The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals

Cañas, Carlos A.

doi:10.1016/j.mehy.2020.110345

Cited by 95 publications

(85 citation statements)

References 59 publications

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“…The use and withdrawal may paradoxically induce autoimmunity. It has been hypothesized that transient immunosuppression followed by inappropriate immune reconstitution itself may result in autoimmunity [ 88 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and the clinical course of rheumatic manifestations

2021

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The manifestations of COVID-19 have been evolving over time. Various post-COVID-19 syndromes are being recognised. Various viruses have been implicated in the pathogenesis of autoimmune diseases, and we expect a similar outcome with the severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus penetrates various tissues and organs and has a predisposition to lead to endotheliitis that may cause vascular manifestations including thrombosis. SARS-CoV-2 has been shown to activate Toll-like receptors and the complement system. It perpetuates NETosis and leads to autoantibody formation. These predispose to systemic autoimmunity. Both reactive arthritis and connective tissue disorders such as lupus and inflammatory myositis have been reported after COVID-19. Other reported autoimmune disorders include haemolytic anaemia, immune thrombocytopenia, cutaneous vasculitis, and Guillain Barré-like acute demyelinating disorders. The multisystem inflammatory syndrome in children and its adult counterpart are another post-COVID-19 entity that presents as an admixture of Kawasaki disease and staphylococcal toxic shock syndrome. Patients with preexisting rheumatic diseases may flare during the SARS-CoV-2 infection. They may develop novel autoimmune features also. The immune-suppressants used during the acute COVID-19 illness may confound the outcomes whereas comorbidities present in patients with rheumatic diseases may mask them. There is an urgent need to follow-up patients recovering from COVID and monitor autoantibody production in the context of rheumatic manifestations. Key Points • COVID-19 is associated with both innate and acquired immune reactions and production of various autoantibodies. • Various immune-mediated manifestations such as arthritis, myositis, haemolytic anaemia, thrombocytopenia, and acute demyelination may develop after COVID-19. • Longitudinal cohort data are warranted to describe, predict, and test prevent various rheumatic manifestations in post-COVID-19 subjects.

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Section: Introductionmentioning

confidence: 99%

COVID-19 and the clinical course of rheumatic manifestations

2021

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“…Symptoms associated with autoimmune diseases such as fatigue, joint pain, muscle aches, and brain fog may appear during SARS-CoV-2 infection and persist even after infection. As well as this, autoimmune phenomena are supported by the presence of antinuclear antibodies, anti-DNA, or complement consumption in these patients [ 7 ]. In a study conducted by Bastard et al, it was observed that at least 101 of 987 patients with a life-threatening course of COVID-19 had neutralizing immunoglobulin G autoantibodies against interferon-ω, against interferon-α, or against both in the early stages of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Psychological Health and Insomnia among People with Chronic Diseases

Wańkowicz

Szylińska

Rotter

2021

JCM

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The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic highlighted the serious problems of health care systems but also threatened the mental and physical health of patients worldwide. The goal of this study was to assess psychological health and insomnia in people with chronic diseases in the time of elevated stress associated with the pandemic. The study involved 879 people from Zachodniopomorskie province in Poland. Each participant provided basic demographic data, data on symptoms of insomnia, depression, anxiety and information on concomitant diseases such as hypertension, diabetes mellitus, coronary heart disease, heart failure, dyslipidemia, chronic obstructive pulmonary disease, Hashimoto’s disease and smoking cigarettes. Chronic diseases included in this study showed a strong correlation between Hashimoto’s disease and increase scores according to the Insomnia Severity Index (ISI, r = 0.797, p < 0.001), the Generalized Anxiety Disorder scale (GAD-7, r = 0.766, p < 0.001) and the Patient Health Questionnaire (PHQ-9, r = 0.767, p < 0.001). After the results were corrected for age, gender, diagnosed hypertension, dyslipidemia and cigarette smoking, it was confirmed that the diagnosis of Hashimoto’s disease was associated with an increased risk of anxiety (odds ratio (OR) = 2.225; p < 0.001), depression (OR = 2.518; p < 0.001) and insomnia (OR = 3.530; p < 0.001). Our study showed that during the SARS-CoV-2 pandemic patients with Hashimoto’s disease show a higher risk of insomnia, anxiety and depression.

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“…These cytokines, including IL-1, IL-6, tumor necrosis factor-α (TNF-α), are released, lead to increased vascular permeability, hemorrhage, and multi-organ failure [ 17 ]. More interestingly, one study hypothesized that in the context of SARS-CoV-2 infection, the cause of this transient lymphopenia may be several local inflammatory reaction and release of cytokines, which affect suppression of bone marrow, further, loss of tolerance to self-antigens and, ultimately, autoimmunity [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 illness and autoimmune diseases: recent insights

Liu

Yin

et al. 2021

Inflamm. Res.

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Background The aim of this review is to explore whether patients with autoimmune diseases (AIDs) were at high risk of infection during the COVID-19 epidemic and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affected immune system. Methods A systematic literature search was performed using the foreign databases (NCBI, web of science, EBSCO, ELSEVIER ScienceDirect) and Chinese databases (WanFang, CNKI (China National Knowledge Infrastructure), VIP, CBM) to locate all relevant publications (up to January 10, 2021). The search strategies used Medical Search Headings (MeSH) headings and keywords for “COVID-19” or “SARS-CoV-2” or “coronavirus” and “autoimmune disease”. Results This review evaluates the effect of SARS-CoV-2 on the immune system through ACE-2 receptor binding as the main pathway for cell attachment and invasion. It is speculated that SARS-COV-2 infection can activate lymphocytes and inflammatory response, which may play a role in the clinical onset of AIDs and also patients were treated with immunomodulatory drugs during COVID-19 outbreak. Preliminary studies suggested that the risk of developing severe forms of COVID-19 in patients with AIDs treated with immunomodulators or biologics might not increase. A large number of samples are needed for further verification, leading to an excessive immune response to external stimuli. Conclusion The relationship between autoimmune diseases and SARS-CoV-2 infection is complex. During the COVID-19 epidemic, individualized interventions for AIDs should be provided such as Internet-based service.

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The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals

Cited by 95 publications

References 59 publications

COVID-19 and the clinical course of rheumatic manifestations

COVID-19 and the clinical course of rheumatic manifestations

The Impact of the COVID-19 Pandemic on Psychological Health and Insomnia among People with Chronic Diseases

COVID-19 illness and autoimmune diseases: recent insights

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