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Background: Anti-SARS-CoV2 vaccines showed a good efficacy in prevention of severe COVID-19 1 . Their potential in induction of autoantibodies (abs) has not been well established 1 . One recent study demonstrated an increase of abs’ titre after anti-SARS-CoV2 vaccination only in patients with already pre-existing positivity 2 .
Objectives: To evaluate the potential induction of abs after anti-SARS-CoV2 vaccination in a triple positive antiphospholipid antibodies (aPL) cohort.
Methods: 18 subjects were enrolled [M/F= 17/1; median age=52 years; 5 Primary Antiphospholipid Syndrome (PAPS), 5 Systemic Lupus Erythematosus (SLE) with associated APS and 8 aPL carriers (1 Behçet Disease, 1 SLE, 4 Undifferentiated Connective Tissue Disease, 2 with no diagnosis of systemic autoimmune disease)]. Serum samples were collected before the first (T0) and at least one month after the second administration (T1) of the anti-SARS-CoV2 vaccine (16 BNT162b2, 1 mRNA-1273, 1 Gam-COVID-Vac).
A wide panel of abs were evaluated through routinely methods.
Results: None developed any additional sign of autoimmune diseases upon vaccination. Patients majority did not display any new autoantibody positivity (
Autoantibodies’ titre pre (T0) and post (T1) anti-SARS-CoV2 vaccination.
| Autoantibodies | Level at T0 | Level at T1 | p-value* | Patients positive at T0 | Patients positive at T1 | p-value° |
|---|---|---|---|---|---|---|
| Anti-dsDNA | 28.7 (21.8-64.5) | 25.8 (15.9-68.5) | 0.163 | 7/18 (38.9%) | 6/18 (33.3%) | 0.729 |
| (n.v. <27 IU/ml ) | ||||||
| aCL IgG | 88.1 (27.1-218.9) | 68.2 (18.8-181.3) | 0.118 | 15/18 (83.3%) | 13/18 (72.2%) | 0.691 |
| (n.v. <20 CU ) | ||||||
| aCL IgG | 11.9 (11.2-77.2) | 11.2 (11.2-24.5) | 0.432 | 9/18 (50%) | 7/18 (38.9%) | 0.502 |
| (n.v. <12 IU/ml ) | ||||||
| aCL IgM | 20.8 (5.9-35.9) | 8.9 (3.3-21.6) | 0.006 | 9/18 (50%) | 5/18 (27.8%) | 0.171 |
| (n.v. <20 CU ) | ||||||
| aCL IgM | 30.4 (18.1-170.8) | 23.8 (11.2-82.3) | 0.029 | 14/18 (77.8%) | 12/18 (66.7%) | 0.457 |
| (n.v. <12 IU/ml ) | ||||||
| aCL IgA | 11.7 (11.2-30.9) | 11.2 (11.2-17.6) | 0.029 | 8/18 (44.4%) | 6/18 (33.3%) | 0.494 |
| (n.v. <12 IU/ml ) | ||||||
| aβ2GPI IgG | 230.4 (110.1-971.1) | 242.3 (33.7-652.9) | 0.083 | 16/18 (88.9%) | 14/18 (77.8%) | 0.658 |
| (n.v. <20 CU ) | ||||||
| aβ2GPI IgG | 9.3 (9.3-128.1) | 19.4 (9.3-126.9) | 0.844 | 8/18 (44.4%) | 9/18 (50%) | 0.738 |
| (n.v. <20 IU/ml ) | ||||||
| aβ2GPI IgM | 16.9 (3.6-51.3) | 6.8 (1.5-23.1) | 0.041 | 7/18 (38.9%) | 5/18 (27.8%) | 0.480 |
| (n.v. <20 CU ) | ||||||
| aβ2GPI IgM | 19.8 (11.1-78.8) | 9.9 (9.3-52.4) | 0.109 | 8/18 (44.4%) | 7/18 (38.9) | 0.735 |
| (n.v. <20 IU/ml ) | ||||||
| aβ2GPI IgA | 20.8 (9.3-39.9) | 9.3 (9.3-37.8) | 0.080 | 10/18 (55.6%) | 7/18 (38.9%) | 0.317 |
| (n.v. <20 IU/ml ) |
Antiphospholipid antibodies were determined with chemiluminescence (CU) and home-made ELISA (IU/ml) methods of detection. Pre and post-vaccine values are expressed as median (IQR). In bold, statistically significant comparisons. *Wilcoxon signed-rank test for paired variables was applied. °Chi-square test or Fisher’s exact test were applied.
dsDNA=double-stranded DNA; aCL: anti-cardiolipin; aβ2GPI: anti-beta2-glycoprotein I; n.v.: normal value.
All emerging aPL were low titre. None of the patients displayed raising aPL titres from low to medium-high.
Conclusion: Anti-SARS-CoV2 vaccination did not induce any clinical signs of autoimmunity in a cohort of patients with triple aPL positivity. Serology for autoantibodies remained stable in the majority of patients. Few patients experienced the emergence of low titre aPL, possibly as an expected inter-assay variation rather than an evolving “serological flare”.
REFERENCES:
[1]Ishay Y et al. Int Immunopharmacol. 2021;
[2]Thurm C et al. medRxiv 2021.
Disclosure of Interests: None declared