistula formation. Elicitors of such reactions encompass acrylates and additives such as benzoyl peroxide, N,N-dimethyl-p-toluidine, hydroquinone, or antibiotics (particularly gentamicin). Upon repeated contact with bone cement components, e.g., acrylate monomers, also in medical personnel occasionally hand eczema or even asthma may develop. Therefore, in the case of suspected hypersensitivity reactions to arthroplasty, the allergological diagnostics should include bone cement components.