TLR-4 expression in corrosion metal debri induced hypoxic milieu around stainless steel fracture plates.
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Date
2018-03
Journal Title
Journal ISSN
Volume Title
Publisher
Biomedical Physics & Engineering Express
Abstract
The release of corrosion debris from metallic implants leading to adverse tissue reactions and pain has
jeopardized the lives of patients. This study attempts to observe if this holds true for widely used cost
efficient stainless steel fracture plates and screws by studying the microenvironment in the peri
prosthetic tissue of the retrieved implants. Fracture plates and nails along with adjacent tissues were
collected in 10% neutral buffered formalin. Cellular response was qualitatively evaluated using HE
staining and debris distribution was semi-quantitatively graded. Elemental composition of metallic
debris was analysed by ESEM-EDAX of the tissue sections. The presence of macrophages, endothelial
cells, TLR-4 and HIF-1αwere quantitated by Immunohistochemistry and histomorphometry.
Analysis of TLR-4 gene expression was carried out by real time PCR and the presence of a hypoxic
milieu was confirmed by PCR Array. This study demonstrates the corrosion debris initiated chronic
inflammatory reaction to stainless steel fracture plates. Nickel and Chromium ions released from
implants induce a hypoxic environment resulting in TLR-4 induction. These results emphasize the
need for identification of potential biomarker that could serve as a deciding factor for removal of
stainless steel fracture plates from patients prior to the onset of inflammation associated reaction and
also suggest the use of better manufacturing techniques and newer bio resorbable implants.
Description
Keywords
corrosion debri, stainless steel fracture plates, TLR-4, hypoxia, foreign body reaction
Citation
Ramanathan V, Joseph J, Prasanth MJ, Mohanty M, Sabareeswaran A. TLR-4 expression in corrosion metal debri induced hypoxic milieu around stainless steel fracture plates. Biomedical Physics & Engineering Express. 2018;4(3).