HLA / Leroy Young Studies ... what happened to this important research?

[Guest guest]

Several years ago this research seemed to be pointing in the right

direction as to determining who may be more susceptible to immune

problems with implants than others.

I've not seen later studies on this ... Young was so busy developing

and promoting the disastrous " Tofu Titties " or soybean oil implants

that this research seemed to not have been followed up on. Now he's

into " butt implants. "

Does anyone know of further work on this important marker? I've

never even heard of a plastic surgeon who tells a woman she's

a " good candidate " for breast implants checking this out. Has anyone?

There's an article below that first talked about this study which

now seems to be buried.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

EXCERPT:

These data suggest that symptomatic patients with implants share

important genetic characteristics (primarily HLA- DR53 positivity)

that differentiate them from their asymptomatic counterparts.

DR53 may be a marker of women who are predisposed by their HLA

genotype to develop symptoms following exposure to silicone gel

breast implants.

Young VL ; Nemecek JR ; Schwartz BD ; Phelan DL ; Schorr MW ;

Department of Medicine, Washington University School of Medicine,

St. Louis,

Mo, USA.

Plast Reconstr Surg Vol. 96 no. 7 pp. 1497-519;

discussion 1520

DATE: 1995 Dec

Abstract

Since the 1970s, anecdotal reports have described a relatively small

number of women who received silicone gel breast implants and later

developed either a recognized rheumatologic disease or unexplained

symptoms suggestive of an autoimmune disorder. The study reported

here examined whether there is any association between the symptoms

seen in implant patients and HLA molecules.

One-hundred and ninety-nine subjects were evaluated by HLA typing:

symptomatic patients with implants (group I, n = 77), asymptomatic

women with implants (group II, n = 37), healthy female volunteers

without implants (group III, n = 54), and fibromyalgia patients

without implants (group IV, n = 31).

A statistically significant 68 percent of group I were positive for

HLA-DR53, compared with 35 percent of group II and 52 percent of

group III.

The fibromyalgia patients were strikingly similar to group I women

in terms of HLA-DR molecules, with 65 percent of group IV being

positive for DR53.

Group I also had a statistically significant increased frequency of

HLA-DQ2.

Asymptomatic women with implants (group II) had an increased

frequency of DR1 and DQ1.

In addition, 42 percent of symptomatic patients with implants formed

autoantibodies to their own B cells; of these, 81 percent were DR53-

positive. Although frequencies of capsular contracture and implant

rupture were not significantly different in the two groups with

implants, there were statistically significant associations in group

I between contractures and ruptures and the presence

of DR53 and B-cell autoantibodies.

These data suggest that symptomatic patients with implants share

important genetic characteristics (primarily HLA- DR53 positivity)

that differentiate them from their asymptomatic counterparts.

DR53 may be a marker of women who are predisposed by their HLA

genotype to develop symptoms following exposure to silicone gel

breast implants.

Young VL ; Nemecek JR ; Schwartz BD ; Phelan DL ; Schorr MW ;

Department of Medicine, Washington University School of Medicine,

St. Louis,

Mo, USA.

~~~~~~~~~~~~~~~~~~

Some Women With Breast Implants May Be Genetically

Predisposed to Illness

by Caroline Decker

Contact:

Washington University School of Medicine in St. Louis

Caroline Decker

314-286-0109

Anecdotal reports of illness by some women with silicone gel breast

implants eventually led the federal 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 researchers at Washington University

School of Medicine in St. Louis concludes 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,

muscle or joint pain were more likely to share genetic

characteristics

that differentiate them from women with breast 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 Leroy Young, M.D., a plastic and reconstructive surgeon at

Washington University School of Medicine.

Moreover, the researchers found that women with breast 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 breast implants develop symptoms, " he

said. The team reported its findings in the journal of Plastic and

Reconstructive Surgery in December 1995.

Since the FDA ban, researchers have tried to explain the origin of

symptoms reported by some women with breast implants.

The lack of a recognized disease in these patients and the failure to

find a cause for their symptoms prompted Washington

University researchers to conduct the study.

The researchers studied the genetic characteristics of 199 women --

77

with breast 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 breast implants are prone to develop

the rheumatological disorder. Symptoms of fibromyalgia are similar to

those experienced by women with breast implants who

develop symptoms. " At first, we thought implants might trigger

fibromyalgia, " Young said.

To be considered symptomatic, women with breast implants had to have

one or more of the following: burning breast pain,

chronic fatigue, vague upper body pain, muscle or joint pain. Their

symptoms must have persisted for at least four months and

have interfered with daily activities, particularly with the ability

to maintain a job.

Women with breast 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 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 breast implants

differed from those of women with breast 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

They found that both 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 breast

implants and symptoms actually had fibromyalgia. But when

they looked closer, they found that 42 percent of symptomatic women

with breast implants formed antibodies against their own

B cells. Only 2 percent of healthy women formed autoantibodies,

compared with 14 percent of asymptomatic women with

breast 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 breast 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. " This

may be especially true for those asymptomatic women who are DR-53

positive or who have produced autoantibodies to their

own B cells, " Young said.

Young and his co-workers are now 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, the fibromyalgia patients

might be expected to have higher frequencies of B cell

autoantibodies.

" We can't fully explain the highly statistically significant

formation

of autoantibodies to B cells, but their presence suggests the

activation of an immune-mediated process that is related to DR-53 and

breast implant exposure, " Young said.

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 implants. 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. "

[Guest guest]

I’ll have to ask my doc about this. I’d love to be tested for DR53 and see how it turns out. The test results sound a lot like the info I read regarding positive ANAs and implanted women.

Kenda

Several years ago this research seemed to be pointing in the right

direction as to determining who may be more susceptible to immune

problems with implants than others.

I've not seen later studies on this ... Young was so busy developing

and promoting the disastrous " Tofu Titties " or soybean oil implants

that this research seemed to not have been followed up on. Now he's

into " butt implants. "

Does anyone know of further work on this important marker? I've

never even heard of a plastic surgeon who tells a woman she's

a " good candidate " for breast implants checking this out. Has anyone?

There's an article below that first talked about this study which

now seems to be buried.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

EXCERPT:

These data suggest that symptomatic patients with implants share

important genetic characteristics (primarily HLA- DR53 positivity)

that differentiate them from their asymptomatic counterparts.

DR53 may be a marker of women who are predisposed by their HLA

genotype to develop symptoms following exposure to silicone gel

breast implants.

Young VL ; Nemecek JR ; Schwartz BD ; Phelan DL ; Schorr MW ;

Department of Medicine, Washington University School of Medicine,

St. Louis,

Mo, USA.

Plast Reconstr Surg Vol. 96 no. 7 pp. 1497-519;

discussion 1520

DATE: 1995 Dec

Abstract

Since the 1970s, anecdotal reports have described a relatively small

number of women who received silicone gel breast implants and later

developed either a recognized rheumatologic disease or unexplained

symptoms suggestive of an autoimmune disorder. The study reported

here examined whether there is any association between the symptoms

seen in implant patients and HLA molecules.

One-hundred and ninety-nine subjects were evaluated by HLA typing:

symptomatic patients with implants (group I, n = 77), asymptomatic

women with implants (group II, n = 37), healthy female volunteers

without implants (group III, n = 54), and fibromyalgia patients

without implants (group IV, n = 31).

A statistically significant 68 percent of group I were positive for

HLA-DR53, compared with 35 percent of group II and 52 percent of

group III.

The fibromyalgia patients were strikingly similar to group I women

in terms of HLA-DR molecules, with 65 percent of group IV being

positive for DR53.

Group I also had a statistically significant increased frequency of

HLA-DQ2.

Asymptomatic women with implants (group II) had an increased

frequency of DR1 and DQ1.

In addition, 42 percent of symptomatic patients with implants formed

autoantibodies to their own B cells; of these, 81 percent were DR53-

positive. Although frequencies of capsular contracture and implant

rupture were not significantly different in the two groups with

implants, there were statistically significant associations in group

I between contractures and ruptures and the presence

of DR53 and B-cell autoantibodies.

These data suggest that symptomatic patients with implants share

important genetic characteristics (primarily HLA- DR53 positivity)

that differentiate them from their asymptomatic counterparts.

DR53 may be a marker of women who are predisposed by their HLA

genotype to develop symptoms following exposure to silicone gel

breast implants.

Young VL ; Nemecek JR ; Schwartz BD ; Phelan DL ; Schorr MW ;

Department of Medicine, Washington University School of Medicine,

St. Louis,

Mo, USA.

~~~~~~~~~~~~~~~~~~

Some Women With Breast Implants May Be Genetically

Predisposed to Illness

by Caroline Decker

Contact:

Washington University School of Medicine in St. Louis

Caroline Decker

314-286-0109

Anecdotal reports of illness by some women with silicone gel breast

implants eventually led the federal 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 researchers at Washington University

School of Medicine in St. Louis concludes 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,

muscle or joint pain were more likely to share genetic

characteristics

that differentiate them from women with breast 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 Leroy Young, M.D., a plastic and reconstructive surgeon at

Washington University School of Medicine.

Moreover, the researchers found that women with breast 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 breast implants develop symptoms, " he

said. The team reported its findings in the journal of Plastic and

Reconstructive Surgery in December 1995.

Since the FDA ban, researchers have tried to explain the origin of

symptoms reported by some women with breast implants.

The lack of a recognized disease in these patients and the failure to

find a cause for their symptoms prompted Washington

University researchers to conduct the study.

The researchers studied the genetic characteristics of 199 women --

77

with breast 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 breast implants are prone to develop

the rheumatological disorder. Symptoms of fibromyalgia are similar to

those experienced by women with breast implants who

develop symptoms. " At first, we thought implants might trigger

fibromyalgia, " Young said.

To be considered symptomatic, women with breast implants had to have

one or more of the following: burning breast pain,

chronic fatigue, vague upper body pain, muscle or joint pain. Their

symptoms must have persisted for at least four months and

have interfered with daily activities, particularly with the ability

to maintain a job.

Women with breast 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 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 breast implants

differed from those of women with breast 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

They found that both 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 breast

implants and symptoms actually had fibromyalgia. But when

they looked closer, they found that 42 percent of symptomatic women

with breast implants formed antibodies against their own

B cells. Only 2 percent of healthy women formed autoantibodies,

compared with 14 percent of asymptomatic women with

breast 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 breast 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. " This

may be especially true for those asymptomatic women who are DR-53

positive or who have produced autoantibodies to their

own B cells, " Young said.

Young and his co-workers are now 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, the fibromyalgia patients

might be expected to have higher frequencies of B cell

autoantibodies.

" We can't fully explain the highly statistically significant

formation

of autoantibodies to B cells, but their presence suggests the

activation of an immune-mediated process that is related to DR-53 and

breast implant exposure, " Young said.

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 implants. 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. "

Opinions expressed are NOT meant to take the place of advice given by licensed health care professionals. Consult your physician or licensed health care professional before commencing any medical treatment.

" Do not let either the medical authorities or the politicians mislead you. Find out what the facts are, and make your own decisions about how to live a happy life and how to work for a better world. " - Linus ing, two-time Nobel Prize Winner (1954, Chemistry; 1963, Peace)