title: Immune reactions associated with silicone-based ventriculo-peritoneal shunt malfunctions in children.
abstract: The implantation of ventriculo-peritoneal (VP) shunting systems is the most commonly performed neurological procedure in children with hydrocephalus. Although the overall complication risk is low, the cumulative risk of shunt failure is high and unfortunately results in a high prevalence of revision surgeries. In this study, we explored the concept that some pediatric patients may develop an immune response to either the proteins attached to the silicone implant surface or to the biomaterial itself, and that this reaction may contribute to VP shunt failure in some individuals. The data displays that the sterile shunt malfunction group had a higher rate of protein deposition and increased levels of autoantibodies to the extracted surface proteins as compared to individuals with functioning shunting systems. The precise nature of the shunt-bound proteins that serve as antigens in this experiment have not yet been determined. The data also indicated that some individuals develop antibodies to polymeric substances that cross-react with partially polymerized acrylamide. The detection of significant amounts of shunt-bound protein, antibody responses to these proteins and to polymeric substances suggest that an immunological response to these proteins may play a role in the mechanism behind sterile shunt malfunctions.
authors.affiliation: Departments of Pediatric Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA. pvord@wayne.edu
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: VandeVord
authors.forename: Nalini
authors.initials: N
authors.lastname: Gupta
authors.forename: Russell B
authors.initials: RB
authors.lastname: Wilson
authors.forename: Ricardo Z
authors.initials: RZ
authors.lastname: Vinuya
authors.forename: Caralee J
authors.initials: CJ
authors.lastname: Schaefer
authors.forename: Alexa I
authors.initials: AI
authors.lastname: Canady
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wooley
mesh_terms: D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005549:Foreign-Body Reaction / Q000150:complications / Q000276:immunology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000276:immunology / Q000601:surgery; D008297:Male; D008422:Materials Testing; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000150:complications / Q000276:immunology*; D012828:Silicones / Q000009:adverse effects*; D017211:Treatment Failure; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D012828:Silicones