COVID-19 Autoimmunity

Updated August 11, 2023

4 JUN 2020: Autoimmune and inflammatory diseases following COVID-19(NatRevRheum)
“Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C)”

18 NOV 2020: Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19 (Science)
“These findings suggest that half of patients hospitalized with COVID-19 become at least transiently positive for aPL antibodies and that these autoantibodies are potentially pathogenic.”

24 DEC 2020: High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms (Brain, Behavior, and Immunity)
“The high frequency of autoantibodies targeting the brain in the absence of other explanations suggests a causal relationship to clinical symptoms, in particular to hyperexcitability (myoclonus, seizures). Several underlying autoantigens and their potential molecular mimicry with SARS-CoV-2 still await identification.”

19 JAN 2021: Reaction of Human Monoclonal Antibodies to SARS-CoV-2 Proteins With Tissue Antigens: Implications for Autoimmune Diseases (Frontiers in Immunology)
“our results can establish the potential risk for autoimmunity and multi-system disorders with COVID-19 that may come from cross-reactivity between our own human tissues and this dreaded virus”

19 MAY 2021: Diverse functional autoantibodies in patients with COVID-19 (Nature)
We found that patients with COVID-19 exhibit marked increases in autoantibody reactivities as compared to uninfected individuals, and show a high prevalence of autoantibodies against immunomodulatory proteins (including cytokines, chemokines, complement components and cell-surface proteins). We established that these autoantibodies perturb immune function and impair virological control by inhibiting immunoreceptor signalling and by altering peripheral immune cell composition, and found that mouse surrogates of these autoantibodies increase disease severity in a mouse model of SARS-CoV-2 infection. Our analysis of autoantibodies against tissue-associated antigens revealed associations with specific clinical characteristics. Our findings suggest a pathological role for exoproteome-directed autoantibodies in COVID-19, with diverse effects on immune functionality and associations with clinical outcomes.”

26 MAY 2021: Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation (Pathogens)
“These findings suggest that many long COVID symptoms may not be a direct result of the SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.”

24 Jun 2021: Autoantibodies stabilize neutrophil extracellular traps in COVID-19 (JCI Insight)
Press Release:

1 JUL 2021: Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination (CDC)

7 JUL 2021: How antibodies may cause rare blood clots after some COVID-19 vaccines (ScienceNews)

10 JUL 2021: Autoimmune phenomena following SARS-CoV-2 vaccination (Int Immunepharmacol) 
“We report a series of patients presenting with de-novo or flares of existing autoimmune conditions associated with the Pfizer BNT162b2 mRNA SARS-CoV-2 vaccine.”

27 JUL 2021: Relaxed peripheral tolerance drives broad de novo autoreactivity in severe COVID-19 (medRxiv preprint)
“this study reveals the origins, breadth, and resolution of acute-phase autoreactivity in severe COVID-19, with significant implications in both early interventions and potential treatment of patients with post-COVID sequelae

29 JUL 2021: Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V)  (BMJ Case Reports)

11 AUG 2021: Researchers find important clue to rare inflammatory disease in children following COVID-19 infection (MedicalXpress press release)

14 SEP 2021: New-onset IgG autoantibodies in hospitalized patients with COVID-19 (Nature)

7 OCT 2021: Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome (JAMA)

25 OCT 2021: Anti–SARS-CoV-2 and Autoantibody Profiles in the Cerebrospinal Fluid of 3 Teenaged Patients With COVID-19 and Subacute Neuropsychiatric Symptoms (JAMA)
“A subset of pediatric patients with COVID-19 and subacute neuropsychiatric symptoms have intrathecal antineural autoantibodies, suggesting central nervous system autoimmunity in pediatric patients with COVID-19 and recent neuropsychiatric symptoms.”

12 NOV 2021: COVID‐19 vaccination can occasionally trigger autoimmune phenomena, probably via inducing age‐associated B cells (Int J Rheum Dis) 
“In this article, we discuss the probability of ABC‐mediated autoimmunity (flare or new‐onset) following COVID‐19 vaccination.”

24 NOV 2021: A Possible Role for Anti-idiotype Antibodies in SARS-CoV-2 Infection and Vaccination (NEJM)

1 DEC 2021: ChAdOx1 interacts with CAR and PF4 with implications for thrombosis with thrombocytopenia syndrome (Science)

1 DEC 2021: Postvaccination Multisystem Inflammatory Syndrome in Adult with No Evidence of Prior SARS-CoV-2 Infection (Emerg Infect Dis)
“Ten days after receiving the first dose of coronavirus disease vaccine, a 22-year-old woman in South Korea experienced myocarditis, myopathy, pericarditis, and gastroenteritis; rash subsequently developed. There was no evidence of prior infection with severe acute respiratory syndrome coronavirus 2. The diagnosis was multisystem inflammatory syndrome resulting from coronavirus disease vaccination.”

5 DEC 2021: Brain Injury in COVID-19 is Associated with Autoinflammation and Autoimmunity (medRxiv preprint)

5 DEC 2021: Guillain-Barré Syndrome after COVID-19 Vaccination in the Vaccine Safety Datalink (medRxiv preprint)
“In this interim analysis of surveillance data of COVID-19 vaccines, the incidence of GBS was elevated after Ad.26.COV2.S. Surveillance is ongoing.”

20 DEC 2021: Multisystem Inflammatory Syndrome in Children by COVID-19 Vaccination Status of Adolescents in France (JAMA Research Letter)
“These results suggest that COVID-19 mRNA vaccination was associated with a lower incidence of MIS-C in adolescents.” 

27 DEC 2021: New-onset autoimmune phenomena post-COVID-19 vaccination (Immunology)
“In the light of the information discussed above, emerging evidence has indicated that new onset of autoimmune manifestations including VITT, autoimmune liver diseases, GBS and IgA nephropathy appears to be associated with COVID-19 vaccines. The plausible mechanisms by which COVID-19 vaccines lead to autoimmune manifestations include molecular mimicry, the production of particular autoantibodies and the role of certain vaccine adjuvants.”

30 DEC 2021: Paradoxical sex-specific patterns of autoantibody response to SARS-CoV-2 infection (Journal of Translational Med)
“Our results reveal that prior SARS-CoV-2 infection, even in the absence of severe clinical disease, can lead to a broad AAB response that exhibits sex-specific patterns of prevalence and antigen selectivity. Further understanding of the nature of triggered AAB activation among men and women exposed to SARS-CoV-2 will be essential for developing effective interventions against immune-mediated sequelae of COVID-19.”
Press Release:
“These patterns of immune dysregulation could be underlying the different types of persistent symptoms we see in people who go on to develop the condition now referred to as long COVID-19.”

5 JAN 2022: Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) Aged 12–20 Years in the United States Who Received COVID-19 Vaccine, December 2020 through August 2021 (medRxiv preprint)
“In our case series, we describe a small number of persons with MIS-C who had received ≥1 COVID-19 vaccine dose before illness onset. Continued reporting of potential cases and surveillance for MIS-C illnesses after COVID-19 vaccination is warranted.”

18 FEB 2022: COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database (Brain)
“Analysis of the linked NID/NIMS dataset suggests that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95%CI 0.481-0.691) cases per 100,000 doses. … The pathogenic cause of the ChAdOx1 nCoV-19 specific first dose link warrants further study.”

2 MAR 2022: Severe Neuro-COVID is associated with peripheral immune signatures, autoimmunity and signs of neurodegeneration: a prospective cross-sectional study (medRxiv preprint)
“Neuro-COVID class III patients had a strong, peripheral immune response resulting in (1) BBB impairment (2) ingress of (auto-)antibodies, (3) microglia activation and neuronal damage signatures.”

May 2022: Pediatric Acute Liver Failure Due to Type 2 Autoimmune Hepatitis Associated With SARS-CoV-2 Infection: A Case Report (JPGM)
“We describe the case of a 3-year-old previously healthy female who developed acute liver failure secondary to type 2 autoimmune hepatitis preceded by mild infection with SARS-CoV-2.” 

16 MAY 2022: An Artificial Intelligence-guided signature reveals the shared host immune response in MIS-C and Kawasaki disease (Nature Communications)
Results show that KD and MIS-C are on the same continuum of the host immune response as COVID-19. Both the pediatric syndromes converge upon an IL15/IL15RA-centric cytokine storm, suggestive of shared proximal pathways of immunopathogenesis; however, they diverge in other laboratory parameters and cardiac phenotypes.”

23 MAY 2022: SARS-CoV-2 ORF1abA1061S potentiate autoreactive T cell responses via epitope mimicry: an explanation to hepatitis of unknown cause (bioRxiv preprint)
“our preliminary results raised a possibility that infection by SARS-CoV-2 ORF1abVVVNASN variant might elicit an autoimmune T cell response via epitope mimicry and is associated with the outbreak of unknown hepatitis”

22 JUN 2022: Evidence of recent Epstein-Barr virus reactivation in individuals experiencing Long COVID (medRxiv preprint)
“we observed that LC symptoms such as fatigue and neurocognitive dysfunction at a median of 4 months following initial diagnosis were associated with serological evidence of recent EBV reactivation (early antigen-D IgG positivity or nuclear antigen IgG levels >600 U/mL), but not with ongoing EBV viremia”
Reuters Coverage:

24 AUG 2022: Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review (J Autoimmun) 
“There is likely an association between COVID-19 vaccination and autoimmune and inflammatory diseases. Some ADs seem to be more common than others. The mechanisms of autoimmunity induction by COVID-19 vaccines and SARS-CoV-2 infection may be similar. Large, well-controlled studies are warranted to validate this relationship and assess additional variables such as genetic and environmental influences. Further detailed studies focusing on mechanisms, including molecular mimicry and bystander activation, will be essential to explain these rare events.”

1 FEB 2023: Reports of Guillain-Barré Syndrome After COVID-19 Vaccination in the United States (JAMA Infectious Disease)
“This study found disproportionate reporting and imbalances after Ad26.COV2.S vaccination, suggesting that Ad26.COV2.S vaccination was associated with increased risk for GBS. No associations between mRNA COVID-19 vaccines and risk of GBS were observed.”

17 APR 2023: Insights into new-onset autoimmune diseases after COVID-19 vaccination (Autoimmune Review)
“In this review, we provide evidence that vaccination induces autoimmunity and summarize possible mechanisms of action, such as molecular mimicry, activation by bystanders, and adjuvants. Our objective is not to refute the importance of vaccines, but to raise awareness about the potential risks of COVID-19 vaccination. In fact, we believe that the benefits of vaccination far outweigh the possible risks and encourage people to get vaccinated.”

NOV 2023: T cell cross-reactivity in autoimmune-like hepatitis triggered by COVID-19 (hLife)
“Thus, we hypothesized that following SARS-CoV-2 infection or vaccination, T cells carrying TCRs that recognize self-antigens undergo clonal expansion, which could eventually result in the onset of autoimmune-like hepatitis “