Latent rheumatic, thyroid and phospholipid autoimmunity in hospitalized patients with COVID-19

Anaya, Juan Manuel; Monsalve, Diana M.; Rojas, Manuel; Rodríguez, Yhojan; Montoya-García, Norma; Mancera-Navarro, Laura Milena; Villadiego-Santana, Ana María; Rodríguez-Leguizamón, Giovanni; Acosta-Ampudia, Yeny; Ramírez-Santana, Carolina

doi:10.1016/j.jtauto.2021.100091

Cited by 52 publications

(65 citation statements)

References 28 publications

(37 reference statements)

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“…However, clinical studies showed contradictory results. In one study, increased TPOAb positivity was detected [ 24 ], while increased autoimmunity was not detected in others [ 9 , 12 ]. In the light of this knowledge, we evaluated the TPOAb and TGAb in 205 patients, but we could not observe an increased rate of antibody positivity according to the normal population [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

Yazan

Ilgin

Elbasan

et al. 2021

International Journal of Endocrinology

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Background. COVID-19 infection may have multiorgan effects in addition to effects on the lungs and immune system. Recently, studies have found thyroid function abnormalities in COVID-19 cases which were interpreted as euthyroid sick syndrome (ESS) or destructive thyroiditis. Therefore, in this study, we aimed to evaluate the thyroid function status and thyroid autoimmunity in COVID-19 patients. Material and Method. 205 patients were included. The medical history and laboratory parameters at admission were collected from medical records. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and thyroglobulin antibody were measured, and patients were classified according to thyroid function status. Results. 34.1% of the patients were euthyroid. Length of hospitalization ( p < 0.001 ), rate of oxygen demand ( p < 0.001 ), and intensive care unit (ICU) admission ( p = 0.022 ) were lower, and none of the euthyroid patients died. 108 (52.6%) patients were classified to have ESS, 57 were classified as mild, and 51 were moderate. The inflammatory parameters were higher in patients with moderate ESS. In cluster analysis, a high-risk group with a lower median FT3 value (median = 2.34 ng/L; IQR = 0.86), a higher median FT4 value (median = 1.04 ng/dL; IQR = 0.33), and a lower median TSH value (median = 0.62 mIU/L; IQR = 0.59) included 8 of 9 died patients and 25 of the 31 patients that were admitted to ICU. Discussion. Length of hospitalization, oxygen demand, ICU admission, and mortality were lower in euthyroid patients. Moreover, none of the euthyroid patients died. In conclusion, evaluation of thyroid function tests during COVID-19 infection may give information about the prognosis of disease.

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Section: Discussionmentioning

confidence: 99%

The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

Yazan

Ilgin

Elbasan

et al. 2021

International Journal of Endocrinology

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“…Compared to controls COVID-19 patients displayed latent autoimmunity mediated by a higher frequency of autoantibodies, such as TPOAb, rheumatoid factor (RF), and antinuclear antibodies (ANAs), to mention a few. A meta-analysis of selected studies confirmed such an increased prevalence of autoantibodies in COVID-19 patients, being RF and ANAs the most common autoantibodies [ 80 ]. These findings suggest a role of SARS-CoV-2 infection in promoting/amplifying autoimmune disorders (AIDs) and support further post-COVID studies to evaluate the development of overt autoimmunity.…”

Section: Autoimmune Thyroid Disorders and Covid-19mentioning

confidence: 93%

“…The occurrence of autoimmune complications, including anti-phospholipid syndrome, autoimmune thrombocythemia, hemolytic anemia, Guillain-Barré, has been described in patients following SARS-CoV-2 infection [ 76–79 ]. Moreover, latent autoimmunity was checked by measuring a panel of rheumatic, thyroid, and phospholipid autoantibodies in sera samples from 120 hospitalized patients with COVID-19 in comparison to pre-pandemic samples from 100 healthy individuals [ 80 ]. Compared to controls COVID-19 patients displayed latent autoimmunity mediated by a higher frequency of autoantibodies, such as TPOAb, rheumatoid factor (RF), and antinuclear antibodies (ANAs), to mention a few.…”

Section: Autoimmune Thyroid Disorders and Covid-19mentioning

confidence: 99%

SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives

Ruggeri

Campennì

Deandreis

et al. 2021

Expert Review of Clinical Immunology

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Introduction : During the COVID-19 pandemic thyroid gland alteration/dysfunction has been emerged as a possible endocrine complication. The present review is focused on inflammatory and autoimmune thyroid complications triggered by SARS-CoV-2 infection by searching through databases like MEDLINE and Scopus up to April 2021. Areas covered : Beside the occurrence of ‘non-thyroidal illness’ in severe clinical conditions, alterations of thyroid function and structure may occur during COVID-19 as a consequence of either direct or indirect effects of SARS-CoV-2 infection on the gland. On the one hand, SARS-CoV-2 uses ACE2 as a receptor to infect the host cells and ACE2 is highly expressed by follicular thyroid cells. On the other hand, COVID-19 is associated with a systemic inflammatory and immune response, involving Th1/Th17/Th2 lymphocytes and proinflammatory cytokines, which resembles the immune activation that occurs in immune-mediated thyroid diseases. COVID-19-related thyroid disorders include destructive thyroiditis and onset or relapse of autoimmune thyroid disorders, leading to a broad spectrum of thyroid dysfunction ranging from thyrotoxicosis to hypothyroidism, that may worsen COVID-19 clinical course and affect prognosis. Expert opinion : Physicians should be aware of the possible occurrence of thyroid dysfunction during and after SARS-CoV-2 infection. Further longitudinal studies are warranted to evaluate potential long-term sequelae.

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“…A final sample size of 33 patients was included for longitudinal autoantibody analyses and 12 were assessed for cytokines, lymphocyte populations and anti-SARS-CoV-2 antibodies (Figure 1A). Serological data of 100 patients, previously reported, served as historical control group for autoimmune comparisons [9], and a group of 8 pre-pandemic healthy individuals was the control group for the immunological assessment [8].…”

Section: Methodsmentioning

confidence: 99%

“…In case of ANAs positivity, anti-SSA/Ro, anti-SSB/La, anti-ribonucleoprotein (RNP) and anti-smith (Sm) antibodies were further evaluated by a commercial ELISA. All the assay kits were from Inova Diagnostics, Inc (San Diego, CA, USA) as previously reported [9]. Assessment of anti-IFN-α antibodies was done by ELISA (Thermo Fisher Scientific, Waltham, MA) following manufacturer's specifications.…”

Section: Autoantibodiesmentioning

confidence: 99%

Persistent Autoimmune Activation and Proinflammatory State in Post-COVID Syndrome

Acosta-Ampudia

Monsalve

Rojas

et al. 2021

Preprint

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BackgroundThe immunopathological pathways enabling post-COVID syndrome (PCS) development are not entirely known. We underwent a longitudinal analysis of patients with COVID-19 who developed PCS aiming to evaluate the autoimmune and immunological status associated with this condition.MethodsThirty-three patients were included for longitudinal clinical and autoantibody analyses of whom 12 patients were assessed for cytokines and lymphocyte populations. Patients were followed during 7-11 months after acute COVID-19. Autoimmune profile and immunological status were evaluated mainly by enzyme-linked-immunosorbent assays and flow cytometry.ResultsLatent autoimmunity and overt autoimmunity persisted over time. A proinflammatory state was observed in patients with PCS characterized by upregulated IFN-α, TNF-α, G-CSF, IL-17A, IL-6, IL-1β, and IL-13, whereas IP-10 was decreased. In addition, PCS was characterized by increased levels of Th9, CD8+ effector T cells, naive B cells, and CD4+ effector memory T cells. Total levels of IgG S1-SARS-CoV-2 antibodies remained elevated over time.DiscussionThe clinical manifestations of PCS are associated with the persistence of a proinflammatory, and effector phenotype induced by SARS-CoV-2 infection. This long-term persistent immune activation may contribute to the development of latent and overt autoimmunity. Results suggest the need to evaluate the role of immunomodulation in the treatment of PCS.

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Latent rheumatic, thyroid and phospholipid autoimmunity in hospitalized patients with COVID-19

Cited by 52 publications

References 28 publications

The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives

Persistent Autoimmune Activation and Proinflammatory State in Post-COVID Syndrome

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