Antiphospholipid Antibodies and Infection: Non Nova Sed Nove

Abstract

The clinical significance of antiphospholipid antibodies (aPL) in the context of infections has attracted attention since their first discovery in patients with syphilis. In fact, the recognition of aPL in patients with infections has been described in parallel to the understating of the syndrome. Since the first description of aPL-positive tests in three patients with COVID-19 diagnosed in January 2020 in Wuhan, China, a large number of studies took part in the ongoing debate on SARS-2-Cov 2 induced coagulopathy, and many following reports speculated a potential role for aPL. In order to get further insights on the effective role of detectable aPL in the pro-thrombotic status observed in COVID-19 patients, we performed an observational age-sex controlled study to compare the aPL profile of hospitalized patients with COVID with those observed in a) patients with thrombotic APS and b) patients with cultural/serologically-proved infections. Our data showed positive aPL testing in about half of the patients (53%) with COVID-19 and patients with other viral/bacterial infections (49%). However, aPL profile was different when comparing patients with overt APS and patients with aPL detected in the contest of infections. Caution is therefore required in the interpretation and generalization of the role of aPL s in the management of patients with COVID-19. Before introducing aPL testing as a part of the routine testing in patients with COVID-19, larger well-designed clinical studies are required. While the pro-thrombotic status in patients with COVID-19 is now unquestionable, different mechanisms other than aPL should be further investigated.

Incidence of autoantibodies related to systemic autoimmunity in patients with severe COVID-19 admitted to the intensive care unit

“…and their presence was associated with thrombosis and severity of COVID-19 (18,(39)(40)(41)(42). However, multiple other studies did not demonstrate either differences between COVID-19 and control populations or clinical associations (33,34,(43)(44)(45)(46). The significantly higher frequency of anti-CL IgM autoantibodies that we found in COVID-19 patients compared to controls was not associated with unfavorable outcomes as previously reported (29).…”

Safety and tolerability of mRNA COVID-19 vaccines in people with antiphospholipid antibodies

“…1 , 2 , 3 However, some concerns have been raised regarding the safety of the vaccines in patients with antiphospholipid antibodies, as these antibodies have been reported to appear following both infection and vaccination and have been identified in patients with COVID-19. 4 Although a few cases of thrombocytopenia and thrombotic events with clinical features resembling antiphospholipid syndrome have been reported in recipients of either adenoviral vector-based or mRNA-based COVID-19 vaccines, 5 a pathogenic link and, more critically, the clinical relevance of antiphospholipid antibodies in these clinical settings have yet to be fully elucidated.…”

Not all that is ‘full house’ is systemic lupus erythematosus: a case of membranous nephropathy due to syphilis infection

“…Antiphospholipid antibodies, and particularly anticardiolipin antibody positivity, have been associated with multiple chronic infections including hepatitis C virus (HCV), HIV, syphilis and leprosy, among others 14. These antibodies tend to be transient and not associated with thrombosis 15. Sciascia et al recently found that 49% of patients with a viral or bacterial infection (including T. pallidum, cytomegalovirus and Pseudomonas aeruginosa , among others) and 53% of patients with COVID-19 had antiphospholipid antibodies, although they were unrelated to thrombosis 15.…”

“…These antibodies tend to be transient and not associated with thrombosis 15. Sciascia et al recently found that 49% of patients with a viral or bacterial infection (including T. pallidum, cytomegalovirus and Pseudomonas aeruginosa , among others) and 53% of patients with COVID-19 had antiphospholipid antibodies, although they were unrelated to thrombosis 15. IgM antibodies to both cardiolipin and β2 glycoprotein are correlated with lower antiphospholipid scores (and lower risk of thrombosis in APS) than are the respective IgG antibodies 16.…”