Repeated exposure to silicone gel can induce delayed hypersensitivity

Abstract

The possible immunologic reactivity of silicone gel remains speculative and controversial. In this laboratory, a quantitative lymphocyte localization assay has been developed and well studied using pure lymphocytes collected by the technique of lymph vessel cannulation in sheep. The kinetics of antigen-specific immune responses (e.g., tuberculin reaction) in this model are well described and accepted. Using the known parameters regarding the response to purified protein derivative and the classic adjuvant Freund's Complete Adjuvant, this study was designed to identify the possible antigen-specific immunologic response, in the form of delayed-type hypersensitivity, after repeated exposure to silicone gel. Pure lymphocytes were collected by cannulating the efferent vessel of a subcutaneous lymph node in four groups of primed sheep which, 30 days previously, had received intradermal injections of 0.9% saline (negative controls; n = 6), Freund's Complete Adjuvant only (positive controls; n = 6), silicone gel (n = 7), or Freund's Complete Adjuvant homogenized with silicone gel (n = 7) in an attempt to induce sensitization. Multiple (1040) intradermal skin tests were performed using silicone gel, purified protein derivative, and 0.9% saline. After the skin lesions had developed for 48 hours, 5 x 10(8) lymphocytes were labeled in vitro with indium-111, returned intravenously, and allowed to circulate for 3 hours. Sheep were euthanized, the skin lesions were removed, and the radioactivity was counted in a gamma spectrometer. The radioactivity in each skin lesion is considered a measure of lymphocyte accumulation. The occurrence of augmented accumulation after reexposure to an antigen is a hallmark of delayed-type hypersensitivity. The purified protein derivative and saline lesions functioned as positive and negative controls, with counts per minute (cpm +/- standard error) of 2404 +/- 478 (Freund's Complete Adjuvant group) and 149 +/- 21 (saline group), respectively. Significantly greater (p = 0.0021) radioactivity was found in the silicone gel sites (310 +/- 35) in the silicone gel-primed group and the Freund's Complete Adjuvant plus silicone gel group (453 +/- 44; p = 0.0004) than in normal skin in each group. These data suggest that it may be possible to induce an antigen-specific lymphocyte-mediated response to silicone gel.