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Shen H, Kushioka J, Toya M, Utsunomiya T, Hirata H, Huang EE, Tsubosaka M, Gao Q, Li X, Teissier V, Zhang N, Goodman SB. Sex differences in the therapeutic effect of unaltered versus NFκB sensing IL-4 over-expressing mesenchymal stromal cells in a murine model of chronic inflammatory bone loss. Front Bioeng Biotechnol 2022; 10:962114. [PMID: 36046680 PMCID: PMC9421000 DOI: 10.3389/fbioe.2022.962114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Wear particles from joint arthroplasties induce chronic inflammation associated with prolonged upregulation of nuclear factor kappa-B (NF-κB) signaling in macrophages and osteoclasts, which leads to osteolysis and implant loosening. Mesenchymal stromal cell (MSC)-based therapy showed great potential for immunomodulation and mitigation of osteolysis in vivo, especially in the chronic phase of inflammation. We previously generated genetically modified MSCs that secrete the anti-inflammatory cytokine interleukin 4 (IL-4) in response to NF-κB activation (NFκB-IL-4 MSCs). However, whether the impact of sexual difference in the internal environment can alter the therapeutic effects of IL-4 over-secreting MSCs that simultaneously mitigate prolonged inflammation and enhance bone formation remains unknown. This study investigated the therapeutic effects of unaltered MSCs versus NFκB-IL-4 MSCs in mitigating chronic inflammation and enhancing bone formation in male and female mice. The murine model was established by continuous infusion of polyethylene particles contaminated with lipopolysaccharide (cPE) into the medullary cavity of the distal femur for 6 weeks to induce chronic inflammation. Unaltered MSCs or NFκB-IL-4 MSCs were infused into the femoral intramedullary cavity in sex-matched groups beginning 3 weeks after primary surgery. Femurs were harvested at 6 weeks, and bone marrow density was measured with micro-computational tomography. Numbers of osteoclast-like cells, osteoblasts, and macrophages were evaluated with histochemical and immunofluorescence staining. cPE infusion resulted in severe bone loss at the surgery site, increased tartrate-resistant acid phosphatase positive osteoclasts and M1 pro-inflammatory macrophages, and decreased alkaline phosphatase expression. MSC-based therapy effectively decreased local bone loss and polarized M1 macrophages into an M2 anti-inflammatory phenotype. In females, unaltered MSCs demonstrated a larger impact in enhancing the osteogenesis, but they demonstrated similar anti-inflammatory effects compared to NFκB-IL-4 MSCs. These results demonstrated that local inflammatory bone loss can be effectively modulated via MSC-based treatments in a sexually dimorphic manner, which could be an efficacious therapeutic strategy for treatment of periprosthetic osteolysis in both genders.
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Affiliation(s)
- Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Hirohito Hirata
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ejun Elijah Huang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Victoria Teissier
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Bioengineering, Stanford University, Stanford, CA, United States
- *Correspondence: Stuart B. Goodman,
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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Li Z, Zhu X, Xu R, Wang Y, Hu R, Xu W. Deacylcynaropicrin Inhibits RANKL-Induced Osteoclastogenesis by Inhibiting NF-κB and MAPK and Promoting M2 Polarization of Macrophages. Front Pharmacol 2019; 10:599. [PMID: 31231214 PMCID: PMC6567936 DOI: 10.3389/fphar.2019.00599] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/09/2019] [Indexed: 12/21/2022] Open
Abstract
Inflammation can promote the maturity of osteoclasts and bone resorption in many bone disease such as osteoporosis and arthritis. Here, we aimed to investigate the inhibitory effects of deacylcynaropicrin (DAC) on osteoclastogenesis and bone resorption induced by RANKL. Bone-marrow-derived macrophages were used for assessing the influence of DAC on polarization of macrophages and osteoclastogenesis in vitro. Inducible nitric oxide synthase (iNOS) and CD206, as well as osteoclastogenesis markers, nuclear factor of activated T-cells 1 (NFATc1), and c-Fos, were qualitatively analyzed by immunofluorescence, flow cytometry, reverse transcription polymerase chain reaction, and Western blotting. The results showed that DAC significantly inhibited osteoclastogenesis by suppressing the expression levels of c-Fos and NFATc1 through nuclear factor-κB, c-Jun N-terminal kinase (JNK), and Akt pathway. Moreover, immunohistochemistry and enzyme-linked immunosorbent assays showed that DAC reduced the release of tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 in vivo. Finally, DAC also promoted macrophage polarization from M1 to M2 types. In conclusion, these results demonstrated that DAC suppressed RANKL-induced inflammation and osteoclastogenesis and therefore it can be used as a potential treatment for osteoporosis, arthritis, osteolysis, and aseptic loosening of artificial prostheses.
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Affiliation(s)
- Zhikun Li
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaodong Zhu
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Ruijun Xu
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yi Wang
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Ruixi Hu
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wei Xu
- Department of Orthopaedics, TongRen Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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Liu Y, Song F, Ma S, Moro A, Feng W, Liao S, Lin X, Zhao J, Wang Z, Xu J, Zhan X, Liu Q. Vaccarin prevents titanium particle‐induced osteolysis and inhibits RANKL‐induced osteoclastogenesis by blocking NF‐κB and MAPK signaling pathways. J Cell Physiol 2019; 234:13832-13842. [PMID: 30637734 DOI: 10.1002/jcp.28063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Yun Liu
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Fang‐Ming Song
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Shi‐Ting Ma
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
| | - Abu Moro
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
| | - Wen‐Yu Feng
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Shi‐Jie Liao
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Xi‐Xi Lin
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Jin‐Min Zhao
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
| | - Zi‐yi Wang
- School of Biomedical Sciences, The University of Western Australia Perth Western Australia Australia
| | - Jiake Xu
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
- School of Biomedical Sciences, The University of Western Australia Perth Western Australia Australia
| | - Xin‐Li Zhan
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
| | - Qian Liu
- Department of Orthopaedics First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University Nanning Guangxi China
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Wei G, Liang T, Wei C, Nong X, Lu Q, Zhao J. Arctigenin inhibits RANKL‐induced osteoclastogenesis and hydroxyapatite resorption in vitro and prevents titanium particle–induced bone loss in vivo. J Cell Biochem 2018; 120:5367-5376. [PMID: 30317692 DOI: 10.1002/jcb.27815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/12/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Gejin Wei
- Guangxi Medical University Postdoctoral Research Station, Guangxi Medical University Guangxi China
- Department of Orthopedics, Hospital of PLA Guangxi China
| | - Tihong Liang
- Department of Orthopedics Affiliated Hospital of Guizhou Medical University Guiyang China
| | - Chengming Wei
- Guangxi Medical University Postdoctoral Research Station, Guangxi Medical University Guangxi China
| | - Xiaolian Nong
- Guangxi Medical University Postdoctoral Research Station, Guangxi Medical University Guangxi China
| | - Qiteng Lu
- Guangxi Medical University Postdoctoral Research Station, Guangxi Medical University Guangxi China
| | - Jinmin Zhao
- Guangxi Medical University Postdoctoral Research Station, Guangxi Medical University Guangxi China
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Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
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Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
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Pacheco-Martelo V, Roldán-Vasco S. Enzymes and cytokines disease in total hip arthroplasty: promoters of immune loosening. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.61525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introducción. Una de las causas más importantes de falla de la prótesis de cadera lo constituye el fenómeno de aflojamiento, el cual se relaciona con la liberación de enzimas mediada por citocinas y produce la lisis del hueso que soporta el implante.Objetivo. Describir los mecanismos de interacción biológica de las moléculas promotoras del aflojamiento de la prótesis total de cadera que con mayor frecuencia están presentes en el proceso.Materiales y métodos. Se realizó una búsqueda de artículos originales y casos clínicos en las bases de datos PubMed y Scopus, sin límite de fecha de publicación, utilizando los términos MeSH “hip prosthesis loosening”, “aseptic loosening”, “cytokines” y “hip arthroplasty failure”. La extracción de datos se hizo mediante la lectura de 250 estudios, de los cuales se seleccionaron 66 para fines de redacción.Resultados. Los autores describen las moléculas más representativas implicadas en el aflojamiento de la prótesis de cadera, además se presentan las interacciones entre ellas.Conclusiones. Enzimas y citocinas han sido ampliamente estudiadas por cuatro décadas, aunque sus mecanismos de interacción son poco conocidos. Los autores proponen un mecanismo de interacción, proceso que podría denominarse “enfermedad de las enzimas y citocinas” o “aflojamiento inmunológico”.
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Are periprosthetic osteolytic lesions in ankle worth bone grafting? Foot Ankle Surg 2017; 23:128-133. [PMID: 28578796 DOI: 10.1016/j.fas.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND We retrospectively evaluated the medium-term follow-up of bone grafting due to periprosthetic osteolytic lesions in ankles. METHODS 34 ankles (32 patients) with total ankle arthroplasty (TAA) underwent re operation. Indications were large periprosthetic osteolytic lesions or continuous growing of the lesions. The osteolytic lesions were imaged by CT before reoperation and once a year after that. The mean CT follow-up after re operation was 3.8 years (range, 2-6.2 years). Patient's clinical outcome was also monitored. RESULTS Osteolysis continued to progress in 44 bone grafted lesions (68%) in CT follow-up. Pain (p=0.04) and location of the lesion (p=0.03) were associated with progression of osteolysis. In 18 bone grafted osteolytic lesions (28%) the radiological survival remained excellent. 25 out of 34 ankles showed improvement of the function after bone grafting. CONCLUSIONS There is no established treatment protocol for osteolysis around TAA. Bone grafting is one alternative in the treatment of osteolytic lesions.
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Li Y, Li J, Li B, Qin H, Peng X, Zhao Y, Chen Y. Anthocyanin suppresses CoCrMo particle-induced osteolysis by inhibiting IKKα/β mediated NF-κB signaling in a mouse calvarial model. Mol Immunol 2017; 85:27-34. [PMID: 28208071 DOI: 10.1016/j.molimm.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/20/2017] [Accepted: 02/06/2017] [Indexed: 12/23/2022]
Abstract
Wear particle-induced osteolysis and bone resorption have been identified as critical factors of implant failure and total joint revision, in which nuclear factor kappa B (NF-κB) signaling and chronic inflammation have been shown to play key roles. Although anthocyanin is known to have anti-inflammatory function via blocking NF-κB pathway, it is still unclear whether anthocyanin has a protective effect on particle-induced osteolysis. In the present study, we aimed to investigate the detailed effects and the underlying mechanism of anthocyanin on CoCrMo particle-induced osteolysis in a mouse calvavial model. One hundred and twelve male BALB/c mice were divided randomly into four groups: sham group (sham operation and injection with PBS), vehicle group (CoCrMo particle treatment and injection with PBS), low-dose anthocyanin group (CoCrMo particle treatment and injecting anthocyanin with 0.1mg/g/day), and high-dose anthocyanin group (CoCrMo particle treatment and injecting anthocyanin with 0.4mg/g/day). Mice were sacrificed after two weeks, harvesting the calvariae tissue for in depth analysis by micro-CT, histomorphometry, immunohistochemical and molecular biology analysis. As expected, anthocyanin markedly inhibited CoCrMo particle-induced inflammatory infiltration and decreased bone loss in vivo. Anthocyanin also reversed the increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL)/osteoproteger (OPG) and suppressed osteoclast formation in CoCrMo particle-stimulated calvaria. Additionally, anthocyanin significantly reduced the expression and secretion of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in the calvaria of CoCrMo-stimulated mice. Furthermore, we confirmed that anthocyanin attenuated osteolysis by blocking NF-κB pathway via inhibiting inhibitor of nuclear factor kappa-B kinase α/β (IKKα/β) phosphorylation. In conclusion, our study demonstrated that anthocyanin can protect against CoCrMo particle-induced inflammatory osteolysis via inhibiting the IKKα/β-NF-κB pathway, and have a potential therapeutic effect on the treatment of wear particle-induced osteolysis.
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Affiliation(s)
- Yamin Li
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Juehong Li
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Bin Li
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Hui Qin
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Xiaochun Peng
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Yaochao Zhao
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
| | - Yunsu Chen
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7th Floor Orthopaedic Department, No. 6 Building, No. 600 Yishan Road, Shanghai, China.
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A review of UHMWPE wear-induced osteolysis: the role for early detection of the immune response. Bone Res 2016; 4:16014. [PMID: 27468360 PMCID: PMC4941197 DOI: 10.1038/boneres.2016.14] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/08/2016] [Accepted: 05/13/2016] [Indexed: 12/15/2022] Open
Abstract
In a world where increasing joint arthroplasties are being performed on increasingly younger patients, osteolysis as the leading cause of failure after total joint arthroplasty (TJA) has gained considerable attention. Ultra-high molecular weight polyethylene wear-induced osteolysis is the process by which prosthetic debris mechanically released from the surface of prosthetic joints induces an immune response that favors bone catabolism, resulting in loosening of prostheses with eventual failure or fracture. The immune response initiated is innate in that it is nonspecific and self-propagating, with monocytic cells and osteoclasts being the main effectors. To date, detecting disease early enough to implement effective intervention without unwanted systemic side effects has been a major barrier. These barriers can be overcome using newer in vivo imaging techniques and modules linked with fluorescence and/or chemotherapies. We discuss the pathogenesis of osteolysis, and provide discussion of the challenges with imaging and therapeutics. We describe a positron emission tomography imaging cinnamoyl-Phe-(D)-Leu-Phe-(D)-Leu-Phe-Lys module, specific to macrophages, which holds promise in early detection of disease and localization of treatment. Further research and increased collaboration among therapeutic and three-dimensional imaging researchers are essential in realizing a solution to clinical osteolysis in TJA.
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Wang J, Tao Y, Ping Z, Zhang W, Hu X, Wang Y, Wang L, Shi J, Wu X, Yang H, Xu Y, Geng D. Icariin attenuates titanium-particle inhibition of bone formation by activating the Wnt/β-catenin signaling pathway in vivo and in vitro. Sci Rep 2016; 6:23827. [PMID: 27029606 PMCID: PMC4814911 DOI: 10.1038/srep23827] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/14/2016] [Indexed: 12/20/2022] Open
Abstract
Wear-debris-induced periprosthetic osteolysis (PIO) is a common clinical condition following total joint arthroplasty, which can cause implant instability and failure. The host response to wear debris promotes bone resorption and impairs bone formation. We previously demonstrated that icariin suppressed wear-debris-induced osteoclastogenesis and attenuated particle-induced osteolysis in vivo. Whether icariin promotes bone formation in a wear-debris-induced osteolytic site remains unclear. Here, we demonstrated that icariin significantly attenuated titanium-particle inhibition of osteogenic differentiation of mesenchymal stem cells (MSCs). Additionally, icariin increased bone mass and decreased bone loss in titanium-particle-induced osteolytic sites. Mechanistically, icariin inhibited decreased β-catenin stability induced by titanium particles in vivo and in vitro. To confirm icariin mediated its bone-protective effects via the Wnt/β-catenin signaling pathway, we demonstrated that ICG-001, a selective Wnt/β-catenin inhibitor, attenuated the effects of icariin on MSC mineralization in vitro and bone formation in vivo. Therefore, icariin could induce osteogenic differentiation of MSCs and promote new bone formation at a titanium-particle-induced osteolytic site via activation of the Wnt/β-catenin signaling pathway. These results further support the protective effects of icariin on particle-induced bone loss and provide novel mechanistic insights into the recognized bone-anabolic effects of icariin and an evidence-based rationale for its use in PIO treatment.
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Affiliation(s)
- Junhua Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Yunxia Tao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Zichuan Ping
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, 708, ren min Road, Suzhou, 215006, China
| | - Xuanyang Hu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Yijun Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Liangliang Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Jiawei Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Xiexing Wu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006, China
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Jiang X, Sato T, Yao Z, Keeney M, Pajarinen J, Lin TH, Loi F, Egashira K, Goodman S, Yang F. Local delivery of mutant CCL2 protein-reduced orthopaedic implant wear particle-induced osteolysis and inflammation in vivo. J Orthop Res 2016; 34:58-64. [PMID: 26174978 PMCID: PMC4817847 DOI: 10.1002/jor.22977] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/04/2015] [Indexed: 02/04/2023]
Abstract
Total joint replacement (TJR) has been widely used as a standard treatment for late-stage arthritis. One challenge for long-term efficacy of TJR is the generation of ultra-high molecular weight polyethylene wear particles from the implant surface that activates an inflammatory cascade which may lead to bone loss, prosthetic loosening and eventual failure of the procedure. Here, we investigate the efficacy of local administration of mutant CCL2 proteins, such as 7ND, on reducing wear particle-induced inflammation and osteolysis in vivo using a mouse calvarial model. Mice were treated with local injection of 7ND or phosphate buffered saline (PBS) every other day for up to 14 days. Wear particle-induced osteolysis and the effects of 7ND treatment were evaluated using micro-CT, histology, and immunofluorescence staining. Compared with the PBS control, 7ND treatment significantly decreased wear particle-induced osteolysis, which led to a higher bone volume fraction and bone mineral density. Furthermore, immunofluorescence staining showed 7ND treatment decreased the number of recruited inflammatory cells and osteoclasts. Together, our results support the feasibility of local delivery of 7ND for mitigating wear particle-induced inflammation and osteolysis, which may offer a promising strategy for extending the life time of TJRs.
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Affiliation(s)
- Xinyi Jiang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Taishi Sato
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Michael Keeney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Jukka Pajarinen
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Tzu-hua Lin
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Florence Loi
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Kensuke Egashira
- Department of Cardiovascular Research, Development, and Translational Medicine, Kyushu University, Fukuoka, Japan
| | - Stuart Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305,Department of Bioengineering, Stanford University, Stanford, California 94305
| | - Fan Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305,Department of Bioengineering, Stanford University, Stanford, California 94305
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13
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Mediero A, Ramkhelawon B, Wilder T, Purdue PE, Goldring SR, Dewan MZ, Loomis C, Moore KJ, Cronstein BN. Netrin-1 is highly expressed and required in inflammatory infiltrates in wear particle-induced osteolysis. Ann Rheum Dis 2015; 75:1706-13. [PMID: 26452536 DOI: 10.1136/annrheumdis-2015-207593] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/20/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Netrin-1 is a chemorepulsant and matrix protein expressed during and required for osteoclast differentiation, which also plays a role in inflammation by preventing macrophage egress. Because wear particle-induced osteolysis requires osteoclast-mediated destruction of bone, we hypothesised that blockade of Netrin-1 or Unc5b, a receptor for Netrin-1, may diminish this pathological condition. METHODS C57BL/6 mice, 6-8 weeks old, had 3 mg of ultrahigh-molecular-weight polyethylene particles implanted over the calvaria and then received 10 µg of monoclonal antibodies for Netrin-1 or its receptors, Unc5b and deleted in colon cancer (DCC), injected intraperitoneally on a weekly basis. After 2 weeks, micro-computed tomography and histology analysis were performed. Netrin-1 expression was analysed in human tissue obtained following primary prosthesis implantation or after prosthesis revision for peri-implant osteolysis and aseptic implant loosening. RESULTS Weekly injection of anti-Netrin-1 or anti-Unc5b-antibodies significantly reduced particle-induced bone pitting in calvaria exposed to wear particles (46±4% and 49±3% of control bone pitting, respectively, p<0.001) but anti-DCC antibody did not affect inflammatory osteolysis (80±7% of control bone pitting, p=ns). Anti-Netrin-1 or anti-Unc5b, but not anti-DCC, antibody treatment markedly reduced the inflammatory infiltrate and the number of tartrate resistance acid phosphatase (TRAP)-positive osteoclasts (7±1, 4±1 and 14±1 cells/high power field (hpf), respectively, vs 12±1 cells/hpf for control, p<0.001), with no significant changes in alkaline phosphatase-positive osteoblasts on bone-forming surfaces in any antibody-treated group. Netrin-1 immunostaining colocalised with CD68 staining for macrophages. The peri-implant tissues of patients undergoing prosthesis revision surgery showed an increase in Netrin-1 expression, whereas there was little Netrin-1 expression in soft tissues removed at the time of primary joint replacement. CONCLUSIONS These results demonstrate a unique role for Netrin-1 in osteoclast biology and inflammation and may be a novel target for prevention/treatment of inflammatory osteolysis.
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Affiliation(s)
- Aránzazu Mediero
- Division of Translational Medicine, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Bhama Ramkhelawon
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Tuere Wilder
- Division of Translational Medicine, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | | | | | - M Zahidunnabi Dewan
- Office of Collaborative Sciences, NYU School of Medicine, New York, New York, USA
| | - Cynthia Loomis
- Office of Collaborative Sciences, NYU School of Medicine, New York, New York, USA Department of Pathology, NYU School of Medicine, New York, New York, USA
| | - Kathryn J Moore
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Bruce N Cronstein
- Division of Translational Medicine, Department of Medicine, NYU School of Medicine, New York, New York, USA
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Shao H, Shen J, Wang M, Cui J, Wang Y, Zhu S, Zhang W, Yang H, Xu Y, Geng D. Icariin protects against titanium particle-induced osteolysis and inflammatory response in a mouse calvarial model. Biomaterials 2015; 60:92-9. [PMID: 25985156 DOI: 10.1016/j.biomaterials.2015.04.048] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/19/2015] [Accepted: 04/30/2015] [Indexed: 01/17/2023]
Abstract
Periprosthetic osteolysis and subsequent aseptic loosening are common in implant failure, a complication with revision surgery being the only established treatment. Wear particle-induced inflammation and extensive osteoclastogenesis play critical roles in periprosthetic osteolysis. A recent approach in limiting osteolysis is therefore focused on inhibiting osteoclastic bone resorption. This study aimed to investigate the potential impact of icariin, the major ingredient of Epimedium, on titanium particle-induced osteolysis in a mouse calvarial model. Eighty-four male C57BL/J6 mice were divided randomly into four groups. Mice in the sham group underwent sham surgery only, whereas animals in the vehicle, low- and high-concentration icariin groups received titanium particles. Mice in the low- and high-concentration icariin groups were gavage-fed with icariin at 0.1 or 0.3 mg/g/day, respectively, until sacrifice. Mice in the sham and vehicle groups received phosphate-buffered saline daily. After 2 weeks, mouse calvariae were collected for micro-computed tomography, histomorphometry and molecular analysis. Icariin significantly reduced particle-induced bone resorption compared with the vehicle group. Icariin also prevented an increase in receptor activator of nuclear factor kappa B ligand/osteoprotegerin ratio and subsequently suppressed osteoclast formation in titanium particle-charged calvariae. In addition, immunohistochemical analysis and enzyme-linked immunosorbent assay showed icariin significantly reduced expression and secretion of tumor necrosis factor-α, interleukin-1β and interleukin-6 in the calvariae of titanium-stimulated mice. Collectively, these results suggest that icariin represents a potential treatment for titanium particle-induced osteolysis and could be developed as a new therapeutic candidate for the prevention and treatment of aseptic loosening.
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Affiliation(s)
- Hongguo Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Ji Shen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China; Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, PR China
| | - Mingjun Wang
- Department of Rheumatology, The First Affiliated Hospital of Soochow University, PR China
| | - Jingfu Cui
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Yijun Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Shijun Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, PR China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China.
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China.
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15
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Smith RL, Schwarz EM. Are biologic treatments a potential approach to wear- and corrosion-related problems? Clin Orthop Relat Res 2014; 472:3740-6. [PMID: 24993143 PMCID: PMC4397762 DOI: 10.1007/s11999-014-3765-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
WHERE ARE WE NOW?: Biological treatments, defined as any nonsurgical intervention whose primary mechanism of action is reducing the host response to wear and/or corrosion products, have long been postulated as solutions for osteolysis and aseptic loosening of total joint arthroplasties. Despite extensive research on drugs that target the inflammatory, osteoclastic, and osteogenic responses to wear debris, no biological treatment has emerged as an approved therapy. We review the extensive preclinical research and modest clinical research to date, which has led to the central conclusion that the osteoclast is the primary target. We also allude to the significant changes in health care, unabated safety concerns about chronic immunosuppressive/antiinflammatory therapies, industry's complete lack of interest in developing an intervention for this condition, and the practical issues that have narrowly focused the possibilities for a biologic treatment for wear debris-induced osteolysis. WHERE DO WE NEED TO GO?: Based on the conclusions from research, and the economic, regulatory, and practical issues that limit the future directions toward the development of a biologic treatment, there are a few rational approaches that warrant investigation. These largely focus on FDA-approved osteoporosis therapies that target the osteoclast (bisphosphonates and anti-RANK ligand) and recombinant parathyroid hormone (teriparatide) prophylactic treatment to increase osseous integration of the prosthesis to overcome high-risk susceptibility to aseptic loosening. The other roadblock that must be overcome if there is to be an approved biologic therapy to prevent the progression of periprosthetic osteolysis and aseptic loosening is the development of radiological measures that can quantify a significant drug effect in a randomized, placebo-controlled clinical trial. We review the progress of volumetric quantification of osteolysis in animal studies and clinical pilots. HOW DO WE GET THERE?: Accepting the aforementioned rigid boundaries, we describe the emergence of repurposing FDA-approved drugs for new indications and public (National Institutes of Health, FDA, Centers for Disease Control and Prevention) and private (universities and drug and device manufactures) partnerships as the future roadmap for clinical translation. In the case of biologic treatments for wear debris-induced osteolysis, this will involve combined federal and industry funding of multicenter clinical trials that will be run by thought leaders at large medical centers.
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Affiliation(s)
- R. Lane Smith
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA USA
| | - Edward M. Schwarz
- Department of Orthopaedics, University of Rochester, Rochester, NY USA ,The Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
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Mitigative effect of erythromycin on PMMA challenged preosteoblastic MC3T3-E1 cells. ScientificWorldJournal 2014; 2014:107196. [PMID: 25110723 PMCID: PMC4119688 DOI: 10.1155/2014/107196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 11/19/2022] Open
Abstract
Background. Aseptic loosening (AL) is a major complication of total joint replacement. Recent approaches to limiting AL have focused on inhibiting periprosthetic inflammation and osteoclastogenesis. Questions/Purposes. The purpose of this study was to determine the effects of erythromycin (EM) on polymethylmethacrylate (PMMA) particle-challenged MC3T3 osteoblast precursor cells. Methods. MC3T3 cells were pretreated with EM (0–10 μg/mL) and then stimulated with PMMA (1 mg/mL). Cell viability was evaluated by both a lactate dehydrogenase (LDH) release assay and cell counts. Cell differentiation was determined by activity of alkaline phosphatase (ALP). Gene expression was measured via real-time quantitative RT-PCR. Results. We found that exposure to PMMA particles reduced cellular viability and osteogenetic potential in MC3T3 cell line. EM treatment mitigated the effects of PMMA particles on the proliferation, viability and differentiation of MC3T3 cells. PMMA decreased the gene expression of Runx2, osterix and osteocalcin, which can be partially restored by EM treatment. Furthermore, EM suppressed PMMA- induced increase of NF-κB gene expression. Conclusions. These data demonstrate that EM mitigates the effects of PMMA on MC3T3 cell viability and differentiation, in part through downregulation of NF-κB pathway. EM appeared to represent an anabolic agent on MC3T3 cells challenged with PMMA particles.
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The pathology of orthopedic implant failure is mediated by innate immune system cytokines. Mediators Inflamm 2014; 2014:185150. [PMID: 24891761 PMCID: PMC4033543 DOI: 10.1155/2014/185150] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/25/2014] [Accepted: 04/08/2014] [Indexed: 12/22/2022] Open
Abstract
All of the over 1 million total joint replacements implanted in the US each year are expected to eventually fail after 15–25 years of use, due to slow progressive subtle inflammation at the bone implant interface. This inflammatory disease state is caused by implant debris acting, primarily, on innate immune cells, that is, macrophages. This slow progressive pathological bone loss or “aseptic loosening” is a potentially life-threatening condition due to the serious complications in older people (>75 yrs) of total joint replacement revision surgery. In some people implant debris (particles and ions from metals) can influence the adaptive immune system as well, giving rise to the concept of metal sensitivity. However, a consensus of studies agrees that the dominant form of this response is due to innate reactivity by macrophages to implant debris where both danger (DAMP) and pathogen (PAMP) signalling elicit cytokine-based inflammatory responses. This paper discusses implant debris induced release of the cytokines and chemokines due to activation of the innate (and the adaptive) immune system and the subsequent formation of osteolysis. Different mechanisms of implant-debris reactivity related to the innate immune system are detailed, for example, danger signalling (e.g., IL-1β, IL-18, IL-33, etc.), toll-like receptor activation (e.g., IL-6, TNF-α, etc.), apoptosis (e.g., caspases 3–9), bone catabolism (e.g., TRAP5b), and hypoxia responses (Hif1-α). Cytokine-based clinical and basic science studies are in progress to provide diagnosis and therapeutic intervention strategies.
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18
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Goodman SB, Gibon E, Pajarinen J, Lin TH, Keeney M, Ren PG, Nich C, Yao Z, Egashira K, Yang F, Konttinen YT. Novel biological strategies for treatment of wear particle-induced periprosthetic osteolysis of orthopaedic implants for joint replacement. J R Soc Interface 2014; 11:20130962. [PMID: 24478281 DOI: 10.1098/rsif.2013.0962] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wear particles and by-products from joint replacements and other orthopaedic implants may result in a local chronic inflammatory and foreign body reaction. This may lead to persistent synovitis resulting in joint pain and swelling, periprosthetic osteolysis, implant loosening and pathologic fracture. Strategies to modulate the adverse effects of wear debris may improve the function and longevity of joint replacements and other orthopaedic implants, potentially delaying or avoiding complex revision surgical procedures. Three novel biological strategies to mitigate the chronic inflammatory reaction to orthopaedic wear particles are reported. These include (i) interference with systemic macrophage trafficking to the local implant site, (ii) modulation of macrophages from an M1 (pro-inflammatory) to an M2 (anti-inflammatory, pro-tissue healing) phenotype in the periprosthetic tissues, and (iii) local inhibition of the transcription factor nuclear factor kappa B (NF-κB) by delivery of an NF-κB decoy oligodeoxynucleotide, thereby interfering with the production of pro-inflammatory mediators. These three approaches have been shown to be viable strategies for mitigating the undesirable effects of wear particles in preclinical studies. Targeted local delivery of specific biologics may potentially extend the lifetime of orthopaedic implants.
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Affiliation(s)
- S B Goodman
- Department of Orthopaedic Surgery, Stanford University, , Stanford, CA, USA
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Yao Z, Keeney M, Lin TH, Pajarinen J, Barcay K, Waters H, Egashira K, Yang F, Goodman S. Mutant monocyte chemoattractant protein 1 protein attenuates migration of and inflammatory cytokine release by macrophages exposed to orthopedic implant wear particles. J Biomed Mater Res A 2013; 102:3291-7. [PMID: 24123855 DOI: 10.1002/jbm.a.34981] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/11/2013] [Accepted: 09/25/2013] [Indexed: 12/31/2022]
Abstract
Wear particles generated from total joint replacements can stimulate macrophages to release chemokines, such as monocyte chemoattractant protein 1 (MCP-1), which is the most important chemokine regulating systemic and local cell trafficking and infiltration of monocyte/macrophages in chronic inflammation. One possible strategy to curtail the adverse events associated with wear particles is to mitigate migration and activation of monocyte/macrophages. The purpose of this study is to modulate the adverse effects of particulate biomaterials and inflammatory stimuli such as endotoxin by interfering with the biological effects of the chemokine MCP-1. In the current study, the function of MCP-1 was inhibited by the mutant MCP-1 protein called 7ND, which blocks its receptor, the C-C chemokine receptor type 2 (CCR2) on macrophages. Addition of 7ND decreased MCP-1-induced migration of THP-1 cells in cell migration experiments in a dose-dependent manner. Conditioned media from murine macrophages exposed to clinically relevant polymethylmethacrylate (PMMA) particles with/without endotoxin [lipopolysaccharide (LPS)] had a chemotactic effect on human macrophages, which was decreased dramatically by 7ND. 7ND demonstrated no adverse effects on the viability of macrophages, and the capability of mesenchymal stem cells (MSCs) to form bone at the doses tested. Finally, proinflammatory cytokine production was mitigated when macrophages were exposed to PMMA particles with/without LPS in the presence of 7ND. Our studies confirm that the MCP-1 mutant protein 7ND can decrease macrophage migration and inflammatory cytokine release without adverse effects at the doses tested. Local delivery of 7ND at the implant site may provide a therapeutic strategy to diminish particle-associated periprosthetic inflammation and osteolysis.
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Affiliation(s)
- Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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20
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Purdue PE, Levin AS, Ren K, Sculco TP, Wang D, Goldring SR. Development of polymeric nanocarrier system for early detection and targeted therapeutic treatment of peri-implant osteolysis. HSS J 2013; 9:79-85. [PMID: 24426848 PMCID: PMC3640727 DOI: 10.1007/s11420-012-9307-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 08/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extensive research has implicated inflammation as a necessary and causative factor in the development of peri-implant osteolysis, suggesting that such an inflammatory response is the sentinel event for the process. The potential to impact the clinical course of this condition is hampered by the lack of an effective medical therapy, as well as a limited ability for early detection prior to radiographically evident osteolysis. Advances in nanotechnology have allowed for the production of engineered water-soluble nanocarriers, which exploit changes in the microvascular architecture for selective distribution to inflamed tissues. Evaluation of the uptake of the nanocarriers in sites of inflammation has elucidated a novel mechanism of cellular uptake and retention of these particles. PURPOSE The current review discusses the development of a novel, biocompatible, water-soluble nanocarrier utilizing copolymers of N-(2-hydroxypropyl)methacrylamide (HPMA), conjugated to imaging and therapeutic agents for the detection and targeted treatment of inflammatory conditions. METHODS We performed Medline searches for the terms "periprosthetic osteolysis," "murine osteolysis model," "HPMA osteolysis," and "HPMA inflammation." These searches identified 631, 306, 1, and 6 articles, respectively. These were then manually searched for articles relevant to the development of mouse models for inflammatory osteolysis and the use of HPMA copolymer technology in mouse models of inflammation. RESULTS Promising results in a small animal model of osteolysis have demonstrated the capability for detection prior to the development of bone loss, and have highlighted the utility of nanocarriers for selective drug delivery to the affected tissues. CONCLUSIONS Challenges to the clinical translation of HPMA nanocarriers in peri-implant osteolysis remain, and the future research directions necessary for human clinical application are reviewed.
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Affiliation(s)
- P. Edward Purdue
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Adam S. Levin
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ke Ren
- />Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Thomas P. Sculco
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Dong Wang
- />Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Steven R. Goldring
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Beck RT, Illingworth KD, Saleh KJ. Review of periprosthetic osteolysis in total joint arthroplasty: an emphasis on host factors and future directions. J Orthop Res 2012; 30:541-6. [PMID: 21922533 DOI: 10.1002/jor.21554] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 08/24/2011] [Indexed: 02/04/2023]
Abstract
Periprosthetic osteolysis is one of the leading causes of total joint revision procedures. If allowed to progress in the absence of radiographic diagnosis and/or proper medical treatment, osteolysis may result in aseptic loosening yielding failure of the implant and the need for complex revision arthroplasty. The purpose of this review was to assess the current understanding of periprosthetic osteolysis with an emphasis on host factors and future directions. A PubMed search was conducted using the following key words; osteolysis, periprosthetic osteolysis, osteolysis imaging. Pertinent articles, as it pertained to the outline of the review, were selected. Periprosthetic osteolysis stems from numerous risk factors. Osteolysis host characteristic risk factors include gender, body weight, and genetics. Current implant designs have reduced the incidence of this disease; however no current design has been able to replicate the in vivo characteristics and therefore development of wear particles continues to be seen. Advanced methods of imaging diagnosis are on the rise, however early imaging diagnosis is currently ineffective. Pharmacologic intervention appears to be a logical avenue for medical intervention, but no approved drug therapy to prevent or inhibit periprosthetic osteolysis is currently available. Although the rate of periprosthetic osteolysis seems to be decreasing with advances in implant design and increased knowledge of the biological process of wear particle induced osteolysis, the rapid increase in the total number of total joint arthroplasties over the next two decades means that better ways of detecting and treating periprosthetic osteolysis are greatly needed.
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Affiliation(s)
- Ryan T Beck
- Division of Orthopaedics and Rehabilitation, Department of Surgery, School of Medicine, Southern Illinois University, Springfield 62794-9679, IL
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Song W, Yu X, Wang S, Blasier R, Markel DC, Mao G, Shi T, Ren W. Cyclodextrin-erythromycin complexes as a drug delivery device for orthopedic application. Int J Nanomedicine 2011; 6:3173-86. [PMID: 22228990 PMCID: PMC3252670 DOI: 10.2147/ijn.s23530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Erythromycin, a hydrophobic antibiotic used to treat infectious diseases, is now gaining attention because of its anti-inflammatory effects and ability to inhibit osteoclasts formation. The aim of this study was to explore a cyclodextrin-erythromycin (CD-EM) complex for sustained treatment of orthopedic inflammation. Methods and results Erythromycin was reacted with β-cyclodextrin to form a nonhost-guest CD-EM complex using both kneading and stirring approaches. Physiochemical measurement data indicated that erythromycin and cyclodextrin formed a packing complex driven by intermolecular forces instead of a host-guest structure due to the limited space in the inner cavity of β-cyclodextrin. The CD-EM complex improved the stability of erythromycin in aqueous solution and had a longer duration of bactericidal activity than free erythromycin. Cytotoxicity and cell differentiation were evaluated in both murine MC3T3 preosteoblast cells and RAW 264.7 murine macrophage cells. The CD-EM complex was noncytotoxic and showed significant inhibition of osteoclast formation but had little effect on osteoblast viability and differentiation. Conclusion These attributes are especially important for the delivery of an adequate amount of erythromycin to the site of periprosthetic inflammation and reducing local inflammation in a sustained manner.
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Affiliation(s)
- Wei Song
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA
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23
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Atkins GJ, Haynes DR, Howie DW, Findlay DM. Role of polyethylene particles in peri-prosthetic osteolysis: A review. World J Orthop 2011; 2:93-101. [PMID: 22474627 PMCID: PMC3302032 DOI: 10.5312/wjo.v2.i10.93] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 09/30/2011] [Accepted: 10/07/2011] [Indexed: 02/06/2023] Open
Abstract
There is convincing evidence that particles produced by the wear of joint prostheses are causal in the peri-prosthetic loss of bone, or osteolysis, which, if it progresses, leads to the phenomenon of aseptic loosening. It is important to fully understand the biology of this bone loss because it threatens prosthesis survival, and loosened implants can result in peri-prosthetic fracture, which is disastrous for the patient and presents a difficult surgical scenario. The focus of this review is the bioactivity of polyethylene (PE) particles, since there is evidence that these are major players in the development and progression of osteolysis around prostheses which use PE as the bearing surface. The review describes the biological consequences of interaction of PE particles with macrophages, osteoclasts and cells of the osteoblast lineage, including osteocytes. It explores the possible cellular mechanisms of action of PE and seeks to use the findings to date to propose potential non-surgical treatments for osteolysis. In particular, a non-surgical approach is likely to be applicable to implants containing newer, highly cross-linked PEs (HXLPEs), for which osteolysis seems to occur with much reduced PE wear compared with conventional PEs. The caveat here is that we know little as yet about the bioactivity of HXLPE particles and addressing this constitutes our next challenge.
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Ren W, Markel DC. Emerging ideas: can erythromycin reduce the risk of aseptic loosening? Clin Orthop Relat Res 2011; 469:2399-403. [PMID: 21584820 PMCID: PMC3126949 DOI: 10.1007/s11999-011-1918-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/04/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent inflammatory reaction to wear debris causes periprosthetic osteolysis and loosening. Some authors have advocated pharmaceutical approaches to reduce the inflammatory reaction. Erythromycin has antiinflammatory effects independent of its antimicrobial properties. Although oral erythromycin reportedly inhibits periprosthetic tissue inflammation in patients with aseptic loosening, long-term systematic erythromycin treatment is not recommended owing to its side effects. Therefore, it would be advantageous to restrict erythromycin delivery to the inflammatory periprosthetic tissue without causing side effects. QUESTIONS/HYPOTHESES Erythromycin eluted from hydroxyapatite-coated titanium (Ti) pins inhibits periprosthetic tissue inflammation and osteolysis. METHOD OF STUDY We propose restricting erythromycin delivery to the inflammatory periprosthetic site. A previously described rat model of ultrahigh molecular weight polyethylene (UHMWPE) particle-induced periprosthetic tissue inflammation and osteolysis will be used to test the effect of local delivery of erythromycin via Peri-Apatite(TM)-coated Ti implants. The outcome measures will include bone ingrowth (μCT), implant stability (pullout test), and histologic analysis of periprosthetic tissues. SIGNIFICANCE Pharmacologic intervention aimed at slowing, preventing, or reversing the aseptic loosening process would represent an advance in the management of joint replacement. Erythromycin may be appropriate for prophylactically treating patients who have repeated revision surgery and/or show early signs of progressive osteolysis after arthroplasty.
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Affiliation(s)
- Weiping Ren
- Department of Biomedical Engineering, Wayne State University, 818 West Hancock, Detroit, MI 48201, USA.
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25
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Poly(amidoamine) dendrimer-erythromycin conjugates for drug delivery to macrophages involved in periprosthetic inflammation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2011; 7:284-94. [DOI: 10.1016/j.nano.2010.10.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/12/2010] [Accepted: 10/27/2010] [Indexed: 11/21/2022]
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Song W, Ren W, Wan C, Esquivel AO, Shi T, Blasier R, Markel DC. A novel strontium-doped calcium polyphosphate/erythromycin/poly(vinyl alcohol) composite for bone tissue engineering. J Biomed Mater Res A 2011; 98:359-71. [DOI: 10.1002/jbm.a.33127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 03/27/2011] [Accepted: 04/08/2011] [Indexed: 11/08/2022]
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27
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Wang SQ, Rao W, Deng LF, Zhu YP, Chen YQ. [Effects of rat serum containing Chinese herbal medicine Sangen Decoction on osteoclastogenesis and bone resorption of osteoclasts induced by polymethylmethacrylate particles]. ACTA ACUST UNITED AC 2011; 9:64-9. [PMID: 21227035 DOI: 10.3736/jcim20110111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of Sangen Decoction, a compound Chinese herbal medicine, on osteoclastogenesis and bone resorption function of osteoclasts induced by polymethylmethacrylate particles in vitro. METHODS Macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL) were used to induce differentiation of bone marrow-derived macrophages (BMMs) towards osteoclasts. BMMs and polymethylmethacrylate particles with ratio of 1:3 were added to the 24-well plate and 96-well plate with bone slices respectively. A total of 50 male SD rats were divided into 5 groups randomly with each group containing 10 rats. After being treated with different drugs, serum samples of rats in each group were extracted, i.e., the blank serum, Western medicine (ibandronate) serum and high-, medium-, and low-dose Sangen Decoction serum and were added to the medium respectively. The tartrate-resistant acid phosphatase (TRAP) staining was used to identify the differentiation of BMMs and for counting of osteoclasts. Area of lacuna induced by osteoclast bone resorption on the bone slices was measured by computer image processing. RESULTS Numbers of osteoclasts of treatment groups were less than that of blank group by TRAP staining (P<0.05); numbers of osteoclasts of positive control group and high-dose Sangen Decoction group were much lower than those of medium- and low-dose Sangen Decoction groups (P<0.05), and no difference was found between Western medicine group and high-dose Sangen Decoction group (P>0.05). In bone resorption assay, area of lacuna of blank group was larger than those of treatment groups (P<0.05); areas of lacuna of Western medicine group and high-dose Sangen Decoction group were much smaller than those of medium- and low-dose Sangen Decoction groups (P<0.05), and no difference was found between Western medicine group and high-dose Sangen Decoction group (P>0.05). CONCLUSION Sangen Decoction can inhibit osteoclastogenesis induced by polymethylmethacrylate particles as well as bone resorption function of osteoclasts.
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Affiliation(s)
- Shu-qiang Wang
- Department of Orthopaedics and Traumatology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
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Ren W, Zhang R, Hawkins M, Shi T, Markel DC. Efficacy of periprosthetic erythromycin delivery for wear debris-induced inflammation and osteolysis. Inflamm Res 2010; 59:1091-7. [PMID: 20607583 DOI: 10.1007/s00011-010-0229-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 06/21/2010] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We have reported that oral erythromycin (EM) inhibits periprosthetic tissue inflammation in a group of patients with aseptic loosening. The purpose of this study was to assess the efficacy of local, periprosthetic EM delivery in a rat model. METHODS Uncoated Ti pins were press-fit into the right tibia of fourteen Sprague-Dawley rats following an intramedullar injection of UHMWPE (ultra high molecular weight polyethylene) particles. Revision surgeries were performed 2 months after the primary surgery. EM was applied to the Peri-Apatite™ (PA) layer of the titanium (Ti) pins. The previously implanted Ti pins were withdrawn and replaced with Ti pins coated either with (n = 7) or without (n = 7) EM. The rats were killed 1 month after "revision surgery". The EM efficacy was evaluated by (MicroCT) μCT and histology. RESULTS μCT analysis showed that bone volume percentage (BV/TV) was significantly higher in the EM-treated group compared to the untreated group (p < 0.05). Histological analysis showed that EM treatment inhibits UHMWPE particle-induced periprosthetic tissue inflammation compared to the untreated group. CONCLUSION This study demonstrated that periprosthetic EM delivery reduced periprosthetic inflammation and improved the quality of surrounding bone.
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Affiliation(s)
- Weiping Ren
- Department of Orthopaedic Surgery, Detroit Medical Center and Providence Hospital Orthopaedic Residency, Detroit, MI, USA.
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Goodman SB, Ma T. Cellular chemotaxis induced by wear particles from joint replacements. Biomaterials 2010; 31:5045-50. [PMID: 20398931 DOI: 10.1016/j.biomaterials.2010.03.046] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 03/19/2010] [Indexed: 12/12/2022]
Abstract
The destruction of bone around joint replacements (periprosthetic osteolysis) is an adverse biological response associated with the generation of excessive wear particles. Wear debris from the materials used for joint replacements stimulate a chronic inflammatory and foreign body reaction that leads to increased osteoclast differentiation and maturation, and decreased bone formation. Wear debris induces both local and systemic trafficking of inflammatory cells to the site of particle generation. Recent studies have shown that this effect is mediated primarily by chemotactic cytokines (chemokines) including macrophage chemotactic protein-1 (MCP-1, also known as CCL2), macrophage inhibitory protein-1 (MIP-1), Interleukin-8 (IL-8 or CXCL8) and others. These ligands migrate along a concentration gradient to interact with G-protein-linked transmembrane receptors on the cell surface. Chemokines are involved in the innate and adaptive immune responses, angiogenesis, wound healing and tissue repair. In vitro, in vivo and tissue retrieval studies have shown that chemokine-directed systemic trafficking of polymorphonuclear leukocytes and cells of the monocyte/macrophage lineage to wear particles result in the release of pro-inflammatory factors and subsequent bone loss. Modulation of the chemokine ligand-receptor axis is a potential strategy to mitigate the adverse effects of wear particles from joint replacements.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States.
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Cheng T, Zhang GY, Guo CJ, Zhang X. Effects of NF-kappaB inhibitor on titanium particulate-induced inflammation in a murine model. J Surg Res 2009; 162:225-30. [PMID: 19628224 DOI: 10.1016/j.jss.2009.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/12/2009] [Accepted: 03/18/2009] [Indexed: 10/25/2022]
Abstract
BACKGROUND Activation of nuclear factor kappa B (NF-kappaB) signaling in response to implant particulates may be critical in the pathogenesis of implant loosening after joint arthroplasty. The purpose of this study was to investigate the inhibitory effects of pyrrolidine dithiocarbamate (PDTC) in a murine model of inflammation induced by titanium (Ti) particulates. MATERIALS AND METHODS Ti particulates were introduced into established air pouches on C57BL/6J mice. Mice were injected intraperitoneally with either high-dose PDTC (100 mg/kg) or low-dose PDTC (50 mg/kg). Mice without drug treatment, as well as mice injected with saline alone were included. Each group consisted of sixteen mice. The membranes and lavage fluid were harvested 2 d or 7 d after injection of particulate suspension for histological and molecular analysis. RESULTS Histologic analysis showed that PDTC reduced inflammatory responses in air pouches, that is, thinner membrane and decreased cellular infiltration. In addition, PDTC reduced the release of inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in the lavage fluid or supernatant of homogenates as evaluated by ELISA. CONCLUSION These results suggest that PDTC inhibits Ti particulate-induced inflammatory responses in the murine model; thus it represents a promising therapeutic candidate for the prevention and treatment of implant loosening.
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Affiliation(s)
- T'ao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Ren W, Blasier R, Peng X, Shi T, Wooley PH, Markel D. Effect of oral erythromycin therapy in patients with aseptic loosening of joint prostheses. Bone 2009; 44:671-7. [PMID: 19154802 DOI: 10.1016/j.bone.2008.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/10/2008] [Accepted: 12/12/2008] [Indexed: 12/28/2022]
Abstract
There is currently no cure for aseptic loosening (AL) of total joint replacement (TJR) except surgical revision. The purpose of this study was to determine whether oral EM could improve the periprosthetic tissue profiles and reduce serum cytokine production in AL patients who are candidates for surgical revision. We recruited 32 AL patients. AL patients were treated with either EM (600 mg/day, n=18) or placebo (n=14) daily, started one month before surgery and ending on the day of surgery. Blood samples were obtained before EM treatment and during surgery. Periprosthetic tissues and joint fluids were collected during surgery. Our results demonstrate that oral EM reduces the inflammation of periprosthetic tissues, as manifested by the reduction of the numbers of infiltrating cells, CD68+ macrophages, RANKL+ cells, and TRAP+ cells. Remarkable decreases of TNFalpha (9.6-fold), IL-1beta (21.2-fold), and RANKL (76-fold) gene transcripts were observed in periprosthetic tissues of patients treated with oral EM. Serum levels of both TNFalpha and (to a lesser extent) IL-1beta were significantly reduced following EM treatment (p<0.05). Our results suggest that EM represents a biological cure or prevention for those patients who might need repeated revision surgeries and/or show the early signs of progressive osteolysis after TJR.
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Affiliation(s)
- Weiping Ren
- Department of Biomedical Engineering, Wayne State University, 818 W. Hancock, Detroit, MI 48201, USA.
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