Autoantibodies to protein S may explain rare cases of coagulopathy following COVID-19 vaccination

While Coronavirus disease 2019 (COVID-19) vaccines have proven to be both effective and generally safe, rare but severe adverse events following immunization (AEFIs) are described. Autoantibodies to platelet factor-4 are associated with catastrophic thrombotic AEFIs, but comprehensive investigations...

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Hauptverfasser: Yalcinkaya, Ahmet, Cavalli, Marco, Aranda-Guillén, Maribel, Cederholm, Axel, Güner, Almira, Rietrae, Isabel, Mildner, Hedvig, Behere, Anish, Eriksson, Oskar, Gonzalez, Laura, Mugabo, Constantin Habimana, Johnsson, Anette, Lakshmikanth, Tadepally, Brodin, Petter, Wadelius, Mia, Hallberg, Pär, Landegren, Nils
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Sprache:eng
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Zusammenfassung:While Coronavirus disease 2019 (COVID-19) vaccines have proven to be both effective and generally safe, rare but severe adverse events following immunization (AEFIs) are described. Autoantibodies to platelet factor-4 are associated with catastrophic thrombotic AEFIs, but comprehensive investigations of other autoantibodies are lacking. We aimed to detect and describe autoantibodies targeting coagulation-related proteins in a population-wide cohort (SWEDEGENE) including AEFIs attributed to COVID-19 vaccines in Sweden. Subjects were recruited from December 2020 to October 2022 and were stratified based on diagnosis and COVID-19 exposure. Screening was carried out in two phases, with a multiplex bead-based assay in the first subset (until September 2021) and with targeted assays for the second (until October 2022). Positivity was defined based on absolute, relative, and biological/technical thresholds. Patients with coagulation-related AEFIs were older and the Vaxzevria vaccine was overrepresented in this group. Two cases had antiphospholipid antibodies but none had PF4 antibodies. We identified six positives for protein S autoantibodies. Protein S concentrations were negatively correlated with autoantibody response in patients with immunoreactivity and functional analysis revealed low protein S activity in three subjects. Our population-wide analysis reveals cases with autoantibodies against protein S which possibly underlie coagulopathic AEFIs.
DOI:10.1038/s41598-024-75514-x