Janz Viktor, Rakow Anastasia, Schröder Leonie, Hofer André, Wiebe Sergej, Schoon Janosch, Weiss Stefan, Bröker Barbara M, Wassilew Georgi I, Raafat Dina
Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany.
Sporthopaedicum, 93053, Regensburg, Germany.
Infection. 2024 Dec;52(6):2325-2337. doi: 10.1007/s15010-024-02285-y. Epub 2024 May 31.
Periprosthetic joint infections (PJIs) are a very demanding complication of arthroplasty. Diagnosis of PJI and pathogen identification pose considerable challenges in clinical practice. We hypothesized that the pathogen-specific immune response to PJI reflects the infection process, provides clinically relevant information on disease course, and has the potential to further optimize antimicrobial therapy.
We conducted a prospective matched cohort pilot study with 13 patients undergoing two-stage septic revision arthroplasty (PJI patients) between 06/2020 and 06/2021, as well as 11 control patients undergoing one-stage aseptic revision arthroplasty (Non-PJI patients). Pre-, intra- and postoperative serum samples were collected at standardized time points. We developed a custom Luminex®-based quantitative bead-based suspension array (Infection Array; IA), and used it for simultaneous measurement of antibody specificities against 32 pathogens commonly associated with PJI in 267 serum samples.
The IA was able to trace the dynamics of the pathogen-specific humoral immune response in all patients against PJI-related pathogens, prominently coagulase-negative staphylococci and streptococci. Pathogen-specific serum antibody titers declined in 62% of PJI patients over the course of treatment, while no changes in antibody titers were observed in 82% of Non-PJI patients during this study. Our serological data strongly suggested that antibody signatures reflect an immune response to microbial invasion.
Our results provide insights into the pathophysiology of PJI and information on the individual disease courses. The IA is therefore a promising and novel serological tool of high resolution for monitoring the immunoproteomic footprints of infectious pathogens in the course of PJI.
人工关节周围感染（PJI）是关节置换术极具挑战性的并发症。PJI的诊断和病原体鉴定在临床实践中面临相当大的挑战。我们假设，针对PJI的病原体特异性免疫反应反映了感染过程，提供了有关疾病进程的临床相关信息，并有可能进一步优化抗菌治疗。
我们进行了一项前瞻性匹配队列试点研究，纳入了2020年6月至2021年6月期间接受两阶段感染性翻修关节成形术的13例患者（PJI患者），以及11例接受一阶段无菌翻修关节成形术的对照患者（非PJI患者）。在标准化时间点收集术前、术中和术后血清样本。我们开发了一种基于定制Luminex®的定量微珠悬浮阵列（感染阵列；IA），并用于同时测量267份血清样本中针对32种通常与PJI相关的病原体的抗体特异性。
IA能够追踪所有患者针对PJI相关病原体，尤其是凝固酶阴性葡萄球菌和链球菌的病原体特异性体液免疫反应的动态变化。在治疗过程中，62%的PJI患者病原体特异性血清抗体滴度下降，而在本研究期间，82%的非PJI患者抗体滴度未观察到变化。我们的血清学数据强烈表明，抗体特征反映了对微生物入侵的免疫反应。
我们的结果为PJI的病理生理学提供了见解，并提供了个体疾病进程的信息。因此，IA是一种有前景的新型高分辨率血清学工具，可用于监测PJI过程中感染病原体的免疫蛋白质组学特征。
