title: Do genetic susceptibility, Toll-like receptors, and pathogen-associated molecular patterns modulate the effects of wear?
abstract: Overwhelming evidence supports the concept that wear particles are the primary initiator of aseptic loosening of orthopaedic implants. It is likely, however, that other factors modulate the biologic response to wear particles. This review focuses on three potential other factors: genetic susceptibility, Toll-like receptors (TLRs), and bacterial pathogen-associated molecular patterns (PAMPs). WHERE ARE WE NOW?: Considerable evidence is emerging that both genetic susceptibility and TLR activation are important factors that modulate the biologic response to wear particles, but it remains controversial whether bacterial PAMPs also do so. WHERE DO WE NEED TO GO?: Detailed understanding of the roles of these other factors may lead to identification of novel therapeutic targets for patients with aseptic loosening. HOW DO WE GET THERE?: Highest priority should be given to polymorphism replication studies with large numbers of patients and studies to replicate the reported correlation between bacterial biofilms and the severity of aseptic loosening.
authors.affiliation: Department of Orthopaedics, Case Western Reserve University, University Hospitals Case Medical Center, Biomedical Research Building, Room 331, 2109 Adelbert Road, Cleveland, OH, 44106, USA, emg3@cwru.edu.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Greenfield
mesh_terms: D000818:Animals; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D001419:Bacteria / Q000276:immunology; D018441:Biofilms; D001696:Biomechanical Phenomena; D020022:Genetic Predisposition to Disease; D054884:Host-Pathogen Interactions; D006801:Humans; D007595:Joint Prosthesis; D007596:Joints / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000235:genetics / Q000276:immunology / Q000382:microbiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D015398:Signal Transduction; D013314:Stress, Mechanical; D051193:Toll-Like Receptors / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D051193:Toll-Like Receptors