Classical examples of the concept of the ASIA Syndrome; CPI, SBI and vaccines

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 by Shoenfeld et al. and encompasses a cluster of related immune mediated diseases, which develop among genetically prone individuals as a result of adjuvant agent exposure. Since the recognition of ASIA syndrome, more than 4400 documented cases have been reported so far, illustrated by heterogeneous clinical manifestations and severity. In this review, five enigmatic conditions, including sarcoidosis, Sjögren’s syndrome, undifferentiated connective tissue disease, silicone implant incompatibility syndrome (SIIS), and immune-related adverse events (irAEs), are defined as classical examples of ASIA. Certainly, these disorders have been described after an adjuvant stimulus (silicone implantation, drugs, infections, metals, vaccines, etc.) among genetically predisposed individuals (mainly the HLA-DRB1 and PTPN22 gene), which induce an hyperstimulation of the immune system resulting in the production of autoantibodies, eventually leading to the development of autoimmune diseases. Circulating autonomic autoantibodies in the sera of patients with silicone breast implants, as well as anatomopathological aspects of small fiber neuropathy in their skin biopsies have been recently described. To our knowledge, these novel insights serve as a common explanation to the non-specific clinical manifestations reported in patients with ASIA, leading to the redefinition of the ASIA syndrome diagnostic criteria.

Prof. 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 in Tel-Aviv University in Israel.

Professor Shoenfeld’s clinical and scientific works focus on autoimmune and rheumatic diseases, and he has published more than 1750 papers in journals such as New Eng J Med, Nature, The Lancet, Proc Nat Acad Scie, J Clin Invest, J Immunol, Blood, FASEB, J Exp Med, Circulation, Cancer and others.

Professor Shoenfeld is on the editorial boards of 43 journals in the fields of rheumatology and autoimmunity and is the founder and the editor of the IMAJ (Israel Medical Association Journal), the representative journal of science and medicine in the English language in Israel, and also is the founder and Editor of Autoimmunity Reviews (Elsevier) (Impact factor 7.9) and co-Editor of the Journal of Autoimmunity (Impact factor 8). For the past twenty years Yehuda has been the Editor of “Harefuah” – The Israel Journal in Medicine (Hebrew).

Professor Shoenfeld received the EULAR prize in 2005, in Vienna, Austria. In UC Davis, USA, Professor Shoenfeld received the Nelson’s Prize for Humanity and Science for 2008. He was recently awarded a Life Contribution Prize in Internal Medicine in Israel, 2012 as well as the ACR Master Award in 2013.