Inflammation and foreign body

reaction
Sonia Contreras Ortiz, PhD
Introduction
 The success of use of biomaterials in the body depends
on:
 Material properties
 Design
 Biocompatibility
 Technique used by the surgeon
 Patient’s health and activities
 Biocompatibility can be defined as the acceptance of an
artificial implant by the surrounding tissues and by the
body as a whole
Cell injury and regeneration
Cell injury and regeneration
Inflammation
 It is the vascular reaction that follows exposure to
injurious stimuli (microorganism, foreign body, etc...) and
leads to accumulation of fluid and white blood cells in
extravascular tissues.
 Signs:
 Rubor (redness)
 Tumor (swelling, edema)
 Calor (heat)
 Dolor (pain)
 Functio laesa (functional changes)
Inflammation
 It is a protective mechanism which attempts to
promote wound healing, remove offending
substance(s) and promote repair.

Tissue Injury Inflammation healing

 Inflammation involves proteins, leukocytes and

phagocytic cells that derive from blood cells.
Inflammation process
Response to biomaterial implantation
 Generally, the body tries to get rid of foreign materials in
several ways:
 Extruding them from the body
 Isolating them from healthy tissue (scar)
 Removing them by phagocytes if the material is particulate or
fluid
 Synthetic biomaterials are not immunogenic, so they are
not “rejected” like a transplanted organ.
 They elicit the foreign body reaction (FBR), where
macrophages attempt to phagocytose the material.
 The more biocompatible the implant, less inflammation is
produced.
Response to biomaterial implantation

Fibrosis
Calcification
Chronic
Biomaterial Acute
inflammation
implantation inflammation
FBR
Resolution,
healing,
regeneration
Accute inflammation

ACTIVITY

Neutrophils

Monocytes/Macrophage
Edema

1 2 3 Days
•Vasodilation
•Increased vascular
permeability
Neutrophils
 The first line of defense
 Polymorphonuclear cell
 Respond within 24 hours
 Half life: 6 hours
 Functions:
 Accute inflammation
 Bacterial and foreign-body phagocytosis
 Cytocidal activity: cell destruction
 Chemotactic factors stimulate cell migration
Macrophages
 The second line of defense
 Mononuclear leukocyte
 Arrives within 2 – 3 days
 Can persist indefinitely
 Functions:
 Chronic inflammation
 Bacterial killing – phagocytosis
 Regulates limphocytes
 Regulates coagulation
Bacterial phagocytosis
Chronic inflammation
 Persistent “activated” macrophages;
 Foreign body giant cells
 Mesenchymal cell proliferation
 Tissue destruction
 Can evolve into repair with formation of new blood
vessels (angiogenesis) and collagen deposition (fibrosis)
 Scarring occurs when repair cannot be accomplished by
regeneration, and includes three secuential processes:
angiogenesis, fibrosis, and maduration and remodeling of
the scar
Inflammation outcomes
Inflammation outcomes
Sugested reading
 http://www.intechopen.com/books/calcific-aortic-valve-
disease/the-immune-response-in-in-situ-tissue-
engineering-of-aortic-heart-valves