A conversation between Robert Whitfield MD and another clinician/researcher about biomarkers related to breast implant illness. They discuss bacterial biofilms (Cutibacterium acnes, Staphylococcus epidermidis), clinical symptoms (fatigue, dry eyes, myalgias), historical tests (ESR, complement, clotting factors), and emerging markers such as fibroblast growth factor 19. The speakers express the need for diagnostic and monitoring biomarkers to guide explant decisions and track symptom resolution post-explant; they call for more research into inflammatory and immune pathway markers and potential therapeutic targets.
Chapters
Since you found so many people with bacterial contamination, and there's a growing amount of literature to support both the interaction of the biofilm and the breast tissue leading to kind of downstream what we see in terms of symptoms. So like fatigue and dry eyes and myalgias and things like that which are both of us see resolved after, after explant. And then some of these newer concepts of things like fibroblast growth factor 19, where that's been something that is elevated and then returns to more of a normal state. Because you and I both would like to have a biomarker to be able to follow our patients and know that that is getting better, or identify them pre op and say, oh, hey, we, well, this is what we find when someone has cutobacterium agonists or if they have staph epidermidis, this biomarker is relevant. What are your thoughts about what is a growing amount of evidence supporting these biomarkers?
I would love to have a tool like a diagnostic tool, a screening tool or a tool that allows me to follow patient response over time, both before and after surgeries. You know, in the old days, we had very little to go by. There was the erythrocyte sedimentation rate, the esr, and then there were complement factors that were looked at and then certain clotting factors. And now there's more significant understanding about inflammatory pathways in the body and drugs that we use to treat inflammation. And perhaps there are going to be precise markers that we use in the long term. I'm not a laboratory scientist. I don't know all of the potential markers that are being studied out there, but I do believe there are going to be answers in that universe ways that we can say this patient with symptoms has an elevated biomarker and that gives us more confidence that if we do this procedure, they're going to get symptom relief. Because I don't know how to guarantee that to patients. I just knew that many patients are improved for any number of reasons. But we definitely need to invest more in this type of research because the immune and inflammatory pathways of the body have much greater impact on our sense of wellness and health than we understand and that we appreciate. And it has, you know, not just diagnostic implications, but therapeutic implications, you know, with agents that block certain inflammatory, you know, or immune pathways.
