Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Patient Groups
2.2. Clinical and Radiological Follow-Up
2.3. Blood Metal Ion Analysis
2.4. Sample Preparation and Flow Cytometry Analysis
2.5. Statistical Analysis
3. Results
3.1. Description of the Study Cohort
3.2. Clinical and Radiological Evaluation
3.3. Blood Metal Ion Analysis
3.4. Phenotypic Analysis of Peripheral Blood Mononuclear Cells
3.5. Comparison of Lymphocyte Cell Counts between Patients with ALTR and Patients without ALTR
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Leucocytes | Marker | Main Functions |
---|---|---|
T cells | CD3+ | |
-T helper cells | CD4+ | Mediators of the adaptive immune system; release cytokines that influence/activate other lymphocytes |
-Th1 helper cells | IFN-γ | Produce IFN-γ, which leads to a cell-mediated immune response; key role in delayed type IV hypersensitivity reactions |
-Th2 helper cells | IL-4 | Produce IL-4 among others, which leads to a humoral immune response, typically against extracellular bacteria and parasites; |
-Th17 helper cells | IL-17A | Produce IL-17, a pro-inflammatory cytokine linked to autoimmune related diseases such as rheumatoid arthritis |
-T regulatory cells | CD25+/CD127− | Modulators of the immune system; inhibit proliferation of effector T cells; maintain immunological tolerance to self-antigens |
-Cytotoxic T cells | CD8+ | Effector cells that induce apoptosis in virus-infected cells or tumor cells by secretion of different cytotoxins |
B cells | CD19+ | Major cells involved in the creation of antibodies (immunoglobulin), known as the humoral immunity of the adaptive immune system; |
NK (Natural killer) cells | CD16+/CD56+ | Part of the innate immune system; function similar to that of cytotoxic T cells; destroy virus-infected cells and tumor cells |
Monocytes/Macrophages | CD14+ | Phagocytic leukocytes; differentiate into tissue resident macrophages; activate T lymphocytes by antigen presentation |
Parameter | MoM Group (n = 34) | MoM-C Group (n = 15) | CoP Group (n = 15) | p-Value MoM vs. MoM-C | p-Value MoM vs. CoP | p-Value MoM-C vs. CoP |
---|---|---|---|---|---|---|
Age at follow-up † (years) | 67.8 (50–78) | 69.1 (56–81) | 61.1 (27–82) | 1.000 | 0.446 | 0.387 |
Female gender (%) | 47 | 27 | 53 | 0.221 | 0.762 | 0.264 |
Body mass index † (kg/m2) | 27 (18–40) | 29 (21–41) | 28 (20–35) | 0.347 | 0.774 | 0.815 |
Time of follow-up † (years) | 15.6 (13.7–18.3) | 14.4 (13.3–16.9) | 1.5 (0.3–5.9) | 0.080 | <0.001 * | 0.002 * |
Pat. with bilateral THA (%) | 70 | 13 | 13 | <0.001 * | <0.001 * | 1.000 |
Harris Hip Score † (points) | 90 (50–100) | 88 (61–100) | - | 0.641 | - | - |
Metal ion level (Co + Cr) † (µg/L) | 6.88 (2.04–41.50) | 0.78 (0.32–0.97) | 0.83 (0.29–1.07) | <0.001 * | <0.001 * | 1.000 |
Parameter | Metal-on-Metal Study Group (n = 34) | Metal-on-Metal Control Group (n = 15) | Ceramic-on-Polyethylene Group (n = 9) | |
---|---|---|---|---|
Cobalt | Mean (SD) | 2.87 (4.62) | 0.41 (0.12) | 0.20 (0.16) |
Median (range) | 1.53 (0.42–24.75) | 0.42 (0.24–0.63) | 0.16 (0.08–0.61) | |
Chromium | Mean (SD) | 4.01 (4.91) | 0.37 (0.15) | 0.64 (0.22) |
Median (range) | 2.10 (0.66–22.69) | 0.34 (0.06–0.64) | 0.65 (0.21–0.93) | |
Titanium | Mean (SD) | 4.94 (6.24) | 2.09 (1.03) | 1.73 (1.23) |
Median (range) | 2.96 (0.99–27.25) | 1.94 (0.44–3.83) | 1.56 (0.47–3.92) |
Leucocytes | Metal-on-Metal Study Group (n = 34) | Metal-on-Metal Control Group (n = 15) | Ceramic-on-Polyethylene Group (n = 15) | p-Value MoM vs. MoM-C | p-Value MoM vs. CoP | p-Value MoM-C vs. CoP |
---|---|---|---|---|---|---|
CD3+ | 88.85 (5.40) | 89.61 (4.28) | 91.27 (2.37) | 1.000 | 0.351 | 1.000 |
CD4+ | 22.70 (9.92) | 25.19 (9.63) | 18.76 (11.48) | 0.713 | 0.435 | 0.206 |
CD8+ | 8.51 (4.58) | 12.60 (11.22) | 13.60 (10.01) | 0.520 | 0.613 | 1.000 |
CD19+ | 5.04 (2.36) | 4.47 (2.04) | 6.97 (3.58) | 1.000 | 0.340 | 0.113 |
CD14+ | 12.17 (5.18) | 11.64 (4.95) | 9.71 (2.89) | 0.930 | 0.217 | 0.501 |
CD16+/CD56+ | 6.90 (4.49) | 8.80 (5.41) | 6.85 (4.11) | 0.390 | 1.000 | 0.488 |
CD25+/CD127− | 6.91 (1.56) | 6.94 (1.45) | 7.09 (1.43) | 1.000 | 1.000 | 1.000 |
IFN-γ | 6.68 (3.03) | 4.21 (3.23) | 11.65 (4.79) | 0.092 | <0.001 * | <0.001 * |
IL-4 | 3.46 (1.77) | 4.60 (3.18) | 3.51 (1.89) | 0.847 | 1.000 | 0.973 |
IL-17 | 2.19 (0.92) | 2.29 (1.77) | 2.48 (0.99) | 1.000 | 0.871 | 0.469 |
Leucocytes/Blood Metal Ion Levels | Patients without ALTR (n = 16) | Patients with ALTR (n = 11) | p-Value |
---|---|---|---|
CD3+ | 86.95 (7.05) | 90.78 (2.81) | 0.101 |
CD4+ | 23.71 (8.85) | 23.25 (11.99) | 0.910 |
CD8+ | 8.92 (4.94) | 9.40 (4.86) | 0.802 |
CD14+ | 12.82 (6.33) | 9.84 (4.20) | 0.184 |
CD19+ | 5.27 (2.33) | 4.65 (2.15) | 0.487 |
CD16+/CD56+ | 5.99 (4.28) | 6.24 (3.70) | 0.877 |
CD25+/CD127− | 6.88 (1.38) | 6.21 (2.73) | 0.409 |
IFN-γ | 6.04 (2.93) | 6.94 (2.84) | 0.439 |
IL-4 | 3.15 (1.74) | 4.06 (1.92) | 0.210 |
IL-17 | 2.44 (1.19) | 2.00 (0.59) | 0.273 |
Cobalt ion level (µg/L) | 1.06 (0.47) | 3.63 (3.85) | <0.001 * |
Chromium ion level (µg/L) | 4.38 (5.67) | 2.62 (2.22) | 0.178 |
Titanium ion level (µg/L) | 4.40 (4.45) | 7.44 (9.27) | 0.865 |
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Reiner, T.; Haubenreisser, H.; Tripel, E.; Rosshirt, N.; Sorbi, R.; Nees, T.A.; Gotterbarm, T.; Merle, C.; Moradi, B.; Hagmann, S. Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up. J. Clin. Med. 2020, 9, 2877. https://doi.org/10.3390/jcm9092877
Reiner T, Haubenreisser H, Tripel E, Rosshirt N, Sorbi R, Nees TA, Gotterbarm T, Merle C, Moradi B, Hagmann S. Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up. Journal of Clinical Medicine. 2020; 9(9):2877. https://doi.org/10.3390/jcm9092877
Chicago/Turabian StyleReiner, Tobias, Hester Haubenreisser, Elena Tripel, Nils Rosshirt, Reza Sorbi, Timo Albert Nees, Tobias Gotterbarm, Christian Merle, Babak Moradi, and Sébastien Hagmann. 2020. "Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up" Journal of Clinical Medicine 9, no. 9: 2877. https://doi.org/10.3390/jcm9092877