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Wear debris from titanium joint replacements could be cause of inflammatory response

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Microparticles of titanium can flake away from artificial joints through normal wear and tear, playing a role in inflammation that may lead to bone destruction and loosening, according to a study from researchers in New Jersey.

The findings, published in the Journal of Immunology, suggest that previous assumptions as to the nature of this inflammation — specifically that it may be caused by bacteria adhering to dislodged titanium particles and activating an immune response — may be erroneous and the titanium particles themselves may trigger the inflammatory response.

Working with mice, the researchers found that introducing these titanium particles induced a Th2 response. The Th2 response, according to the study abstract and a University of Medicine and Dentistry of New Jersey press release, is typically associated with allergic responses and results in the generation of alternatively activated macrophages (AAMs). These lead the immune system to respond as if the particles are allergens or invading parasites.

AltThough the potential effects of a Th2 response in the joint are not completely clear, the release noted there is increasing evidence that AAMs contribute to bone destruction in prosthesis recipients and patients with specific varieties of arthritis.

“Assessment of the innate response indicated that [titanium microparticles] induced rapid recruitment and differentiation of [AAMs] in vivo, through IL-4- and TLR4-independent pathways. These studies suggest that solid microparticles alone can act as adjuvants to induce potent innate and adaptive Th2-type immune responses and further suggest that wear debris in joint replacements may have Th2-type inflammatory properties,” the authors wrote.

Reference:

• Mishra PK, Wu W, Rozo C, et al. Micrometer-sized titanium particles can induce potent Th2-type responses through the TLR4-independent pathways. J Immunol. 2011. doi: 10.4049/?jimmunol.1101392

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