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A thorough understanding of macrophage behavior is essential for comprehending the immunomodulatory properties of implantable materials. Several studies have reported heterogeneous markers, a variety of cell models, and protocols for characterizing macrophage polarization in vitro17,18,19,20. To improve reproducibility, reliability, and comparability of experimental results, standardized and verified protocols, along with a suitable cell model and consensus characterization markers, are essential. Accordingly, an accurate simulation of the immunomodulatory properties of implant materials requires first a proper cell model. Different studies have utilized a wide range of cell models, such as isolated tissue macrophages, differentiated macrophages derived from blood monocytes, and immortalized monocytic cell lines. Although tissue-isolated macrophages may be considered more representative of in vivo conditions, they are technically and ethically challenging21,22. Macrophages are also frequently obtained from established immortalized monocytic cell lines, such as THP1 cells23,24,25,26. While these cells may offer more homogeneity in cell response as an unlimited source of non-senescent cells, they are usually obtained from patients with hematological neoplasms, and their responses may differ significantly from normal cells. Monocytic THP1 cells, for instance, have been reported to be more responsive to M1 simulators and more likely to exhibit M1 characteristics22. The results of this study are in line with those from our preliminary study (data not presented here).
Furthermore, as blood-derived monocytes are considered the precursors of tissue-resident macrophages and can be readily obtained in higher yields, they may be a feasible alternative for macrophages27,28,29. Based on our study using blood monocyte-derived macrophages, we found that these cells were equally responsive to M1 and M2 stimulators on both titanium and cell culture-treated coverslips. Additionally, they exhibited multiple M1 and M2 consensus markers, some of which are shown in the representative results. The results demonstrated that MDMs can be utilized as a feasible in vitro model for simulating implant-macrophage interactions.
For further advancements in immunomodulation studies, constant and specific characterization markers are essential. Studies have introduced a variety of markers for macrophage characterization that differ not only between macrophages from different sources but also between macrophages from the same source17,18,19,24. A panel of M1 and M2 markers characteristic of MDMs was determined and verified via the evaluation of different reported markers. Some of the most important key markers are presented in this article.
Determining the most appropriate methods of detection is also a crucial part of the evaluation process. Analysis techniques commonly used to assess cell surface markers typically require the removal of cells from biomaterials. However, this process has been observed to negatively affect the cells by damaging their surface markers and resulting in a low number of detached cells30. Consequently, flow cytometry, which requires cell detachment, is not appropriate for evaluating macrophages that are tightly attached to implants. In this study, cell surface marker detection was conducted using CLSM. By using the appropriate markers and optimizing the staining process, we were able to successfully characterize M1 and M2 subtypes in comparison to each other and to M0 cells. It is important to note that fluorescence staining is semi-quantitative, which is one of its limitations. This can complicate the evaluation of cells using markers expressed across all subtypes without significant differences. CCR7 and CD209 were selected after testing different markers to characterize the MDMs using CLSM. CCR7 and CD209 were consistently higher expressed in M1 and M2 subtypes, respectively.
Within the limitations of this study, the results highlight the utility and effectiveness of implemented protocols in polarizing macrophages on implant surfaces and accurately characterizing them in terms of gene expression, secreted proteins, and cell surface markers. Additionally, the analysis of the markers described revealed consistent and specific expression patterns that can be used to distinguish different subtypes of MDMs. This in vitro model, however, does not fully reflect the phenotypic diversity and plasticity of human macrophages. Several macrophage subtypes (M2a, M2b, M2c, M2d) are now being identified, which indicates a need for more diverse in vitro models to study how various biomaterials and their characteristics (e.g., physicochemical properties) affect macrophage plasticity and polarization31,32. Although it is not possible to mirror the complex in vivo situation using in vitro models, many results can be obtained using the presented in vitro protocol to effectively describe the immunomodulatory potential of new implantable biomaterials9. Last but not least, further establishment is necessary to characterize macrophages in more complex in vitro or in vivo models involving the role of other players in complex physiological contexts. Overall, this study will contribute to the development and designing of immunomodulatory biomaterials to improve and promote favorable tissue regeneration processes and successful implant integration, as well as to prevent implant-associated chronic inflammation.