Scientific Article   |    
Effect of Anti‐Tumor Necrosis Factor-α Gene Therapy on Wear Debris‐Induced Osteolysis
Lisa M. Childs, MS; J. Jeffrey Goater, MS; Regis J. O'Keefe, MD, PhD; Edward M. Schwarz, PhD
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Investigation performed at the University of Rochester Medical Center, Rochester, New York

Lisa M. Childs, MS
Department of Microbiology and Immunology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 672, Rochester, NY 14642. E-mail address: lisachilds@mail.com

J. Jeffrey Goater, MS
Regis J. O’Keefe, MD, PhD
Edward M. Schwarz, PhD
Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for J.J. Goater: jeff_goater@urmc.rochester.edu. E-mail address for R.J. O’Keefe: regis_okeefe@urmc.rochester.edu. E-mail address for E.M. Schwarz: edward_schwarz@urmc.rochester.edu

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (Public Health Service Grants AR45971 and AR46545), the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Orthopaedic Research and Education Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2001 Dec 01;83(12):1789-1797
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Background: Particle phagocytosis by macrophages induces the secretion of tumor necrosis factor-a, which is involved in the development of an osteolytic response. Therefore, we aimed to determine whether gene delivery of a soluble inhibitor of tumor necrosis factor-a (sTNFR:Fc) could prevent wear debris-induced osteolysis in a mouse model. sTNFR:Fc is a fusion protein containing the extracellular domain of the human type-I tumor necrosis factor receptor fused to the Fc region of mouse immunoglobulin. It acts by binding to tumor necrosis factor-a and preventing signaling through the membrane-bound tumor necrosis factor receptors.

Methods: An adenoviral vector encoding the LacZ gene (Ad.CMV-NlacZ) was propagated and was tested for its ability to transduce calvarial tissue. Ad.CMV-TNFR:Fc (encoding sTNFR:Fc) or Ad.CMV-NlacZ was administered to CBAxB6 mice in the presence or absence of titanium particles implanted onto the calvaria. Serum levels of sTNFR:Fc were measured with enzyme-linked immunosorbent assay, and the mice were killed on the tenth postoperative day for histological analysis. The experiments were repeated in athymic nude mice to avoid complications associated with the adenovirus-specific immune response.

Results: Administration of the control virus (Ad.CMV-NlacZ) transduced 10% of the cells in the periosteum. Ad.CMV-NlacZ treatment of sham-treated or titanium-treated animals induced significant bone resorption and osteoclastogenesis above control levels (that is, those in animals not treated with a virus). Treatment with the sTNFR:Fc virus did not reduce bone resorption or osteoclast numbers below control levels in CBAxB6 mice. In the athymic mice, no increase in the midline sagittal suture area or osteoclastogenesis was observed after treatment with the control vector and sTNFR:Fc gene therapy reduced the suture area to background levels.

Conclusions: An immunologic response to Ad.CMV-NlacZ was most likely responsible for the increase in bone resorption and osteoclastogenesis in the animals treated with the control vector alone. In the athymic mice, in the absence of this immune response, sTNFR:Fc gene therapy reduced bone resorption in the midline sagittal suture area but had no effect on osteoclastogenesis.

Clinical Relevance: These results indicate that adenoviral vectors should not be used for gene therapy for the prevention of osteolysis. The results of adenovirus-mediated gene therapy in other systems should also be questioned because of the strong immune response to this vector. However, administration of the sTNFR:Fc gene in a different, nonimmunogenic vector may be useful for the treatment or prevention of wear debris-induced osteolysis.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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