Welcome to the Autoimmunity 2021 Congress Calendar

Background and Aims

Autoinflammatory/autoimmunity Syndrome induced by Adjuvants (ASIA) can be induced by implantation of foreign bodies such as vaginal mesh and silicone breast implants. Sterilization using the Essure device has been associated with various safety issues. The aim of the present study was to determine whether these patients may suffer from a foreign-body type of ASIA.

Methods

A case report is presented. In addition, patient files of 34 consecutive patients who underwent surgical removal of their Essure device were studied for symptoms compatible with ASIA

Results

A 38 year old female patient known for 10 years with Granulomatosis and Polyangiitis developed symptoms compatible with ASIA (severe fatigue, myalgias, arthralgias, cognitive impairment and irritable bowel syndrome (IBS)) after Essure sterilization in 2014. Directly after removal of the device (July 2016), all complaints disappeared. Out of 34 evaluated patients that underwent Essure removal in Yorkville, IL, USA, because of pelvic pain, 14 of 34 patients spontaneously reported prior to Essure removal severe fatigue, 21 of 34 reported myalgias/arthralgias, and 11 of 34 reported cognitive impairment. In addition, after Essure placement 17 of 34 developed IBS, 10 of 34 developed hair loss, whereas 2 patients had a new diagnosis of inflammatory bowel disease. Post-operative recovery was good with disappearance of nearly all symptoms.

Conclusions

Essure device implementation may cause symptoms as has been found in other forms of foreign body induced ASIA. We postulate that Polyethylene Teraphalate (PET) fibers and Nickel/Titanium alloy coil (both present in the Essure device) may be responsible for this effect.

Background and Aims

During the past few years, the safety of silicone breast implants (SBIs) has stirred an intense debate, concerning their potential for induction of autoimmunity. Recently we found that women with SBIs had an increased risk of having an autoimmune disease. The serologic presence of autoantibodies against muscarinic/adrenergic receptors, has been described previously in autoimmune diseases. In the current study, we aimed to evaluate circulating autoantibodies level against muscarinic (M1-M5) and adrenergic (α1, α2, β1, β2) receptors in women with SBIs, and to explore any correlation between autoantibodies level and the severity of clinical symptoms reported by the patients.

Methods

A test panel of autoantibodies against muscarinic (M1-M5) and adrenergic (α1, α2, β1, β2) receptors was determined in the sera of 25 females with SBIs, using 'Auto-Antibodies against G protein-coupled receptors ELISA' kit.

Results

Patients reported shared clinical symptoms such as myalgia, arthralgia, sleep disturbance, chronic fatigue, memory loss and dry mouth. ELISA examination of circulating autoantibodies revealed 100% of patients with positive levels of anti-muscarinic cholinergic receptor type 3 (anti-M3R) antibodies, 80% of patients with positive levels of anti-α1 adrenergic receptor (anti-α1AR) antibody and 54% of patients shows positive levels of both anti-M2R and anti-α2AR antibodies. More importantly, we found direct correlation between certain anti-muscarinic or adrenergic receptor autoantibody level and the severity of specific reported symptoms which relates to the receptor’s physiological function in the body.

Conclusions

Our results highlight the importance of circulating anti-muscarinic and adrenergic autoantibodies for the diagnosis, pathogenesis and potential therapy for women with SBIs-induced clinical syndrome.

Background and Aims

Orthostatic intolerance (OI) is defined by multiple symtpoms resulting from upright position, that are usually alleviated by recumbency. Postural tachycardia syndrome (POTS) and orthostatic hypotension (OH) are the most prevalent forms of OI.
Evidence suggest that many patients develop OH or POTS after experiencing febrile, predominantly viral ilness, which has lead to hypothesis of an autoimmune mediated cause of orthostatic intolerance. Several studies demonstrated the presence of autoantibodies against adrenergic receptors, particularly β1, β2 and α1 in majority of patients with POTS. Similar results have been observed in demonstration of the presence of antibodies to cholinergic receptors.
Moreover patients with POTS were found to have significantly higher prevalence of other non organ specific autoantibodies, especially antinuclear antibodies (ANA), antophospholipid antibodies (aPL) and also various co-morbid autoimmune disorders. Hashimoto thyroiditis was the most common associated autoimmune disease (p < 0.001), followed by rheumatoid arthritis ( p < 0.01) and SLE (p < 0.001), respectively. Recent studies have focused on the role of renin-angiotensin system in the pathogenesis of OI showing that most patients with POTS harbor antibodies against angiotensin 1 receptor (AT1R). Less is known about the role of adrenal cortex in the manifestation of POTS or OH symptoms.
Autoimmune etiology of some forms of OI is also supported by few reports demonstrating that immunomodulation therapy resulted in a significant improvement of orthostatic symptoms. Studies on larger groups of patients are required.

Methods

Results

Conclusions

Background and Aims

Introduction: Aluminum salts containing adjuvants, with or without HSA, have been used in vaccines for more than 70 years. The addition of aluminum to viral or bacterial antigens results in neoantigen formation. Increased consumption of processed foods is a major source of aluminum exposure, which makes the gut the main target of inflammation and autoimmunity. About 1% of ingested aluminum accumulates in the skeletal system and the brain, where aluminum induces the cross-linking of Aβ-42 peptide and the formation of amyloid aggregates that is observed in Alzheimer’s disease.

Methods

We used ELISA methodology to measure IgG antibody against HSA-bound aluminum compounds in 94 different sera from healthy controls and patients with rheumatoid arthritis (RA), Crohn’s, celiac, mixed connective tissue and Alzheimer’s disease.

Results

Our results demonstrated that in control groups the mean OD of aluminum-HSA IgG antibody was 0.58. In comparison, the mean level of aluminum-HSA antibody was 0.96 for Crohn’s , 1.0 for celiac, 1.25 for Alzheimer’s, 0.61 for RA, and 0.57 for mixed connective tissue disease. The differences in antibody level against aluminum-HSA were highly significant for Crohn’s, celiac and Alzheimer’s disease, less significant for RA, and insignificant for mixed connective tissue disease.

Conclusions

We demonstrate extensive IgG reactivity against aluminum bound to HSA in the sera of patients with Crohn’s, celiac and Alzheimer’s disease, to a lesser degree with RA, and not in mixed connective tissue disease. We concluded that aluminum ingestion and absorption from the GI tract contributes to some of these diseases.

Background and Aims

Bullous pemphigoid (BP), represents the most common autoimmune bullous disease and mostly affects the elderly, being rare among pediatric population. Although a clear trigger is not well established, it has been recognized that a combination of genetic predisposing factors, as class II HLA (e.g., HLA-DQβ1 * 0301), and environmental influences, such as vaccines, viral infections, diet, neoplasms, and drugs, may contribute to the loss of immune tolerance. Along the years, growing incidence of autoimmune diseases after vaccination have been reported specially, among children.

Methods

Case report and literature review.

Results

Postvaccination BP is an idiopathic disorder that has been predominantly associated with tetanus, diphtheria, pertussis, hepatitis, influenza and polio vaccine alone or in combination with other vaccines.

Conclusions

In this structured review, we describe a case report of a four-month old female patient who presented with a new onset of BP following the second inoculation with HBV HBsAg vaccine, and summarize the current evidence on the association between BP and HBV vaccine, focusing on molecular mimicry as the underlying tie which link the virus, the vaccine and the disease.

Background and Aims

Autoimmune syndrome induced by adjuvants (ovine ASIA) has been related to aluminum (Al)-induced persistent subcutaneous post-vaccination granulomas. They consist on Al-laden macrophages that can translocate to the lymph node and other tissues. A suitable in vivo detection method is not yet available: granulomas cannot be properly assessed by palpation or routine imagine diagnostic techniques such as ultrasounds or radiographic evaluation. Computed tomography (CT) scan has been recently applied to sheep and the aim of this study is to test its performance in the detection of subcutaneous Al-induced granulomas in sheep.

Methods

Thoracic CT scans of 56 sheep submitted to the Veterinary Teaching Hospital for clinical reasons were undertaken. Age was variable and vaccination schedule was mostly unknown. CT subcutaneous masses were evaluated by cross-sections, visualization after intravenous administration of a contrast agent and 3D reconstructions. Histopathologic and microbiologic studies were performed in a selection (n=8) of the total number of masses compatible with granulomas detected by CT scan (n=36).

Results

Subcutaneous soft tissue masses, compatible with Al-induced granulomas were observed in 36 out of 56 sheep (64.3%) by CT. The necrotic center was clearly defined after intravenous contrast. Histologically, all selected masses showed the characteristic pattern of post-vaccination Al-induced granulomas. Microbiology was negative.

Conclusions

CT scan is able to easily detect Al-induced granulomas in sheep and provides unmatched information (location, extension, necrosis, and mineralization). CT detection of Al-induced granulomas could improve the diagnostic tools available to diagnose ovine ASIA syndrome and perhaps guide future therapeutic approaches.

Background and Aims

The loss of the ability of the immune system to recognize “self” antigens mounts an immune response against one’s own tissues and cells, hence autoimmunity. Specific environmental triggers include both intrinsic and extrinsic factors. Of those factors; dietary factors, infections, smoking, stress, and chemicals have been shown to influence disease etiopathogenesis.

Heavy metals are naturally occurring elements with high atomic density. Their wide distribution stems from their widespread use in industry, medical and technological fields. Heavy metals exert an important biochemical and physiological function in the human body. They are considered important constituents of several key enzymes and thus play an important role in oxidation-reduction reactions. Nevertheless, at high doses, heavy metals could have detrimental effects resulting in epigenetic modifications, reactive oxygen species production, activation of the innate and adaptive immune cells, and shifting the cytokine expression to proinflammatory profile. Current scientific evidence points towards the role of heavy metals in the exacerbation of various autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. Similarly, heavy metals were shown to be associated with the induction of autoimmune disease in animal models. Interestingly, Aluminum which has been used as an adjuvant was shown to activate both arms of the immune system thus resulting in a hyperinflammatory response. Aluminum accumulation has been shown to be associated with autoimmune diseases including inflammatory bowel disease, system lupus erythematosus, multiple sclerosis among others.

Methods

This is a review

Results

This is a review

Conclusions

This is a review