Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.

Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopatho...

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Autores principales: Saloni Mittal, Matthew Revell, Francesca Barone, Debbie L Hardie, Gulraj S Matharu, Alison J Davenport, Richard A Martin, Melissa Grant, Frederick Mosselmans, Paul Pynsent, Vaiyapuri P Sumathi, Owen Addison, Peter A Revell, Christopher D Buckley
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spelling oai:doaj.org-article:9cc69897c8dd49659c6f235b160f75982021-11-18T07:44:11ZLymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.1932-620310.1371/journal.pone.0063470https://doaj.org/article/9cc69897c8dd49659c6f235b160f75982013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23723985/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopathological changes were examined in the periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, with particular emphasis on the characteristics and pattern of the lymphocytic infiltrate. Immunofluorescence and immunohistochemistry were used to study the classical features of TLOs in cases where large organized lymphoid follicles were present. Synchrotron X-ray fluorescence (XRF) measurements were undertaken to detect localisation of implant derived ions/particles within the samples. Based on type of lymphocytic infiltrates, three different categories were recognised; diffuse aggregates (51%), T cell aggregates (20%), and organised lymphoid aggregates (29%). Further investigation of tissues with organised lymphoid aggregates showed that these tissues recapitulate many of the features of TLOs with T cells and B cells organised into discrete areas, the presence of follicular dendritic cells, acquisition of high endothelial venule like phenotype by blood vessels, expression of lymphoid chemokines and the presence of plasma cells. Co-localisation of implant-derived metals with lymphoid aggregates was observed. These findings suggest that in addition to the well described general foreign body reaction mediated by macrophages and a T cell mediated type IV hypersensitivity response, an under-recognized immunological reaction to metal wear debris involving B cells and the formation of tertiary lymphoid organs occurs in a distinct subset of patients with M-M implants.Saloni MittalMatthew RevellFrancesca BaroneDebbie L HardieGulraj S MatharuAlison J DavenportRichard A MartinMelissa GrantFrederick MosselmansPaul PynsentVaiyapuri P SumathiOwen AddisonPeter A RevellChristopher D BuckleyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e63470 (2013)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Saloni Mittal
Matthew Revell
Francesca Barone
Debbie L Hardie
Gulraj S Matharu
Alison J Davenport
Richard A Martin
Melissa Grant
Frederick Mosselmans
Paul Pynsent
Vaiyapuri P Sumathi
Owen Addison
Peter A Revell
Christopher D Buckley
Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
description Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopathological changes were examined in the periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, with particular emphasis on the characteristics and pattern of the lymphocytic infiltrate. Immunofluorescence and immunohistochemistry were used to study the classical features of TLOs in cases where large organized lymphoid follicles were present. Synchrotron X-ray fluorescence (XRF) measurements were undertaken to detect localisation of implant derived ions/particles within the samples. Based on type of lymphocytic infiltrates, three different categories were recognised; diffuse aggregates (51%), T cell aggregates (20%), and organised lymphoid aggregates (29%). Further investigation of tissues with organised lymphoid aggregates showed that these tissues recapitulate many of the features of TLOs with T cells and B cells organised into discrete areas, the presence of follicular dendritic cells, acquisition of high endothelial venule like phenotype by blood vessels, expression of lymphoid chemokines and the presence of plasma cells. Co-localisation of implant-derived metals with lymphoid aggregates was observed. These findings suggest that in addition to the well described general foreign body reaction mediated by macrophages and a T cell mediated type IV hypersensitivity response, an under-recognized immunological reaction to metal wear debris involving B cells and the formation of tertiary lymphoid organs occurs in a distinct subset of patients with M-M implants.
format article
author Saloni Mittal
Matthew Revell
Francesca Barone
Debbie L Hardie
Gulraj S Matharu
Alison J Davenport
Richard A Martin
Melissa Grant
Frederick Mosselmans
Paul Pynsent
Vaiyapuri P Sumathi
Owen Addison
Peter A Revell
Christopher D Buckley
author_facet Saloni Mittal
Matthew Revell
Francesca Barone
Debbie L Hardie
Gulraj S Matharu
Alison J Davenport
Richard A Martin
Melissa Grant
Frederick Mosselmans
Paul Pynsent
Vaiyapuri P Sumathi
Owen Addison
Peter A Revell
Christopher D Buckley
author_sort Saloni Mittal
title Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
title_short Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
title_full Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
title_fullStr Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
title_full_unstemmed Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
title_sort lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements.
publisher Public Library of Science (PLoS)
publishDate 2013
url https://doaj.org/article/9cc69897c8dd49659c6f235b160f7598
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