Pandemic is Over….Post-COVID vaccine autoimmune syndrome and Long covid, could they be related?
- Long-COVID impact
Long COVID symptoms can be grouped into three general clusters, 1) neurological, 2) respiratory, and 3) systemic inflammatory. Neurological symptoms appear to have been receiving more attention. A research team from the Northwestern University School of Medicine reported that non-hospitalized COVID-19 patients continue to experience neurological symptoms, fatigue, and compromised quality of life for 14.8 months after initial infection. Their average age was 42.8 years old, 73% were female and 77% had received COVID vaccine. (https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.51570)
According to the CDC, up to 1 in 13 American adults have long COVID symptoms, younger adults are more likely than older adults to have long COVID, and women are about twice as likely as men to have long COVID. Unfortunately, there is currently no test to diagnose long COVID. (https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html)
- Long-COVID Why?
Some studies suggested that the virus may be lingering in the whole human body, particularly in the brain, causing ongoing damage. https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576 , https://www.bmj.com/content/377/bmj.o1555
But other studies suggested our body’s own immune response may be responsible.
Researchers from Yale University School of Medicine reported finding autoantibodies, a type of antibodies that attack a person’s healthy cells in acute COVID-19 patients. These autoantibodies particularly target the immune systems and brain. https://www.nature.com/articles/s41586-021-03631-y
A team from the Cedars-Sinai Medical Center reported that autoantibodies could last up to six months after infection. They also observed that women with asymptomatic infection had more autoantibodies, and men developed more autoantibodies with mildly symptomatic infection. However, their study did not correlate autoantibodies with long COVID symptoms. https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-03184-8
A recent German review article has an English abstract. It summarized that neurological damage after COVID-19 is not likely caused by the invasion of SARS-CoV-2 into the brain or spinal cord, but it is rather possible due to the development of specific autoantibody against CNS tissue. https://pubmed.ncbi.nlm.nih.gov/35552466/
All of these studies suggested autoimmunity could be one of the reasons for long-COVID, but how does it relate to post-COVID vaccine autoimmune syndrome?
- Post-COVID vaccine autoimmunity
In a conference meeting abstract published by the American College of Rheumatology, researchers from NYU reported 3 of 60 patients had antinuclear antibodies, a type of autoantibody that target the normal proteins within the nucleus of a cell, four to five weeks after mRNA COVID vaccine. One was a healthy individual, and two had other immune-mediated inflammatory diseases.
The healthy individual also had Scl-70 autoantibodies, a specific marker for systemic sclerosis, a condition characterized by hardening and tightening of the skin. https://www.sciencedirect.com/topics/medicine-and-dentistry/anti-scl-70-antibodies
https://www.mayoclinic.org/diseases-conditions/scleroderma/symptoms-causes/syc-20351952
Fortunately, antinuclear antibodies were no longer detected at the 3-month time point, and no participant developed new autoimmune diseases.
Autoimmune or autoinflammatory syndrome also does not appear to be exclusively associated with the mRNA vaccine. A review article published in April 2022 in Clinical Rheumatology provided a summary table showing reports of a spectrum of autoimmune diseases and detected autoantibodies in association with most of the COVID vaccines. However, it is important to note that these were associations, not causation. The incidence was very low, and in most cases, these autoimmune syndromes are controlled with steroids and other immune medications and are short-lived.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8979721/
Dr. Avindra Nath, a senior investigator from NIH, and his team released a pre-print in May 2022, describing different neuropathic symptoms with COVID vaccination. They studied 23 relatively young patients who reported new neuropathic symptoms beginning within one month after COVID vaccination. All of the patients reported feeling a severe burning sensation on their faces and/or limb. Biopsies from five randomly selected patients showed immune complexes deposition in endothelial cells. Again, fortunately, most patients had complete symptom improvement after receiving steroid and immune medications.
- Possible immunological mechanism
In January, a potential immunological mechanism of how the bodies generate autoantibodies after COVID infection and vaccination was published in the NEJM.
It is possible that the immune-generated antibodies against the spike protein after infection and vaccination (Ab1 in the figure) further stimulated the formation of anti-idiotype antibodies (Ab2). These anti-idiotype antibodies may contain binding sites that mimic part of the spike protein and neutralize the anti-spike antibodies. At the same time, these anti-idiotype antibodies may also block or activate ACE2 receptors on target cells, leading to abnormal cellular functions.
https://www.nejm.org/doi/full/10.1056/NEJMcibr2113694
- Hurdle for Discussion
So apparently, some research is looking into the possible tie between autoimmunity, long-COVID, and post-COVID vaccine symptoms. But why haven’t we heard more from the mainstream?
According to a health science report on Science, Dr. Nath mentioned his study about neuropathic symptoms with COVID vaccination was rejected twice since March 2021. Even now, in September, his report is still in pre-print.
Other researchers also noted that it is not easy to approach studies about vaccine-related autoimmune side effects. It almost looks like the topic is taboo.
Take the Australian government website as an example. The official language simply stated there is no evidence to suggest that COVID-19 vaccines can cause autoimmune disease without further discussing the observed association between the two.
Is simplified language enough to communicate vaccine safety to the public?
Let’s wrap up with what the officials say. The American College of Rheumatology stated that the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination.
