“…Studies have also shown a variety of cell signaling pathways are involved in the cellular response to debris. These include mitogenactivated protein kinase activation [1], induction of granulocyte macrophage colony-stimulating factor [6], C-C chemokine expression [55], matrix metalloproteinase induction [56], NFkB activation [59,66,72], nitric oxide elicitation [45,64,75], induction of apoptosis [74], cytokine activation [43,78], and direct activation of cyclooxygenase-2 [82]. Although most studies on the etiology of aseptic loosening have been focused on macrophage as the central cell of interest, there is recent interest in examining the role of the fibroblasts in the MMPs 56 UHMWPE = ultrahigh-molecular-weight polyethylene; IL = interleukin; TNF = tumor necrosis factor; GM-CSF = granulocyte macrophage colony-stimulating factor; MMPs = matrix metalloproteinases.…”