Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; School for Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, the Netherlands.
Chief Rheumatology Department, National Institute of Cardiology, Mexico City, Mexico.
Autoimmun Rev. 2023 May;22(5):103287. doi: 10.1016/j.autrev.2023.103287. Epub 2023 Feb 3.
In 2011, a syndrome entitled ASIA (Autoimmune/inflammatory Syndrome Induced by Adjuvants; Shoenfeld's syndrome) was first described. ASIA aimed to organize under a single umbrella, the existing evidence regarding certain environmental factors which possess immune stimulatory properties, in order to shed light on a common pathway of autoimmune pathogenesis. Such environmental immune stimulators, or adjuvants, include among others: aluminum salts as in vaccines, various medical implants, as well as various infectious agents. After the launch of the ASIA syndrome, the expansion and recognition of this syndrome by different researchers from different countries began. During the past decades, evidence had been accumulating that (auto)immune symptoms can be triggered by exposure to environmental immune stimulatory factors that act as an adjuvant in genetically susceptible individuals. A panoply of unexplained subjective and autonomic-related symptoms has been reported in patients with ASIA syndrome. The current review summarizes and updates accumulated knowledge from the past decades, describing new adjuvants- (e.g. polypropylene meshes) and vaccine- (e.g. HPV and COVID vaccines) induced ASIA. Furthermore, a direct association between inflammatory/autoimmune diseases with ASIA syndrome, will be discussed. Recent cases will strengthen some of the criteria depicted in ASIA syndrome such as clear improvement of symptoms by the removal of adjuvants (e.g. silicone breast implants) from the body of patients. Finally, we will introduce additional factors to be included in the criteria for ASIA syndrome such as: (1) dysregulated non-classical autoantibodies directed against G-protein coupled receptors (GPCRs) of the autonomic nervous system and (2)) small fiber neuropathy (SFN), both of which might explain, at least in part, the development of 'dysautonomia' reported in many ASIA patients.
2011 年，首次描述了一种称为 ASIA（佐剂诱导的自身免疫/炎症综合征；Shoenfeld 综合征）的综合征。ASIA 的目的是将具有免疫刺激特性的某些环境因素的现有证据组织在一个单一的保护伞下，以阐明自身免疫发病机制的共同途径。此类环境免疫刺激剂或佐剂包括但不限于：疫苗中的铝盐、各种医疗植入物以及各种感染性因子。ASIA 综合征推出后，来自不同国家的不同研究人员开始对该综合征进行扩展和认可。在过去的几十年中，有证据表明（自身）免疫症状可以由暴露于环境免疫刺激因子引起，这些因子在遗传易感个体中充当佐剂。患有 ASIA 综合征的患者报告了一系列无法解释的主观和自主相关症状。目前的综述总结并更新了过去几十年积累的知识，描述了新的佐剂-（例如，聚丙烯网）和疫苗-（例如，HPV 和 COVID 疫苗）诱导的 ASIA。此外，还将讨论炎症/自身免疫性疾病与 ASIA 综合征之间的直接关联。最近的病例将加强 ASIA 综合征中描述的一些标准，例如通过从患者体内去除佐剂（例如硅胶乳房植入物）来明显改善症状。最后，我们将介绍其他一些应包含在 ASIA 综合征标准中的因素，例如：（1）针对自主神经系统 G 蛋白偶联受体（GPCR）的失调性非经典自身抗体；和（2）小纤维神经病（SFN），这两者至少可以部分解释许多 ASIA 患者报告的“自主神经功能障碍”的发展。
