COVID-19 and Autoimmunity: A Single Center Prospective Follow-Up Study

Abstract

Background: Various factors, such as viral infections, can act as triggers for the development of autoimmune diseases.In our recent study we reported the presence of autoantibodies in patients diagnosed with COVID-19. To verify whether these autoantibodies persisted over time and led to the development of chronic autoimmune diseases, we conducted a follow-up study at 3 and 6 months after admission.Methods:Thirteen of 40 patients enrolled in the previous study gave their consent to the analysis. The same autoimmunity tests performed at the time of diagnosis were carried out in these patients during follow up.Results:We showed, compatibly with an acute inflammatory response, that two patients were negative 6 months after diagnosis. In nine patients, autoantibodies were still present at follow-up. Among them, one patient had only ENA positivity. Another patient developed strong positivity for ANA and M2-β and Ku antigens. Currently, the symptoms do not meet full diagnostic criteria for diagnosis of polymyositis, but the patient is closely monitored to check its possible onset.Three patients developed: transient alopecia, autoimmune thrombocytopenia and hearing loss. Other four patients did not show any clinical symptoms.Conclusions:In conclusion, our data show that after 6 months, the autoantibodies are still present in the majority of patients. Further investigations will be necessary to check whether these patients will become negative over time or may develop clinical symptoms compatible with the onset of longer-term chronic autoimmune diseases.

Inflammation and autoimmune myasthenia gravis

“…The changes are thought to be prompted by innate immune activation (e.g., TLRs) triggered in a host following a viral infection that leads to the production of an array of inflammatory molecules. Further supporting the reports, infections with certain microbes and viruses (including recent SARS-CoV-2) were found to initiate or exacerbate an autoimmune condition, likely through induction of interferon (IFN)-mediated immune response (21)(22)(23)(24). Also, the antigenicity of exogenous molecules (e.g., a microbial protein) with significant homology with a host protein or host-derived endogenous protein associated with cell stress or cell damage is believed to act as an autoantigen to trigger such onset of the autoimmune response (25).…”

Autoimmune and immunoserological markers of COVID-19 pneumonia: Can they help in the assessment of disease severity

“…These similarities in pathogenesis of AIIRD and severe COVID-19 suggest that the presence of autoantibodies in COVID-19 patients is not just an epiphenomenon but might indicate loss of self-tolerance. Increased prevalence of ANA ranging from 25 to 57.5% in patients with COVID is reported by many studies (10)(11)(12)(13)(14). ANA titer and pattern were rarely reported.…”

New insights into the pathogenesis of SARS-CoV-2 during and after the COVID-19 pandemic

“…The damage generated by SARS-CoV-2 in tissues may be due to the destruction of infected cells by CD8+ T cells and the production of pro-inflammatory cytokines by other immune cells, which can produce collateral damage to tissues when fighting the viral infection (197). Some reports of this self-tolerance and crossreactivity effect have shown that they are due to antiphospholipid antibodies, antitype I interferon, and antinuclear polymorphs, among others (198)(199)(200). This, in turn, increases the risk of contracting autoimmune diseases such as Guillain-Barreś yndrome and systemic lupus erythematosus.…”

“…In addition, studies have suggested the relationship between autoantibody levels and COVID-19 severity, so it has been proposed that self-tolerance may be affected in SARS-CoV-2 infection, leading to reactivity against host cells. Several autoantibodies have been found in patients with COVID-19, including antiphospholipid, anti-type I interferons, anti-nuclear polymorph anti-antibodies, and anti-neutrophil cytoplasmic antibodies (200,221). In turn, some autoantibodies have been linked to a potential risk of autoimmune diseases, such as Guillain-Barrésyndrome, systemic lupus erythematosus, Kawasaki disease, and autoimmune hemolytic anemia, among others (201).…”