HLA TYPING IN WOMEN WITH BREAST IMPLANTS

Since the 1970s, anecdotal reports have described a relatively small n umber of women who received silicone gel breast implants and later dev eloped either a recognized rheumatologic disease or unexplained sympto ms suggestive of an autoimmune disorder. The study reported here exami ned whether there is any association between the symptoms seen in impl ant patients and HLA molecules. One-hundred and ninety-nine subjects w ere evaluated by HLA, typing: symptomatic patients with implants (grou p I, n = 77), asymptomatic women with implants (group II, n = 3'7), he althy female volunteers without implants (group III, n = 54), and fibr omyalgia patients without implants (group IV, n = 31). A statistically significant 68 percent of group I were positive for HLA-DR53, compare d with 35 percent of group II and 52 percent of group III. The fibromy algia patients were strikingly similar to group I women in terms of HL A-DR molecules, with 65 percent of group IV being positive for DR53. G roup I also had a statistically significant increased frequency of HLA -DQ2. Asymptomatic women with implants (group II) had an increased fre quency of DR1 and DQ1. In addition, 42 percent of symptomatic patients with implants formed autoantibodies to their own B cells; of these, 8 1 percent were DR53-positive. Although frequencies of capsular contrac ture and implant rupture were not significantly different in the two g roups 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 patien ts with implants share important genetic characteristics (primarily HL A-DR53 positivity) that differentiate them from their asymptomatic cou nterparts. DR53 may be a marker of women who are predisposed by their HLA genotype to develop symptoms following exposure to silicone gel br east implants.