Fuchs Michael, Trampuz Andrej, Kirschbaum Stephanie, Winkler Tobias, Sass F Andrea
RKU University Department of Orthopaedics, University of Ulm, 89081 Ulm, Germany.
Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 10117 Berlin, Germany.
J Clin Med. 2021 Feb 5;10(4):612. doi: 10.3390/jcm10040612.
A reliable workup with regard to a single diagnostic marker indicating periprosthetic joint infection (PJI) with sufficient sensitivity and specificity is still missing. The immunologically reactive molecule Pecam-1 is shed from the T-cell surface upon activation via proinflammatory signaling, e.g., triggered by specific pathogens. We hypothesized that soluble Pecam-1 (sPecam-1) can hence function as a biomarker of PJI. Fifty-eight patients were prospectively enrolled and assigned to one of the respective treatment groups (native knees prior to surgery, aseptic, and septic total knee arthroplasty (TKA) revision surgeries). Via synovial sample acquisition and ELISA testing, a database on local sPecam-1 levels was established. We observed a significantly larger quantity of sPecam-1 in septic ( = 22) compared to aseptic TKA revision surgeries ( = 20, ≤ 0.001). Furthermore, a significantly larger amount of sPecam-1 was found in septic and aseptic revisions compared to native joints ( = 16, ≤ 0.001). Benchmarking it to the gold standard showed a high predictive power for the detection of PJI. Local sPecam-1 levels correlated to the infection status of the implant, and thus bear a strong potential to act as a biomarker of PJI. While a clear role of sPecam-1 in infection could be demonstrated, the underlying mechanism of the molecule's natural function needs to be further unraveled.
目前仍缺乏一种可靠的检查方法，来检测具有足够敏感性和特异性的单一诊断标志物以指示假体周围关节感染（PJI）。免疫反应性分子Pecam-1在通过促炎信号（例如由特定病原体触发）激活后会从T细胞表面脱落。我们假设可溶性Pecam-1（sPecam-1）因此可以作为PJI的生物标志物。前瞻性招募了58名患者，并将其分配到相应的治疗组之一（手术前的天然膝关节、无菌和感染性全膝关节置换术（TKA）翻修手术）。通过滑膜样本采集和ELISA检测，建立了关于局部sPecam-1水平的数据库。我们观察到，与无菌TKA翻修手术（n = 20，p≤0.001）相比，感染性TKA翻修手术（n = 22）中的sPecam-1量明显更多。此外，与天然关节（n = 16，p≤0.001）相比，在感染性和无菌性翻修手术中发现的sPecam-1量明显更多。将其与金标准进行对比，结果显示其对PJI检测具有较高的预测能力。局部sPecam-1水平与植入物的感染状态相关，因此具有作为PJI生物标志物的强大潜力。虽然可以证明sPecam-1在感染中具有明确作用，但其分子天然功能的潜在机制仍需进一步阐明。
