Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Rehabilitation, Yamagata University, Faculty of Medicine, Yamagata, Japan.
J Biomed Mater Res A. 2024 Aug;112(8):1172-1187. doi: 10.1002/jbm.a.37599. Epub 2023 Sep 1.
The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long-term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co-workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.
生物材料和植入物在关节置换、骨折固定、脊柱稳定等骨科适应证中的应用，通过可靠地减轻疼痛和改善功能，彻底改变了患者的治疗效果。这些手术程序最初总是会引发急性炎症反应，而在大多数情况下，这种反应会很快消退。但偶尔，植入物周围会出现慢性炎症并持续存在；这会导致持续的疼痛并影响功能。慢性炎症的病因可能是特定的，如感染，也可能是未知的。慢性炎症的组织学特征包括活化的巨噬细胞、成纤维细胞、T 细胞亚群和固有免疫系统的其他细胞。适应性免疫系统细胞的存在通常表明对金属半抗原的过敏反应。异物反应由活化的巨噬细胞、巨细胞、成纤维细胞和其他细胞组成，这些细胞通常以特征性的组织学排列方式分布；这种反应通常是由植入物中使用的生物材料的颗粒碎片和其他副产物引起的。慢性炎症和异物反应都会对植入物与周围组织的整合产生不良的生物学影响。减轻慢性炎症和异物反应的策略将增强植入物的初始结合和耐久性，从而改善患者的长期疼痛缓解和整体功能。James Anderson 博士及其同事在实验室进行的开创性研究，为我们实验室在间充质细胞、免疫细胞和血管谱系以及骨科生物材料之间的相互作用和串扰方面的工作提供了灵感和动力。Anderson 博士阐明了急性和慢性炎症、异物反应、消退以及不同器官系统中植入物最终功能整合的基本生物学过程和机制，为研究人员提供了一种战略性方法，可用于利用生物材料改善众多临床情况下的健康状况。
