Cobalt-specific T lymphocytes in synovial tissue after an allergic reaction to a cobalt alloy joint prosthesis

• Published in: Journal of rheumatology Vol. 28; no. 5; pp. 1121 - 1128
• Main Authors: Thomssen, H, Hoffmann, B, Schank, M, Höhler, T, Thabe, H, Meyer zum Büschenfelde, K H, Märker-Hermann, E
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-05-2001; Journal of Rheumatology Publishing
• Subjects: Antigen Presentation - immunology; Arthritis, Psoriatic - immunology; Arthritis, Psoriatic - surgery; Biological and medical sciences; Cell Division - immunology; Cobalt - adverse effects; Cobalt - immunology; Cytokines - immunology; Cytokines - secretion; Female; Histocompatibility Antigens Class II - immunology; Humans; Hypersensitivity - etiology; Hypersensitivity - immunology; Hypersensitivity - pathology; Immunophenotyping; Joint Prosthesis - adverse effects; Medical sciences; Middle Aged; Orthopedic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Synovial Membrane - immunology; Synovial Membrane - pathology; T-Lymphocytes - cytology; T-Lymphocytes - immunology; Human; Postoperative; Immunopathology; Allergy; Immune response; Pathogenesis; Prosthesis; Cellular immunity; Joint; Case study; Orthopedic surgery; Synovial membrane; Cobalt alloy; T-Lymphocyte; Total; Adult; Complication; Biomaterial
• ISSN: 0315-162X; 1499-2752

Metals such as cobalt and nickel are common contact allergens. We studied the mechanisms underlying an allergic reaction with
marked synovial inflammation in a patient with a cobalt alloy arthroplasty. After removing the joint prosthesis the adjacent
synovial tissue was examined for cobalt-specific T lymphocytes. Synovial membrane mononuclear cells were expanded in interleukin
2 and cloned using a representative cloning protocol. T cell clones were tested for their proliferative response to cobalt
and further characterized with regard to cytokine secretion, phenotype, and HLA restriction. Additionally, synovial fibroblasts
were tested for their function as antigen presenting cells (APC). Almost 30% of the T cell clones reacted to cobalt, but not
to the control nickel. All these T cell clones were CD4 positive. The cobalt induced proliferative response could be blocked
by anticlass II antibodies. Also, synovial fibroblasts expressing class II molecules induced by interferon-gamma were able
to serve as APC. However, when testing a panel of APC of HLA class II mismatched donors, no requirement for a certain HLA
class II molecule could be defined. Further studies are necessary to determine mechanisms of presentation and recognition
of cobalt by T lymphocytes, a prerequisite for improved prevention and treatment of metal induced allergic reactions.