Abstract
Silicon has a molecular mass of 28 daltons. In nature, silicon is found as silicon dioxide (silica) or in a variety of silicates (e.g., in talc or asbestos). Furthermore, silicon is present in silicones, polymerized siloxanes, which are often used as medical silicones in breast implants. Silicon exposure is associated with different systemic autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis, and vasculitis. Remarkably, silicon in silicone-filled breast implants is considered to be safe, not increasing the risk of developing autoimmune diseases. We analyzed the impact of silicone-filled breast implants on the immune system in 32 consecutive patients attending a specialized autoimmunity clinic. All 32 patients had silicone implant incompatibility syndrome and complaints fulfilling the diagnostic criteria of ASIA (autoimmune/inflammatory syndrome induced by adjuvants). Furthermore, in 17 of the 32 patients, a systemic autoimmune disease was diagnosed, and 15 of the 32 patients had an impaired humoral immune system. Patients developed symptoms and signs after long-term follow-up, suggesting that these symptoms and signs started after implant aging and/or rupture. We postulate that silicon in silicone-filled breast implants may increase the risk of developing (auto) immune diseases and immune deficiencies.
Similar content being viewed by others
References
Cohen Tervaert JW. Silicon exposure and vasculitis. In: Uversky VN, Kretsinger RH, Permyakov EA (eds). Encyclopedia of metalloproteins. Springer Science + Business Media, LLC: Berlin 2012 doi:10.1007/978-1-4614-1533-6.
Tervaert JW, Stegeman CA, Kallenberg CG. Silicon exposure and vasculitis. Curr Opin Rheumatol. 1998;10:12–7.
Parks CG, et al. Occupational exposure to crystalline silica and autoimmune disease. Environ Health Perspect. 1999;107(S 5):793–802.
Cohen Tervaert, et al. Principles and methods for assessing autoimmunity associated with exposure to chemicals. Environmental health criteria; 236. International programme on chemical safety. World Health Organization. 2006; pp.122–130.
Makol A, et al. Prevalence of connective tissue disease in silicosis (1985–2006)—a report from the state of Michigan surveillance system for silicosis. Am J Ind Med. 2011;54:255–62.
Yashiro M, et al. Significantly high regional morbidity of MPO-ANCA-related angitis and/or nephritis with respiratory tract involvement after the 1995 great earthquake in Kobe (Japan). Am J Kidney Dis. 2000;35:889–95.
Noonan CW, Pfau JC, Larson TC, Spence MR. Nested case-control study of autoimmune disease in an asbestos-exposed population. Environ Health Perspect. 2006;114:1243–7.
Rocha MC, et al. Genetic polymorphisms and surface expression of CTLA-4 and PD-1 on T cells of silica-exposed workers. Int J Hyg Environm Health. 2012;215:562–9.
Lee S, et al. Environmental factors producing autoimmune dysregulation—chronic activation of T cells caused by silica exposure. Immunobiology. 2012;217:743–8.
Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006;118(3 Suppl):77S–84S.
Janowsky EC, Kupper LL, Hulka BS. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med. 2000;342:781–90.
SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks), Breast implant failure, 2012. http://ec.uropa/health/scientific committees/policy/index en.htm.
Shoenfeld Y, Agmon-Levin N. ‘ASIA’—autoimmune/inflammatory syndrome induced by adjuvants. J Autoimmun. 2011;36:4–8.
Tervaert JW, Limburg PC, Elema JD, Huitema MG, Horst G, The TH, Kallenberg CG. Detection of autoantibodies against myeloid lysosomal enzymes: a useful adjunct to classification of patients with biopsy-proven necrotizing arteritis. Am J Med. 1991;91:59–66.
Damoiseaux JG, Tervaert JW. From ANA to ENA: how to proceed? Autoimmun Rev. 2006;5:10–7.
Damoiseaux JG, Slot MC, Vaessen M, Stegeman CA, Van Paassen P, Tervaert JW. Evaluation of a new fluorescent-enzyme immuno-assay for diagnosis and follow-up of ANCA-associated vasculitis. J Clin Immunol. 2005;25:202–8.
Tervaert JW, Van Paassen P, Damoiseaux J. Type II cryoglobulinemia is not associated with hepatitis C infection: the Dutch experience. Ann N Y Acad Sci. 2007;1107:251–8.
Drijkoningen J, Damoiseaux J, van Paassen P, Tervaert JW. Clinical manifestations of the anti-phospholipid syndrome as defined by the updated Sapporo classification criteria. Ann Rheum Dis. 2007;66:1407–8.
Dennert R, van Paassen P, Wolffs P, Bruggeman C, Velthuis S, Felix S, van Suylen RJ, Crijns HJ, Tervaert JWC, Heymans S. Differences in virus prevalence and load in the hearts of patients with idiopathic dilated cardiomyopathy with and without immune-mediated inflammatory diseases. Clin Vaccine Immunol. 2012;19:1182–7.
Kappel RM, Pruijn GJ. The monobloc hydrogel breast implant, experiences and ideas. Eur J Plast Surg. 2012;35:229–33.
Jewell M, Spear SL, Largent J, Oefelein MG, Adams WP Jr. Anaplastic large T-cell lymphoma and breast implants: a review of the literature. Plast Reconstr Surg. 2011;128:651–61.
van Nunen SA, Gatenby PA, Basten A. Post-mammoplasty connective tissue disease. Arthr Rheum. 1982;25:694–7.
Hajdu SD, Agmon-Levin N, Shoenfeld Y. Silicone and autoimmunity. Eur J Clin Invest. 2011;41:203–11.
Brown SL, Pennello G, Berg WA, Soo MS, Middleton MS. Silicone gel breast implant rupture, extracapsular silicone, and health status in a population of women. J Rheumatol. 2001;28:996–1003.
Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham Alabama. AJR Am J Roentgenol. 2000;175:1057–64.
Csako G, Costello R, Shamim EA, O’Hanlon TP, Tran A, Clauw DJ, Williams HJ, Miller FW. Serum proteins and para proteins in women with silicone implants and connective tissue disease: a case-control study. Arthr Res Ther. 2007;9:R95.
Backovic A, Huang HL, Del Frari B, Piza H, Huber LA, Wick G. Identification and dynamics of proteins adhering to the surface of medical silicones in vivo and in vitro. J Proteome Res. 2007;6:376–81.
Warnatz K, Voll RE. Pathogenesis of autoimmunity in common variable immunodeficiency. Front Immunol. 2012;3:210.
Vera-Lastra O, Medina G, Cruz-Dominguez P, Mdel P, Ramirez P, Gayosso-Rivera JA, Anduaga Dominguez H, Lievana Torres C, Jara LJ. Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld’s syndrome). Lupus. 2012;21:128–35.
Davenward S, Bentham P, Wright J, Crome P, Job D, Polwart A, Exley C. Silicon–rich mineral water as a non-invasive test of the ‘aluminum hypothesis’ in Alzheimer’s disease. J Alzheimers Dis. 2013;33:423–30.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cohen Tervaert, J.W., Kappel, R.M. Silicone implant incompatibility syndrome (SIIS): A frequent cause of ASIA (Shoenfeld’s syndrome). Immunol Res 56, 293–298 (2013). https://doi.org/10.1007/s12026-013-8401-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12026-013-8401-3