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. 2000 Oct;59(10):822–827. doi: 10.1136/ard.59.10.822

Expression of epidermal growth factor and transforming growth factor α in interfacial membranes retrieved at revision total hip arthroplasty

J Xu 1, J Ma 1, T Li 1, E Waris 1, A Alberty 1, S Santavirta 1, Y Konttinen 1
PMCID: PMC1753009  PMID: 11005785

Abstract

BACKGROUND—The interfacial membrane between bone and implant has been shown to be a key tissue in the process of aseptic loosening of total hip arthroplasty. The cells within the interfacial membrane produce numerous inflammatory mediators which, through complex mechanisms, cause periprosthetic osteolysis and aseptic loosening. Both epidermal growth factor (EGF) and transforming growth factor α (TGFα) have similar biological functions. They have been found to stimulate bone resorption.
OBJECTIVE—To investigate the presence, cellular localisation, and extent of expression of EGF and TGFα in interfacial membrane retrieved from revision total hip arthroplasty and compare it with that in synovial membrane from primary total hip arthroplasty.
METHODS—Ten interfacial membranes and 10 synovial membranes were stained with avidin-biotin-peroxidase complex for EGF and TGFα. The staining process was done using the Lab Vision Autostainer. The results were measured by a semiautomatic VIDAS image analysis system.
RESULTS—Immunoreactivity for both EGF and TGFα was found in the endothelial cells of blood vessels, macrophages, and fibroblasts, both in interfacial membranes and synovial membranes. However, the number of EGF (980 (370)) and TGFα (1070 (360)) positive cells per mm2 was greater in interfacial membranes than in the synovial membranes (220 (200), 270 (100); p<0.01).
CONCLUSION—It is suggested that owing to their increased expression in interfacial membrane, EGF and TGFα may have an important pathogenetic role in stimulating periprosthetic bone resorption in aseptic loosening of total hip arthroplasty.



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Figure 1  .

Figure 1  

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Immunostaining for epidermal growth factor (EGF) (A) and transforming growth factor α (TGFα) (B) in the synovial-like membrane from a patient with aseptic loosening of total hip arthroplasty. Macrophage staining, in particular, was strong and positive cells were almost restricted to the lining of layer of the interface toward the implant side (arrows). The histological features of this membrane were similar to those of synovial membrane from a patient with osteoarthritis (C). (D) Metal-containing macrophages (small arrows) or foreign body giant cells (larger arrows) were positively stained with EGF antibody. (E) Cement particulate debris, which was oval, was surrounded by macrophages which were positively stained with TGFα antibody. (F) Polyethylene wear particles were surrounded by macrophages which were positively stained with TGFα antibody. (Figures A, B, D, E, F: original magnification ×250, avidin-biotin-peroxidase complex staining, without counterstaining; fig C: original magnification ×250, haematoxylin and eosin staining.)

Figure 2  .

Figure 2  

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(A) Epidermal growth factor (EGF) and (B) transforming growth factor α (TGFα) positive fibroblasts in the synovial-like membrane from a patient with aseptic loosening of total hip arthroplasty. These microphotographs were of a relatively fibrous area, where the long and slender fibroblast-like cells predominate. In contrast with the EGF and TGFα staining in the synovial-like membrane from a patient with aseptic loosening of total hip arthroplasty, there were only a few EGF (C) and TGFα (D) positive cells in the synovial membrane from patients with osteoarthritis who had undergone primary total hip arthroplasty, and staining was relatively weak. In addition to EGF and TGFα positive macrophages and fibroblasts seen in the synovial-like membrane, EGF (E) and TGFα (F) positive vascular endothelial cells (marked with arrows) were also found in this membrane. No EGF (G) and TGFα (H) positive cells were found in any of the staining controls obtained by using an avidin-biotin-peroxidase complex (ABC) staining sequence, in which the primary antibody was omitted and replaced by same isotype IgG serum. (Original magnification ×250, ABC staining, without counterstaining).

Selected References

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