Comment on “Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: Causality or casualty?”

Capecchi, Pier Leopoldo; Lazzerini, Pietro Enea; Brillanti, Stefano

doi:10.1016/j.jhep.2021.04.039

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…She developed generalized pruritus, choluria and jaundice 13 days after receiving COVID-19 vaccine, coupled with positive antinuclear antibody and double-stranded DNA antibodies [96]. However, Capecchi PL et al questioned that the recent pregnancy represents a tremendous confounding factor associated with the development of AIH, rather than the COVID-19 vaccine [97]. However, two additional male cases excluded pregnancy as a confounding factor.…”

Section: Autoimmuneliverdiseasesmentioning

confidence: 99%

New‐onset autoimmune phenomena post‐COVID‐19 vaccination

et al. 2022

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Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented setback for global economy and health. Vaccination is one of the most effective interventions to substantially reduce severe disease and death due to SARS-CoV-2 infection.Vaccination programmes are being rolled out globally, but most of these vaccines have been approved without extensive studies on their side-effects and efficacy.Recently, new-onset autoimmune phenomena after COVID-19 vaccination have been reported increasingly (e.g. immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, IgA nephropathy, rheumatoid arthritis and systemic lupus erythematosus). Molecular mimicry, the production of particular autoantibodies and the role of certain vaccine adjuvants seem to be substantial contributors to autoimmune phenomena. However, whether the association between COVID-19 vaccine and autoimmune manifestations is coincidental or causal remains to be elucidated. Here, we summarize the emerging evidence about autoimmune manifestations occurring in response to certain COVID-19 vaccines.Although information pertaining to the risk of autoimmune disease as a consequence of vaccination is controversial, we merely propose our current understanding of autoimmune manifestations associated with COVID-19 vaccine. In fact, we do not aim to disavow the overwhelming benefits of mass COVID-19 vaccination in preventing COVID-19 morbidity and mortality. These reports could help guide clinical assessment and management of autoimmune manifestations after COVID-19 vaccination.

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Section: Autoimmuneliverdiseasesmentioning

confidence: 99%

New‐onset autoimmune phenomena post‐COVID‐19 vaccination

et al. 2022

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“…Moreover, a study of this association from 18 countries, consisting mostly of previously published case reports, has been published [60], and a description of the histological and serological features of these patients has been analyzed [61]. The clinical features of the cases that developed autoimmune-like hepatitis shortly after the first report [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] were remarkably similar. Patients had a hepatocellular-type liver injury with classical biochemical features and histological and clinical features of genuine or classic autoimmune hepatitis.…”

Section: Liver Injury Due To Covid-19 Vaccinesmentioning

confidence: 99%

“…The authors raised concerns relating to vaccine-induced autoimmunity but were careful in their interpretation and suggested that the association could be coincidental [ 40 ]. However, during 2021 and 2022, at least 19 additional case reports or case series were published on this association [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Most of the patients reported have been isolated case reports; however, one series that included 16 patients has also been published [ 55 ].…”

Section: Liver Injury Due To Covid-19 Vaccinesmentioning

confidence: 99%

“…COVID-19-vaccination-induced autoimmune-like hepatitis is a type of DI-ALH. In around 100 reports, no AIH relapse has been reported [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. This is similar to infliximab-induced AIH-like hepatitis [ 64 ] and other drugs with a well-documented capacity to induce autoimmune-like hepatitis [ 65 ].…”

Section: Liver Injury Due To Covid-19 Vaccinesmentioning

confidence: 99%

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The Epidemiology of Newly Recognized Causes of Drug-Induced Liver Injury: An Update

Björnsson

2024

Pharmaceuticals

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The incidence and prevalence of drug-induced liver injury appear to be increasing globally, for example, with the introduction of checkpoint inhibitors. Several reviews have been published in the last decade on the epidemiology of DILI, both among hospitalized patients and in the general population, as well as from retrospective and prospective studies on DILI. Most of these reviews have not focused on newly recognized agents that have recently changed the landscape of DILI. Apart from liver injury associated with antibiotics, oncological agents, particularly checkpoint inhibitors, are increasingly being recognized as causing liver injury. The type of liver injury associated with these agents is not idiosyncratic but rather an indirect type of injury. Furthermore, recently, COVID-19 vaccines and green tea extract have been found to lead to liver injury. Checkpoint inhibitors have revolutionized the treatment of many malignancies, such as malignant melanoma, lung cancer, and renal cancer. Via the activation of T cells, they can increase immune activity against malignant cells, but at the same time, they can decrease immune tolerance and therefore lead to immune-related adverse effects in many organs. The most common adverse effect in clinical practice is liver injury. A recent prospective study demonstrated an 8% frequency of DILI due to the use of checkpoint inhibitors among patients with malignant melanoma and renal cancer. This rate is much higher than observed with drugs, leading to idiosyncratic liver injury. Shortly after the implementation of the worldwide vaccination program against COVID-19, several case reports were published on suspected vaccination-induced autoimmune-like hepatitis occurring shortly after the vaccination. At first, these reports were met with skepticism, but currently, around 100 reports have been published, and cases of positive recurrence have been reported. The clinical, biochemical, immunological, and histological features are indistinguishable from classic autoimmune hepatitis (AIH). These reactions are very similar to drug-induced autoimmune-like hepatitis (DI-ALH) due to drugs such as nitrofurantoin, minocycline, and infliximab, which do not relapse after a short course of corticosteroids, which is the general rule in classic autoimmune hepatitis (AIH). Green tea extract has been found to be a well-documented cause of acute hepatocellular liver injury with jaundice. A strong HLA association has been reported, showing a high prevalence of HLA-B*35:01 among patients suffering from green tea-induced liver injury. Overall, 3% of patients recruited in the DILIN study were supplemented with green tea extract as one of the ingredients. In a prospective population-based study from Iceland, green tea was implicated in approximately 8% of patients with DILI.

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“…Our observation is not in agreement with those reports because the latency period was relatively brief, which might question the association between the potential trigger and the autoimmune process. However, brief latency periods after vaccination have been previously described 8,9 . Moreover, and until the present time, as all of COVID-19 vaccines are recent, it is yet not feasible to perform an in-vitro provocation test, to establish a causal link between AstraZeneca vaccine and the development of AIH.…”

Section: -39mentioning

confidence: 99%

Autoimmune Hepatitis after AstraZeneca Coronavirus Disease 2019 (COVID-19) vaccine: need for epidemiological study

Ponte¹,

Clara²,

Furtado³

2022

Gal. Clin.

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This case-report and brief review of literature were written concerning autoimmune hepatitis potentially triggered by virus vaccines. Soon after the Astrazeneca COVID-19 vaccine, a 70-year-old women presented with jaundice and nausea, with significant hepatic injury (aspartate aminotransferase (AST) 746 U/L; hyperbilirubinemia 9,30 mg/dL (conjugated bilirubin 7,14 mg/dL), elevated immunoglobulin (Ig)G and antinuclear, anti-smooth muscle and anti-actin F antibodies were detected. Considering autoimmune hepatitis (AIH) as a possible cause, a liver biopsy was performed and compatible with AIH. Prednisolone therapy was initiated, with optimal response. This report suggests that immunization against COVID-19 might precipitate or induce AIH. Further data regarding confirmed cases of AIH are mandatory in order to establish a causal link. Therefore, long-term pharmacovigilance surveillance of large cohorts of patients is needed.

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Comment on “Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: Causality or casualty?”

Cited by 13 publications

References 10 publications

New‐onset autoimmune phenomena post‐COVID‐19 vaccination

New‐onset autoimmune phenomena post‐COVID‐19 vaccination

The Epidemiology of Newly Recognized Causes of Drug-Induced Liver Injury: An Update

Autoimmune Hepatitis after AstraZeneca Coronavirus Disease 2019 (COVID-19) vaccine: need for epidemiological study

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