Hercus B, Revell P A
Department of Histopathology, Royal Free and University College Medical School, IRC in Biomedical Materials and Osteoarticular Research Group, Rowland Hill Street, London NW3, UK.
J Mater Sci Mater Med. 2001 Oct-Dec;12(10-12):1063-7. doi: 10.1023/a:1012806409544.
Aseptic loosening of prosthetic joints represents a major cause for revision surgery. Wear particles represent the initial stimulus in the production of a multi-cellular inflammatory membrane at the bone-implant interface. The mechanisms by which this membrane is established and its influence on bone resorption are central to understanding aseptic loosening. T cells have been identified as a component of interface tissue a feature confirmed in this study. Of the 15 cases studied, 12 cases (12/15) stained positive for CD3. T cell infiltration was present throughout the sections with some perivascular clustering. Multiplex PCR (MPCR) testing of eight of the 15 cases for Th1/Th2 cytokines did not show a predominance of either "type" of T cell response. Interleukin (IL)-2 mRNA expression was the most common feature (7/8) while IL-4 (6/8), IL-13 (6/8) and IFN-gamma mRNA expression (6/8) was also prevalent. IL-5 (4/8) and IL-10 (4/8) mRNA expression was less and IL-12 (3/8) mRNA expression was the least. Recent work has shown furthermore, that activated T cells can directly stimulate osteoclastogenesis through the expression of RANK ligand. However, although staining for RANK ligand was a consistent feature of all cases stained, such RANK ligand expression was limited to endothelial cells. Helper T cells control and develop immune responses, their role in the inflammation seen in aseptic loosening will aid further understanding of this reaction and may also identify key points for therapeutic intervention.
人工关节的无菌性松动是翻修手术的主要原因。磨损颗粒是在骨-植入物界面产生多细胞炎性膜的初始刺激因素。该膜形成的机制及其对骨吸收的影响是理解无菌性松动的核心。T细胞已被确定为界面组织的一个组成部分，本研究证实了这一特征。在研究的15例病例中，12例（12/15）CD3染色呈阳性。整个切片均有T细胞浸润，部分血管周围有聚集。对15例中的8例进行Th1/Th2细胞因子的多重PCR（MPCR）检测，未显示出任何一种“类型”的T细胞反应占优势。白细胞介素（IL）-2 mRNA表达是最常见的特征（7/8），而IL-4（6/8）、IL-13（6/8）和干扰素-γ mRNA表达（6/8）也很普遍。IL-5（4/8）和IL-10（4/8）mRNA表达较少，IL-12（3/8）mRNA表达最少。此外，最近的研究表明，活化的T细胞可通过RANK配体的表达直接刺激破骨细胞生成。然而，尽管所有染色病例中RANK配体染色都是一个一致的特征，但这种RANK配体表达仅限于内皮细胞。辅助性T细胞控制并发展免疫反应，它们在无菌性松动中所见炎症中的作用将有助于进一步理解这种反应，也可能确定治疗干预的关键点。
