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A predisposition: Genetic factors may be key to symptoms of breast implant illness

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Thanks Sis . . . Just wanted to make sure this link

didn't get broken! Good article!

However, it should be noted that Leroy Young is not

very well thought of . . . If I understand it

correctly, tofu titties (soy oil) implants were his

invention - Rogene

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A predisposition: Genetic factors may be key to

symptoms of breast implant illness

Anecdotal reports of illness by some women with

silicone gel breast implants eventually led the Food

and Drug Administration in 1992 to ban their use

pending a safety review. However, researchers still do

not know why some women with implants, and not others,

develop symptoms suggestive of an illness. Now, a

study by School of Medicine researchers has concluded

that genetic factors may play a role.

The study found that women with breast implants who

had debilitating symptoms such as chronic fatigue,

burning breast pain and muscle or joint pain were more

likely to share genetic characteristics that

differentiate them from women with implants who have

no symptoms.

" To our surprise, we found that some women with

implants may be genetically predisposed to develop

symptoms, " said lead researcher V. Leroy Young, M.D.,

professor of surgery.

Moreover, the researchers found that women with

implants and symptoms also were more likely than

others in the study to produce autoantibodies against

their B cells. B cells are a key component of the

immune system, and high frequencies of such

autoantibodies are clearly abnormal, Young said.

" Autoantibodies to B cells may hold clues that will

help explain why some women with implants develop

symptoms, " he said. The team reported its findings in

the Plastic and Reconstructive Surgery journal in

December 1995.

The researchers studied the genetic characteristics of

199 women -- 77 with implants and symptoms, 37 with

implants and no symptoms, 54 healthy women without

implants and 31 women diagnosed with fibromyalgia, a

disease defined by pain in connective tissues such as

muscles, tendons and ligaments. Fibromyalgia is not

known to be immune-mediated and has no known cause.

Women with fibromyalgia were included in the study to

determine whether women with implants are prone to

develop the rheumatological disorder. Symptoms of

fibromyalgia are similar to those experienced by women

with implants who develop symptoms. " At first, we

thought implants might trigger fibromyalgia, " Young

said.

Women with implants and those with fibromyalgia

averaged 46 years of age; those in the healthy

comparison group were slightly younger, averaging 37

years of age. Virtually all of the women in the study

were white.

Genetic characteristics were determined by analyzing

blood samples. The researchers zeroed in on a group of

proteins encoded by a collection of genes called the

major histocompatibility complex (MHC), which is known

to play an important role in immune response. They

wanted to find out whether the MHC molecules of

symptomatic women with implants differed from those of

women with implants who did not have symptoms.

The investigators used HLA (human leukocyte antigen)

typing to analyze blood samples; organ transplant

teams use the same procedure to assess genetic

similarities between organ donors and recipients.

Molecule could be a marker

Women with implants and symptoms and women with

fibromyalgia were significantly more likely to have an

HLA molecule called DR-53. The molecule was present in

68 percent of symptomatic breast implant patients and

65 percent of fibromyalgia patients, compared with 35

percent of the asymptomatic implant patients.

Fifty-two percent of the healthy women also had the

DR-53 molecule, which is similar to its natural

frequency among white women. DR molecules play a

critical immunoregulatory role because they control

the interactions among the immune system's T cells, B

cells and antigen-presenting cells.

Young and his colleagues initially suspected that

women with implants and symptoms actually had

fibromyalgia. But when they looked closer, they found

that 42 percent of symptomatic women with implants

formed antibodies against their own B cells. Only 2

percent of healthy women formed autoantibodies,

compared with 14 percent of asymptomatic women with

implants and 19 percent of fibromyalgia patients.

More striking, however, was the observation that 81

percent of the patients with implants who produced

autoantibodies were DR-53 positive. This compares with

33 percent of fibromyalgia patients who were positive

for both autoantibodies and DR-53.

" There's clearly a link between DR-53 and

autoantibodies, " Young said. " But we won't know what

it means until we find out why these women are forming

autoantibodies at such a high rate. "

Women with symptoms had had their implants for an

average of 12 years, compared with asymptomatic women

who had had their implants for an average of 10 years.

So it's possible that the latter group may develop

symptoms over time.

Young and his co-workers now are trying to find out

what is triggering the production of autoantibodies.

If they are formed in response to silicone gel or one

of its components, then the asymptomatic implant group

also might be expected to have high frequencies. On

the other hand, if the autoantibodies are somehow

related to the presence of DR-53, fibromyalgia

patients might be expected to have higher frequencies

of B cell autoantibodies.

If the study's results are confirmed, DR-53 could be

viewed as a marker for individuals who may be

predisposed to develop an immune-mediated response or

hypersensitivity reaction following silicone breast

implantation.

But Young cautioned that it is too early for the

information to be used clinically and that women with

implants should not rush to their doctors and request

HLA tissue typing, a test that costs about $1,300.

" The test is useful as a research tool but would not

be helpful in making clinical decisions, " Young

explained. " However, women with breast implants need

regular follow-ups with their physicians. "

-- Caroline Decker

Please send comments and suggestions to:

Record Comments < record @wupa.wustl.edu >

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