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Panez-Toro I, Heymann D, Gouin F, Amiaud J, Heymann MF, Córdova LA. Roles of inflammatory cell infiltrate in periprosthetic osteolysis. Front Immunol 2023; 14:1310262. [PMID: 38106424 PMCID: PMC10722268 DOI: 10.3389/fimmu.2023.1310262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Classically, particle-induced periprosthetic osteolysis at the implant-bone interface has explained the aseptic loosening of joint replacement. This response is preceded by triggering both the innate and acquired immune response with subsequent activation of osteoclasts, the bone-resorbing cells. Although particle-induced periprosthetic osteolysis has been considered a foreign body chronic inflammation mediated by myelomonocytic-derived cells, current reports describe wide heterogeneous inflammatory cells infiltrating the periprosthetic tissues. This review aims to discuss the role of those non-myelomonocytic cells in periprosthetic tissues exposed to wear particles by showing original data. Specifically, we discuss the role of T cells (CD3+, CD4+, and CD8+) and B cells (CD20+) coexisting with CD68+/TRAP- multinucleated giant cells associated with both polyethylene and metallic particles infiltrating retrieved periprosthetic membranes. This review contributes valuable insight to support the complex cell and molecular mechanisms behind the aseptic loosening theories of orthopedic implants.
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Affiliation(s)
- Isidora Panez-Toro
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Dominique Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
- The University of Sheffield, Dept of Oncology and Metabolism, Sheffield, United Kingdom
| | - François Gouin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Jérôme Amiaud
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
| | - Marie-Françoise Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Luis A. Córdova
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
- Oral and Maxillofacial Surgery, Clínica MEDS, Santiago, Chile
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Planitzer U, Hammer N, Bechmann I, Glätzner J, Löffler S, Möbius R, Tillmann BN, Weise D, Winkler D. Positional Relations of the Cervical Vagus Nerve Revisited. Neuromodulation 2017; 20:361-368. [PMID: 28145065 DOI: 10.1111/ner.12557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/19/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The cervical part of the vagus nerve (CVN) has become an important target for stimulation therapy to treat epilepsy and psychiatric conditions. For this purpose, the CVN is visualized in the carotid sheath, assuming it to be localized dorsomedially between the carotid artery (CA) and the internal jugular vein (JV). The aim of our morphological study was therefore to revisit the CVN relationships to the CA and JV, hypothesizing it to have common variations to this classical textbook anatomy. MATERIALS AND METHODS Positional relations of the CVN, CA and JV were investigated in the carotid sheath of 35 cadavers at the C3 to C6 level. Positional relations of the CVN, CA and JV were documented on the basis of a 3 × 3 chart. RESULTS Eighteen different arrangements of the CVN, CA and JV were observed. The typical topographic relationship of the CVN dorsomedially between the CA and JV was only found in 42% of all cases. The CVN was located dorsally or (dorso-)laterally to the CA in 80% and dorsally or (dorso-)medially of the JV in 96% of all cases. CONCLUSIONS Classical textbook anatomy of the CVN is only present in a minority of cases. Positional variations in contrast to textbook anatomy are considerably more frequent than previously described, which might be a hypothetical morphological explanation for the lack of efficacy or side effects of CVN stimulation. Furthermore, the position of the CVN relative to the internal jugular vein is more consistent than to the CA.
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Affiliation(s)
- Uwe Planitzer
- Faculty of Medicine, Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany.,Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Ingo Bechmann
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Juliane Glätzner
- Faculty of Medicine, Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany
| | - Sabine Löffler
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Robert Möbius
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | | | - David Weise
- Faculty of Medicine, Department of Neurology, University Clinic of Leipzig, Leipzig, Germany
| | - Dirk Winkler
- Faculty of Medicine, Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany
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Hammer N, Glätzner J, Feja C, Kühne C, Meixensberger J, Planitzer U, Schleifenbaum S, Tillmann BN, Winkler D. Human vagus nerve branching in the cervical region. PLoS One 2015; 10:e0118006. [PMID: 25679804 PMCID: PMC4332499 DOI: 10.1371/journal.pone.0118006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. MATERIALS AND METHODS Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. RESULTS Cervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm2 vs. 5.28 mm2). DISCUSSION Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.
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Affiliation(s)
- Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Juliane Glätzner
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christine Feja
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christian Kühne
- Department of Cardiology, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Uwe Planitzer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopedic, Trauma and Reconstructive Surgery, University Clinic of Leipzig, Leipzig, Germany
| | | | - Dirk Winkler
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
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Hammer N, Huster D, Fritsch S, Hädrich C, Koch H, Schmidt P, Sichting F, Wagner MFX, Boldt A. Do cells contribute to tendon and ligament biomechanics? PLoS One 2014; 9:e105037. [PMID: 25126746 PMCID: PMC4134275 DOI: 10.1371/journal.pone.0105037] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/18/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen. MATERIAL AND METHODS Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS), while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay. RESULTS The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain. DISCUSSION The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in soft tissue repair. Further research will help optimize the SDS-protocol for clinical application.
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Affiliation(s)
- Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Daniel Huster
- Institute of Medical Physics and Biophysics, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Sebastian Fritsch
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - Carsten Hädrich
- Institute of Forensic Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Holger Koch
- Translational Centre for Regenerative Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Peter Schmidt
- Institute of Medical Physics and Biophysics, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Freddy Sichting
- Institute of Sport Science, Department Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Martin Franz-Xaver Wagner
- Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - Andreas Boldt
- Translational Centre for Regenerative Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Institute of Clinical Immunology, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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Winkler D, Hammer N, Gossner J, Schober R, Vitzthum HE, Meixensberger J. Does histology predict the clinical outcome after lumbar intervertebral disc herniation: no. Med Hypotheses 2012; 80:215-9. [PMID: 23265362 DOI: 10.1016/j.mehy.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/18/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The histological analysis of extirpated intervertebral disc material from patients undergoing discectomy due to lumbar disc herniation remains an established procedure. In looking at whether the high costs that histological examination entails can be justified, it is worthwhile to ascertain the actual diagnostic benefit of this procedure. The aim of this study was to address the following hypothesis: Do histological characteristics such as the presence of inflammatory cells (macrophages) predict the clinical outcome of patients undergoing discectomy? MATERIALS AND METHODS A total of 343 patients (221 males, 122 females, mean age 44.7 years) were treated microsurgically by root decompression subsequent to interlaminar fenestration. The patient history, the operated disc segment, the radicular and vegetative symptoms as well as the early and long-term outcome were evaluated. The excised disc material was classified histologically. CD68 staining was performed in 11 randomly chosen patients with good and in 11 patients with poor subjective long-term outcome for quantitative evaluation of macrophage count. RESULTS The follow up rate was 69.7%. Three hundred and five patients underwent disc surgery for the first time and 38 patients underwent relapse disc surgery. Moderate, pronounced and severe degeneration was found in 16, 231 and 92 patients, respectively. Positive subjective assessment of early outcome was 91% and 92% for the primary and relapse group, whereas long-term outcome was positive in 69% and 50% for the primary and the relapse group respectively. No histological features including CD68 (macrophage) count showed statistically significant correlations with the success of clinical treatment. DISCUSSION AND CONCLUSIONS A reliable prediction of the success of treatment, including patient outcome, cannot be made on the basis of the present histological criteria. The hypothesis must therefore be rejected.
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Affiliation(s)
- Dirk Winkler
- Department of Neurosurgery, University of Leipzig, Germany.
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