Organ-Specific Therapeutic Intervention

Angle, Carol R.

doi:10.1016/b978-0-12-294375-1.50008-8

Cited by 21 publications

(13 citation statements)

References 163 publications

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“…Immunologic responses (e.g., cell‐mediated hypersensitivity) associated with metal components may be partly responsible for this differential reactivity. The most common metals that are allergens/sensitizers include nickel,17, 33–35 cobalt,35 and chromium,35 while occasional responses have been reported to tantalum,36 titanium,37, 38 and vanadium 36. Nickel is the most common metal sensitizer in humans followed by cobalt and chromium,17, 23, 33, 34 and cross reactivity between nickel and cobalt is common 23.…”

Section: Introductionmentioning

confidence: 99%

In vitro reactivity to implant metals demonstrates a person‐dependent association with both T‐cell and B‐cell activation

Hallab

Caicedo

Epstein

et al. 2009

J Biomedical Materials Res

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Hypersensitivity to metallic implants remains relatively unpredictable and poorly understood. We initially hypothesized that metal-induced lymphocyte proliferation responses to soluble metal challenge (ions) are mediated exclusively by early T-cell activation (not B-cells), typical of a Delayed-Type-Hypersensitivity response. We tested this by comparing proliferation (6-days) of primary lymphocytes with early T-cell and B-cell activation (48-hours) in three groups of subjects likely to demonstrate elevated metal-reactivity: Group 1(n=12) history of metal-sensitivity with no implant; Group 2a(n=6) well performing metal-on-metal THRs, and Group 2b(n=20) subjects with poorly performing metal-on-polymer total joint arthroplasties (TJA). Group 1 showed 100%(12/12) metal reactivity (Stimulation Index>2) to Ni. Group 2a&2b were 83%(5/6) and 75%(15/22) metal reactive (to Co, Cr or Ni) respectively. Of the n=32 metal reactive subjects to Co, Cr or Ni (SI>2), n=22/32 demonstrated >2-fold elevations in % of T-cell or B-cell activation (CD25+,CD69+) to metal challenge compared to untreated control. 18/22 metal-activated subjects demonstrated an exclusively T-cell or B-cell activation response to metal challenge, where 6/18 demonstrated exclusively B-cell activation and 12/18 demonstrated a T-cell only response, as measured by surface activation markers CD25+ and CD69+. However, there was no direct correlation (R 2 <0.1) between lymphocyte proliferation and % T-cell or B-cell activation (CD25+:CD69+). Proliferation assays (LTT) showed greater ability to detect metal reactivity than did subject-dependent results of flow-cytometry analysis of T-cell or B-cell activation. The high incidence of lymphocyte reactivity and activation, indicate that more complex than initially hypothesized immune responses may contribute to the etiology of debris induced osteolysis in metal-sensitive individuals.

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Section: Introductionmentioning

confidence: 99%

In vitro reactivity to implant metals demonstrates a person‐dependent association with both T‐cell and B‐cell activation

Hallab

Caicedo

Epstein

et al. 2009

J Biomedical Materials Res

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“…[7][8][9] Dermal hypersensitivity, either immediate or delayed, due to contact with metal, corrosion products, or metallic salts is fairly common, affecting about 10 -15% of the population. 1,7,8,10 Metals accepted as sensitizers (haptenic moieties in antigens), are beryllium, 11 nickel, [10][11][12][13] cobalt, 11 and chromium, 11 while occasional responses have been reported to tantalum, 14 titanium, 15,16 and vanadium. 14 The most common metal sensitizer in humans is nickel, followed by cobalt and chromium.…”

Section: Introductionmentioning

confidence: 99%

“…1,7,8,10 Metals accepted as sensitizers (haptenic moieties in antigens), are beryllium, 11 nickel, [10][11][12][13] cobalt, 11 and chromium, 11 while occasional responses have been reported to tantalum, 14 titanium, 15,16 and vanadium. 14 The most common metal sensitizer in humans is nickel, followed by cobalt and chromium. 7,10,12,13 Cross-sensitivity reactions between metals are most common with nickel and cobalt.…”

Section: Introductionmentioning

confidence: 99%

A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty

Hallab

Mikecz

Jacobs

2000

J. Biomed. Mater. Res.

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The determination of biocompatibility has been dominated historically by the characterization of candidate materials based upon the observation of adverse host responses. However, some adverse responses are subtle in clinical settings and continue to foster debate and investigation. One of these responses is "metal allergy" or hypersensitivity to metallic biomaterials. Current methods used to diagnose hypersensitivity reactions, such as dermal patch testing and migration inhibition assays, are not well accepted in orthopedic practice as a means for the characterization of hypersensitivity to metallic joint-replacement components. An increasing need to resolve whether metal sensitivity may be a significant and/or predisposing factor for eliciting an over-aggressive immune response in patients with metallic implant components requires improved and standardized widespread study. Here we present three in vitro methodologies: (1) a proliferation assay, (2) cytokine analysis using ELISA, and (3) a migration inhibition assay. When in conjunction with one another, these assays may be used to more comprehensively quantify metal-induced hypersensitivity responses. Therefore, these methodologies are detailed with the intent of facilitating multi-center large-scale studies. In the following cases, a multi-assay approach for measuring the prevalence of delayed-type hypersensitivity in orthopedic patients shows the propensity to yield a more comprehensive and, therefore, more conclusive determination than currently employed patch testing or single assay techniques.

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“…In addition, there is no accepted threshold above which serum concentrations of metals such as cobalt, chromium, and titanium are known to be toxic in patients with a joint replacement. Cobalt and chromium are toxic in high concentrations in vivo, and titanium is potentially carcinogenic at high levels in animal models 11 . Our original report examined serum metal ion concentrations after primary total hip arthroplasty in a prospective, controlled, longitudinal study with three-year follow-up 12 .…”

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confidence: 99%

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

101

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We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobaltalloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.continued

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Organ-Specific Therapeutic Intervention

Cited by 21 publications

References 163 publications

In vitro reactivity to implant metals demonstrates a person‐dependent association with both T‐cell and B‐cell activation

In vitro reactivity to implant metals demonstrates a person‐dependent association with both T‐cell and B‐cell activation

A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

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