HLA typing in women with breast implants

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

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