A new study has shown that mRNA vaccines against SARS-CoV-2 do not induce short-term worsening of autoimmunity in patients with autoimmune liver diseases (AILD). The collaborative study between EUROIMMUN and researchers at the Epatocentro Ticino, Lugano and other institutes and clinics in Switzerland was published recently in the Journal of Autoimmunity.
The mRNA vaccines against SARS-CoV-2 have previously been associated with rare immune-related adverse effects, such as circulating autoantibodies and new overt autoimmune diseases, raising concerns about their safety in patients predisposed to autoimmunity. The researchers therefore investigated panels of liver- and non-liver-related autoantibodies in patients with primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) or primary sclerosing cholangitis (PSC) and in healthcare workers (HW) before and after vaccination. They looked for autoantibodies that appeared de novo, disappeared or significantly changed in titer. The autoantibodies were tested by two complementary approaches to provide wider information. EUROLINE immunoblots allow detection of a large variety of antibody reactivities, while indirect immunofluorescence (IIF) tests enable detection of reactivity to conformational antigenic determinants. All laboratory tests were performed at EUROIMMUN.
The investigated liver-specific autoantibodies encompassed anti-smooth-muscle antibody (SMA), anti-liver-kidney microsomal antibody type I (LKM-1), anti-liver cytosol type I antibody (LC-1) and anti-mitochondrial antibody (AMA) detected by IIF using Liver Mosaics. A EUROLINE profile provided specific detection of autoantibodies against the antigens SLA, M2, M2-3E, Sp100, PML, gp210, LKM-1, LC-1, Ro-52, F-actin and PGDH. The investigated non-liver-related autoantibodies included anti-nuclear antibodies (ANA) and anti-neutrophil cytoplasmic autoantibodies (ANCA) detected by IIF. A range of specific ANA and ANCA reactivities was also tested using EUROLINE profiles. In addition, anti-cyclic citrullinated peptides, anti-transglutaminase IgA and anti-thyroid peroxidase antibodies were analysed by ELISA. Anti-SARS-CoV-2 antibodies elicited by natural infection or by vaccination were also measured by ELISA.
While AILD patients developed autoantibodies more frequently than HW after mRNA vaccination, the autoantibodies also frequently disappeared after vaccination. The proportion of patients with at least one autoantibody positivization after vaccination amounted to 37% for AIH, 35% for PBC and 56% for PSC, compared to 11% in the HW group. The proportion of patients with negativization for at least one autoantibody was 57% for AIH, 40% for PBC, 50% for PSC and 25% for HW. Notably, in the AIH group there were more negativizations than positivizations. This suggests that in this autoimmunity-prone population, the mRNA vaccines do not induce worsening of autoimmunity. This was confirmed by the clinical course, which did not worsen after vaccination, except in one AIH patient who was easily treated. No new onset autoimmune disease was observed in the cohort after one year. These data provide reassurance regarding the safety of mRNA vaccines in AILD patients. In this context, it should be noted that SARS-CoV-2 infection itself can be associated with autoimmunity, further highlighting the suitability of SARS-CoV-2 vaccination in patients with AILD.
Read more about the study
Kälin T, Passarin K, Filipowic-Sinnreich M, et al. Swiss Autoimmune Hepatitis Cohort Study; Swiss Primary Biliary Cholangitis Cohort Study; Swiss Primary Sclerosing Cholangitis Study. SARS-CoV-2 mRNA vaccines do not worsen autoimmunity in patients with autoimmune liver diseases. J Autoimmun. 2024 Oct 15;149:103325. doi: 10.1016/j.jaut.2024.103325.