Mast Cells Mediate Acute Inflammatory Responses to Implanted Biomaterials (Histamine͞phagocytes)
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Proc. Natl. Acad. Sci. USA Vol. 95, pp. 8841–8846, July 1998 Medical Sciences Mast cells mediate acute inflammatory responses to implanted biomaterials (histamineyphagocytes) LIPING TANG*†,TIMOTHY A. JENNINGS‡, AND JOHN W. EATON* *Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030; and ‡Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208 Edited by Anthony Cerami, The Kenneth S. Warren Laboratories, Tarrytown, NY, and approved May 26, 1998 (received for review March 2, 1998) ABSTRACT Implanted biomaterials trigger acute and In attempting to define the mechanisms involved in bioma- chronic inflammatory responses. The mechanisms involved in terial-mediated inflammatory responses, we have somewhat such acute inflammatory responses can be arbitrarily divided arbitrarily divided the events into (i) phagocyte transmigration into phagocyte transmigration, chemotaxis, and adhesion to through the endothelial barrier, (ii) chemotaxis toward the implant surfaces. We earlier observed that two chemokines— implant, and (iii) phagocyte adherence to implant surfaces. macrophage inflammatory protein 1aymonocyte chemoat- Our earlier results indicate that interaction between the tractant protein 1—and the phagocyte integrin Mac-1 phagocyte integrin, Mac-1 (CD11byCD18), and surface fibrin- (CD11byCD18)ysurface fibrinogen interaction are, respec- ogen is critical in the adherence of phagocytes to biomaterial tively, required for phagocyte chemotaxis and adherence to implants (1, 20). In addition, both macrophage inflammatory biomaterial surfaces. However, it is still not clear how the protein 1a and monocyte chemoattractant protein 1, two initial transmigration of phagocytes through the endothelial potent chemokines, are involved in phagocyte chemotaxis barrier into the area of the implant is triggered. Because toward the implant (21). However, it is still unclear how implanted biomaterials elicit histaminic responses in the inflammatory cells initially are recruited to the site of implan- surrounding tissue, and histamine release is known to pro- tation. We hypothesized that mast cells and their granular mote rapid diapedesis of inflammatory cells, we evaluated the products, specifically histamine, might play a pivotal role in possible role of histamine and mast cells in the recruitment of this recruitment. This hypothesis was indirectly supported by phagocytes to biomaterial implants. Using i.p. and s.c. im- three observations. First, in agreement with other investigators plantation of polyethylene terephthalate disks in mice we find: (22), we observe modest hyperemia and edema—typical his- (i) Extensive degranulation of mast cells, accompanied by tamine-mediated responses—surrounding experimental s.c. histamine release, occurs adjacent to short-term i.p. implants. and i.p. implants. Second, mast cells, which store and release (ii) Simultaneous administration of H1 and H2 histamine large amounts of histamine, often are found associated with receptor antagonists (pyrilamine and famotidine, respec- implant surfaces (23). Third, release of histamine is known to tively) greatly diminishes recruitment and adhesion of both promote transmigration of phagocytes through the endothelial neutrophils (<20% of control) and monocytesymacrophages barrier and up-regulation of phagocyte adhesion molecules (<30% of control) to implants. (iii) Congenitally mast cell- (24–26). deficient mice also exhibit markedly reduced accumulation of Here, we report experiments aimed at testing the impor- phagocytes on both i.p. and s.c implants. (iv) Finally, mast cell tance of mast cells and histamine in the pathogenesis of acute reconstitution of mast cell-deficient mice restores ‘‘normal’’ inflammatory responses to biomaterial implants. Overall, the inflammatory responses to biomaterial implants. We con- results support the conclusion that mast cells and histamine clude that mast cells and their granular products, especially release are critical to recruitment of inflammatory cells during histamine, are important in recruitment of inflammatory cells biomaterial-mediated inflammatory responses. to biomaterial implants. Improved knowledge of such re- sponses may permit purposeful modulation of both acute and chronic inflammation affecting implanted biomaterials. MATERIALS AND METHODS Materials. Human albumin (AlbumarC 25%) was pur- The increasing usage of implanted devices in the practice of chased from Baxter Healthcare (Glendale, CA). Polyethylene medicine demands improved knowledge of events occurring at terephthalate (PET) film, type A, 0.005 mm thick, was ob- the hostyimplant interface. Commonly used biomaterials may tained from Cadillac Plastic and Chemical (Birmingham, MI). trigger an array of iatrogenic effects including inflammation, All other reagents were purchased from Sigma. fibrosis, coagulation, and infection. In view of the inert and Preparation of PET Disks. PET film was chosen as a model nontoxic nature of most biomaterials, it is puzzling that tissue biomaterial because the knitted form, Dacron (frequently used contact implants very often acquire an extensive overlay of in vascular grafts), is known to provoke inflammatory and phagocytic cells (1–9). These phagocytes have been implicated thrombotic responses (27–30). PET film was cut into circular in a number of subsequent adverse effects such as osteolytic disks of 1.2-cm diameter for use as implants. Disks then were changes around joint implants (7, 10, 11), stress cracking of cleaned and sterilized with multiple changes of 70% ethanol pacemaker leads (12, 13), degradation of biomaterial implants for 24 hr (detailed in ref. 1) and stored in 95% ethanol. (14, 15), and fibrosis surrounding mammary prostheses and Immediately before implantation, disks were thoroughly many other types of implants (16–19). This paper was submitted directly (Track II) to the Proceedings office. The publication costs of this article were defrayed in part by page charge Abbreviations: PMN, polymorphonuclear neutrophils; MPO, myelo- peroxidase; MØ, monocytesymacrophages; NSE, nonspecific esterase; payment. This article must therefore be hereby marked ‘‘advertisement’’ in PET, polyethylene terephthalate. accordance with 18 U.S.C. §1734 solely to indicate this fact. †To whom reprint requests should be addressed at: Department of © 1998 by The National Academy of Sciences 0027-8424y98y958841-6$2.00y0 Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX PNAS is available online at http:yywww.pnas.org. 77030. e-mail: [email protected]. 8841 Downloaded by guest on September 24, 2021 8842 Medical Sciences: Tang et al. Proc. Natl. Acad. Sci. USA 95 (1998) washed in large volumes of sterile saline to remove all traces surface-associated phagocytes (for both MPO and NSE vs. cell of ethanol. number, r 5.0.90) (1). PET disks were implanted with or without precoating with Phagocyte Recruitment. We also investigated the total either albumin (25 mgyml) or fibrinogen (500 mgyml) (1, 20). numbers of phagocytic cells appearing in the peritonea of After 4-hr incubation at room temperature under sterile implant-bearing animals. This was done by peritoneal lavage of conditions, the protein-coated materials were thoroughly animals after implantation for 16 hr. Mice were euthanized washed in sterile saline. It should be noted that none of the with inhaled CO2, and cold PBS (4 ml, pH 7.3) was injected protein-coated (or uncoated) implants had detectable surface- into the peritoneal cavity. After gentle external massage of the associated endotoxin (2). intact peritoneal area for 2 min, the peritoneal cavity was Implantation of PET Disks. All of the animals in this study opened, and the peritoneal fluid and disks were recovered. The [including Swiss–Webster mice from Taconic Farms and mast cells in lavage fluids were concentrated by centrifugation cell-deficient mice (WBB6F1-WyWv) (2y2) and congenic (900 3 g for 10 min). The cell pellets and disks then were controls (WBB6F1-1y1)(1y1) from Jackson Laboratory] incubated with 0.5 ml of 1.0% Triton X-100 for 1 hr to release were male and 20–25 g body weight. Because inflammatory cytosolic and granular enzymes. Enzyme assays then were response to implanted biomaterials varies in mice of different conducted to estimate the numbers of phagocytes. In the ages or shipment batches, only mice of the same age and from results shown, the numbers of peritoneal inflammatory cells a single shipment were used in individual experiments, and are the sum of the cells in lavage fluids and on the disks. control groups were included in every experiment for com- Administration of Histamine Antagonists and 48y80 to parison. Consequently, the experimental values shown in all Mice. In accord with earlier pharmacokinetic studies (41–44), graphs represent results of a single implantation experiment solutions of H1 antagonist (pyrilamine, 5 mgykg body weight) involving 5–6 animals per treatment group as noted. However, andyor H2 antagonist (famotidine, 10 mgykg body weight), all experiments were repeated at least three times, and the and saline (as control) were injected s.c. (supra scapular) into results shown are representative of all trials. mice 1 hr before material samples were implanted and at 5 and In most cases, the variously prepared sterile PET disks were 11 hr after implantation. Dosages and timing were meant to implanted i.p. as previously described (1, 2). However, in a few optimize the extent of continuous blockade of histamine studies,