Periprosthetic osteolysis: induction of vascular endothelial growth factor from human monocyte/macrophages by orthopaedic biomaterial particles.
VEGF and VEGF receptor, Flt-1, expression was observed in periprosthetic tissues surrounding loosened total joint implants. Exposure of monocyte/macrophages to titanium particles resulted in increased VEGF expression, p44/42 MAPK activation, and VEGF-dependent macrophage chemotaxis. Increased levels of angiogenic factors, such as VEGF, may be critically important in wear debris-induced implant loosening after total joint arthroplasty.


BACKGROUND
Periprosthetic osteolysis after total hip arthroplasty occurs in association with formation of a vascularized granulomatous tissue in response to particulate debris.


METHODS
This study examined expression of vascular endothelial growth factor (VEGF) and the VEGF receptor in 10 periprosthetic tissues from loosened prostheses and quantified effects of titanium particles on VEGF release, intracellular signaling, and VEGF-dependent chemotaxis in primary cultures of human monocyte/macrophages.


RESULTS
Double immunofluorescent staining showed that VEGF and Flt-1 co-localized with cells positive for the macrophage marker, CD11b, in the periprosthetic tissues. Monocyte/macrophages challenged with titanium particles showed a dose- and time-dependent release of VEGF ranging from 2.8- to 3.1-fold and exhibited increased expression of VEGF121 and VEGF165 mRNAs, reaching levels up to 5.0- and 8.6-fold, respectively, by 48 h (p < 0.01). Exposure of monocyte/macrophages to titanium particles upregulated phosphorylated-p44/42 mitogen-activated protein kinase (MAPK) within 30 minutes. Particle-induced activation of p44/42 MAPK and release of VEGF were dose-dependently suppressed by pretreatment of cells with PD98059, a specific inhibitor of p44/42 MAPK. Monocyte/macrophages challenged with titanium particles also showed a time-dependent activation of AP-1, a transcription factor associated with VEGF expression (p < 0.01). Supernatants from particle-challenged monocyte/macrophages increased macrophage chemotactic activity by 30%, which was significantly inhibited by anti-VEGF neutralizing antibody (p < 0.01).


CONCLUSIONS
This study suggests that induction of VEGF release from monocyte/macrophages in response to orthopaedic biomaterial wear debris may contribute to periprosthetic osteolysis and implant loosening.
Miyanishi
Keita
K
Orthopaedic Research Laboratory, Stanford University School of Medicine, Stanford, California 94305-5341, USA.
Trindade
Michael C D
MC
Ma
Ting
T
Goodman
Stuart B
SB
Schurman
David J
DJ
Smith
R Lane
RL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D001672:Biocompatible Materials / Q000009:adverse effects; D002478:Cells, Cultured; D002633:Chemotaxis; D018076:DNA, Complementary / Q000235:genetics; D016326:Extracellular Matrix Proteins / Q000096:biosynthesis; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007595:Joint Prosthesis; D020935:MAP Kinase Signaling System / Q000187:drug effects; D008264:Macrophages / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009000:Monocytes / Q000378:metabolism; D010014:Osteolysis / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D011475:Prosthesis Failure; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D014025:Titanium / Q000009:adverse effects; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis* / Q000235:genetics; D040281:Vascular Endothelial Growth Factor Receptor-1
D001672:Biocompatible Materials; D018076:DNA, Complementary; D016326:Extracellular Matrix Proteins; D012333:RNA, Messenger; D042461:Vascular Endothelial Growth Factor A; D014025:Titanium; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1