“…Recognition of microbial pathogens by PRRs sets in motion multiple signalling cascades that culminate in the production of proinflammatory cytokines, which recruit effector innate immune leukocytes, particularly neutrophils; those, in turn, destroy invading pathogens by various direct or indirect mechanisms such as phagocytosis, bursts of ROS, AMP production and NETs (Brinkmann et al, 2004;Dovi et al, 2004). Unfortunately, pathogens have evolved various mechanisms to dampen innate immune responses, blocking production of pro-inflammatory cytokines as well as inducing cell death and blocking proliferation in target host cells (Faure et al, 2014;Hornef et al, 2002;Lai et al, 2009;Mohamed et al, 2021;Shafikhani and Engel, 2006;Shafikhani et al, 2008;Tolle et al, 2015;Wood et al, 2015a;Wood et al, 2015b). The study hypothesis was that local administration of immunomodulators that can accelerate and direct innate immune leukocyte responses (particularly neutrophils) toward the site of the surgically placed implant would enhance the immune responses toward infection and be effective in reducing PJI, even in the absence of prophylactic antibiotics.…”