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Mir TH, Zargar PA, Sharma A, Jabeen B, Sharma S, Parvaiz MO, Bashir S, Javeed R. Post COVID-19 AA amyloidosis of the kidneys with rapidly progressive renal failure. Prion 2023; 17:111-115. [PMID: 37055928 PMCID: PMC10114959 DOI: 10.1080/19336896.2023.2201151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 12/15/2022] [Accepted: 01/22/2023] [Indexed: 04/15/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has taken the world by a storm, posing a gruelling challenge to the medical fraternity globally. Besides its very high infectivityinfectivity, significant organ dysfunction occurs in critically ill COVID-19 patients, leading to severe morbidity and mortality. Pulmonary involvement is the leading cause of death in these patients to be followed by the cardiovascular involvement. Kidney involvement due to COVID-19 is becoming more discernible with AKI adversely affecting the outcome. Besides AKI, a few cases of collapsing FSGS in genetically vulnerable patients and thrombotic microangiopathies have been reported as well. We report a case of AA amyloidosis of the kidney with a rapidly progressive renal failure and congestive heart failure with preserved left ventricular functions, which complicated a moderate COVID-19 pneumonia providing some clues to a possible association of this novel virus disease with this complication, which needs to be confirmed in future studies.
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Affiliation(s)
- Tajamul H. Mir
- Department of Nephrology, Government Medical College, Srinagar, Jammu and Kashmir, India
- Department of Nephrology, Khyber Medical Institute Nowpora, Srinagar, Jammu and Kashmir, India
| | - Parvaiz A Zargar
- Department of Cardiology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Alok Sharma
- Department of Renal Pathology, Dr. Lal Path lab/National Reference lab, New Delhi, India
| | - Bushra Jabeen
- Department of Radiology, SMHS Hospital, Srinagar, Jammu and Kashmir, India
| | - Shephali Sharma
- Department of Renal Pathology, Dr. Lal Path lab/National Reference lab, New Delhi, India
| | - M. Omar Parvaiz
- Department of Medicine, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | - Sabah Bashir
- Department of Nephrology, Khyber Medical Institute Nowpora, Srinagar, Jammu and Kashmir, India
| | - Reem Javeed
- Department of Nephrology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Root-Bernstein R, Churchill E, Oliverio S. T Cell Receptor Sequences Amplified during Severe COVID-19 and Multisystem Inflammatory Syndrome in Children Mimic SARS-CoV-2, Its Bacterial Co-Infections and Host Autoantigens. Int J Mol Sci 2023; 24:ijms24021335. [PMID: 36674851 PMCID: PMC9861234 DOI: 10.3390/ijms24021335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Published hypervariable region V-beta T cell receptor (TCR) sequences were collected from people with severe COVID-19 characterized by having various autoimmune complications, including blood coagulopathies and cardiac autoimmunity, as well as from patients diagnosed with the Kawasaki disease (KD)-like multisystem inflammatory syndrome in children (MIS-C). These were compared with comparable published v-beta TCR sequences from people diagnosed with KD and from healthy individuals. Since TCR V-beta sequences are supposed to be complementary to antigens that induce clonal expansion, it was surprising that only a quarter of the TCR sequences derived from severe COVID-19 and MIS-C patients mimicked SARS-CoV-2 proteins. Thirty percent of the KD-derived TCR mimicked coronaviruses other than SARS-CoV-2. In contrast, only three percent of the TCR sequences from healthy individuals and those diagnosed with autoimmune myocarditis displayed similarities to any coronavirus. In each disease, significant increases were found in the amount of TCRs from healthy individuals mimicking specific bacterial co-infections (especially Enterococcus faecium, Staphylococcal and Streptococcal antigens) and host autoantigens targeted by autoimmune diseases (especially myosin, collagen, phospholipid-associated proteins, and blood coagulation proteins). Theoretical explanations for these surprising observations and implications to unravel the causes of autoimmune diseases are explored.
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Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
| | - Elizabeth Churchill
- School of Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Shelby Oliverio
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
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Root-Bernstein R, Huber J, Ziehl A. Complementary Sets of Autoantibodies Induced by SARS-CoV-2, Adenovirus and Bacterial Antigens Cross-React with Human Blood Protein Antigens in COVID-19 Coagulopathies. Int J Mol Sci 2022; 23:ijms231911500. [PMID: 36232795 PMCID: PMC9569991 DOI: 10.3390/ijms231911500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/11/2022] Open
Abstract
COVID-19 patients often develop coagulopathies including microclotting, thrombotic strokes or thrombocytopenia. Autoantibodies are present against blood-related proteins including cardiolipin (CL), serum albumin (SA), platelet factor 4 (PF4), beta 2 glycoprotein 1 (β2GPI), phosphodiesterases (PDE), and coagulation factors such as Factor II, IX, X and von Willebrand factor (vWF). Different combinations of autoantibodies associate with different coagulopathies. Previous research revealed similarities between proteins with blood clotting functions and SARS-CoV-2 proteins, adenovirus, and bacterial proteins associated with moderate-to-severe COVID-19 infections. This study investigated whether polyclonal antibodies (mainly goat and rabbit) against these viruses and bacteria recognize human blood-related proteins. Antibodies against SARS-CoV-2 and adenovirus recognized vWF, PDE and PF4 and SARS-CoV-2 antibodies also recognized additional antigens. Most bacterial antibodies tested (group A streptococci [GAS], staphylococci, Escherichia coli [E. coli], Klebsiella pneumoniae, Clostridia, and Mycobacterium tuberculosis) cross-reacted with CL and PF4. while GAS antibodies also bound to F2, Factor VIII, Factor IX, and vWF, and E. coli antibodies to PDE. All cross-reactive interactions involved antibody-antigen binding constants smaller than 100 nM. Since most COVID-19 coagulopathy patients display autoantibodies against vWF, PDE and PF4 along with CL, combinations of viral and bacterial infections appear to be necessary to initiate their autoimmune coagulopathies.
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Abou-Dakn M. Mikroangiopathien in der Schwangerschaft. DIE GYNÄKOLOGIE 2022. [PMCID: PMC9310689 DOI: 10.1007/s00129-022-04972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Das Wissen um die Differentialdiagnose der Mikroangiopathien ist auch für Geburtshelfer:innen wichtig. So ist die Kombination aus einer Thrombopenie und Hämolysezeichen wegweisend in der Erkennung der Erkrankung. Es sollten die Differenzialdiagnosen bekannt sein, da diese zu unterschiedlichen Therapienotwendigkeiten führen und Langzeitschäden, beispielsweise für die Niere, vermieden werden müssen. Die Differenzialdiagnosen der Thrombopenie stellen den Einstieg für die weitere Diagnostik dar. In der Kombination mit Hämolysezeichen und Veränderungen der Erythrozytenmorphologie (Fragmentozyten) liegen unterschiedliche Ursachen für die Mikroangiopathie vor. Eine thrombotisch-thrombozytopenische Purpura (TTP) kann während der gesamten Schwangerschaft, aber insbesondere im letzten Trimenon, die Ursache für solche Veränderungen sein. Bei dieser finden sich häufig gastrointestinale oder auch zusätzliche neurologische Symptome. Die Präeklampsie, insbesondere beim HELLP(„hemolysis, elevated liver enzymes, and a low platelet count“)-Syndrom, kann ebenfalls zu einer Mikroangiopathie führen, dieses i.d.R. mit entsprechender Erhöhung des Blutdrucks und insbesondere mit einer deutlichen Erhöhung der Lebertransaminasen, ebenfalls typischerweise im letzten Trimenon kombiniert. Wenn entsprechende Veränderungen nach der Geburt auftreten und diese neben der Hämolyse mit einem Nierenversagen verbunden sind, kann es sich hierbei um ein atypisches hämolytisch-urämisches Syndrom (aHUS) handeln, das spezifisch durch Antikörper therapiert werden sollte. Neben der typischen Gerinnungsaktivierung im Sinne einer Thrombosierung findet sich bei COVID-19 („corona virus disease“) auch das gesamte Bild einer entsprechenden Mikroangiopathie, zum Teil durch entsprechende Aktivierung des Gerinnungssystem, zum Teil durch eine Verstärkung der anderen Mikroangiopathien. Für alle Bereiche werden die Differenzialdiagnosen und mögliche Therapien skizziert.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus Berlin-Tempelhof, Wüsthoffstr. 15, 12101 Berlin, Deutschland
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Azukaitis K, Stankute‐Kolosova A, Burokiene V, Saulyte Trakymiene S, Jankauskiene A. Possible microangiopathic overlap between COVID-19 and Shiga toxin-associated hemolytic uremic syndrome. Pediatr Blood Cancer 2022; 69:e29798. [PMID: 35593662 PMCID: PMC9348490 DOI: 10.1002/pbc.29798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Austeja Stankute‐Kolosova
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Vilmanta Burokiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Sonata Saulyte Trakymiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
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Cardesa‐Salzmann TM, Stephan B, Simon A, Furtwängler R, Schöndorf D, Heine S, Torfah E, Lux M, Meyer S, Graf N. Immune‐mediated thrombotic thrombocytopenic purpura in a Jehovah’s Witness – Effectiveness of incorporating extracorporeal immunoadsorption to caplacizumab, steroids and rituximab. Clin Case Rep 2022; 10:e05902. [PMID: 35600013 PMCID: PMC9122792 DOI: 10.1002/ccr3.5902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
We report the case of a Jehovah's Witness adolescent patient with immune‐mediated thrombotic thrombocytopenic purpura after SARS‐Cov2 infection successfully treated without therapeutic plasma exchange (TPE) using caplacizumab, corticosteroids, rituximab, and extracorporeal immunoadsorption (EIA). Further patients for whom TPE is not an option might benefit from this approach. Our experience in this case suggests that caplacizumab together with corticosteroids, rituximab, and EIA may be an effective treatment option for further patients with i‐TTP who are unable to undergo TPE. EIA is as a treatment in place of TPE contributing to a very rapid removal of autoantibodies against ADAMTS‐13.
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Affiliation(s)
| | - Bernhard Stephan
- Department of Hemostaseology and Transfusion Medicine Universitätsklinikum des Saarlandes Homburg Germany
| | - Arne Simon
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Dominik Schöndorf
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Sabine Heine
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Eyad Torfah
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Margaux Lux
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Sonja Meyer
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
| | - Norbert Graf
- Department of Pediatric Hematology & Oncology Universitätsklinikum des Saarlandes Homburg Germany
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Root‐Bernstein R. COVID-19 coagulopathies: Human blood proteins mimic SARS-CoV-2 virus, vaccine proteins and bacterial co-infections inducing autoimmunity: Combinations of bacteria and SARS-CoV-2 synergize to induce autoantibodies targeting cardiolipin, cardiolipin-binding proteins, platelet factor 4, prothrombin, and coagulation factors. Bioessays 2021; 43:e2100158. [PMID: 34677872 PMCID: PMC8646673 DOI: 10.1002/bies.202100158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Abstract
Severe COVID-19 is often accompanied by coagulopathies such as thrombocytopenia and abnormal clotting. Rarely, such complications follow SARS-CoV-2 vaccination. The cause of these coagulopathies is unknown. It is hypothesized that coagulopathies accompanying SARS-CoV-2 infections and vaccinations result from bacterial co-infections that synergize with virus-induced autoimmunity due to antigenic mimicry of blood proteins by both bacterial and viral antigens. Coagulopathies occur mainly in severe COVID-19 characterized by bacterial co-infections with Streptococci, Staphylococci, Klebsiella, Escherichia coli, and Acinetobacter baumannii. These bacteria express unusually large numbers of antigens mimicking human blood antigens, as do both SARS-CoV-2 and adenoviruses. Bacteria mimic cardiolipin, prothrombin, albumin, and platelet factor 4 (PF4). SARS-CoV-2 mimics complement factors, Rh antigens, platelet phosphodiesterases, Factors IX and X, von Willebrand Factor (VWF), and VWF protease ADAMTS13. Adenoviruses mimic prothrombin and platelet factor 4. Bacterial prophylaxis, avoidance of vaccinating bacterially infected individuals, and antigen deletion for vaccines may reduce coagulopathy risk. Also see the video abstract here: https://youtu.be/zWDOsghrPg8.
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