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Wang JJ, Schönborn L, Warkentin TE, Chataway T, Grosse L, Simioni P, Moll S, Greinacher A, Gordon TP. Antibody Fingerprints Linking Adenoviral Anti-PF4 Disorders. N Engl J Med 2024; 390:1827-1829. [PMID: 38749041 DOI: 10.1056/nejmc2402592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Affiliation(s)
| | | | | | | | | | | | - Stephan Moll
- University of North Carolina School of Medicine, Chapel Hill, NC
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Zhang Y, Bissola AL, Treverton J, Hack M, Lychacz M, Kwok S, Arnold A, Nazy I. Vaccine-Induced Immune Thrombotic Thrombocytopenia: Clinicopathologic Features and New Perspectives on Anti-PF4 Antibody-Mediated Disorders. J Clin Med 2024; 13:1012. [PMID: 38398325 PMCID: PMC10889051 DOI: 10.3390/jcm13041012] [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: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare yet severe adverse complication first identified during the global vaccination effort against SARS-CoV-2 infection, predominantly observed following administration of the ChAdOx1-S (Oxford-AstraZeneca) and Ad26.CoV2.S (Johnson & Johnson/Janssen) adenoviral vector-based vaccines. Unlike other anti-platelet factor 4 (PF4) antibody-mediated disorders, such as heparin-induced thrombocytopenia (HIT), VITT arises with the development of platelet-activating anti-PF4 antibodies 4-42 days post-vaccination, typically featuring thrombocytopenia and thrombosis at unusual sites. AIM To explore the unique properties, pathogenic mechanisms, and long-term persistence of VITT antibodies in patients, in comparison with other anti-PF4 antibody-mediated disorders. DISCUSSION This review highlights the complexity of VITT as it differs in antibody behavior and clinical presentation from other anti-PF4-mediated disorders, including the high incidence rate of cerebral venous sinus thrombosis (CVST) and the persistence of anti-PF4 antibodies, necessitating a re-evaluation of long-term patient care strategies. The nature of VITT antibodies and the underlying mechanisms triggering their production remain largely unknown. CONCLUSION The rise in awareness and subsequent prompt recognition of VITT is paramount in reducing mortality. As vaccination campaigns continue, understanding the role of adenoviral vector-based vaccines in VITT antibody production is crucial, not only for its immediate clinical implications, but also for developing safer vaccines in the future.
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Affiliation(s)
- Yi Zhang
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Anna-Lise Bissola
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Jared Treverton
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Michael Hack
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Mark Lychacz
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Sarah Kwok
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Addi Arnold
- Department of Pathology and Laboratory Medicine, Western University, London, ON N6A 5A5, Canada;
| | - Ishac Nazy
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
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