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Hypersensitivity reactions to metal implants: laboratory options

View Article: PubMed Central - PubMed

ABSTRACT

Background: All implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected.

Methods: We analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy.

Results: Our results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses.

Results: The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis.

Results: The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing.

Conclusions: The Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.

No MeSH data available.


Related in: MedlinePlus

a, b Lymphocyte Transformation Test Response. The effect of various metals and PHA on the proliferation rate of patients’ and controls’ lymphocytes: mean lymphocyte response (SI) of each of the three patient groups compared to controls. Group 1 = patients scheduled for pTKA, labelling for a clinical history of metal allergy; Group 2A = TKA patients with pain and clinical signs of metal allergies; Group 2B = TKA patients with pain and no clinical signs of metal allergies; Group 3 = Control subjects. Metal concentrations: (a) = 0.1 mM; (b) = 0,01 mM. Asterisks indicate: (*) p < 0.05; (**) p < 0.005; (***) p < 0.0001
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Fig1: a, b Lymphocyte Transformation Test Response. The effect of various metals and PHA on the proliferation rate of patients’ and controls’ lymphocytes: mean lymphocyte response (SI) of each of the three patient groups compared to controls. Group 1 = patients scheduled for pTKA, labelling for a clinical history of metal allergy; Group 2A = TKA patients with pain and clinical signs of metal allergies; Group 2B = TKA patients with pain and no clinical signs of metal allergies; Group 3 = Control subjects. Metal concentrations: (a) = 0.1 mM; (b) = 0,01 mM. Asterisks indicate: (*) p < 0.05; (**) p < 0.005; (***) p < 0.0001

Mentions: Figure 1a,b shows the effect of sensitiser metals on lymphocyte response. Mean SI values for each of the 3 patient groups were compared to controls. At the concentration of 0.1 mM, (Fig. 1a), NiCl2 produced the highest degree of proliferative response, with a more than fivefold increase in Group 1 and Group 2A (5.1 and 5.3 respectively), and a twofold increase in Group 2B. Statistically significant difference was reached in Group 1 (p = 0.004) and Group 2A (p = 0.001). Moreover, Ni increased proliferative response by about twofold in Group 1 and Group 2A (2.2 and 1.7 respectively), with a statistically significant difference in Group 1 (p = 0.001), and Group 2A (p = 0.01). Group I patients showed a statistically significant proliferative response in the presence of CrCl3 (1.7; p = 0.001) and Cr (1.4; p = 0.03), while Group 2A patients showed a high proliferative response, about a sixfold increase, in the presence of Co (5.7; p < 0.0001).Fig. 1


Hypersensitivity reactions to metal implants: laboratory options
a, b Lymphocyte Transformation Test Response. The effect of various metals and PHA on the proliferation rate of patients’ and controls’ lymphocytes: mean lymphocyte response (SI) of each of the three patient groups compared to controls. Group 1 = patients scheduled for pTKA, labelling for a clinical history of metal allergy; Group 2A = TKA patients with pain and clinical signs of metal allergies; Group 2B = TKA patients with pain and no clinical signs of metal allergies; Group 3 = Control subjects. Metal concentrations: (a) = 0.1 mM; (b) = 0,01 mM. Asterisks indicate: (*) p < 0.05; (**) p < 0.005; (***) p < 0.0001
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Related In: Results  -  Collection

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Fig1: a, b Lymphocyte Transformation Test Response. The effect of various metals and PHA on the proliferation rate of patients’ and controls’ lymphocytes: mean lymphocyte response (SI) of each of the three patient groups compared to controls. Group 1 = patients scheduled for pTKA, labelling for a clinical history of metal allergy; Group 2A = TKA patients with pain and clinical signs of metal allergies; Group 2B = TKA patients with pain and no clinical signs of metal allergies; Group 3 = Control subjects. Metal concentrations: (a) = 0.1 mM; (b) = 0,01 mM. Asterisks indicate: (*) p < 0.05; (**) p < 0.005; (***) p < 0.0001
Mentions: Figure 1a,b shows the effect of sensitiser metals on lymphocyte response. Mean SI values for each of the 3 patient groups were compared to controls. At the concentration of 0.1 mM, (Fig. 1a), NiCl2 produced the highest degree of proliferative response, with a more than fivefold increase in Group 1 and Group 2A (5.1 and 5.3 respectively), and a twofold increase in Group 2B. Statistically significant difference was reached in Group 1 (p = 0.004) and Group 2A (p = 0.001). Moreover, Ni increased proliferative response by about twofold in Group 1 and Group 2A (2.2 and 1.7 respectively), with a statistically significant difference in Group 1 (p = 0.001), and Group 2A (p = 0.01). Group I patients showed a statistically significant proliferative response in the presence of CrCl3 (1.7; p = 0.001) and Cr (1.4; p = 0.03), while Group 2A patients showed a high proliferative response, about a sixfold increase, in the presence of Co (5.7; p < 0.0001).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: All implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected.

Methods: We analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy.

Results: Our results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses.

Results: The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis.

Results: The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing.

Conclusions: The Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.

No MeSH data available.


Related in: MedlinePlus