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Soluble Pecam-1 as a Biomarker in Periprosthetic Joint Infection
Michael Fuchs1, Andrej Trampuz2, Stephanie Kirschbaum2
1RKU University Department of Orthopaedics, University of Ulm, 89081 Ulm, Germany.
Abstract:
A reliable workup with regard to a single diagnostic marker indicating periprosthetic joint infection (PJI) with sufficient sensitivity and specificity is still missing. The immunologically reactive molecule Pecam-1 is shed from the T-cell surface upon activation via proinflammatory signaling, e.g., triggered by specific pathogens. We hypothesized that soluble Pecam-1 (sPecam-1) can hence function as a biomarker of PJI. Fifty-eight patients were prospectively enrolled and assigned to one of the respective treatment groups (native knees prior to surgery, aseptic, and septic total knee arthroplasty (TKA) revision surgeries). Via synovial sample acquisition and ELISA testing, a database on local sPecam-1 levels was established. We observed a significantly larger quantity of sPecam-1 in septic (n = 22) compared to aseptic TKA revision surgeries (n = 20, p ≤ 0.001). Furthermore, a significantly larger amount of sPecam-1 was found in septic and aseptic revisions compared to native joints (n = 16, p ≤ 0.001). Benchmarking it to the gold standard showed a high predictive power for the detection of PJI. Local sPecam-1 levels correlated to the infection status of the implant, and thus bear a strong potential to act as a biomarker of PJI. While a clear role of sPecam-1 in infection could be demonstrated, the underlying mechanism of the molecule's natural function needs to be further unraveled.
Insights
Soluble Pecam-1 (sPecam-1) shows potential as a diagnostic biomarker for periprosthetic joint infection (PJI). Elevated sPecam-1 levels in synovial fluid accurately indicate PJI, aiding in diagnosis.
Area of Science:
- Biomarkers
- Immunology
- Orthopedic Surgery
Background:
- A single, reliable diagnostic marker for periprosthetic joint infection (PJI) with high sensitivity and specificity is currently lacking.
- Soluble Pecam-1 (sPecam-1), an immunologically reactive molecule shed from T-cells during inflammation, is hypothesized to be a potential biomarker for PJI.
Purpose of the Study:
- To investigate the potential of soluble Pecam-1 (sPecam-1) as a diagnostic biomarker for periprosthetic joint infection (PJI).
- To establish local sPecam-1 levels in patients undergoing knee arthroplasty revision surgery.
Main Methods:
- Prospective enrollment of 58 patients into native knee, aseptic, and septic total knee arthroplasty (TKA) revision groups.
- Synovial fluid sample acquisition and Enzyme-Linked Immunosorbent Assay (ELISA) testing to quantify local sPecam-1 levels.
Main Results:
- Significantly higher sPecam-1 levels were observed in septic TKA revisions compared to aseptic TKA revisions (p ≤ 0.001).
- Elevated sPecam-1 levels were also found in both septic and aseptic revisions compared to native joints (p ≤ 0.001).
- sPecam-1 demonstrated high predictive power for PJI detection when benchmarked against the gold standard.
Conclusions:
- Local sPecam-1 levels correlate with implant infection status, indicating strong potential as a PJI biomarker.
- The study confirms a role for sPecam-1 in infection, though its precise biological function requires further investigation.
