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ASIA is a new syndrome, which means autoimmune syndromes induced by adjuvants. It's a new
syndrome, which refers to several conditions, that are not necessarily as full characterized
autoimmunue diseases like systemic lupus or rheumatoid arthritis, or scleroderma, which
are induced by chronic stimulation, of the immune system by substances which may react
as adjuvants. Namely that they stimulate chronically the immune system, sometimes for the benefits
of the subject to get an immune reaction, but in this case the reaction is unnecessary,
and leads to the emergence of these new signs and symptoms.
Actually the ASIA was unrecognised for decades, and the first note of the ASIA came out following
some studies on the Gulf Syndrome, in which it had been shown that many of those soldiers
who complain about their severe fatigue, cognitive impairment, myalgias and arthralgias- they
were the soldiers that were not deployed to the Gulf area. This raised most probably the
question of whether it was the vaccines who induced the ASIA syndrome. So right now, the
ASIA syndrome falls in the category of rheumatologists and neurologists. Yet, depending on the different
clinical manifestations, it may fall in any discipline in internal medicine.
By and large, most probably the ASIA is due to the chronic stimulation of the immune system.
Having said that there are some specific adjuvants which were already shown to induce the ASIA
for instance aluminium. Aluminium is the oldest, the cheapest and the most efficient adjuvant
so far. And this is the reason why it is employed in so many vaccines- even nowadays. In a syndrome
called macrophagicmyofasciitis syndrome, or MMF, described first by Romain Gherardi in
France- he showed that in the children and the adults, who were vaccinated by the hepatitis
C virus, which contains aluminium, they developed this severe myalgia with the neurological
manifestations, including cognitive impairment, and some kind of dizziness and the inability
to concentrate, as well as unfresh sleep. And following many studies, he was able to
demonstrate that the aluminium is deposited in the muscle and then wanders from the muscles
via the macrophages, to different organs and especially penetrates the blood-brain barrier.
So, the MMF is actually part of the ASIA syndrome. It is believed also that not only the Gulf
War syndrome, vaccine etc , but also an entity called the sick building syndrome. People
who stay in a room, in an apartment and they develop all the clinical manifestations that
I have mentioned. And then once they move from the same room to another room or to another
building, then they feel better - they completely recover. And it is believed that in that room,
there is some substance that reacts or behaves like the adjuvant. Now having mentioned the
aluminium as a specific material that is used and employed as an adjuvant, aluminium is
widespread- is one of the most common materials in the world, but we, during daily life, use
many substances and many equipments which are purely done from aluminium.
Just as a joke I will mention that I have seen an advertisement in the Time magazine,
that a man of steel drives a car of aluminium- and the car is Mercedes! So this raises a
question whether rich people who drive Mercedes may develop more autoimmune diseases than
people who drive, for instance Honda - which is not done from aluminium!
First of all, vaccines are very widespread. I would like to say in the beginning of my
words, that definitely I am not against vaccines. Vaccines are the best medical development
that humankind had in the last 300 years. They have brought almost eradication of some
viral diseases. However, it has to be considerable, that when you give a million people, an active
substance, and it is an active substance- being the viral particles or synthetic particles
emulsified in adjuvant, which is supposed to enhance the immune reaction, that amongst
those billions of people there will be no people who will react in an adverse way to
these injections. So, we have to identify these people- first
of all we have to diagnose them, to treat them- some of them should be compensated,
because the vaccine quite often are imposed either by the country, either by the government,
or by the employer and so forth. In regard to the silicone implants, there
are countries in which it is more prevalent than in others but it's quite a very common
cosmetic operation. It brings, and it leads to a better mood for the lady (or even if
the man is doing it)- and therefore it is important. It's part of our health. Yet again,
complaining that the silicone is completely inert , and it doesn't leak, and doesn't wander
in our body and doesn't induce granulomas, is misunderstanding. And especially if the
silicone is wrapped in a bad way, like in recent years we have heard about this French
company, PIP who distributed more than 300,000 silicones which were easily ruptured. But
not necessarily only when there is a silicone rupture, there is a leakage. Also, with unruptured
silicones, there are small nanoparticles of silicone that can wander in the body, and
therefore we can find the silicone in different parts of the body- in the hands, in the chest
and so forth. Now, they are quite prevalent. Luckily enough, the syndrome itself is rare.
Like autoimmune diseases, which are definitely induced by infections. They are not as common
as the infections- because we always need the consort play of the infective agent and
the genetic material. The same with the ASIA syndrome, it has been found that it is more
prevalent in subjects that carry a specific genetic background which is HLA-DRB 1. This
is, by the way, the same HLA which was found also amongst those who developed this side-effect
of ASIA following vaccines. So, maybe in the future when more personalized medicine will
prevail, we will be able to screen the people and to avoid the ASIA syndrome by avoiding
some vaccines or changing in the vaccine the type of adjuvant with one which might not
be associated with the ASIA syndrome. And I would like to emphasize that currently there
are novel adjuvants which we have to test and to see whether they are as efficient as
the old and good adjuvants, but might have less side-effects than the aluminium and the
other old adjuvants.
We have published the criteria in an extensive article which was the first one to inform
and to crystallize the ASIA syndrome in the Journal of Autoimmunity, and we have classified
it as we do usually in different autoimmune diseases- namely into major criteria and minor
criteria. Major criteria entails clinical manifestations, which include for instance,
the severe fatigue- and when we say about severe fatigue, which is not caused by an
effort- you wake up feeling tired, unfresh sleep, as well as pains in your muscles which
is called myalgia, arthralgia. But as I mentioned before, many of these patients may evolve
into a more well defined autoimmune condition. So for instance, if they will evolve into
scleroderma, systemic sclerosis, they will have tight skin, they will have the complication
of the lung involvement, they may have the complication of the kidney involvement , and
so forth. I just recently, sat with a famous professor
in England in his clinic, and to my surprise he told me that just three weeks ago he saw
a patient who developed polychronditis (which is actually inflammation of the cartilage
over different organs in our body, but mainly in the face) and following enquiries he found
that it developed following silicone transplant, and the patient is going through explant of
this transplant.
In part, the mechanism may involve the chronic stimulation of the immune system. So, as you
know when we have a stimulation of the immune system, we may develop inflammatory cytokines
like interferon gamma, interferon alpha, IL-1, IL-6, TNF alpha and so forth. So in part,
this syndrome can be induced by this avalanche of cytokines due to the chronic stimulation.
This chronic stimulation may also involve the opening of the blood-brain barrier, and
therefore penetration of different substances into the brain. One of the mechanisms which
was well defined, is the aluminium that positions in our body, following the injection, or following
the exposure, and also the wandering of this aluminium to the brain, through the blood-brain
barrier. Actually when you expose mice and also human
beings to aluminium, you get very similar clinical symptoms that you get with the ASIA
syndrome. In the past, we physicians were exposed to this aluminium 'toxicity' of the
brain where patient went through dialysis, and the dialysate fluid contained aluminium
and actually diffused into the body through the blood-brain barrier and then there was
an aluminium intoxication, and the patient complained very similarly to the ASIA syndrome.
I want to mention that this mechanism, by ways of chronic stimulation also induces different
autoantibodies. Now not necessarily the autoantibodies indicate the specific autoimmune disease,
so it might be a combination of anti-DNA antibody which is more classical for SLE, but also
anti-mitochondrial antibodies which may indicate primary biliary cirrhosis. So, only after
years of evolution, as I mentioned some of the patients may evolve to one or another
disease, or sometimes to combine to define full autoimmune diseases.
The question of environmental factors, in addition to the silicone implants as well
as the adjuvants in the vaccine is not known yet. But I can assume from knowledge, reading
literature, that aluminium in different materials used in daily life may be associated with
that. Toxins in the environment, for instance it has been found that in the United States,
in one of the towns there was a significant increase in lupus cases, and following inquiries
it had been found that there was some sort of a sewage system or drainage system in which
toxic material was drained to there and concentrated there. And the people in the area actually
complained about inspiring, or smelling or difficulties in the air. So, seeing in a large
context I would say that it might be that part of what we call "idiopathic" autoimmune
diseases, they are caused by toxic materials which may react like the adjuvants in the
ASIA syndrome. It may contain aluminium, it may be other metals which are known to induce
autoimmune diseases.
There is no knowledge about geographical distribution. We do know that many of the autoimmune diseases
are more prevalent as you go further away from the equator. It was believed and it is
believed that the lack of exposure, or the decreased exposure to sun, and induction of
Vitamin D. And today we know that Vitamin D may play an instrumental role in all autoimmune
diseases. For instance when we have analyzed more than 40 different autoimmune diseases,
we found lower levels in comparison to the healthy population at the same geographical
area. So I am not aware about the ASIA- the ASIA
is a new syndrome which is now recognised. We have papers now from the Philippines, papers
from Mexico, we have papers from all over the world. But these are just small series
of cases there was no epidemiological study known or done to analyse the geographical
distribution. But I believe that eventually we will find that it is related to the geographical
distribution for these toxic materials. Having said that, there were papers from two countries.
One of them was from Finland showing an avalanche of cases of a disease, that now is recognised
as an autoimmune one, called narcolepsy- sudden attacks of sleeping, which appeared following
the H1N1 epidemic and vaccines. Now having said that, I would like to emphasize that
this disease is recognized in Finland and is strictly associated with HLA BR1 or 6 or
2. And when the vaccine was delivered after the epidemic, there was a 13-fold increase
in this geographical area of this narcolepsy which may now be considered as an autoimmune
disease. So the geographic distribution in this case was not to the substance, but to
the genetic constellation of the people who live in the area. Since Finland is a small
country of close to 5 million people, and the inter-marriages is high you may assume
that one of the genetic materials, which by the way could give you a benefit in the evolution,
more prevails in this area than in other areas.
The future directions should be directed to understand better the mechanism, develop better
adjuvants, especially in vaccine because with vaccines we are dealing with billions of people
sometimes who are vaccinated and we would like to minimize at least these side effects.
We should learn from the ASIA to better understand the etiology of other autoimmune diseases,
which currently are regarded as idiopathic- which means that we are idiots, that we don't
know the pathology and that we don't know the etiology! And I would like, not to see
in the future the sentence "autoimmune diseases have an unknown etiology" because we are coming
closer to better understanding the etiology. Also, I have still a perplexion about those
women who have these silicone implants whether to explants the implants or not, for there
is no guarantee that by explanting the silicone implants, the patient will recover completely-
and then she will lose the implant and still have the ASIA syndrome.
Again having said that, there are a few cases in which explanting the silicone implants
led to a complete recovery of the patient from the ASIA syndrome. So I would like to
understand better whether to instruct the patient, those who suffer from the ASIA syndrome,
whether to explant these implants or not- so there is a lot when a new syndrome is crystallized,
a lot of research is going on all over the world, and I hope that in the future we'll
be able to better define who are those who are candidates or at risk to develop this
syndrome, and to avoid it before we develop it.
There is no screening for ASIA, because we don't a surrogate marker that we can screen
for that. My advice to the clinician is to pay more attention to the past history of
the patient, always to ask about vaccines, when the vaccines were delivered. I would
like in the future the clinician will diagnose this patient and may help them first of all,
for compensating them if they deserve the compensation after all these patients suffer,
they were completely healthy, they were vaccinated and suddenly they develop the disease. So
better understanding of the symptoms, the signs in the serological markers, and knowing
the syndrome may help to identify the condition at a very early stage. The therapy should
be the same therapy as for autoimmune diseases. Until we will understand it better, maybe
to switch to other drugs rather to the old drugs we are using currently.