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Taritsa IC, Jagasia PM, Boctor M, Kim JY, Fracol M. Breast Implant Silicones and B Cell-Mediated Immune Responses: A Systematic Review of Literature. JPRAS Open 2024; 41:353-367. [PMID: 39188658 PMCID: PMC11345937 DOI: 10.1016/j.jpra.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/23/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Breast implants are under recent scrutiny owing to concerns about their potential for inducing immunological diseases, namely breast implant-associated anaplastic large cell lymphoma and breast implant illness. However, the impact of silicone on biologic systems remains unclear. Therefore, we performed a systematic literature review to evaluate the information available on silicone breast implants and their effect on one arm of the adaptive immune response-B lymphocytes and antibody formation. Methods We conducted a systematic review in EMBASE/PUBMED in accordance with the PRISMA guidelines, with search entry terms requiring discussion of silicone and immunity. The initial review returned 1079 citations. Manual screening was performed to include studies that were specific to the humoral response after exposure to silicone. Secondary full text review was performed. The extracted data included animal models and findings pertinent to B cells/antibodies in response to breast implant silicones. Results In total, 39 studies on B cells/antibodies and breast-implant-associated silicones were identified. Among them, 23 studies were in humans, 14 in animal models, and 2 were in vitro. Common themes included identification of antisilicone antibodies in women with breast implants, anticollagen antibodies, presence of activated B cells or immunoglobulin G in implant capsules, and sensitization of lymphocytes to silicone in vitro. Conclusion Despite controversial findings in the literature, there is evidence that silicone breast implants activate B cells in the breast implant capsule and may have systemic effects on the production of autoantibodies and/or sensitization of B lymphocytes to silicone. Further research is needed on how breast implants impact other arms of the immune system to understand their long-term biological impact.
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Affiliation(s)
- Iulianna C. Taritsa
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Puja M. Jagasia
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Boctor
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Y.S. Kim
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Fracol
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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2
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Su B, Chen L, Zhang B, Wang H, Zhou J, Du B. Major Clinical Adverse Events of Breast Implant in the Manufacturer and User Facility Device Experience Database. J Patient Saf 2024; 20:267-271. [PMID: 38635526 DOI: 10.1097/pts.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Search the Manufacturer and User Facility Device Experience database to collect information on adverse events of breast implant. We analyzed the local complications and the breast implant illness (BII) of silicone breast implants, as well as saline breast implants separately, aim to provide a reference for women who want to breast augmentation. MATERIALS AND METHODS The Manufacturer and User Facility Device Experience database was queried for events reports related to the breast implant between July 1, 2012, and June 30, 2022. Event year and reporting year were summarized. Patient problem was collected and analyzed to distinguish between local complications and BII. RESULTS A total of 108,728 adverse events in the past 3 years were analyzed, silicone breast implants accounted for 62.1% and saline breast implants accounted for 37.9%. The most common local complication of women receiving silicone breast implants was "Capsular Contracture," accounting for 48.73%. However, the incidence of "capsular contracture" in women who received saline breast implants was only 17.49%. The most common BII was "fatigue/weakness" in both women receiving 2 different breast implants, 17.20% in women receiving silicone breast implants and 24.71% in women receiving saline breast implants. Of note, in all the reports, there was a wide variation in the timing of reporting as compared with the timing of the adverse event. CONCLUSIONS Although the adverse events of breast implant cannot completely be determined from this study, we provide a reference for women who want to get breast implants, so that they can choose breast implants more carefully. In addition, a better understanding of BII may allow them to think further about whether the benefits of breast implants outweigh the risks.
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Affiliation(s)
- Bing Su
- From the Nanfang Hospital, Southern Medical University, Guangzhou
| | - Lichuan Chen
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Bohan Zhang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Hong Wang
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Jie Zhou
- Pufeisheng Pharmaceutical Technology Co, Ltd, Nanjing
| | - Benjun Du
- From the Nanfang Hospital, Southern Medical University, Guangzhou
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3
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Chen T, Roelofs KA, Rootman DB. Allergic conjunctivitis and contact dermatitis following silicone tube intubation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e36-e38. [PMID: 35868439 DOI: 10.1016/j.jcjo.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA.
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4
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Spit K, Azahaf S, de Blok C, Nanayakkara P. Measuring Platinum Levels in Hair in Women with Silicone Breast Implants and Systemic Symptoms. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4373. [PMID: 35702355 PMCID: PMC9187172 DOI: 10.1097/gox.0000000000004373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
It has been suggested that compounds present in silicone breast implants (eg, silicone particles or heavy metals such as platinum) migrate into the body and can cause systemic symptoms in susceptible women, causing what is known as breast implant illness. This pilot study investigates possible associations between hair platinum levels in patients with breast implants and breast implant illness, and evaluates its possible use for diagnostic purposes. Methods Patients were included from the silicone outpatient clinic at Amsterdam University Medical Centre. Platinum concentration in hair samples of 10 women with breast implants and systemic symptoms (group A) was compared with that in 10 women with breast implants but no symptoms (group B), and a control group of 10 women without implants or symptoms (group C), using laser ablation inductively coupled plasma mass spectrometry. Radiological imaging was used to assess implant ruptures or silicone leakage. Results A median platinum concentration of 0.09 μg per kg [IQR 0.04-0.15] was found in group A, 0.08 μg per kg [IQR 0.04-0.12] in group B, and 0.04 μg per kg [IQR 0.02-0.13] in group C, with no statistical significant difference between the groups (Kruskal-Wallis test, P = 0.43). No correlation between radiologically proven implant leakage and platinum level was found. Conclusions There was no statistically significant difference in hair platinum levels in women with or without silicone breast implants or breast implant illness. Therefore, based on this pilot study, we do not recommend this test for clinical use. Given the small sample size, more research is required to fully assess its possible use for diagnostic purposes.
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Affiliation(s)
- K.A. Spit
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - S. Azahaf
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - C.J.M. de Blok
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - P.W.B. Nanayakkara
- From the Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
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5
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Yang S, Klietz ML, Harren AK, Wei Q, Hirsch T, Aitzetmüller MM. Understanding Breast Implant Illness: Etiology is the Key. Aesthet Surg J 2022; 42:370-377. [PMID: 33871569 DOI: 10.1093/asj/sjab197] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Because breast augmentation is one of the most popular cosmetic procedures, the issue of implant-related complications has been widely debated ever since the FDA approved the use of implants in 1962. Although decades have passed, breast implant illness (BII) still represents a poorly defined and controversial complication. With ongoing nonscientific discussion in the mainstream media and on social media, revealing the etiology of BII is urgent because knowledge of this subject ultimately influences patients' decisions. Little or no scientific research is currently available on BII and no final conclusions regarding its etiology, clinical manifestations, diagnostic criteria, or treatment have been made. This review aims to give an overview of the hypotheses on the etiology of BII and seeks inspiration to improve the conditions of BII patients.
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Affiliation(s)
- Siling Yang
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Marie-Luise Klietz
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Anna Katharina Harren
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Qiang Wei
- Department of Plastic and Aesthetic Surgery, First Affiliated Hospital of Guangxi Medical University, GuangXi, China
| | - Tobias Hirsch
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
| | - Matthias M Aitzetmüller
- Department for Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Fachklinik Horneide, Münster, Germany
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6
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Pocevski B, Pavlov-Dolijanović S. Autoimmune inflammatory syndrome induced by adjuvants (silicone breast implants and lip fillers). MEDICINSKI PODMLADAK 2021. [DOI: 10.5937/mp72-26494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Silicone breast implants (SBI) have been used since 1962 in the reconstruction of post-mastectomy cases, in augmentation of the breast, or for cosmetic purposes, while fillers with biopolymer (FB) have been used since the 1990s. Today, they are considered adjuvants of the immune system. Most complications of SBI and FB are local in nature, but some patients experience systemic symptoms, which are defined as adjuvant-induced autoimmune inflammatory syndrome (ASIA). Aim: The aim of this study is to demonstrate the possible association of silicone breast implants and FB with the development of immune-mediated inflammatory rheumatic diseases (IMIRD). Material and methods: The research represents retrospective study which involved 15 female patients with immune-mediated inflammatory rheumatic diseases, 6 of whom were patients with implanted silicone breast implants for cosmetic reasons, and 9 patients with placement of fillers with biopolymer on the lips. Results: The average time from silicone implantation to the onset of the first symptoms was 6.10 ± 5.3 (range 6 months to 24 years). The following immune-mediated inflammatory rheumatic diseases were recorded: 3 patients with systemic sclerosis (SSc), 3 patients with undifferentiated arthritis, 3 patients with seropositive rheumatoid arthritis, 1 patient with systemic lupus erythematosus, 2 patients with undifferentiated SCTD, 2 patients with mixed connective tissue disease, and one patient with unexplained systemic disease. Seven patients had the Raynaud phenomenon. Spontaneous abortions were reported in 2 patients. Conclusion: Earlier reports that silicone breast implants and biopolymer fillers are safe, today are changing with the description of ASIA syndrome.
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7
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De Angelis R, Di Battista J, Smerilli G, Cipolletta E, Di Carlo M, Salaffi F. Association of Silicone Breast Implants, Breast Cancer and Anti-RNA Polymerase III Autoantibodies in Systemic Sclerosis: Case-Based Review. Open Access Rheumatol 2020; 12:207-213. [PMID: 33061688 PMCID: PMC7519586 DOI: 10.2147/oarrr.s262428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 01/16/2023] Open
Abstract
Some case reports and small case series of patients with silicone breast implant (SBI) have reported the development of systemic sclerosis (SSc) many years later, despite conflicting evidence of this association in the literature. Recently, patients with SSc and anti-RNA polymerase III antibodies positivity have been associated with previous silicone implants and/or breast cancer, showing clinical features that differ from the classic SSc, such as rapid and diffuse cutaneous involvement and scleroderma renal crisis (SRC). The specific autoimmune reaction is not yet fully understood, although knowledge in this regard is increasing. We describe a case that can support these previous observations, strengthening this association which must be taken into account. Clinicians should be aware of this new clinical entity, given the widespread use of silicone implants.
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Affiliation(s)
- Rossella De Angelis
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
| | - Jacopo Di Battista
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
| | - Fausto Salaffi
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Jesi, Ancona, Italy
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8
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Breast Prosthesis Syndrome: Pathophysiology and Management Algorithm. Aesthetic Plast Surg 2020; 44:1423-1437. [PMID: 32152711 DOI: 10.1007/s00266-020-01663-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/23/2020] [Indexed: 02/05/2023]
Abstract
The cosmetic use of devices like prostheses to increase breast volume is nothing new. It is calculated that millions of people have been exposed to silicone in several ways, including breast implants, and since 1964 there has been uncertainty regarding their safety. We did not find in the literature any studies that reported the appearance of a specific immunological disease in patients with silicone breast implants. Furthermore, there are also neither case-control studies nor reports of patients proving that symptoms of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) occurred after the placement of silicone implants nor that the patients had pre-existing symptoms. Several studies link silicone to allergic reactions and the development of systemic autoimmune diseases; however, other studies deny this association. There are currently several theories about the effect of silicone on the body. One theory with greater acceptance proposes an adjuvant effect of silicone on the development of autoimmune diseases in genetically predisposed patients. However, the variety of symptoms occurring in patients who develop these pathologies leads to doubts about the relationship between the adjuvant effects of a silicone prosthesis may have with a specific autoimmune disease or a mix of these diseases. The lack of consensus on this topic obliges a full review of what has already been reported in the literature to integrate the knowledge and propose a focus for new research on this matter. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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9
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Cordel E, Reix N, Mathelin C. [ASIA syndrome associated with breast implants: Fortuitous link or association?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:754-762. [PMID: 32522615 DOI: 10.1016/j.gofs.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The "Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants" (ASIA syndrome) described in 2011 by Shoenfeld and Agmon-Levin is believed to be the consequence of several immunological dysfunctions triggered by exposure to an adjuvant. Controversies regarding the existence of this syndrome and its possible link to silicone breast implants (SBI) have been growing via social networks and patient groups. The objective of our review was to identify all published cases of ASIA syndromes in SBI carriers to determine the circumstances of onset, key characteristics, and possible biases. METHOD A literature search of the Pubmed database selecting only original articles written in English between 2011 and 2019 found 126 cases of ASIA syndromes, defined according to the criteria of Shoenfeld and Agmon-Levin, associated with SBI. RESULTS This syndrome was diagnosed in nearly ¾ cases in a context of prosthetic complications (rupture, effusion, peri-prosthetic shell, infection) with a median time interval of 4 years between SBI implantation and the onset of symptoms. Explantation of the SBI led to an improvement in symptoms in about half of the cases. However, animal, biological and histological studies have provided conflicting results on the links between silicone and dysimmune syndromes. CONCLUSION Women should be clearly, fairly and appropriately informed of our uncertainties about ASIA syndrome. Mandatory reporting of dysimmune syndromes occurring in silicone MI carriers would increase our knowledge of this still poorly understood condition, for which a genetic predisposition is being investigated.
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Affiliation(s)
- E Cordel
- Service de chirurgie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg cedex, France
| | - N Reix
- Service de chirurgie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg cedex, France; ICube UMR 7357, CNRS, fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France; Laboratoire de biochimie et biologie moléculaire, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - C Mathelin
- Service de chirurgie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire, biologie du cancer (IGBMC), 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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10
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Watad A, Quaresma M, Brown S, Cohen Tervaert JW, Rodríguez-Pint I, Cervera R, Perricone C, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld’s syndrome) – An update. Lupus 2017; 26:675-681. [DOI: 10.1177/0961203316686406] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been widely described in many studies conducted thus far. The syndrome incorporates five immune-mediated conditions, all associated with previous exposure to various agents such as vaccines, silicone implants and several others. The emergence of ASIA syndrome is associated with individual genetic predisposition, for instance those carrying HLA-DRB1*01 or HLA-DRB4 and results from exposure to external or endogenous factors triggering autoimmunity. Such factors have been demonstrated as able to induce autoimmunity in both animal models and humans via a variety of proposed mechanisms. In recent years, physicians have become more aware of the existence of ASIA syndrome and the relationship between adjuvants exposure and autoimmunity and more cases are being reported. Accordingly, we have created a registry that includes at present more than 300 ASIA syndrome cases that have been reported by different physicians worldwide, describing various autoimmune conditions induced by diverse adjuvants. In this review, we have summarized the updated literature on ASIA syndrome and the knowledge accumulated since 2013 in order to elucidate the association between the exposure to various adjuvant agents and its possible clinical manifestations. Furthermore, we especially referred to the relationship between ASIA syndrome and systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).
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Affiliation(s)
- A Watad
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - M Quaresma
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - S Brown
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Spain
| | - C Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialita Mediche, Sapienza Universita di Roma, Italy
| | - Y Shoenfeld
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
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11
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Guimarães LE, Baker B, Perricone C, Shoenfeld Y. Vaccines, adjuvants and autoimmunity. Pharmacol Res 2015; 100:190-209. [PMID: 26275795 PMCID: PMC7129276 DOI: 10.1016/j.phrs.2015.08.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/15/2022]
Abstract
Vaccines and autoimmunity are linked fields. Vaccine efficacy is based on whether host immune response against an antigen can elicit a memory T-cell response over time. Although the described side effects thus far have been mostly transient and acute, vaccines are able to elicit the immune system towards an autoimmune reaction. The diagnosis of a definite autoimmune disease and the occurrence of fatal outcome post-vaccination have been less frequently reported. Since vaccines are given to previously healthy hosts, who may have never developed the disease had they not been immunized, adverse events should be carefully accessed and evaluated even if they represent a limited number of occurrences. In this review of the literature, there is evidence of vaccine-induced autoimmunity and adjuvant-induced autoimmunity in both experimental models as well as human patients. Adjuvants and infectious agents may exert their immune-enhancing effects through various functional activities, encompassed by the adjuvant effect. These mechanisms are shared by different conditions triggered by adjuvants leading to the autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome). In conclusion, there are several case reports of autoimmune diseases following vaccines, however, due to the limited number of cases, the different classifications of symptoms and the long latency period of the diseases, every attempt for an epidemiological study has so far failed to deliver a connection. Despite this, efforts to unveil the connection between the triggering of the immune system by adjuvants and the development of autoimmune conditions should be undertaken. Vaccinomics is a field that may bring to light novel customized, personalized treatment approaches in the future.
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Affiliation(s)
- Luísa Eça Guimarães
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Britain Baker
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-kipp chair for research of autoimmune diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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12
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Nesher G, Soriano A, Shlomai G, Iadgarov Y, Shulimzon TR, Borella E, Dicker D, Shoenfeld Y. Severe ASIA syndrome associated with lymph node, thoracic, and pulmonary silicone infiltration following breast implant rupture: experience with four cases. Lupus 2015; 24:463-8. [DOI: 10.1177/0961203314562622] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Silicone has been considered biologically inert; thus it has been employed in many medical devices and nowadays is commonly used in plastic surgery for mammary prosthesis. It is well tolerated in most cases. However, autoimmune disorders and siliconomas with granulomatous reactions after silicone implant rupture have been described. We report cases of four women who developed systemic disorders following rupture of silicone breast implants resulting in lymph node and thoracic silicone infiltration. The symptoms in these cases, including arthralgia, myalgia, generalized weakness, severe fatigue, sleeping disturbances, cognitive impairment, memory loss, irritable bowel syndrome, and weight loss, clearly match the criteria of the recently defined autoimmune/inflammatory syndrome induced by adjuvants (ASIA).
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Affiliation(s)
- G Nesher
- Department of Internal Medicine A, Shaare Zedek Medical Center and the Hebrew University Medical School, Jerusalem, Israel
| | - A Soriano
- Department of Clinical Medicine and Rheumatology, Campus Bio-Medico University, Rome, Italy
| | - G Shlomai
- Department of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Iadgarov
- Department of Internal Medicine, Hasharon Hospital – Rabin Medical Center, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - T R Shulimzon
- The Pulmonary Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - E Borella
- Department of Internal Medicine, Division of Rheumatology, University of Padova, Italy
| | - D Dicker
- Department of Internal Medicine, Hasharon Hospital – Rabin Medical Center, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Y Shoenfeld
- Sackler School of Medicine, Tel Aviv University, Israel
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
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14
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Shakya AK, Nandakumar KS. Applications of polymeric adjuvants in studying autoimmune responses and vaccination against infectious diseases. J R Soc Interface 2013; 10:20120536. [PMID: 23173193 PMCID: PMC3565688 DOI: 10.1098/rsif.2012.0536] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/01/2012] [Indexed: 12/18/2022] Open
Abstract
Polymers as an adjuvant are capable of enhancing the vaccine potential against various infectious diseases and also are being used to study the actual autoimmune responses using self-antigen(s) without involving any major immune deviation. Several natural polysaccharides and their derivatives originating from microbes and plants have been tested for their adjuvant potential. Similarly, numerous synthetic polymers including polyelectrolytes, polyesters, polyanhydrides, non-ionic block copolymers and external stimuli responsive polymers have demonstrated adjuvant capacity using different antigens. Adjuvant potential of these polymers mainly depends on their solubility, molecular weight, degree of branching and the conformation of polymeric backbone. These polymers have the ability not only to activate humoral but also cellular immune responses in the host. The depot effect, which involves slow release of antigen over a long duration of time, using different forms (particulate, solution and gel) of polymers, and enhances the co-stimulatory signals for optimal immune activation, is the underlying principle of their adjuvant properties. Possibly, polymers may also interact and activate various toll-like receptors and inflammasomes, thus involving several innate immune system players in the ensuing immune response. Biocompatibility, biodegradability, easy production and purification, and non-toxic properties of most of the polymers make them attractive candidates for substituting conventional adjuvants that have undesirable effects in the host.
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Affiliation(s)
| | - Kutty Selva Nandakumar
- Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
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15
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Del Giacco S, Firinu D, Piludu G, Settembrini A, Tulli M, Pirari P, Nalli E, Mura M, Manconi P, Del Giacco G. Raynaud's Phenomenon and Scleroderma Associated with Silicone Gel Breast Implants: An Example of Asia Syndrome. EUR J INFLAMM 2012; 10:233-238. [DOI: 10.1177/1721727x1201000209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- S.R. Del Giacco
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - D. Firinu
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - G. Piludu
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - A.M. Settembrini
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - M. Tulli
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - P. Pirari
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - E. Nalli
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - M.N. Mura
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - P.E. Manconi
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
| | - G.S. Del Giacco
- Department of Medical Sciences “M. Aresu” and Unit of Internal Medicine, Allergy and Clinical Immunology, Azienda Ospedaliero-Universitaria, University of Cagliari, Italy
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Abstract
Silicone, a synthetic polymer considered to be a biologically inert substance, is used in a multitude of medical products, the most publicly recognized of which are breast implants. Silicone breast implants have been in use since the early 1960s for cosmetic and reconstructive purposes, and reports of autoimmune disease-like syndromes began appearing in the medical literature soon thereafter. Over the previous year, silicone implants have been suggested as playing a role in a new syndrome that encompasses a wide array of immune-related manifestations, termed ASIA ('Autoimmune Syndrome Induced by Adjuvant'). Scleroderma, a relatively rare connective tissue disease with skin manifestations and systemic effects, has also been described in association with silicone implantation and rupture. However, epidemiological studies and meta-analyses have failed to corroborate the clinical impression of silicone-induced scleroderma. The following review describes the mechanisms by which silicone may mediate autoimmunity in general, as well as the evidence for causal associations with more specific autoimmune syndromes in general, and scleroderma in particular.
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Affiliation(s)
- M Lidar
- Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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17
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Abstract
BACKGROUND Since the 1960s, silicone implants have been successfully used for breast augmentation and reconstruction. However, safety issues regarding the use of silicone have led to a moratorium by the US Food and Drug Administration between 1992 and 2006. DESIGN To date, although the moratorium has been removed and women overwhelmingly prefer silicone over saline implants, local and systemic adverse effects still remain a concern. RESULTS Silicone-elicited inflammatory fibro-proliferative response and capsular contracture is irrefutable. Studies on silicone breast implants have not supported a relationship to carcinogenesis, whereas that to autoimmunity mainly to nondefined autoimmune phenomena seems very plausible. These silicone-related autoimmune adverse events termed 'siliconosis' are probably limited to a small minority of implanted patients. CONCLUSIONS Risk factors, such as characteristic environmental exposure and/or genetic predisposition, still require further elucidation. Similarly to antibacterial agents, texturized implants and Zafirlukast that were found to be beneficial in inhibiting fibro-proliferative response and capsular contracture, elucidating autoimmune-related risk factors might subsequently enable physicians to accurately predict long-term health status of silicone implant recipients.
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Affiliation(s)
- Steven D Hajdu
- The Zabludowicz Center for Autoimmune Diseases and Department of Medicine B, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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18
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Levy Y, Rotman-Pikielny P, Ehrenfeld M, Shoenfeld Y. Silicone breast implantation-induced scleroderma: description of four patients and a critical review of the literature. Lupus 2009; 18:1226-32. [DOI: 10.1177/0961203309347795] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the early 1980s, case reports and case series describe an association between silicon breast implants and the appearance of autoimmune diseases, particularly scleroderma. The publication of those cases led to a large number of studies to investigate this association. The conclusion of those studies is that most probably there has not been an increased incidence of autoimmune diseases in women with silicon breast implants. Nevertheless, the US Food and Drug Administration determined that silicone gel breast implants are not completely safe, only that they are ‘reasonably safe.’ The debate continues regarding this association. In this article we present new cases of silicon breast implant-induced scleroderma and review the literature on this subject. Lupus (2009) 18, 1226—1232.
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Affiliation(s)
- Y. Levy
- Department of Medicine 'E', Meir Medical Center, Kfar Saba, Israel,
| | | | - M. Ehrenfeld
- The Autoimmune Center For Autoimmune Disease, Sheba Medical Center-Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y. Shoenfeld
- The Autoimmune Center For Autoimmune Disease, Sheba Medical Center-Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Antisilicone antibodies are biologically unlikely. Clin Rheumatol 2008; 27:1077-8. [DOI: 10.1007/s10067-008-0913-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 04/21/2008] [Indexed: 11/25/2022]
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