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Schönborn L, Seck SE, Thiele T, Kaderali L, Hoffmann T, Hlinka A, Lindhoff-Last E, Völker U, Selleng K, Buoninfante A, Cavaleri M, Greinacher A. Long-term outcome in vaccine-induced immune thrombocytopenia and thrombosis. J Thromb Haemost 2023; 21:2519-2527. [PMID: 37394120 DOI: 10.1016/j.jtha.2023.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Rapid diagnosis and treatment has improved outcome of patients with vaccine-induced immune thrombocytopenia and thrombosis (VITT). However, after the acute episode, many questions on long-term management of VITT remained unanswered. OBJECTIVES To analyze, in patients with VITT, the long-term course of anti-platelet factor 4 (PF4) antibodies; clinical outcomes, including risk of recurrent thrombosis and/or thrombocytopenia; and the effects of new vaccinations. METHODS 71 patients with serologically confirmed VITT in Germany were enrolled into a prospective longitudinal study and followed for a mean of 79 weeks from March 2021 to January 2023. The course of anti-PF4 antibodies was analyzed by consecutive anti-PF4/heparin immunoglobulin G enzyme-linked immunosorbent assay and PF4-enhanced platelet activation assay. RESULTS Platelet-activating anti-PF4 antibodies became undetectable in 62 of 71 patients (87.3%; 95% CI, 77.6%-93.2%). In 6 patients (8.5%), platelet-activating anti-PF4 antibodies persisted for >18 months. Five of 71 patients (7.0%) showed recurrent episodes of thrombocytopenia and/or thrombosis; in 4 of them (80.0%), alternative explanations beside VITT were present. After further COVID-19 vaccination with a messenger RNA vaccine, no reactivation of platelet-activating anti-PF4 antibodies or new thrombosis was observed. No adverse events occurred in our patients subsequently vaccinated against influenza, tick-borne encephalitis, varicella, tetanus, diphtheria, pertussis, and polio. No new thrombosis occurred in the 24 patients (33.8%) who developed symptomatic SARS-CoV-2 infection following recovery from acute VITT. CONCLUSION Once the acute episode of VITT has passed, patients appear to be at low risk for recurrent thrombosis and/or thrombocytopenia.
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Affiliation(s)
- Linda Schönborn
- Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sabrina E Seck
- Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Medicine Rostock, Rostock, Germany
| | - Lars Kaderali
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Till Hoffmann
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Annalena Hlinka
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Edelgard Lindhoff-Last
- Cardioangiology Center Bethanien Hospital, CCB Coagulation Center and CCB Coagulation Research Center, Frankfurt, Hessen, Germany
| | - Uwe Völker
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Kathleen Selleng
- Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alessandra Buoninfante
- Health Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, The Netherlands
| | - Marco Cavaleri
- Health Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, The Netherlands
| | - Andreas Greinacher
- Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany.
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2
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Buoninfante A, Andeweg A, Baker AT, Borad M, Crawford N, Dogné JM, Garcia-Azorin D, Greinacher A, Helfand R, Hviid A, Kochanek S, López-Fauqued M, Nazy I, Padmanabhan A, Pavord S, Prieto-Alhambra D, Tran H, Wandel Liminga U, Cavaleri M. Understanding thrombosis with thrombocytopenia syndrome after COVID-19 vaccination. NPJ Vaccines 2022; 7:141. [PMID: 36351906 PMCID: PMC9643955 DOI: 10.1038/s41541-022-00569-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alessandra Buoninfante
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Arno Andeweg
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Alexander T. Baker
- grid.417468.80000 0000 8875 6339Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85054 USA ,grid.5600.30000 0001 0807 5670Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Mitesh Borad
- grid.417467.70000 0004 0443 9942Mayo Clinic Cancer Center, Phoenix, AZ 85054 USA
| | - Nigel Crawford
- grid.1008.90000 0001 2179 088XRoyal Children’s Hospital, Murdoch Children’s Research Institute, Department Paediatrics, The University of Melbourne, Melbourne, VIC Australia
| | - Jean-Michel Dogné
- grid.6520.10000 0001 2242 8479Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium ,grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands
| | - David Garcia-Azorin
- grid.411057.60000 0000 9274 367XDepartment of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Andreas Greinacher
- grid.5603.0Department of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rita Helfand
- grid.416738.f0000 0001 2163 0069National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA ,grid.3575.40000000121633745WHO’s Global Advisory Committee on Vaccine Safety, WHO, Geneva, Switzerland
| | - Anders Hviid
- grid.5254.60000 0001 0674 042XPharmacovigilance Research Center, Department of Drug Development and Clinical Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Stefan Kochanek
- grid.6582.90000 0004 1936 9748Department of Gene Therapy, University of Ulm, Ulm, Germany
| | - Marta López-Fauqued
- grid.452397.eVaccines and Therapies for Infectious Diseases, European Medicines Agency, Amsterdam, the Netherlands
| | - Ishac Nazy
- grid.25073.330000 0004 1936 8227McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON Canada
| | - Anand Padmanabhan
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Sue Pavord
- grid.410556.30000 0001 0440 1440Department Hematology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, UK
| | - Daniel Prieto-Alhambra
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK ,grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Huyen Tran
- grid.1623.60000 0004 0432 511XDepartment of Clinical Haematology, The Alfred Hospital, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, VIC Australia
| | - Ulla Wandel Liminga
- grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands ,grid.415001.10000 0004 0475 6278Medical Products Agency, Uppsala, Sweden
| | - Marco Cavaleri
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands ,grid.452397.eEMA Emergency Task Force Chair, Amsterdam, The Netherlands
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Fernandez J, Sanders H, Henn J, Wilson JM, Malone D, Buoninfante A, Willms M, Chan R, DuMont AL, McLahan C, Grubb K, Romanello A, van den Dobbelsteen G, Torres VJ, Poolman JT. Vaccination with Detoxified Leukocidin AB Reduces Bacterial Load in a Staphylococcus aureus Minipig Deep Surgical Wound Infection Model. J Infect Dis 2021; 225:1460-1470. [PMID: 33895843 PMCID: PMC9016470 DOI: 10.1093/infdis/jiab219] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Vaccines against Staphylococcus aureus have eluded researchers for >3 decades while the burden of staphylococcal diseases has increased. Early vaccine attempts mainly used rodents to characterize preclinical efficacy, and all subsequently failed in human clinical efficacy trials. More recently, leukocidin AB (LukAB) has gained interest as a vaccine antigen. We developed a minipig deep surgical wound infection model offering 3 independent efficacy readouts: bacterial load at the superficial and at the deep-seated surgical site, and dissemination of bacteria. Due to similarities with humans, minipigs are an attractive option to study novel vaccine candidates. With this model, we characterized the efficacy of a LukAB toxoid as vaccine candidate. Compared to control animals, a 3-log reduction of bacteria at the deep-seated surgical site was observed in LukAB-treated minipigs and dissemination of bacteria was dramatically reduced. Therefore, LukAB toxoids may be a useful addition to S. aureus vaccines and warrant further study.
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Affiliation(s)
| | - H Sanders
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - J Henn
- Bacterial Vaccines, Spring House, PA, USA
| | | | - D Malone
- Bacterial Vaccines, Spring House, PA, USA
| | - A Buoninfante
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - M Willms
- Bacterial Vaccines, Spring House, PA, USA
| | - R Chan
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - A L DuMont
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - C McLahan
- In Vivo Sciences, Spring House, PA, USA
| | - K Grubb
- Bacterial Vaccines, Spring House, PA, USA
| | | | | | - V J Torres
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - J T Poolman
- Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
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