The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants
The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants
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DOI：
10.1093/asj/sjy335
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发表时间：
2019-03-01
影响因子：
2.9
通讯作者：
Hammond, Dennis
中科院分区：
文献类型：
--
作者：
Hallab, Nadim James;Samelko, Lauryn;Hammond, Dennis
目前，关于乳房植入体（BI）颗粒脱落程度以及BI碎片的一般生物学后果的信息缺乏。因此，尚不清楚BI碎片对BI长期生物学性能的影响程度。对于骨科植入物，已经确定植入物碎片的生物反应性严重程度决定了长期临床性能。骨科植入物颗粒碎片的直径通常在0.01至100 m范围内。植入物碎屑诱导的生物反应/炎症主要是由产生促炎细胞因子（如肿瘤坏死因子、白细胞介素-1、白细胞介素-6和前列腺素2（PGE 2））的局部先天免疫细胞（如巨噬细胞）引起的植入物周围现象。在骨科中，除了记录到扩散到远端器官（例如肝脏、脾脏等）外，几乎没有与聚合物植入物碎片（如硅胶）相关的全身性问题。没有已知的相关致病性。对于金属植入物碎片，情况并非如此，正常（功能良好）的植入物可诱导全身反应，如迟发型超敏反应。骨科组织的诊断分析集中在先天性（巨噬细胞介导的）和适应性（淋巴细胞介导的超敏反应）免疫反应。骨科植入物碎片相关淋巴细胞癌在40多年的骨科文献中尚未报道。适应性免疫反应，如对骨科植入物碎片的超敏反应，主要是由产生特定类型碎片的某些植入物类型（例如，金属对金属全关节假体）引起的。骨科超敏反应和非典型BI生物反应性（如BI相关间变性大细胞淋巴瘤）共享交叉诊断标志物。区分对间变性大细胞淋巴瘤反应和对BI相关植入物碎片的迟发型超敏反应的颗粒的正常先天免疫反应仍然不清楚，但对患者和外科医生至关重要。
Currently, there is a dearth of information regarding the degree of particle shedding from breast implants (BIs) and what are the general biological consequences of BI debris. Thus, it is unclear to what degree BI debris compromises the long-term biological performance of BIs. For orthopedic implants, it is well established that the severity of biological reactivity to implant debris governs long-term clinical performance. Orthopedic implant particulate debris is generally in the range of 0.01 to 100 m in diameter. Implant debris-induced bioreactivity/inflammation is mostly a peri-implant phenomenon caused by local innate immune cells (eg, macrophages) that produce proinflammatory cytokines such as tumor necrosis factor-, interleukin-1, interleukin-6, and prostaglandin 2 (PGE2). In orthopedics, there have been few systemic concerns associated with polymeric implant debris (like silicone) other than documented dissemination to remote organs (eg, liver, spleen, etc.) with no known associated pathogenicity. This is not true of metal implant debris where normal (well-functioning) implants can induce systemic reactions such as delayed type hypersensitivity. Diagnostic analysis of orthopedic tissues has focused on innate (macrophage mediated) and adaptive (lymphocyte-mediated hypersensitivity) immune responses. Orthopedic implant debris-associated lymphocyte cancers have not been reported in over 40 years of orthopedic literature. Adaptive immune responses such as hypersensitivity reactions to orthopedic implant debris have been dominated by certain implant types that produce specific kinds of debris (eg, metal-on-metal total joint prostheses). Orthopedic hypersensitivity responses and atypical BI bioreactivity such as BI-associated anaplastic large cell lymphoma share crossover markers for diagnosis. Differentiating normal innate immune reactivity to particles from anaplastic large cell lymphoma reactions from delayed type hypersensitivity reactions to BI-associated implant debris remains unclear but vital to patients and surgeons.