Infectious Disease

Studying COVID-19 offers an unprecedented opportunity to expand knowledge about autoimmunity

March 11, 2021

3 min read

Source / information

Published by:

Disclosure:
The researchers report funding from the RJ Fasenmyer Center for Clinical Immunology. They also report consulting fees from AbbVie, Bristol Myers Squibb, Crescendo, Genentech, Gilead Sciences, GlaxoSmithKline, Horizon, Janssen, Novartis and Sanofi, as well as consulting fees from AbbVie, Crescendo, Genentech, Janssen, Novartis and Sanofi.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Studies examining the immunopathogenesis of COVID-19 and its association with immune dysregulation offer an “unprecedented opportunity” to learn more about autoimmunity, according to a review published in Pathogens and Immunity.

“This is a very recent review, and like all things in COVID, it is dated.” Leonard H. Calabrese, DO, RJ Fasenmyer, Chair of Clinical Immunology at Cleveland Clinic, and a review writer, told Healio Rheumatology. “There has been an increase in publications on the COVID-19 autoimmune axis in recent months. A number of publications have identified a variety of autoantibodies that are present in acute COVID. However, we currently do not know the function or the effects. It is currently unknown whether these autoantibodies are drivers or mere passengers in both acute and post-COVID manifestations. “

In their review, Leonard H. Calabrese, DO, and colleagues noted the “unprecedented” pace of research and other findings on these topics. As of December 30, 2020, nearly 100,000 articles and studies have been published – less than a year since the pandemic began.

Calabrese, who is also editor-in-chief for Healio Rheumatology, took part in the review Nicole Eve Winchester, BS, the Cleveland Clinic Lerner College of Medicine, and Cassandra Calabrese, DO, the Cleveland Clinic’s Department of Rheumatic and Immunological Diseases answering critical questions about the interfaces between COVID-19 and autoimmunity. They aimed to answer these questions with a critical synthesis of selected articles and research results.

Critical questions included: What do we know about the clinical history of patients with immune-mediated inflammatory diseases (IMIDs) who develop COVID-19? What lessons can be learned from examining the clinical outcomes of patients on immunomodulatory therapy at baseline? Does COVID-19 induce autoantibodies and autoimmune diseases?

Also, what is the relationship between autoimmunity and the newly defined post-COVID-19 syndromes such as multisystem inflammatory syndrome in children (MIS-C) and adults (MIS-A)? Do We Understand the Mechanisms of Autoimmunity in COVID-19? What do we know about immunizing patients with IMIDs against COVID-19? Does Autoimmunity Contribute to Long-Term COVID-19 Syndrome?

According to the authors, some critical questions about people with pre-existing IMIDs and COVID-19 remain unanswered, whether they are at an increased risk of infection and whether they may have a more severe illness after being infected. With respect to patients receiving basic immunomodulatory therapy, the authors found “a consistent finding” that daily moderate to high-dose glucocorticoids were associated with a significant risk of serious outcomes.

“The investigation of the clinical results of COVID-19 in patients with IMIDs who have already been infected with biological disease-modifying anti-inflammatory drugs, in particular anti-cytokine agents, as well as targeted synthetic DMARDs (e.g. JAK inhibitors and others)”, is even more meaningful. write. “In these situations, the effects of selected immune inhibition early in the course of the infection may offer unique opportunities for insights that are not possible when such agents are used only after the disease has progressed.”

The authors also found that more than 1,200 cases of MIS-C have been reported since April 2020. The current understanding of the immunopathogenic mechanisms underlying MIS-C is evolving rapidly. According to Calabrese and colleagues, some data “imply” an aberrant innate immunity in MIS-C, with reports of increased complement activation and activated neutrophils and monocytes and increased proinflammatory cytokines and markers of inflammation.

Finally, the authors wrote that the “next frontier” of the disease will be “long-term COVID-19” or the various long-term signs and symptoms of patients who have recovered from the acute phase of infection. So far, these have most commonly been fatigue, shortness of breath, brain fog, arthralgia, autonomic symptoms, and others. According to the researchers, there is currently little data on a role for autoimmunity in long-term COVID-19 and studies to better understand its pathogenesis are urgently needed.

“The investigation of COVID-19 into its immunopathogenesis and its relationship to immune system dysregulatory diseases provides an unprecedented opportunity for advances in the study of the human immune system,” the authors wrote in the review. “The massive output of this biomedical research effort is likely to provide important insight into the immunopathogenesis, treatment, and possibly prevention of immune system disorders, including congenital immunodeficiencies, autoimmune and auto-inflammatory diseases, and immunothrombotic diseases.”

In addition, the authors noted the “unprecedented” pace of research and other findings on these topics. As of December 30, 2020, nearly 100,000 articles and studies had been published – less than a year since the pandemic began.

“It should be noted that some of the things we see after COVID, like postural orthostatic tachycardia syndrome, or POTS, are associated with autoantibodies, but we are awaiting solid studies,” Calabrese told Healio Rheumatology. “Even while we speak: The early coverage of a multitude of anecdotes of post-COVID vaccine of inflammatory origin, which clearly burden acute inflammation and possible immunodeficiency. It is clear that the COVID-autoimmune crossbreed will be full in the further course and rheumatologists will have a lot to offer. “

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

COVID-19 Resource Center

COVID-19 Resource Center

Related Articles