TLR-4 expression in corrosion metal debri induced hypoxic milieu around stainless steel fracture plates.

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.

Date

2018-03

Authors

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.

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).