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Azzarone B, Veneziani I, Moretta L, Maggi E. Pathogenic Mechanisms of Vaccine-Induced Immune Thrombotic Thrombocytopenia in People Receiving Anti-COVID-19 Adenoviral-Based Vaccines: A Proposal. Front Immunol 2021; 12:728513. [PMID: 34484238 PMCID: PMC8415022 DOI: 10.3389/fimmu.2021.728513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
VITT is a rare, life-threatening syndrome characterized by thrombotic symptoms in combination with thrombocytopenia, which may occur in individuals receiving the first administration of adenoviral non replicating vectors (AVV) anti Covid19 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is characterized by high levels of serum IgG that bind PF4/polyanion complexes, thus triggering platelet activation. Therefore, identification of the fine pathophysiological mechanism by which vaccine components trigger platelet activation is mandatory. Herein, we propose a multistep mechanism involving both the AVV and the neo-synthetized Spike protein. The former can: i) spread rapidly into blood stream, ii), promote the early production of high levels of IL-6, iii) interact with erythrocytes, platelets, mast cells and endothelia, iv) favor the presence of extracellular DNA at the site of injection, v) activate platelets and mast cells to release PF4 and heparin. Moreover, AVV infection of mast cells may trigger aberrant inflammatory and immune responses in people affected by the mast cell activation syndrome (MCAS). The pre-existence of natural antibodies binding PF4/heparin complexes may amplify platelet activation and thrombotic events. Finally, neosynthesized Covid 19 Spike protein interacting with its ACE2 receptor on endothelia, platelets and leucocyte may trigger further thrombotic events unleashing the WITT syndrome.
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Affiliation(s)
- Bruno Azzarone
- Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irene Veneziani
- Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Moretta
- Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enrico Maggi
- Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Eby JM, Barse L, Henning SW, Rabelink MJWE, Klarquist J, Gilbert ER, Hammer AM, Fernandez MF, Yung N, Khan S, Miller HG, Kessler ER, Garrett-Mayer E, Dilling DF, Hoeben RC, Le Poole IC. Alpha-N-acetyl-neuraminide alpha-2,8-sialyltransferase 1 can support immune responses toward tumors overexpressing ganglioside D3 in mice. Cancer Immunol Immunother 2017; 66:63-75. [PMID: 27787577 PMCID: PMC11028533 DOI: 10.1007/s00262-016-1920-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
An immunotherapeutic strategy is discussed supporting anti-tumor activity toward malignancies overexpressing ganglioside D3. GD3 can be targeted by NKT cells when derived moieties are presented in the context of CD1d. NKT cells can support anti-tumor responses by secreting inflammatory cytokines and through cytotoxicity toward CD1d+GD3+ tumors. To overexpress GD3, we generated expression vector DNA and an adenoviral vector encoding the enzyme responsible for generating GD3 from its ubiquitous precursor GM3. We show that DNA encoding α-N-acetyl-neuraminide α-2,8-sialyltransferase 1 (SIAT8) introduced by gene gun vaccination in vivo leads to overexpression of GD3 and delays tumor growth. Delayed tumor growth is dependent on CD1d expression by host immune cells, as shown in experiments engaging CD1d knockout mice. A trend toward greater NKT cell populations among tumor-infiltrating lymphocytes is associated with SIAT8 vaccination. A single adenoviral vaccination introduces anti-tumor activity similarly to repeated vaccination with naked DNA. Here, greater NKT tumor infiltrates were accompanied by marked overexpression of IL-17 in the tumor, later switching to IL-4. Our results suggest that a single intramuscular adenoviral vaccination introduces overexpression of GD3 by antigen-presenting cells at the injection site, recruiting NKT cells that provide an inflammatory anti-tumor environment. We propose adenoviral SIAT8 (AdV-SIAT8) can slow the growth of GD3 expressing tumors in patients.
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Affiliation(s)
- Jonathan M Eby
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Levi Barse
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Department of Pharmacology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Steven W Henning
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Martijn J W E Rabelink
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jared Klarquist
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Department of Immunology and Microbiology, University of Colorado Denver, Denver, CO, USA
| | - Emily R Gilbert
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Adam M Hammer
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Burn and Shock Trauma Institute, Loyola University Chicago, Maywood, IL, USA
| | - Manuel F Fernandez
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Nathan Yung
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Safia Khan
- Oakton Community College, Des Plaines, IL, USA
| | | | - Edward R Kessler
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel F Dilling
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Rob C Hoeben
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Caroline Le Poole
- Oncology Research Institute, Loyola University Medical Center, Loyola University Chicago, Rm 203, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.
- Departments of Pathology, Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA.
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