麻省理工大学：《生物材料——组织交互作用》教学讲义（英文版）RESPONSE TO IMPLANTS

Massachusetts Institute of Technology yE图 Harvard medical school Brigham and women's hospital VA Boston Healthcare System 2.79J/3.96J/BE,441/HST522J FORMATION OF SOFT TISSUE AND BONE AROUND IMPLANTS The Chronic Response to Implants I.V. YannaS, Ph. D and M. spector, Ph D

Massachusetts In Massachusetts Institute of Technology stitute of Technology Harvard Medical School Harvard Medical School Brigham and Wo Brigham and Women’s Hospital men’s Hospital VA Boston Healthcare System VA Boston Healthcare System 2.79J/3.96J/BE.441/HST522J 2.79J/3.96J/BE.441/HST522J FORMATION OF SOFT TISSUE AND BONE FORMATION OF SOFT TISSUE AND BONE AROUND IMPLANTS: AROUND IMPLANTS: The Chronic Response to Implants The Chronic Response to Implants I.V. Yannas, Ph.D. and M. Spector, Ph.D. I.V. Yannas, Ph.D. and M. Spector, Ph.D

RESPONSE TO IMPLANTS WOUND HEALING Surgical Implantation Inc. time ascular Response Acute Clotting Inflammation Phagocytosis Granulation Neovascularization New Collagen Synthesis Tissue Tissue of labile and stable cells Tissue of permanent cells Implant Movement FrameworkFramework scarring Intact Destroved (fibrous encapsulation synovium Regen. scarring Chronic Inflammation (incorp. (fibrous encapsulation; of implant) synovium) hronic inflammation

RESPONSE TO IMPLANTS: RESPONSE TO IMPLANTS: WOUND HEALING WOUND HEALING Surgical Implantation Surgical Implantation Vascular Response Vascular Response Clotting Clotting Phagocytosis Phagocytosis Neovascularization Neovascularization New Collagen Synthesis New Collagen Synthesis Tissue of Labile and Stable Cells Tissue of Labile and Stable Cells Tissue of Permanent Cells Tissue of Permanent Cells Framework Framework Framework Framework Scarring Scarring Intact Destroyed Intact Destroyed (fibrous encapsulation; (fibrous encapsulation; synovium) synovium) Regen. Scarring Scarring Chronic Inflammation Chronic Inflammation (incorp. (fibrous encapsulation; (fibrous encapsulation; of implant) of implant) synovium) synovium) Chronic Inflammation Chronic Inflammation Acute Inflammation Inflammation Granulation Granulation Tissue Imp lant Movement ant Movement Inc. time Inc. time

Photo removed due to copyright considerations I Metchnikoff

Photo removed due to copyright considerations. I. Metchnikoff

In 1923 a piece of glass was removed from a patients back: it had been there for year. It was surrounded by a minimal amount of fibrous tissue, lined by a glistening synovial sac, containing a few drops of clear yellow fluid. Photo removed due to copyright considerations Smith-Peterson J. Bone Jt. Surg 30-B:59(1948)

In 1923 a piece of glass was removed from a patient’s back; it had been there for a year. It was surrounded by a minimal amount of fibrous tissue, lined by a glistening synovial sac, containing a few drops of clear yellow fluid. Photo removed due to copyright considerations. Smith-Peterson J. Bone Jt. Surg., 30-B:59 (1948)

Four pages removed due to copyright considerations I. Silver

Four pages removed due to copyright considerations. I. Silver

CHRONIC RESPONSE TO IMPLANTS Persistence of macrophages* at the implant surface Presence of fibroblasts x Proliferation and increased matrix synthesis of fibroblasts can result from mechanical perturbation by the implant or by agents released by the implant, leading to an increase in the thickness and density of the scar tissue. Fibroblast contraction can result in scar contracture Constituents of synovium

CHRONIC RESPONSE TO IMPLANTS CHRONIC RESPONSE TO IMPLANTS • Persistence of macrophages* at the implant Persistence of macrophages* at the implant surface surface • Presence of fibroblasts* Presence of fibroblasts* • Proliferation and increased matrix synthesis of Proliferation and increased matrix synthesis of fibroblasts can result from mechanical fibroblasts can result from mechanical perturbation by the implant or by agents perturbation by the implant or by agents released by the implant, leading to an increase in released by the implant, leading to an increase in the thickness and density of the scar tissue. the thickness and density of the scar tissue. • Fibroblast contraction can result in scar Fibroblast contraction can result in scar contracture. contracture. * Constituents of synovium * Constituents of synovium

MACROPHAGE AND FIBROBLAST INTERACTIONS IN SYNOVIUM Ions Mechanical force Endocytosis Macrophage part Sol, Part Reg Mitosis Fibroblast ECM t res Migration Fibroblast Ecm reg Synthesis Fibroblast ECM reg Contraction Fibroblast Ecm reg

MACROPHAGE AND FIBROBLAST MACROPHAGE AND FIBROBLAST INTERACTIONS IN SYNOVIUM INTERACTIONS IN SYNOVIUM Macrophage + Part. Sol. Part + Macrophage + Part. Sol. Part + Reg . Endocytosis Endocytosis Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Fibroblast + ECM + Fibroblast + ECM + Reg . Mitosis Mitosis Migration Migration Synthesis Synthesis Contraction Contraction Ion s Mechanical force Mechanical force

RESPONSE TO IMPLANTS WOUND HEALING Surgical Implantation Inc. time ascular Response Acute Clotting Inflammation Phagocytosis Granulation Neovascularization New Collagen Synthesis Tissue Tissue of labile and stable cells Tissue of permanent cells Implant Movement FrameworkFramework scarring Intact Destroved (fibrous encapsulation synovium Regen. scarring Chronic Inflammation (incorp. (fibrous encapsulation; of implant) synovium) hronic inflammation

RESPONSE TO IMPLANTS: RESPONSE TO IMPLANTS: WOUND HEALING WOUND HEALING Surgical Implantation Surgical Implantation Vascular Response Vascular Response Clotting Clotting Phagocytosis Phagocytosis Neovascularization Neovascularization New Collagen Synthesis New Collagen Synthesis Tissue of Labile and Stable Cells Tissue of Labile and Stable Cells Tissue of Permanent Cells Tissue of Permanent Cells Framework Framework Framework Framework Scarring Scarring Intact Destroyed Intact Destroyed (fibrous encapsulation; (fibrous encapsulation; synovium) synovium) Regen. Scarring Scarring Chronic Inflammation Chronic Inflammation (incorp. (fibrous encapsulation; (fibrous encapsulation; of implant) of implant) synovium) synovium) Chronic Inflammation Chronic Inflammation Acute Inflammation Inflammation Granulation Granulation Tissue Imp lant Movement ant Movement Inc. time Inc. time

IMPLANT MATERIALS BIOMATERIALS TISSUE RESPONSE Soft Tissue(that does not regenerate Fibrous capsule(scar) Synovium: fibrous tissue interspersed with macrophages Wound healing response of repair(scar formation) coupled with macrophage accretion at the " dead space s). chronic inflammation Bone Tissue integration and tissue bonding

IMPLANT MATERIALS/BIOMATERIALS IMPLANT MATERIALS/BIOMATERIALS TISSUE RESPONSE TISSUE RESPONSE Soft Tissue (that does not regenerate) Soft Tissue (that does not regenerate) • Fibrous capsule (scar) Fibrous capsule (scar) Synovium: fibrous tissue interspersed with Synovium: fibrous tissue interspersed with macrophages macrophages Wound healing response of repair (scar formation) Wound healing response of repair (scar formation) coupled with macrophage accretion at the “dead coupled with macrophage accretion at the “dead space” - chronic inflammation chronic inflammation Bone • Tissue integration and tissue bonding Tissue integration and tissue bonding

TISSUE INTEGRATION TISSUE BONDING Tissue Integration(Osseointegration) Apposition of tissue(bone) to the implant(contact of bone with the surface but not necessarily bonding no macrophage layer Regeneration of tissue up to the surface of the implant Tissue Bonding (bone bonding) Chemical bonding of tissue(viz., bone) to the surface Protein adsorption and cell adhesion Biomaterials: calcium phosphates and titanium(?)

TISSUE INTEGRATION TISSUE INTEGRATION TISSUE BONDING TISSUE BONDING • Tissue Integration (Osseointegration) Tissue Integration (Osseointegration) Apposition of tissue (bone) to the implant (contact of Apposition of tissue (bone) to the implant (contact of bone with the surface but not necessarily bonding); bone with the surface but not necessarily bonding); no macrophage layer? no macrophage layer? Regeneration of tissue up to Regeneration of tissue up to the surface of the implant the surface of the implant • Tissue Bonding (Bone Bonding) Tissue Bonding (Bone Bonding) Chemical bonding of tissue ( Chemical bonding of tissue (viz., bone) to the surface ., bone) to the surface Protein adsorption and cell adhesion Protein adsorption and cell adhesion Biomaterials: calcium phosphates and titanium (?) Biomaterials: calcium phosphates and titanium (?)