Welcome to the 13th International Congress on Autoimmunity interactive program

Displaying One Session

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Room
NIKOS SKALKOTAS
Session Type
PARALLEL SESSIONS

AUTOIMMUNITY TRIGGERED BY SARS-COV2 VIRUS (ID 783)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
10:30 - 10:45

IMMUNOTHERAPY OF NEUROIMMUNE DISEASES IN THE COVID-19 EPIDEMIC ERA (ID 786)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
10:45 - 11:00

IS007 - MOLECULAR AND IMMUNOLOGICAL EVIDENCE FOR SARS-COV-2 BEING THE AUTOIMMUNE VIRUS (ID 788)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
11:00 - 11:15

Abstract

Abstract Body

Cumulative evidence indicates that SARS-CoV-2 has the ability to induce hyper-stimulation of the immune system, leading to the synthesis of multiple autoantibodies. That is why the virus and the disease have been associated with various autoimmune disorders, including type 1 diabetes, Graves’ disease, autoimmune hemolytic anemia, polyneuritis cranialis, systemic lupus erythematosus, antiphospholipid syndrome, Guillain-Barré syndrome, rheumatoid arthritis, immune thrombocytopenic purpura, Miller-Fisher syndrome, vasculitis, Kawasaki disease, and more. Because of this, and many other reasons, SARS-CoV-2 has been called the autoimmune virus. However, experimental evidence is needed to support the induction of autoimmunity by this virus. In this review article, the following molecular and immunological experimental evidence will be discussed to strengthen the connection between SARS-CoV-2 and many autoimmune diseases:

1. Identification of cross-reactive epitopes from SARS-CoV-2 that share homology with human tissue antigens

2. Reaction of mouse, rabbit and human monoclonal antibodies to SARS-CoV-2 that react with human tissue antigens

3. Reaction of antibodies made against human tissue with SARS-CoV-2 spike and nucleoprotein

4. Detection of autoantibodies against human autoantigens in the sera of COVID-19 patients that cross-reacted with SARS-CoV-2 antigens

This experimental evidence further supports that the title of autoimmune virus given to SARS-CoV-2 is very well deserved.

Hide

O008 - COVID-19 AND THE HYPERFERRITINEMIC SYNDROMES (ID 706)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
11:15 - 11:30

Abstract

Background and Aims

Background: The hyperferritinemic syndromes include macrophage activation syndrome, adult onset Still's disease, catastrophic antiphospholipid syndrome, and septic shock. The syndrome is characterized by life threatening disease due to the development of a cytokine storm, multi-organ damage, elevated ferritin levels, and the response to similar therapies. Aims: Proof of concept for severe COVID-19 as a hyperferritinemic syndrome.

Methods

Methods: We reviewed the literature on elevated levels of ferritin in sever COVID-19.

Results

Results: In the third phase of SARS-COV2 disease, the hyper-inflammatory phase, elevated ferritin levels and the development of a cytokine storm are present. A new entity, multisystem inflammatory syndrome (MIS), described predominantly in pediatric patients, mimics MAS, yet develops without a previous symptomatic disease. In these patients, hyperferritinemia is prominent. Elevated ferritin levels in COVID-19 intensive care unit patients predicts mortality. Ferritin levels in non-survivors are much higher than those who survive. Consecutive measurements of a rising ferritin level may predict the need for assisted ventilation. Treatments such as corticosteroids, biologics, and IVIG may also be beneficial for COVID-19 as they are for the other hyperferritinemic syndromes.

Conclusions

Conclusion: Severe COVID-19 may be recognized as one of the hyperferritinemic syndromes.

Hide

COVID-19 AND MUSCULOSKELETAL INVOLVEMENT (ID 785)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
11:30 - 11:40

O009 - SERIAL MEASUREMENTS OF CIRCULATING CALPROTECTIN OUTPERFORM CRP AS PREDICTIVE BIOMARKER IN COVID-19 PATIENTS (ID 326)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
11:40 - 11:50

Abstract

Background and Aims

Circulating calprotectin (cCLP) has shown to be a promising prognostic marker for COVID-19 severity. We aimed to investigate the prognostic value of cCLP kinetics in COVID-19 patients hospitalized at intensive care unit (ICU).

Methods

Blood samples of 66 patients with COVID-19 admitted to the ICU of OLV Hospital, Aalst, Belgium were collected from 11/2020-05/2021. Sample collection was performed at admission and subsequently every 48 hours during ICU stay. Finally, cCLP (serum and citrate plasma; EliATM Calprotectin 2, Phadia 200, Thermo Fisher; serum/plasma protocol RUO) and C-reactive protein (CRP; cobas c501/c503, Roche) were measured on 301 samples. Linear mixed models were used to associate biomarker levels with mortality, need for mechanical ventilation, length of stay at ICU (LOS-ICU) and medication use.

Results

During ICU hospitalization, cCLP levels increased significantly in deceased patients (n=21/66) and decreased in non-deceased patients. In contrast, CRP levels decreased significantly for both patient groups. Patients requiring mechanical ventilation (n=25/66) expressed significantly higher cCLP and CRP values compared to non-mechanically ventilated patients, although without significant differences in evolution over time. Similar results were observed in patients with longer LOS-ICU compared to patients with shorter LOS-ICU. The effect of medication use (antibiotics, corticosteroids, antiviral and immune suppressant/modulatory drugs) on cCLP and CRP levels was consistent over time.

Conclusions

Serial measurements of cCLP provide prognostic information to ICU clinicians potentially guiding clinical management of COVID-19 patients.

Hide

O010 - AUTOANTIBODIES LINKED TO AUTOIMMUNE DISEASES ASSOCIATE WITH COVID-19 OUTCOMES (ID 220)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
11:50 - 12:00

Abstract

Background and Aims

The SARS-CoV-2 infection is associated with increased levels of autoantibodies targeting immunological proteins such as cytokines and chemokines. Reports further indicate that COVID-19 patients may develop a wide spectrum of autoimmune diseases due to reasons not fully understood. Even so, the landscape of autoantibodies induced by SARS-CoV-2 infection remains uncharted territory.

Methods

To gain more insight, we carried out a comprehensive assessment of autoantibodies known to be linked to diverse autoimmune diseases observed in COVID-19 patients, in a cohort of 248 individuals, of which 171 were COVID-19 patients (74 with mild, 65 moderate, and 32 with severe disease) and 77 were healthy controls.

Results

Dysregulated autoantibody serum levels, characterized mainly by elevated concentrations, occurred mostly in patients with moderate or severe COVID-19 infection, and was accompanied by a progressive disruption of physiologic IgG and IgA autoantibody signatures. A similar perturbation was found in patients with anosmia. Notably, autoantibody levels often accompanied anti-SARS-CoV-2 antibody concentrations, being both indicated by random forest classification as strong predictors of COVID-19 outcome, together with age. Moreover, higher levels of autoantibodies (mainly IgGs) were seen in the elderly with severe disease compared with young COVID-19 patients with severe disease

Conclusions

These findings suggest that the SARS-CoV-2 infection induces a broader loss of self-tolerance than previously thought, providing new ideas for therapeutic interventions.

Hide

O011 - SPERMATOGENESIS-RELATED AUTOANTIBODIES IN PATIENTS WITH ACUTE AND LONG COVID-19 (ID 693)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
12:00 - 12:10

Abstract

Background and Aims

Viruses are factors that may contribute to the production of autoantibodies and autoimmune diseases. Although few evidences have shown the involvement of autoimmunity in COVID-19 patients, numerous reports show that COVID-19 patients developed multiple types of autoantibodies, resulting from a hyperstimulation of the immune system or from molecular mimicry involving protein sequences in SARS-CoV-2 and self-components. Here, we assess the presence of IgG antibodies against spermatogenesis-related proteins in acute and long-COVID-19 patients.

Methods

A list of ~60 sequences containing at least 5 continuous residues shared by SARS-CoV-2 Spike protein and spermatogenesis-linked proteins were identified. Four peptides were chemically-synthesized. Using ELISA screening, we analyzed more than 300 sera from independent cohorts of acute and long COVID-19 patients. Sera from donors collected before the worldwide outbreak of COVID-19 were used as control.

Results

Among the four peptides analysed, two of them were recognized by IgG antibodies of COVID-19 patients. The two others didn’t show any reactivity. Correlative studies have been carried out to define possible links between peptide autoantibodies reactivity and clinical signs of disease or biological markers developed by patients. Some significant associations have been identified, which differ according to the gender of patients.

Conclusions

Preliminary data indicate first that some COVID-19 patients produce autoantibodies linked to spermatogenesis suggesting that cross-reactivity is a potential mechanism linking anti-viral immune responses, spermatogenesis-associated antigen alterations and possible male fertility disorders. Second, the peptide cross-reactivity identified in this study might be useful to predict possible after-effects of COVID-19 on fertility that may develop years after infection by SARS-CoV-2.

Hide

O012 - NEW ONSET RHEUMATOLOGIC SYNDROMES AFTER COVID-19 VACCINATION: SYSTEMATIC REVIEW (ID 758)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
12:10 - 12:20

Abstract

Background and Aims

To establish the frequency of new onset rheumatological syndromes associated to COVID-19 vaccination.

Methods

Systematic search for original research articles published between January 2021 and February 2022 was made. PRISMA guidelines were used. Electronic searches for cohort studies, case reports or case series were performed in Medline, EMBASE, Cochrane, Scopus, EBSCO, WoS and LILACS using the following key terms in all possible combinations: “Rheumatic diseases”, “Systemic Vasculitis”, “Myositis”, “Polymyositis”, “Lupus Erythematosus, Systemic”, “Antiphospholipid Syndrome”, “Still’s Disease, Adult-Onset”, “Rheumatoid arthritis”, “ANCA-associated vasculitis”, “Spondyloarthritis”, “Reactive arthritis”, “Sjögren's syndrome”, “Systemic sclerosis”, “Covid-19 vaccine” and “SARS-CoV2 vaccine”. Reference lists of all retrieved articles were manually reviewed.

Results

264 publications were reviewed.150 articles were evaluated and 45 reports with 62 patients (ACG 6, IgA vasculitis 5, SLE 8, ANCA vasculitis 22, adult-onset Still's disease 9, reactive arthritis 2, rheumatoid arthritis 1, Sjögren's syndrome 3, systemic sclerosis 2, Takayasu's arteritis 2, cryoglobulinemic vasculitis 1, Kawasaki disease 1) were included. 58.1% were women with a median age of 54 years (iQR 36.75-76/o), 51% developed rheumatic disease after the first dose and 49% after the second dose, with a median of 10 days (IQR 5.2-14 days). Patients were treated with variable steroids doses and in some cases inmunosupresive therapy , 54% achieved remissión or complete response (mean 6-12 weeks) and 22.4% partial response.

Conclusions

Despite the increasing number of documented cases, the incidence remains low compared to the benefits of vaccination. Rheumatologic syndromes associated to COVID-19 vaccination appeared to have a good short term prognosis. Long-term follow-up is required.

Hide

O013 - THROMBOCYTOPENIA IN PRIMARY ANTIPHOSPHOLIPID SYNDROME: SIGNIFICANCE IN CLINICAL IMPLICATIONS AND PROGNOSES (ID 15)

Date
Tue, 28.02.2023
Session Time
10:30 - 12:30
Session Type
PARALLEL SESSIONS
Room
NIKOS SKALKOTAS
Lecture Time
12:20 - 12:30
Presenter

Abstract

Background and Aims

Thrombocytopenia as a frequently seen clinical manifestation in patients with Antiphospholipid syndrome (APS) could be an independent predictor of recurrent thrombotic, obstetrical events and severe extra-criteria events.

Methods

This is a prospective study enrolling 218 consecutive patients diagnosed with primary APS (PAPS) between 2010 to 2021. A platelet count less than 100 × 109/L is defined as thrombocytopenia.

Results

Our cohort included 74 patients with thrombocytopenia and 144 patients with continuous normal platelet count. Comparison of baseline characteristics indicated that patients with thrombocytopenia had more visceral venous thromboses[10 (13.51%) vs 5(3.47%), p=0.009] and extra-criteria manifestations (mainly hemolytic anemia) [20 (27.03%) vs 17 (11.81%), p=0.007] than those with continuous normal platelet count. Hypocomplementemia tend to appear among patients with thrombocytopenia [19 (25.68%) vs 16 (11.11%), p=0.0099]. The aCL-IgG/IgM, anti-β2-glycoprotein I (GPI) and lupus anticoagulant (LA) were more frequently found in patients with thrombocytopenia. In survival analysis, thrombotic, obstetrical and severe extra-criteria survival rate was significantly poorer among patients with thrombocytopenia (Figure 1). In multivariate Cox regression, thrombocytopenia was an independent risk factor for all endpoint events[HR (95%CI) 2.93 (95%CI 1.31, 6.56), p=0.009; 8.00 (2.43, 26.37), p=0.0006; 16.84 (2.07, 136.73), p=0.008 respectively]. 12 (16.22%) patients with thrombocytopenia appeared to be no response (NR) to the received treatment. Their minimum PLT count was significantly lower than the non-NR group [22.5 (14.25, 36.25) vs 68.5 (26.25, 99), p=0.0112].

figure1_12.jpg

Conclusions

Thrombocytopenia could be a predictor to early identify PAPS patients at high risk of developing thrombotic events, pathological gestation and severe extra-criteria events.

Hide