逃避宿主反应:隐藏在皮质骨小管系统中的葡萄球菌会导致细菌负荷增加。

Evading the host response: Staphylococcus "hiding" in cortical bone canalicular system causes increased bacterial burden.

作者信息

Zoller Stephen D, Hegde Vishal, Burke Zachary D C, Park Howard Y, Ishmael Chad R, Blumstein Gideon W, Sheppard William, Hamad Christopher, Loftin Amanda H, Johansen Daniel O, Smith Ryan A, Sprague Marina M, Hori Kellyn R, Clarkson Samuel J, Borthwell Rachel, Simon Scott I, Miller Jeff F, Nelson Scott D, Bernthal Nicholas M

机构信息

Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA.

David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.

出版信息

Bone Res. 2020 Dec 10;8(1):43. doi: 10.1038/s41413-020-00118-w.

Abstract

Extremity reconstruction surgery is increasingly performed rather than amputation for patients with large-segment pathologic bone loss. Debate persists as to the optimal void filler for this "limb salvage" surgery, whether metal or allograft bone. Clinicians focus on optimizing important functional gains for patients, and the risk of devastating implant infection has been thought to be similar regardless of implant material. Recent insights into infection pathophysiology are challenging this equipoise, however, with both basic science data suggesting a novel mechanism of infection of Staphylococcus aureus (the most common infecting agent) into the host lacunar-canaliculi network, and also clinical data revealing a higher rate of infection of allograft over metal. The current translational study was therefore developed to bridge the gap between these insights in a longitudinal murine model of infection of allograft bone and metal. Real-time Staphylococci infection characteristics were quantified in cortical bone vs metal, and both microarchitecture of host implant and presence of host immune response were assessed. An orders-of-magnitude higher bacterial burden was established in cortical allograft bone over both metal and cancellous bone. The establishment of immune-evading microabscesses was confirmed in both cortical allograft haversian canal and the submicron canaliculi network in an additional model of mouse femur bone infection. These study results reveal a mechanism by which Staphylococci evasion of host immunity is possible, contributing to elevated risks of infection in cortical bone. The presence of this local infection reservoir imparts massive clinical implications that may alter the current paradigm of osteomyelitis and bulk allograft infection treatment.

摘要

对于患有大段病理性骨缺损的患者,越来越多地采用肢体重建手术而非截肢手术。关于这种“保肢”手术的最佳骨缺损填充材料是金属还是同种异体骨,仍存在争议。临床医生致力于为患者优化重要的功能恢复,并且认为无论植入材料如何,毁灭性植入物感染的风险相似。然而,最近对感染病理生理学的深入了解正在挑战这种平衡,基础科学数据表明金黄色葡萄球菌(最常见的感染病原体)感染宿主骨陷窝-小管网络的新机制,临床数据也显示同种异体骨的感染率高于金属。因此,开展了当前的转化研究,以在同种异体骨和金属感染的纵向小鼠模型中弥合这些见解之间的差距。对皮质骨与金属中的实时葡萄球菌感染特征进行了量化,并评估了宿主植入物的微观结构和宿主免疫反应的存在情况。与金属和松质骨相比,皮质同种异体骨中的细菌载量高出几个数量级。在另一个小鼠股骨感染模型中,在皮质同种异体骨哈弗斯管和亚微米小管网络中均证实了免疫逃逸微脓肿的形成。这些研究结果揭示了葡萄球菌逃避宿主免疫的一种机制,导致皮质骨感染风险升高。这种局部感染源的存在具有重大的临床意义,可能会改变目前骨髓炎和大块同种异体骨感染治疗的模式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/baf9/7728749/f9d0526c3a65/41413_2020_118_Fig1_HTML.jpg

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