Metallosis: A New Form of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants Syndrome (ASIA)?

Abstract

Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) is a new entity in which exposure to an adjuvant triggers an aberrant autoimmune response. Metallosis is a rare condition characterized by the deposition and build-up of metal debris in the soft tissues of the body associated with metal-on-metal (MOM) prosthetic devices. It can present with local/systemic symptoms and signs due to a chronic inflammatory host response. The authors present the case of a 51-year-old woman with a 6-month history of systemic complaints due to intoxication with metal ions from hip metallosis. This case highlights the importance of follow-up and continuous monitoring of patients with a hip prosthesis. As this is a rare condition, a patient presenting with unspecific symptoms such as ASIA syndrome induced by metallosis requires a high level of clinical suspicion as the removal of the adjuvant can resolve the condition. LEARNING POINTS Asia syndrome is a new entity in which exposure to an adjuvant triggers an aberrant autoimmune response. Metallosis is an uncommon condition with local and systemic presentation. A high level of suspicion and close monitoring is needed in patients with vague systemic complaints.

The Mechanism of Metallosis After Total Hip Arthroplasty

“…Tissues' immune response during wound healing at postoperative periods affects the activities of implants and the surrounding tissues [17,45]. Although most biomedical implants have been deemed safe, sterile, and biocompatible by FDA [3], various biochemical and physiological systems become activated under specific conditions [13,44]. However, the body's biological effect on implant material is by some means dependent on the biodegradable mechanism by which it releases particles into the surrounding tissues as well as patient factors.…”

“…The layer of surface-adsorbed proteins modulates macrophage phenotypes and subsequent functions of phagocytosis and cytokine expression. Vascular endothelial cells and fibroblasts in the implant site proliferate leading to the formation of granulation tissue [26,44]. The end stage of these reactions is the formation of a fibrous capsule around the implant with little restitution of normal tissue structure.…”

“…However, wear particles alone can be recognized as antigens in certain instances [43]. The uptake of particulate metal debris by macrophages through phagocytosis is a key process by which implants may trigger inflammatory responses leading to metallosis [28,29,44]. After macrophages identify particles through pattern recognition receptors, including toll-like receptor, retinoid acid-inducible gene-1-like receptors, aim 2-like receptor, and nucleotide-binding oligomerization domain-like receptors, they form a cascade of reactions generating pro-inflammatory cytokines, including interleukin-1β, interleukin-6, interleukin-18, and tissue necrosis factor-α, as well as the chemokines (CXCL8, CCL2, and CCL3), and other small molecule inflammatory mediators [31,42].…”

Systemic lupus erythematosus induced by adjuvants after metal-on-polyethylene total hip arthroplasty

“…[ 1 ] Some scholars have recently proposed an ASIA. [ 2 ] Our patient was diagnosed as having SLE; whether this was caused by adjuvants remains unclear. Titanium-molybdenum alloy allergy is reportedly associated with development of SLE.…”

De Centro Interescolar de Segundo Grau a Escola Técnica Estadual do Maranhão \"Dr. João Bacelar Portela\": história e memória de uma instituição escolar (1980-1996)

“…CEFET. Contudo, a localização de estudos em períodos diversos sobre a instituição (ROSAR; CABRAL, 2004;SILVA, 2008;VAZ, LEOPOLDO;VAZ, DELZUITE;VAZ, LORETA, 2009) e a ausência de pesquisas voltadas para a história do Centro Interescolar de Segundo Grau Dr.…”