Autoimmune complications of COVID‐19

Yazdanpanah, Niloufar; Rezaei, Nima

doi:10.1002/jmv.27292

Cited by 138 publications

(125 citation statements)

References 136 publications

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“…In the latter case, to improve diagnostic specificity, we considered only cases with platelet counts <100,000/mmc, with a rapid response to steroid therapy and without alternative explanation. According to previous reports ( 25 ), thrombocytopenia has been described as an autoimmune manifestation in COVID-19 although without anti-platelet antibodies, likewise in our patients.…”

Section: Discussionsupporting

confidence: 84%

SARS-COV-2 Infection, Vaccination, and Immune-Mediated Diseases: Results of a Single-Center Retrospective Study

et al. 2022

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ObjectivesThe relationship between infections or vaccine antigens and exacerbations or new onset of immune-mediated diseases (IMDs) has long been known. In this observational study, conducted during the COVID-19 pandemic, we evaluated the onset of clinical and laboratory immune manifestations related to COVID-19 or SARS-CoV-2 vaccination.MethodsFour groups of patients were evaluated: A) 584 COVID-19 inpatients hospitalized from March 2020 to June 2020 and from November 2020 to May 2021; B) 135 outpatients with previous SARS-CoV-2 infection, assessed within 6 months of recovery; C) outpatients with IMDs in remission and flared after SARS-COV-2 infection; D) outpatients with symptoms of probable immune-mediated origin after SARS-CoV-2 vaccination.ResultsIn cohort A we observed n. 28 (4.8%) arthralgia/myalgia, n. 2 (0.3%) arthritis, n. 3 (0.5%) pericarditis, n. 1 (0.2%) myocarditis, n. 11 (1.9%) thrombocytopenia or pancytopenia, and in the follow up cohort B we identified 9 (6.7%) cases of newly diagnosed IMDs after the recovery from COVID-19. In all cases, serological alterations were not observed.In cohort C we observed n.5 flares of pre-existing IMD after SARS-COV2 infection, and in the cohort D n. 13 IMD temporally close with SARS-CoV-2 vaccination in 8 healthy subjects (with clinical classifiable IMD-like presentation) and in 5 patients affected by an anamnestic IMD. Also in these latter cases, except in 2 healthy subjects, there were not found serological alterations specific of a classifiable IMD.ConclusionsThis study suggests that the interplay between SARS-CoV-2 and the host may induce complex immune-mediated reactions, probably induced by the anti-spike antibodies, in healthy people and IMD patients without specific serological autoimmunity. Moreover, our data suggest that the anti-SARS-CoV-2 antibodies generated by the vaccination may cause in healthy subjects’ clinical manifestations similar to well-definite IMDs. These findings support the hypothesis that SARS-Cov2 infection in COVID-19 induce an innate and adaptive immune response that may be both responsible of the symptoms correlated with the occurrence of the IMDs described in our study. And, in this context, the IMDs observed in healthy people in close temporal correlation with the vaccination suggest that the anti-Spike antibodies may play a key role in the induction of an abnormal and deregulated immune response.

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Section: Discussionsupporting

confidence: 84%

SARS-COV-2 Infection, Vaccination, and Immune-Mediated Diseases: Results of a Single-Center Retrospective Study

et al. 2022

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“…Bystander activation is an antigen non-specific process that results in the activation of autoreactive T cells [ 5 , 88 ]. In bystander activation, host tissue damage due to immunopathologic responses or infection leads to the releasing of sequestered autoantigens, activating antigen-presenting cells (APCs) and autoreactive Th cells.…”

Section: Mechanisms Of Covid-19 Vaccination-induced Thyroid Dysfunctionsmentioning

confidence: 99%

“…In bystander activation, host tissue damage due to immunopathologic responses or infection leads to the releasing of sequestered autoantigens, activating antigen-presenting cells (APCs) and autoreactive Th cells. After that, activated macrophages and autoreactive T cells produce cytokines, which result in the recruitment of more Th cells promoting local inflammation [ 5 , 88 ]. Abnormal cytokine and chemokine production can lead to aberrant expression of major histocompatibility complex (MHC) class II molecules, contributing to the pathogenesis of viral diseases, probably through the presentation of autoantigens [ 84 ].…”

Section: Mechanisms Of Covid-19 Vaccination-induced Thyroid Dysfunctionsmentioning

confidence: 99%

Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence

Jafarzadeh

Nemati

Jafarzadeh

et al. 2022

J Endocrinol Invest

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Purpose The safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination. Methods A comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines. Results Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3–21 days) and 10.0 days (ranged: 1–60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5–37 days) and 14.0 days (ranged: 2–35 days) after vaccination, respectively. Conclusion Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.

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“…SARS-CoV-2 innate immune system evasion strategies have been reported; this virus infects airway epithelial cells by the receptor-binding domain of the spike glycoprotein that binds to the tip of subdomain I of the trans-membrane enzyme angiotensin-converting enzyme 2 (ACE2). While RNA viruses usually activate TLR3 and/or 7 in intracellular endosomes and RNA sensors RIG-I and MDA5, SARS-CoV-2 effectively suppresses the activation of TNF receptor-associated factors (TRAFs) limiting the activation of NFκB and IRFs and inhibiting early pro-inflammatory responses by IFN or proinflammatory cytokines like IL-1, IL-6 and TNF-α [109]. Immune complexes consisting of ineffective SARS-CoV-2 antibodies may also be phagocytized by macrophages causing their infection.…”

Section: Evidence For a Role Of Native Immunity In Covid-19 Kidney Injurymentioning

confidence: 99%

The innate immune system in human kidney inflammaging

et al. 2021

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Elderly individuals with chronic disorders tend to develop inflammaging, a condition associated with elevated levels of blood inflammatory markers, and increased susceptibility to chronic disease progression. Native and adaptive immunity are both involved in immune system senescence, kidney fibrosis and aging. The innate immune system is characterized by a limited number of receptors, constantly challenged by self and non-self stimuli. Circulating and kidney resident myeloid and lymphoid cells are all equipped with pattern recognition receptors (PRRs). Recent reports on PRRs show kidney overexpression of toll-like receptors (TLRs) in inflammaging autoimmune renal diseases, vasculitis, acute kidney injury and kidney transplant rejection. TLR upregulation leads to proinflammatory cytokine induction, fibrosis, and chronic kidney disease progression. TLR2 blockade in a murine model of renal ischemia reperfusion injury prevented the escape of natural killer cells and neutrophils by inflammaging kidney injury. Tumor necrosis factor-α blockade in endothelial cells with senescenceassociated secretory phenotype significantly reduced interleukin-6 release. These findings should encourage experimental and translational clinical trials aimed at modulating renal inflammaging by native immunity blockade. KeywordsAcute kidney injury • Aging • COVID-19 • Hemodialysis • Inflammaging • Innate immune system Abbreviations ACE2 Angiotensin-converting enzyme 2 aHUS Atypical hemolytic uremic syndrome (thrombotic microangiopathy) ANCA Anti-neutrophil cytoplasmic antibody AP Complement alternative pathway ASC Or PYCARD is an apoptosis-associated speck-like protein containing a CARD ATN Acute tubular necrosis AKI Acute kidney injury CARD Caspase recruitment domain CD Cluster of differentiation CKD Chronic kidney disease CMV Cytomegalovirus COVID-19 Corona virus disease-2019 novel coronavirus CXCL16 Chemokine (C-X-C motif) ligand 16 CTLRs C-type lectin receptors CP Complement classical pathway CRP C-reactive protein CXCR6 C-X-C motif chemokine receptor 6 DCs Dendritic cells DAMPs Dander-associated molecular patterns or alarmins DGF Delayed graft function DKD Diabetic kidney disease or diabetic nephropathy ds Double-stranded ECM Extracellular matrix eNOS Endothelial nitric oxide synthase ESRD End-stage renal disease FGF-2 Fibroblast growth factor 2 * Vincenzo Sepe

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Autoimmune complications of COVID‐19

Cited by 138 publications

References 136 publications

SARS-COV-2 Infection, Vaccination, and Immune-Mediated Diseases: Results of a Single-Center Retrospective Study

SARS-COV-2 Infection, Vaccination, and Immune-Mediated Diseases: Results of a Single-Center Retrospective Study

Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence

The innate immune system in human kidney inflammaging

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