title: Polymorphonuclear neutrophils in posttraumatic osteomyelitis: cells recovered from the inflamed site lack chemotactic activity but generate superoxides.
abstract: The pathogenesis of posttraumatic osteomyelitis, one of the major complications after orthopedic surgery, is not yet understood. Formation of bacterial biofilms on the implant is presumed, conferring resistance to antibiotic therapy and probably also to the host defense mechanisms. In that context, the polymorphonuclear neutrophils (PMN) having infiltrated the infected site were recovered and characterized phenotypically and functionally. Loss of CD62L and upregulation of CD14 were seen, as was expression of CD83. Expression of the latter is dependent on de novo protein synthesis and thus is indicative of an extended life span and a transdifferentiation of the PMN at the infected site. The infiltrated PMN had lost their chemotactic activity, whereas the capacity to produce superoxides was preserved and in some patients even enhanced. In vitro experiments done in parallel showed that long-term culture with interferon-gamma resulted in similar alterations of PMN: loss of chemotactic activity, whereas other functions of PMN, such generation of superoxides and phagocytosis of opsonized bacteria, were preserved or even enhanced. The loss of the migratory capacity of PMN having already emigrated from the blood vessel to the infected site is not expected to affect the host defense negatively. Assuming, however, that bacteria are organized as a biofilm and that infiltration into this biofilm is required for phagocytosis of the bacteria, our data could to some extent explain why despite being activated, the PMN are not able to control the infection. By releasing their cytotoxic, proteolytic, and collagenolytic potential, PMN might instead contribute to tissue destruction and eventually to osteolysis.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Wagner
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaksa
authors.forename: Wencke
authors.initials: W
authors.lastname: Müller
authors.forename: Birgit
authors.initials: B
authors.lastname: Denefleh
authors.forename: Volkmar
authors.initials: V
authors.lastname: Heppert
authors.forename: Andreas
authors.initials: A
authors.lastname: Wentzensen
authors.forename: G Maria
authors.initials: GM
authors.lastname: Hänsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD; D002465:Cell Movement; D002633:Chemotaxis; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007136:Immunoglobulins / Q000096:biosynthesis; D019041:L-Selectin / Q000096:biosynthesis; D018950:Lipopolysaccharide Receptors / Q000096:biosynthesis; D008297:Male; D008562:Membrane Glycoproteins / Q000096:biosynthesis; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010019:Osteomyelitis / Q000097:blood* / Q000378:metabolism; D010587:Phagocytosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013481:Superoxides / Q000378:metabolism; D013997:Time Factors; D015854:Up-Regulation; D000097802:CD83 Antigen
chemical_list: D015703:Antigens, CD; D007136:Immunoglobulins; D019041:L-Selectin; D018950:Lipopolysaccharide Receptors; D008562:Membrane Glycoproteins; D013481:Superoxides; D000097802:CD83 Antigen