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Hubert J, Ritter J, Krüger L, Simon A, Beil FT, Jandl NM, Rolvien T. Are Synovial Inflammatory Markers Increased in Patients Who Have Aseptic Total Hip Arthroplasty Dislocation Indicated for Revision? J Arthroplasty 2024; 39:787-794.e1. [PMID: 37611677 DOI: 10.1016/j.arth.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Previous studies have speculated on elevated synovial inflammatory markers in patients undergoing surgical revision for total hip arthroplasty (THA) dislocation. However, this assumption is based on small patient series and a full investigation according to International Consensus Meeting (ICM) criteria has not yet been performed. METHODS Patients who had aseptic THA dislocation indicated for revision surgery were identified retrospectively. Only patients who had available diagnostic workup according to ICM 2018 criteria, including preoperative and intraoperative parameters, were included. For comparison, we analyzed a matched cohort of patients indicated for aseptic THA revision for other conditions. The 2 cohorts each consisted of 55 patients and were not different regarding age, sex, BMI, or implant fixation. RESULTS There was no difference in synovial white blood cell count (2,238 ± 2,544 versus 2,533 ± 3,448 c/μL; P = .601), alpha-defensin quotient (0.14 ± 0.11 versus 0.19 ± 0.28; P = .207), or polymorphonuclear neutrophil percentage (% PMN) (36.7 ± 22.6 versus 31.3 ± 24.5%; P = .312) between the groups. In the dislocation cohort, 20% of patients had a synovial white blood cell count of 3,000 c/μL or higher, compared with 18% in the control cohort. However, all patients in the dislocation cohort were below the cutoff for alpha-defensin or % PMN. CONCLUSION In patients who have aseptic THA dislocation, synovial inflammatory markers are not elevated compared with patients undergoing aseptic revision for other complications. A detailed preoperative analysis of synovial inflammatory markers using ICM criteria appears critical in patients who have a THA dislocation to exclude periprosthetic joint infection. LEVEL OF EVIDENCE Level III, retrospective, comparative study.
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Affiliation(s)
- Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacob Ritter
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Krüger
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico Maximilian Jandl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Heckmann ND, Wang JC, Liu KC, Won P, Chung BC, Mayer LW, Longjohn DB, Oakes DA, Christ AB, Lieberman JR. Refining the Role of Routine Synovial Alpha-Defensin in Periprosthetic Joint Infection Following Total Knee Arthroplasty: An Analysis of Limitations. J Arthroplasty 2023; 38:2691-2697. [PMID: 37295619 DOI: 10.1016/j.arth.2023.05.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The utility of the synovial alpha-defensin test in diagnosing periprosthetic joint infections (PJIs) remains controversial. This study aimed to examine the diagnostic utility of this test. METHODS A retrospective review was conducted to identify adults evaluated for PJI following total knee arthroplasty at a single institution. Patient demographics, laboratory results, and operative details were recorded. Using the 2018 Musculoskeletal Infection Society (MSIS) criteria, cases were categorized as definitive, inconclusive, or negative for PJI. The sensitivity, specificity, positive predictive value, and negative predictive value of each MSIS criterion was determined. The number of patients whose PJI diagnosis was contingent on alpha-defensin positivity was calculated. RESULTS Overall, 172 total knee arthroplasty patients were included, who had an average age of 70.4 years (range, 39 to 95). Of the 21 patients who met major criteria, 20 (95.2%) were alpha-defensin positive. Of the remaining 151 patients, 85 did not meet minor criteria, all of whom were alpha-defensin negative. Among the 30 patients who met minor criteria, 28 (93.3%) were alpha-defensin positive and 2 (6.7%) were negative. The remaining 36 patients were deemed inconclusive preoperatively. In total, alpha-defensin testing changed the diagnosis in only 9 of 172 patients (5.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of alpha-defensin in this cohort were 94.1, 100, 100, and 97.6, respectively. CONCLUSION Alpha-defensin may assist in the diagnosis of PJI when a preoperative workup is inconclusive. However, this test is often unnecessary when the diagnosis of PJI can be made using the 2018 MSIS criteria.
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Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Jennifer C Wang
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kevin C Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Paul Won
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Lucas W Mayer
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Daniel A Oakes
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
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Eng SJ, Nonnecke EB, de Lorimier AJ, Ali MR, Tsolis RM, Bevins CL, Ashwood P. FOXO inhibition rescues α-defensin expression in human intestinal organoids. Proc Natl Acad Sci U S A 2023; 120:e2312453120. [PMID: 37956278 PMCID: PMC10666032 DOI: 10.1073/pnas.2312453120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
To mediate critical host-microbe interactions in the human small intestine, Paneth cells constitutively produce abundant levels of α-defensins and other antimicrobials. We report that the expression profile of these antimicrobials is dramatically askew in human small intestinal organoids (enteroids) as compared to that in paired tissue from which they are derived, with a reduction of α-defensins to nearly undetectable levels. Murine enteroids, however, recapitulate the expression profile of Paneth cell α-defensins seen in tissue. WNT/TCF signaling has been found to be instrumental in the regulation of α-defensins, yet in human enteroids exogenous stimulation of WNT signaling appears insufficient to rescue α-defensin expression. By stark contrast, forkhead box O (FOXO) inhibitor AS1842856 induced the expression of α-defensin mRNA in enteroids by >100,000-fold, restoring DEFA5 and DEFA6 to levels comparable to those found in primary human tissue. These results newly identify FOXO signaling as a pathway of biological and potentially therapeutic relevance for the regulation of human Paneth cell α-defensins in health and disease.
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Affiliation(s)
- Serena J. Eng
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA95616
- Medical Investigation of Neurodevelopmental Disorders Institute, University of California Davis, Sacramento, CA95817
| | - Eric B. Nonnecke
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA95616
| | - Arthur J. de Lorimier
- University of California Davis Medical Center, Department of Pediatrics, Sacramento, CA95817
| | - Mohamed R. Ali
- University of California Davis Medical Center, Department of Surgery, Sacramento, CA95817
| | - Renée M. Tsolis
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA95616
| | - Charles L. Bevins
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA95616
| | - Paul Ashwood
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, CA95616
- Medical Investigation of Neurodevelopmental Disorders Institute, University of California Davis, Sacramento, CA95817
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Maraga E, Safadi R, Amer J, Higazi AAR, Fanne RA. Alleviation of Hepatic Steatosis by Alpha-Defensin Is Associated with Enhanced Lipolysis. Medicina (Kaunas) 2023; 59:medicina59050983. [PMID: 37241215 DOI: 10.3390/medicina59050983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The neutrophilic peptide, alpha-defensin, is considered an evolving risk factor intimately linked with lipid mobilization. It was previously linked to augmented liver fibrosis. Here, we assess a potential association between alpha-defensin and fatty liver. Materials and Methods: A cohort of transgenic C57BL/6JDef+/+ male mice that overexpress the human neutrophil-derived alpha-defensin in their polymorphonuclear neutrophils (PMNs) were assessed for liver steatosis and fibrosis development. Wild type (C57BL/6JDef.Wt) and transgenic (C57BL/6JDef+/+) mice were maintained on a standard rodent chow diet for 8.5 months. At the termination of the experiment, systemic metabolic indices and hepatic immunological cell profiling were assessed. Results: The Def+/+ transgenic mice exhibited lower body and liver weights, lower serum fasting glucose and cholesterol, and significantly lower liver fat content. These results were associated with impaired liver lymphocytes count and function (lower CD8, NK cells, and killing marker CD107a). The metabolic cage demonstrated dominant fat utilization with a comparable food intake in the Def+/+ mice. Conclusions: Chronic physiological expression of alpha-defensin induces favorable blood metabolic profile, increased systemic lipolysis, and decreased hepatic fat accumulation. Further studies are needed to characterize the defensin net liver effect.
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Affiliation(s)
- Emad Maraga
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Rifaat Safadi
- Liver Unit, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Johnny Amer
- Liver Unit, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Rami Abu Fanne
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Owens JM, Dennis DA, Abila PM, Johnson RM, Jennings JM. Alpha-Defensin Offers Limited Utility in Work-Up Prior to Reimplantation in Chronic Periprosthetic Joint Infection in Total Joint Arthroplasty Patients. J Arthroplasty 2022; 37:2431-2436. [PMID: 35803520 DOI: 10.1016/j.arth.2022.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alpha-defensin (AD) is a synovial biomarker included in the 2018 consensus criteria for diagnosing periprosthetic joint infection (PJI). Its value in assessing eradication of infection prior to second stage reimplantation is unclear. The purpose of this study was to evaluate the impact of AD on eligibility for reimplantation following resection for chronic PJI. METHODS This study included patients who previously underwent resection arthroplasty for PJI. Synovial fluid aspirated from 87 patients was retrospectively reviewed. All patients completed a 6-week course of intravenous antibiotics and an appropriate drug holiday. Synovial white blood cell count, percentage neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 consensus criteria was used, including white blood cell count, percentage neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then added to determine if it changed diagnosis or clinical management. RESULTS Four patients were categorized as "infected" (score >6), none exhibited a positive AD or positive culture. Sixty eight patients were diagnosed as "possibly infected" (score 2 to 5), none had a positive AD, and one had a positive culture (Cutibacterium acnes). AD did not change the diagnosis from "possibly infected" to "infected" in any case or alter treatment plans. Fifteen patients had a score of <2 (not infected) and none had a positive AD. CONCLUSION The routine use of AD in the work-up prior to a second-stage arthroplasty procedure for PJI may not be warranted.
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Affiliation(s)
| | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | | | | | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
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Kuo FC, Lin PC, Yen SH, Tan TL, Wu CT, Wang JW. Which Minor Criteria is the Most Accurate Predictor for the Diagnosis of Hip and Knee Periprosthetic Joint Infection in the Asian Population? J Arthroplasty 2022; 37:2076-2081. [PMID: 35537614 DOI: 10.1016/j.arth.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/07/2022] [Accepted: 05/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic performance of minor criteria from the 2018 International Consensus Meeting (ICM) for the diagnosis of chronic periprosthetic joint infection (PJI) in an Asian population. METHODS We retrospectively reviewed 76 patients who underwent a revision knee or hip arthroplasty at an academic institution between September 2018 and December 2019. All major and minor 2018 ICM criteria were available for all patients included. Cases with at least 1 major criterion or score ≥6 in minor criteria were considered as infected. The diagnostic performance was evaluated by a receiver operative characteristic curve analysis and area under the curve (AUC) for each minor criterion. An AUC value of more than 0.9 was considered outstanding and 0.8-0.9 as excellent. RESULTS When using 2018 ICM threshold, the diagnostic performance ranked based on AUC was the following: alpha defensin (0.92), positive histology (0.83), leukocyte esterase (0.82), synovial white blood cell (0.81), serum erythrocyte sedimentation rate (0.78), synovial polymorphonuclear neutrophils (0.77), serum C-reactive protein (0.74), D-dimer (0.59), single positive culture (0.53), and positive intraoperative purulence (0.51). Alpha defensin was considered as an outstanding test among the 2018 ICM minor criteria. Positive histology, leukocyte esterase, and synovial white blood cell were considered as excellent tests. CONCLUSION Based on our findings, alpha-defensin has the best diagnostic performance in Asian population among the minor criteria of 2018 ICM.
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Center for General Education, Cheng Shiu University, Kaohsiung, Taiwan
| | - Po-Chun Lin
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Hsiang Yen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Timothy L Tan
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Cheng-Ta Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Nonnecke EB, Castillo PA, Johansson MEV, Hollox EJ, Shen B, Lönnerdal B, Bevins CL. Human intelectin-2 (ITLN2) is selectively expressed by secretory Paneth cells. FASEB J 2022; 36:e22200. [PMID: 35182405 PMCID: PMC9262044 DOI: 10.1096/fj.202101870r] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 01/04/2023]
Abstract
Intelectins (intestinal lectins) are highly conserved across chordate evolution and have been implicated in various human diseases, including Crohn's disease (CD). The human genome encodes two intelectin genes, intelectin-1 (ITLN1) and intelectin-2 (ITLN2). Other than its high sequence similarity with ITLN1, little is known about ITLN2. To address this void in knowledge, we report that ITLN2 exhibits discrete, yet notable differences from ITLN1 in primary structure, including a unique amino terminus, as well as changes in amino acid residues associated with the glycan-binding activity of ITLN1. We identified that ITLN2 is a highly abundant Paneth cell-specific product, which localizes to secretory granules, and is expressed as a multimeric protein in the small intestine. In surgical specimens of ileal CD, ITLN2 mRNA levels were reduced approximately five-fold compared to control specimens. The ileal expression of ITLN2 was unaffected by previously reported disease-associated variants in ITLN2 and CD-associated variants in neighboring ITLN1 as well as NOD2 and ATG16L1. ITLN2 mRNA expression was undetectable in control colon tissue; however, in both ulcerative colitis (UC) and colonic CD, metaplastic Paneth cells were found to express ITLN2. Together, the data reported establish the groundwork for understanding ITLN2 function(s) in the intestine, including its possible role in CD.
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Affiliation(s)
- Eric B Nonnecke
- Department of Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, California, USA
| | - Patricia A Castillo
- Department of Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, California, USA
| | - Malin E V Johansson
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Edward J Hollox
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Bo Shen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Charles L Bevins
- Department of Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, California, USA
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Shrivastava S, Chelluboina S, Jedge P, Doke P, Palkar S, Mishra AC, Arankalle VA. Elevated Levels of Neutrophil Activated Proteins, Alpha-Defensins (DEFA1), Calprotectin (S100A8/A9) and Myeloperoxidase (MPO) Are Associated With Disease Severity in COVID-19 Patients. Front Cell Infect Microbiol 2021; 11:751232. [PMID: 34746027 PMCID: PMC8566808 DOI: 10.3389/fcimb.2021.751232] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Understanding of the basis for severity and fatal outcome of SARS-CoV-2 infection is of paramount importance for developing therapeutic options and identification of prognostic markers. So far, accumulation of neutrophils and increased levels of pro-inflammatory cytokines are associated with disease severity in COVID-19 patients. In this study, we aimed to compare circulatory levels of neutrophil secretory proteins, alpha-defensins (DEFA1), calprotectin (S100A8/A9), and myeloperoxidase (MPO) in COVID-19 patients with different clinical presentations. We studied 19 healthy subjects, 63 COVID-19 patients with mild (n=32) and severe (n=31) disease, 23 asymptomatic individuals identified through contact tracing programme and 23 recovering patients (1-4 months post-disease). At the time of disease presentation, serum levels of DEFA1 were significantly higher in patients with mild (mean230 ± 17, p<0.0001) and severe (mean452 ± 46, p<0.0001) disease respectively in comparison to healthy subjects (mean113 ± 11). S100A8/A9 proteins were significantly higher in COVID-19 patients (p<0.0001) irrespective of disease severity. The levels of DEFA1, S100A8/A9 and MPO reduced to normal in recovering patients and comparable to healthy subjects. Surprisingly, DEFA1 levels were higher in severe than mild patients in first week of onset of disease (p=0.004). Odds-ratio analysis showed that DEFA1 could act as potential biomarker in predicting disease severity (OR=11.34). In addition, levels of DEFA1 and S100A8/A9 were significantly higher in patients with fatal outcome (p=0.004 and p=0.03) respectively. The rise in DEFA1 levels was independent of secondary infections. In conclusion, our data suggest that induction of elevated levels of alpha-defensins and S100A8/A9 is associated with poor disease outcome in COVID-19 patients.
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Affiliation(s)
- Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shweta Chelluboina
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Prashant Jedge
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Purwa Doke
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Sonali Palkar
- Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Akhilesh Chandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Vidya A. Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
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Shohat N, Yacovelli S, Chisari E, Clarkson S, Mann D, Parvizi J. Alpha-defensin does not provide additional benefit over leukocyte esterase in the diagnosis of periprosthetic joint infection. Expert Rev Mol Diagn 2021; 21:845-849. [PMID: 34254869 DOI: 10.1080/14737159.2021.1943364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Leukocyte esterase (LE) and α-defensin (AD) are two synovial biomarkers that are used for the diagnosis of periprosthetic joint infection (PJI), however, the superiority of one over the other remains unknown. We aimed to compare their diagnostic value.Methods: In this retrospective study, we evaluated patients who underwent revision total hip and knee arthroplasty at a single institution between 2013 and 2019 for whom both LE and AD were available. PJI was defined by the 2018 International Consensus Meeting criteria. The diagnostic performance of AD and LE was compared.Results: Overall, 122 patients (28 PJI and 94 aseptic revisions) were included. The area under the curve was 0.905 (95% confidence interval[CI]:0.820-0.991) and 0.913 [95%CI:0.834-0.992] for LE and AD, respectively. Positive and negative predictive values were 95.8% (95%CI:76.5%-99.4%) and 94.9% (95%CI:89.4%-97.6%) for LE and 89.0% (95%CI:72.2%-96.1%) and 96.0% (95%CI:90.5%-98.3%) for AD. While both tests were useful in 18 cases that were inconclusive based on preoperative findings, AD had no benefit over LE.Conclusion: Both LE and AD are valuable markers in patients with suspected PJI. Since LE is very inexpensive and readily available point-of-care test, we believe it offers more value in the work up of suspected PJI.
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Affiliation(s)
- Noam Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Steven Yacovelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samuel Clarkson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Derek Mann
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kleeman-Forsthuber LT, Dennis DA, Brady AC, Pollet AK, Johnson RM, Jennings JM. Alpha-Defensin Is Not Superior to Traditional Diagnostic Methods for Detection of Periprosthetic Joint Infection in Total Hip Arthroplasty and Total Knee Arthroplasty Patients. J Arthroplasty 2021; 36:2144-2149. [PMID: 33602586 DOI: 10.1016/j.arth.2021.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Synovial fluid alpha-defensin (AD) may improve diagnostic accuracy of periprosthetic joint infection (PJI) following total knee (TKA) and hip (THA) arthroplasty but is only available as send-out test. This study evaluated laboratory result accuracy between send-out test vs hospital labs and if AD made a difference in treatment plan. METHODS A retrospective review was performed of 152 consecutive patients with a TKA or THA joint aspiration for painful or clinically concerning joint. Synovial fluid was sent to our institution (hospital-based labs, HBL) and send-out immunoassay laboratory (Synovasure). Patients were scored with specific criteria from validated scoring system for PJI using HBL and Synovasure results. The score with and without AD test was compared to determine if AD impacted patient management. RESULTS Overall, there was strong agreement between institutions for PJI diagnosis (Cohen's kappa score 0.96). Twenty-nine patients had PJI diagnosis (score ≥6), of which 28 (97%) had positive AD with 1 false-negative result. Sixty-three patients had inconclusive score (between 2 and 5) and 60 patients had negative PJI diagnosis (score ≤1). Of these patients, 5 underwent surgery for infection. Two patients had surgery for positive AD, 2 for positive culture, and 1 because of elevated HBL results. The AD test changed the PJI diagnosis and influenced decision for surgery in only 1.3% (2/152) of patients. CONCLUSION Minimal differences were found in laboratory values between institutions. The addition of AD may be useful in cases of equivocal laboratory results but does not appear to be necessary for routine diagnosis of PJI after TKA/THA. LEVEL EVIDENCE Level III.
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Affiliation(s)
| | - Douglas A Dennis
- Department of Orthopaedics, Colorado Joint Replacement, Denver, CO; Department of Bioengineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO; Department Engineering and Computer Science, University of Denver, Denver, CO
| | - Anna C Brady
- Department of Orthopaedics, Colorado Joint Replacement, Denver, CO
| | - Aviva K Pollet
- Department of Orthopaedics, Colorado Joint Replacement, Denver, CO
| | | | - Jason M Jennings
- Department of Orthopaedics, Colorado Joint Replacement, Denver, CO; Department Engineering and Computer Science, University of Denver, Denver, CO
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Kleeman-Forsthuber LT, Johnson RM, Brady AC, Pollet AK, Dennis DA, Jennings JM. Alpha-Defensin Offers Limited Utility in Routine Workup of Periprosthetic Joint Infection. J Arthroplasty 2021; 36:1746-1752. [PMID: 33386183 DOI: 10.1016/j.arth.2020.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alpha-defensin (AD) is a synovial biomarker included as a minor criterion in the scoring system for diagnosing periprosthetic joint infection (PJI). The purpose of this study is to study the impact of AD on diagnosis and management of PJI. METHODS Synovial fluid from 522 patients after total knee and hip arthroplasty was retrospective reviewed. Synovial white blood cell count, percentage of neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 scoring system for diagnosis of PJI was used, only scoring white blood cell count, percentage of neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then analyzed with these scores to determine if AD changed diagnostic findings or clinical management. RESULTS Eight-two patients were categorized as "infected" (score ≥6), of which 76 patients had positive AD. Of the 6 "infected" patients with negative AD, 2 had positive cultures (Staphylococcus epidermidis). Two-hundred thirteen patients were diagnosed as "possibly infected" (score 2-5). Fourteen of these patients had positive AD, of which 5 had positive cultures assisting with the diagnosis. The AD test changed the diagnosis from "possibly infected" to "infected" in 8 patients (1.5%) but only altered treatment plan in 6 patients (1.1%). A score <2 (not infected) was calculated in 227 patients with no patients having positive AD. CONCLUSION AD may be beneficial in some cases where laboratory values are otherwise equivocal; however, its routine use for the diagnosis of PJI may not be warranted.
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Affiliation(s)
| | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, CO; Department of Bioengineering, Colorado Joint Replacement, University of Tennessee, Knoxville, TN; Department of Orthopaedics, Colorado Joint Replacement, University of Colorado School of Medicine, Denver, CO; Department of Bioengineering, University of Denver, Denver, CO
| | - Jason M Jennings
- Colorado Joint Replacement, Denver, CO; Department of Bioengineering, University of Denver, Denver, CO
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Narita A, Suzuki A, Nakajima T, Takakubo Y, Ito J, Sasaki A, Takagi M. Assessing an alpha-defensin lateral flow device for diagnosing septic arthritis: reporting on a false-negative case and a false-positive case. Mod Rheumatol Case Rep 2020; 4:156-160. [PMID: 33086964 DOI: 10.1080/24725625.2019.1683134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Alpha-defensin (αD), an antimicrobial peptide released by neutrophils in response to bacterial pathogens, was proposed as a novel diagnostic biomarker in synovial fluid. Several reports have shown that αD can serve as a reliable biomarker in the diagnosis of periprosthetic joint infection (PJI). We assessed whether αD could also serve to diagnosis of septic arthritis, a similarly difficult to diagnose PJI. To our knowledge, besides PJI, few reports exist assessing the utility of αD for septic arthritis. We have attempted to diagnose several cases of suspected septic arthritis using the Synovasure® αD detection lateral flow device. We report a false-positive case and a false-negative case. The false-negative case we experienced was caused by Staphylococcus capitis, which is coagulase-negative, and possibly represents a low virulence micro-organism infection. The false-positive case was ultimately diagnosed as seronegative rheumatoid arthritis and possessed calcium pyrophosphate depositions. False positives have been suggested to occur in conditions where neutrophils are mobilised. As for PJI, in cases where diagnosis is difficult, αD can be an additional diagnostic indicator. However, making a definitive diagnosis using the αD lateral flow device alone was found to be difficult. The utility of αD in assessing septic arthritis is inconclusive; therefore, larger prospective clinical studies should be considered for a better assessment.
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Affiliation(s)
- Atsushi Narita
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akemi Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Taku Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuya Takakubo
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Juji Ito
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akiko Sasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
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Nakamura K, Yokoi Y, Fukaya R, Ohira S, Shinozaki R, Nishida T, Kikuchi M, Ayabe T. Expression and Localization of Paneth Cells and Their α-Defensins in the Small Intestine of Adult Mouse. Front Immunol 2020; 11:570296. [PMID: 33154750 PMCID: PMC7590646 DOI: 10.3389/fimmu.2020.570296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
Paneth cells contribute to intestinal innate immunity by sensing bacteria and secreting α-defensin. In Institute of Cancer Research (ICR) mice, α-defensin termed cryptdin (Crp) in Paneth cells consists of six major isoforms, Crp1 to 6. Despite accumulating evidences that α-defensin functions in controlling the intestinal microbiota, topographical localization of Paneth cells in the small intestine in relation to functions of α-defensin remains to be determined. In this study, we examined the expression level of messenger RNA (mRNA) encoding six Crp-isoforms and Crp immunoreactivities using singly isolated crypts together with bactericidal activities of Paneth cell secretions from isolated crypts of duodenum, jejunum, and ileum. Here we showed that levels of Crp mRNAs in the single crypt ranged from 5 x 103 to 1 x 106 copies per 5 ng RNA. For each Crp isoform, the expression level in ileum was 4 to 50 times higher than that in duodenum and jejunum. Furthermore, immunohistochemical analysis of isolated crypts revealed that the average number of Paneth cell per crypt in the small intestine increased from proximal to distal, three to seven-fold, respectively. Both Crp1 and 4 expressed greater in ileal Paneth cells than those in duodenum or jejunum. Bactericidal activities in secretions of ileal Paneth cell exposed to bacteria were significantly higher than those of duodenum or jejunum. In germ-free mice, Crp expression in each site of the small intestine was attenuated and bactericidal activities released by ileal Paneth cells were decreased compared to those in conventional mice. Taken together, Paneth cells and their α-defensin in adult mouse appeared to be regulated topographically in innate immunity to control intestinal integrity.
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Affiliation(s)
- Kiminori Nakamura
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan.,Innate Immunity Laboratory, Department of Cell Biological Science, Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
| | - Yuki Yokoi
- Innate Immunity Laboratory, Department of Cell Biological Science, Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
| | - Rie Fukaya
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Shuya Ohira
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Ryuga Shinozaki
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Takuto Nishida
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Mani Kikuchi
- Innate Immunity Laboratory, Department of Cell Biological Science, Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
| | - Tokiyoshi Ayabe
- Innate Immunity Laboratory, Department of Cell Biological Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan.,Innate Immunity Laboratory, Department of Cell Biological Science, Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
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14
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Forlizzi JM, Ryan JM, Galow KE, Shang AC, Polakoff DR. Acute pseudogout presenting as an exception to Musculoskeletal Infection Society criteria in total knee arthroplasty: a case report. AME Case Rep 2020; 4:21. [PMID: 33178993 DOI: 10.21037/acr-20-82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
In this case, a 78-year-old female with no previous medical history of crystalline arthropathy presented with pain, effusion, and erythema about a total knee arthroplasty (TKA) performed 13 years prior. Implementation of a novel synovial fluid alpha-defensin assay ruled out periprosthetic joint infection (PJI) despite a positive 2018 Musculoskeletal Infection Society (MSIS) minor criteria score of 8 points, a significant diagnostic differentiation which prevented secondary invasive debridement or joint irrigation intervention. Confirmatory histologic study was positive for calcium pyrophosphate crystals, indicative of acute pseudogout inflammation rather than PJI or septic arthritis manifestation. The patient was then conservatively managed medically for a pseudogout flare and had no evidence of infection with normal physical exam and laboratory study at one- and two-years post treatment, respectively. Given the predominantly clinical nature of current PJI assessment in-clinic coupled with notable risks associated with aggressive re-intervention in the setting of suspected infection, critical need exists for the maturation of sensitive, reliable empiric measures which may assist in guiding orthopaedic surgeon evaluation of patients presenting with inflammatory symptomology around a previous surgical site. In this case, we conclude that patients with a negative alpha-defensin assay alongside crystalline arthropathy on histology may be cautiously yet successfully treated non-operatively despite clinical MSIS criteria concerning for PJI.
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Affiliation(s)
| | - James M Ryan
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Aaron C Shang
- University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK.,Hackensack Meridian School of Medicine, Nutley NJ, USA
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15
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Tajima T, Mori T, Hirano F, Sabanai K, Kawasaki M, Yamanaka Y, Tsukamoto M, Sakai A. Alpha-Defensin-1 in Synovial Fluid is Useful for Diagnosis of Joint Infection. J UOEH 2020; 42:167-73. [PMID: 32507840 DOI: 10.7888/juoeh.42.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The distinction between bacterial infectious and noninfectious arthritis is typically challenging in the early stages; however, it is critical for treatment decision making. Here, we investigated the diagnostic relevance of alpha- and beta-defensin levels in serum and synovial fluid as biomarkers of joint infection in patients presenting with fever and arthritis. The study included 12 patients who presented with fever (≥37°C) and arthritis (pain in the knee or hip joint). The diagnostic criteria for periprosthetic joint infection proposed by the Musculoskeletal Infection Society were used to detect joint infection and categorize the patients into infection and non-infection groups. Alpha-defensin-1 and beta-defensin-3 levels in serum and synovial fluid were measured using enzyme-linked immunosorbent assay. No significant between-group difference was observed with respect to serum alpha-defensin-1 levels; however, synovial fluid alpha-defensin-1 levels were significantly higher in the infection group (33.6 ± 26.2 ng/ml) than in the non-infection group (0.9 ± 0.4 ng/ml). No significant between-group differences were observed with respect to serum or synovial fluid beta-defensin-3 levels. Furthermore, synovial fluid alpha-defensin-1 levels were increased in patients without prosthesis in the infection group. In conclusion, in patients with fever and arthritis, synovial fluid alpha-defensin-1 levels were significantly higher in patients with infectious arthritis than in those with noninfectious arthritis. Therefore, synovial fluid alpha-defensin-1 levels is a useful diagnostic marker for joint infection.
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Abstract
Culture-negative periprosthetic joint infections (CN-PJI) pose a significant challenge in terms of diagnosis and management. The reported incidence of CN-PJI is reported to be between 7% and 15%. Fungi and mycobacterium are thought to be responsible for over 85% of such cases with more fastidious bacteria accounting for the rest. With the advent of polymerase chain reaction, mass spectrometry and next generation sequencing, identifying the causative organism(s) may become easier but such techniques are not readily available and are very costly. There are a number of more straightforward and relatively low-cost methods to help surgeons maximize the chances of diagnosing a PJI and identify the organisms responsible. This review article summarizes the main diagnostic tests currently available as well as providing a simple diagnostic clinical algorithm for CN-PJI.
Cite this article: EFORT Open Rev 2019;4:585-594. DOI: 10.1302/2058-5241.4.180067
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Affiliation(s)
- Jeya Palan
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Ciaran Nolan
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Kostas Sarantos
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Richard Westerman
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Richard King
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pedro Foguet
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
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17
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Miyamae Y, George J, Klika AK, Barsoum WK, Higuera CA. Diagnostic Accuracy of the Alpha-Defensin Test for Periprosthetic Joint Infection in Patients With Inflammatory Diseases. J Arthroplasty 2019; 34:1767-1771. [PMID: 31122850 DOI: 10.1016/j.arth.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The alpha-defensin test has been reported to have high accuracy to diagnose periprosthetic joint infection (PJI). There are remaining concerns about the utility of the test in patients with inflammatory diseases. The purpose of this study is to determine sensitivity and specificity of laboratory-based alpha-defensin in diagnosing PJI in patients with systemic inflammatory disease in revision total hip/knee arthroplasty. METHODS A retrospective review was conducted of 1374 cases who underwent revision total hip/knee arthroplasty at a single healthcare system from 2014 to 2017. Cases with inflammatory diseases who received a 1-stage revision arthroplasty, the first stage of 2-stage revision arthroplasty, or irrigation and debridement with available preoperative alpha-defensin results were included. Patients who received a second-stage procedure, spacer exchange, who had insufficient Musculoskeletal Infection Society criteria, or with early postoperative PJI were excluded from this study. Cases were classified as infected or not according to Musculoskeletal Infection Society criteria. A total of 41 cases met the inclusion criteria. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of alpha-defensin to diagnose PJI were calculated. RESULTS The alpha-defensin test demonstrated a sensitivity of 93%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96%, and an accuracy of 97% for diagnosing PJI. There was 1 patient with polymyositis who had a false-negative result. CONCLUSION Alpha-defensin had high accuracy for diagnosing PJI even in inflammatory diseases. The alpha-defensin test provides useful information with high accuracy in diagnosing PJI in patients with inflammatory diseases.
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Affiliation(s)
- Yushi Miyamae
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic, Weston, FL
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Bauer TW, Bedair H, Creech JD, Deirmengian C, Eriksson H, Fillingham Y, Grigoryan G, Hickok N, Krenn V, Krenn V, Lazarinis S, Lidgren L, Lonner J, Odum S, Shah J, Shahi A, Shohat N, Tarabichi M, W-Dahl A, Wongworawat MD. Hip and Knee Section, Diagnosis, Laboratory Tests: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S351-S359. [PMID: 30343973 DOI: 10.1016/j.arth.2018.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Barrack R, Bhimani S, Blevins JL, Blevins K, Demetres M, Figgie M, Fillingham Y, Goodman S, Huddleston J, Kahlenberg C, Lautenbach C, Lin J, Lonner J, Lynch M, Malkani A, Martin L, Mirza S, Rahim Najjad MK, Penna S, Richardson S, Sculco P, Shahi A, Szymonifka J, Wang Q. General Assembly, Diagnosis, Laboratory Test: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S187-S195. [PMID: 30348554 DOI: 10.1016/j.arth.2018.09.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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20
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Corona PS, Goswami K, Kobayashi N, Li W, Llinás A, Marín-Peña Ó, Monsalvo D, Motta F, Shope AJ, Tarabichi M, Vicente M, Yazdi H. General Assembly, Diagnosis, Pathogen Isolation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S207-14. [PMID: 30348573 DOI: 10.1016/j.arth.2018.09.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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21
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Okroj KT, Calkins TE, Kayupov E, Kheir MM, Bingham JS, Beauchamp CP, Parvizi J, Della Valle CJ. The Alpha-Defensin Test for Diagnosing Periprosthetic Joint Infection in the Setting of an Adverse Local Tissue Reaction Secondary to a Failed Metal-on-Metal Bearing or Corrosion at the Head-Neck Junction. J Arthroplasty 2018; 33:1896-1898. [PMID: 29452973 DOI: 10.1016/j.arth.2018.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In patients with adverse local tissue reaction (ALTR) secondary to a failed metal-on-metal (MoM) bearing or corrosion at the head-neck junction in a metal-on-polyethylene bearing, ruling in or out periprosthetic joint infection (PJI) can be challenging. Alpha-defensin has emerged as an accurate test for PJI. The purpose of this multicenter, retrospective study was to evaluate the accuracy of the alpha-defensin synovial fluid test in detecting PJI in patients with ALTR. METHODS We reviewed medical records of 26 patients from 3 centers with ALTR that had an alpha-defensin test performed. Patients were assessed for PJI using the Musculoskeletal Infection Society criteria. Thirteen of these subjects had MoM total hip arthroplasty, 9 had ALTR secondary to head-neck corrosion, and 4 had MoM hip resurfacing. RESULTS Only 1 of the 26 patients met Musculoskeletal Infection Society criteria for infection. However, 9 hips were alpha-defensin positive, including 1 true positive and 8 that were falsely positive (31%). All 8 of the false positives were also Synovasure positive, although 5 of 8 had an accompanying warning stating the results may be falsely positive due to a low synovial C-reactive protein value. CONCLUSION Similar to synovial fluid white blood cell count, alpha-defensin testing is prone to false-positive results in the setting of ALTR. Therefore, we recommend an aggressive approach to ruling out PJI including routine aspiration of all hips with ALTR before revision surgery to integrate the synovial fluid blood cell count, differential, cultures and adjunctive tests like alpha-defensin to allow for accurate diagnosis preoperatively.
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Affiliation(s)
| | - Tyler E Calkins
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL
| | - Erdan Kayupov
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL
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Kasparek MF, Kasparek M, Boettner F, Faschingbauer M, Hahne J, Dominkus M. Intraoperative Diagnosis of Periprosthetic Joint Infection Using a Novel Alpha-Defensin Lateral Flow Assay. J Arthroplasty 2016; 31:2871-2874. [PMID: 27329580 DOI: 10.1016/j.arth.2016.05.033] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The present study investigates the novel Synovasure periprosthetic joint infection (PJI) lateral flow test device for detection of alpha-defensin and attempts to determine its diagnostic accuracy for the intraoperative diagnosis of PJI and compares it to frozen section. METHODS Forty consecutive patients, who underwent revision surgery, between September 2014 and September 2015 were included. The patients underwent 29 revision total knee arthroplasties and 11 revision total hip arthroplasties. Twelve patients had a confirmed PJI based on Musculoskeletal Infection Society criteria, and 28 patients were considered aseptic. RESULTS The overall accuracy to detect PJI using the lateral flow assay was 85% (95% CI 70%-93%). The device has a positive predictive value of 80% (95% CI 44%-96%) and a negative predictive value of 87% (95% CI 68%-96%) and showed a sensitivity of 67% (95% CI 35%-89%) and specificity of 93% (95% CI 75%-99%). Frozen section had a lower sensitivity (58% [95% CI 29%-84%]) but a higher specificity (96% [95% CI 80%-100%]). Receiver operator curve analysis demonstrates an area under the curve of the Synovasure PJI Lateral Flow Test Kit and frozen section of 0.80 and 0.77, respectively. CONCLUSION The present study suggests that the intraoperative lateral flow test is at least equivalent to intraoperative frozen section and is a useful tool to confirm the absence of PJI. Although the clinical results are promising, they are not as good as previous studies using alpha-defensin levels measured in a laboratory.
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Affiliation(s)
- Maximilian F Kasparek
- Department of Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Michael Kasparek
- II. Department of Orthopedic Surgery, Orthopedic Hospital Speising, Vienna, Austria
| | - Friedrich Boettner
- Department of Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Martin Faschingbauer
- Department of Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Julia Hahne
- Vinzenz Gruppe Center of Orthopedic Excellence, Orthopedic Hospital Speising, Vienna, Austria
| | - Martin Dominkus
- II. Department of Orthopedic Surgery, Orthopedic Hospital Speising, Vienna, Austria; Medical Department, Sigmund Freud University, Vienna, Austria
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Maneerat Y, Prasongsukarn K, Benjathummarak S, Dechkhajorn W, Chaisri U. Increased alpha-defensin expression is associated with risk of coronary heart disease: a feasible predictive inflammatory biomarker of coronary heart disease in hyperlipidemia patients. Lipids Health Dis 2016; 15:117. [PMID: 27430968 DOI: 10.1186/s12944-016-0285-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/30/2016] [Indexed: 02/05/2023] Open
Abstract
Background Atherosclerosis is a multifactorial disorder of the heart vessels that develops over decades, coupling inflammatory mechanisms and elevated total cholesterol levels under the influence of genetic and environmental factors. Without effective intervention, atherosclerosis consequently causes coronary heart disease (CHD), which leads to increased risk of sudden death. Polymorphonuclear neutrophils play a pivotal role in inflammation and atherogenesis. Human neutrophil peptides (HNPs) or alpha (α)-defensins are cysteine-rich cation polypeptides that are produced and released from activated polymorphonuclear neutrophil granules during septic inflammation and acute coronary vascular disorders. HNPs cause endothelial cell dysfunction during early atherogenesis. In this cross-sectional study, control, hyperlipidemia and CHD groups were representative as atherosclerosis development and CHD complications. We aimed to assess the correlation between α-defensin expression and the development of CHD, and whether it was a useful predictive indicator for CHD risk. Methods First, DNA microarray analysis was performed on peripheral blood mononuclear cells (PBMCs) from Thai control, hyperlipidemia and CHD male patients (n = 7). Gene expression profiling revealed eight up-regulated genes common between hyperlipidemia and CHD patients, but not controls. We sought to verify and compare α-defensin expression among the groups using: 1) real-time quantitative RT-PCR (qRT-PCR) to determine α-defensin mRNA expression (n = 10), and 2) enzyme-linked immunosorbent assay to determine plasma HNP 1–3 levels (n = 17). Statistically significant differences and correlations between groups were determined by the Mann–Whitney U test or the Kruskal–Wallis test, and the Rho-Spearman correlation, respectively. Results We found that α-defensin mRNA expression increased (mean 2-fold change) in the hyperlipidemia (p = 0.043) and CHD patients (p = 0.05) compared with the controls. CHD development moderately correlated with α-defensin mRNA expression (r = 0.429, p = 0.023) and with plasma HNP 1–3 levels (r = 0.486, p = 0.000). Conclusions Increased α-defensin expression is a potential inflammatory marker that may predict the risk of CHD development in Thai hyperlipidemia patients.
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