Guillain-Barré syndrome after vaccination against COVID-19

Chun, June Young; Park, Sohyun; Jung, Ji Yun; Kim, Suhyun; Kim, Taesung; Choi, Young Ju; Kim, Ho Jin; Eom, Hyeon-Seok; Hyun, Jae‐Won

doi:10.1016/s1474-4422(21)00416-6

Cited by 31 publications

(22 citation statements)

References 5 publications

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“…Some of the reported cases include patients who may have predisposing factors, such as a prior history of GBS following vaccination (149), although a cohort study of patients with prior GBS who received mRNA vaccination did not show any major complications and argues strongly against any major risk (150). Another report of two patients with remission from diffuse large B-cell lymphoma who developed GBS after vaccination with tozinameran suggesting that aberrant B-cell function may be relevant to risk of GBS (151). This remains an evolving area of research and recently there appears to be an association possible for the adenovirus-based SARS-CoV-2 vaccinations with GBS (152).…”

Section: Vaccination Against Sars-cov-2 and Neuromuscular Complicationsmentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.

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Section: Vaccination Against Sars-cov-2 and Neuromuscular Complicationsmentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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“…Neurological side effects have been observed following vaccination with authorized viral vector-based vaccines against SARS-CoV-2 (Chun, Park et al, 2022, Greinacher et al, 2021, Sharifian-Dorche, Bahmanyar et al, 2021, Zuhorn et al, 2021). Particularly, cerebrovascular venous and sinus thrombosis (CVST) is a subtype of stroke in which blood clots form and obstruct blood flow in the brain’s vascular system (Stam, 2005).…”

Section: Resultsmentioning

confidence: 99%

Preclinical establishment of a divalent vaccine against SARS-CoV-2

Wagner

Hevesi

Harkany

et al. 2022

Preprint

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First-generation vaccines against SARS-CoV-2 have been administered to more than 60% of the population in developed countries. However, the monovalent vaccines currently available in Europe do not confer adequate and durable immune protection. To satisfy the need for a novel vaccine, we engineered a divalent gene construct consisting of the receptor binding domain (RBD, 300-685 aa) of the spike protein and the immunodominant region of the nucleocapsid (100-300 aa). This fusion protein was cloned into a pET-30a plasmid and expressed either in Escherichia coli or in a recombinant baculovirus in insect cells. Following purification via its His-tag, the fusion protein was mixed with adjuvant, and administered to mice in a prime-booster-mode. Upon testing for IgG antibody response against nucleocapsid and RBD, a titer of 10-4 - 10-5 was demonstrated 14 days after the first booster injection in 72% of the animals, which could be increased to 100% by a second booster. Notably, comparable IgG responses were detected against the delta, gamma and omicron variants of the RBD region. Durability testing revealed the presence of IgG beyond 90 days. In addition, granzyme A and perforin mRNA expression (cytolytic effector cell molecules) was increased in peripheral blood cytotoxic lymphocytes. Ex vivo stimulation of T-cells by nucleocapsid and RBD peptides showed antigen-specific upregulation of CD44 in vaccinated mice among their CD4+ and CD8+ T-cells. No side-effect was documented in the central nervous system, be it either endothelial inflammation or neuronal damage. Cumulatively, the combined induction of B-cell and T-cell response by a bivalent protein-based vaccine directed against two structural SARS-CoV-2 proteins represents a proof-of-principle approach alternative to existing mRNA vaccination strategies, which could confer long-lasting immunity against all known viral strains.

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“…GBS was diagnosed based on clinical symptoms, electrophysiological characteristics and cerebrospinal fluid characteristics, according to the guidelines published in 2014 ( 1 ): progressive weakness of limbs, including areflexia in weak limbs or decreased tendon reflexes ( 2 ); typical electromyography ( 3 ); albuminocytologic dissociation in cerebrospinal fluid analysis; and ( 4 ) absence of other possible neuropathic causes. From January 2017 to December 2021, 223 patients (including 221 adult patients) with GBS-type peripheral neuropathy were admitted to our hospital.…”

Section: Methodsmentioning

confidence: 99%

“…GBS usually follows an abnormal autoimmune response to peripheral nerves and spinal cord roots caused by infection or other immune stimulation. Recent studies have shown that GBS is one of the serious complications of COVID-19 and one of the serious adverse reactions to COVID-19 vaccination ( 2 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Remnant Cholesterol and Dyslipidemia Are Risk Factors for Guillain–Barré Syndrome and Severe Guillain–Barré Syndrome by Promoting Monocyte Activation

et al. 2022

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BackgroundGuillain–Barré syndrome (GBS) is the most common severe acute paralytic neuropathy, with a mortality rate of 5% and permanent sequelae rate of 10%. Currently, the cause of GBS remains unclear. Therefore, we sought to determine potential predictors for GBS and its severity.MethodsA case–control study was performed at Tiantan Hospital in Beijing from January 2017 to December 2021. Laboratory and clinical characteristics were assessed in recruited GBS patients and healthy control individuals (matched by sex and age). The potential risk factors for GBS and severe GBS were assessed using a logistic regression analysis. The mRNA levels of toll-like receptor 4 (TLR4), toll-like receptor 2 (TLR2) and nuclear factor κB (NF-κB) in GBS patients and control PBMCs were detected by fluorescence quantitative PCR. THP-1 cells were costimulated with LPS and free cholesterol to demonstrate the effect of free cholesterol on monocyte activation.ResultsA total of 147 GBS patients and 153 healthy individuals were included in the study. Logistic regression analyses showed that preceding infection, alcohol consumption, remnant cholesterol, homocysteine and the dyslipidemia index were correlated with a higher risk of GBS. In contrast, increased HDL cholesterol was correlated with a lower risk of GBS. Moreover, remnant cholesterol and the dyslipidemia index were significantly correlated with severe GBS. The mRNA levels of TLR4, TLR2 and NF-κB in the PBMCs of GBS patients were significantly higher than those of healthy individuals. LPS activated THP-1 cells, and free cholesterol treatment increased the expression of TLR4, TLR2, NF-κB and IL-1β mRNA in LPS-activated THP-1 cells.ConclusionDyslipidemia was correlated with the risk of GBS and severe GBS. Remnant cholesterol may promote the activation of monocytes in GBS patients. It may be valuable to control lipid levels in the prevention of GBS and severe GBS.

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Guillain-Barré syndrome after vaccination against COVID-19

Cited by 31 publications

References 5 publications

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Preclinical establishment of a divalent vaccine against SARS-CoV-2

Remnant Cholesterol and Dyslipidemia Are Risk Factors for Guillain–Barré Syndrome and Severe Guillain–Barré Syndrome by Promoting Monocyte Activation

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