Activated polymorphonuclear derived extracellular vesicles are potential biomarkers of periprosthetic joint infection

Extracellular vesicles (EVs) are considered as crucial players in a wide variety of biological processes. Although their importance in joint diseases or infections has been shown by numerous studies, much less is known about their function in periprosthetic joint infection (PJI). Our aim was to investigate activated polymorphonuclear (PMN)-derived synovial EVs in patients with PJI. Researchers at Semmelweis University asked: (1) Is there a difference in the number and size of extracellular vesicles between periprosthetic joint aspirates of patients with PJI and aseptic loosening? (2) Are these vesicles morphologically different in the two groups? (3) Are there activated PMN-derived EVs in septic samples evaluated by flow cytometry after CD177 labelling? (4) Is there a difference in the protein composition carried by septic and aseptic vesicles?

Thirty-four patients (n = 34) were enrolled into our investigation, 17 with PJI and 17 with aseptic prosthesis loosening. Periprosthetic joint fluid was aspirated and EVs were separated. Samples were analysed by nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM) and flow cytometry (after Annexin V and CD177 labelling). The protein content of the EVs was studied by mass spectrometry (MS).

NTA showed particle size distribution in both groups between 150 nm and 450 nm. The concentration of EVs was significantly higher in the septic samples (p = 0.0105) and showed a different size pattern as compared to the aseptic ones. The vesicular nature of the particles was confirmed by TEM and differential detergent lysis. In the septic group, FC analysis showed a significantly increased event number both after single and double labelling with fluorochrome conjugated Annexin V (p = 0.046) and Annexin V and anti-CD177 (p = 0.0105), respectively. MS detected a significant difference in the abundance of lactotransferrin (p = 0.00646), myeloperoxidase (p = 0.01061), lysozyme C (p = 0.04687), annexin A6 (p = 0.03921) and alpha-2-HS-glycoprotein (p = 0.03146) between the studied groups.

Smaller vesicles in a lower concentration, surrounded by a thin membrane (dashed line arrow) could be observed during the TEM analysis of aseptic samples

(A). Acute septic samples (B) showed a markedly higher number of vesicles with a thin, irregularly shaped membrane (arrow) and containing a dense cargo (circle). The same dense material could be seen also outside the vesicles (circle). Low-grade septic samples (C) provided more vesicles than aseptic aspirates, the EVs were larger than aseptic particles with a thick wall (arrow) and a dense substance inside them (circle). (Magnitude: 30x and the markers show the 500 nm size range).

An increased number of activated PMN derived EVs were detected in the synovial fluid of PJI patients with a characteristic size distribution and a specific protein composition. The activated PMNs-derived extracellular vesicles can be potential biomarkers of PJI.

Sallai I, Marton N, Szatmári A, Kittel Á, Nagy G, Buzás EI, et al. (2022) Activated polymorphonuclear derived extracellular vesicles are potential biomarkers of periprosthetic joint infection. PLoS ONE 17(5): e0268076. [article]

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