ABSTRACT
The involvement of T cells in the progression of inflammation in response to wear debris at the interface of aseptically loosened joints is currently undefined. This cell type has repeatedly been demonstrated to be a common component of the cellular membrane, the interface, which forms between the bone and implant of total joint replacements (TJRs) [1, 2]. Three further insights into the role of this cell type in the interface were investigated here. Immunostaining demonstrated CD4 expression in 80% of the 15 cases tested while CD8 expression was present in 60% of the cases. Polymerase chain reaction (PCR) detected IFN-gamma mRNA expression in 75% of eight cases tested; in contrast IL-10 mRNA was only demonstrated in 50% of these same cases. Proteins extracted from another eight cases of revision tissue were analyzed using Western blotting for IL-17, fractalkine (Fkn) and CD40. IL-17 and Fkn were a consistent feature of all cases tested (8/8), while CD40 was undetectable in one case (7/8). These results show that T cells present in the interface are more commonly of the helper T cell phenotype, although cytotoxic T cells are also present. Helper T cells (Th) are responsible for the polarization of the immune response through their production of key mediators. The PCR results obtained in this study suggest that a Th1 response characterized by the production of IFN-gamma predominates over the Th2, IL-10 mediated response. Furthermore the demonstration of the expression of IL-17, Fkn and CD40, all of which are Th1 associated molecules, supports this conclusion.