1
|
Gibon E, Takakubo Y, Zwingenberger S, Gallo J, Takagi M, Goodman SB. Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials. J Biomed Mater Res A 2024; 112:1172-1187. [PMID: 37656958 DOI: 10.1002/jbm.a.37599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long-term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co-workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.
Collapse
Affiliation(s)
- Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuya Takakubo
- Department of Rehabilitation, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Stefan Zwingenberger
- University Center for Orthopaedics, Traumatology, and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc Teaching Hospital, Olomouc, Czech Republic
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Stuart B Goodman
- Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Stanford University Medical Center Outpatient Center, California, USA
| |
Collapse
|
2
|
Torosyan Y, Spece H, Goodacre N, Azarbaijani Y, Marinac-Dabic D, Kurtz SM. In silico approaches for enhancing retrieval analysis as a source for discovery of implant reactivity-related mechanisms and biomarkers. J Biomed Mater Res B Appl Biomater 2019; 108:263-271. [PMID: 31012261 DOI: 10.1002/jbm.b.34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
The ability to characterize implant debris in conjunction with corresponding immune and tissue-destructive responses renders retrieval analysis as an important tool for evaluating orthopedic devices. We applied advanced analytics and in silico approaches to illustrate the retrieval-based potential to elucidate host responses and enable discovery of corresponding biomarkers indicative of in vivo implant performance. Hip retrieval analysis was performed using variables based on immunostaining, polarized microscopy, and fretting-corrosion and oxidation analyses. Statistical analyses were performed in R. Hierarchical/k-means clustering and principal component analysis were used for data analysis and visualization. Correlation Engine (CE) and Ingenuity Pathway Analysis (IPA) were employed for in silico corroboration of putative biomarkers. Higher giant cell and histiocyte scores and positivity for CD68 and CD3 indicating infiltration with macrophages and T-cells, respectively, were detected mainly among older generation hips with higher ultra-high-molecular-weight-polyethylene loads. Our in silico analysis using pre-existing data on wear particle-induced loosening substantiated the role of CD68 in implant-induced innate responses and identified the CD68-related molecular signature that can be indicative of development of aseptic loosening and can be further corroborated for diagnostic/prognostic testing in clinical setting. Thus, this study confirmed the great potential of advanced analytics and in silico approaches for enhancing retrieval analysis applications to discovery of new biomarkers for optimizing implant-related preclinical testing and clinical management. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:263-271, 2020.
Collapse
Affiliation(s)
- Yelizaveta Torosyan
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Hannah Spece
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland.,Drexel University, Philadelphia, Pennsylvania
| | - Norman Goodacre
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Yasameen Azarbaijani
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, Office of Clinical Evidence and Analysis, Food and Drug Administration, Silver Spring, Maryland
| | - Steven M Kurtz
- Drexel University, Philadelphia, Pennsylvania.,Exponent, Inc., Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Rong JJ, Liang M, Xuan FQ, Sun JY, Zhao LJ, Zheng HZ, Tian XX, Liu D, Zhang QY, Peng CF, Li F, Wang XZ, Han YL, Yu WT. Thrombin-loaded alginate-calcium microspheres: A novel hemostatic embolic material for transcatheter arterial embolization. Int J Biol Macromol 2017; 104:1302-1312. [DOI: 10.1016/j.ijbiomac.2017.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 11/27/2022]
|
4
|
Vaculova J, Gallo J, Hurnik P, Motyka O, Goodman SB, Dvorackova J. Low intrapatient variability of histomorphological findings in periprosthetic tissues from revised metal/ceramic on polyethylene joint arthroplasties. J Biomed Mater Res B Appl Biomater 2017; 106:2008-2018. [PMID: 29044940 DOI: 10.1002/jbm.b.33990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 11/05/2022]
Abstract
The type of tissue response to implant by-products can be determined by examination of periprosthetic tissues. However, little is known about the most suitable location for tissue sampling. The main goal of this study was to evaluate the extent of variability in tissue response in relation to location of tissue sampling, implant fixation, age and sex in total joint arthroplasties with metal-on-polyethylene or ceramic-on-polyethylene bearing pairs. We processed 236 histology slides from 21 patients and focused on the association between the location of tissue samples and histological features. The presence of the synovial hyperplasia showed a significant association with the particular sampling site. A higher density of high endothelial cell venules was seen in the samples from around the joint, and polyethylene particles were more abundant in noncemented TJA but both findings did not show statistically significant association with the sampling site. The results showed a relatively small variance in the tissue response to prosthetic by-products among tissues sampled from the same patient. Our findings indicate that tissue samples retrieved from similar distance from around the TJA during the revision operation show comparable results of histological analysis. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2008-2018, 2018.
Collapse
Affiliation(s)
- Jana Vaculova
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Faculty Hospital Olomouc, Olomouc, 775 20, Czech Republic.,Department of Pathology, University Hospital Ostrava, Ostrava-Poruba, 708 52, Czech Republic
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Faculty Hospital Olomouc, Olomouc, 775 20, Czech Republic
| | - Pavel Hurnik
- Department of Pathology, University Hospital Ostrava, Ostrava-Poruba, 708 52, Czech Republic.,CBG Laboratory a. s., Ostrava 3, 703 00, Czech Republic
| | - Oldrich Motyka
- Nanotechnology Centre, VŠB - Technical University of Ostrava, Ostrava-Poruba, 708 33, Czech Republic
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Medical Center Outpatient Clinic, Redwood City, CA, 94063
| | - Jana Dvorackova
- Department of Pathology, University Hospital Ostrava, Ostrava-Poruba, 708 52, Czech Republic.,CBG Laboratory a. s., Ostrava 3, 703 00, Czech Republic
| |
Collapse
|
5
|
Nandi A, Bishayi B. CCR-2 neutralization augments murine fresh BMC activation by Staphylococcus aureus via two distinct mechanisms: at the level of ROS production and cytokine response. Innate Immun 2017; 23:345-372. [PMID: 28409543 DOI: 10.1177/1753425917697806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CCR-2 signaling regulates recruitment of monocytes from the bone marrow into the bloodstream and then to sites of infection. We sought to determine whether CCL-2/CCR-2 signaling is involved in the killing of Staphylococcus aureus by murine bone marrow cells (BMCs). The intermittent link of reactive oxygen species (ROS)-NF-κB/p38-MAPK-mediated CCL-2 production in CCR-2 signaling prompted us to determine whether neutralization of CCR-2 augments the response of murine fresh BMCs (FBMCs) after S. aureus infection. It was observed that anti-CCR-2 Ab-treated FBMCs released fewer ROS on encountering S. aureus infection than CCR-2 non-neutralized FBMCs, also correlating with reduced killing of S. aureus in CCR-2 neutralized FBMCs. Staphylococcal catalase and SOD were also found to play a role in protecting S. aureus from the ROS-mediated killing of FBMC. S. aureus infection of CCR-2 intact FBMCs pre-treated with either NF-κB or p-38-MAPK blocker induced less CCL-2, suggesting that NF-κB or p-38-MAPK is required for CCL-2 production by FBMCs. Moreover, blocking of CCR-2 along with NF-κB or p-38-MAPK resulted in elevated CCL-2 production and reduced CCR-2 expression. Inhibition of CCR-2 impairs the response of murine BMCs to S. aureus infection by attenuation ROS production and modulating the cytokine response.
Collapse
Affiliation(s)
- Ajeya Nandi
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, West Bengal, India
| | - Biswadev Bishayi
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, West Bengal, India
| |
Collapse
|
6
|
Alvarez F, Lozano Puerto RM, Pérez-Maceda B, Grillo CA, Fernández Lorenzo de Mele M. Time-Lapse Evaluation of Interactions Between Biodegradable Mg Particles and Cells. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2016; 22:1-12. [PMID: 26810154 DOI: 10.1017/s1431927615015597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mg-based implants have promising applications as biodegradable materials in medicine for orthopedic, dental, and cardiovascular therapies. During wear and degradation microdebris are released. Time-lapse multidimensional microscopy (MM) is proposed here as a suitable tool to follow, in fixed intervals over 24-h periods, the interaction between cells and particles. Results of MM show interactions of macrophages (J774) with the magnesium particles (MgPa) that led to modifications of cell size and morphology, a decrease in duplication rate, and cell damage. Corrosion products were progressively formed on the surface of the particles and turbulence was generated due to hydrogen development. Changes were more significant after treating MgPa with potassium fluoride. In order to complement MM observations, membrane damage as detected by a lactase dehydrogenase (LDH) assay and mitochondrial activity as detected by a WST-1 assay with macrophages and osteoblasts (MC3T3-E1) were compared. A more significant concentration-dependent effect was detected for macrophages exposed to MgPa than for osteoblasts. Accordingly, complementary data showed that viability and cell cycle seem to be more altered in macrophages. In addition, protein profiles and expression of proteins associated with the adhesion process changed in the presence of MgPa. These studies revealed that time-lapse MM is a helpful tool for monitoring changes of biodegradable materials and the biological surrounding in real time and in situ. This information is useful in studies related to biodegradable biomaterials.
Collapse
Affiliation(s)
- Florencia Alvarez
- 1Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA),1900 La Plata,Argentina
| | - Rosa M Lozano Puerto
- 2Cell-Biomaterial Recognition Group,Cellular and Molecular Biology Department,Centro de Investigaciones Biológicas (CIB-CSIC),28040 Madrid,Spain
| | - Blanca Pérez-Maceda
- 2Cell-Biomaterial Recognition Group,Cellular and Molecular Biology Department,Centro de Investigaciones Biológicas (CIB-CSIC),28040 Madrid,Spain
| | - Claudia A Grillo
- 1Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas (INIFTA),1900 La Plata,Argentina
| | | |
Collapse
|
7
|
Ren W, Jackson N, Song W, Shi T, Flynn JC, Markel DC. Implant wear induced inflammation is mitigated in CX3CR1(-/-) mice. J Orthop Res 2014; 32:1037-43. [PMID: 24700421 DOI: 10.1002/jor.22625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/05/2014] [Indexed: 02/04/2023]
Abstract
Wear debris-induced monocyte recruitment plays a key role in the formation of chronic periprosthetic tissue inflammation associated with aseptic loosening. The purpose of this study was to investigate the role(s) of chemokine receptor CX3CR1 in ultra high molecular weight polyethylene (UHMWPE) particle-induced tissue inflammation using a murine air pouch model developed in CX3CR1 knockout (CX3CR1(-/-) ) mice. UHMWPE debris or saline were introduced into established air pouches on CX3CR1(-/-) and CX3CR1(+/+) mice. Pouch tissues were collected 7 days after UHMWPE inoculation. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in CX3CR1(+/+) mice, as manifested by inflammatory cellular infiltration (mainly macrophages), pouch tissue proliferation, and increased gene expression of IL-1ß and TNFα. UHMWPE-induced inflammation was significantly mitigated in CX3CR1(-/-) mice, as manifested by reduction of tissue inflammation (pouch thickness and cell density), inflammatory cytokine production (IL-1ß and TNFα) and macrophage accumulation. The observations support the hypothesis that the activation of the CX3CR1 chemokine pathway contributes to the severity of UHMWPE particle-induced tissue inflammation, and suggests that CX3CR1 signaling is involved in the recruitment of monocytes to the wear debris-containing inflammatory tissues. Blocking of CX3CR1 pathway may represent a viable therapeutic approach to the prevention and treatment of patients with aseptic loosening.
Collapse
Affiliation(s)
- Weiping Ren
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan; Department of Orthopaedic Surgery, Providence Hospital, Southfield, Michigan
| | | | | | | | | | | |
Collapse
|
8
|
Xiao F, Zhai Z, Jiang C, Liu X, Li H, Qu X, Ouyang Z, Fan Q, Tang T, Qin A, Gu D. Geraniin suppresses RANKL-induced osteoclastogenesis in vitro and ameliorates wear particle-induced osteolysis in mouse model. Exp Cell Res 2014; 330:91-101. [PMID: 25016282 DOI: 10.1016/j.yexcr.2014.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 02/09/2023]
Abstract
Wear particle-induced osteolysis and subsequent aseptic loosening remains the most common complication that limits the longevity of prostheses. Wear particle-induced osteoclastogenesis is known to be responsible for extensive bone erosion that leads to prosthesis failure. Thus, inhibition of osteoclastic bone resorption may serve as a therapeutic strategy for the treatment of wear particle induced osteolysis. In this study, we demonstrated for the first time that geraniin, an active natural compound derived from Geranium thunbergii, ameliorated particle-induced osteolysis in a Ti particle-induced mouse calvaria model in vivo. We also investigated the mechanism by which geraniin exerts inhibitory effects on osteoclasts. Geraniin inhibited RANKL-induced osteoclastogenesis in a dose-dependent manner, evidenced by reduced osteoclast formation and suppressed osteoclast specific gene expression. Specially, geraniin inhibited actin ring formation and bone resorption in vitro. Further molecular investigation demonstrated geraniin impaired osteoclast differentiation via the inhibition of the RANKL-induced NF-κB and ERK signaling pathways, as well as suppressed the expression of key osteoclast transcriptional factors NFATc1 and c-Fos. Collectively, our data suggested that geraniin exerts inhibitory effects on osteoclast differentiation in vitro and suppresses Ti particle-induced osteolysis in vivo. Geraniin is therefore a potential natural compound for the treatment of wear particle induced osteolysis in prostheses failure.
Collapse
Affiliation(s)
- Fei Xiao
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Zanjing Zhai
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Chuan Jiang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xuqiang Liu
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Haowei Li
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xinhua Qu
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Zhengxiao Ouyang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China; Department of Orthopaedics, Hunan Provincial Tumor Hospital and Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, PR China
| | - Qiming Fan
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Tingting Tang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - An Qin
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
| | - Dongyun Gu
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People׳s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of PR China, PR China; School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China.
| |
Collapse
|
9
|
Gallo J, Vaculova J, Goodman SB, Konttinen YT, Thyssen JP. Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement. Acta Biomater 2014; 10:2354-66. [PMID: 24525037 DOI: 10.1016/j.actbio.2014.02.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 12/13/2022]
Abstract
Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. "Control" samples were reported in 45 of the 101 studies. The most frequently examined tissues were the bone-implant interface membrane and pseudosynovial tissues. Histopathological studies contribute importantly to determination of key cell populations underlying the biological mechanisms of aseptic loosening and osteolysis. The studies demonstrated the key molecules of the host response at the protein level (chemokines, cytokines, nitric oxide metabolites, metalloproteinases). However, these studies also have important limitations. Tissues harvested at revision surgery reflect specifically end-stage failure and may not adequately reveal the evolution of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies.
Collapse
Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic.
| | - Jana Vaculova
- Department of Pathology, University Hospital Ostrava, Czech Republic
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yrjö T Konttinen
- Institute of Clinical Medicine, Department of Medicine, FIN-00029 HUS, Finland; ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland; COXA Hospital for Joint Replacement, Tampere, Finland
| | - Jacob P Thyssen
- Department of Dermatology and Allergology, Copenhagen University, Hospital Gentofte, Denmark
| |
Collapse
|
10
|
Esposito CI, Oliver RA, Campbell PA, Yu Y, Walter WL, Walter WK, Walsh WR. Human polyethylene granuloma tissues inhibit bone healing in a novel xenograft animal model. J Orthop Res 2014; 32:735-43. [PMID: 24619566 DOI: 10.1002/jor.22588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 01/10/2014] [Indexed: 02/04/2023]
Abstract
During revision of a conventional polyethylene joint replacement, surgeons usually remove the source of osteolysis (polyethylene) but cannot always remove all of the polyethylene granuloma tissues. We developed a human/rat xenograft model to investigate the effects of polyethylene granuloma tissues on bone healing. Human osteoarthritic and periprosthetic tissues collected during primary and revision hip arthroplasty surgeries were transplanted into the distal femora of athymic nude rats. After 3 weeks in vivo, there was a significant difference in the bone volume fraction (Vf ) between empty, primary, and revision defects (p = 0.02), with a lower Vf in defects with revision granuloma tissues compared to defects with primary osteoarthritic tissues. Polyethylene granuloma tissues in trabecular bone defects inhibited bone healing. Therefore, debridement around a metal-on-polyethylene hip replacement may shorten the time it takes to achieve secondary stability around a revision hip replacement.
Collapse
Affiliation(s)
- Christina I Esposito
- Surgical and Orthopaedic Research Laboratories, Clinical Sciences Building, Level 1, Prince of Wales Hospital, Randwick, NSW, 2031, Australia; Specialist Orthopaedic Group, Mater Clinic, Suite 1.08, 3-9 Gillies Street, Wollstonecraft, NSW, 2065, Australia
| | | | | | | | | | | | | |
Collapse
|
11
|
Rao AJ, Gibon E, Ma T, Yao Z, Smith RL, Goodman SB. Revision joint replacement, wear particles, and macrophage polarization. Acta Biomater 2012; 8:2815-23. [PMID: 22484696 DOI: 10.1016/j.actbio.2012.03.042] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/21/2012] [Accepted: 03/28/2012] [Indexed: 02/07/2023]
Abstract
Currently, younger, more active patients are being offered total joint replacement (TJR) for end-stage arthritic disorders. Despite improved durability of TJRs, particle-associated wear of the bearing surfaces continues to be associated with particulate debris, which can activate monocyte/macrophages. Activated macrophages then produce pro-inflammatory factors and cytokines that induce an inflammatory reaction that activates osteoclasts leading to bone breakdown and aseptic loosening. We hypothesized that activated macrophages in tissues harvested from revised joint replacements predominantly express an M1 pro-inflammatory phenotype due to wear-particle-associated cell activation, rather than an M2 anti-inflammatory phenotype. We further questioned whether it is possible to convert uncommitted monocyte/macrophages to an M2 phenotype by the addition of interleukin-4 (IL-4), or whether it is necessary to first pass through an M1 intermediate stage. Retrieved periprosthetic tissues demonstrated increased M1/M2 macrophage ratios compared to non-operated osteoarthritic synovial tissues, using immunohistochemical staining and Western blotting. Uncommitted monocyte/macrophages with/without polymethyl-methacrylate particles were transformed to an M2 phenotype by IL-4 more efficiently when the cells were first passed through an M1 phenotype by exposure to endotoxin. Wear particles induce a pro-inflammatory microenvironment that facilitates osteolysis; these events may potentially be modulated favorably by exposure to IL-4.
Collapse
|
12
|
Baxter RM, Freeman TA, Kurtz SM, Steinbeck MJ. Do tissues from THA revision of highly crosslinked UHMWPE liners contain wear debris and associated inflammation? Clin Orthop Relat Res 2011; 469:2308-17. [PMID: 21136220 PMCID: PMC3126969 DOI: 10.1007/s11999-010-1713-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyethylene wear debris is a major contributor to inflammation and the development of implant loosening, a leading cause of THA revisions. To reduce wear debris, highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) was introduced to improve wear properties of bearing surfaces. As highly crosslinked UHMWPE revision tissues are only now becoming available, it is possible to examine the presence and association of wear debris with inflammation in early implant loosening. QUESTIONS/PURPOSES We asked: (1) Does the presence of UHMWPE wear debris in THA revision tissues correlate with innate and/or adaptive immune cell numbers? (2) Does the immune cell response differ between conventional and highly crosslinked UHMWPE cohorts? METHODS We collected tissue samples from revision surgery of nine conventional and nine highly crosslinked UHMWPE liners. Polarized light microscopy was used to determine 0.5- to 2-μm UHMWPE particle number/mm2, and immunohistochemistry was performed to determine macrophage, T cell, and neutrophil number/mm2. RESULTS For the conventional cohort, correlations were observed between wear debris and the magnitude of individual patient macrophage (ρ=0.70) and T cell responses (ρ=0.71) and between numbers of macrophages and T cells (ρ=0.77) in periprosthetic tissues. In comparison, the highly crosslinked UHMWPE cohort showed a correlation between wear debris and the magnitude of macrophage responses (ρ=0.57) and between macrophage and T cell numbers (ρ=0.68). Although macrophages and T cells were present in both cohorts, the highly crosslinked UHMWPE cohort had lower numbers, which may be associated with shorter implantation times. CONCLUSIONS The presence of wear debris and inflammation in highly crosslinked UHMWPE revision tissues may contribute to early implant loosening.
Collapse
Affiliation(s)
- Ryan M. Baxter
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 323 Bossone, 3120 Market Street, Philadelphia, PA 19104 USA
| | - Theresa A. Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA USA
| | | | - Marla J. Steinbeck
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 323 Bossone, 3120 Market Street, Philadelphia, PA 19104 USA
| |
Collapse
|
13
|
Baxter RM, Ianuzzi A, Freeman TA, Kurtz SM, Steinbeck MJ. Distinct immunohistomorphologic changes in periprosthetic hip tissues from historical and highly crosslinked UHMWPE implant retrievals. J Biomed Mater Res A 2010; 95:68-78. [PMID: 20740602 DOI: 10.1002/jbm.a.32813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Assessment of immune response to implant wear debris in periprosthetic tissue following total hip arthroplasty suggests that multiple factors are involved in the loss implant function. The current study investigated wear debris and the associated immunohistomorphologic changes in tissues from nine patients with historical (gamma air-sterilized) and nine highly crosslinked UHMWPE implant components. Paraffin embedded tissue sections were evaluated for the presence of histiocytes, giant cells, fibrocartilage/bone, and necrosis. To determine the incidence, degree and co-localization of immunohistomorphologic changes and wear, overlapping full-field tissue arrays were collected in brightfield and polarized light. The historical cohort tissues predominantly showed histiocytes associated with significant accumulations of small wear (0.5-2 microm), and giant cells associated with large wear (> or =2 microm). Frequently, focal regions of necrosis were observed in association with wear debris. For the highly crosslinked cohort, inflammation and associated wear debris were limited, but in tissues from patients revised after implantation times of >2 years a response was observed. Whereas significant amounts of fibrocartilage/bone were observed in patients at earlier implantation times. In both cohorts, tissue responses were more extensive in the retroacetabular or proximal femoral regions. The current findings suggest that wear debris-induced inflammation may be a major contributor to the loss of implant function for both the historical and highly crosslinked cohorts, but it is not the primary cause of early implant loosening. This study highlights the importance of using a more quantitative and standardized assessment of immunohistomorphologic responses in periprosthetic tissues, and emphasizes differences in specific anatomical regions of individual patient tissues.
Collapse
Affiliation(s)
- Ryan M Baxter
- Department of Biomedical Engineering, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | |
Collapse
|
14
|
The Bryan Cervical Disc Replacement. Tech Orthop 2010. [DOI: 10.1097/bto.0b013e3181df2f78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Proinflammatory and osteoclastogenic effects of beta-tricalciumphosphate and hydroxyapatite particles on human mononuclear cells in vitro. Biomaterials 2009; 30:5312-8. [PMID: 19577291 DOI: 10.1016/j.biomaterials.2009.06.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 06/12/2009] [Indexed: 01/30/2023]
Abstract
Particulate wear debris can activate defence cells and osteoclasts at the bone-implant interface possibly leading to bone resorption and implant failure. Cellular responses and inflammatory effects have been reported for particulate hydroxyapatite (HA). However, the immunological effects of particulate beta-tricalciumphosphate (beta-TCP) have not been studied and the question of whether beta-TCP is more biocompatible in this regard as is HA remains to be determined. Therefore the present work investigates effects of endotoxin-free HA and beta-TCP particles of the same size (d(50)=1 microm) and dose (SAR 10:1) on human peripheral blood mononuclear cells in vitro. The production of proinflammatory cytokines (TNF-alpha, IL-1beta, IL-8) and cytokines connected to osteoclast and dendritic cell differentiation (OPG, RANKL, M-CSF, GM-CSF) was determined by ELISA. After 6 and 18 h of incubation HA and beta-TCP caused a quite similar induction of TNF-alpha, IL-1beta and IL-8. Effects of particles on the production of M-CSF and OPG were not detectable. However, in sharp contrast to HA, beta-TCP caused less induction of GM-CSF and not any of RANKL, both known for promoting dendritic cells and osteoclastogenesis respectively. Therefore these in vitro data suggest that wear debris of beta-TCP poses lesser risk of the detrimental effects of osteoclast induction known from HA.
Collapse
|
16
|
Lenz R, Mittelmeier W, Hansmann D, Brem R, Diehl P, Fritsche A, Bader R. Response of human osteoblasts exposed to wear particles generated at the interface of total hip stems and bone cement. J Biomed Mater Res A 2009; 89:370-8. [PMID: 18431768 DOI: 10.1002/jbm.a.31996] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aseptic loosening of total hip replacement is mainly caused by wear particles. Abrasive wear occurs at articulating surfaces or as a consequence of micro-motions at the interface between femoral stem and bone cement. Direct impact of wear particles on osteolysis, the remodeling of the bone stock and a directly affected function of osteoblasts was described. The present study examined the response of human osteoblasts exposed to different wear particles, which were generated in a test device providing oscillating micro-motions at the interface between femoral stem and standard bone cement. Characterization of released particles was performed by quantifying the size distribution and the metal content of the wear debris. Human osteoblasts were incubated with particles obtained from hip stems with different material compositions (Ti-6Al-7Nb and Co-28Cr-6Mo) and rough and smooth surface finishings combined with standard bone cement (Palacos(R) R) containing zirconium oxide particles. Commercially pure titanium particles (cp-Ti) and particulate zirconium oxide (ZrO(2)) were used for comparative analyses. The results revealed significant (p < 0.05) reduction of the cell viability after exposure to higher concentration of metallic particles, particularly from Co-based alloys. In contrast, ZrO(2) alone showed significantly less adverse effects on the cells. When increasing metallic particle concentrations massive inhibition was also observed in the release of cytokines including interleukine-6 (IL-6) and interleukine-8 (IL-8), but the expression of Procollagen I and the cell viability showed the highest reduction after exposure to Co-based alloy particles from rough stems.
Collapse
Affiliation(s)
- Robert Lenz
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
| | | | | | | | | | | | | |
Collapse
|
17
|
Kranz I, Gonzalez JB, Dörfel I, Gemeinert M, Griepentrog M, Klaffke D, Knabe C, Österle W, Gross U. Biological response to micron- and nanometer-sized particles known as potential wear products from artificial hip joints: Part II: Reaction of murine macrophages to corundum particles of different size distributions. J Biomed Mater Res A 2009; 89:390-401. [DOI: 10.1002/jbm.a.32121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
18
|
Whittingham-Jones PM, Dunstan E, Altaf H, Cannon SR, Revell PA, Briggs TWR. Immune responses in patients with metal-on-metal hip articulations: a long-term follow-up. J Arthroplasty 2008; 23:1212-8. [PMID: 18534468 DOI: 10.1016/j.arth.2007.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 09/27/2007] [Accepted: 10/14/2007] [Indexed: 02/01/2023] Open
Abstract
Metal-on-metal (MoM) hip bearings are being inserted into ever-younger patients. The effects on the immune system of chronic exposure are unknown. We investigated the immune response of patients with MoM hip bearings. In patients with MoM implants, the expression of antigen-presenting cell (APC) surface molecules (CD86 and HLA-DR) was seen to be significantly higher (P < .05) than control group. High levels of APC surface molecules suggest an activated state and attempts to propagate an immune response. However, in the same group, the expression of T-cell markers (CD3 and CD28) was low, indicating a small T-cell population. This suggests, despite the activation of APCs, that T cells down-regulate immune responses in MoM articulations. Conversely, in metal-on-polyethylene articulations, expression of T-cell molecules was elevated and expression of APC molecules lowered.
Collapse
|
19
|
Growth factors in bone repair. ACTA ACUST UNITED AC 2008; 92:161-8. [PMID: 19043663 DOI: 10.1007/s12306-008-0064-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
The role of growth factors (GF) in bone repair is widely recognised, particularly for bone morphogenetic proteins (BMPs), fibroblast growth factor (FGF), insulin-like growth factors (IGFs), platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF). GF are usually stored in the extracellular matrix (ECM), but after injury are actively released by ECM, cells and platelets. In this paper, the use of different recombinant GF for bone repair stimulation is summarised in experimental research and clinical applications. Drug delivery systems, including carriers, cell or gene therapy, are needed to ensure a sustained local release of the factors, but efficacy and potential side effects of such systems require additional research prior to clinical applications. Current sources for delivery of a GF mixture into the site of bone repair are platelet gel and demineralised bone matrix. Nevertheless, the levels of GF in such preparations are affected by variability among donors and differences in preparation. Autogenous GF, produced by the patient himself during the bone repair process, potentially interfere with prosthetic devices or even have a role in implant loosening due to the periprosthetic tissue reaction. In conclusion, GF are key components of functional bone regeneration: screening of basic research results and controlled clinical trials are accelerating the development of GF in orthopaedic surgery.
Collapse
|
20
|
Hoenders CSM, Harmsen MC, van Luyn MJA. The local inflammatory environment and microorganisms in “aseptic” loosening of hip prostheses. J Biomed Mater Res B Appl Biomater 2008; 86:291-301. [DOI: 10.1002/jbm.b.30992] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
21
|
Kaufman AM, Alabre CI, Rubash HE, Shanbhag AS. Human macrophage response to UHMWPE, TiAlV, CoCr, and alumina particles: analysis of multiple cytokines using protein arrays. J Biomed Mater Res A 2008; 84:464-74. [PMID: 17618502 DOI: 10.1002/jbm.a.31467] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aseptic loosening of total joint replacements is believed to be initiated by a macrophage response to prosthetic wear debris. To better characterize the early response to clinically relevant wear debris, we challenged primary human macrophages from four donors with ultra high molecular weight polyethylene (UHMWPE), TiAlV, CoCr, and alumina particles. After a 24-h culture, protein arrays were used to quantify the secretion of 30 different cytokines and chemokines. Macrophages secreted detectable levels of nine mediators in culture: Interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), IL-1beta, MCP-1, IL-8, IL-6, GM-CSF, IL-10, and IL-12p40. TiAlV particles were the most stimulatory, causing 5- to 900-fold higher cytokine expression compared with nonstimulated cells and uniquely eliciting high levels of IL-1alpha, IL-6, IL-10, and GM-CSF. CoCr and alumina were mildly stimulatory and typically elicited two- to fivefold greater levels than nonstimulated cells. Surprisingly, UHMWPE did not elicit a significant increase in cytokine release. Our data suggests that IL-1alpha, TNF-alpha, IL-1beta, and MCP-1 are the primary initiators of osteolysis and implicates metallic debris as an important trigger for their release.
Collapse
Affiliation(s)
- Adam M Kaufman
- Biomaterials Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02474, USA
| | | | | | | |
Collapse
|
22
|
What are the local and systemic biologic reactions and mediators to wear debris, and what host factors determine or modulate the biologic response to wear particles? J Am Acad Orthop Surg 2008; 16 Suppl 1:S42-8. [PMID: 18612013 PMCID: PMC2714366 DOI: 10.5435/00124635-200800001-00010] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
New clinical and basic science data on the cellular and molecular mechanisms by which wear particles stimulate the host inflammatory response have provided deeper insight into the pathophysiology of periprosthetic bone loss. Interactions among wear particles, macrophages, osteoblasts, bone marrow-derived mesenchymal stem cells, fibroblasts, endothelial cells, and T cells contribute to the production of pro-inflammatory and pro-osteoclastogenic cytokines such as TNF-alpha, RANKL, M-SCF, PGE2, IL-1, IL-6, and IL-8. These cytokines not only promote osteoclastogenesis but interfere with osteogenesis led by osteoprogenitor cells. Recent studies indicate that genetic variations in TNF-alpha, IL-1, and FRZB can result in subtle changes in gene function, giving rise to altered susceptibility or severity for periprosthetic inflammation and bone loss. Continuing research on the biologic effects and mechanisms of action of wear particles will provide a rational basis for the development of novel and effective ways of diagnosis, prevention, and treatment of periprosthetic inflammatory bone loss.
Collapse
|
23
|
Abstract
Potential systemic markers of implant wear include products of the wear process (particles and ions) and mediators of the inflammatory reaction that can be induced by wear. Ions from polymers used in arthroplasty are not specific, but high metal ion levels may help identify patients with unexpectedly high wear of metal-on-metal implants. The kinetics of ion production, transport, and excretion are complex, however, so it is currently difficult to interpret the significance of mild elevations in metal ions. Indices of bone turnover (eg, collagen fragments) and mediators involved in the inflammatory reaction to particles (eg, osteoprotegerin, RANKL, interleukins) may be associated with osteolysis, but systemic disorders (eg, osteoarthritis) and the use of medications that influence bone remodeling limit the predictive value of these analytes with respect to the consequences of implant wear. Using genomic and proteomic methods to measure multiple analytes offers promise, but the challenge is to identify markers specifically associated with wear that are not elevated by other conditions that often coexist in this patient population.
Collapse
|
24
|
Tunyogi-Csapo M, Koreny T, Vermes C, Galante JO, Jacobs JJ, Glant TT. Role of fibroblasts and fibroblast-derived growth factors in periprosthetic angiogenesis. J Orthop Res 2007; 25:1378-88. [PMID: 17557346 DOI: 10.1002/jor.20449] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The periprosthetic granulomatous soft tissue [designated iterfacial membrane (IFM) in this study] exhibits heterogeneous histopathological features, in which highly vascularized areas with dense cellularity alternate with fibrotic and pseudocapsule-like tissue structures. Although macrophage/monocyte activation is a prominent event in the periprosthetic environment, fibroblasts also phagocytose particulate wear debris both in vivo and in vitro. Particulate wear debris and/or cytokines/growth factors alone or in combination (e.g., in conditioned media of explant cultures of IFMs) stimulated normal synovial and IFM fibroblasts to express inflammatory mediators and growth factors such as interleukin (IL)-1beta, IL-6, IL-8, three isoforms of vascular endothelial growth factor (VEGF), monocyte/macrophage chemoattractant protein-1 (MCP-1), macrophage-colony-stimulating factor (M-CSF), cycloxygenases (Cox-1 and Cox-2), acid- and basic-fibroblast growth factors (FGF-1 and FGF-2), leukemia inhibitory factor-1 (LIF-1), transforming growth factor beta-1 (TGF-beta1), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG). Thus, the fibroblast is capable of expressing a wide array of angiogenic and osteoclastogenic factors which are involved in the detrimental processes of the periprosthetic osteolysis.
Collapse
Affiliation(s)
- Miklos Tunyogi-Csapo
- Department of Orthopedic Surgery, Rush University Medical Center, 1735 W. Harrison Street, Cohn Research Building, Chicago, Illinois 60612, USA
| | | | | | | | | | | |
Collapse
|
25
|
Shanbhag AS, Kaufman AM, Hayata K, Rubash HE. Assessing osteolysis with use of high-throughput protein chips. J Bone Joint Surg Am 2007; 89:1081-9. [PMID: 17473147 DOI: 10.2106/jbjs.f.00330] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies of bone resorption around failed joint replacements have focused on a limited number of cytokines, primarily tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, and IL-6, with use of enzyme-linked immunosorbent assay and immunohistochemistry techniques. In this study, we utilized high-throughput protein chips to profile twenty-nine inflammatory cytokines around failed total joint replacements. METHODS Peri-implant granulomatous tissues were harvested from around the failed total hip prostheses of thirteen patients. Synovial lining capsular tissues from thirteen patients with end-stage degenerative joint disease were used as controls. After homogenization, twenty-nine cytokines were quantified with use of high-throughput protein chips. RESULTS IL-6 and IL-8 were found consistently in failed joint replacement tissues, reaffirming their prominent role in osteoclastogenesis and end-stage bone resorption. High levels of interferon-gamma-inducible protein of 10 kDa (IP-10) and monokine induced by interferon-gamma (MIG), both chemoattractants of activated Th1 lymphocytes, were also detected. Soluble intercellular adhesion molecule (sICAM) and transforming growth factor-beta1 (TGF-beta(1)) were not detected universally, nor were TNF-alpha or IL-1. After a twenty-four-hour organ culture, IL-1beta levels increased substantially along with those of other mediators. We measured but did not detect any activators of cytotoxic T-cells, antibody-producing Bcells, or eosinophils involved in delayed-type hypersensitivity. Variations from patient to patient were seen across all cytokines and highlight the unique response of individual patients to their joint replacements. CONCLUSIONS In failed total joint replacements in patients with end-stage osteolysis, IL-6 and IL-8 may be the primary drivers of osteoclastogenesis. The presence of IP-10 and MIG imply a role for T-cells, while TGF-beta(1) and sICAM may represent a systemic attempt to modulate the inflammation. TNF-alpha and IL-1 do not appear to play a major role in the end stages of the disease.
Collapse
Affiliation(s)
- Arun S Shanbhag
- Biomaterials Laboratory, Massachusetts General Hospital, GRJ 1115, 55 Fruit Street, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
26
|
Koreny T, Tunyogi-Csapó M, Gál I, Vermes C, Jacobs JJ, Glant TT. The role of fibroblasts and fibroblast-derived factors in periprosthetic osteolysis. ACTA ACUST UNITED AC 2006; 54:3221-32. [PMID: 17009257 DOI: 10.1002/art.22134] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study was undertaken to investigate how fibroblasts respond to stimulation with particulate wear debris and/or conditioned media obtained from pathologic tissue, and whether these activated fibroblasts express compounds that are involved in bone resorption. METHODS Conditioned media from explant cultures of synovial tissue, periprosthetic soft tissue (interface membranes), titanium particles, and proinflammatory cytokines were used to stimulate fibroblasts. RNase protection assay was used to measure altered gene expression, and enzyme-linked immunosorbent assay, Western blot hybridization, and flow cytometry were used to determine fibroblast protein expression. Tartrate-resistant acid phosphatase staining was used to identify multinucleated osteoclast-like cells. RESULTS The most dominant compounds measured in the conditioned media from interface membranes were tumor necrosis factor alpha (TNFalpha), monocyte chemoattractant protein 1 (MCP-1), interleukin-1beta (IL-1beta), IL-6, IL-8, and vascular endothelial growth factor. Fibroblasts phagocytosed particulate wear debris and responded to cytokine/chemokine stimulation. The most prominent up-regulated genes and proteins secreted by fibroblasts in response to stimulation were matrix metalloproteinase 1, MCP-1, IL-1beta, IL-6, IL-8, cyclooxygenase 1 (COX-1), COX-2, leukemia inhibitory factor 1, transforming growth factor beta1 (TGFbeta1), and TGFbeta receptor type I. In addition, interface membrane fibroblasts expressed RANKL and osteoprotegerin in response to stimulation with conditioned media, TNFalpha, or IL-1beta. Stimulated fibroblasts cocultured with bone marrow cells in the presence of macrophage colony-stimulating factor induced osteoclastogenesis. CONCLUSION Interface membrane fibroblasts respond directly to particulate wear debris, possibly via phagocytosis, expressing proinflammatory cytokines and RANKL. Thus, these cells may be actively involved in osteoclastogenesis and pathologic (periprosthetic) bone resorption.
Collapse
Affiliation(s)
- Tamas Koreny
- Rush University Medical Center, Chicago, Illinois 60612, USA
| | | | | | | | | | | |
Collapse
|
27
|
Ren W, Wu B, Peng X, Hua J, Hao HN, Wooley PH. Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice. J Orthop Res 2006; 24:1575-86. [PMID: 16779834 DOI: 10.1002/jor.20190] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.
Collapse
Affiliation(s)
- Weiping Ren
- Department of Orthopedic Surgery, Wayne State University School of Medicine, University Health Center 7C, 4201 St. Antoine Boulevard, Detroit, Michigan 48201, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Ramachandran R, Goodman SB, Smith RL. The effects of titanium and polymethylmethacrylate particles on osteoblast phenotypic stability. J Biomed Mater Res A 2006; 77:512-7. [PMID: 16482550 DOI: 10.1002/jbm.a.30649] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Wear particles generated following total joint arthroplasty interact with cells at the periprosthetic margin and induce an inflammatory response that contributes to osteolysis, aseptic loosening, and implant failure. This study examined the long-term effects of particles from two commonly implanted materials, titanium (Ti) and polymethylmethacrylate (PMMA), on cell viability and metabolism over a 21-day time course, using the human osteoblast-like cell line MG-63. Addition of particles was not associated with increased cell death or nitric oxide production at the particle concentration chosen. Collagen production was increased with exposure to titanium particles, whereas alkaline phosphatase and osteocalcin expression remained unchanged following exposure to both types of particles. The data show that titanium but not PMMA particles shifts bone cell metabolism to preferentially produce fibrous tissue rather than bone.
Collapse
Affiliation(s)
- R Ramachandran
- Department of Orthopedic Surgery, Stanford University, California, USA.
| | | | | |
Collapse
|
29
|
Cenni E, Savarino L, Antonioli D, Pellacani A, Giunti A, Baldini N. Plasma levels of platelet-derived growth factor BB and transforming growth factor in patients with failed hip prostheses. Acta Orthop 2005; 76:61-6. [PMID: 15788309 DOI: 10.1080/00016470510030337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The role of growth factors in prosthesis loosening is unclear. We evaluated the levels of platelet-derived growth factor BB (PDGF-BB), transforming growth factors beta1 (TGF-beta1) and beta2 (TGF-beta2), both before and after activation, in patients with aseptic loosening of their hip prosthesis. PATIENTS AND METHODS 26 patients with loosened hip implants were compared with 21 patients who had stable hip prostheses, and 28 patients undergoing primary hip replacement. The plasma levels of the growth factors were analyzed by enzyme immunoassay. TGF-beta1 and TGF-beta2 were determined both before and after activation. RESULTS Patients with aseptic loosening had significantly lower PDGF-BB levels than patients undergoing primary hip replacement, and significantly lower TGF-beta2 levels than patients with a stable implant. Patients with stable prostheses had significantly higher TGF-beta1 and TGF-beta2 levels than patients undergoing primary hip replacement. INTERPRETATION It is possible that the prosthetic implant itself causes a local increase in PDGF-BB, TGF-beta1 and TGF-beta2, released by osteoblasts and other cells in the microenvironment. The plasma PDGF-BB measured does not correspond to local release, which is probably due to local consumption or degradation. The consumption of PDGF-BB is low in stable implants, and TGF-beta1 and TGF-beta2 levels increase during bone formation. In loosening, PDGF-BB consumption is higher and causes a significant reduction in plasma levels as compared to presurgery. The formation of poor-quality bone may be related to the scarce increase in TGF-beta1 and TGF-beta2. In conclusion, compared with patients with a stable implant, a reduction in bone-forming growth factors appears to occur in individuals with aseptic loosening.
Collapse
Affiliation(s)
- Elisabetta Cenni
- Laboratory for Pathophysiology of Orthopedic Implants, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, IT-40136 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
30
|
El-Warrak AO, Olmstead M, Schneider R, Meinel L, Bettschart-Wolfisberger R, Akens MK, Auer J, von Rechenberg B. An experimental animal model of aseptic loosening of hip prostheses in sheep to study early biochemical changes at the interface membrane. BMC Musculoskelet Disord 2004; 5:7. [PMID: 15113432 PMCID: PMC404466 DOI: 10.1186/1471-2474-5-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 03/03/2004] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Aseptic loosening of hip prosthesis as it occurs in clinical cases in human patients was attributed to wear particles of the implants, the response of the tissue dominated by macrophages and the production of inflammatory mediators and matrix degrading enzymes; however, the cascade of events initiating the process and their interaction regarding the time course is still open and discussed controversially. Therefore, the goal of this study was to establish an experimental animal model in sheep allowing to follow the cascade of early mechanical and biochemical events within the interface membrane and study the sequence of how they contribute to the pathological bone resorption necessary for aseptic loosening of the implant. METHODS A cemented modular system (Biomedtrix) was used as a hip replacement in 24 adult Swiss Alpine sheep, with one group receiving a complete cement mantle as controls (n = 12), and the other group a cement mantle with a standardized, lateral, primary defect in the cement mantle (n = 12). Animals were followed over time for 2 and 8.5 months (n = 6 each). After sacrifice, samples from the interface membranes were harvested from five different regions of the femur and joint capsule. Explant cell cultures were performed and supernatant of cultures were tested and assayed for nitric oxide, prostaglandin E2, caseinolytic and collagenolytic activity. RNA extraction and quantification were performed for inducible nitric oxide synthase, cyclooxygenase-2, interleukin 1, and interleukin 6. Overall differences between groups and time periods and interactions thereof were calculated using a factorial analysis of variance (ANOVA). RESULTS The development of an interface membrane was noticed in both groups at both time points. However, in the controls the interface membrane regressed in thickness and biological activity, while both variables increased in the experimental group with the primary cement mantle defect over time. Nitric oxide (NO) and PGE2 concentrations were higher in the 8.5 months group (P < 0.0001) compared to the 2 months group with a tendency for the unstable group to have higher concentrations. The same was true for collagenolytic activity (P = 0.05), but not for caseinolytic activity that decreased over time (P < 0.0001). CONCLUSION In this study, a primary cement mantle defect of the femoral shaft elicited biomechanical instability and biochemical changes over time in an experimental animal study in sheep, that resembled the changes described at the bone cement-interface in aseptic loosening of total hip prosthesis in humans. The early biochemical changes may well explain the pathologic bone resorption and formation of an interface membrane as is observed in clinical cases. This animal model may aid in future studies aiming at prevention of aseptic loosening of hip prosthesis and reflect some aspects of the pathogenesis involved.
Collapse
Affiliation(s)
- Alexander O El-Warrak
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
- CNPq, Brasilia, Brazil
| | - Marvin Olmstead
- Department of Veterinary Clinical Sciences, The Ohio State University, College of Veterinary Medicine, Columbus, OH 43210, USA
| | - Rebecca Schneider
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Lorenz Meinel
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Regula Bettschart-Wolfisberger
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Margarete K Akens
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Joerg Auer
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Dept. of Veterinary Surgery, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| |
Collapse
|
31
|
Wong N, Trindade MCD, Patel R, Yaszay B, Goodman SB, Smith RL. Effects of interleukin-10 on titanium particle-induced macrophage transcription factor activation and cytokine expressionin vitro. ACTA ACUST UNITED AC 2004; 69:40-6. [PMID: 14999749 DOI: 10.1002/jbm.a.20097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study tests the hypothesis that transcription factor activation by exposure of macrophages to titanium particles can be modulated by the addition of the antiinflammatory cytokine, interleukin 10 (IL-10). The experiments were carried out with primary human monocyte/macrophages that were treated in the presence or absence of IL-10 with and without exposure to titanium particles. The time course for experiments varied from 1 h-5 h for analysis of nuclear protein and up to 48 h for analysis of cytokine release. Transcription factor translocation to the nucleus was analyzed using electrophoretic gel shift assays and cytokine release was quantified by enzyme-linked immunosorbent assay. Addition of titanium particles increased release of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-1 beta (IL-1 beta). In addition, titantium particle induced translocation of the transcription factors, NF-kappa B and NF-IL6, in the nucleus within 1 h. Treatment of macrophages with IL-10 prior to exposure to titanium particles decreased translocation of NF-IL6 but did not significantly alter nuclear levels of NF-kappa B. In addition, pretreatment of the cells with IL-10 decreased particle-induced cytokine release. These data show that antiinflammatory cytokines may provide a mechanism by which particle-induced inflammatory response may be modulated in vivo.
Collapse
Affiliation(s)
- Neal Wong
- Orthopaedic Research Laboratory, Stanford University School of Medicine, 300 Pasteur Drive, R144, Stanford, California 94305-5341, USA
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
STUDY DESIGN In vitro wear testing of the Bryan Cervical Disc prosthesis was performed in a cervical spine simulator. The biologic response was assessed in chimpanzee and goat animal models. OBJECTIVE Determine the wear characteristics of the Bryan disc. SUMMARY OF BACKGROUND DATA Large joint arthroplasties fail most commonly by wear and consequent formation of particulate material, which induces an inflammatory response. Therefore, measuring the wear characteristics of the new spinal disc replacements is important. METHODS Six prosthetic assembles were tested to 10 or 40 million cycles by load and motion and 3 additional assemblies were tested by load only in a cervical spine simulator. Any debris was examined using ASTM standards. The local biologic response to the prosthesis was examined in two chimpanzees. Nine goats were used to assess the biologic response in both local and distant tissues. Arthrodesis was performed on three additional control goats that received an allograft and an anterior cervical plate. RESULTS Wear results: cervical spine simulators that applied the loads and motions associated with activities of daily living produced wear particulate at a rate of 1.2 mg per million cycles. Device height decreased 0.02 mm per million cycles with approximately 77% of this decrease due to gradual creep of the nucleus under the constant compressive load. Particles generated were granular in shape with a mean feret diameter of 3.9 microm. All animals tolerated placement of the Bryan disc. Wear debris was present in the periprosthetic and epidural spaces in some animals. However, no significant inflammatory response was observed. No wear material was found distant from the implant in draining lymph tissue, the liver, or the spleen. CONCLUSIONS The Bryan disc has satisfactory wear characteristics and does not produce a significant inflammatory response.
Collapse
Affiliation(s)
- Paul A Anderson
- University of Wisconsin, Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin Hospitals, Madison, Wisconsin 53792, USA.
| | | | | | | |
Collapse
|
33
|
Cenni E, Granchi D, Ciapetti G, Savarino L, Corradini A, Vancini M, Giunti A. Gene expression of bone-associated cytokines in MG63 osteoblast-like cells incubated with acrylic bone cement extracts in minimum essential medium. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2003; 13:1283-94. [PMID: 12555896 DOI: 10.1163/15685620260449697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study examined the effects of in vitro challenge with four polymerized acrylic bone cements (Sulfix-60, CMW 1, CMW 2, and CMW 3) on the expression of interleukin-1beta (IL-1beta), interleukin-6 (IL-6), and transforming growth factor-beta1 (TGF-beta1) mRNAs in the osteoblast-like cell line MG63. The extracts of the cements in minimal essential medium (MEM) were tested following 1-h and 7-day curing. A semi-quantitative analysis of the cytokine-specific mRNAs was carried out by agarose gel densitometry and expression was compared with the GAPDH housekeeping gene. The ratio between cytokine gene expression and GAPDH expression was calculated. The mRNA specific for the bone-resorbing cytokines IL-1beta and IL-6 was low in basal conditions. IL-1beta mRNA increased only after incubation with the extract of CMW 1 following 1-h curing. The mRNA specific for the bone-resorbing cytokine IL-6 also increased after contact with CMW 1 at both curing times. Sulfix-60 and CMW 3 following 7-day curing, but not after 1 h, induced higher levels of IL-6 mRNA than the control. CMW 2 after 1-h curing constantly determined the expression of IL-6 mRNA, but at low levels. The mRNA specific for TGF-beta1 was also expressed by the MG63 osteoblast-like cells in basal conditions. The levels increased after contact with Sulfix-60 after 7-day curing and with CMW 1 after 1-h curing. CMW 2 after 7-day curing decreased TGF-beta1 mRNA. In conclusion, the highest expression of the cytokines IL-1beta, IL-6, and TGF-beta1 mRNA was determined by CMW 1. If the results are confirmed in vivo, the increased expression of the osteolytic cytokines induced by the bone cement might result in loosening of the prosthesis, even with all the restrictions of an in vitro study on continuous cell lines.
Collapse
Affiliation(s)
- E Cenni
- Laboratorio di Fisiopatologia degli Impianti Ortopedici, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
34
|
Affatato S, Mattarozzi A, Taddei P, Robotti P, Soffiatti R, Sudanese A, Toni A. Investigations on the wear behaviour of the temporary PMMA-based hip Spacer-G. Proc Inst Mech Eng H 2003; 217:1-8. [PMID: 12578213 DOI: 10.1243/095441103762597665] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Total hip replacement has become one of the most successful orthopaedic procedures. However, complications due to infections may give serious problems and have devastating consequences for the hip implant. The use of a temporary three-dimensional polymethylmethacrylate (PMMA) cement spacer may be an alternative to solve infections in hip implants, improving the lives of patients awaiting reimplantation. In order to evaluate their wear behaviour, five PMMA Spacer-G femoral heads were tested against five post-mortem pelves in a hip joint simulator with bovine calf serum as lubricant. The surface of the worn spacers was characterized by scanning electron microscopy (SEM) analysis; all the samples revealed a similar morphology, showing areas characterized by different degrees of wear. Particle debris was isolated from the lubricant and PMMA particles and bone fractions were quantified. The amount of debris was found to be higher than where no-temporary prostheses were used. However, this result is acceptable since wear debris is removed by lavage irrigation when the Spacer-G is explanted. On the basis of these data, it is considered that the use of the cement Spacer-G could be a promising approach to the treatment of complicated infections of the hip joint. Therefore, Spacer-G is worthy of further research.
Collapse
Affiliation(s)
- S Affatato
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | | | | | | |
Collapse
|
35
|
Sun DH, Trindade MCD, Nakashima Y, Maloney WJ, Goodman SB, Schurman DJ, Smith RL. Human serum opsonization of orthopedic biomaterial particles: protein-binding and monocyte/macrophage activation in vitro. J Biomed Mater Res A 2003; 65:290-8. [PMID: 12734824 DOI: 10.1002/jbm.a.10477] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wear particles generated after total joint arthroplasty activate monocyte/macrophages and incite formation of a granulomatous periprosthetic tissue associated with bone loss and implant loosening. This study tested the hypothesis that selective opsonization of orthopedic implant biomaterial wear particles by human serum proteins influences monocyte/macrophage activation. Serum protein binding to metallic, polymeric, and ceramic particles was determined by one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Individual proteins bound to particles were subsequently identified using two-dimensional SDS-PAGE, microsequencing techniques, and SWISS-PROT analysis. Effects of selective protein opsonization on particle-induced monocyte/macrophage activation were assessed by quantification of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha release. Results from one-dimensional gel analyses revealed distinct serum protein-binding patterns specific for each material tested. Two-dimensional gel analysis together with amino acid sequencing of the prominent protein species confirmed the presence of albumin and alpha-1-antitrypsin bound to all particles tested. In contrast to the metallic particles, apolipoprotein was a major species associated with polymeric particles. Opsonization of PMMA particles with purified preparations of each of the identified proteins showed that albumin significantly enhanced particle-induced monocyte/macrophage activation. These data confirm orthopedic biomaterial specific binding of human serum proteins and demonstrate that albumin exacerbates particle-induced monocyte/macrophage activation. Alterations in the chemical and surface properties of orthopedic biomaterials to modulate protein interactions may improve implant longevity.
Collapse
Affiliation(s)
- Doo-Hoon Sun
- Orthopaedic Research Laboratory, Stanford University School of Medicine, Stanford, CA 94305-5341, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Arora A, Song Y, Chun L, Huie P, Trindade M, Smith RL, Goodman S. The role of the TH1 and TH2 immune responses in loosening and osteolysis of cemented total hip replacements. J Biomed Mater Res A 2003; 64:693-7. [PMID: 12601781 DOI: 10.1002/jbm.a.10200] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mechanisms underlying the development of osteolysis and aseptic loosening have an impact on the longevity of total hip replacements (THRs). This study examines the specific roles of lymphocytes in the TH1 and TH2 subsets in osteolysis and aseptic loosening of THR. Tissue from periprosthetic regions from patients with loose, cemented acetabular components were used to determine the TH1 and TH2 cytokine profile. Twelve tissue specimens from patients with radiographic signs of osteolysis, and nine tissue specimens from patients with no signs of osteolysis were harvested during revision surgery. Immunohistochemistry using primary antibodies against CD3, interferon (IFN)-gamma, interleukin (IL)-2, IL-4, and IL-10 was performed on frozen sections to determine the percentage of positive cells for each of the sections. No statistically significant differences in the percentage of positive cells expressing cytokines characteristic of the TH1 pathway (IFN-gamma, IL-2) or TH2 pathway (IL-4, IL-10) were found when comparing osteolytic and non-osteolytic tissues. However, significant numbers of T cells (averaging about 10% of the total cells) and TH1 and TH2 immune cytokines (averaging 3-5% of cells) implicate a possible role for immune processes at the prosthetic interface.
Collapse
Affiliation(s)
- Amarpal Arora
- Division of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, California 94305, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Bos I, Johannisson R. [Transmission electron microscopy image of wear particles of joint endoprostheses and ultrastructural cell changes]. BIOMED ENG-BIOMED TE 2003; 48:20-6. [PMID: 12655845 DOI: 10.1515/bmte.2003.48.1-2.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Wear particles from joint endoprostheses vary considerably in size, and may be detectable in tissue only by electron microscopy. Wear debris plays a central role in the non-infectious late loosening of prostheses, and it has been estimated that the submicron particles induce increased liberation of mediators of osteolysis by activated macrophages. From the types of prostheses currently in use, bone cement and polyethylene particles greatly predominate over metallic and ceramic particles. Since it had formerly not been possible to reliably identify wear particles in the transmission electron microscopy, and descriptions of them in the literature varied considerably, we analysed ultrathin sections obtained from periprosthetic tissue containing wear particles previously identified by laser microprobe mass analysis. Using this method, it proved possible to classify almost all the wear particles detected in the electron microscope, to determine their size range and to represent the cellular alterations caused by them.
Collapse
Affiliation(s)
- I Bos
- Institut für Pathologie, Universitätsklinik Schleswig-Holstein-Campus Lübeck.
| | | |
Collapse
|
38
|
Stea S, Visentin M, Donati ME, Granchi D, Ciapetti G, Sudanese A, Toni A. Nitric oxide synthase in tissues around failed hip prostheses. Biomaterials 2002; 23:4833-8. [PMID: 12361623 DOI: 10.1016/s0142-9612(02)00236-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nineteen patients who had undergone hip revision surgery for aseptic loosening of joint prostheses were studied. Tissue samples were harvested at the interface between bone and implant, either at the stem or at the cotyle level. Immunohistochemistry was performed on tissue sections to detect nitric oxide synthase (NOS), the enzyme which enables the synthesis of nitric oxide (NO), a molecule which can activate bone resorption. Quantitative analysis of the positive cells and correlation with the presence of particulate wear debris and radiological data were performed. The authors observed a trend towards a moderate increase in positive cells due to inducible NOS in tissues containing particulate wear debris, especially of a plastic material. This increase, however, did not achieve statistical significance. On the contrary, there was a statistical correlation between iNOS (inducible NOS) and the severity of osteolysis around the prosthetic implant. Pharmacological control of the biosynthesis of NO may be considered in the prevention or treatment of loosening.
Collapse
Affiliation(s)
- S Stea
- Laboratory of Medical Technology, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
39
|
Sypniewska G, Lis K, Bilinski PJ. Bone turnover markers and cytokines in joint fluid: analyses in 10 patients with loose hip prosthesis and 39 with coxarthrosis. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:518-22. [PMID: 12440494 DOI: 10.1080/000164702321022785] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We analyzed bone turnover markers (osteocalcin, bone ALP, beta-crosslaps-CTX) and cytokines (IL-1, IL-8 and IL-10) in hip joint fluid in 10 patients before revision surgery and in 39 with idiopathic coxarthrosis. Patients with loose implants had lower concentrations of resorption marker than those with arthrosis (0.8 vs 1.3 ng/mL), but bone formation marker osteocalcin was reduced (4.2 vs 22.6 ng/mL). IL-8 and IL-10 levels were elevated in patients with implant failure (870 vs 340 pg/mL; 14.3 vs 4.0 pg/mL). We found a negative correlation between the bone resorption marker (CTX) and IL-10 in cases with prosthesis loosening and a positive correlation between IL-10 and time-to-revision. We conclude that enhanced local production of inflammatory cytokines leading to suppressed bone formation is a part of the loosening process. The expression of anti-inflammatory mediators is not sufficient to counteract the imbalance in bone turnover.
Collapse
Affiliation(s)
- Grazyna Sypniewska
- Department of Laboratory Medicine, The L. Rydygier Medical University, Bydgoszcz, Poland
| | | | | |
Collapse
|
40
|
Campbell PA, Wang M, Amstutz HC, Goodman SB. Positive cytokine production in failed metal-on-metal total hip replacements. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:506-12. [PMID: 12440492 DOI: 10.1080/000164702321022767] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tissues surrounding failed conventional total hips have been shown to produce inflammatory cytokines that can induce osteoclastic bone resorption. We evaluated the cytokine profiles of tissues from 5 failed metal-on-metal total hip replacements. Serial frozen sections were stained using immunohistochemical and in situ hybridization techniques. Inflammatory and osteoclast-stimulating cytokines were noted in the tissues. As compared to a group of 5 metal-polyethylene hip tissues, we found fewer CD68 positive macrophages, and lower levels of TGF-beta and TNF-alpha, but no differences in CD3 positive lymphocytes, IL-1beta, IL-6 and PDGF-alpha in the metal-on-metal tissues. This may be due, in part to the presence of wear particles from sources other than the bearing surfaces. Thus, cytokines associated with bone resorption and implant loosening may occur in total hips despite the use of alternative bearing materials.
Collapse
Affiliation(s)
- Patricia A Campbell
- Joint Replacement Institute, Orthopaedic Hospital, Los Angeles, CA 9000, USA.
| | | | | | | |
Collapse
|
41
|
Gretzer C, Werthén M, Thomsen P. Apoptosis and cytokine release in human monocytes cultured on polystyrene and fibrinogen-coated polystyrene surfaces. Biomaterials 2002; 23:1639-48. [PMID: 11922467 DOI: 10.1016/s0142-9612(01)00290-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of polystyrene (PS) material surface preadsorption with fibrinogen (3 mg/ml) and a low concentration of lipopolysaccharide (LPS; 10 ng/ml) and polystyrene particles (PS; 10(5)/ml) on human monocyte adhesion, viability and cytokine release were studied during 24h culture in vitro. LPS caused an upregulation of CD14 in adherent cells. In comparison with unstimulated cells on uncoated polystyrene surfaces, LPS did not alter the number of adherent cells but caused a markedly increased release of the proinflammatory cytokines (IL-1alpha and TNF-alpha) and the down-regulating IL-10. The expression of indicators of various stages of cell death, TdT, annexin-V, propidium iodide (PI) and lactate dehydrogenase (LDH), were unaltered, decreased, decreased and increased, respectively, after LPS stimulation. PS particles (3 microm psi) caused an increased DNA fragmentation but had a reduced proportion of annexin-V and PI positive cells in comparison with unstimulated cells on uncoated PS. In contrast, 1microm psi particles had a similar proportion of TdT, annexin-V and PI expressing cells as unstimulated controls. Cultures stimulated with particles (irrespective of size), had a similar concentration of proinflammatory cytokines as unstimulated controls, whereas a higher level of IL-10 was detected. Precoating of PS with fibrinogen revealed an enhanced cell adhesion and a concomitant reduction of CD14 expression. irrespective of stimulation with various agonists. The proportions of TdT, annexin-V and PI positive cells were unaltered or reduced on fibrinogen-coated PS in both unstimulated and agonist-challenged cultures. However, depending on the presence and type of agonist, fibrinogen mediated either a markedly increased (LPS) or equivalent (particles and unstimulated) IL-1alpha and TNFalpha release. Further, in comparison with uncoated substrates, fibrinogen was associated with a reduction of IL-10 release, irrespective of the type of stimuli. These observations, using low concentrations of bacterial and material products, indicate that fibrinogen modulates cell material interactions and up- and down-regulates specific events depending on the nature/ type of immediate stimuli.
Collapse
Affiliation(s)
- C Gretzer
- Institute of Anatomy and Cell Biology, Göteborg University, Sweden.
| | | | | |
Collapse
|
42
|
Akisue T, Bauer TW, Farver CF, Mochida Y. The effect of particle wear debris on NFkappaB activation and pro-inflammatory cytokine release in differentiated THP-1 cells. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2002; 59:507-15. [PMID: 11774309 DOI: 10.1002/jbm.1264] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Orthopedic wear debris has been thought to be an important factor associated with osteolysis and loosening of total joint arthroplasties. Previous in vitro studies have reported that particles of wear debris induce the release of pro-inflammatory cytokines and other inflammatory mediators from macrophages and other cells. Several recent investigations, however, have suggested that the wear particles themselves may not be primarily responsible for the inflammatory cellular responses, but that the observed cytokine release in vitro may be caused by endotoxin adsorbed to commercially available particle preparations. The intracellular pathways involved in macrophage signal transduction also are poorly understood. The purposes of this study are to use isolated orthopedic wear debris particles to evaluate pro-inflammatory cytokine release and nuclear factor kappa B (NFkappaB) activation from macrophages. Cells from human monocyte/macrophage cell line (THP-1) were differentiated and incubated with particles of debris that had been isolated from a failed human total hip arthroplasty. The titanium-alloy particles did not evoke release of TNF-alpha or IL-1beta whereas lipopolysaccharide (LPS) or LPS-treated debris particles induced both TNF-alpha and IL-1beta. LPS-treated particles, but not particles alone, stimulated NFkappaB activation. Our results suggest that at the concentrations tested in this study, endotoxin-free wear debris particles may not themselves initiate inflammatory cellular responses in differentiated THP-1 cells. It is unclear whether adsorbed endotoxin is clinically associated with osteolysis and/or loosening in total joint arthroplasties, but several factors, including adsorbed endotoxin, need to be investigated to explore the cellular responses responsible for osteolysis and/or loosening.
Collapse
Affiliation(s)
- Toshihiro Akisue
- Departments of Anatomic Pathology and Orthopaedic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | | | | |
Collapse
|
43
|
Yaszay B, Trindade MC, Lind M, Goodman SB, Smith RL. Fibroblast expression of C-C chemokines in response to orthopaedic biomaterial particle challenge in vitro. J Orthop Res 2001; 19:970-6. [PMID: 11562149 DOI: 10.1016/s0736-0266(01)00003-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
C-C chemokines are soluble mediators that occur in a periprosthetic granuloma and influence recruitment, localization and activation of inflammatory cells. This study tested effects of titanium and polymethylmethacrylate (PMMA) particles on expression of selected C-C chemokines in cultured human fibroblasts. The C-C chemokines analyzed included monocyte chemoattractant protein-1. 2 (MCP-1. 2), monocyte inflammatory protein-1 alpha (MIP-1 alpha), and regulated on activation, normal T-cell expressed and secreted protein (RANTES). Interleukin-1 beta (IL-1 beta) served as a known stimulator of chemokine release while interleukin-6 (IL-6) expression served as a marker for fibroblast activation. Protein and mRNA signal levels were determined by ELISA and RT-PCR, respectively. The results demonstrated that exposure of fibroblasts to titanium and PMMA particles resulted in increased release of MCP-1 in a dose- and time-dependent manner. After 24 h, titanium particles maximally upregulated MCP-1 release 7-fold while PMMA particles increased MCP-1 levels 2-fold, when compared to unchallenged fibroblasts. MCP-2, MIP-1 alpha and RANTES levels remained unchanged following exposure of fibroblasts to titanium or PMMA particles at any concentration or time point tested. However, IL-1 beta stimulated release of MCP-1, MCP-2, and RANTES, but not MIP-1 alpha from the fibroblasts. IL-1 beta, not particles, exhibited the most prominent effect on MCP-1 mRNA levels. Increased release of MCP-1 from fibroblasts exposed to titanium and PMMA particles coincided with increased release of IL-6. This study suggests that release of chemoattractant factors from fibroblasts localized in periprosthetic membranes enhances the chronic inflammatory process leading to bone resorption and implant loosening.
Collapse
Affiliation(s)
- B Yaszay
- Orthopaedic Research Laboratory, Stanford University, School of Medicine, CA 94305-5341, USA
| | | | | | | | | |
Collapse
|
44
|
Trindade MC, Lind M, Nakashima Y, Sun D, Goodman SB, Schurman DJ, Smith RL. Interleukin-10 inhibits polymethylmethacrylate particle induced interleukin-6 and tumor necrosis factor-alpha release by human monocyte/macrophages in vitro. Biomaterials 2001; 22:2067-73. [PMID: 11432585 DOI: 10.1016/s0142-9612(00)00376-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Periprosthetic membranes commonly observed at sites of total joint implant loosening exhibit abundant macrophages and particulate debris. Macrophages phagocytose orthopedic debris and release the pro-inflammatory mediators interleukin-1, interleukin-6, tumor necrosis factor-alpha, and prostaglandin E2. Populations of activated lymphocytes are often seen in periprosthetic membranes. These lymphocytes may modulate the monocyte/macrophage response to particulate debris and influence aseptic loosening. In addition, other immunologic agents, such as interleukin-10, are present in tissues harvested from the bone-implant interface of failed total joint arthroplasties. The present study examined the effects of interleukin-10 on polymethylmethacrylate (PMMA) particle challenged human monocyte/macrophages in vitro. Human monocyte/macrophages isolated from buffy coats of five healthy individuals were exposed to 1-10 microm PMMA particles. Interleukin-10 was added to the monocyte/macrophages with and without the addition of PMMA particles. Interleukin-10-induced alterations in monocyte/macrophage metabolism were determined measuring interleukin-6 and tumor necrosis factor-alpha release by the cells following exposure to PMMA particles. Exposure of the monocyte/macrophages to PMMA particles resulted in a dose-dependent release of interleukin-6 and tumor necrosis factor-alpha at 48 h. Interleukin-10 reduced the levels of interleukin-6 and tumor necrosis factor-alpha release by macrophages in response to PMMA particles in a dose-dependent manner. At 48 h, particle-induced interleukin-6 release was inhibited by 60 and 90% with 1.0 and 10.0 ng/ml treatments of interleukin-10, respectively. At 48 h, particle-induced tumor necrosis factor-alpha release was inhibited by 58 and 88% with 1.0 and 10.0 ng/ml treatments of interleukin-10, respectively. Interleukin-10 challenge alone did not significantly alter basal interleukin-6 or tumor necrosis factor-alpha release relative to control cultures. The data presented in this study demonstrate that the anti-inflammatory cytokine, interleukin-10, inhibits monocyte/macrophage release of the pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha in response to PMMA particle challenge in vitro.
Collapse
Affiliation(s)
- M C Trindade
- Orthopaedic Research Laboratory, Stanford University Medical Center, CA 94305-5341, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Fisher J, Bell J, Barbour PS, Tipper JL, Matthews JB, Besong AA, Stone MH, Ingham E. A novel method for the prediction of functional biological activity of polyethylene wear debris. Proc Inst Mech Eng H 2001; 215:127-32. [PMID: 11382071 DOI: 10.1243/0954411011533599] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The comparative performance of artificial hip joints has been extensively investigated in vitro through measurements of wear volumes. In vivo a major cause of long-term failure is wear-debris-induced osteolysis. These adverse biological reactions are not simply dependent on wear volume, but are also controlled by the size and volumetric concentration of the debris. A novel model is presented which predicts functional biological activity; this is determined by integrating the product of the biological activity function and the volumetric concentration function with the wear volume over the whole particle size range. This model combines conventional wear volume measurements with particle analysis and the output from in vitro cell culture studies to provide a new indicator of osteolytic potential. The application of the model is demonstrated through comparison of the functional biological activity of wear debris from polyethylene acetabular cups articulating under three different conditions in a hip joint simulator.
Collapse
Affiliation(s)
- J Fisher
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Inomoto M, Miyakawa S, Mishima H, Ochiai N. Elevated interleukin-12 in pseudosynovial fluid in patients with aseptic loosening of hip prosthesis. J Orthop Sci 2001; 5:369-73. [PMID: 10982686 DOI: 10.1007/s007760070045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Loosening of a prosthesis is a major problem in total joint arthroplasty. To assess levels of cytokines in patients with such loosening, we measured the pseudosynovial fluid concentration of the following cytokines; tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-4, IL-6, IL-10, IL-12, matrix metalloproteinase (MMP)-1, and MMP-3. We examined the pseudosynovial fluid in patients with a loose hip prosthesis (group A; n = 8) and the synovial fluid in patients with osteoarthritis (OA) of the hip (group B; n = 18) using enzyme-linked immunosorbent assays. The mean concentration of IL-12 was significantly higher in group A than in group B (P < 0.01). Also, we found a significant (P < 0.05) correlation between the concentration of IL-12 and the concentration of MMP-1 in the patients with prosthesis loosening. The concentrations of TNF-alpha, IL-1beta, IL-4, IL-6, IL-10, IFN-gamma, MMP-1, and MMP-3 appeared to be similar in the two groups, although the small number of samples available precluded us from determining that there was no significant difference. The present study is the first to report elevated IL-12 levels in the pseudosynovial fluid of patients with a loose prosthesis. The immunoregulatory effect of IL-12 against wear particles could play an important role in causing loosening of the prosthesis.
Collapse
Affiliation(s)
- M Inomoto
- Department of Orthopaedic Surgery, Institute of Clinical Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | | | | | | |
Collapse
|
47
|
Xu JW, Ma J, Li TF, Waris E, Alberty A, Santavirta S, Konttinen YT. Expression of epidermal growth factor and transforming growth factor alpha in interfacial membranes retrieved at revision total hip arthroplasty. Ann Rheum Dis 2000; 59:822-7. [PMID: 11005785 PMCID: PMC1753009 DOI: 10.1136/ard.59.10.822] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The interfacial membrane between bone and implant has been shown to be a key tissue in the process of aseptic loosening of total hip arthroplasty. The cells within the interfacial membrane produce numerous inflammatory mediators which, through complex mechanisms, cause periprosthetic osteolysis and aseptic loosening. Both epidermal growth factor (EGF) and transforming growth factor alpha (TGFalpha) have similar biological functions. They have been found to stimulate bone resorption. OBJECTIVE To investigate the presence, cellular localisation, and extent of expression of EGF and TGFalpha in interfacial membrane retrieved from revision total hip arthroplasty and compare it with that in synovial membrane from primary total hip arthroplasty. METHODS Ten interfacial membranes and 10 synovial membranes were stained with avidin-biotin-peroxidase complex for EGF and TGFalpha. The staining process was done using the Lab Vision Autostainer. The results were measured by a semiautomatic VIDAS image analysis system. RESULTS Immunoreactivity for both EGF and TGFalpha was found in the endothelial cells of blood vessels, macrophages, and fibroblasts, both in interfacial membranes and synovial membranes. However, the number of EGF (980 (370)) and TGFalpha (1070 (360)) positive cells per mm(2) was greater in interfacial membranes than in the synovial membranes (220 (200), 270 (100); p<0.01). CONCLUSION It is suggested that owing to their increased expression in interfacial membrane, EGF and TGFalpha may have an important pathogenetic role in stimulating periprosthetic bone resorption in aseptic loosening of total hip arthroplasty.
Collapse
Affiliation(s)
- J W Xu
- Institute of Biomedicine, Department of Anatomy, University of Helsinki, Finland
| | | | | | | | | | | | | |
Collapse
|
48
|
Trindade MC, Schurman DJ, Maloney WJ, Goodman SB, Smith RL. G-protein activity requirement for polymethylmethacrylate and titanium particle-induced fibroblast interleukin-6 and monocyte chemoattractant protein-1 release in vitro. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 51:360-8. [PMID: 10880077 DOI: 10.1002/1097-4636(20000905)51:3<360::aid-jbm9>3.0.co;2-e] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Periprosthetic granulomatous membranes consisting of fibroblasts, macrophages, lymphocytes, foreign body giant cells, and abundant particulate debris occur at sites of implant loosening. Previous studies demonstrate that fibroblasts respond to particulate debris through the release of interleukin-6 (IL-6), prostaglandin E(2), and matrix metalloproteinases in vitro. C-C chemokines are observed in granulomatous tissue surrounding loosened prosthetic implants and are released by macrophages and fibroblasts in response to particle challenge in vitro. This study tested the hypothesis that G protein activity is required for fibroblast activation by titanium and polymethylmethacrylate (PMMA) particles, and that inhibition of G protein activity would alter IL-6 and and monocyte chemoattractant protein-1 (MCP-1) release from activated fibroblasts. The specific inhibitor of G protein activity, pertussis toxin, was added to the fibroblasts to examine the effects of G protein activity with respect to the production of IL-6 and MCP-1 by orthopedic biomaterial-challenged fibroblasts in vitro. Interleukin-1beta (IL-1beta), a proven activator of MCP-1 and interleukin-6, was used as a positive control. Exposure of fibroblasts to titanium and polymethylmethacrylate (PMMA) particles resulted in a dose-dependent release of MCP-1 and IL-6. Challenge with PMMA particles at doses of 0.150%, 0.300%, and 0.600% vol/vol increased the release of interleukin-6 by 7-, 19-, and 22-fold, respectively, compared to fibroblasts exposed to serum-free culture medium alone at 24 h. Challenge with PMMA particles at doses of 0.075%, 0.150%, 0.300%, and 0.600% vol/vol increased the release of MCP-1-6 by 2.5-, 3.6-, 4. 3-, and 4.5-fold, respectively, compared to fibroblasts exposed to serum-free culture medium alone. Challenge with titanium particles at concentrations of 0.075%, 0.150%, 0.300%, and 0.600% vol/vol increased the release of interleukin-6 by 2.6-, 6.4-, 9.6-, and 10. 0-fold, respectively, compared to fibroblasts exposed to serum-free culture medium alone at 24 h. Challenge with titanium particles at concentrations of 0.038%, 0.075%, 0.150%, 0.300%, and 0.600% vol/vol increased the release of MCP-1 by 2.9-, 3.1-, 5.8-, 5.4-, and 5. 8-fold, respectively, compared to fibroblasts exposed to serum-free culture medium alone. Pretreatment of fibroblasts with pertussis toxin inhibited the release of interleukin-6 and MCP-1 from PMMA and titanium particle challenged fibroblasts in a dose-dependent manner. PMMA particle induced fibroblast IL-6 release was inhibited by 23.6% and 35.3% with 20- and 200-ng/mL doses of pertussis toxin, respectively. Titanium particle induced fibroblast IL-6 release was inhibited by 48.2% and 56.3% with 20- and 200-ng/mL doses of pertussis toxin, respectively. PMMA particle-induced fibroblast MCP-1 release was inhibited by 36.0%, 50.4%, and 60.1% with 2-, 20- and 200-ng/mL doses of pertussis toxin, respectively. Titanium particle-induced fibroblast MCP-1 release was inhibited by 15.5%, 53.2%, and 64.6% with 2-, 20-, and 200-ng/mL doses of pertussis toxin, respectively. This study suggests that fibroblasts localized in periprosthetic membranes are a source of macrophage chemoattractant factors and proinflammatory mediators that may influence granuloma formation and lead to periprosthetic bone resorption. Furthermore, this study shows that G proteins are involved in particle-induced fibroblast activation, as evidenced by decrease levels of particle induced IL-6 and MCP-1 release following pertussis toxin treatment. (c) 2000 John Wiley & Sons, Inc.
Collapse
Affiliation(s)
- M C Trindade
- Orthopaedic Research Laboratory, Stanford University School of Medicine, Stanford, California 94305, USA.
| | | | | | | | | |
Collapse
|
49
|
Abstract
The vast majority of total hip prostheses currently implanted consist of a hard metal or ceramic femoral head articulating against an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Over the last 10 years, evidence has accumulated to show that these prostheses are prone to failure due to late aseptic loosening and few survive beyond 25 years. With an increasing need to implant hip prostheses in the younger, more active patient the need to understand the mechanisms of failure and to develop artificial hip joints using alternative materials have become major issues in the orthopaedic community. This review focuses initially on our current understanding of the biological reactions to UHMWPE prosthetic wear debris in vivo and in vitro since this is believed to be the main cause of late aseptic loosening. While the precise mechanisms of osteolysis induced by UHMWPE wear debris have not been elucidated, the major message to emerge is that it is not the wear volume that determines the biological response to the debris, but the concentration of the wear volume that is within the critical size range (0.2-0.8 micron) for macrophage activation. The review then considers whether the problem of wear-debris-induced osteolysis may be overcome with the use of new generation metal-on-metal or ceramic-on-ceramic prostheses. For metal-on-metal prostheses, the prospects for increasing the osteolysis free life of the implant are good but additional biological problems associated with the nanometre size and reactivity of the wear particles in vivo may emerge. For the ceramic-on-ceramic prostheses, although initial prospects are encouraging, more data are needed on the characteristics of the wear particles generated in vivo before predictions can be made. It is concluded that the pre-clinical testing of any new materials for joint replacement must include an analysis of the wear particle characteristics and their biological reactivity in addition to the usual assessment of wear.
Collapse
Affiliation(s)
- E Ingham
- Department of Microbiology, University of Leeds, UK
| | | |
Collapse
|
50
|
Jones LC, Frondoza C, Hungerford DS. Immunohistochemical evaluation of interface membranes from failed cemented and uncemented acetabular components. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 48:889-98. [PMID: 10556856 DOI: 10.1002/(sici)1097-4636(1999)48:6<889::aid-jbm19>3.0.co;2-s] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aseptic loosening of acetabular components is a primary factor compromising the long-term outcome of cemented and cementless total hip replacement. It is unknown whether the pathogenesis of the loosening process is identical for both types of fixation. The specific aim of this study was to determine whether there is a difference in the cellular and cytokine profiles of interface membranes removed from between the implant and the host bone from failed cemented (n = 5) and failed cementless acetabulae (n = 5). Routine histology and immunohistochemical evaluations were completed on each tissue specimen. The monoclonal antibodies used included those specific for cell types (macrophages, fibroblasts, T lymphocytes) and for cytokines (IL-1beta, IL-6, TNF-alpha). The patients were all revised for loosening. The time to revision was significantly longer for the cemented group (16.6 yr; 13-21 range) than for the cementless group (8.9 yr; 4-13 range). In all cases, slides from each group stained positively for each of the cell types and cytokines evaluated. Immunohistochemical analyses indicated a predominance of macrophages and ubiquitous staining for the cytokines IL-1beta and TNF-alpha within the membranes of both patient groups. The intensities of cytokine staining were similar for both patient groups. More regions of fibroblastic connective tissue were observed surrounding failed cementless components as compared to those of the cemented group. The clinical ramification of our findings is that, despite differences in the cellular composition of the periprosthetic membranes, the membranes from failed cemented and cementless implants contain cytokines, which have been shown to be capable of modulating the inflammatory response. These inflammatory mediators are likely to play a significant role in the development of osteolysis and prosthetic loosening.
Collapse
Affiliation(s)
- L C Jones
- Division of Arthritis Surgery, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | |
Collapse
|