title: Effect of oral erythromycin therapy in patients with aseptic loosening of joint prostheses.
abstract: There is currently no cure for aseptic loosening (AL) of total joint replacement (TJR) except surgical revision. The purpose of this study was to determine whether oral EM could improve the periprosthetic tissue profiles and reduce serum cytokine production in AL patients who are candidates for surgical revision. We recruited 32 AL patients. AL patients were treated with either EM (600 mg/day, n=18) or placebo (n=14) daily, started one month before surgery and ending on the day of surgery. Blood samples were obtained before EM treatment and during surgery. Periprosthetic tissues and joint fluids were collected during surgery. Our results demonstrate that oral EM reduces the inflammation of periprosthetic tissues, as manifested by the reduction of the numbers of infiltrating cells, CD68+ macrophages, RANKL+ cells, and TRAP+ cells. Remarkable decreases of TNFalpha (9.6-fold), IL-1beta (21.2-fold), and RANKL (76-fold) gene transcripts were observed in periprosthetic tissues of patients treated with oral EM. Serum levels of both TNFalpha and (to a lesser extent) IL-1beta were significantly reduced following EM treatment (p<0.05). Our results suggest that EM represents a biological cure or prevention for those patients who might need repeated revision surgeries and/or show the early signs of progressive osteolysis after TJR.
authors.affiliation: Department of Biomedical Engineering, Wayne State University, 818 W. Hancock, Detroit, MI 48201, USA. wren@med.wayne.edu
authors.forename: Weiping
authors.initials: W
authors.lastname: Ren
authors.forename: Ralph
authors.initials: R
authors.lastname: Blasier
authors.forename: Xin
authors.initials: X
authors.lastname: Peng
authors.forename: Tong
authors.initials: T
authors.lastname: Shi
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wooley
authors.forename: David
authors.initials: D
authors.lastname: Markel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015703:Antigens, CD / Q000096:biosynthesis / Q000187:drug effects; D015214:Antigens, Differentiation, Myelomonocytic / Q000096:biosynthesis / Q000187:drug effects; D016207:Cytokines / Q000187:drug effects; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D015870:Gene Expression / Q000187:drug effects; D020869:Gene Expression Profiling; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000188:drug therapy; D007595:Joint Prosthesis / Q000009:adverse effects*; D007963:Leukocytes, Mononuclear / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology / Q000517:prevention & control*; D053244:Osteoprotegerin / Q000096:biosynthesis / Q000187:drug effects; D011475:Prosthesis Failure; D053245:RANK Ligand / Q000096:biosynthesis / Q000187:drug effects; D012086:Reoperation; D020133:Reverse Transcriptase Polymerase Chain Reaction; D000097382:CD68 Molecule
chemical_list: D000900:Anti-Bacterial Agents; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D016207:Cytokines; D004917:Erythromycin; D053244:Osteoprotegerin; D053245:RANK Ligand; C067980:CD68 antigen, human; D000097382:CD68 Molecule