title: Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature.
abstract: The development of autoimmunity and/or autoimmune diseases is multifactorial. Vitamin D is one of the factors that might play a role. We postulated that both the presence of adjuvants and insufficient levels of vitamin D may result in the development of autoimmunity in patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in relation to silicone implant incompatibility. We measured vitamin D levels in 135 patients with ASIA in relation to silicone implant incompatibility and related findings to the presence of autoantibodies that are commonly used to diagnose systemic autoimmune diseases. Furthermore, we systematically reviewed the literature regarding vitamin D deficiency as a risk factor for the development of autoantibodies. Vitamin D measurements were available for analysis in 131 of 135 patients with ASIA in relation to SIIS. Twenty-three patients (18%) tested positive for autoantibodies, from which 18 patients (78%) had either a vitamin D deficiency or insufficiency (median vitamin D level 60.5 mmol/L), whereas five patients (22%) had sufficient vitamin D levels. The risk to develop autoantibodies was significantly increased in vitamin D deficient and/or insufficient patients [RR 3.14; 95% CI, 1.24-7.95; p = 0.009]. Reviewed literature suggested an association between vitamin D levels and the presence and/or titer levels of autoantibodies in different autoimmune diseases. From our current study and from our review of the literature, we conclude that vitamin D deficiency is related to the presence of autoantibodies. Whether vitamin D supplementation results in a decrease of autoimmunity needs to be studied prospectively.
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40 6229 ER, Maastricht, the Netherlands.|Department of Reconstructive, Plastic and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Maartje J L
authors.initials: MJL
authors.lastname: Colaris
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40 6229 ER, Maastricht, the Netherlands.|Department of Reconstructive, Plastic and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Rene R
authors.initials: RR
authors.lastname: van der Hulst
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40 6229 ER, Maastricht, the Netherlands. jw.cohentervaert@maastrichtuniversity.nl.|Clinical and Experimental Immunology, Reinaert Clinic, Maastricht, the Netherlands. jw.cohentervaert@maastrichtuniversity.nl.
authors.forename: Jan Willem Cohen
authors.initials: JWC
authors.lastname: Tervaert
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D018427:Breast Implants / Q000009:adverse effects*; D015331:Cohort Studies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D012307:Risk Factors; D012826:Silicone Elastomers / Q000009:adverse effects*; D014807:Vitamin D / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; D012826:Silicone Elastomers; D014815:Vitamins; D014807:Vitamin D
keywords: Autoantibodies; Autoimmune diseases; Vitamin D; Vitamin D deficiency; Vitamin D supplementation