The Healing of Tibial Fracture and Response of the Local Lymphatic System

Szczęsny, Grzegorz; Olszewski, Waldemar L.; Gewartowska, Magdalena; Zaleska, Marzanna; Górecki, Andrzej

doi:10.1097/01.ta.0000236641.51515.8f

Cited by 20 publications

(10 citation statements)

References 10 publications

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“…LCs are the prototypic antigen-presenting dendritic cells residing in the epidermis, which acquire antigens in the peripheral tissue and transport them to regional lymph node following stimulation by cutaneous injury, infection, or in other disease states [ 37 , 38 ]. Popliteal and iliac lymph node enlargement has been previously observed at 7 days after tibia fracture and casting in rats [ 39 ] and after tibia fracture in man [ 40 ]. Lymph nodes from a number of mammalian species have been reported to possess SP and CGRP nerve fibers that travel as individual fibers in the parenchyma of the cortex and medulla among lymphocytes.…”

Section: Resultsmentioning

confidence: 99%

Neuropeptide regulation of adaptive immunity in the tibia fracture model of complex regional pain syndrome

Guo

Shi

et al. 2018

J Neuroinflammation

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BackgroundBoth dysfunctional neuropeptide signaling and immune system activation are characteristic of complex regional pain syndrome (CRPS). Unknown is whether substance P (SP) or calcitonin gene-related peptide (CGRP) support autoantibody production and, consequently, nociceptive sensitization.MethodsThese experiments involved the use of a well-characterized tibia fracture model of CRPS. Mice deficient in SP expression (Tac1−/−) and CGRP signaling (RAMP1−/−) were used to probe the neuropeptide dependence of post-fracture sensitization and antibody production. The deposition of IgM in the spinal cord, sciatic nerves, and skin was followed using Western blotting, as was expression of the CRPS-related autoantigen cytokeratin 16 (Krt16). Passive serum transfer to B-cell-deficient muMT mice was used to assess the production of functional autoantibodies in CRPS model mice. The use of immunohistochemistry allowed us to assess neuropeptide-containing fiber distribution and Langerhans cell abundance in mouse and human CRPS patient skin, while Langerhans cell-deficient mice were used to assess the functional contributions of these cells.ResultsFunctional SP and CGRP signaling were required both for the full development of nociceptive sensitization after fracture and the deposition of IgM in skin and neural tissues. Furthermore, the passive transfer of serum from wildtype but not neuropeptide-deficient mice to fractured muMT mice caused enhanced allodynia and postural unweighting. Langerhans cells were increased in number in the skin of fracture mice and CRPS patients, and those increases in mice were reduced in neuropeptide signaling-deficient animals. Unexpectedly, Langerhans cell-deficient mice showed normal nociceptive sensitization after fracture. However, the increased expression of Krt16 after tibia fracture was not seen in neuropeptide-deficient mice.ConclusionsCollectively, these data support the hypothesis that neuropeptide signaling in the fracture limb of mice is required for autoantigenic IgM production and nociceptive sensitization. The mechanism may be related to neuropeptide-supported autoantigen expression.

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Section: Resultsmentioning

confidence: 99%

Neuropeptide regulation of adaptive immunity in the tibia fracture model of complex regional pain syndrome

Guo

Shi

et al. 2018

J Neuroinflammation

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“…Previous studies showed that the lymphatic draining in the injured bone is activated upon fracture and that prolonged lymphonodal activity is associated with successful healing (57, 58). Ocn -positive cells accumulate in the peripheral blood after an injury (59) and osteoblastic precursors have been reported to invade fractured bone via blood vessels (60).…”

Section: Discussionmentioning

confidence: 99%

T Lymphocytes Influence the Mineralization Process of Bone

et al. 2017

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Bone is a unique organ able to regenerate itself after injuries. This regeneration requires the local interplay between different biological systems such as inflammation and matrix formation. Structural reconstitution is initiated by an inflammatory response orchestrated by the host immune system. However, the individual role of T cells and B cells in regeneration and their relationship to bone tissue reconstitution remain unknown. Comparing bone and fracture healing in animals with and without mature T and B cells revealed the essential role of these immune cells in determining the tissue mineralization and thus the bone quality. Bone without mature T and B cells is stiffer when compared to wild-type bone thus lacking the elasticity that helps to absorb forces, thus preventing fractures. In-depth analysis showed dysregulations in collagen deposition and osteoblast distribution upon lack of mature T and B cells. These changes in matrix deposition have been correlated with T cells rather than B cells within this study. This work presents, for the first time, a direct link between immune cells and matrix formation during bone healing after fracture. It illustrates specifically the role of T cells in the collagen organization process and the lack thereof in the absence of T cells.

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“…Combined closed fracture and acute hematogenous osteomyelitis is rare. The surgeon should consider the origin of the pathogen which could be from soft tissue or the lymphatic or hematogenous systems [ [10] , [11] , [12] , [13] ]. The groups most at risk of developing an infection after a closed fracture are pediatric and immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

Closed infected tibial plateau fracture and tibial tubercle avulsion: A case report

Chuaychoosakoon

Parinyakhup

2020

International Journal of Surgery Case Reports

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Highlights The incidence of closed infected fracture is rare. Any patient can become infected even with closed fracture and despite being an immunocompetent host. In this patient, the risk factors of closed infected tibial plateau fracture are subdural hematoma and multiple skin abrasions. Any sign of surgical site infection with sepsis is an indication perform, the surgeon should operate to irrigation and debridement.

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The Healing of Tibial Fracture and Response of the Local Lymphatic System

Cited by 20 publications

References 10 publications

Neuropeptide regulation of adaptive immunity in the tibia fracture model of complex regional pain syndrome

Neuropeptide regulation of adaptive immunity in the tibia fracture model of complex regional pain syndrome

T Lymphocytes Influence the Mineralization Process of Bone

Closed infected tibial plateau fracture and tibial tubercle avulsion: A case report

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