Foreign Body Reaction to Subcutaneous Implants

Kastellorizios, Michail; Tipnis, Namita; Burgess, Diane J.

doi:10.1007/978-3-319-18603-0_6

Cited by 85 publications

(74 citation statements)

References 84 publications

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“…Macrophages play a significant role in the inflammation process and are considered as key effector and dominant cells secreting pro‐inflammatory cytokines such as IL‐1β and tumour necrosis factor‐α (TNFα), chemokines and growth factors, such as monocyte chemoattracting protein 1 (MCP‐1), transforming growth factor‐β, and platelet‐derived growth factor (Oishi & Manabe, ; Wynn & Vannella, ). In addition, macrophages may fuse on the biomaterial in an attempt to phagocytose the implant larger in size than themselves, forming foreign body giant cells, which represents also a sign of chronic inflammation (Kastellorizios, Tipnis, & Burgess, ; Moore & Kyriakides, ).…”

Section: Introductionmentioning

confidence: 99%

Study on the potential mechanism of anti‐inflammatory activity of covalently immobilized hyaluronan and heparin

Al-Khoury

Hautmann

Erdmann

et al. 2020

J Biomedical Materials Res

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Inflammation and subsequent fibrotic encapsulation that occur after implantation of biomaterials are issues that fostered efforts in designing novel biocompatible materials to modulate the immune response. In this study, glycosaminoglycans (GAG) like hyaluronic acid (HA) and heparin (Hep) that possess anti‐inflammatory activity were covalently bound to NH2‐modified surfaces using EDC/NHS cross‐linking chemistry. Immobilization and physical surface properties were characterized by atomic forces microscopy, water contact angle studies and streaming potential measurements demonstrating the presence of GAG on the surfaces that became more hydrophilic and negatively charged compared to NH2‐modified. THP‐1 derived macrophages were used here to study the mechanism of action of GAG to affect the inflammatory responses illuminated by studying macrophage adhesion, the formation of multinucleated giant cells (MNGCs) and IL‐1β release that were reduced on GAG‐modified surfaces. Detailed investigation of the signal transduction processes related to macrophage activation was performed by immunofluorescence staining of NF‐κB (p65 subunit) together with immunoblotting. We studied also association and translocation of FITC‐labeled GAG. The results show a significant decrease in NF‐κB level as well as the ability of macrophages to associate with and take up HA and Hep. These results illustrate that the anti‐inflammatory activity of GAG is not only related to making surfaces more hydrophilic, but also their active involvement in signal transduction processes related to inflammatory reactions, which may pave the way to design new anti‐inflammatory surface coatings for implantable biomedical devices.

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Section: Introductionmentioning

confidence: 99%

Study on the potential mechanism of anti‐inflammatory activity of covalently immobilized hyaluronan and heparin

Al-Khoury

Hautmann

Erdmann

et al. 2020

J Biomedical Materials Res

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“…, Kastellorizios et al. ). A foreign body reaction is characterized by the infiltration of inflammatory cells, the presence of granulation tissue, the up‐regulation of inflammatory markers, and the absence of osteogenic protein expression (Sela et al.…”

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confidence: 98%

“…Fibrous encapsulation is a hallmark of failed implants (Tonetti & Schmid 1994), but it also occurs in response to a foreign body reaction (Coleman et al 1974, Kastellorizios et al 2015. A foreign body reaction is characterized by the infiltration of inflammatory cells, the presence of granulation tissue, the up-regulation of inflammatory markers, and the absence of osteogenic protein expression (Sela et al 1986, Rolfe et al 2011).…”

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confidence: 99%

Rescuing failed oral implants via Wnt activation

Yin

Chen

et al. 2016

J Clinic Periodontology

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Aim Implant osseointegration is not always guaranteed and once fibrous encapsulation occurs clinicians have few options other than implant removal. Our goal was to test whether a WNT protein therapeutic could rescue such failed implants. Material and Methods Titanium implants were placed in over-sized murine oral osteotomies. A lack of primary stability was verified by mechanical testing. Interfacial strains were estimated by finite element modelling and histology coupled with histomorphometry confirmed the lack of peri-implant bone. After fibrous encapsulation was established peri-implant injections of a liposomal formulation of WNT3A protein (L-WNT3A) or liposomal PBS (L-PBS) were then initiated. Quantitative assays were employed to analyse the effects of L-WNT3A treatment. Results Implants in gap-type interfaces exhibited high interfacial strains and no primary stability. After verification of implant failure, L-WNT3A or L-PBS injections were initiated. L-WNT3A induced a rapid, significant increase in Wnt responsiveness in the peri-implant environment, cell proliferation and osteogenic protein expression. The amount of peri-implant bone and bone in contact with the implant were significantly higher in L-WNT3A cases. Conclusions These data demonstrate L-WNT3A can induce peri-implant bone formation even in cases where fibrous encapsulation predominates.

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“…In contrast, there was an abundant fibrous sheath around/between the electrode and positioner in Case 2. Formation of a fibrous sheath around biomaterials involves a foreign body reaction, which consists of protein adsorption on the implant surface, inflammatory cell infiltration, macrophage fusion into foreign body giant cells, fibroblast activation, and fibrous encapsulation of the foreign body (17). Macrophages that attach and recognize an implanted biomaterial larger than 5 μm attempt to coalesce to form foreign body giant cells (18).…”

Section: Discussionmentioning

confidence: 99%

“…The chronic inflammatory response includes granulation tissue identified by the presence of macrophages, infiltration of fibroblasts, and angiogenesis. Fibroblasts activated by macrophages and foreign body giant cells synthesize and deposit collagen that results in material encapsulation (17, 18). The foreign body giant cell infiltration and granulomatous reaction were observed in 27 of 28 temporal bones from individuals who had undergone cochlear implantation (19), but the degree of inflammatory cell infiltration varied among individuals.…”

Section: Discussionmentioning

confidence: 99%

Cochlear Histopathology as Observed in Two Patients With a Cochlear Implant Electrode With Positioner

Kamakura

Nadol²

2016

Otology &Amp; Neurotology

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Hypothesis This study reports the cochlear histopathology of two cases who during life underwent cochlear implantation with a positioner. Background A silastic positioner introduced by the Advanced Bionics Corporation in 1999 was designed to position the electrode of the cochlear implant close to the modiolus. The positioner was recalled in the United States in July 2002 because of an apparent higher incidence of bacterial meningitis in patients in whom the positioner had been placed. Methods Four celloidin-embedded temporal bones from two patients with cochlear implants with a positioner from the temporal bone collection of the Massachusetts Eye and Ear Infirmary were included in the study. In a previous study, we reported histopathologic findings in Case 1, and in this report, we present the findings in a second case in a 94-year-old woman (Case 2), and the similarities and differences between the two cases. All four specimens were prepared for histologic study by conventional techniques and 2-D reconstruction. Results Evidence of insertion trauma was seen in all three implanted specimens. More significant trauma was found in Case 2 than Case 1 including disruption of the osseous spiral lamina and the basilar membrane. In addition, there was more new fibrous tissue and bone in Case 2 than Case 1. There was a large fluid space in all three implanted temporal bones around the electrode and positioner. Conclusion The findings seen in the two cases may help to explain the increased risk of meningitis in patients implanted with a positioner.

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Foreign Body Reaction to Subcutaneous Implants

Cited by 85 publications

References 84 publications

Study on the potential mechanism of anti‐inflammatory activity of covalently immobilized hyaluronan and heparin

Study on the potential mechanism of anti‐inflammatory activity of covalently immobilized hyaluronan and heparin

Rescuing failed oral implants via Wnt activation

Cochlear Histopathology as Observed in Two Patients With a Cochlear Implant Electrode With Positioner

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