Department of Orthopaedic Surgery, University of Virginia , Charlottesville, VA, USA.
Department of Radiology and Medical Imaging, University of Virginia , Charlottesville, VA, USA.
Bone Res. 2016 Jul 12;4:16014. doi: 10.1038/boneres.2016.14. eCollection 2016.
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.
在一个越来越多的年轻患者接受关节置换术的世界里，作为全关节置换术 (TJA) 后失败的主要原因，骨溶解已经引起了相当大的关注。超高分子量聚乙烯磨损诱导的骨溶解是指假体关节表面机械释放的假体碎片引起免疫反应，有利于骨分解代谢，导致假体松动，最终导致失败或骨折。这种免疫反应是先天的，因为它是非特异性的，具有自我传播性，单核细胞和破骨细胞是主要的效应细胞。迄今为止，及早发现疾病并进行有效的干预而不产生不必要的全身副作用一直是一个主要障碍。这些障碍可以通过使用与荧光和/或化学疗法相结合的更新的体内成像技术和模块来克服。我们讨论了骨溶解的发病机制，并讨论了成像和治疗的挑战。我们描述了一种针对巨噬细胞的正电子发射断层扫描成像肉桂酰-苯丙氨酸-(D)-亮氨酸-苯丙氨酸-(D)-亮氨酸-苯丙氨酸-赖氨酸模块，该模块在早期发现疾病和定位治疗方面具有很大的潜力。进一步的研究和治疗与三维成像研究人员之间的更多合作对于实现 TJA 中临床骨溶解的解决方案至关重要。
