Black and white microscope in a lab

Coronavirus:

Covid-19 News As It Relates to Autoimmune Disease

*Updated June 18, 2021

An ongoing timeline summarizing key COVID-19 scientific developments, especially as it pertains to autoimmune disease

analysis of remaining long-covid symptoms following recovery of initial infection

June 18, 2021

FAIRHealth published its eighth white paper study on COVID-19 this past Tuesday. This iteration of the report detailed findings regarding the experiences of long-haul COVID patients who were 30 days or more removed from their initial COVID-19 diagnosis. 

One key finding identified that 23.2% of patients who had COVID-19 experienced at least one post-COVID condition. Moreover, the severity of one’s COVID-19 case seemed to play a role in one’s susceptibility to long-haul COVID conditions. Regardless of whether a person was hospitalized or experienced no symptoms, at least some portion of those who had COVID-19 were found to be susceptible to developing long-haul COVID conditions. Specifically, 50% of patients were hospitalized for their COVID-19 symptoms, 27.5% of those who were symptomatic but not hospitalized, and 19% of asymptomatic patients developed a post-COVID condition.

The most common post-COVID conditions for these individuals across every age group included pain, difficulties breathing, hyperlipidemia, malaise and fatigue, and hypertension. In more refined sample populations, there were some notable variances. Specifically, there were some slight variations between the different age groups. For example, the pediatric population (those between 0 and 18) had intestinal issues as the third most common post-COVID condition rather than hyperlipidemia. 

The study also focused on the mental health implications of COVID-19. Four different mental conditions were also a focal point of the study. The research found that anxiety cases were the most common out of the four, with depression, adjustment disorders, and tic disorders following.

Notably, females were generally more affected by long-COVID conditions than males were, except for 12 specific conditions (including post-COVID cardiac inflammation). 

Mortality rates were the final focus of the long-haul COVID patient study. With this lens, researchers found that the severity of one’s COVID-19 experience played a role in their likelihood of surviving following 30+ days after their initial diagnosis. Specifically, the study found that those hospitalized and later discharged were 46 times more likely to die than those who had never been hospitalized. Additionally, those with intellectual disabilities who suffered from COVID-19 were the most likely group out of all preexisting conditions to die 30+ days after their COVID-19 diagnosis.

REGEN-COV Phase 3 Trial Improves Survival in Patients Hospitalized with Severe COVID-19

June 17, 2021

A Phase 3 RECOVERY trial in the UK found that Regeneron’s REGEN-COV antibody treatment reduced the risk of death by 20% in patients who had not mounted their own immune response against COVID-19. In addition, among patients without their own immune response, the median duration of hospital stay was 4 days shorter in the REGEN-COV group, and there was a greater proportion of patients discharged by 28 days. Research has also shown that the treatment remains effective against the main variants of COVID-19 in the United States. 

REGEN-COV is a mix of two monoclonal antibodies known as casirivimab and imdevimab. These antibodies block the infection ability of SARS-COV-2, the virus that causes COVID-19.

The results of the RECOVERY trial demonstrate that REGEN-COV can “alter the course of COVID-19 infection from prevention, to very early infection, all the way through to when patients are on a ventilator in the hospital.” Regeneron is working with the FDA to expand its current EUA to other populations such as hospitalized patients.

Safety, Immunogenicity and Efficacy of the Pfizer vaccine amongst 686 patients with Autoimmune inflammatory rheumatic diseases

June 16, 2021

Israel has been a model for vaccination success against COVID-19, with over 56% of the country being fully vaccinated. On Monday, June 13, Israeli researchers published the findings of the largest observational prospective study confirming the immunogenicity, efficacy, and safety of the Pfizer vaccine amongst 686 patients with autoimmune inflammatory rheumatic diseases (AIIRD). 

Rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus (SLE), systemic vasculitis, Behcet’s disease, and Susac syndrome were included under the umbrella of AIIRD. Patients were instructed to continue all medications besides rituximab (pending physician’s recommendations). 

Healthcare providers made up the majority of the control group (121 participants), and all participants were given a complete dose of the Pfizer vaccine three weeks apart. Post-vaccination status and activity were assessed within 2-6 weeks following the second dose.

While the immunogenicity rates (immune response towards a vaccine over a long period of time) amongst those on immunosuppressive therapies such as rituximab and glucocorticoids were lower than average, there were no post-vaccination symptomatic COVID-19 cases amongst those with AAIRD. This data is concurrent with available data recorded in the US and short-term efficacy research published by the American College of Rheumatology.

The prevalence of adverse events was also similar between patients with AIIRD and the control group. Post-vaccination disease remained relatively stable in the majority of patients with AIIRD, and adverse events were typically mild in nature. Major adverse events included herpes zoster (6 cases), uveitis (2), pericarditis (1), and two deaths several weeks after receiving the second dose. 

AIIRD patients exhibited a reduced antibody production rate of 86% following the vaccine compared to 100% in controls. Patients with psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus (SLE), and systemic vasculitis demonstrated a seropositivity rate (positive serum reaction when testing for antibodies) above 90%. The seropositivity rate amongst patients with rheumatoid arthritis was 82.1%. “The seropositivity rate in patients vaccinated within 6 months after rituximab treatment was below 20% but increased to about 50% in patients vaccinated 1 year after rituximab treatment.”

Treating MIS-C with Phase 3 Celiac drug

June 15, 2021

Even after a COVID-19 infection has passed, SARS-CoV-2 particles may linger in the gut and make their way into the bloodstream. This often triggers a cytokine storm and hyper-inflammatory response (MIS-C) within multiple areas of the body. These include the heart, lungs, kidneys, brain, and GI organs. 

A new study published in the Journal of Clinical Investigation focuses on the role of SARS-CoV-2 particles in the gut as the root cause of MIS-C weeks to months after a COVID-19 infection. The study tested the stool of 100 children, 19 of which had MIS-C and 26 who tested positive for a COVID-19 infection. 55 children served as healthy controls. 

18 of the 19 children who developed MIS-C had high levels of the SARS-CoV-2 virus in their stool. They also presented with high levels of zonulin, a protein that regulates the permeability of the digestive tract. “Increased circulating zonulin levels resulting in increased intestinal permeability have been reported in several diseases including auto-immune and hyper-inflammatory diseases such as celiac disease, inflammatory bowel disease, and Kawasaki disease.” 

Investigators obtained permission to treat one patient with Larazotide – a zonulin antagonist that strengthens the gut barrier and is currently in Phase 3 clinical trials for use in celiac patients. “Inhibition of intestinal permeability in a patient with MIS-C prevents SARS-CoV-2 antigens from trafficking into the bloodstream, conferring clinical benefit by addressing the underlying trigger for MIS-C rather than just the inflammatory consequences.” Researchers from this study are planning to conduct a clinical trial using Larazotide to treat MIS-C. They will use this as a starting point for the development of an effective treatment or even prophylaxis for COVID-19 infections amongst children.

Correction June 17: Originally stated that Larazotide has already gained FDA approval; it is currently in Phase 3 clinical trials. 

Targeted COVID-19 therapy: What can we learn from autoimmune kidney diseases?

June 10, 2021

A study was recently published on the ability of antiphospholipid antibodies (aPLs) to bind to the “EPCR-LBPA” complex. Antiphospholipid antibodies are autoantibodies that target and attack phospholipid-binding proteins. This, researchers found, initiates a self-amplifying signaling loop related to the innate immune complement and coagulation pathways. 

The EPCR-LBPA complex contains lipid-proteins that are located on the interior of blood vessels involved in the innate immune and clotting systems. The complex activates in the face of antiphospholipid antibodies, and has been found to be involved in severe COVID-19 and systemic lupus erythematosus (SLE) cases. Once activated, the body’s inflammatory pathways and the primary pathway for blood coagulation are initiated. This initiation results in the exponentially increased production of autoantibodies as immune cell and B cell synthesis increases. 

This finding by the German-based research group has proved notable, particularly because of its implications for treating both SLE and COVID-19 patients. Specifically, the study group found that blocking the EPCR-LBPA signaling pathway in mice subjects helped prevent aPL-related blood clotting and an autoimmune response, further illuminating a potential treatment path for human patients. 

Oxford-AstraZeneca vaccine found to be associated with small risk of developing rare autoimmune blood disorder

June 9, 2021

A new study, published today in Nature, has reported the observance of a slightly increased risk of developing immune thrombocytopenic purpura (ITP) following inoculation with the Oxford-AstraZeneca vaccine. ITP is a rare autoimmune condition that results in excessive bruising or bleeding due to a decrease in the number of platelets in the blood.

The study looked at 2.53 million adults in Scotland who received their first doses of either the Oxford-AstraZeneca or Pfizer-BioNtech vaccine. There was no increased risk of blood disorders observed with the Pfizer-BioNtech vaccine. However, the Oxford-AstraZeneca vaccine risk of developing ITP was estimated at 1.13 cases per 100,000 people*. Risk factors found to be associated with developing post-vaccination ITP and other blood disorders included older age, male sex, smoking, and having other underlying conditions. 

* This very small risk is important but needs to be seen within the context of the overall benefits of receiving the vaccine for most people. ITP is still a very rare vaccine-induced adverse event and researchers plan to update their analysis as the vaccine program is extended to a larger demographic.

Can Vitiligo protect against the SARS-CoV-2 virus?

June 8, 2021

The Amsterdam Institute for Infection and Immunity has released a research proposal hypothesizing that non-segmental vitiligo, an autoimmune skin disorder, may protect against the SARS-CoV-2 virus developing into a COVID-19 infection.

The researchers hypothesize that vitiligo could lower the risk for COVID-19 development and clear the viral infection more efficiently. “Conversely, in case of COVID-19 development, vitiligo autoimmunity may influence the cytokine storm-related disease burden.” There is also a potential for a COVID-19 infection to increase vitiligo flare-ups, or increase the activity of the autoimmune condition. Read more about the influence of cytokine storms in the development of autoimmune disease in our article. 

Protection against COVID-19 relies on both innate and adaptive immunity. Patients with vitiligo display both adaptive and innate immune responses which, according to the study’s researchers, can result in clearing COVID-19 infections. To test this hypothesis, the researchers propose reviewing patient data registries while also employing a questionnaire study amongst patients with vitiligo and controls. Participants will range from ages 16-55, and the study will account for gender differences and co-morbidities with other autoimmune diseases in its analysis. “Since the history of autoimmune co-morbidities of both vitiligo patients and controls is also collected, we can subsequently determine the effect of other frequently found autoimmune diseases on COVID-19 disease development and severity.”

Due to the high prevalence of vitiligo worldwide, the study will be conducted internationally. 

Data from 1,500 rheumatic disease patients shows vaccine is well tolerated

June 7, 2021

Data recently sourced from the European League Against Rheumatism (EULAR) shows that the COVID-19 vaccine is well tolerated amongst patients with rheumatic disease. The registry was launched February 5, 2021, and includes reports from 28 countries across Europe. 1,519 patients were reported to the registry as of April 27, with close to two-thirds being from women. To learn why women experience side-effects from vaccines more often than men, check out our article. 

“The majority (91%) had inflammatory RMDs [rheumatic and musculoskeletal diseases]. Inflammatory joint diseases accounted for 51% of cases, connective tissue diseases 19%, vasculitis 16%, other immune mediated inflammatory diseases 4%, and non-inflammatory/mechanical RMDs 9%.” Reports of side effects were submitted most often from patients living with these common diseases: rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and axial spondyloarthritis.

Potential vaccine side effects were reported by 31% of patients included in the registry, while disease flares – to include arthritis, joint pain, cutaneous flare, and fatigue – occurred in 5% of patients. 1.2% were labeled as severe flares. Mild symptoms included fatigue, headache, muscle pain and most commonly, pain at the injection site. 

Overall, experts are reassured by these safety profiles, as the majority of adverse events were similar to the general population, short-term and mild in nature. 

Covid-19 infection may lead to influx of autoantibody production

June 4, 2021

Yesterday, The University of Birmingham published the results of a study investigating the autoimmune response of COVID-19 patients. More specifically, researchers explored the type and frequency of autoantibody production in both short and long-term symptoms. Autoantibodies – antibodies produced by the immune system that can cause autoimmune disease by targeting one or more of the body’s own proteins – have recently been of particular interest to researchers looking into COVID-19. To learn more about autoantibodies in the development of autoimmune diseases, check out our article. 

Graphic explaining role of autoantibodies in autoimmune disease and covid-19utoantibodies in AD and COVID-19

In their study, researchers split test subjects into four cohorts to compare the common autoantibodies produced in COVID-19 patients versus non-COVID-19 patients. The first cohort consisted of a control group of non COVID-19 patients in the intensive treatment unit (ITU). The other cohorts included patients with acute cases of COVID-19 in the ITU and patients with previously severe cases of COVID-19 who had since left the ITU. The final test group included patients with mild cases of COVID-19 who had not been admitted to the ITU. For each of these groups, the researchers tested patient samples for specific autoantibodies. 

The study, supported by the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI), found that COVID-19 patients had significantly more autoantibodies than those in the control group. The subgroups of COVID-19 patients who exhibited severe active or recovered cases also demonstrated significantly more frequent instances of possessing autoantibodies than the control group. Mild cases exhibited autoantibodies in their system less frequently but still more than the control group.

These findings imply that COVID-19 cases are still open-ended and do not necessarily resolve when patients are no longer contagious.

Immunocompromised patients exhibit low antibody response even after 2 doses of mRNA vaccine

June 3, 2021

This past March, results of a study monitoring the immune response to the Covid-19 vaccine in solid organ transplant patients indicated that antibodies were detected in only 17% of patients after the first dose of an mRNA vaccine. Since then, data from the same study has been published on the antibody response to the second dose of an mRNA vaccine in immunocompromised persons. Among 658 participants who received two doses of an mRNA vaccine, 15% had measurable antibody response after dose 1 and dose 2. Among 473 participants on antimetabolites, 8% exhibited an antibody response after dose 1 and dose 2. 

“Poor humoral response was persistently associated with use of antimetabolite immunosuppression.” Unfortunately, this may mean that immunocompromised individuals, even after taking a full dose of the vaccine, will not exhibit protective immunity to SARS-CoV-2. “Although no threshold has been established for protective immunity, antibody levels were well below that which has been observed in immunocompetent vaccines.” To read more about how people living with autoimmune disease and taking medications with antimetabolites may be affected by the vaccine, check out our Vaccine and Autoimmune Disease FAQ page and recommendations for those with specific autoimmune diseases.

“If someone had no, or limited, immune response to two doses, will a third dose help? Should the third dose be of the sample platform or a different platform? Is it reasonable for some patients to reduce immunosuppression, risking rejection, just to achieve an immune response? How do B cell and T cell responses look in immunosuppressed people?” These are some questions the National Vaccine Research Study for Transplant Recipients hope to answer, which is ongoing and currently still open for enrollment.

The NIH begins trial on mixing Covid-19 vaccine boosters

June 2, 2021

A trial funded by the NIH has entered Phase 1/2 testing to study COVID-19 vaccine boosters from different manufacturers on fully vaccinated adults

While it has not been determined whether boosters will be necessary, Dr. Fauci has stated that “we need to prepare for the possibility… to counter waning immunity and to keep pace with an evolving virus” (1).

The trial includes 150 participants who have been fully immunized with either the Johnson & Johnson, Moderna, or Pfizer vaccine. “Twelve to 20 weeks following their initial vaccination regimen, participants will receive a single booster dose of the Moderna COVID-19 vaccine as part of the trial.” Those who have not been fully vaccinated are eligible to enroll as part of a separate cohort, in which volunteers will receive two doses of the Moderna vaccine and will receive a third dose of a vaccine 12-20 weeks later. 

“All trial participants will be followed for one year after receiving their last vaccination as part of the study,” and will provide blood samples to evaluate the antibody response to current and variant strains of SARS-CoV-2. The initial results are expected by the end of Summer 2021. 

This is the first US trial to test the effects of mixing vaccines, while the Com-COV study began earlier this spring. Com-COV is a “UK multi-centre, participant-masked, randomized heterologous prime-boost COVID-19 vaccination study,” monitoring the effects of mixing vaccine doses between AstraZeneca, Pfizer, Moderna, and Novavax (2). 

While participants are experiencing higher rates of adverse events, the vaccine is still being deemed safe as the side effects are not severe. Reported side effects include fever, chills, headache, fatigue, joint pain, malaise, and aching muscles. Symptoms have reportedly been “short lived, and there [are] no concerns from the limited hematology and biochemistry data available.”

Preliminary data shows that those vaccinated with both the AstraZeneca and Pfizer vaccines are producing robust antibodies to SARS-CoV-2. Studies incorporating the Moderna and Novavax vaccines are also ongoing. Data around the primary immunological outcome is planned to be released in June 2021. 

Update June 3*

Canada has also instituted a new policy in which citizens may receive a Pfizer booster after one dose of the AstraZeneca vaccine. This is due to vaccine shortages across Canada; currently less than 6% of Canada’s population has been fully vaccinated.

The National Advisory Committee on Immunization also stated that Moderna and Pfizer vaccines may be used interchangeably between doses, although it’s recommended that people complete their vaccination schedule using the same manufacturer.

Research on lasting immunity to SARS-CoV-2

June 1, 2021

New research published in Nature has shown that immunity to SARS-CoV-2 can last from one year to possibly a lifetime, as a “SARS-CoV-2 infection induces a robust antigen-specific, long-lived humoral immune response in humans.”

The research, conducted at Washington University in St. Louis, studied participants who had been previously infected with Covid-19. Blood samples from 77 participants who experienced mild Covid infection were studied at three-month intervals starting at one month post-infection. Antibody levels declined sharply during the first four months and then steadily thereafter, and remained detectable at least 11 months post-infection. Bone marrow samples were also taken from 18 participants 7-8 months after infection, 15 of which exhibited memory B cells. 

“Bone marrow plasma cells are a persistent and essential source of protective antibodies,” and memory B cells contained in the bone marrow remain dormant and ready to produce antibodies in case of re-exposure to the virus. This may even include variants. 

Immune memory after fighting a live virus from natural infection is different to vaccine immunity, in which the body is exposed to a deconstructed viral protein. Those immunized 6-12 months post Covid-infection may have a different immune response than those who have not experienced infection and get immunized. Thus, boosters are not necessary for those previously infected with Covid-19 who have also been inoculated with a full dose of the vaccine. To learn more about how each dose of the mRNA vaccine produces separate antibody responses, check out our article.

6 month effects of Multisystem Inflammatory Syndrome in children

May 27, 2021

Multisystem Inflammatory Syndrome (MIS-C) is a hyper-inflammatory response occurring in children following COVID-19 infection. While more research has been conducted on the symptoms of this syndrome, not much is known about its long term impact on the overall health of children.

The Lancet Child and Adolescent Health Journal published a study giving closer insight into the long term effects of MIS-C. The study followed the outcomes of 46 adolescents with MIS-C (known as PIMS-TS in the United Kingdom) 6 months after being discharged from the hospital. All of the children included in the sample experienced systemic inflammation, as well as gastrointestinal  and neurological symptoms.

The most notable symptoms among the findings were psychological distress such as “trauma and anxiety,” along with a reduction in “functional exercise capacity.” It is still unclear, however, if these symptoms are a result of preexisting physical and psychological  conditions or the impact of the COVID-19 pandemic in general. Nonetheless, the most severe symptoms from MIS-C were resolved by 6 months. Future research regarding outcomes of MIS-C beyond the 6 month mark will be necessary to further understand the long-term impact of this syndrome. 

Gastrointestinal issues persist in many, months after COVID-19 infection

May 26, 2021

Diarrhea and other gastrointestinal (GI) issues are known to be non-respiratory COVID-19 symptoms during an active infection. However, a team of researchers in Italy were curious whether their patients were continuing to experience these symptoms after their period of infection ended. Their study utilized a self-report survey, which was emailed to patients that had been treated for COVID-19 in March and May 2020 at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan. Hospital workers who had tested negative for COVID served as controls. 164 COVID-19 survivors and 183 uninfected controls submitted their survey responses. The results indicated that loose stool was ranked as the most commonly experienced GI issue and it appeared twice as frequently in the responses of survivors when compared to controls.

Covid-19 and the development of autoimmune thyroid disease 

May 25, 2021

A recent literature review illuminated the association between both relapsing and newly diagnosed thyroid disease, to include Grave’s disease, following a Covid-19 infection. Graves’ disease is an autoimmune disease where the immune system attacks the thyroid, causing an overproduction of hormones (hyperthyroidism). 

Reports were usually documented one month after a Covid-19 infection. Cases showed that a Covid-19 infection may aggravate autoimmune thyroid disease through the development of a cytokine storm. Read more about cytokine storms, autoimmune disease, and Covid-19 infection in our article that dives into the juxtaposition of both the Sars-CoV-2 virus and autoimmunity.

Graphic explaining role of hyperferritinemia and cytokine storms in autoimmune disease and covid-19

Data accumulated in the literature review indicates that the thyroid hormone plays a role in protecting the lungs from injury, to include injury from Covid-19. Only a small fraction of the literature covers patients developing autoimmune hypothyroidism, and it has yet to be determined if these cases preceded infection or were triggered by it. The literature is also unclear whether Covid-19 definitively increases the risk of developing autoimmune hypothyroidism. That being said, the “known association between COVID-19, the development of cytokine release syndrome, and the triggering of autoimmunity, supports the hypothesis of COVID-19 triggering autoimmune thyroid disease, including autoimmune hypothyroidism.

There has been an influx of literature covering patients with Graves’ disease (one type of hyperthyroidism), including how these patients may experience enhanced symptoms of both Graves’ disease and Covid-19. Additionally, around 15% of patients experiencing mild to moderate cases of Covid-19 have experienced thyroid dysfunction.

Researchers from this study are calling out for thyroid function to be routinely assessed when caring for patients with a Covid-19 infection. Further research must be conducted to clarify whether a SARS-CoV-2 infection targeting the thyroid is influenced by patient co-morbidities, genetic factors, or disease history. 

Research developments on the World’s Prominent Covid-19 vaccines

May 19, 2021

Researchers around the world are creating and testing close to 100 vaccines in an effort to combat the novel coronavirus. The following Vaccine Comparison Chart provides a breakdown of leading vaccines which have shown promise through pre-clinical data, completed Phase 1/2/3 clinical trials, and have been authorized for emergency use.

Preclinical data is collected when testing a vaccine on cells and animals. If an immune response is detected, the study moves forward as a Phase 1 safety trial by testing the safety of the vaccine on a select number of people (typically around 20-80 people).

If the dosage is deemed safe and effective, the trial progresses to a Phase 2 expanded trial, in which hundreds of people receive the vaccine. At this stage, participants are split into groups to observe the vaccine’s efficacy and safety across a spectrum of ages.

A Phase 3 efficacy trial tests for vaccine efficacy against volunteers who receive a placebo. Thousands of participants are included in the trial, and an efficacy rate is determined for the vaccine against a virus.

Due to the nature of the coronavirus, some vaccine trials underwent combined phases (e.g. Phase 1/2) in order to accelerate development.

CDC announces recommendation of Pfizer Vaccine for 12-15 Year olds

May 13, 2021

There have been over 1.5 million cases of COVID-19 amongst children, with more hospital cases than the annual flu in an average year (1). Most children with COVID-19 have mild or no symptoms, however some children can develop multisystem inflammatory syndrome (MIS-C) after a COVID-19 infection and require hospitalization.

Yesterday, the CDC announced their recommendation to use the Pfizer vaccine in children ages 12-15 (2). While 12-15 year olds account for roughly 5% of the US population, their ability to transmit the virus is thought to increase with age, and inoculating this age group against COVD-19 will increase immunity as a whole. Reports from clinical trials submitted to the FDA and reviewed by the CDC’s Advisory Committee on Immunization Practices verify the dose used for adults is safe and effective in this younger age group. This means many of the unused vaccine doses can be redirected to inoculate children.

FDA extends Pfizer Vaccine EUA to children 12-15 years old

May 11, 2021

On Monday, the FDA granted Pfizer emergency use authorization of their vaccine in children ages 12-15 years old. This is the first vaccine authorized for persons 12+ years old. 

In a Phase 3 clinical trial, 2,260 participants ages 12-15 were given a placebo or two doses of the vaccine, 21-days apart. Eighteen cases of symptomatic COVID-19 were recorded in the placebo group, but none were recorded amongst children who received the vaccine. The trial showed a “vaccine efficacy of 100% in participants with or without prior SARS-CoV-2 infection and robust antibody responses.” The vaccine was also “well tolerated,” and side effects were comparable to those seen in clinical trials amongst young adults, ranging from 16-25 years of age.

Pfizer is continuing to collect data on asymptomatic cases from clinical trial participants, and participants will be monitored “for long-term protection and safety for an additional two years after their second dose.” 

While the risk of children catching COVID-19 is low, the risk of developing multi-inflammatory syndrome (MIS-C) is higher than the potential risk of experiencing symptoms from the vaccine. Additionally, being vaccinated against COVID-19 mitigates the development and spread of variants

The CDC’s Advisory Committee on Immunization Practices will be convening shortly to review the clinical data and make recommendations on the vaccine’s use in adolescents. After their endorsement, immunizations can begin. The data from Pfizer’s trial has also been submitted to the European Medicines Agency and other regulators to extend the EUA.

The CureVac Vaccine

May 10, 2021

The German company, CureVac, is in the process of finalizing an RNA vaccine against COVID-19 with the culmination of its Phase 3 trial (1). The trial included 40,000 participants across Latin America and Europe. If the data shows the vaccine to be safe and effective, this may be the third RNA vaccine authorized for emergency use. Moreover, the CureVac vaccine is refrigerator-stable, making it more transportable than the Pfizer and Moderna vaccines. This gives CureVac an unique opportunity to supply vaccines to more remote locations, as well as locations that have yet to be supplied with ample doses, like lower and middle-income countries.

Data from the trial is expected by mid-May with promising results against variants such as the B.1.351 variant.

Pfizer submits application for FDA approval of COVID-19 vaccine

May 7, 2021

This morning, Pfizer-BioNTech submitted a Biologics License Application (BLA) to the FDA for approval of their COVID-19 vaccine. Currently, the Pfizer vaccine has been granted an EUA due to the state of the pandemic, which allowed them to provide safety and efficacy data from two months of trials versus the standard six months. “Data to support the BLA will be submitted by the companies to the FDA on a rolling basis over the coming weeks, with a request for Priority Review” (1).  

The Pfizer vaccine has been readily available since mid-December 2020. Alongside their Phase 3 clinical trial, data regarding the vaccine’s safety and efficacy has been collected from the 170+ million doses administered in the U.S.

Pfizer is currently the only vaccine manufacturer authorized for people 16+ years of age. The approval would cover the same ages, even though Pfizer is currently applying for an EUA extending use of their vaccine to children 12-15 years of age. They expect to apply for final approval after acquiring six months worth of data after the second dose is administered.

Yale to begin study on Covid long-haulers

May 7, 2021

Yale Medicine is launching a collaborative study on Covid long-haulers and the Covid vaccine

Yale will be recruiting participants with long-term symptoms following a Covid-19 infection, who have not been vaccinated yet. Blood and saliva samples will be collected prior and post vaccination to compare and correlate immune responses in long-haulers and symptom changes (if any). Participants will evaluate any changes to their post-Covid conditions after being vaccinated. Researchers will also study the mechanisms behind how the vaccine resolves post-Covid conditions – whether the vaccine is stopping a harmful immune response, resetting the immune system, or is fighting against residual virus.

Reportedly, 30-40% of long haulers who receive the vaccine experience improvement of symptoms like brain fog, gastrointestinal issues, and shortness of breath. Autoimmune reactions are one possible reason why Covid-19 patients continue to experience symptoms 4+ weeks after infection, and those with compromised immune systems are thought to be more likely to experience long Covid.

Rare Skin Reactions Following COVID-19 Vaccines Are Being Studied

May 6, 2021

Recent findings from the COVID-19 Dermatology Registry, run by the American Academy of Dermatology (AAD) and the International League of Dermatologic Societies, helped shed some light on the skin reactions reported after Moderna and Pfizer COVID-19 vaccinations in some individuals. In this study, 414 cutaneous reactions were reviewed, ranging from minor injection-site inflammation to an episode of shingles.

This research is unique because it delves into a whole range of reactions that had not been reported in vaccine clinical trials. Detailed information was collected from registry participants, including which type of vaccine was received and when and the morphology, timing, duration, and treatment of the skin reactions. The most common morphologies seen in this study were “delayed large local reactions, local injection site reactions, urticaria, and morbilliform eruptions.”

The skin reaction seen most often following the Moderna vaccine was urticaria, also known as hives. Researchers have found that in 50% of patients who experience chronic idiopathic urticaria, the immune system behaves erratically and attacks the body’s normal tissues, causing hives. Could this be the same mechanism happening in these rare cases following the COVID-19 vaccine? What can these post-vaccine reactions tell us about the field of autoimmunity as a whole? While we wait for scientists to uncover these answers, the good news is that none of the patients who had skin reactions reported severe adverse events, and less than half did not experience a recurrence with their second dose.

FDA may expand EUA of Pfizer vaccine to include 12-15 year olds

May 4, 2021

In March, Pfizer released the results of a clinical trial announcing that their COVID-19 vaccine displayed 100% efficacy in adolescents ages 12-15 years of age. The FDA has been reviewing the results of this Phase 3 trial, and an amendment to the current Emergency Use Authorization (EUA) of Pfizer’s vaccine is said to be determined next week. While 22% of the U.S. population is composed of children under 18 years of age, Pfizer is the only vaccine manufacturer in the U.S. currently authorized for ages 16-18. If the EUA is amended, Pfizer will be the first vaccine manufacturer authorized for use in people ages 12-18.

The COVID-19 Vaccine and Immune Disorders

April 27, 2021

The NIH will be conducting a clinical trial testing COVID-19 vaccine responses in people with immune deficiencies. These will include primary and secondary immune system disorders. In addition to learning how this population responds to the COVID-19 vaccine, this study aims to fill the gap regarding the clinical presentation of COVID-19 in those with immune deficiencies, “especially those who have inborn conditions involving deficits or dysregulations in antibody or cell-based immune responses to infections.”

Because those with immune disorders were excluded from the COVID-19 vaccine clinical trials prior to emergency authorization, this study will “characterize the features and adequacy of immune responses to COVID-19 vaccination in people with a range of immune deficiencies and dysregulation syndromes.” The study will include 500 participants, 400 of which have primary or secondary immune system disorders and are 16 years of age or older. If participants get vaccinated during the study, blood samples will be taken before and after vaccination and studied for “short-term immunological effects of immunization.”

Participants may voluntarily provide blood samples at different intervals following their last dose of the vaccine. Researchers will then assess the T-cell response and vaccine-induced antibody production in those with immune disorders compared to those without immune system disorders.

For more information regarding the study and enrollment, visit clinicaltrials.gov and use the search code NCT04852276.

Johnson & Johnson's COVID-19 vaccine has been resumed

April 26, 2021

This past Friday, the CDC lifted the pause on Johnson & Johnson’s COVID-19 vaccine usage. During this pause, which was announced April 13, the CDC confirmed an additional 9 cases of women developing thrombosis with thrombocytopenia syndrome (TTS) – blood clots with low platelet count – after receiving the J&J vaccine. The pause was initiated after 6 cases were presumed to be linked to the J&J vaccine. 13 of the 15 women were between the ages of 18-49.

Before getting the vaccine, recipients are encouraged to review the Janssen COVID-19 Vaccine fact sheet for recipients and caregivers, which includes side effects and risk information. That being said, the FDA and CDC state this vaccine is safe and effective in preventing COVID-19, and that the potential risks are outweighed by the benefits of receiving the COVID-19 vaccine. Furthermore, “at this time, the available data suggests that the chance of TTS occurring is very low, but the FDA and CDC will remain vigilant in continuing to investigate this risk” (1). 

The CDC and FDA continue to encourage those who have received the vaccine and experienced adverse effects to submit a report to the Vaccine Adverse Event Reporting System

6 patients with autoimmune inflammatory disorders develop shingles after mrna vaccine

April 20, 2021

The Tel Aviv Medical Center and Carmel Medical Center are conducting a study monitoring adverse events in patients with autoimmune inflammatory disorders. This includes patients with rheumatoid arthritis, vasculitis, myositis, Sjogren’s and spondyloarthritis for 6-weeks post COVID-19 vaccination. Of 491 patients with autoimmune inflammatory rheumatic diseases, six have been diagnosed with herpes zoster (shingles) for the first time after receiving an mRNA vaccine. Five cases occurred after receiving the first dose, and one after the second dose. Five of the six patients had not been vaccinated for shingles prior to receiving the COVID-19 vaccine. 

As of now, there have not been reports of shingles in clinical trials. That being said, there is limited data regarding the safety of COVID-19 vaccines in those with autoimmune and rheumatic disease, as immunocompromised participants were not included in clinical trials.

The authors of this study make it clear that these six cases do not determine a causal link, especially since other factors were likely to impact these outcomes. For example, the risk of shingles doubles in patients with rheumatoid arthritis. Risk also increases when taking high doses of prednisone, and doubles when being treated with certain anti-rheumatic drugs (such as tofacitinib, e.g. Xeljanz). “Potential mechanisms that might explain the pathogenetic link between mRNA-COVID-19 vaccination and herpes zoster reactivation are related to stimulation of innate immunity through toll-like receptors by mRNA-based vaccines” (1). 

Five patients received antiviral treatments which resolved their shingles; the five patients who had only received one dose before the onset of their symptoms received the second dose and did not experience other adverse effects.

Herpes zoster reactivation after vaccination has been studied with other diseases such as Hepatitis A and rabies (2). According to the authors of this study, these are the first reported cases of shingles reactivation after a COVID-19 vaccine. There has also been an uptick of shingles cases reported globally in the context of COVID-19 infection (1).

Further investigation and reporting of adverse events is crucial to understanding the prevalence of herpes zoster reactivation after COVID-19 infection. This study started in December 2020 and is ongoing.

Americans 16+ are eligible for COVID-19 vaccine

April 20, 2021

As of yesterday, Monday, April 19, all American ages 16+ are eligible to get the COVID-19 vaccine. According to the CDC’s COVID Data Tracker, over 132 million Americans have received one dose of the vaccine, and over 85 million have been fully vaccinated against the novel coronavirus. This 85 million figure represents 64.9% of Americans 65+ years of age. 

As of now, the Johnson & Johnson vaccine has been paused in all 50 states, with facilities distributing Moderna and Pfizer vaccines. During a press briefing this past Sunday, Dr. Fauci stated he expects a decision to be made by this upcoming Friday whether or not to continue the pause of Johnson & Johnson’s vaccine (1). This will be decided by the FDA. 

NIH funds clinical trial for new COVID-19 antibody therapy

April 19, 2021

The NIH is funding a Phase 2 clinical trial testing a monoclonal antibody for COVID-19 patients hospitalized with respiratory disease and low blood oxygen count. The FDA has previously issued emergency use authorization for COVID-19 antibody therapies by Eli Lilly and Regeneron

This new IC14 monoclonal antibody “binds to a human protein, CD14, that is found on the surface of immune cells circulating in the blood and airway fluid… CD14 helps immune cells recognize pathogens and injured or dying cells, alerting the immune system to danger and prompting it to respond” (1). 

CD14 may be one factor that induces a “cytokine storm.” Cytokines play an influential role in the immune response to a viral infection. Moreover, a cytokine storm provokes a severe immune reaction, and in COVID-19 patients, often causes “dangerous levels” of inflammation and tissue damage in the lungs, which can result in acute respiratory distress syndrome and failure (1). Blocking CD14 proteins using the IC14 antibody may decrease the immune system’s hyper response to a COVID-19 infection. To read more about cytokines and the overlap between a COVID-19 infection and autoimmune disease, check out our featured article. 

Researchers hope to determine whether the IC14 antibody decreases in-hospital recovery time for patients with COVID-19-induced respiratory disease, as well as its severity.

U.K. expands clinical trial for mixing COVID-19 vaccines between four manufacturers

April 16, 2021

The University of Oxford has expanded their clinical trial investigating the safety and efficacy of interchanging COVID-19 vaccines (1). While interchanging doses will primarily reduce vaccine shortages and allow for more rapid vaccinations, countries such as Germany have already updated vaccine recommendations for mixing vaccines. Those under 60 years of age who have received the AstraZeneca vaccine are recommended to get Pfizer or Moderna for their second dose. This is in response to several dozen blood clotting cases amongst German citizens under 60 years old (2). 

The U.K. clinical trial began in February, interchanging vaccine doses between AstraZeneca and Pfizer. As of this past Wednesday, it will expand to include the Novavax and Moderna vaccines. Participants will include women and men 50 years of age and older, who have already received one dose of the COVID-19 vaccine.

Investigators will observe any adverse reactions and compare efficacy rates between mixing doses versus using one manufacturer to complete the vaccine schedule.

NIH to study allergic reactions to mRNA vaccines

April 14, 2021

The NIH is sponsoring a clinical trial focusing on the risk of allergic reactions to Moderna and Pfizer’s mRNA vaccines. The COVID-19 mRNA vaccines are the first mRNA vaccines to be authorized by the FDA. 

This clinical trial will “determine whether people who are highly allergic or have a mast cell disorder are at increased risk for an immediate, systemic allergic reaction to the Moderna or Pfizer-BioNTech COVID-19 vaccines.” A systemic allergic reaction is qualified as a vaccine reaction in one or more regions of the body outside of the injection site. A mast cell disorder occurs when mast cells (white blood cells) are overly active or behaving abnormally, causing allergic reactions. Investigators will also “examine the biological mechanism behind the reactions and whether a genetic pattern or other factors can predict who is at most risk.”

Investigators aim to enroll 3,400 adults, aged 18-69, across 35 allergy-research centers. Approximately 60% of participants will need to have a history of “severe allergic reactions or a diagnosis of a mast cell disorder.” Allergic reactions can be related to food, insect stings, or an allergen immunotherapy that requires treatment with an epi-pen (epinephrine). Participants may also enroll if they have a history of immediate allergic reactions to a vaccine or one or more drugs. This study plans to enroll more women than men, as women account for the majority of severe allergic reactions to the COVID-19 vaccine. 

The clinical trial is currently enrolling participants.

Adenovirus vaccines shown to have hematological side effect concerns

April 13, 2021

As of yesterday, 6.8 million doses of the Johnson & Johnson (Janssen) vaccine have been administered throughout the United States. As of today, the CDC and FDA announced that they are reviewing six reported cases of a “rare & severe type of blood clot in individuals after receiving the vaccine” and are recommending a “pause” in the use of the single-dose Johnson & Johnson COVID-19 vaccine until a more thorough investigation can be conducted. The CDC will convene a meeting of the Advisory Committee on immunization practices (ACIP) tomorrow, Wednesday, April 14th, to further review these cases and assess their potential significance, and this analysis will also be reviewed by the FDA.

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This is not the first time we’re hearing about rare blood clots forming following COVID-19 vaccination, as reports from the Oxford-AstraZeneca vaccine have shown similar concerns. As of this week in Europe, 34 million people have received their first dose of the AstraZeneca vaccine and there are at least 222 suspected cases of dangerous blood clots and low platelet counts. On April 7, the UK Medicines and Healthcare Products Regulatory Agency stated that it had been “investigating at least 79 cases of strokes and clotting events tied to the vaccine, at least 18 of them fatal.”

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The side effects being observed following vaccination are a combination of cerebral venous sinus thrombosis (blood clotting in the sinus that drains blood from the brain) and thrombocytopenia (low levels of blood platelets that stop bleeding). Researchers have concluded that the side effects resemble an autoimmune disorder called heparin-induced thrombocytopenia (HIT) and significantly all six cases occurred among women between the ages of 18 and 48

Some experts initially theorized that vaccine-induced immune thrombotic thrombocytopenia (VITT) was occurring as a result of the antibodies created to fight the virus’ spike protein cross-reacting with Platelet Factor 4 (PF4). PF4 is involved in wound repair and inflammatory responses. If this were the case, it would be a safety concern for all COVID-19 vaccines. However, there is currently no evidence that messenger RNA-based vaccines (such as Pfizer and Moderna), which have been received by tens of millions of people, are causing similar blood clotting and low platelet issues

Regeneron antibody cocktail protects against COVID-19

April 12, 2021

Regeneron published a news release this morning stating their REGEN-COV antibody drug demonstrated high levels of protection against COVID-19 in a Phase 3 clinical trial. Those eligible to enroll in the study were not infected with COVID-19, did not show symptoms, did not have SARS-Cov-2 antibodies, and were living with someone who tested positive for COVID-19 within four days of enrolling. Of 1,505 volunteers, the antibody drug demonstrated 72% protection against symptomatic infection in the first week, and 93% in weeks thereafter. Those who received the antibody drug were also 81% less likely to get sick with COVID compared to those who received the placebo. On average, those experiencing symptoms “resolved their symptoms in 1 week, compared to 3 weeks with placebo. Infected individuals also cleared the virus faster with REGEN-COV.”

The REGEN-COV cocktail combines two drugs which mimic the antibodies created by the immune system when exposed to the virus. These monoclonal antibodies block the COVID-19 infection and neutralize the virus by diminishing its ability to “escape treatment.”

Even though experts are hoping Regeneron’s antibody cocktail will be used as a preventative measure for those who are immunocompromised, this population was not included in the clinical trial. That being said, this can be used as another option for high-risk COVID patients, those who experienced an adverse reaction after receiving their first dose of the COVID-19 vaccine, or those currently on immunosuppressive therapies (whose immune system may not respond well to the vaccine).

Regeneron plans to seek emergency authorization by the F.D.A to use the antibody cocktail as a preventative measure against the coronavirus. They are also seeking approval to administer the cocktail via injection versus intravenous infusion. 

Risk of contracting SARS-CoV-2 from surfaces is less than 1 in 10,000

April 9, 2021

The CDC has updated their SARS-CoV-2 and Surface Transmission guidelines, stating that the chance of contracting the coronavirus from surfaces is less than 1 in 10,000.

This comes after mounting evidence that the virus primarily spreads through airborne droplets, which can remain in the air for minutes to hours. “The length of time [the] virus remains suspended and is infectious depends on numerous factors, including viral load in respiratory droplets or in small particles, disturbance of air and surfaces, ventilation, temperature, and humidity.”

The infection-rate within the community, the amount of viral shedding by those who are infected, and the interaction between virus particles and the environment, are some factors that can increase the risk of viral transmission. This reinforces the necessity of wearing masks, especially in closed spaces, to reduce the spread of the virus both in the air and on surfaces.

The CDC also states that “in most situations, cleaning surfaces using soap or detergent, and not disinfecting, is enough to reduce risk.” The envelope (the outer layer of proteins and lipids) housing the genetic material of the SARS-CoV-2 virus is easily altered and can “degrade quickly upon contact with surfactants contained in cleaning agents and under environmental conditions.” Cleaning agents alone can remove the virus from surfaces. However, to “substantially inactivate” the virus on surfaces, it must be treated with a disinfectant product. Increasing ventilation is one way of reducing the risk of airborne transmission. 

Vaccine and Immune Response Efficacy Against SARS-CoV-2 variants 

April 6, 2021

The NIH published a news release on a recent NIAID study evaluating blood samples of COVID-19 patients to determine the efficacy of vaccines and the immune system’s ability to recognize and combat new SARS-CoV-2 variants. 

The emergence of new SARS-CoV-2 variants have raised concerns across the scientific community in regard to variant severity. COVID-19 variants are mutations in the SARS-CoV-2 virus, which ultimately make the virus less recognizable to antibodies and have the possibility to impact immune response and vaccine efficacy in future COVID-19 infections.

The study focused on CD8+ T cells; these are critical in establishing adaptive immunity against the virus by recognizing and killing viral proteins. The NIAID’s findings determined that the CD8+ T cells “are largely not affected by the mutations found in these variants, and should offer protection against emerging variants.” Prime immunity through vaccination and antibody creation require strong CD8+ T cell responses to recognize and protect against evolving SARS-CoV-2 strains. Investigators noted that more research is needed in understanding T cell defense against current and variant strains of SARS-CoV-2. That being said, this study provides a greater understanding of the SARS-CoV-2 virus, which is critical in developing vaccines with high efficacy rates against variants. 

Neon Turquoise colorized scanning electron micrograph of a T cell
Colorized scanning electron micrograph of a T cell. Credit: NIAID, NIH

 

Vaccine Eligibility by State 

April 5, 2021

As eligibility requirements expand to include more occupations and health statuses, those living with autoimmune disease will have access to the COVID-19 vaccine. Many states have already instituted universal eligibility, with others set to expand eligibility requirements in April. Check out this vaccine eligibility tracker updated regularly by the New York Times to view vaccine eligibility by state.

Changing Vaccine Manufacturers between Doses

April 2, 2021

The UK has established a vaccine protocol allowing patients to receive their first and second vaccine doses from different manufacturers. This is permissible if a second dose of the vaccine is unavailable or the manufacturer of the first dose is unknown. Currently, the only vaccines authorized for emergency use in the UK are by Pfizer, Moderna, and AstraZeneca.

The government protocol adds that “this option is preferred if the individual is likely to be at immediate high risk or is considered unlikely to attend again” (1). It is not required that patients receive a second dose if it means using a vaccine from a different manufacturer than the first dose. 

It is important to note that the Pfizer and Moderna vaccines use lipid nanoparticles (non-water-soluble liquids) to deliver the mRNA, whereas AstraZeneca uses an adenovirus to deliver a coronavirus spike protein. The double-stranded DNA is a “cousin” of mRNA, and the vehicles for delivery are unique. 

Trials are currently underway studying the safety and efficacy of mixing vaccines from different manufacturers. 

The CDC has made it clear that patients in the US should receive doses from the same vaccine manufacturer. The only time vaccines should be mixed is after receiving an mRNA vaccine and using a single-dose of Johnson & Johnson’s (J&J) vaccine as the second dose. The protocol for changing vaccine manufacturers between doses has not been tested and should be limited to “exceptional situations;” for example, where the patient experienced an adverse reaction after receiving the first mRNA vaccine (2). The J&J vaccine may be administered 28+ days after the first mRNA COVID-19 vaccine. Patients are encouraged to view the CDC’s list of Contraindications and Precautions beforehand if they’ve experienced an adverse reaction to the mRNA COVID-19 vaccine and are hoping to get the J&J vaccine. To learn more about getting vaccinated when you have an autoimmune disease and why contraindications can occur, check out our article. 

Because the vaccines deliver genetic material through different methods, use different fillers, and are designed to induce an immune response over a two-step process using the same delivery method, it is not yet possible to say whether interchanging vaccines will offer the same rate of efficacy or safety demonstrated in clinical trials.

Pfizer Confirms High Efficacy and Safety 6 months following second vaccine

April 1, 2021

Today, Pfizer released a statement confirming their vaccine has exhibited “high efficacy and no serious safety concerns through up to six months following [the] second dose.” 

The Pfizer vaccine has demonstrated a 91.3% efficacy rate against COVID-19 from seven days through up to six months after delivery of the second dose. The vaccine was 100% effective against severe COVID-19. The vaccine also demonstrated 100% efficacy against the B1.351 variant. This data provides “the first clinical results that a vaccine can effectively protect against currently circulating variants.” 

“Vaccine safety has now been evaluated in more than 44,000 participants aged 16 years and older with more than 12,000 vaccinated participants having at least six months of follow-up after their second dose.” Over the six month period, no serious safety concerns were observed after receiving the second dose.

It should be noted that “immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to the Pfizer-BioNTech COVID-19 Vaccine,” according to the U.S. FDA Emergency Use Authorization Prescribing Information. Data on Pfizer’s COVID-19 Vaccine administered to immunocompromised patients and people with autoimmune disease are incomplete, and are insufficient in informing risks for this population group. That being said, the FDA has said that those living with autoimmune disease may receive the COVID-19 vaccine. Patients should speak with their doctors regarding their healthcare plan before receiving the vaccine.

Pfizer vaccine demonstrates 100% efficacy in 12-15 year olds

March 31, 2021

Today, Pfizer-BioNTech published a press release announcing the results of their Phase 3 clinical trial in adolescents. The trial enrolled 2,260 participants in the United States, aged 12 to 15, with 1,129 participants in the placebo group and 1,131 participants in the vaccinated group. In the trial, 18 cases of COVID-19 infections were observed in the placebo group. Comparatively, none of the participants from the vaccinated group contracted COVID-19.

The vaccine is currently only authorized for people aged 16 and older in the United States, so this data may play a role in amending the vaccine’s emergency use authorization. It is important to note that while this data is still under review, this is promising news. The next steps include requesting expansion of the Emergency Use Authorization (EUA) by the FDA in the United States.

UK begins first COVID-19 Human Challenge Trial

March 30, 2021

On February 17, 2021, the UK approved the world’s first COVID-19 human challenge trial. The trial includes infecting up to 90 healthy participants with the virus and tracking just how it affects the human body, in an effort to aid the development of new vaccines and treatments for the novel coronavirus. This trial differs from typical clinical trials in that participants are not receiving an experimental vaccine but rather the pathogen itself. 

As of March 25, three volunteers who had been exposed to SARS-CoV-2 via nasal droplets finished quarantining at the Royal Free Hospital in London, and will continue to be monitored by a clinical team (1). These three patients did not experience unexpected issues or complications, and “are in good health(1). While further details of the study – including symptoms – will be kept confidential, researchers are recruiting more healthy volunteers between the ages of 18-30 to “establish the lowest possible dose of virus needed to cause viral replication in the nose and throat” (1). This study will also assist in understanding the progression of the virus once inside the body, natural immune response, and transmission.

COVID-19 versus seasonal influenza outcomes in autoimmune disease patients 

March 29, 2021

A recent multi-national study evaluated 30-day outcomes in hospitalized COVID-19 patients living with autoimmune disease (AD). Data was aggregated from centers including Columbia University Irving Medical Center and Information System for Research in Primary Care-Hospitalisation Linked Data in Spain. 133,589 patients diagnosed and 48,428 hospitalized with COVID-19 and living with autoimmune disease were included in the study.  

This international study used inpatient electronic health records (EHR) to collect and compare data of autoimmune disease patients infected with COVID-19 (between January and June 2020) to those infected with seasonal influenza (between 2017-2018). The most prevalent autoimmune diseases reported in the study were psoriasis, rheumatoid arthritis, and vasculitis. 

Data showed that roughly 30% of patients infected with COVID-19 were hospitalized while roughly 17% of influenza patients were hospitalized. On average, 30% of COVID-19 patients developed acute respiratory distress syndrome (ARDS) compared to 22% of seasonal influenza patients. Overall, hospitalized patients with COVID-19 and living with autoimmune disease experienced higher mortality rates and intensive care requirements compared to seasonal influenza patients (1).

This study highlights the prevalence of respiratory complications in COVID-19 patients versus influenza patients. It is clear that patients with autoimmune disease are at risk of more severe outcomes, complications and higher mortality rates after COVID-19 infection compared to influenza. This data is especially significant to confute assertions that the severity of COVID-19 parallels seasonal influenza; those who are immunocompromised should continue to take proper prevention measures to decrease risk of infection. 

Astrazeneca's COVID-19 vaccine demonstrates 76% efficacy

March 26, 2021

AstraZeneca has released an updated statement revealing their vaccine demonstrates 76% efficacy against symptomatic COVID-19 and 100% efficacy against severe COVID-19 and hospitalization. They previously stated a 79% efficacy based on data through February 17, 2021. Experts credit this discrepancy to a rounding error (1).

These results have been submitted for review to the Data Safety Monitoring Board, and will be the “basis for a regulatory submission for Emergency Use Authorization to the US Food and Drug Administration in the coming weeks” (2).

Some immunosuppressants dampen vaccine’s ability to create immune response

March 24, 2021

Last week, researchers at Johns Hopkins released the results of a cohort study measuring the antibody production of 436 solid organ transplant recipients following their first dose of an mRNA vaccine. Immunocompromised patients were excluded from mRNA clinical trials. The results of this study – although they’re exclusive to solid organ transplant recipients – can shed light on antibody production for those on immunosuppressant therapies. 

Participants collected blood samples at home with a TAII blood collection device or standard venipuncture in a medical office, which was then tested for antibodies against the SARS-CoV-2 spike protein. Tests were conducted 14-21 days after receiving the first dose of the Moderna or Pfizer vaccine. 

The median time since transplant was 6.2 years, and participants reported taking tacrolimus, corticosteroids, mycophenolate, azathioprine, sirolimus and everolimus as part of their maintenance regimen. Mycophenolate and Azathioprine have antimetabolite agents and can be used to treat autoimmune diseases such as lupus, rheumatoid arthritis, and IBD (1, 2). 

Antibodies were detectable in 75 of 436 participants following the first dose of the vaccine. This is approximately 17% of participants. Transplant recipients on antimetabolite therapies like Mycophenolate and Azathioprine were around 5x less likely to develop an antibody response than those not receiving such immunosuppression therapy. 

Overall, younger participants who were not under antimetabolite maintenance immunosuppression and received the Moderna vaccine were more likely to develop antibodies. Those who received the Moderna vaccine were more likely to develop antibodies than those who received the Pfizer vaccine (60% versus 31%). While clinical trials observed a 100% antibody response for both the Moderna and Pfizer vaccines, this vast discrepancy shows the impact of immunosuppressants on the vaccine’s ability to create a robust immune response. 

Vaccine recipients taking immunosuppressants should be made aware that they may still be high-risk to COVID-19. Dr. Segev, associate vice chair of surgery at Johns Hopkins University School of Medicine and Bloomberg School of Public Health, as well as a co-author of the study, is calling for the CDC to update their guidelines to reflect the ongoing risk immunosuppressed people, as well as certain autoimmune patients, may have to COVID-19 even after vaccination (3). This study is ongoing and researchers are in the process of collecting data on antibody production after receiving a second dose of the vaccine, as well as T-cell and B-cell responses when antibodies are scarce.

3-D rendering of B cell antibodies attacking COVID-19 cellGraphic rendition of yellow B cells (antibodies) attacking a COVID-19 cell

 

NIH Releases Statement Regarding AstraZeneca Vaccine

March 23, 2021

The National Institute of Allergy and Infectious Diseases (NIAID) published a news release today regarding AstraZeneca’s COVID-19 vaccine clinical trial, after being notified by the Data and Safety Monitoring Board that outdated information “may have provided an incomplete view of the efficacy data” (1). Which information is outdated has not been specifically disclosed. This statement was released one day after the NIH published a media advisory that the investigational AstraZeneca vaccine prevents COVID-19

The placebo-controlled trial included 32,449 adult participants across the US, Chile, and Peru, with approximately 20,000 receiving the vaccine versus 10,000 receiving a placebo. The vaccine was administered as two doses, four weeks apart, and demonstrated 79% efficacy in preventing symptomatic COVID-19. The vaccine showed 100% efficacy in preventing severe symptoms. 

Symptomatic COVID-19 was defined as having a SARS-CoV-2 infection and at least one respiratory symptom, or at least two of the following: loss of taste and/or smell, fever, muscle pain, fatigue, vomiting and/or diarrhea, and cough. Severe symptoms included a SARS-CoV-2 infection and at least one of the following: signs of severe systemic illness, respiratory failure, shock, significant acute renal, hepatic or neurologic dysfunction, ICU admission, and death. 

Similar to Johnson & Johnson’s COVID-19 vaccine, the AstraZeneca vaccine uses an adenovirus to deliver incomplete SARS-CoV-2 genetic material to the body; it does not carry a live SARS-CoV-2 virus. 

AstraZeneca published an update this morning following NIAID’s follow-up statement, stating they will “immediately engage” with the Data and Safety Monitoring Board and share the most up-to-date efficacy data within the next 48 hours (2). Any updated information provided by AstraZeneca will be reviewed by independent advisory committees to ensure accuracy before the FDA and CDC start the authorization process for the use of AstraZeneca’s vaccine in the U.S. It is currently available for use in over 70 countries (3).

Some states are lifting vaccine eligibility requirements

March 19, 2021

The following states will be lifting eligibility requirements for residents to be vaccinated: 

 

March 2021:

Utah (week of March 21, 2021)

Ohio (starting March 29, 2021)

 

April 2021:

Connecticut

Illinois

Kentucky

Maryland 

Missouri 

Rhode Island

 

Alaska and Mississippi have already instituted universal eligibility. 

As of today, March 19, 39.6% of adults 65 years and older have been fully vaccinated in the U.S. View more stats and daily updates regarding vaccine distribution in the U.S. with this COVID Data Tracker by the CDC. You can also check out this resource by The Wall Street Journal for a state-by-state guide on vaccine eligibility requirements.

Some long-haulers find relief after getting the COVID-19 vaccine

March 18, 2021

Long-haulers are sharing stories of symptom relief after receiving the COVID-19 vaccine. While anecdotal as of now, patients from across the country are reporting that their symptoms have improved or even resolved after getting their first dose of the COVID-19 vaccine. Survivor Corps, one of the largest patient communities advocating for COVID-19 long haulers, recently released a poll on Facebook asking members how they felt post-vaccination. As of March 18, 2021, 40% of participants said that their long-COVID symptoms improved after being vaccinated (1). 

University of California San Francisco is currently conducting a clinical trial studying the long-term impact of a COVID-19 infection. This observational study is investigating the “clinical consequences of a SARS-CoV-2 infection” to include immune activation, changes in immunologic function, and the development of medical conditions (2). The NIH also announced February 23 that they will be allocating more than $1.1 billion over the next four years to study the impact long-COVID.

Typically, long-haulers experience fatigue, shortness of breath, body aches, inability to concentrate, headaches, loss of taste and/or smell, as well as other symptoms continuing 6+ weeks after a COVID-19 infection (3). Experts are unsure as to why or how vaccination is leading to symptom relief for some long-haulers. Long COVID has been likened to Lyme disease, and the production of autoantibodies leading to autoimmune disease has also been discussed as a theory behind some long-COVID symptoms. Some hypothesize that the immune system may be getting a “boost” from the vaccine to resolve persistent symptoms (1, 4). 

You can find more news on long-haulers through the Survivor Corps website.

Updated CDC Guidelines on Vaccinations

March 10, 2021

The CDC updated their COVID-19 guidelines on March 8, 2021 for people who are vaccinated. Those who have been fully vaccinated are safe to: 

  • Gather indoors with other fully vaccinated people without masks
  • Gather indoors with unvaccinated people from one other household without masks
  • Do not need to quarantine after exposure to someone with COVID-19 unless symptoms are present

Of course, those who are immunocompromised or have an increased risk of severe COVID-19 symptoms should continue to take extra precaution.

It is still unclear how long immunity lasts after being vaccinated, how effective these vaccines are against certain variants, and just how much vaccines mitigate the spread of COVID-19 from person-to-person contact. Bearing these unknowns in mind, the CDC cautions everyone to continue wearing a mask in public places, maintaining physical distancing, avoiding crowded spaces, as well as getting tested if COVID-19 symptoms occur, even if they are fully vaccinated (1).

Type 1 Diabetes patients become eligible for covid-19 vaccine in 12+ states

March 5, 2021

The Colorado Department of Health along with 11 other states just raised vaccination eligibility requirements for type 1 diabetes patients as a “high risk” group (2, 3). In Colorado, anyone between the ages of 16-64 who have T1 diabetes and one other high risk condition will be eligible to get the coronavirus vaccine as early as today, March 5. They will be included in the 1B.3 vaccine group (1). This comes after Juvenile Diabetes Research Foundation’s (JDRF) extensive lobbying efforts to list T1 diabetes as a high risk condition alongside T2 diabetes (2).

As of now, the CDC’s vaccine recommendation includes frontline essential workers and people 75 years and older in Phase 1B. Persons 65 years and older and those at high risk for severe COVID-19 symptoms are included in Phase 1C. 

This can be seen as encouraging news for the autoimmune disease community, as health authorities begin taking certain high risk autoimmune diseases into account for vaccination priority. The rollout of Johnson & Johnson’s vaccine will undoubtedly aid these efforts by increasing vaccine availability. 

To find vaccine eligibility and prioritization criteria by state, view this resource by Kaiser Family Foundation. 

Autoimmune diseases reported to be triggered by SARS-CoV-2

March 4, 2021

The group at the Zabludowicz Center for Autoimmune Diseases of the Sheba Medical Center and the Laboratory of the Mosaic of Autoimmunity at Saint Petersburg State University have comprehensively investigated and reported the association between various common pathogenic viruses and the development of autoimmune and chronic inflammatory diseases. In light of the current global pandemic, they have also shifted their focus to include a recent (December 2020) review of the appearance of autoimmune diseases reported to be triggered by a SARS-CoV-2 infection. (1)

A list of Autoimmune Diseases and Autoantibodies associated with COVID-19 Infection

Table 1: Halpert, G., & Shoenfeld, Y. (2020). SARS-CoV-2, the autoimmune virusAutoimmunity reviews19(12), 102695. https://doi.org/10.1016/j.autrev.2020.102695

The Johnson & Johnson COVID Vaccine Receives Emergency Use Authorization by the FDA

March 2, 2021

The Johnson & Johnson COVID vaccine received emergency use authorization (EUA) by the FDA this past weekend. This single-shot vaccine is the third COVID vaccine to be released in the United States, with plans to deliver 16 million doses to the federal government by the end of March. Due to production issues, this will be significantly less than the 37 million dose figure released by Johnson & Johnson while recommendation by the FDA was still under review. The first 3.9 million doses, created in Johnson & Johnson’s Netherland factory, are expected to arrive in America by today, March 2 (2).

“A committee of independent advisors to the Centers for Disease Control and Prevention voted as expected to recommend distribution of the Johnson & Johnson vaccine to all adults in the United States” (2). That being said, it has not been decided whether states should prioritize this particular vaccine for certain population groups – including at-risk and immunocompromised groups – over others. 

The Johnson & Johnson vaccine has shown an 85% efficacy rate against severe COVID-19 cases, with complete protection against hospitalizations and death as of 28 days. A concern from officials and patients alike, it “appears to do well against the highly contagious B.1.351 variant” (3). 

In addition to being a single-dose, this vaccine can be stored in standard refrigerators instead of freezers, making it easier to transport and distribute. The Johnson & Johnson vaccine has also been shown to trigger less side-effects than Pfizer and Moderna; the side effects are usually more prevalent after the second dose has been administered (3). Again, this will not be an issue as Johnson & Johnson’s vaccine only requires one dose. That being said, Janssen Pharmaceuticals (owned and operated by Johnson & Johnson), instructs patients to let their medical provider know if they have “allergies… [and/or] are immunocompromised” before getting the Johnson & Johnson vaccine, and that “there is a remote chance that the Janssen COVID-19 vaccine could cause a severe allergic reaction… [usually] within a few minutes to one hour after getting a dose of the Janssen COVID-19 vaccine” (4). 

Check out this Vaccine Tracker by the New York Time for up-to-date information regarding vaccine research, production, testing and approval for around the world.

The VAXICOV study, autoimmune disease and vaccination concerns

February 25, 2021

The results of the international VAccinations against COVid-19 (VAXICOV) study were published this week, revealing patient concerns and expectations around receiving the COVID-19 vaccine.

Patients with systemic autoimmune or inflammatory rheumatic diseases were asked to participate in the online survey across 56 countries. Health care workers were also included as a control group.

The most commonly documented autoimmune conditions were systemic lupus erythematosus, spondyloarthritis, and rheumatoid arthritis. The median score for patients who reported “being afraid to get infected” with COVID-19 was 8, and afraid to “develop severe COVID-19” was 9 (1). That being said, only 54.2% of patients with systemic autoimmune or rheumatic disease were willing to get vaccinated against COVID-19 prior to seeing their specialist. 32.2% of patients were uncertain and 13% stated they were unwilling.

67.5% of patients were recommended by their specialist to get vaccinated – this is confirmation that the medical professional community at large is in favor of vaccinations for otherwise at-risk patients. Willingness to get vaccinated jumped to 67.5% post recommendation from their specialist. Uncertainty decreased to 28.4%, and unwillingness to 8.8%.

Additionally, the VAXICOV study confirms that patients with systemic autoimmune and inflammatory rheumatic diseases are generally willing to get vaccinated against COVID-19. “Willingness” to get a COVID-19 vaccine was associated with fear of getting a COVID-19 infection, not with fear around comorbidities or immunocompromised status. “These results show that a significant proportion of patients with systemic autoimmune or inflammatory rheumatic diseases who are at risk of severe COVID-19 do not perceive themselves as such, and highlight the importance of increasing patient education in this context” (1). Main concerns included a lack of context around COVID-19 vaccine data and testing, especially in regards to the new use of mRNA vaccines, as well as the risk of flare-ups and side effects.

Given the broad span of participants from across the globe, it is reasonable to consider these answers representative of the general population living with autoimmune and rheumatic diseases.

COVID-19, Autoantibodies, and Multisystem Inflammatory Syndrome in Children

February 23, 2021

Throughout the pandemic, cases have been reported of children experiencing a hyper-inflammatory response after a COVID-19 infection (1, 2). What was first described as a cluster of intense symptoms, has since come to be known as Multisystem Inflammatory Syndrome in Children (MIS-C). 

The pool of data around SARS-CoV-2 infection and MIS-C is still small, and a lack of consistency in clinical presentations of MIS-C make it easy for clinicians to misdiagnose symptoms for other conditions where hyperinflammation is prevalent, like Kawasaki disease, toxic shock syndrome, and macrophage-activation syndrome (MAS). Due to the general ambiguity around MIS-C’s cause and development, as well as its mechanisms for tissue damage, the CDC and WHO have constructed different clinical criteria for the diagnosis of MIS-C (3).

The American Academy of Pediatrics (AAP) recently published the results of an international survey detailing MIS-C cases from April-June 2020. Data was provided from 33 hospitals and included 183 pediatric patients ages 1.2 months to 18 years. In the clinical presentations of MIS-C, all patients presented with a fever (>100.4 F) and over 60% had gastrointestinal symptoms. The second most common symptom was cardiovascular. These findings coincide with previously published reports and classification criteria for MIS-C; other common clinical manifestations include dermatologic/ mucocutaneous symptoms, cardiovascular symptoms, respiratory symptoms, and neurologic symptoms (4). Examples can include rash, swelling of hands and/or feet, change to oral mucosa, pink eye, and swollen lymph nodes. It is unknown why a hyperimmune response occurs, and why autoantibodies against endothelial, gastrointestinal, and immune cells are produced. One study conducted by the Icahn School of Medicine found that MIS-C may share some pathophysiology with autoimmune disease. 

114 of the 183 patients included in the AAP survey tested positive for current or recent SARS-CoV-2 infection (3). Patients who did not test positive for COVID but presented symptoms concurrent to MIS-C may have experienced a COVID-19 exposure 2-6 weeks prior to the onset of symptoms (4). 

Continued research studying this occurrence will help to shed light on the long-standing damage this hyperimmune response may have on the body. Additionally, as criteria for clinical diagnosis is standardized, children experiencing MIS-C can have more immediate access to tailored therapies and treatment, to mitigate the often severe symptoms that accompany MIS-C. 

The Johnson & Johnson COVID Vaccine + Autoimmune Disease

February 16, 2021

In early February 2021, Janssen Pharmaceutical Companies of Johnson & Johnson requested emergency authorization by the FDA to distribute their COVID-19 vaccine. Come the end of the month, the FDA will be reviewing their request; if approved, the Janssen COVID-19 vaccine could be rolled out across the U.S. as early as the end of March. 

According to the press release on their website, this single shot vaccine is “85% effective overall in preventing severe disease, demonstrat[ing] complete protection against COVID-19 related hospitalization and death as of Day 28” (1). 

Within the trial, “moderate” COVID was defined as having received a lab-confirmed COVID diagnosis as well as experiencing the following symptoms: pneumonia, DVT (deep vein thrombosis), shortness of breath and/or abnormal oxygen and respiratory rates. “Severe” COVID includes “signs consistent with severe systemic illness, admission to an intensive care unit, respiratory failure, shock, organ failure or death” (1).

No anaphylaxis was observed during the clinical trials, and overall serious adverse events reported were actually higher from placebo groups than those who received the vaccine. While the population size was not released, it was confirmed that immunocompromised participants were in the study (1).

Janssen’s COVID-19 vaccine uses an inactive virus to deliver SARS-CoV-2 proteins to the body. These proteins are recognized as invaders by the body, signaling the production of antibodies as an immune response. This particular vaccine uses an adenovirus (which causes the common cold) as a vector (a device used to deliver genetic material) containing incomplete genetic material of the coronavirus. The genetic makeup cannot replicate; therefore, patients are not at risk for infection of SARS-CoV-2 from inoculation (2). 

Rheumatology International recently published a scientific review on the range of SARS-CoV-2 vaccines as they pertain to autoimmune inflammatory diseases. As of January 2021, there has been “no experience of viral-vector based vaccines against infectious agents in patients with [autoimmune inflammatory disorders]” (3). While this may spark initial concern, available data on vector-based vaccines in immunocompromised patients shows that these vaccines are not only well tolerated, but even more, severe adverse events are unlikely to occur (4). At the time of publication, only patients with rheumatic diseases have been included as an autoimmune disease population group in the most recent stage of clinical trials. While “well-known vaccines can provide guidance and partial confidence for the use of the ‘new vaccines,’” including more varied population groups going forward will ensure vaccine efficacy and safety for those living with autoimmune disease (3). 

The B.1.1.7 Coronavirus Variant

February 11, 2021

The B.1.1.7 coronavirus variant was first identified in the UK this past fall, emerging in Colorado soon thereafter. According to the CDC, there have been upwards of 1,000 cases caused by the B.1.1.7 variant across 34 states as of February 9, 2021. California and Florida, two states that have taken vastly different approaches for containing the novel coronavirus, have both reported the highest numbers of B.1.1.7 cases. 

While a preliminary report by the UK government’s NERVT advisory group indicates “there is a realistic possibility that…B.1.1.7 is associated with an increased risk of death,” research has yet to officially state if the B.1.1.7 variant causes more severe COVID symptoms (1). That being said, this variant has the potential to become the dominant strain of SARS-CoV-2, as its mutation is associated with a higher transmission rate than its predecessors. According to preliminary data, the B.1.1.7 variant is doubling in frequency every 9-10 days across the U.S. Moderna and Pfizer have released preliminary data verifying that their vaccines are likely to neutralize the B.1.1.7 variant; however, the efficacy rate may be negatively affected.

For regularly updated information and news on coronavirus mutations and variants, check out this comprehensive tracker created by The New York Times.

Scanning electron microscope image of SARS-CoV-2 emerging from the surface of cells.Scanning electron microscope image of SARS-CoV-2. Credit: NIAID-RML

 

clinical trial tests new antibody cocktail in patients with covid-19

February 10, 2021

On February 8, the NIH released a news statement announcing the implementation of a Phase 3 clinical trial for a new combination of antibodies as a therapy treatment for COVID-19.

“Antibodies are infection-fighting proteins naturally made by the immune system… [they] prevent viruses from infecting cells, usually by binding to the surface of the virus” (1). AZD7442 antibodies are the third antibody combination to be studied in patients currently hospitalized for COVID-19, being tested under a “master protocol” which allows investigators to trial multiple antibody combinations at the same time. This means less patients are receiving the placebo while providing a more robust pool of results on the efficacy of antibodies as a therapeutic measure.

AZD7442 antibodies work for a longer period of time once administered in patients infected with COVID, and may also function as a preventative measure against SARS-CoV-2.

Similarities Between COVID-19 and Autoimmune Disease

February 6, 2021

Recent studies have demonstrated the distinct relationship between the infectious disease COVID-19 and autoimmune disease. The review titled “COVID-19 and Autoimmune Diseases” by Yu Liu, Amr Sawalha, and Qianjin Lu delves into the most recent research on the similarities, which include: dysregulated immune responses, the promise of immunomodulatory drugs to treat both conditions, the detection of certain autoantibodies, and the development of autoimmune diseases after SARS-CoV-2 infection. Investigating the relationship between these diseases is critical in preventing and treating COVID-19, as well as understanding the risks for individuals living with autoimmune disease.

In some individuals, SARS-CoV-2 infection triggers immune system dysregulation with the overproduction and release of pro-inflammatory cytokines and, in effect, damage to one or multiple organ systems. Cytokines are proteins that signal the immune system to fight infection, but in excess they indicate the breakdown of self-tolerance. Similarly, autoimmune disease involves increased levels of pro-inflammatory cytokines, a loss of immune tolerance, and subsequent organ injury. As stated in the review, this parallel story between COVID-19 and autoimmune disease suggests that medications effective in treating autoimmune disease can have a similar impact on COVID-19. In fact, immunomodulatory drugs targeting excess cytokines (such as corticosteroids) are now being used to dampen the immune response in autoimmune disease as well as in severe COVID-19 in cases. While aiding in treatment of the disease, the fact that SARS-CoV-2 triggers immune dysregulation may also “have important implications in the development of vaccine strategies against this virus,” state the authors of the review (1).

Another likeness between autoimmune diseases and COVID-19 is the release of autoantibodies, which are proteins that can target and attack the body’s own immune system and organs (2). Antinuclear antibodies (ANA) and antiphospholipid antibodies (APL) are examples of autoantibodies found in both autoimmune disease and COVID-19 patients. The results of one study “showed that 45% of the [COVID-19] patients were positive for at least one autoantibody and patients with positive autoantibodies tended to have a worse prognosis” (1).

We are also beginning to learn that a loss of immune tolerance from COVID-19 can lead to full-blown autoimmune diseases such as Guillain-Barre syndrome (GBS) and systemic lupus erythematosus (SLE) (1). While more of these post-infection autoimmunity cases are likely to be discovered, researchers are still unsure whether individuals with preexisting autoimmune diseases are at higher risk of SARS-CoV-2 infection in the first place. Studies around the world have returned with conflicting results, and thus no clear consensus on the issue.

As the scale is poised to tip in either direction, the authors of the review urge autoimmune disease patients to continue physical distancing, washing their hands, wearing masks, and sticking to their medical protocols – including any prescribed immunosuppressive drugs – to prevent flare-ups and avoid potential organ damage. While there are still unknowns about COVID-19 and its connection to autoimmune diseases, the evolving clues about their relationship bring us hope in understanding and characterizing COVID-19.

The Development of Autoantibodies after Contracting COVID-19

February 3, 2021

While COVID-19 short-term impacts have been identified, the long-term effects of the disease are still widely unknown. Many new studies have shed some light on the potential long-term consequences of COVID-19, focusing on autoimmunity. A recent study from The University of Stanford School of Medicine directly links COVID-19 to autoimmunity and autoantibody development. This suggests that severe cases of COVID-19 can lead to a progression of “symptomatic classifiable autoimmunity in the future” (1). The linking of coronavirus to an increase in autoimmunity indicates significant concerns, especially for those with autoimmune diseases, whose immune systems are already impacted.

Many autoantibodies were found in this study’s COVID-19 patients, but the most common was Immunoglobin G (IgG) autoantibodies. IgG antibodies make up most of our blood’s antibodies, protecting us from infection, meaning that IgG autoantibodies pose potential threats as they could be pathogenic. The study used protein chips to track protein interactions that measure distinct IgG autoantibodies associated with connective tissue disease (CTD), anti-cytokine antibodies (ACA), and anti-viral antibody response.

This study’s findings signify that over 58% of the COVID-19 patients had at least one ACA that targeted interferons (IFN), which are proteins that inhibit virus replication. This emphasizes that the autoantibodies produced by infection from COVID-19 attack the vital proteins needed to protect the immune system. This study also measured autoantibodies levels throughout the patient’s sickness period, distinctly showing that the levels of autoantibodies increased in many patients over time. This is particularly important because it demonstrates that infection from COVID-19 can lead to the development of new autoantibodies.

Throughout this pandemic, many discoveries have been found, including one linking COVID-19 to autoimmunity. Such studies are leading scientists to a better understanding of the COVID-19 virus and the rise to autoimmunity and other diseases.

The P.1 Coronavirus Variant

January 25, 2021

A coronavirus variant (called P.1) that was first detected in Brazil was just confirmed by the Minnesota Department of Health as being the first documented case of the variant in the United States. (1) This variant has been particularly worrying scientists because of the mutations it has that let the virus spread faster and evade the immune system more effectively. This evolution could make it easier for COVID-19 survivors to contract the disease again and could potentially impede the effectiveness of vaccines. (2) While this is a daunting premonition, Marion Pepper, an immunologist at the University of Washington, wants us to remember that “even though everyone is obviously concerned about a virus evolving, your memory B cell responsiveness also evolves over time.” (3

So, let’s talk about these hero memory B cells how do they actually help fight our battles? The main function of the memory B cells is to retain and recall an infection (when presented with one that the body has experienced before) and react accordingly by producing corresponding antibodies. This sounds great, but what about when the body is presented with a new virus variant like the P.1 variant? The way these cells keep up with ever-evolving viruses is by randomly generating new antibodies that are similar to ones they’ve created in the past. (3) This essentially gives our immune system an unlimited defense arsenal. For more information on memory B cells, check out this great summary created at Arizona State University.

Blue and green colorized scanning electron micrograph of a human B cell.
Colorized scanning electron micrograph of a human B cell. Credit: NIAID, NIH

 

The mRNA Vaccine

January 19, 2021

These are truly novel times that we are experiencing, and the scientific community is no different. Interest in messenger RNA (mRNA) continues to grow within the medical community, especially since the developments of breakthrough COVID-19 vaccines. It is important to note that even after 30 years of research, mRNA vaccines have never before been approved for use in any disease, until now (1). However, researchers in Germany recently used mRNA technology to reduce disease activity in mice with Experimental Autoimmune Encephalomyelitis (EAE), a disease similar to multiple sclerosis (2).

mRNA vaccines involve using a small strand of distinct genetic material that carries the instructions for building a specific part of a cell. In the case of COVID-19, the mRNA vaccine contains instructions for building the virus’s “spike” protein. When a person receives the mRNA vaccine for the virus that causes COVID-19, their own cells are able to build the spike protein. This ramps up an immune system response against the virus. 

This response is especially important when it comes to battling the virus that causes COVID-19 because the SARS-CoV-2 virus in particular has the ability to dampen the immune system response while it is still replicating. This can lead to infected individuals spreading the virus to others while still asymptomatic. This technique has never been seen before. Virologist Benjamin tenOever of the Icahn School of Medicine at Mount Sinai stated that “it’s something I have never seen in my 20 years of studying viruses” when discussing the virus’ ability to commandeer cells’ genomes (3).

Although it may be quite a while before human clinical trials become a possibility, this research is significant. It shows the potential of mRNA vaccines to treat disease-specific autoimmunity without relying on therapies that suppress immune system function as a whole.

Vaccines and Autoimmune Disease

January 12, 2021

As distribution continues, experts are working diligently to uncover everything we need to know about the safety and efficacy of the emerging COVID-19 vaccines. The CDC advises the following: “People with autoimmune conditions may receive an mRNA COVID-19 vaccine. However, they should be aware that no data are currently available on the safety of mRNA COVID-19 vaccines for them. Individuals from this group were eligible for enrollment in clinical trials.” (1)

Despite lingering questions and uncertainties, there is one concern that researchers have been able to adequately address: Do vaccines cause autoimmune diseases? Check out Deplatform Disease’s article outlining what we already know about immunological function, autoimmune disease, and the science of vaccines. (2)

The illustration shows a coronavirus membrane decorated with spike glycoproteins. Red protein sequences indicate a potential target for vaccines to neutralize the coronavirus.
Credit: NIH Image Gallery

 

Increase in Coronavirus Variants and their Effects on the Vaccine

January 7, 2021

Recent developments concerning the COVID-19 virus are leading to an increase in questions and unknowns about it. While various vaccines are being distributed across the globe, recent findings on SARS-CoV-2 variants are worrying many. Some of these variants are known to spread faster and transmit more efficiently than other variants of the virus. Three of the most wide-spread variants are the UK variant (D614G), the Y453F mutation found in minks, and the N501Y cluster spreading in England. The research article “Genetic Variants of SARS-CoV-2—What Do They Mean?” explains that while the specific manifestation of these variants differs, the Y453F brings into question other evolutionary challenges, such as an abundance of a new COVID-19 from other mammals to humans. What makes these coronavirus variants even more worrisome is that they are advanced concerning “viral replication, transmission, and escape immunity,” making them even more difficult to contend with than the original COVID-19 virus (1).

One primary concern is the vaccine effectiveness of these variants. The variants are mostly mutations in the spike protein; therefore, scientists have to consider if the vaccines, which stimulate an immune response to the spike protein, are still effective. Thus far, the major consensus regarding vaccine effectiveness is that since current vaccines target the entire spike protein, they are effective regardless of the few changes in the variant. It is also important to note that while the mutations are considered efficient for the virus, they can make it inefficient in the future. To be certain, the evolution of SARS-CoV-2 must be carefully monitored over time. In addition, regulation of mask mandates and physical distancing guidelines is essential in stopping the spread of COVID-19 and all of its variants.

Understanding Long COVID

December 22, 2020

Signs or symptoms that continue or develop after a COVID-19 infection is known as long COVID. A recent study indicated that as many as 1 in 20 people will develop an illness that persists for weeks or months after they’ve had COVID-19. (1) Long COVID symptoms vary greatly from person to person, and in some cases, bear a close resemblance to autoimmune-related diseases like myalgic encephalomyelitis (ME/CFS).

Researchers across the world are working to answer key questions, like who is at risk for long COVID? What is the link between COVID-19 and autoimmune disease? What are the most useful treatments for long COVID? Check out our latest article, “Understanding Long COVID” for a breakdown of this condition and how the experts are working to address it.

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