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Suffritti C, Gualtierotti R, Arcudi S, Ciavarella A, Novembrino C, Lecchi A, La Marca S, Padovan L, Scalambrino E, Clerici M, Bono P, Ceriotti F, Muscatello A, Siboni SM, Peyvandi F. Characterization of Immunogenicity and Safety of COVID-19 mRNA-1273 in HIV-Positive Italian Patients with Hemophilia: A Prospective Single-Center Cohort Study. J Clin Med 2023; 12:5475. [PMID: 37685542 PMCID: PMC10487950 DOI: 10.3390/jcm12175475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
To characterize the immunogenicity of mRNA-1273 (Moderna, Cambridge, MA, USA) vaccine in HIV-positive hemophilic patients during the third COVID-19 wave in Italy and to investigate biomarkers of coagulation and endothelial perturbation before and after complete vaccination schedule, twenty-three consecutive adult HIV-positive patients with hemophilia were included. Blood was collected before and two weeks after vaccination. We measured anti-SARS-CoV-2 spike protein antibodies to assess immunogenicity; circulating biomarkers of coagulation (protein C and D-dimer), endothelial perturbation (von Willebrand factor (VWF)) and anti-Platelet Factor 4 (PF4) antibodies were analyzed. Flow-based analysis of thrombus formation was performed in nine patients using a flow-chamber device. Two weeks after completing the vaccination schedule, all patients had anti-spike antibodies values consistent with an effective immunization. Mean (±standard deviation) basal values of protein C and VWF (106 ± 21% and 171 ± 45%, respectively) were not significantly different from data obtained two weeks after the second dose (103 ± 20%, 162 ± 43%, respectively). D-dimer median values (interquartile range) were not significantly different at baseline (442 (603-142) ng/mL) and after the second dose (477 (654-262) ng/mL). Anti-PF4 antibodies were detected in three patients with no associated clinical manifestations. No significant differences were found in flow-based analysis of thrombus formation. Our data demonstrate that in HIV-positive patients with hemophilia, SARS-CoV-2 vaccination is effective and safe, with no effects on coagulation and endothelial perturbation.
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Affiliation(s)
- Chiara Suffritti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Roberta Gualtierotti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sara Arcudi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alessandro Ciavarella
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Cristina Novembrino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Anna Lecchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Silvia La Marca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Lidia Padovan
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Erica Scalambrino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Marigrazia Clerici
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Patrizia Bono
- Clinical Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simona Maria Siboni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
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Seneff S, Nigh G, Kyriakopoulos AM, McCullough PA. Innate immune suppression by SARS-CoV-2 mRNA vaccinations: The role of G-quadruplexes, exosomes, and MicroRNAs. Food Chem Toxicol 2022; 164:113008. [PMID: 35436552 PMCID: PMC9012513 DOI: 10.1016/j.fct.2022.113008] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/12/2022]
Abstract
The mRNA SARS-CoV-2 vaccines were brought to market in response to the public health crises of Covid-19. The utilization of mRNA vaccines in the context of infectious disease has no precedent. The many alterations in the vaccine mRNA hide the mRNA from cellular defenses and promote a longer biological half-life and high production of spike protein. However, the immune response to the vaccine is very different from that to a SARS-CoV-2 infection. In this paper, we present evidence that vaccination induces a profound impairment in type I interferon signaling, which has diverse adverse consequences to human health. Immune cells that have taken up the vaccine nanoparticles release into circulation large numbers of exosomes containing spike protein along with critical microRNAs that induce a signaling response in recipient cells at distant sites. We also identify potential profound disturbances in regulatory control of protein synthesis and cancer surveillance. These disturbances potentially have a causal link to neurodegenerative disease, myocarditis, immune thrombocytopenia, Bell's palsy, liver disease, impaired adaptive immunity, impaired DNA damage response and tumorigenesis. We show evidence from the VAERS database supporting our hypothesis. We believe a comprehensive risk/benefit assessment of the mRNA vaccines questions them as positive contributors to public health.
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Affiliation(s)
- Stephanie Seneff
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA, 02139.
| | - Greg Nigh
- Immersion Health, Portland, OR, 97214, USA.
| | - Anthony M Kyriakopoulos
- Research and Development, Nasco AD Biotechnology Laboratory, Department of Research and Development, Sachtouri 11, 18536, Piraeus, Greece.
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Short-time Safety of the Sinopharm COVID-19 Vaccine in Patients with Hemophilia. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-122097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The COVID-19 pandemic, caused by SARS-Cov-2, has affected the care of patients with hemophilia, indicating the necessity of their vaccination. Nevertheless, there are concerns about using anti-SARS-Cov-2 virus vaccines for hemophilic patients, particularly concerning bleeding adverse events. Methods: Following a cross-sectional design, all adult hemophilic patients who received two doses of Sinopharm anti-SARS-Cov-2 virus vaccine in Afzalipour Hospital, Kerman, Iran, during May and June 2021 were recruited. The participants were followed for two weeks after receiving each dose of vaccine. Results: Fifty-one patients with a mean age of 37.07 ± 11.45 years were included, of whom 27 (61.4 %) patients experienced at least one adverse reaction. Pain was the most frequent local adverse event (occurred in 20 (39.2%) and 15 (29.4%) cases after 1st and 2nd doses, respectively). Menometrorrhagia and epistaxis were reported by two and one patients, respectively. Conclusions: Overall Sinopharm anti-SARS-Cov-2 virus vaccine seems to be safe for patients with hemophilia in the short term.
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Tiede A, Leise H, Horneff S, Oldenburg J, Halimeh S, Heller C, Königs C, Holstein K, Pfrepper C. Safety of intramuscular COVID-19 vaccination in patients with haemophilia. Haemophilia 2022; 28:687-693. [PMID: 35561276 PMCID: PMC9348084 DOI: 10.1111/hae.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
Background Guidelines recommend that patients with haemophilia should preferably receive vaccination subcutaneously. COVID‐19 and other vaccines, however, are only licenced for intramuscular application. Aims To assess the safety of intramuscular COVID‐19 vaccination in patients living with haemophilia. Methods Part A of this prospective observational study enrolled consecutive patients with haemophilia A (HA) and B (HB) of all ages and severities and assessed injection site bleeding and other complications within 30 days of vaccination. Part B enrolled patients providing informed consent for detailed data collection including medication and prophylaxis around the time of vaccination. Logistic regression was performed to assess potential risk factors for bleeding. Results Four hundred and sixty‐one patients were enrolled into part A. The primary endpoint injection site bleeding occurred in seven patients (1.5%, 95% confidence interval .7–3.1%). Comprehensive analysis of 214 patients (404 vaccinations, part B) revealed that 97% of patients with severe haemophilia had prophylaxis before vaccination, either as part of their routine prophylaxis or using additional doses. 56% and 30% of patients with moderate and mild haemophilia, respectively, received prophylaxis before vaccination. Among the seven bleeds recorded, three occurred when intramuscular vaccination was done without prophylaxis (odds ratio 12). Conclusions This is the first prospective study reporting on the safety of intramuscular vaccination in haemophilia. The rate of injection site bleeding was low in mild haemophilia, and in moderate and severe haemophilia if patients received factor prophylaxis.
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Affiliation(s)
- Andreas Tiede
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Hendrik Leise
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Silvia Horneff
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Christine Heller
- Clinical and Molecular Haemostasis, Department of Paediatrics and Adolescent Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Königs
- Clinical and Molecular Haemostasis, Department of Paediatrics and Adolescent Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Christian Pfrepper
- Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
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Behera G, Jossy A, Deb AK, Neelakandan S, Basavarajegowda A. Spontaneous suprachoroidal haemorrhage in haemophilia coincident with ChAdOx1 nCoV-19 vaccine. Eur J Ophthalmol 2022:11206721221098207. [PMID: 35484818 DOI: 10.1177/11206721221098207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of spontaneous suprachoroidal haemorrhage in a haemophilia patient immediately following ChAdOx1 nCoV-19 vaccination. CASE PRESENTATION A 60-year-old man with haemophilia developed painful vision loss in his left eye a day following the ChAdOx1 nCoV-19 vaccination due to acute angle-closure glaucoma from a massive suprachoroidal haemorrhage. He had an extremely deranged coagulation profile; activated partial thromboplastin time (APTT): 89 s, normal range 29-35 s After factor VIII transfusion, ocular hypotensive therapy and systemic/topical steroids, the suprachoroidal haemorrhage and glaucoma resolved, but the vision remained poor. CONCLUSION Spontaneous suprachoroidal haemorrhage may be seen in haemophiliacs with deranged coagulation profiles. In our case, it followed ChAdOx1 nCoV-19 vaccination, and we recommend caution and checking the coagulation profile in such patients apriori.
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Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, 29988Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ajax Jossy
- Department of Ophthalmology, 29988Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Amit Kumar Deb
- Department of Ophthalmology, 29988Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Siddharth Neelakandan
- Department of Internal Medicine, 29988Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Abhishek Basavarajegowda
- Department of Transfusion Medicine, 29988Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
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Kocher F, Seeber A, Fauser J, Petzer V, Wolf D, Feistritzer C. High SARS-CoV-2 vaccination coverage but still room for improvement in patients with haemophila: A single-centre analysis. Haemophilia 2022; 28:e71-e72. [PMID: 35106872 DOI: 10.1111/hae.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/05/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Florian Kocher
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Seeber
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Josia Fauser
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Petzer
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Feistritzer
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
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Peck RC, Clark A, Shapiro S. Experience of Covid 19 vaccination in patients with bleeding disorders. Haemophilia 2022; 28:e9-e11. [PMID: 34664358 PMCID: PMC8653333 DOI: 10.1111/hae.14437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Rachel C. Peck
- Clinical HaematologyUniversity Hospitals Bristol and Weston NHS Foundation TrustUK
| | - Amanda Clark
- Clinical HaematologyUniversity Hospitals Bristol and Weston NHS Foundation TrustUK
| | - Susan Shapiro
- Oxford University Hospitals NHS Foundation TrustNIHR Oxford Biomedical Research CentreOxfordUK
- Oxford UniversityOxfordUK
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Hodroj MH, El Hasbani G, Al-Shamsi HO, Samaha H, Musallam KM, Taher AT. Clinical burden of hemophilia in older adults: Beyond bleeding risk. Blood Rev 2021; 53:100912. [PMID: 34887154 DOI: 10.1016/j.blre.2021.100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 01/18/2023]
Abstract
The prospect of hemophilia patients has dramatically improved in the last few decades with the introduction of various interventions that can effectively treat or prevent their bleeding risk. The life expectancy of patients can now reach that of the healthy population, but this has paved the way for several previously unrecognized morbidities to manifest in older adults with hemophilia. Such clinical complications are attributed to suboptimal management or poor access to effective therapy during childhood as well as chronicity and prolonged exposure to the underlying pathophysiology of the disease and its treatment. Complications common in the aging population are also becoming increasingly relevant in this vulnerable patient subgroup. In this review, we highlight peculiarities of such morbidities including chronic viral infections and liver disease, debilitating joint impairment and bone disease, cardiovascular and chronic kidney disease, and cancers. We also reflect on topics of special interest in adulthood such as sexuality.
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Affiliation(s)
| | | | - Humaid O Al-Shamsi
- Burjeel Medical City, Abu Dhabi, United Arab Emirates; Emirates Oncology Society, Dubai, United Arab Emirates; University of Sharjah, Sharjah, United Arab Emirates
| | - Hanady Samaha
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Ali T Taher
- American University of Beirut Medical Center, Beirut, Lebanon.
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