COVID‐19: A trigger of autoimmune diseases

Abstract

The SARS‐coronavirus‐2 (SARS‐CoV‐2) that causes coronavirus disease 2019 (COVID‐19), has spread worldwide and caused a global health emergency. SARS‐CoV‐2 is a coronaviridae virus that infects target cells by interacting with the plasma membrane‐expressed angiotensin‐converting enzyme 2 (ACE2) via the S1 component of the S protein. Effective host immune response to SARS‐CoV‐2 infection, which includes both innate and adaptive immunity, is critical for virus management and elimination. The intensity and outcome of COVID‐19 may be related to an overabundance of pro‐inflammatory cytokines, which results in a “cytokine storm” and acute respiratory distress syndrome. After SARS‐CoV‐2 infection, the immune system's hyperactivity and production of autoantibodies may result in autoimmune diseases such as autoimmune hemolytic anemia, autoimmune thrombocytopenia, Guillain‐Barré syndrome, vasculitis, multiple sclerosis, pro‐thrombotic state, and diffuse coagulopathy, as well as certain autoinflammatory conditions such as Kawasaki disease in children. We have reviewed the association between COVID‐19 and autoimmune disorders in this article.

Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

“…Secondary AIHA may occur due to many underlying medical disorders, including autoimmune illnesses such as lupus, chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL), and other blood malignancies, as well as infections caused by Epstein-Barr virus, cytomegalovirus, Mycoplasma pneumonia, hepatitis, and HIV [3,8,13,14]. Recently, AIHA has been associated with COVID-19 [15] AIHA is further classified according to the temperature at which red blood cells experience opsonization and destruction.…”

“…AIHA comprises seven distinct types that have been categorized mainly based on serological findings [3,12]. The seven types of AIHA are as follows: warm-antibody autoimmune hemolytic anemia (wAIHA); cold-antibody AIHA (includes cold agglutinin syndrome (CAS) and cold agglutinin disease (CAD)); mixed AIHA (also called combined cold and warm AIHA); paroxysmal cold hemoglobinuria (PCH), also called Donath-Landsteiner antibody test-positive AIHA; direct antiglobulin test-negative AIHA (DATnegative AIHA); drug-induced autoimmune hemolytic anemia (DIAIHA); and passenger lymphocyte syndrome (PLS) (related to transplantation, and presenting as AIHA with a specificity) [2,3,5,[15][16][17][18][19][20][21][22][23][24][25] (see Table 1). AIHA should be suspected if the patient shows signs and symptoms of anemia and other causes of the anemia, such as bleeding, underproduction, paroxysmal nocturnal hemoglobinuria (PNH), and other potential causes of anemia have been ruled out [3], see Section 1.1 above.…”

Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis

“…Current mechanisms suggested to explain the sequelae of chronic fatigue and post-exertional malaise in patients with Long-Covid include reduced tissue perfusion [ 9 ], viral infiltration of tissues, inflammation in the brain and peripheral organs [ 10 ], the persistence of SARS-CoV-2 spike proteins [ 11 ], and reactivation of other infectious agents including Epstein-Barr Virus, CMV and other infectious components [ 12 – 16 ]. Furthermore, recent data have demonstrated that there is a major rise in autoimmune diseases following COVID-19 [ 17 – 19 ] due to the generation of known and hitherto unknown autoantibodies [ 20 ]. For example, neurotransmitter autoantibodies and other autoantibodies have been suggested to play a role in COVID-19 severity [ 21 ] and Long-Covid [ 20 , 22 ].…”

Virome analysis provides new insights into the pathogenesis mechanism and treatment of SLE disease

“…Viruses have been shown to modify the clinical picture of several autoimmune diseases, such as SLE, type 1 diabetes, rheumatoid arthritis, Sjögren's syndrome, herpetic stromal keratitis, celiac disease, and multiple sclerosis [6][7][8] . Infections of multiple viruses including Coxsackie B virus (CVB), rotavirus, influenza A virus (IAV), and herpesvirus, have been proposed to modulate the induction and development of autoimmune diseases 9,10 .…”