Giant cells around bone biomaterials: Osteoclasts or multi-nucleated giant cells?
Recently accumulating evidence has put into question the role of large multinucleated giant cells (MNGCs) around bone biomaterials. While cells derived from the monocyte/macrophage lineage are one of the first cell types in contact with implanted biomaterials, it was originally thought that specifically in bone tissues, all giant cells were bone-resorbing osteoclasts whereas foreign body giant cells (FBGCs) were found associated with a connective tissue foreign body reaction resulting in fibrous encapsulation and/or material rejection. Despite the great majority of bone grafting materials routinely found with large osteoclasts, a special subclass of bone biomaterials has more recently been found surrounded by large giant cells virtually incapable of resorbing bone grafts even years after their implantation. While original hypotheses believed that a 'foreign body reaction' may be taking place, histological data retrieved from human samples years after their implantation have put these original hypotheses into question by demonstrating better and more stable long-term bone volume around certain bone grafts. Exactly how or why this 'special' subclass of giant cells is capable of maintaining long-term bone volume, or methods to scientifically distinguish them from osteoclasts remains extremely poorly studied. The aim of this review article was to gather the current available literature on giant cell markers and differences in expression patterns between osteoclasts and MNGCs utilizing 19 specific markers including an array of CD-cell surface markers. Furthermore, the concept of now distinguishing between pro-inflammatory M1-MNGCs (previously referred to as FBGCs) as well as wound-healing M2-MNGCs is introduced and discussed.



This review article presents 19 specific cell-surface markers to distinguish between osteoclasts and MNGCs including an array of CD-cell surface markers. Furthermore, the concept of now distinguishing between pro-inflammatory M1-MNGCs (often previously referred to as FBGCs) as well as wound-healing M2-MNGCs is introduced and discussed. The proposed concepts and guidelines aims to guide the next wave of research facilitating the differentiation between osteoclast/MNGCs formation, as well as provides the basis for increasing our understanding of the exact function of MNGCs in bone tissue/biomaterial homeostasis.
Department of Oral Surgery and Stomatology, Department of Periodontology, University of Bern, Switzerland; Department Periodontology, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States. Electronic address: rmiron@nova.edu.
Richard J
RJ
Miron
Department of Biomedical Engineering, University of Bern, Switzerland.
Hamoon
H
Zohdi
Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland; Department of Oral Surgery, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Masako
M
Fujioka-Kobayashi
Department of Oral Surgery and Stomatology, Department of Periodontology, University of Bern, Switzerland. Electronic address: dieter.bosshardt@zmk.unibe.ch.
Dieter D
DD
Bosshardt
D001672:Biocompatible Materials / Q000494:pharmacology*; D015415:Biomarkers / Q000378:metabolism; D001842:Bone and Bones / Q000166:cytology*; D015726:Giant Cells / Q000166:cytology* / Q000187:drug effects; D006801:Humans; D007962:Leukocytes / Q000166:cytology / Q000187:drug effects; D010010:Osteoclasts / Q000166:cytology* / Q000187:drug effects
D001672:Biocompatible Materials; D015415:Biomarkers
Bone biomaterial homeostasis; Giant cell formation; Immune cells; Immune response to biomaterials; Osteal macrophages; OsteoMacs; Osteoclast or osteoclastogenesis; Osteoimmunology; Tissue integration