Revell P A, Matharu G S, Mittal S, Pynsent P B, Buckley C D, Revell M P
The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK.
Bone Joint Res. 2016 Feb;5(2):52-60. doi: 10.1302/2046-3758.52.2000574.
T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty.
In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry.
The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05).
Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure.Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52-60. doi: 10.1302/2046-3758.52.2000574.
T细胞被认为在导致关节置换失败的炎症反应中起重要作用。本研究的目的是调查金属对金属（MoM）和金属对聚乙烯（MoP）髋关节置换失败后接受翻修手术患者以及等待全髋关节置换患者的外周血（PB）和滑液（SF）中CD4 + T细胞表型的组成和分布。
在这项前瞻性病例对照研究中，从22例（23髋）接受MoM（n = 14）和MoP（n = 9）髋关节置换翻修手术的患者中获取PB和SF，并从等待关节置换的原发性髋骨关节炎病例中提供8例对照。使用流式细胞术分析样本中的淋巴细胞亚群。
各组PB中CD4 + T细胞亚群的百分比无差异。与同一患者PB中的表型相比，MoM髋关节SF中的CD4 + T细胞表型分布完全不同，包括SF中CD4 + T中央记忆细胞显著减少（p < 0.05）和T效应记忆细胞增加（p < 0.0001）。诱导性共刺激分子（ICOS）是各组间CD4 + CD28 +细胞上唯一具有不同表达的共刺激分子。在PB中，与对照组相比，MoM（p < 0.001）和MoP（p < 0.05）病例中ICOS表达增加。在SF中，与MoP髋关节相比，MoM髋关节中ICOS表达增加（p < 0.05）。
关节置换失败患者的PB和SF中CD4 + T细胞上ICOS表达增加表明这些细胞被激活并参与产生免疫反应。MoM和MoP髋关节之间ICOS表达的差异可能表明关节置换失败的不同模式。引用本文：P. A. Revell教授。髋关节置换失败患者外周血和滑液中CD4 + T细胞上诱导性共刺激分子表达增加。骨关节研究2016；5：52 - 60。doi：10.1302/2046 - 3758.52.2000574。
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