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Cong Y, Wang Y, Yuan T, Zhang Z, Ge J, Meng Q, Li Z, Sun S. Macrophages in aseptic loosening: Characteristics, functions, and mechanisms. Front Immunol 2023; 14:1122057. [PMID: 36969165 PMCID: PMC10030580 DOI: 10.3389/fimmu.2023.1122057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Aseptic loosening (AL) is the most common complication of total joint arthroplasty (TJA). Both local inflammatory response and subsequent osteolysis around the prosthesis are the fundamental causes of disease pathology. As the earliest change of cell behavior, polarizations of macrophages play an essential role in the pathogenesis of AL, including regulating inflammatory responses and related pathological bone remodeling. The direction of macrophage polarization is closely dependent on the microenvironment of the periprosthetic tissue. When the classically activated macrophages (M1) are characterized by the augmented ability to produce proinflammatory cytokines, the primary functions of alternatively activated macrophages (M2) are related to inflammatory relief and tissue repair. Yet, both M1 macrophages and M2 macrophages are involved in the occurrence and development of AL, and a comprehensive understanding of polarized behaviors and inducing factors would help in identifying specific therapies. In recent years, studies have witnessed novel discoveries regarding the role of macrophages in AL pathology, the shifts between polarized phenotype during disease progression, as well as local mediators and signaling pathways responsible for regulations in macrophages and subsequent osteoclasts (OCs). In this review, we summarize recent progress on macrophage polarization and related mechanisms during the development of AL and discuss new findings and concepts in the context of existing work.
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Affiliation(s)
- Yehao Cong
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yi Wang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tao Yuan
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zheng Zhang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jianxun Ge
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Qi Meng
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ziqing Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
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Shelly S, Liraz Zaltsman S, Ben-Gal O, Dayan A, Ganmore I, Shemesh C, Atrakchi D, Garra S, Ravid O, Rand D, Israelov H, Alon T, Lichtenstein G, Sharabi S, Last D, Gosselet F, Rosen V, Burstein G, Friedlander A, Harel R, Vogel G, Schnaider Beeri M, Mardor Y, Lampl Y, Fleminger G, Cooper I. Potential neurotoxicity of titanium implants: Prospective, in-vivo and in-vitro study. Biomaterials 2021; 276:121039. [PMID: 34352627 DOI: 10.1016/j.biomaterials.2021.121039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 02/08/2023]
Abstract
Titanium dioxide (TiO2) is a frequently used biomaterial, particularly in orthopedic and dental implants, and it is considered an inert and benign compound. This has resulted in toxicological scrutiny for TiO2 in the past decade, with numerus studies showing potential pathologic downstream effects. Herein we describe case report of a 77-year-old male with subacute CNS dysfunction, secondary to breakdown of a titanium-based carotid stent and leading to blood levels 1000 times higher (3 ppm) than the reported normal. We prospectively collected tissues adjacent to orthopedic implants and found a positive correlation between titanium concentration and time of implant in the body (r = 0.67, p < 0.02). Rats bearing titanium implants or intravascularly treated with TiO2 nanoparticles (TiNP) exhibited memory impairments. A human blood-brain barrier (BBB) in-vitro model exposed to TiNP showed paracellular leakiness, which was corroborated in-vivo with the decrease of key BBB transcripts in isolated blood vessels from hippocampi harvested from TiNP-treated mice. Titanium particles rapidly internalized into brain-like endothelial cells via caveolae-mediated endocytosis and macropinocytosis and induced pro-inflammatory reaction with increased expression of pro-inflammatory genes and proteins. Immune reaction was mediated partially by IL-1R and IL-6. In summary, we show that high levels of titanium accumulate in humans adjacent to orthopedic implants, and our in-vivo and in-vitro studies suggest it may be neurotoxic.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, College of Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Sigal Liraz Zaltsman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Department of Pharmacology, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel; Institute for Health and Medical Professions, Department of Sports Therapy, Ono Academic College, Kiryat Ono, Israel
| | - Ofir Ben-Gal
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Avraham Dayan
- The Shmunis School of Biomedicine and Cancer Research, The George Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Chen Shemesh
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Dana Atrakchi
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Sharif Garra
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Orly Ravid
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Daniel Rand
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Israelov
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel
| | - Tayir Alon
- Neurology Department, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | | | - Shirley Sharabi
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - David Last
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - Fabien Gosselet
- Univ. Artois, UR 2465, Blood-brain Barrier Laboratory (LBHE), F-62300 Lens, France
| | - Vasiliy Rosen
- The ICP Unit, The Core Facility of the Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, 7610001, Israel
| | | | - Alon Friedlander
- Spine Surgery Division, Department of Orthopedics, Sheba Medical Center, Israel
| | - Ran Harel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Israel
| | - Guy Vogel
- Department of Orthopedic, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel; Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yael Mardor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, 52621, Israel
| | - Yair Lampl
- Department of Neurology, Wolfson Medical Center, Holon, Israel
| | - Gideon Fleminger
- The Shmunis School of Biomedicine and Cancer Research, The George Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Itzik Cooper
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Israel; School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel; The Nehemia Rubin Excellence in Biomedical Research - The TELEM Program, Sheba Medical Center, Tel-Hashomer, Israel.
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