Biofilm Derived Oxylipin Mediated Autoimmune Response in Breast Implant Subjects

Abstract

Over 10 million women worldwide have breast implants for breast cancer/prophylactic reconstruction or cosmetic augmentation. In recent years, a number of patients have described a constellation of symptoms that are believed to be related to their breast implants. This constellation of symptoms has been named Breast Implant Illness (BII). The symptoms described include chronic fatigue, joint pain, muscle pain and a host of other manifestations often associated with autoimmune illnesses. In this work, we report that bacterial biofilm is associated with BII. We postulate that the pathogenesis of BII is mediated via a host-pathogen interaction whereby the biofilm bacteria Staphylococcus epidermidis interacts with breast lipids to form the oxylipin 10-HOME. The oxylipin 10-HOME was found to activate CD4+ T cells to Th1 subtype. An increased abundance of CD4+Th1 was observed in the breast tissue of BII subjects. The identification of a mechanism of immune activation associated with BII via a biofilm enabled pathway provides insight into the pathogenesis for implant-associated autoimmune symptoms.

Biofilm-derived oxylipin 10-HOME mediated immune response in women with breast implants

“…This data is an important addition to the literature, as previous investigations have only employed clinical microbiological testing, which has struggled to completely define the rate and types of chronic infections in BII (6). Furthermore, the authors show that (E)-10-hydroxyoctadecenoic acid (10-HOME), an oxylipin produced by bacteria that oxidize host oleic acids, is higher in the periprosthetic breast tissue of patients with BII (10). It is known that oxylipins such as 10-HOME promote the establishment of bacterial biofilms (11).…”

“…It is known that oxylipins such as 10-HOME promote the establishment of bacterial biofilms (11). The authors show that the bacteria in higher abundance in the BII group produced more 10-HOME (10).…”

“…In this issue of the JCI, Khan and authors present the largest translational study of human BII patients to date, observing nearly 140 total patients undergoing breast implant removal, with over half reporting BII symptoms (10). Through electron microscopy and the use of next generation sequencing, the authors show that there is a higher likelihood of S. epidermidis, among other bacteria, present on the implants of patients with BII.…”

“…This work provides a pathophysiologic mechanism for a currently understudied and poorly characterized disease. BII (10). It appears that BII is, at the very least, associated with bacterial biofilms, and this disease is driven by chronic host response to bacterial colonization.…”

Breast Implant-Associated Immunological Disorders

“…Positive culture results with BII symptoms were most commonly associated with the Staphylococcus genus [ 39 ]. In a recent report by Khan et al, authors noted that biofilm-forming bacteria S. epidermidis in breast implants results in host immune activation [ 69 ]. The formation of biofilm of both S. epidermidis and C. acnes has been previously established to be associated with a positive causative role in the pathogenesis of capsular contracture in breast implant patients as well [ 70 ].…”