1
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Younes S, Nicolai E, Younes N, Pieri M, Bernardini S, Nizamuddin PB, Al-Sadeq DW, Daas HI, Ismail A, Yassine HM, Abu-Raddad LJ, Nasrallah GK. Comparable antibody levels in heterologous and homologous mRNA COVID-19 vaccination, with superior neutralizing and IgA antibody responses in mRNA homologous boosting. Vaccine 2024; 42:126042. [PMID: 38845303 DOI: 10.1016/j.vaccine.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Priming with two doses of AZD1222 (Oxford-AstraZeneca; ChAd) followed by a third mRNA vaccine boosting is considered in several countries, yet comparisons between heterologous and homologous booster efficacy remain unexplored. AIM To evaluate and contrast the immunogenicity of homologous and heterologous boosting regimens. METHOD The study examined antibody responses in 1113 subjects, comprising 895 vaccine-naïve individuals across different vaccination strategies (partial, primary series, heterologous booster, homologous booster) and 218 unvaccinated, naturally infected individuals. Assessments included neutralizing total antibodies (NTAbs), total antibodies (TAbs), anti-S-RBD IgG, and anti-S1 IgA levels. RESULTS The study found mRNA vaccines to exhibit superior immunogenicity in primary series vaccination compared to ChAd, with mRNA-1273 significantly enhancing NTAbs, TAbs, anti-S-RBD IgG, and anti-S1 IgA levels (p < 0.001). Both booster types improved antibody levels beyond primary outcomes, with no significant difference in TAbs and anti-S-RBD IgG levels between regimens. However, homologous mRNA boosters significantly outperformed heterologous boosters in enhancing NTAbs and anti-S1 IgA levels, with the BNT/BNT/BNT regimen yielding particularly higher enhancements (p < 0.05). CONCLUSION The study concludes that although TAbs and anti-S-RBD IgG antibody levels are similar for both regimens, homologous mRNA boosting outperform heterologous regimen by enhancing anti-S1 IgA and neutralizing antibody levels.
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Affiliation(s)
- Salma Younes
- Biomedical Research Center, Qatar University, Doha, P.O. Box 2713, Qatar; Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar
| | - Eleonora Nicolai
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Nadin Younes
- Biomedical Research Center, Qatar University, Doha, P.O. Box 2713, Qatar; Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar
| | - Massimo Pieri
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; Clinical Biochemistry, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; Clinical Biochemistry, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Parveen B Nizamuddin
- Biomedical Research Center, Qatar University, Doha, P.O. Box 2713, Qatar; Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar
| | - Duaa W Al-Sadeq
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Hanin I Daas
- College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box 2713, Qatar
| | - Ahmed Ismail
- Laboratory Section, Medical Commission Department, Ministry of Public Health, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, P.O. Box 2713, Qatar; Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, NY, USA
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha, P.O. Box 2713, Qatar; Biomedical Sciences Department, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar.
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Mekheal EM, Millet C, Mekheal N, Ghrewati M, Mechineni A, Maroules M. Coincidental or causal? A case report of acquired thrombotic thrombocytopenic purpura following mRNA-1273 Covid-19 vaccination. Hematol Transfus Cell Ther 2024; 46:489-493. [PMID: 36467111 PMCID: PMC9701639 DOI: 10.1016/j.htct.2022.09.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
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3
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Mesina FZ. Severe Relapsed Autoimmune Hemolytic Anemia after Booster with mRNA-1273 COVID-19 vaccine. Hematol Transfus Cell Ther 2024; 46:485-488. [PMID: 35662882 PMCID: PMC9149200 DOI: 10.1016/j.htct.2022.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/29/2022] [Accepted: 05/04/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Flordeluna Z Mesina
- University of Santo Tomas, Faculty of Medicine and Surgery; Hospital of the Infant Jesus, Manila, Philippines.
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4
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Yang C, Wang I, Chitkara A, Swankutty J, Patel R, Kubba SV. Anti-PF4 antibodies and their relationship with COVID infection. Hematol Transfus Cell Ther 2024; 46:516-523. [PMID: 38388299 DOI: 10.1016/j.htct.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 02/24/2024] Open
Abstract
Detecting anti-PF4 antibodies remains the golden diagnostic method for heparin-induced thrombocytopenia (HIT) diagnosis with high sensitivity and specificity. Various lab tests detect anti-PF4 antibodies, including immunoassays and functional assays. Even with positive detection of the anti-PF4 antibody, several factors are involved in the result. The concept of anti-PF4 disorders was recently brought to light during the COVID pandemic since the development of vaccine-induced thrombotic thrombocytopenia (VITT) with the adenovirus-vectored-DNA vaccine during the pandemic. Circumstances that detect anti-PF4 antibodies are classified as anti-PF4 disorders, including VITT, autoimmune HIT and spontaneous HIT. Some studies showed a higher percentage of anti-PF4 antibody detection among the population infected by COVID-19 without heparin exposure and some supported the theory that the anti-PF4 antibodies were related to the disease severity. In this review article, we provide a brief review of anti-PF4 disorders and summarize the current studies of anti-PF4 antibodies and COVID-19 infection.
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Affiliation(s)
- Chieh Yang
- School of Medicine, University of California Riverside, USA
| | - Irene Wang
- School of Medicine, University of California Riverside, USA
| | | | | | | | - Samir V Kubba
- School of Medicine, University of California Riverside, USA.
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5
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Blasco A, Royuela A, García-Gómez S, Gómez-Lozano N, Sánchez-Arjona A, de la Fuente J, Anel J, Sánchez-Galarraga I, Pérez-Redondo M, González E, Silva L. Association of SARS-CoV-2 immunoserology and vaccination status with myocardial infarction severity and outcome. Vaccine 2024; 42:126305. [PMID: 39244425 DOI: 10.1016/j.vaccine.2024.126305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected the severity and prognosis of patients with acute myocardial infarction (MI) caused by atherothrombosis (type 1 MI). The effect, if any, of COVID-19 vaccination and natural SARS-CoV2 serologic immunity in these patients is unclear. Our aim was to analyze the association between the severity and outcome of patients with type 1 MI and their previous SARS-CoV2 vaccination and serostatus. METHODS A single-center retrospective cohort study conducted between March 1, 2020 and March 1, 2023. Clinical and follow-up information was collected from medical records and patients. Total antibodies (IgM, IgA, IgG) to nucleocapsid (N) antigens were measured by ECLIA (electrochemiluminescence-based immunoassay) to test the immune response to natural infection. If positive, IgM and IgG antibodies to spike (S) surface antigens were measured by CLIA to test the immune response to vaccine or natural infection. Multivariable logistic regression analysis was performed, adjusting for age, sex, hypertension, diabetes, and dyslipidemia. RESULTS Total sample of 949 patients, 656 with ST-segment elevation MI (STEMI) and 293 with non-ST-segment elevation MI (NSTEMI). Mean age was 64 (SD 13) years, 80 % men. Pre-admission vaccination status was: ≥ 1 dose, 53 % of patients; complete vaccination, 49 %; first booster dose, 25 %. The majority (84 %) of vaccines administered were mRNA-based. Six months after MI, 92 (9.7 %) patients had a major adverse cardiac event (MACE) and 50 died; 11 % of patients had severe heart failure or cardiogenic shock (Killip III-IV) after STEMI. Vaccinated patients with STEMI and positive serology (Pos/Vax group) had a higher risk of Killip III-IV on admission: OR 2.63 (1.27-5.44), p = 0.010. SARS-CoV-2 S-specific IgG titers were highest in this group (median > 2080 AU/mL, [IQR 1560- >2080] vs 91 [32-198] in the unvaccinated group). In the overall sample, a higher incidence of 6-month MACE was not demonstrated (OR 1.89 [0.98-3.61], p = 0.055). CONCLUSIONS The combination of vaccination and natural SARS-CoV2 infection was associated with the development of severe heart failure and cardiogenic shock in patients with STEMI, possibly related to an increased serological response.
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Affiliation(s)
- Ana Blasco
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; Research Ethics Committee, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain.
| | - Ana Royuela
- Biostatistics Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Sergio García-Gómez
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Natalia Gómez-Lozano
- Immunology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Alberto Sánchez-Arjona
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jorge de la Fuente
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jorge Anel
- Microbiology Department, Serology Section, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Marina Pérez-Redondo
- Intensive Care Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Elisa González
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Lorenzo Silva
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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6
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Handunnetthi L, Ramasamy MN, Turtle L, Hunt DPJ. Identifying and reducing risks of neurological complications associated with vaccination. Nat Rev Neurol 2024; 20:541-554. [PMID: 39112653 DOI: 10.1038/s41582-024-01000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 09/04/2024]
Abstract
Vaccines protect against many infectious diseases, including some that can directly or indirectly cause nervous system damage. Serious neurological consequences of immunization are typically extremely rare, although they have the potential to jeopardize vaccination programmes, as demonstrated most recently during the COVID-19 pandemic. Neurologists have an important role in identifying safety signals at population and individual patient levels, as well as providing advice on the benefit-risk profile of vaccination in cohorts of patients with diverse neurological conditions. This article reviews the links between vaccination and neurological disease and considers how emerging signals can be evaluated and their mechanistic basis identified. We review examples of neurotropic infections with live attenuated vaccines, as well as neuroimmunological and neurovascular sequelae of other types of vaccines. We emphasize that such risks are typically dwarfed by neurological complications associated with natural infection and discuss how the risks can be further mitigated. The COVID-19 pandemic has highlighted the need to rapidly identify and minimize neurological risks of vaccination, and we review the structures that need to be developed to protect public health against these risks in the future.
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Affiliation(s)
- Lahiru Handunnetthi
- Nuffield Department of Neurosciences, Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Lance Turtle
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David P J Hunt
- UK Dementia Research Institute, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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7
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Ryu JK, Yan Z, Montano M, Sozmen EG, Dixit K, Suryawanshi RK, Matsui Y, Helmy E, Kaushal P, Makanani SK, Deerinck TJ, Meyer-Franke A, Rios Coronado PE, Trevino TN, Shin MG, Tognatta R, Liu Y, Schuck R, Le L, Miyajima H, Mendiola AS, Arun N, Guo B, Taha TY, Agrawal A, MacDonald E, Aries O, Yan A, Weaver O, Petersen MA, Meza Acevedo R, Alzamora MDPS, Thomas R, Traglia M, Kouznetsova VL, Tsigelny IF, Pico AR, Red-Horse K, Ellisman MH, Krogan NJ, Bouhaddou M, Ott M, Greene WC, Akassoglou K. Fibrin drives thromboinflammation and neuropathology in COVID-19. Nature 2024:10.1038/s41586-024-07873-4. [PMID: 39198643 DOI: 10.1038/s41586-024-07873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/24/2024] [Indexed: 09/01/2024]
Abstract
Life-threatening thrombotic events and neurological symptoms are prevalent in COVID-19 and are persistent in patients with long COVID experiencing post-acute sequelae of SARS-CoV-2 infection1-4. Despite the clinical evidence1,5-7, the underlying mechanisms of coagulopathy in COVID-19 and its consequences in inflammation and neuropathology remain poorly understood and treatment options are insufficient. Fibrinogen, the central structural component of blood clots, is abundantly deposited in the lungs and brains of patients with COVID-19, correlates with disease severity and is a predictive biomarker for post-COVID-19 cognitive deficits1,5,8-10. Here we show that fibrin binds to the SARS-CoV-2 spike protein, forming proinflammatory blood clots that drive systemic thromboinflammation and neuropathology in COVID-19. Fibrin, acting through its inflammatory domain, is required for oxidative stress and macrophage activation in the lungs, whereas it suppresses natural killer cells, after SARS-CoV-2 infection. Fibrin promotes neuroinflammation and neuronal loss after infection, as well as innate immune activation in the brain and lungs independently of active infection. A monoclonal antibody targeting the inflammatory fibrin domain provides protection from microglial activation and neuronal injury, as well as from thromboinflammation in the lung after infection. Thus, fibrin drives inflammation and neuropathology in SARS-CoV-2 infection, and fibrin-targeting immunotherapy may represent a therapeutic intervention for patients with acute COVID-19 and long COVID.
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Affiliation(s)
- Jae Kyu Ryu
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Zhaoqi Yan
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Mauricio Montano
- Gladstone Institute of Virology, San Francisco, CA, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA
| | - Elif G Sozmen
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Karuna Dixit
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | | | - Yusuke Matsui
- Gladstone Institute of Virology, San Francisco, CA, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA
| | - Ekram Helmy
- Gladstone Institute of Virology, San Francisco, CA, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA
| | - Prashant Kaushal
- Department of Microbiology, Immunology and Molecular Genetics (MIMG), University of California Los Angeles, Los Angeles, CA, USA
- Institute for Quantitative and Computational Biosciences (QCBio), University of California Los Angeles, Los Angeles, CA, USA
| | - Sara K Makanani
- Department of Microbiology, Immunology and Molecular Genetics (MIMG), University of California Los Angeles, Los Angeles, CA, USA
- Institute for Quantitative and Computational Biosciences (QCBio), University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas J Deerinck
- National Center for Microscopy and Imaging Research, Center for Research on Biological Systems, University of California San Diego, La Jolla, CA, USA
| | | | | | - Troy N Trevino
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Min-Gyoung Shin
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
| | - Reshmi Tognatta
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Yixin Liu
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Renaud Schuck
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Lucas Le
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Hisao Miyajima
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Andrew S Mendiola
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Nikhita Arun
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Brandon Guo
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Taha Y Taha
- Gladstone Institute of Virology, San Francisco, CA, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA
| | - Ayushi Agrawal
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
| | - Eilidh MacDonald
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Oliver Aries
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Aaron Yan
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Olivia Weaver
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Mark A Petersen
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Rosa Meza Acevedo
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Maria Del Pilar S Alzamora
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
| | - Reuben Thomas
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
| | - Michela Traglia
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, University of California San Diego, La Jolla, CA, USA
- CureScience Institute, San Diego, CA, USA
| | - Igor F Tsigelny
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- San Diego Supercomputer Center, University of California San Diego, La Jolla, CA, USA
- CureScience Institute, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Alexander R Pico
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
| | - Kristy Red-Horse
- Department of Biology, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Mark H Ellisman
- National Center for Microscopy and Imaging Research, Center for Research on Biological Systems, University of California San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Nevan J Krogan
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- COVID-19 Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
| | - Mehdi Bouhaddou
- Department of Microbiology, Immunology and Molecular Genetics (MIMG), University of California Los Angeles, Los Angeles, CA, USA
- Institute for Quantitative and Computational Biosciences (QCBio), University of California Los Angeles, Los Angeles, CA, USA
| | - Melanie Ott
- Gladstone Institute of Virology, San Francisco, CA, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA
- COVID-19 Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Warner C Greene
- Gladstone Institute of Virology, San Francisco, CA, USA.
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, CA, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA.
| | - Katerina Akassoglou
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA.
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA.
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
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8
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Spanehl L, Walter U, Thiele T, Dubinski D, Behmanesh B, Freiman TM, Wittstock M, Schuss P, Vatter H, Schneider M, Gessler F, Won SY. Cranioplasty after Decompressive Craniectomy (DC) in a Patient with Intracerebral Hemorrhage after SARS-CoV-2 Vaccination-Related Vaccine-Induced Thrombotic Thrombocytopenia (VITT)-Proposal of a Management Protocol for This Rare Pathological Condition. J Clin Med 2024; 13:4778. [PMID: 39200920 PMCID: PMC11355267 DOI: 10.3390/jcm13164778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
The COVID-19 (coronavirus disease) pandemic had a severe impact on public health worldwide. A rare but serious complication after administration of adenoviral vaccines against SARS-CoV-2 (AstraZeneca-Oxford and Johnson & Johnson) is vaccine-induced immune thrombotic thrombocytopenia and thrombosis (VITT), which can lead to serious complications such as cerebral venous sinus thrombosis (CVST). CVST itself can cause subarachnoid hemorrhage (SAH) and/or intracerebral hemorrhage (ICH), leading to high mortality due to herniation of brain parenchyma. In those patients, an emergent decompressive hemicraniectomy (DC) is regularly performed. Herein, the authors want to focus on the patients who survive DC following VITT-associated CVST and shed light on the neurosurgical considerations in those patients. We herein propose a treatment algorithm regarding the timing and the perioperative management of cranioplasty. We describe an exemplary case highlighting that special circumstances may result in a more urgent need for autologous cranioplasty than usual, based on individual risk assessment.
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Affiliation(s)
- Lennard Spanehl
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, 18057 Rostock, Germany; (U.W.); (M.W.)
| | - Thomas Thiele
- Department of Transfusion Medicine, University Medicine Rostock, 18057 Rostock, Germany;
| | - Daniel Dubinski
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
| | - Bedjan Behmanesh
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
| | - Thomas M. Freiman
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
| | - Matthias Wittstock
- Department of Neurology, Rostock University Medical Center, 18057 Rostock, Germany; (U.W.); (M.W.)
| | - Patrick Schuss
- Department of Neurosurgery, Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (H.V.); (M.S.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (H.V.); (M.S.)
| | - Florian Gessler
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
| | - Sae-Yeon Won
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany; (D.D.); (B.B.); (T.M.F.); (F.G.); (S.-Y.W.)
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9
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Vayne C, Rollin J, Clare R, Daka M, Atsouawe M, Guéry EA, Cauchie P, Cordonnier C, Cuisenier P, De Maistre E, Donnard M, Drillaud N, Faille D, Galinat H, Gouin-Thibault I, Lemoine S, Mourey G, Mullier F, Siguret V, Susen S, Godon A, Nazy I, Gruel Y, Pouplard C. The use of 1E12, a monoclonal anti-platelet factor 4 antibody, to improve the diagnosis of vaccine-induced immune thrombotic thrombocytopenia. J Thromb Haemost 2024; 22:2306-2315. [PMID: 38762021 DOI: 10.1016/j.jtha.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a complication of adenoviral-based vaccine against SARS-CoV-2 due to prothrombotic immunoglobulin (Ig) G antibodies to platelet factor 4 (PF4) and may be difficult to distinguish from heparin-induced thrombocytopenia (HIT) in patients treated with heparin. OBJECTIVES We assessed the usefulness of competitive anti-PF4 enzyme immunoassays (EIAs) in this context. METHODS The ability of F(ab')2 fragments of 1E12, 1C12, and 2E1, 3 monoclonal anti-PF4 antibodies, to inhibit the binding of human VITT or HIT antibodies to PF4 was evaluated using EIAs. Alanine-scanning mutagenesis was performed to define the amino acids involved in the interactions between the monoclonal antibodies and PF4. RESULTS A strong inhibition of VITT IgG binding to PF4 was measured with 1E12 (median inhibition, 93%; n = 8), whereas it had no effect on the binding of HIT antibodies (median, 6%; n = 8). In contrast, 1C12 and 2E1 inhibited VITT (median, 74% and 76%, respectively) and HIT antibodies (median, 68% and 53%, respectively) binding to PF4. When a competitive anti-PF4 EIA was performed with 1E12 for 19 additional VITT samples, it strongly inhibited IgG binding to PF4, except for 1 patient, who had actually developed HIT according to the clinical history. Epitope mapping showed that 1E12 interacts with 5 key amino acids on PF4, of which 4 are also required for the binding of human VITT antibodies, thus explaining the competitive inhibition. CONCLUSION A simple competitive anti-PF4 EIA with 1E12 could help confirm VITT diagnosis and distinguish it from HIT in patients when both diagnoses are possible.
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MESH Headings
- Humans
- Platelet Factor 4/immunology
- Heparin/adverse effects
- Heparin/immunology
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/adverse effects
- COVID-19 Vaccines/adverse effects
- COVID-19 Vaccines/immunology
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Predictive Value of Tests
- Anticoagulants/adverse effects
- Anticoagulants/immunology
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19/diagnosis
- Immunoglobulin Fab Fragments/immunology
- Immunoglobulin Fab Fragments/adverse effects
- Protein Binding
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/chemically induced
- SARS-CoV-2/immunology
- Binding, Competitive
- Purpura, Thrombotic Thrombocytopenic/immunology
- Purpura, Thrombotic Thrombocytopenic/diagnosis
- Purpura, Thrombotic Thrombocytopenic/blood
- Purpura, Thrombotic Thrombocytopenic/chemically induced
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Affiliation(s)
- Caroline Vayne
- Department of Haemostasis, Regional University Hospital Centre Tours, Tours, France; Institut National de la Santé et de la Recherche Médicale INSERM U1327 ISCHEMIA, Membrane Signalling and Inflammation in Reperfusion Injuries, Université de Tours, Tours, France.
| | - Jérôme Rollin
- Department of Haemostasis, Regional University Hospital Centre Tours, Tours, France; Institut National de la Santé et de la Recherche Médicale INSERM U1327 ISCHEMIA, Membrane Signalling and Inflammation in Reperfusion Injuries, Université de Tours, Tours, France
| | - Rumi Clare
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Transfusion Research, Hamilton, Ontario, Canada
| | - Mercy Daka
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Transfusion Research, Hamilton, Ontario, Canada
| | - Merveille Atsouawe
- Institut National de la Santé et de la Recherche Médicale INSERM U1327 ISCHEMIA, Membrane Signalling and Inflammation in Reperfusion Injuries, Université de Tours, Tours, France
| | - Eve-Anne Guéry
- Department of Haemostasis, Regional University Hospital Centre Tours, Tours, France
| | - Philippe Cauchie
- Service de Biologie Clinique, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Charlotte Cordonnier
- Inserm, Centre Hospitalier Universitaire Lille, U1172-Lille Neurosciences and Cognition, University of Lille, Lille, France
| | - Pauline Cuisenier
- Stroke Unit, Neurology Department, University Hospital of Grenoble Alpes, Grenoble, France
| | | | - Magali Donnard
- Haemostasis Unit, Limoges University Hospital, Limoges, France
| | - Nicolas Drillaud
- Department of Haemostasis, Nantes University Hospital, Nantes, France
| | - Dorothée Faille
- Département d'Hématologie Biologique, Institut National de la Santé et de la Recherche Médicale U1148, Laboratory for Vascular Translational Science, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - Hubert Galinat
- Service d'Hématologie Biologique, Centre Hospitalier Régional Universitaire Brest, Brest, France
| | - Isabelle Gouin-Thibault
- Department of Hemostasis, University Hospital of Rennes, Institut National de la Santé et de la Recherche Médicale, Ecole des Hautes Etudes en Santé Publique, Institut de Recherche en Santé, Environnement et Travail, Unité Mixte de Recherche_S 1085, University of Rennes, Rennes, France
| | - Sandrine Lemoine
- Centre Hospitalier Universitaire Angers, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, Laboratoire d'Hématologie, Université d'Angers, Nantes Université, Angers, France
| | - Guillaume Mourey
- Service d'Hémostase, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - François Mullier
- Université Catholique de Louvain Namur, Thrombosis and Hemostasis Center, Université catholique de Louvain, Centre Hospitalier Universitaire, Yvoir, Belgium
| | - Virginie Siguret
- Service d'Hématologie biologique, Hôpital Lariboisière, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche_S1140, Innovative Therapeutics in Haemostasis, University of Paris, Paris, France
| | - Sophie Susen
- Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire Lille, University of Lille, Institut Pasteur de Lille, U1011-Europena Genomic Institute for Diabetes, Lille, France
| | - Alban Godon
- Centre Hospitalier Universitaire Angers, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, Laboratoire d'Hématologie, Université d'Angers, Nantes Université, Angers, France
| | - Ishac Nazy
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Transfusion Research, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Yves Gruel
- Department of Haemostasis, Regional University Hospital Centre Tours, Tours, France; Institut National de la Santé et de la Recherche Médicale INSERM U1327 ISCHEMIA, Membrane Signalling and Inflammation in Reperfusion Injuries, Université de Tours, Tours, France
| | - Claire Pouplard
- Department of Haemostasis, Regional University Hospital Centre Tours, Tours, France; Institut National de la Santé et de la Recherche Médicale INSERM U1327 ISCHEMIA, Membrane Signalling and Inflammation in Reperfusion Injuries, Université de Tours, Tours, France
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10
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Wittstock M, Cantré D, Won SY, Jürs AV, Wesche J, Greger N, Greinacher A, Thiele T. An anti-PF4 antibody-related disorder with cerebral venous sinus thrombosis and thrombocytopenia initially presenting as intracranial hemorrhage. J Neurol 2024; 271:4651-4654. [PMID: 38597942 PMCID: PMC11233355 DOI: 10.1007/s00415-024-12373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Matthias Wittstock
- Department of Neurology, University Medical Center Rostock, Schillingallee 36, 18057, Rostock, Germany.
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany
| | - Alexandra V Jürs
- Department of Neurology, University Medical Center Rostock, Schillingallee 36, 18057, Rostock, Germany
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Jan Wesche
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Nico Greger
- Institute of Transfusion Medicine, University Medical Center Rostock, Rostock, Germany
| | - Andreas Greinacher
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
- Institute of Transfusion Medicine, University Medical Center Rostock, Rostock, Germany
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11
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Huang JH, Ju KS, Liao TW, Lin YK, Yeh JS, Chen YJ. Adverse Cardiovascular Effects of COVID-19 Vaccination: A Systematic Review. Cardiol Rev 2024; 32:314-319. [PMID: 38848534 DOI: 10.1097/crd.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Several vaccines against coronavirus disease 2019 (COVID-19)-caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-have been developed since the COVID-19 pandemic began. Of these, 7 have been approved in the World Health Organization's Emergency Use Listing. However, these vaccines have been reported to have rare or serious adverse cardiovascular effects. This review presents updated information on the adverse cardiovascular effects of the approved COVID-19 vaccines-including inactivated vaccines, protein subunit vaccines, virus-like particles, nucleic acid vaccines, and viral vector vaccines-and the underlying mechanisms.
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Affiliation(s)
- Jen-Hung Huang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Ke-Shiuan Ju
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Wei Liao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jong-Shiuan Yeh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
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12
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Khatami SS, Revheim ME, Høilund-Carlsen PF, Alavi A, Ghorbani Shirkouhi S, Andalib S. Central nervous system manifestations following vaccination against COVID-19. Brain Behav Immun Health 2024; 38:100788. [PMID: 38818372 PMCID: PMC11137405 DOI: 10.1016/j.bbih.2024.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/03/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccination has become the most effective countermeasure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, vaccination is associated with side effects. This narrative review focuses on central nervous system (CNS) manifestations following COVID-19 vaccination and provides a summary of the potential underlying mechanisms and methods of diagnosis and management of the vaccination-related CNS manifestations. Headache, myalgia, optic neuritis, seizure, multiple sclerosis, acute disseminated encephalomyelitis and encephalitis, delirium, acute transverse myelitis, and stroke have been reported after COVID-19 vaccination. Constant headache and myalgia are common manifestations that may necessitate further clinical investigation for stroke. To limit consequences, it is imperative to follow standard treatment protocols for each neurological disorder following COVID-19 vaccination. Immunosuppressive medication can be helpful in the treatment of seizures following vaccination since the immune response is involved in their etiology. Clinicians should be aware of the manifestations after COVID-19 vaccination to respond promptly and effectively. Clinical guidelines for the management of CNS manifestations following COVID-19 vaccination are in high demand and would be useful in each new SARS-CoV-2 variant pandemic.
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Affiliation(s)
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | | | - Sasan Andalib
- Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
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13
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Meier RT, Porcelijn L, Hofstede-van Egmond S, Henskens YMC, Coutinho JM, Kruip MJHA, Stroobants AK, Zwaginga JJ, van der Bom JG, van der Schoot CE, de Haas M, Kapur R. Laboratory approach for vaccine-induced thrombotic thrombocytopenia diagnosis in the Netherlands. Vox Sang 2024; 119:728-736. [PMID: 38597072 DOI: 10.1111/vox.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare adverse effect characterized by thrombocytopenia and thrombosis occurring after COVID-19 vaccination. VITT pathophysiology is not fully unravelled but shows similarities to heparin-induced thrombocytopenia (HIT). HIT is characterized by the presence of antibodies against platelet factor 4 (PF4)/heparin complex, which can activate platelets in an FcγRIIa-dependent manner, whereas IgG-antibodies directed against PF4 play an important role in VITT. MATERIALS AND METHODS We characterized all clinically suspected VITT cases in the Netherlands from a diagnostic perspective and hypothesized that patients who developed both thrombocytopenia and thrombosis display underlying mechanisms similar to those in HIT. We conducted an anti-PF4 ELISA and a functional PF4-induced platelet activation assay (PIPAA) with and without blocking the platelet-FcγRIIa and found positivity in both tests, suggesting VITT with mechanisms similar to those in VITT. RESULTS We identified 65 patients with both thrombocytopenia and thrombosis among 275 clinically suspected VITT cases. Of these 65 patients, 14 (22%) tested positive for anti-PF4 and PF4-dependent platelet activation. The essential role of platelet-FcγRIIa in VITT with mechanisms similar to those in HIT was evident, as platelet activation was inhibited by an FcγRIIa-blocking antibody in all 14 patients. CONCLUSION Our study shows that only a small proportion of clinically suspected VITT patients with thrombocytopenia and thrombosis have anti-PF4-inducing, FcɣRIIa-dependent platelet activation, suggesting an HIT-like pathophysiology. This leaves the possibility for the presence of another type of pathophysiology ('non-HIT like') leading to VITT. More research on pathophysiology is warranted to improve the diagnostic algorithm and to identify novel therapeutic and preventive strategies.
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Affiliation(s)
- Romy T Meier
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Sanquin, The Netherlands
| | | | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - An K Stroobants
- Department of Clinical Chemistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap J Zwaginga
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Sanquin, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Hulscher N, Alexander PE, Amerling R, Gessling H, Hodkinson R, Makis W, Risch HA, Trozzi M, McCullough PA. Withdrawn: A systematic review of autopsy findings in deaths after COVID-19 vaccination. Forensic Sci Int 2024:112115. [PMID: 39120477 DOI: 10.1016/j.forsciint.2024.112115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/17/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024]
Abstract
This Article-in-Press has been withdrawn at the request of the Editors-in-Chief. Members of the scientific community raised concerns about this Article-in-Press following its posting online. The concerns encompassed. • Inappropriate citation of references. • Inappropriate design of methodology. • Errors, misrepresentation, and lack of factual support for the conclusions. • Failure to recognise and cite disconfirming evidence. The concerns were shared with the authors, who prepared a response and submitted a revised manuscript for consideration by the journal. In consideration of the extent of the concerns raised and the responses from the authors, the journal sent the revised manuscript to two independent peer-reviewers. The peer-reviewers concluded that the revised manuscript did not sufficiently address the concerns raised by the community and that it was not suitable for publication in the journal. The authors disagree with this withdrawal and dispute the grounds for it. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Nicolas Hulscher
- University of Michigan School of Public Health, Ann Arbor, MI, United States.
| | | | | | | | | | - William Makis
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Harvey A Risch
- Professor Emeritus, Yale University School of Public Health, New Haven, CT, United States
| | | | - Peter A McCullough
- The Wellness Company, Boca Raton, FL, United States; Truth for Health Foundation, Tucson, AZ, United States
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15
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Padilla‐Flores T, Sampieri A, Vaca L. Incidence and management of the main serious adverse events reported after COVID-19 vaccination. Pharmacol Res Perspect 2024; 12:e1224. [PMID: 38864106 PMCID: PMC11167235 DOI: 10.1002/prp2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2n first appeared in Wuhan, China in 2019. Soon after, it was declared a pandemic by the World Health Organization. The health crisis imposed by a new virus and its rapid spread worldwide prompted the fast development of vaccines. For the first time in human history, two vaccines based on recombinant genetic material technology were approved for human use. These mRNA vaccines were applied in massive immunization programs around the world, followed by other vaccines based on more traditional approaches. Even though all vaccines were tested in clinical trials prior to their general administration, serious adverse events, usually of very low incidence, were mostly identified after application of millions of doses. Establishing a direct correlation (the cause-effect paradigm) between vaccination and the appearance of adverse effects has proven challenging. This review focuses on the main adverse effects observed after vaccination, including anaphylaxis, myocarditis, vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, and transverse myelitis reported in the context of COVID-19 vaccination. We highlight the symptoms, laboratory tests required for an adequate diagnosis, and briefly outline the recommended treatments for these adverse effects. The aim of this work is to increase awareness among healthcare personnel about the serious adverse events that may arise post-vaccination. Regardless of the ongoing discussion about the safety of COVID-19 vaccination, these adverse effects must be identified promptly and treated effectively to reduce the risk of complications.
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Affiliation(s)
- Teresa Padilla‐Flores
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Alicia Sampieri
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Luis Vaca
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
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16
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Kozłowski P, Leszczyńska A, Ciepiela O. Long COVID Definition, Symptoms, Risk Factors, Epidemiology and Autoimmunity: A Narrative Review. AMERICAN JOURNAL OF MEDICINE OPEN 2024; 11:100068. [PMID: 39034937 PMCID: PMC11256271 DOI: 10.1016/j.ajmo.2024.100068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 07/23/2024]
Abstract
The virus called SARS-CoV-2 emerged in 2019 and quickly spread worldwide, causing COVID-19. It has greatly impacted on everyday life, healthcare systems, and the global economy. In order to save as many lives as possible, precautions such as social distancing, quarantine, and testing policies were implemented, and effective vaccines were developed. A growing amount of data collected worldwide allowed the characterization of this new disease, which turned out to be more complex than other common respiratory tract infections. An increasing number of convalescents presented with a variety of nonspecific symptoms emerging after the acute infection. This possible new global health problem was identified and labelled as long COVID. Since then, a great effort has been made by clinicians and the scientific community to understand the underlying mechanisms and to develop preventive measures and effective treatment. The role of autoimmunity induced by SARS-CoV-2 infection in the development of long COVID is discussed in this review. We aim to deliver a description of several conditions with an autoimmune background observed in COVID-19 convalescents, including Guillain-Barré syndrome, antiphospholipid syndrome and related thrombosis, and Kawasaki disease highlighting a relationship between SARS-CoV-2 infection and the development of autoimmunity. However, further studies are required to determine its true clinical significance.
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Affiliation(s)
- Paweł Kozłowski
- Central Laboratory, University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Leszczyńska
- Central Laboratory, University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
| | - Olga Ciepiela
- Central Laboratory, University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
- Department of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
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17
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Younes S, Nicolai E, Pieri M, Bernardini S, Daas H, Al‐Sadeq D, Younes N, Shurrab F, Nizamuddin P, Humaira F, Al‐Dewik N, Yassine H, Abu‐Raddad L, Ismail A, Nasrallah G. Follow-Up and Comparative Assessment of SARS-CoV-2 IgA, IgG, Neutralizing, and Total Antibody Responses After BNT162b2 or mRNA-1273 Heterologous Booster Vaccination. Influenza Other Respir Viruses 2024; 18:e13290. [PMID: 38706402 PMCID: PMC11070770 DOI: 10.1111/irv.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 12/26/2023] [Accepted: 03/25/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Priming with ChAdOx1 followed by heterologous boosting is considered in several countries. Nevertheless, analyses comparing the immunogenicity of heterologous booster to homologous primary vaccination regimens and natural infection are lacking. In this study, we aimed to conduct a comparative assessment of the immunogenicity between homologous primary vaccination regimens and heterologous prime-boost vaccination using BNT162b2 or mRNA-1273. METHODS We matched vaccinated naïve (VN) individuals (n = 673) with partial vaccination (n = 64), primary vaccination (n = 590), and primary series plus mRNA vaccine heterologous booster (n = 19) with unvaccinated naturally infected (NI) individuals with a documented primary SARS-CoV-2 infection (n = 206). We measured the levels of neutralizing total antibodies (NTAbs), total antibodies (TAbs), anti-S-RBD IgG, and anti-S1 IgA titers. RESULTS Homologous primary vaccination with ChAdOx1 not only showed less potent NTAb, TAb, anti-S-RBD IgG, and anti-S1 IgA immune responses compared to primary BNT162b2 or mRNA-1273 vaccination regimens (p < 0.05) but also showed ~3-fold less anti-S1 IgA response compared to infection-induced immunity (p < 0.001). Nevertheless, a heterologous booster led to an increase of ~12 times in the immune response when compared to two consecutive homologous ChAdOx1 immunizations. Furthermore, correlation analyses revealed that both anti-S-RBD IgG and anti-S1 IgA significantly contributed to virus neutralization among NI individuals, particularly in symptomatic and pauci-symptomatic individuals, whereas among VN individuals, anti-S-RBD IgG was the main contributor to virus neutralization. CONCLUSION The results emphasize the potential benefit of using heterologous mRNA boosters to increase antibody levels and neutralizing capacity particularly in patients who received primary vaccination with ChAdOx1.
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Affiliation(s)
- Salma Younes
- Biomedical Sciences Department, College of Health SciencesQatar UniversityDohaQatar
- Biomedical Research CenterQatar UniversityDohaQatar
| | - Eleonora Nicolai
- Department of Experimental MedicineUniversity of Rome Tor VergataRomeItaly
| | - Massimo Pieri
- Department of Experimental MedicineUniversity of Rome Tor VergataRomeItaly
- Clinical BiochemistryTor Vergata University HospitalRomeItaly
| | - Sergio Bernardini
- Department of Experimental MedicineUniversity of Rome Tor VergataRomeItaly
- Clinical BiochemistryTor Vergata University HospitalRomeItaly
| | - Hanin I. Daas
- College of Dental Medicine, QU HealthQatar UniversityDohaQatar
| | - Duaa W. Al‐Sadeq
- Department of Basic Medical Sciences, College of Medicine, QU HealthQatar UniversityDohaQatar
| | - Nadin Younes
- Biomedical Sciences Department, College of Health SciencesQatar UniversityDohaQatar
- Biomedical Research CenterQatar UniversityDohaQatar
| | | | | | - Fathima Humaira
- Biomedical Sciences Department, College of Health SciencesQatar UniversityDohaQatar
| | - Nader Al‐Dewik
- Department of Research and Translational and Precision Medicine Research Lab, Women's Wellness and Research CenterHamad Medical CorporationDohaQatar
- Genomics and Precision Medicine (GPM), College of Health & Life Science (CHLS)Hamad Bin Khalifa University (HBKU)DohaQatar
| | - Hadi M. Yassine
- Biomedical Sciences Department, College of Health SciencesQatar UniversityDohaQatar
- Biomedical Research CenterQatar UniversityDohaQatar
| | - Laith J. Abu‐Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–QatarCornell University, Qatar Foundation – Education CityDohaQatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–QatarCornell University, Qatar Foundation – Education CityDohaQatar
- Department of Healthcare Policy and Research, Weill Cornell MedicineCornell UniversityNew YorkUSA
| | - Ahmed Ismail
- Laboratory Section, Medical Commission DepartmentMinistry of Public HealthDohaQatar
| | - Gheyath K. Nasrallah
- Biomedical Sciences Department, College of Health SciencesQatar UniversityDohaQatar
- Biomedical Research CenterQatar UniversityDohaQatar
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18
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Lotti E, Gori AM, Berteotti M, Rogolino A, Cesari F, Poli D, Vannini F, Bertelli A, Giusti B, Marcucci R. Natural history of anti-PF 4 antibodies in patients with vaccine-induced immune thrombocytopenia and thrombosis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:246-252. [PMID: 38315531 PMCID: PMC11073623 DOI: 10.2450/bloodtransfus.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/12/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Elena Lotti
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Anna M. Gori
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Martina Berteotti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Angela Rogolino
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Daniela Poli
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Vannini
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Bertelli
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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19
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Yamada S, Asakura H. How We Interpret Thrombosis with Thrombocytopenia Syndrome? Int J Mol Sci 2024; 25:4956. [PMID: 38732176 PMCID: PMC11084439 DOI: 10.3390/ijms25094956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Platelets play an important role in hemostasis, and a low platelet count usually increases the risk of bleeding. Conditions in which thrombosis occurs despite low platelet counts are referred to as thrombosis with thrombocytopenia syndrome, including heparin-induced thrombocytopenia, vaccine-induced immune thrombotic thrombocytopenia, paroxysmal nocturnal hemoglobinuria, antiphospholipid syndrome, thrombotic microangiopathy (TMA), and disseminated intravascular coagulation. TMA includes thrombotic thrombocytopenic purpura, Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (HUS), and atypical HUS. Patients with these pathologies present with thrombosis and consumptive thrombocytopenia associated with the activation of platelets and the coagulation system. Treatment varies from disease to disease, and many diseases have direct impacts on mortality and organ prognosis if therapeutic interventions are not promptly implemented. Underlying diseases and the results of physical examinations and general laboratory tests as part of a thorough workup for patients should promptly lead to therapeutic intervention before definitive diagnosis. For some diseases, the diagnosis and initial treatment must proceed in parallel. Utilization of not only laboratory tests but also various scoring systems is important for validating therapeutic interventions based on clinical information.
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Affiliation(s)
| | - Hidesaku Asakura
- Department of Hematology, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa City 920-8640, Ishikawa, Japan;
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20
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Nguyen SN, Le SH, Ivanov DG, Ivetic N, Nazy I, Kaltashov IA. Structural Characterization of a Pathogenic Antibody Underlying Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT). Anal Chem 2024; 96:6209-6217. [PMID: 38607319 DOI: 10.1021/acs.analchem.3c05253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but dangerous side effect of adenoviral-vectored COVID-19 vaccines. VITT had been linked to production of autoantibodies recognizing platelet factor 4 (PF4). Here, we characterize anti-PF4 antibodies obtained from a VITT patient's blood. Intact mass measurements indicate that a significant fraction of these antibodies represent a limited number of clones. MS analysis of large antibody fragments (the light chain and the Fc/2 and Fd fragments of the heavy chain) confirms the monoclonal nature of this component of the anti-PF4 antibodies repertoire and reveals the presence of a mature complex biantennary N-glycan within the Fd segment. Peptide mapping using two complementary proteases and LC-MS/MS was used to determine the amino acid sequence of the entire light chain and over 98% of the heavy chain (excluding a short N-terminal segment). The sequence analysis allows the monoclonal antibody to be assigned to the IgG2 subclass and verifies that the light chain belongs to the λ-type. Incorporation of enzymatic de-N-glycosylation into the peptide mapping routine allows the N-glycan in the Fab region of the antibody to be localized to the framework 3 region of the VH domain. This novel N-glycosylation site is the result of a single mutation within the germline sequence. Peptide mapping also provides information on lower-abundance (polyclonal) components of the anti-PF4 antibody ensemble, revealing the presence of all four subclasses (IgG1-IgG4) and both types of the light chain (λ and κ). This case study demonstrates the power of combining the intact, middle-down, and bottom-up MS approaches for meaningful characterization of ultralow quantities of pathogenic antibodies extracted directly from patients' blood.
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Affiliation(s)
- Son N Nguyen
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Si-Hung Le
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Daniil G Ivanov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Igor A Kaltashov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
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21
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van der Neut Kolfschoten M, Inganäs H, Perez-Peinado C, Calado da Silva Freire J, Melchers JM, van Dijk N, Przeradzka M, Kourkouta E, van Manen D, Vellinga J, Custers J, Bos R. Biophysical studies do not reveal direct interactions between human PF4 and Ad26.COV2.S vaccine. J Thromb Haemost 2024; 22:1046-1055. [PMID: 38159648 DOI: 10.1016/j.jtha.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND COVID-19 vaccines have been widely used to control the SARS-CoV-2 pandemic. In individuals receiving replication-incompetent, adenovirus vector-based COVID-19 vaccines (eg, ChAdOx1 nCoV-19 [AstraZeneca] or Ad26.COV2.S [Johnson & Johnson/Janssen] vaccines), a very rare but serious adverse reaction has been reported and described as vaccine-induced immune thrombotic thrombocytopenia (VITT). The exact mechanism of VITT following Ad26.COV2.S vaccination is under investigation. Antibodies directed against human platelet factor 4 (PF4) are considered critical in the pathogenesis of VITT, suggesting similarities with heparin-induced thrombocytopenia. It has been postulated that components of these vaccines mimic the role of heparin by binding to PF4, triggering production of these anti-PF4 antibodies. OBJECTIVES This study aimed to investigate the potential interaction between human PF4 and Ad26.COV2.S vaccine using several biophysical techniques. METHODS Direct interaction of PF4 with Ad26.COV2.S vaccine was investigated using dynamic light scattering, biolayer interferometry, and surface plasmon resonance. For both biosensing methods, the Ad26.COV2.S vaccine was immobilized to the sensor surface and PF4 was used as analyte. RESULTS No direct interactions between PF4 and Ad26.COV2.S vaccine could be detected using dynamic light scattering and biolayer interferometry. Surface plasmon resonance technology was shown to be unsuitable to investigate these types of interactions. CONCLUSION Our findings make it very unlikely that direct binding of PF4 to Ad26.COV2.S vaccine or components thereof is driving the onset of VITT, although the occurrence of such interactions after immunization (potentially facilitated by unknown plasma or cellular factors) cannot be excluded. Further research is warranted to improve the understanding of the full mechanism of this adverse reaction.
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Affiliation(s)
| | - Hanna Inganäs
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | | | | | - Jelle M Melchers
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | - Nelie van Dijk
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | | | - Eleni Kourkouta
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | - Danielle van Manen
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | - Jort Vellinga
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | - Jerome Custers
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands
| | - Rinke Bos
- Janssen Vaccines & Prevention B.V., Leiden, South Holland, The Netherlands.
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22
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Razzaque MS. Can adverse cardiac events of the COVID-19 vaccine exacerbate preexisting diseases? Expert Rev Anti Infect Ther 2024; 22:131-137. [PMID: 38284355 DOI: 10.1080/14787210.2024.2311837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection and COVID-19 vaccination can both lead to serious cardiac conditions such as myocarditis, arrhythmia, acute myocardial infarction, and coagulopathy. Further studies are needed to better understand the risks and benefits of COVID-19 vaccination, and to determine the best course of action for individuals with preexisting heart conditions. AREAS COVERED The current knowledge and challenges in understanding vaccine-associated heart issues concerning the COVID-19 pandemic are briefly summarized, highlighting similar cardiac conditions caused by either SARS-CoV-2 infection or COVID-19 vaccination and the potential clinical impacts. EXPERT OPINION The short-term risks of severe cardiovascular side effects following COVID-19 vaccination are relatively low. However, further studies are needed to determine whether adverse vaccination events outweigh the long-term benefits in specific groups of individuals. Since cardiac inflammation, blood pressure dysregulation, coagulopathy, acute myocardial infarction, or arrhythmia could be the consequences of either SARS-CoV-2 infection or COVID-19 vaccination, clinical questions should be asked whether the COVID-19 vaccine worsens the condition in persons with preexisting heart diseases. It is important to carefully assess the potential risks and benefits of COVID-19 vaccination, especially for individuals with preexisting heart conditions, and to continue monitoring and studying the long-term effects of vaccination on cardiovascular health.
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Affiliation(s)
- Mohammed S Razzaque
- Professor of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
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23
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Duchez AC, Heestermans M, Arthaud CA, Eyraud MA, Portier M, Prier A, Hamzeh-Cognasse H, Cognasse F. In platelet single donor apheresis, platelet factor 4 levels correlated with donor's age and decreased during storage. Sci Rep 2024; 14:6231. [PMID: 38485973 PMCID: PMC10940288 DOI: 10.1038/s41598-024-56826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
The human population is ageing worldwide. The World Health Organization estimated that the world's population of people aged 60 years and older will increase to at least 30%, coinciding with a growing frequency of cognitive and cardiovascular disease. Recently, in preclinical studies platelet Factor 4 (PF4) was presented as a pro-cognitive factor. This molecule is released by platelets in the circulation and could be present in blood products destined for transfusion. We wondered if PF4 levels are correlated to the age of the blood donor or to the storage time of platelet concentrates (PCs) intended for transfusion? We observed higher levels of PF4 in PCs from elderly donors compared to younger donors, while PC storage time did not determine PF4 levels expression.
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Affiliation(s)
- Anne Claire Duchez
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Marco Heestermans
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Charles-Antoine Arthaud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Marie-Ange Eyraud
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Mailys Portier
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Amélie Prier
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France
| | - Hind Hamzeh-Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France
| | - Fabrice Cognasse
- INSERM, U 1059 SAINBIOSE, Université Jean Monnet, Mines Saint-Étienne, 42023, Saint-Etienne, France.
- Establissement Français du Sang Auvergne-Rhône-Alpes and INSERM U1059, 25 Boulevard Pasteur, 42100, Saint-Etienne, France.
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24
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Schönborn L, Pavord S, Chen VMY, Pai M, Gwarzo DH, Buttery J, Munoz FM, Tran H, Greinacher A, Law B. Thrombosis with thrombocytopenia syndrome (TTS) and vaccine-induced immune thrombocytopenia and thrombosis (VITT): Brighton Collaboration case definitions and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2024; 42:1799-1811. [PMID: 38302339 DOI: 10.1016/j.vaccine.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
This is a revision of the online November 2021 Brighton thrombosis with thrombocytopenia syndrome (TTS) case definition and a new Brighton Collaboration case definition for vaccine-induced immune thrombocytopenia and thrombosis (VITT). These case definitions are intended for use in clinical trials and post-licensure pharmacovigilance activities to facilitate safety data comparability across multiple settings. They are not intended to guide clinical management. The case definitions were developed by a group of subject matter and Brighton Collaboration process experts as part of the Coalition for Epidemic Preparedness Innovations (CEPI)-funded Safety Platform for Evaluation of vACcines (SPEAC). The case definitions, each with defined levels of diagnostic certainty, are based on relevant published evidence and expert consensus and are accompanied by specific guidelines for TTS and VITT data collection and analysis. The document underwent peer review by a reference group of vaccine safety stakeholders and haematology experts to ensure case definition useability, applicability and scientific integrity.
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Affiliation(s)
- Linda Schönborn
- University Medicine Greifswald, Institute for Transfusion Medicine, Greifswald, Germany.
| | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Vivien Mun Yee Chen
- Department of Haematology, Concord Repatriation General Hospital and NSW Health Pathology, Concord, NSW, Australia; ANZAC Research Institute, Concord, NSW, Australia; Sydney Medical School, University of Sydney, Concord, NSW, Australia.
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.
| | - Dalha Haliru Gwarzo
- Institution: Bayero University, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - Jim Buttery
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
| | - Huyen Tran
- Clinical Haematology Department, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Andreas Greinacher
- University Medicine Greifswald, Institute for Transfusion Medicine, Greifswald, Germany.
| | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Stratford, Ontario, Canada.
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25
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Dul-Amnuay A. Case Study of Autopsy Findings in a Population of Post-COVID-19 Vaccination in Thailand. Am J Forensic Med Pathol 2024; 45:45-50. [PMID: 38127652 DOI: 10.1097/paf.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Thailand began offering the coronavirus disease 2019 (COVID-19) vaccine nationwide in February 2021, with 1,885 deaths reported by the end of the year. Therefore, it is essential to assess the correlation between vaccination and cause of death from autopsy. This study included 34 autopsies of a deceased within 30 days after COVID-19 vaccination performed in Bangkok under the postmortem inquest service area of Bhumibol Adulyadej Hospital. The autopsies were performed by forensic pathologists. Moreover, detailed information about the deceased was collected, including age, sex, medical records, vaccination history, scene investigation reports, autopsy reports, cause of death, and a probable causal relationship between vaccination and cause of death. There were 24 males (70.59%), and the average age of the deceased was 52.76 years. Of all individuals, 28 (82.36%), 4 (11.76%), and 2 (5.88%) were vaccinated with AstraZeneca, Sinopharm, and SinoVac, respectively. The most common cause of death was ischemic heart disease (n = 17). None of the deceased patients had a causal relationship to the vaccine. Deaths were due to natural causes, as no definitive link between vaccination and cause of death was established in the study.
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26
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Marwah V, Choudhary R, Kumar TA, Sharma M. Haemophagocytic lymphohistiocytosis post-ChAdOx1 nCoV-19 vaccine: A rare case. THE NATIONAL MEDICAL JOURNAL OF INDIA 2024; 37:90-92. [PMID: 39222526 DOI: 10.25259/nmji_ms_466_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic started in December 2019, spread like wildfire and took an immense toll on human life. ChAdOx1 nCoV-19 vaccine was used worldwide for the prevention of Covid-19. Covid-19 has been implicated in the causation of severe haemophagocytic lymphohistiocytosis (HLH) syndrome. However, the same has not been reported with ChAdOx1 nCoV-19 vaccine in the literature. We report a young man who developed secondary HLH post-ChAdOx1 nCoV-19 vaccination.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Robin Choudhary
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Tentu Ajai Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Manish Sharma
- Department of Pathology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
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27
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Yalcinkaya A, Cavalli M, Cederholm A, Aranda-Guillén M, Behere A, Mildner H, Lakshmikanth T, Gonzalez L, Mugabo CH, Johnsson A, Ekwall O, Kämpe O, Bensing S, Brodin P, Hallberg P, Wadelius M, Landegren N. No link between type I interferon autoantibody positivity and adverse reactions to COVID-19 vaccines. NPJ Vaccines 2024; 9:42. [PMID: 38388530 PMCID: PMC10883980 DOI: 10.1038/s41541-024-00829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Type I interferons act as gatekeepers against viral infection, and autoantibodies that neutralize these signaling molecules have been associated with COVID-19 severity and adverse reactions to the live-attenuated yellow fever vaccine. On this background, we sought to examine whether autoantibodies against type I interferons were associated with adverse events following COVID-19 vaccination. Our nationwide analysis suggests that type I interferon autoantibodies were not associated with adverse events after mRNA or viral-vector COVID-19 vaccines.
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Affiliation(s)
- Ahmet Yalcinkaya
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
- Department of Medical Biochemistry, Hacettepe University Hospital, Ankara, Turkey.
| | - Marco Cavalli
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Pharmacogenomics, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Axel Cederholm
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Maribel Aranda-Guillén
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Anish Behere
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Hedvig Mildner
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Laura Gonzalez
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Anette Johnsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Olle Kämpe
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Bensing
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Petter Brodin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology & Inflammation, Imperial College London, London, UK
| | - Pär Hallberg
- Department of Medical Sciences, Clinical Pharmacogenomics, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacogenomics, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Nils Landegren
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
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28
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Nguyen TH, Chen LY, Khan NZ, Lindenbauer A, Bui VC, Zipfel PF, Heinrich D. The Binding of the SARS-CoV-2 Spike Protein to Platelet Factor 4: A Proposed Mechanism for the Generation of Pathogenic Antibodies. Biomolecules 2024; 14:245. [PMID: 38540666 PMCID: PMC10967930 DOI: 10.3390/biom14030245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 04/02/2024] Open
Abstract
Pathogenic platelet factor 4 (PF4) antibodies contributed to the abnormal coagulation profiles in COVID-19 and vaccinated patients. However, the mechanism of what triggers the body to produce these antibodies has not yet been clarified. Similar patterns and many comparable features between the COVID-19 virus and heparin-induced thrombocytopenia (HIT) have been reported. Previously, we identified a new mechanism of autoimmunity in HIT in which PF4-antibodies self-clustered PF4 and exposed binding epitopes for other pathogenic PF4/eparin antibodies. Here, we first proved that the SARS-CoV-2 spike protein (SP) also binds to PF4. The binding was evidenced by the increase in mass and optical intensity as observed through quartz crystal microbalance and immunosorbent assay, while the switching of the surface zeta potential caused by protein interactions and binding affinity of PF4-SP were evaluated by dynamic light scattering and isothermal spectral shift analysis. Based on our results, we proposed a mechanism for the generation of PF4 antibodies in COVID-19 patients. We further validated the changes in zeta potential and interaction affinity between PF4 and SP and found that their binding mechanism differs from ACE2-SP binding. Importantly, the PF4/SP complexes facilitate the binding of anti-PF4/Heparin antibodies. Our findings offer a fresh perspective on PF4 engagement with the SARS-CoV-2 SP, illuminating the role of PF4/SP complexes in severe thrombotic events.
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Affiliation(s)
- Thi-Huong Nguyen
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
| | - Li-Yu Chen
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Institute of Miccrobiology, Friedrich-Schiller-University, 07745 Jena, Germany
| | - Nida Zaman Khan
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
| | - Annerose Lindenbauer
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
| | - Van-Chien Bui
- Department of Water Supply and Wastewater Treatment, Eichsfeldwerke GmbH, 37308 Heilbad Heiligenstadt, Germany
| | - Peter F. Zipfel
- Institute of Miccrobiology, Friedrich-Schiller-University, 07745 Jena, Germany
| | - Doris Heinrich
- Institute for Bioprocessing and Analytical Measurement Techniques (iba), 37308 Heilbad Heiligenstadt, Germany
- Faculty of Mathematics and Natural Sciences, Technische Universität Ilmenau, 98694 Ilmenau, Germany
- Fraunhofer Institut für Silicatforschung, Neunerplatz, 97082 Würzburg, Germany
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Maan R, Lauw MN, China L, Patch D, Baiges A, Garcia-Pagan JC, Hernández-Gea V, Hilleret MN, Tjwa ET, Kounis I, Bureau C, Giguet B, Heurgué A, Ollivier-Hourmand I, Causse X, Nery F, Eshraghian A, Plessier A, Darwish Murad S. Extensive splanchnic vein thrombosis after SARS-CoV-2 vaccination: A Vascular Liver Disease Group (VALDIG) initiative. Hepatology 2024:01515467-990000000-00747. [PMID: 38358465 DOI: 10.1097/hep.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Since the introduction of SARS-CoV-2 vaccines, several cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) have been described, especially cerebral vein thrombosis. We aimed to retrospectively collect all new cases of acute onset first or recurrent splanchnic vein thrombosis (SVT) following a recent SARS-CoV-2 vaccination within the Vascular Liver Disease Group network. APPROACH AND RESULTS New cases of SVT were identified from April 2021 to April 2022; follow-up was completed on December 31, 2022. Criteria to define VITT were derived from previous studies. Data from a pre-COVID cohort of patients with SVT (N=436) were used for comparison of clinical presentation, etiology, and outcome. Twenty-nine patients were identified with SVT occurring with a median of 11 days (range 2-76) after the first (48%), second (41%), or third (10%) vaccination (ChAdOx1 nCov-19 (n=12) or BNT162b2 (n=14), other (n=3) Only 2 patients(7%) fulfilled criteria for definite VITT. Twenty (69%) had SVT at multiple sites, including 4 (14%) with concomitant extra-abdominal thrombosis. Only 28% had an underlying prothrombotic condition, compared to 52% in the pre-COVID SVT cohort ( p =0.01). Five patients (17%) underwent bowel resection for mesenteric ischemia, compared with 3% in pre-COVID SVT ( p <0.001). Two patients died shortly after diagnosis (7%). CONCLUSIONS Although definite VITT was rare, in 72% of cases, no other cause for SVT could be identified following SARS-CoV-2 vaccination. These cases were different from patients with nonvaccine-related SVT, with lower incidence of prothrombotic conditions, higher rates of bowel ischemia, and poorer outcome. Although SVT after SARS-CoV-2 vaccination is rare in absolute terms, these data remain relevant considering ongoing revaccination programs.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mandy N Lauw
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Loise China
- Institute of Liver and Digestive Health, University College London, United Kingdom
| | - David Patch
- Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anna Baiges
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Juan Carlos Garcia-Pagan
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Virginia Hernández-Gea
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Marie-Noelle Hilleret
- Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes, 38043 Grenoble Cedex, France
| | - Eric T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilias Kounis
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire ; Inserm, Université Paris-Saclay, Université Paris-Saclay, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
| | - Christophe Bureau
- University Hospital of Toulouse and Toulouse III Paul Sabatier University, Toulouse, France
| | - Baptiste Giguet
- Liver Disease Department, CHU Rennes, Univ Rennes, Rennes, France
| | | | | | - Xavier Causse
- Department of Hepatology and Gastroenterology, Orleans, France
| | - Filipe Nery
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- EpiUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Ahad Eshraghian
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran
| | - Aurélie Plessier
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Centre de recherche sur l'inflammation, Inserm, Paris, France
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zhang Y, Bissola AL, Treverton J, Hack M, Lychacz M, Kwok S, Arnold A, Nazy I. Vaccine-Induced Immune Thrombotic Thrombocytopenia: Clinicopathologic Features and New Perspectives on Anti-PF4 Antibody-Mediated Disorders. J Clin Med 2024; 13:1012. [PMID: 38398325 PMCID: PMC10889051 DOI: 10.3390/jcm13041012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare yet severe adverse complication first identified during the global vaccination effort against SARS-CoV-2 infection, predominantly observed following administration of the ChAdOx1-S (Oxford-AstraZeneca) and Ad26.CoV2.S (Johnson & Johnson/Janssen) adenoviral vector-based vaccines. Unlike other anti-platelet factor 4 (PF4) antibody-mediated disorders, such as heparin-induced thrombocytopenia (HIT), VITT arises with the development of platelet-activating anti-PF4 antibodies 4-42 days post-vaccination, typically featuring thrombocytopenia and thrombosis at unusual sites. AIM To explore the unique properties, pathogenic mechanisms, and long-term persistence of VITT antibodies in patients, in comparison with other anti-PF4 antibody-mediated disorders. DISCUSSION This review highlights the complexity of VITT as it differs in antibody behavior and clinical presentation from other anti-PF4-mediated disorders, including the high incidence rate of cerebral venous sinus thrombosis (CVST) and the persistence of anti-PF4 antibodies, necessitating a re-evaluation of long-term patient care strategies. The nature of VITT antibodies and the underlying mechanisms triggering their production remain largely unknown. CONCLUSION The rise in awareness and subsequent prompt recognition of VITT is paramount in reducing mortality. As vaccination campaigns continue, understanding the role of adenoviral vector-based vaccines in VITT antibody production is crucial, not only for its immediate clinical implications, but also for developing safer vaccines in the future.
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Affiliation(s)
- Yi Zhang
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Anna-Lise Bissola
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Jared Treverton
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Michael Hack
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Mark Lychacz
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Sarah Kwok
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Addi Arnold
- Department of Pathology and Laboratory Medicine, Western University, London, ON N6A 5A5, Canada;
| | - Ishac Nazy
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
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31
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de Moraes MC, Duarte I, Nunes R. Pharmacovigilance in Brazil: The Government Monitoring of Adverse Events Reported from COVID-19 Vaccine-A Narrative Review. Healthcare (Basel) 2024; 12:371. [PMID: 38338256 PMCID: PMC10855231 DOI: 10.3390/healthcare12030371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Is pharmacovigilance at a moment of prominence for science, and in relation to governments' responsibilities towards their nations, as the new coronavirus pandemic has surprised everyone in a negative and lethal way? OBJECTIVE Evaluate pharmacovigilance as a resource for controlling and understanding adverse events caused by vaccines in use. METHODS This is a narrative review of the literature. Scientific articles available in databases, government bulletins and similar bodies were used. The search was carried out using the descriptors: "Pharmacovigilance AND COVID-19 in Brazil", "Vaccine Development AND COVID-19", "Vaccination Hesitancy AND COVID-19", "Public Health Surveillance AND COVID-19". The period from May 2021 to June 2022 was covered. RESULTS The occurrence of some adverse events was observed, including cases of allergy, myocarditis and rheumatoid arthritis. It is important to highlight that these adverse events were identified as rare, occurring in a small percentage of the vaccinated population. Despite these adverse events, the benefits of vaccines proved to be essential for controlling the pandemic. CONCLUSIONS The information presented highlights the importance of pharmacovigilance to continuously monitor and evaluate the safety of vaccines, identifying any potential adverse events early. This balance between risk and benefit emphasizes the need for a careful and informed approach when making decisions about vaccination policies, prioritizing public health and population safety.
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Affiliation(s)
- Mariana Carvalho de Moraes
- Department of Social Sciences and Health, Faculty of Medicine, Universidad do Porto, 4200-319 Porto, Portugal (R.N.)
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32
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Wang JJ, van der Neut Kolfschoten M, Rutten L, Armour B, Tan CW, Chataway T, Bos R, Koornneef A, Abeywickrema P, Kapur R, Porcelijn L, Khalifa M, Sadi A, Bouchier P, Kourkouta E, Perkasa A, Kwaks T, Zahn R, Solforosi L, Gordon TP. Characterization of reverse-engineered anti-PF4 stereotypic antibodies derived from serum of patients with VITT. Blood 2024; 143:370-374. [PMID: 37976451 DOI: 10.1182/blood.2023021307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Jing Jing Wang
- Department of Immunology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | | | - Lucy Rutten
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Bridie Armour
- Department of Immunology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Chee Wee Tan
- Department of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Hematology, SA Pathology, Adelaide, SA, Australia
- Department of Hematology, Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, SA, Australia
| | - Tim Chataway
- Flinders Proteomics Facility, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Rinke Bos
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | - Pravien Abeywickrema
- Structural & Protein Sciences, Janssen Research and Development, Spring House, PA
| | - Rick Kapur
- Sanquin Research, Department of Experimental Immunohematology, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Midia Khalifa
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Ava Sadi
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | | | - Aditya Perkasa
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Ted Kwaks
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Roland Zahn
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | | | - Tom P Gordon
- Department of Immunology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
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33
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Li X, Zeng F, Yue R, Ma D, Meng Z, Li Q, Zhang Z, Zhang H, Liao Y, Liao Y, Jiang G, Zhao H, Yu L, Li D, Zhang Y, Liu L, Li Q. Heterologous Booster Immunization Based on Inactivated SARS-CoV-2 Vaccine Enhances Humoral Immunity and Promotes BCR Repertoire Development. Vaccines (Basel) 2024; 12:120. [PMID: 38400104 PMCID: PMC10891849 DOI: 10.3390/vaccines12020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
Recent studies have indicated that sequentially administering SARS-CoV-2 vaccines can result in increased antibody and cellular immune responses. In this study, we compared homologous and heterologous immunization strategies following two doses of inactivated vaccines in a mouse model. Our research demonstrates that heterologous sequential immunization resulted in more immune responses displayed in the lymph node germinal center, which induced a greater number of antibody-secreting cells (ASCs), resulting in enhanced humoral and cellular immune responses and increased cross-protection against five variant strains. In further single B-cell analysis, the above findings were supported by the presence of unique B-cell receptor (BCR) repertoires and diversity in CDR3 sequence profiles elicited by a heterologous booster immunization strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Longding Liu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China (Y.Z.)
| | - Qihan Li
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China (Y.Z.)
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34
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Suto K, Saito A, Mori K, Yoshida A, Sata N. Superior mesenteric vein thrombosis due to COVID-19 vaccination: a case report. J Med Case Rep 2024; 18:23. [PMID: 38200562 PMCID: PMC10782545 DOI: 10.1186/s13256-023-04320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The worldwide vaccination response to COVID-19 has been associated with rare thrombotic complications, including the case of postvaccination splanchnic venous thrombosis we report here. CASE PRESENTATION An 80-year-old Japanese male with abdominal pain presented to our hospital six days after receiving a dose of the COVID-19 messenger ribonucleic acid vaccine. Abdominal computed tomography showed localized edema of the small intestine, increased density of the surrounding adipose tissue, and a thrombus in the superior mesenteric vein. Conservative inpatient treatment with unfractionated heparin relieved the thrombosis, and the patient is currently receiving oral apixaban as an outpatient. CONCLUSION Reported cases of thrombosis after COVID-19 vaccination typically have been associated with viral vector vaccines, with few reports of thrombosis induced by mRNA vaccines. The potential for venous thrombosis should be explored when patients present with abdominal pain soon after COVID-19 vaccination.
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Affiliation(s)
- Keita Suto
- Department of Surgery, Koga Red Cross Hospital, 1150 Shimoyama-Cho, Koga-Shi, Ibaraki, 306-0014, Japan.
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan.
| | - Akira Saito
- Department of Surgery, Koga Red Cross Hospital, 1150 Shimoyama-Cho, Koga-Shi, Ibaraki, 306-0014, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
| | - Katsusuke Mori
- Department of Surgery, Koga Red Cross Hospital, 1150 Shimoyama-Cho, Koga-Shi, Ibaraki, 306-0014, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
| | - Atsushi Yoshida
- Department of Surgery, Koga Red Cross Hospital, 1150 Shimoyama-Cho, Koga-Shi, Ibaraki, 306-0014, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
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Gabarin N, Hack M, Revilla R, Arnold DM, Nazy I. Hematology in the post-COVID era: spotlight on vaccine-induced immune thrombotic thrombocytopenia and a conceptual framework (the 4P's) for anti-PF4 diseases. Expert Rev Hematol 2024; 17:39-45. [PMID: 38149432 DOI: 10.1080/17474086.2023.2298333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a life-threatening prothrombotic disorder first identified following the introduction of adenoviral vector vaccines for COVID-19. The condition is characterized by anti-PF4 antibodies and clinically presents with thrombocytopenia and thrombosis often in unusual anatomical sites. AREAS COVERED In this review, we discuss the clinical presentation, diagnostic testing, and treatment of VITT. We also review VITT-like syndromes that have been described in patients without previous vaccination. We propose a conceptual framework for the mechanism of anti-PF4 diseases that includes sufficiently high levels of PF4, the presence of a Polyanion that can form immune complexes with PF4, a Pro-inflammatory milieu, and an immunological Predisposition - the 4Ps. EXPERT OPINION Significant progress has been made in understanding the characteristics of the VITT antibody and in testing methods that can confirm that diagnosis. Future work should be directed at understanding long-term outcomes, mechanisms of thrombosis, and individual risk factors for this rare but dangerous immune-thrombotic disease.
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Affiliation(s)
- Nadia Gabarin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Michael Hack
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Revilla
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
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36
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Klib M, Alazki O, Issa Nabhan A, Brakat AM, Zuhair Alafandi B, Abdulmoain Idres F, Almenchaf R, Albakkar F, Ghandour M, Zahlout J, Tabsho S, Mouazen S. Assessing the prevalence and patterns of COVID-19 vaccine side effects among Syrian adults: A cross-sectional study. Prev Med Rep 2024; 37:102558. [PMID: 38282667 PMCID: PMC10810828 DOI: 10.1016/j.pmedr.2023.102558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
Aim This study aimed to assess the prevalence and patterns of COVID-19 vaccine side effects among Syrian adults, with a focus on the AstraZeneca and Sputnik Light vaccines, in light of the low vaccination rate in Syria (below 18%) attributed to fear of side effects. Method A cross-sectional study was conducted between January and May 2022, using probability-based and convenient sampling strategies. Data was collected through online, paper, and face-to-face questionnaires that included demographic and vaccine-related questions. Result Out of 3,766 participants, the majority were female (56.7 %) and aged 18-24 years (53.3 %). Most participants had a university-level qualification (71.2 %) and were related to the medical sector (53.2 %). A significant proportion (47.0 %) received AstraZeneca, Sputnik Light (22.1 %) and Sinopharm (14.7 %). Common side effects included sleepiness and lethargy (50.0 %), fever and chills (45.0 %), and pain/swelling at the injection site (35.9 %). Multivariate logistic regression analysis revealed that male (OR: 0.57, CI: 0.48-0.68) and participants aged 45-65 years (OR: 0.53, CI: 0.40-0.70) were less likely to experience side effects. Participants who believed COVID-19 posed a high threat to their personal life had higher odds of side effects (OR: 1.74, CI: 1.22-2.46). Vaccine type was also associated with side effects, with Sputnik Light (OR: 2.52, CI: 1.85-3.46) and AstraZeneca (OR: 1.61, CI: 1.26-2.05) having increased odds. Conclusion Our study found that COVID-19 vaccines are well tolerated among the Syrian population, with short-term side effects that typically resolve within three days. These findings are expected to bolster vaccination rates through enhanced public confidence and acceptance.
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Affiliation(s)
- Mohamad Klib
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Osama Alazki
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Ayman Issa Nabhan
- Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus, Syria
| | - Aml M. Brakat
- Faculty of Medicine, Zagazig University, Ash Sharqia Governorate ,Egypt
| | | | | | | | - Farah Albakkar
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Munir Ghandour
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Jaafar Zahlout
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Somayya Tabsho
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Samar Mouazen
- Faculty of Medicine, Damascus University, Damascus, Syria
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37
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Scully M. VITT-like disorder HITs the headlines. Blood 2023; 142:2229-2230. [PMID: 38153773 DOI: 10.1182/blood.2023022900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Affiliation(s)
- Marie Scully
- University College London Hospitals Biomedical Research Centre
- National Institute for Health Research
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38
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Schönborn L, Esteban O, Wesche J, Dobosz P, Broto M, Puig SR, Fuhrmann J, Torres R, Serra J, Llevadot R, Palicio M, Wang JJ, Gordon TP, Lindhoff-Last E, Hoffmann T, Alberio L, Langer F, Boehme C, Biguzzi E, Grosse L, Endres M, Liman T, Thiele T, Warkentin TE, Greinacher A. Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure. Blood 2023; 142:2305-2314. [PMID: 37883798 PMCID: PMC10862238 DOI: 10.1182/blood.2023022136] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
ABSTRACT Platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies and anti-PF4 antibodies cause heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT), respectively. Diagnostic and treatment considerations differ somewhat between HIT and VITT. We identified patients with thrombocytopenia and thrombosis without proximate heparin exposure or adenovirus-based vaccination who tested strongly positive by PF4/polyanion enzyme-immunoassays and negative/weakly positive by heparin-induced platelet activation (HIPA) test but strongly positive by PF4-induced platelet activation (PIPA) test (ie, VITT-like profile). We tested these patients by a standard chemiluminescence assay that detects anti-PF4/heparin antibodies found in HIT (HemosIL AcuStar HIT-IgG(PF4-H)) as well as a novel chemiluminescence assay for anti-PF4 antibodies found in VITT. Representative control sera included an exploratory anti-PF4 antibody-positive but HIPA-negative/weak cohort obtained before 2020 (n = 188). We identified 9 patients with a clinical-pathological profile of a VITT-like disorder in the absence of proximate heparin or vaccination, with a high frequency of stroke (arterial, n = 3; cerebral venous sinus thrombosis, n = 4), thrombocytopenia (median platelet count nadir, 49 × 109/L), and hypercoagulability (greatly elevated D-dimer levels). VITT-like serological features included strong reactivity by PIPA (aggregation <10 minutes in 9/9 sera) and positive testing in the novel anti-PF4 chemiluminescence assay (3/9 also tested positive in the anti-PF4/heparin chemiluminescence assay). Our exploratory cohort identified 13 additional patient sera obtained before 2020 with VITT-like anti-PF4 antibodies. Platelet-activating VITT-like anti-PF4 antibodies should be considered in patients with thrombocytopenia, thrombosis, and very high D-dimer levels, even without a proximate exposure to heparin or adenovirus vector vaccines.
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Affiliation(s)
- Linda Schönborn
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | | | - Jan Wesche
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | | | | | | | - Jessica Fuhrmann
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | | | | | | | | | - Jing Jing Wang
- Department of Immunology, College of Medicine and Public Health, Flinders University and SA Pathology, Bedford Park, SA, Australia
| | - Tom Paul Gordon
- Department of Immunology, College of Medicine and Public Health, Flinders University and SA Pathology, Bedford Park, SA, Australia
| | - Edelgard Lindhoff-Last
- Cardioangiology Center Bethanien Hospital, CCB Coagulation Center and CCB Coagulation Research Center, Frankfurt, Hessen, Germany
| | - Till Hoffmann
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Lorenzo Alberio
- Service and Central Laboratory of Hematology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florian Langer
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eugenia Biguzzi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Leonie Grosse
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Partner site Berlin, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner site Berlin, Berlin, Germany
| | - Thomas Liman
- Center for Stroke Research Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Partner site Berlin, Berlin, Germany
- Department of Neurology, Evangelical Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany
| | - Thomas Thiele
- Institut für Transfusionsmedizin, Universitätsmedizin Rostock, Rostock, Germany
| | - Theodore E. Warkentin
- Department of Pathology and Molecular Medicine and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Chen D. Untoward immune effects of modern medication. J Biomed Res 2023; 38:17-23. [PMID: 38105750 PMCID: PMC10818179 DOI: 10.7555/jbr.37.20230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 12/19/2023] Open
Abstract
Immune-related adverse events (irAEs) represent an increasingly concerning challenge in the assessment of biopharmaceutical products. In contrast to historically rare allergic reactions associated with small chemical drugs, contemporary biotherapeutics exhibit a significantly higher morbidity of irAEs, because of their complex structure and comprehensive mechanisms of action. While the immunogenicity of protein-based compounds is associated with the induction of anti-drug antibodies, the pathogenesis of irAEs in advanced biologics, such as cell and gene therapy, remains to be further delineated. In the current study, I present an updated profile regarding the untoward immune effects of medications, covering various material categories systematically, with the underlying mechanisms to inspire risk mitigation in biopharmaceutical development and application.
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Affiliation(s)
- Daohong Chen
- Research Institute, Changshan Biochemical Pharmaceutical, Shijiazhuang, Hebei 050800, China
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40
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Raadsen MP, Visser C, Lavell AHA, van de Munckhof AAGA, Coutinho JM, de Maat MPM, GeurtsvanKessel CH, Bomers MK, Haagmans BL, van Gorp ECM, Porcelijn L, Kruip MJHA. Transient Autoreactive PF4 and Antiphospholipid Antibodies in COVID-19 Vaccine Recipients. Vaccines (Basel) 2023; 11:1851. [PMID: 38140254 PMCID: PMC10747426 DOI: 10.3390/vaccines11121851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare autoimmune condition associated with recombinant adenovirus (rAV)-based COVID-19 vaccines. It is thought to arise from autoantibodies targeting platelet factor 4 (aPF4), triggered by vaccine-induced inflammation and the formation of neo-antigenic complexes between PF4 and the rAV vector. To investigate the specific induction of aPF4 by rAV-based vaccines, we examined sera from rAV vaccine recipients (AZD1222, AD26.COV2.S) and messenger RNA (mRNA) based (mRNA-1273, BNT162b2) COVID-19 vaccine recipients. We compared the antibody fold change (FC) for aPF4 and for antiphospholipid antibodies (aPL) of rAV to mRNA vaccine recipients. We combined two biobanks of Dutch healthcare workers and matched rAV-vaccinated individuals to mRNA-vaccinated controls, based on age, sex and prior history of COVID-19 (AZD1222: 37, Ad26.COV2.S: 35, mRNA-1273: 47, BNT162b2: 26). We found no significant differences in aPF4 FCs after the first (0.99 vs. 1.08, mean difference (MD) = -0.11 (95% CI -0.23 to 0.057)) and second doses of AZD1222 (0.99 vs. 1.10, MD = -0.11 (95% CI -0.31 to 0.10)) and after a single dose of Ad26.COV2.S compared to mRNA-based vaccines (1.01 vs. 0.99, MD = 0.026 (95% CI -0.13 to 0.18)). The mean FCs for the aPL in rAV-based vaccine recipients were similar to those in mRNA-based vaccines. No correlation was observed between post-vaccination aPF4 levels and vaccine type (mean aPF difference -0.070 (95% CI -0.14 to 0.002) mRNA vs. rAV). In summary, our study indicates that rAV and mRNA-based COVID-19 vaccines do not substantially elevate aPF4 levels in healthy individuals.
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Affiliation(s)
- Matthijs P. Raadsen
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (M.P.R.); (C.H.G.); (B.L.H.); (E.C.M.v.G.)
| | - Chantal Visser
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (C.V.); (M.P.M.d.M.)
| | - A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.H.A.L.); (M.K.B.)
- Amsterdam Institute for Infection & Immunity, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anita A. G. A. van de Munckhof
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.A.G.A.v.d.M.); (J.M.C.)
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.A.G.A.v.d.M.); (J.M.C.)
| | - Moniek P. M. de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (C.V.); (M.P.M.d.M.)
| | - Corine H. GeurtsvanKessel
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (M.P.R.); (C.H.G.); (B.L.H.); (E.C.M.v.G.)
| | | | - Marije K. Bomers
- Department of Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.H.A.L.); (M.K.B.)
- Amsterdam Institute for Infection & Immunity, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bart L. Haagmans
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (M.P.R.); (C.H.G.); (B.L.H.); (E.C.M.v.G.)
| | - Eric C. M. van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (M.P.R.); (C.H.G.); (B.L.H.); (E.C.M.v.G.)
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands;
| | - Marieke J. H. A. Kruip
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (C.V.); (M.P.M.d.M.)
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Greinacher A. Thrombotic anti-PF4 immune disorders: HIT, VITT, and beyond. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:1-10. [PMID: 38066843 PMCID: PMC10727100 DOI: 10.1182/hematology.2023000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Antibodies against the chemokine platelet factor 4 (PF4) occur often, but only those that activate platelets induce severe prothrombotic disorders with associated thrombocytopenia. Heparin-induced thrombocytopenia (HIT) is the prototypic anti-PF4 disorder, mediated by strong activation of platelets through their FcγIIa (immunoglobulin G [IgG]) receptors (FcγRIIa). Concomitant pancellular activation (monocytes, neutrophils, endothelium) triggers thromboinflammation with a high risk for venous and arterial thrombosis. The classic concept of HIT is that anti-PF4/heparin IgG, recognizing antigen sites on (cationic) PF4 that form in the presence of (anionic) heparin, constitute the heparin-dependent antibodies that cause HIT. Accordingly, HIT is managed by anticoagulation with a nonheparin anticoagulant. In 2021, adenovirus vector COVID-19 vaccines triggered the rare adverse effect "vaccine-induced immune thrombotic thrombocytopenia" (VITT), also caused by anti-PF4 IgG. VITT is a predominantly heparin-independent platelet-activating disorder that requires both therapeutic-dose anticoagulation and inhibition of FcγRIIa-mediated platelet activation by high-dose intravenous immunoglobulin (IVIG). HIT and VITT antibodies bind to different epitopes on PF4; new immunoassays can differentiate between these distinct HIT-like and VITT-like antibodies. These studies indicate that (1) severe, atypical presentations of HIT ("autoimmune HIT") are associated with both HIT-like (heparin-dependent) and VITT-like (heparin-independent) anti-PF4 antibodies; (2) in some patients with severe acute (and sometimes chronic, recurrent) thrombosis, VITT-like antibodies can be identified independent of proximate heparin exposure or vaccination. We propose to classify anti-PF4 antibodies as type 1 (nonpathogenic, non- platelet activating), type 2 (heparin dependent, platelet activating), and type 3 (heparin independent, platelet activating). A key concept is that type 3 antibodies (autoimmune HIT, VITT) require anticoagulation plus an adjunct treatment, namely high-dose IVIG, to deescalate the severe anti-PF4 IgG-mediated hypercoagulability state.
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Affiliation(s)
- Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Singh K, Misra DP. SARS-CoV-2 vaccination appears to be safe in antiphospholipid antibody syndrome: Comment on evaluation of patients with antiphospholipid syndrome subsequently COVID-19 vaccinations. Int J Rheum Dis 2023; 26:2609-2611. [PMID: 38041652 DOI: 10.1111/1756-185x.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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43
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Liu L, Zhou C, Jiang H, Wei H, Zhou Y, Zhou C, Ji X. Epidemiology, pathogenesis, and management of Coronavirus disease 2019-associated stroke. Front Med 2023; 17:1047-1067. [PMID: 38165535 DOI: 10.1007/s11684-023-1041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
The Coronavirus disease 2019 (COVID-19) epidemic has triggered a huge impact on healthcare, socioeconomics, and other aspects of the world over the past three years. An increasing number of studies have identified a complex relationship between COVID-19 and stroke, although active measures are being implemented to prevent disease transmission. Severe COVID-19 may be associated with an increased risk of stroke and increase the rates of disability and mortality, posing a serious challenge to acute stroke diagnosis, treatment, and care. This review aims to provide an update on the influence of COVID-19 itself or vaccines on stroke, including arterial stroke (ischemic stroke and hemorrhagic stroke) and venous stroke (cerebral venous thrombosis). Additionally, the neurovascular mechanisms involved in SARS-CoV-2 infection and the clinical characteristics of stroke in the COVID-19 setting are presented. Evidence on vaccinations, potential therapeutic approaches, and effective strategies for stroke management has been highlighted.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
| | - Chenxia Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
| | - Huimin Jiang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
| | - Xunming Ji
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China.
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China.
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Simpson M, Narwal A, West E, Martin J, Bagot CN, Page AR, Watson HG, Whyte CS, Mutch NJ. Fibrinogenolysis and fibrinolysis in vaccine-induced immune thrombocytopenia and thrombosis. J Thromb Haemost 2023; 21:3589-3596. [PMID: 37734715 DOI: 10.1016/j.jtha.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare syndrome associated with adenoviral vector vaccines for COVID-19. The syndrome is characterized by thrombosis, anti-platelet factor 4 (PF4) antibodies, thrombocytopenia, high D-dimer, and hypofibrinogenemia. OBJECTIVES To investigate abnormalities in fibrinolysis that contribute to the clinical features of VITT. METHODS Plasma samples from 18 suspected VITT cases were tested for anti-PF4 by ELISA and characterized as meeting criteria for VITT (11/18) or deemed unlikely (7/18; non-VITT). Antigen levels of PAI-1, factor XIII (FXIII), plasmin-α2antiplasmin (PAP), and inflammatory markers were quantified. Plasmin generation was quantified by chromogenic substrate. Western blotting was performed with antibodies to fibrinogen, FXIII-A, and plasminogen. RESULTS VITT patients 10/11 had scores indicative of overt disseminated intravascular coagulation, while 0/7 non-VITT patients met the criteria. VITT patients had significantly higher levels of inflammatory markers, IL-1β, IL-6, IL-8, TNFα, and C-reactive protein. In VITT patients, both fibrinogen and FXIII levels were significantly lower, while PAP and tPA-mediated plasmin generation were higher compared to non-VITT patients. Evidence of fibrinogenolysis was observed in 9/11 VITT patients but not in non-VITT patients or healthy controls. Fibrinogen degradation products were apparent, with obvious cleavage of the fibrinogen α-chain. PAP complex was evident in those VITT patients with fibrinogenolysis, but not in non-VITT patients or healthy donors. CONCLUSION VITT patients show evidence of overt disseminated intravascular coagulation and fibrinogenolysis, mediated by dysregulated plasmin generation, as evidenced by increased PAP and plasmin generation. These observations are consistent with the clinical presentation of both thrombosis and bleeding in VITT.
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Affiliation(s)
- Megan Simpson
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. https://twitter.com/SimpsonMegan8
| | - Anuj Narwal
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Eric West
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jill Martin
- Department of Haematology Laboratory, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Andrew R Page
- Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Henry G Watson
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Claire S Whyte
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. https://twitter.com/ClaireW63108369
| | - Nicola J Mutch
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Theodorou DJ, Theodorou SJ, Rizos D. Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study. Thromb Res 2023; 232:146-147. [PMID: 37734969 DOI: 10.1016/j.thromres.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Affiliation(s)
| | | | - Dimitrios Rizos
- Department of Internal Medicine, Intensive Care Unit, General Hospital of Ioannina, Greece
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46
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Dorgalaleh A, Shabannezhad A, Hassani S. COVID-19 vaccine-induced immune thrombotic thrombocytopenia: pathophysiology and diagnosis. Ann Hematol 2023:10.1007/s00277-023-05563-1. [PMID: 38030893 DOI: 10.1007/s00277-023-05563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Coronavirus disease-19 (COVID-19) vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but serious clinical condition with high mortality rate in apparently healthy individuals without noticeable risk factors. VITT typically arises due to the administration of vaccines that possess recombinant adenoviral vectors, including ChAdOx1 nCov-19 (AstraZeneca) and Ad26 COV2.S (Johnson & Johnson/Janssen). Thrombosis frequently occurs at atypical sites, such as the cerebral or splanchnic circulations, in this particular pathological state. Similar to heparin-induced thrombotic thrombocytopenia (HITT), it seems that the cause of VITT is the misdirection of anti-platelet factor 4 antibodies (anti-PF4 Abs), an ancient antimicrobial mechanism. Anti-PF4 Abs in patients with VITT activates the coagulation system, leading to thrombosis. This process occurs through the stimulation of platelets (Plts) and neutrophils and subsequently release of neutrophil extracellular traps (NETs). Due to the potentially fatal consequences of VITT, early diagnosis is mandatory. In addition to thrombocytopenia, thrombosis, and the presence of anti-PF4 Abs, the day of symptoms onset and the elevation of D-dimer are also required for definitive diagnosis of VITT. The absence of one or more criteria can result in the exclusion of definitive VITT and lead to the diagnosis of probable, possible, or unlikely VITT.
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Affiliation(s)
| | - Ashkan Shabannezhad
- Department of Hematology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran.
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Ab Rahman N, Lim MT, Lee FY, Wo WK, Yeoh HS, Peariasamy KM, Sivasampu S. Thrombocytopenia and venous thromboembolic events after BNT162b2, CoronaVac, ChAdOx1 vaccines and SARS-CoV-2 infection: a self-controlled case series study. Sci Rep 2023; 13:20471. [PMID: 37993548 PMCID: PMC10665324 DOI: 10.1038/s41598-023-47486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
This study assessed the association between COVID-19 vaccines, SARS-CoV-2 infection and the risk of thrombocytopenia and venous thromboembolism (VTE). This self-controlled case series study used hospital records between 1st February 2021 and 28th February 2022 linked to the national immunisation registry and COVID-19 surveillance data in Malaysia. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) of events in the risk period (day 1-21 post-exposure) relative to control period with the corresponding 95% confidence interval (CI) adjusted for calendar period. We found no significant increased risk of thrombocytopenia in 1-21 days following BNT162b2, CoronaVac and ChAdOx1 vaccines while the risk was increased following SARS-CoV-2 infection (IRR 15.52, 95% CI 13.38-18.00). Similarly, vaccination with BNT162b2, CoronaVac, or ChAdOx1 was not associated with an increased risk of VTE during the 1-21 days risk period. SARS-CoV-2 infection was associated with increased risk of VTE (IRR 39.84, 95% CI 27.45-32.44). Our findings showed low event rates of thrombocytopenia and VTE following booster vaccination with comparable safety profiles between those who received homologous and heterologous booster combinations. Our findings showed the risk of thrombocytopenia and VTE was not increased after COVID-19 vaccination while the risks were substantially higher after SARS-CoV-2 infection.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Kepong, Selangor, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Hee Sheong Yeoh
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
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Ivanov DG, Ivetic N, Du Y, Nguyen SN, Le SH, Favre D, Nazy I, Kaltashov IA. Reverse Engineering of a Pathogenic Antibody Reveals the Molecular Mechanism of Vaccine-Induced Immune Thrombotic Thrombocytopenia. J Am Chem Soc 2023; 145:25203-25213. [PMID: 37949820 DOI: 10.1021/jacs.3c07846] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The massive COVID-19 vaccine roll-out campaign illuminated a range of rare side effects, the most dangerous of which─vaccine-induced immune thrombotic thrombocytopenia (VITT)─is caused by adenoviral (Ad)-vectored vaccines. VITT occurrence had been linked to the production of pathogenic antibodies that recognize an endogenous chemokine, platelet factor 4 (PF4). Mass spectrometry (MS)-based evaluation of the ensemble of anti-PF4 antibodies obtained from a VITT patient's blood indicates that the major component is a monoclonal antibody. Structural characterization of this antibody reveals several unusual characteristics, such as the presence of an N-glycan in the Fab segment and high density of acidic amino acid residues in the complementarity-determining regions. A recombinant version of this antibody (RVT1) was generated by transient expression in mammalian cells based on the newly determined sequence. It captures the key properties of VITT antibodies such as their ability to activate platelets in a PF4 concentration-dependent fashion. Homology modeling of the Fab segment reveals a well-defined polyanionic paratope, and the docking studies indicate that the polycationic segment of PF4 readily accommodates two Fab segments, cross-linking the antibodies to yield polymerized immune complexes. Their existence was verified with native MS by detecting assemblies as large as (RVT1)3(PF4)2, pointing out at FcγRIIa-mediated platelet activation as the molecular mechanism underlying VITT clinical manifestations. In addition to the high PF4 affinity, RVT1 readily binds other polycationic targets, indicating a polyreactive nature of this antibody. This surprising promiscuity not only sheds light on VITT etiology but also opens up a range of opportunities to manage this pathology.
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Affiliation(s)
- Daniil G Ivanov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Yi Du
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Son N Nguyen
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - S Hung Le
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Daniel Favre
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Igor A Kaltashov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
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Abdelouahed M, Yateem D, Fredericks S. Fc γRIIa - dependent platelet activation identified in COVID-19 vaccine-induced immune thrombotic thrombocytopenia-, heparin-induced thrombocytopenia, streptokinase- and anisoylated plasminogen-streptokinase activator complex-induced platelet activation. Front Cardiovasc Med 2023; 10:1282637. [PMID: 38034388 PMCID: PMC10684751 DOI: 10.3389/fcvm.2023.1282637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which was caused by the coronavirus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was globally responsible for remarkable morbidity and mortality. Several highly effective vaccines for COVID-19 were developed and disseminated worldwide within an unprecedented timescale. Rare but dangerous clotting and thrombocytopenia events, and subsequent coagulation abnormalities, have been reported after massive vaccination against SARS-CoV-2. Soon after their global rollout, reports of a morbid clinical syndrome following vaccination with adenovirus-DNA-based vaccines appeared. In the spring of 2021, reports of a novel, rare and morbid clinical syndrome, with clinically devastating and fatal complication after vaccination with adenovirus-based coronavirus vaccines (Janssen/Johnson & Johnson and Astra-Zeneca vaccines) led to a brief suspension of their use by several countries. Those complications were associated with unusual cerebral and splanchnic venous thrombosis, and circulating autoantibodies directed against anti-platelet factor 4 (PF4), a protein secreted from platelets, leading to the designation: Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT). The reported VITT incidence remains very low and does not affect the overall benefit of immunization, however, if left untreated, VITT can be debilitating or even fatal. VITT resembled specific adverse drugs' reactions that also involved the production of autoantibodies and subsequent abnormal platelet activation through platelet FcγRIIa. These unusual but well-documented drug reactions were heparin-induced thrombocytopenia (HIT), streptokinase- (SK), and anisoylated plasminogen-streptokinase activator complex- (APSAC) associated with platelet-activating antibodies. There was considerable overlapping of clinical features between VITT, COVID-19 and these adverse drugs' reactions. We review the phenomenon of VITT against the backdrop of shared and common mechanisms that underlie HIT-, SK-, and APSAC-platelet FcγRIIa-dependent platelet activation. An understanding of VITT's pathogenesis may be achieved by comparing and contrasting VITT-, HIT-, SK- and APSAC-induced platelet activation mechanisms, their respective physiopathology and similarities. Discussing these conditions in parallel provides insight into complex immunological disorders and diseases associated with abnormal hemostasis and thrombosis in particular.
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Affiliation(s)
- Mustapha Abdelouahed
- Department of Medical Sciences and Education, Boston University School of Medicine, Boston, MA, United States
| | - Dana Yateem
- School of Medicine, The Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Sayh, Muharraq Governorate, Bahrain
| | - Salim Fredericks
- School of Medicine, The Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Sayh, Muharraq Governorate, Bahrain
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50
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Warkentin TE. Autoimmune Heparin-Induced Thrombocytopenia. J Clin Med 2023; 12:6921. [PMID: 37959386 PMCID: PMC10649402 DOI: 10.3390/jcm12216921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Autoimmune thrombocytopenia (aHIT) is a severe subtype of heparin-induced thrombocytopenia (HIT) with atypical clinical features caused by highly pathological IgG antibodies ("aHIT antibodies") that activate platelets even in the absence of heparin. The clinical features of aHIT include: the onset or worsening of thrombocytopenia despite stopping heparin ("delayed-onset HIT"), thrombocytopenia persistence despite stopping heparin ("persisting" or "refractory HIT"), or triggered by small amounts of heparin (heparin "flush" HIT), most cases of fondaparinux-induced HIT, and patients with unusually severe HIT (e.g., multi-site or microvascular thrombosis, overt disseminated intravascular coagulation [DIC]). Special treatment approaches are required. For example, unlike classic HIT, heparin cessation does not result in de-escalation of antibody-induced hemostasis activation, and thus high-dose intravenous immunoglobulin (IVIG) may be indicated to interrupt aHIT-induced platelet activation; therapeutic plasma exchange may be required if high-dose IVIG is ineffective. Also, aHIT patients are at risk for treatment failure with (activated partial thromboplastin time [APTT]-adjusted) direct thrombin inhibitor (DTI) therapy (argatroban, bivalirudin), either because of APTT confounding (where aHIT-associated DIC and resulting APTT prolongation lead to systematic underdosing/interruption of DTI therapy) or because DTI inhibits thrombin-induced protein C activation. Most HIT laboratories do not test for aHIT antibodies, contributing to aHIT under-recognition.
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Affiliation(s)
- Theodore E. Warkentin
- Department of Pathology and Molecular Medicine and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; ; Tel.: +1-(905)-527-0271 (ext. 46139)
- Service of Benign Hematology, Hamilton Health Sciences (General Site), Hamilton, ON L8L 2X2, Canada
- Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton, ON L8L 2X2, Canada
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