By Yehuda Shoenfeld
In this Q&A, we talk to Professor Yehuda Shoenfeld about Autoimmune Syndrome Induced by Adjuvants (ASIA) and discuss his recommendations regarding further research in the field.
Professor Yehuda Shoenfeld talks about ASIA (‘autoimmune syndrome induced by adjuvants’)
Professor Yehuda Shoenfeld is the founder and head of the Zabludowicz Center for Autoimmune Diseases at the Sheba Medical Center, which is affiliated to the Sackler Faculty of Medicine at Tel-Aviv University, Israel. He is also the Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases at Tel-Aviv University. His clinical and scientific works focus on autoimmune and rheumatic diseases, and he has been the recipient of multiple awards, including a Life Contribution Prize in Internal Medicine in Israel, 2012.
In recent years, Professor Shoenfeld noted that four conditions: siliconosis, Gulf War syndrome (GWS), macrophagicmyofasciitis syndrome (MMF) and post-vaccination phenomena were linked with previous exposure to an adjuvant, and that the patients also presented with similar clinical symptoms. In 2011, this led Professor Shoenfeld to suggest these comparable conditions should be grouped under a common syndrome entitled ‘ASIA’, for ‘Autoimmune (Autoinflammatory) Syndrome Induced by Adjuvants’.
In this Q&A we talk to Professor Shoenfeld about ASIA, and discuss his recommendations regarding further research in the field.
What is ASIA?
ASIA is a new syndrome, which refers to autoimmune syndromes induced by adjuvants. It includes several conditions that are not fully characterized as autoimmune diseases like systemic lupus, rheumatoid arthritis or scleroderma, but that are induced by chronic stimulation of the immune system by substances which may react as adjuvants. This chronic stimulation leads to the emergence of these new signs and symptoms, which include fatigue, arthritis, myalgia, and neurological manifestations.
Which adjuvants commonly used in medical practice have been implicated in ASIA?
The idea of ASIA as a new syndrome developed after some studies on Gulf War syndrome reported that soldiers who had not been deployed to the Gulf area were suffering from symptoms such as severe fatigue, cognitive impairment, myalgias and arthralgias. This raised the question of whether it was the vaccines administered to the soldiers that induced these syndromes. The most common adjuvants are silicone implants and aluminum in vaccines.
Are any other adjuvants associated with ASIA?
There are some specific adjuvants which have been shown to induce ASIA; for instance, aluminium. Aluminium is the oldest, the cheapest and the most efficient adjuvant so far, which is why it is still commonly used in the development of vaccines.
In 2001, Romain Gherardi and colleagues reported that patients diagnosed with macrophagic myofasciitis, or MMF (a rare muscle disease characterized by specific myopathological alterations, first described by the Groupe d’Etudes et Recherche sur les Maladies Musculaires Acquises et Dysimmunitaires (GERMMAD)), had previously been vaccinated with hepatitis vaccines containing aluminium hydroxide. These patients went on to develop severe myalgia with neurological manifestations, cognitive impairment, dizziness, inability to concentrate and poor sleep. Following many studies, Romain Gherardi and colleagues were able to demonstrate that the aluminium is deposited in the muscle, and then via macrophages travels from the muscles to different organs and penetrates the blood-brain barrier. On this basis, MMF is part of the ASIA syndrome.