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Im Rahmen der von der Datenbank bone97 erfassten Zeitraums dieser Studie wurde an der Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie der Universität Würzburg zwischen März 1990 und März 2002 in 1073 Fällen bei 794 Patienten (421 männlich und 373 weiblich) autolysierter, Antigen extrahierter, allogener Knochen (AAA-Knochen) in den Kiefer- und Gesichtsbereich implantiert. In 97 Fällen wurde zwischen einzelnen Applikationsformen kombiniert, so dass insgesamt 1278 Präparate eingesetzt wurden. Das verwendete Knochenmaterial stammt aus Multiorganspendern. Das Herstellungsverfahren beinhaltet unter anderem die teilweise oder vollständige Demineralisation von kortikalem Knochen sowie dessen Chemosterilisation. Durch die Konservierung seiner physiologischerweise in der Knochenmatrix lokalisierten Bone Morphogenetic Proteins (BMPs) besitzt AAA-Knochen osteoinduktive Eigenschaften. Der Spenderknochen wurde als Chip (60,9%), als Pulver (mit unterschiedlicher Partikelgröße) (37,4%) sowie als Kalottenchip (1,3%) implantiert. Die häufigste Diagnose, die zur Implantation von AAA-Knochen führte, war die Diagnose Kieferdefekt (259) gefolgt von Zysten (147) und Mittelgesichtshypoplasien (115). Die Liste der Therapieformen wird von der Zystenauffüllung angeführt (147), gefolgt von der Kieferdefektauffüllung (142) und der Mittelgesichtsaugmentation (118). Hierbei lag der Zugang in 63,47% der Fälle intraoral und in 36,53% der Fälle extraoral. Im Laufe des Zeitraums der Nachuntersuchungen kam es zu 44 Implantatverlusten, dies entspricht etwa 3,44%, im Mittel nach 328,52 Tagen. Es traten bei 111 Präparaten Dehiszensen (8,69%)und bei 30 Präparaten Pus (2,35%) auf. Weder die Resuspension der Implantate noch die peri- und postoperativ durchgeführte Antibiose hatten Einfluss auf die Komplikationsrate.
Characterization of tolerogenic rat bone marrow-derived dendritic cells and regulatory T cells
(2010)
Tolerogenic dendritic cells (DC) and regulatory T (Treg) cells are able to prevent destructive immune responses. There is reason to hope that it may soon be possible to use DC and Treg cells to suppress immune responses antigen-specific, not only after transplantation, but also in the case of autoimmunity and allergy. At the moment, the generation of such cell types is very time-consuming and not suitable for clinical routine. In addition, it is not yet fully understood how these cells elicit a desired protective immune response in vivo and how the risks of an excessive immune suppression can be managed. The rat is one of the most important animal models in biomedical research. It is therefore surprising that tolerogenic DC and Treg cells in particular have not been more thoroughly investigated in this model. Thus, the aim of the present study was to systematically characterize these immune cells and investigate their impact on the immune system. Tolerogenic DC were generated from bone marrow precursors cultured with GM-CSF and IL-4 (= IL-4 DC). The proportion of naturally occurring Treg cells with a CD4posCD25posFoxp3pos phenotype comprises approximately 5-8% of the peripheral CD4pos T cells. The characterization of IL-4 DC revealed an up to 26-fold reduced expression of surface molecules such as MHC class II molecules, CD80, CD86, ICAM-1 and CD25 in comparison to mature splenic DC (S-DC). This low expression did not change when the cells where stimulated with different maturation-inducing signals such as replating, LPS, TNF- α and CD40L. Thus, these cells possess a robust phenotype resistant to maturation-inducing stimuli. IL-4 DC take up antigen via endocytosis and are not able to activate naïve T cells or to restimulate antigen-specific T cells. Furthermore, they are able to inhibit and prolongate mature S-DC induced T cell proliferation as well as mature S-DC induced restimulation of antigen-specific T cells, respectively. Thereby, the T cell proliferation was reduced up to 95%. This strong inhibitory effect was mediated within 24 hours in association with a reduced cytokine production (IL-2 about 49% and IFN-γ about 92%). The inhibitory properties of IL-4 DC don´t seem to be caused exclusively by the reduced expression of co-stimulatory molecules. In this study, the detection of the inhibitory molecules PD-L1 and PD-L2 on IL-4 DC suggests they have an impact on mediating inhibitory signals to the T cells. In addition, a suppressive effect of soluble factors was shown. The supernatant of one million IL-4 DC, collected after a 24 hour culture, suppressed mature S-DC induced proliferation of naïve T cells by about 90%. TGF-β, which was detected in the supernatant (up to 300 pg/ml), appears to be the causing soluble factor for this immune inhibition. By contrast, the supernatants of mature S-DC, which did not inhibit the activation of T cells, showed a TGF-β concentration of only about 100 pg/ml. The cytotoxic nitric oxide does not contribute to the IL-4 DC-mediated inhibition of T cell proliferation. The NO synthase inhibitor NMMA reduced the amount of NO by about 50%, but the decreased NO levels did not influence T cell proliferation. Indeed, IL-4 DC are not able to induce T cell proliferation, but this doesn´t mean that there is no change on the molecular level. For instance, T cells co-cultured with IL-4 DC during a first culture are not able to proliferate in the presence of mature S-DC during a second culture. This anergic-like state, however, could be abolished by adding exogenous IL-2. In addition, T cells co-cultured with IL-4 DC are able to inhibit the activation of naïve T cells. Naïve and activated T cells were not able to inhibit the mature S-DC induced T cell proliferation. This observation suggests the induction of Treg cells and was investigated in more detail. Indeed, flow cytometric analysis showed a 1.6-fold expansion of CD4posCD25posFoxp3pos T cells from naturally occurring Treg cells in the presence of IL-4 DC. Thereby, the expansion of CD4posCD25posFoxp3pos T cells occurs independently of the maturation state of DC. Both immature IL-4 DC as well as mature S-DC were able to expand the percentage of naturally occurring Treg cells. However, Treg cells pre-incubated with mature S-DC demonstrated a diminished inhibitory effect compared to Treg cells pre-incubated with IL-4 DC. Treg cells pre-incubated with IL-4 DC were able to inhibit the activation of naïve T cells. In this study it was shown that the regulatory potential of DC cannot be deduced solely by their phenotype or maturation state. Other factors, such as functional properties, need to taken into consideration, too. The induction of Treg cells with suppressive properties induced by in vitro generated tolerogenic IL-4 DC might provide an important mechanism for the maintenance of peripheral tolerance. However, for clinical application further investigation is necessary, not only to understand the interactions between tolerogenic DC and Treg cells, but also to investigate the impact of the transfer of a larger quantity of regulatory cells on the immune system of the recipient.