Electronic health record mining reveals effects of patient immune status on clinical outcomes of biomaterial implantation following skeletal muscle damage

Abstract

Implantation of medical devices and biomaterials can help restore form and function of missing or damaged tissue. It is known that the immune system plays a critical role in both positive and negative outcomes of these implanted materials. The foreign body response is characterized by protein deposition and clotting followed by macrophage inflammation, frustrated phagocytosis, giant cell formation, and ultimately fibrosis. This can inhibit the function of implanted devices (e.g. Insulin pumps) as well as cosmesis (e.g. capsular contracture in breast implants) and persistent inflammation has been associated with more severe outcomes in some patients, including emergence of autoimmune-like pathologies. On the other hand, the immune system plays a constructive role in tissue remodeling and regeneration and is needed for the positive effects of some biomaterials, such as extracellular matrix-based scaffolds in muscle repair. Given these factors, we sought to understand potential variations in post-operative complications in individuals with primary and secondary immune disorders – both autoimmune and immunodeficiencies. This preliminary observational study using electronic health record mining showed increased complication odds for individuals with both autoimmune conditions and immunodeficiencies, with variations dependent upon the individual's sex and age as well as the type of material implanted. Future prospective studies could yield improved insight into both mechanisms of immune response to materials in humans and identify potential risk factors for individual patients undergoing plastics and reconstructive surgeries.