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Bokel J, Martins-Gonçalves R, Grinsztejn E, Mendes-de-Almeida DP, Hoagland B, Cardoso SW, Geraldo KM, Coutinho SN, Georg I, Oliveira MH, Dos Santos Souza F, Sacramento CQ, Rozini SV, Vizzoni AG, Veloso V, Bozza PT, Grinsztejn B. Anti-PF4 positivity and platelet activation after Ad26.COV2·S vaccination in Brazil. Vaccine 2024; 42:126175. [PMID: 39107160 DOI: 10.1016/j.vaccine.2024.126175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 04/13/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The Ad26.COV2·S (Janssen/Johnson & Johnson) COVID-19 vaccine, has been rarely associated with vaccine-induced immune thrombocytopenia and thrombosis (VITT). We investigated the prevalence of anti-PF4 antibody positivity, thrombocytopenia, D-dimer elevation, plasmatic thromboinflammatory markers, and platelet functional assays following Ad26.COV2·S vaccination in Rio de Janeiro, Brazil. METHODS From July to September 2021, participants were assessed prior, 1, and 3 weeks post-vaccination. Platelet count and D-dimer were measured at each visit and anti-PF4 at week 3. A positive anti-PF4 prompted retrospective testing of the sample from week 0. Individuals with new thrombocytopenia or elevated D-dimer, positive anti-PF4, and 38 matched controls without laboratory abnormalities were evaluated for plasmatic p-selectin, tissue factor, and functional platelet activation assays. RESULTS 630 individuals were included; 306 (48.57%) females, median age 28 years. Forty-two (6.67%) presented ≥1 laboratory abnormality in week 1 or 3. Five (0.79%) had thrombocytopenia, 31 (4.91%) elevated D-dimer, and 9 (1.57%) had positive anti-PF4 at week 3. Individuals with laboratory abnormalities and controls showed a slight increase in plasmatic p-selectin and tissue factor. Ten individuals with laboratory abnormalities yielded increased surface expression of p-selectin, and their ability to activate platelets in a FcγRIIa dependent manner was further evaluated. Two were partially inhibited by high concentrations of heparin and blockage of FcγRII with IV.3 antibody. Plasma obtained before vaccination produced similar results, suggesting a lack of association with vaccination. CONCLUSIONS Vaccination with Ad26.COV2·S vaccine led to a very low frequency of low-titer positive anti-PF4 antibodies, elevation of D-dimer, and mild thrombocytopenia, with no associated clinically relevant increase in thromboinflammatory markers and platelet activation.
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Affiliation(s)
- Joanna Bokel
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
| | | | | | - Daniela P Mendes-de-Almeida
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Kim Mattos Geraldo
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Sandro Nazer Coutinho
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ingebourg Georg
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Helena Oliveira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Flávia Dos Santos Souza
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Carolina Q Sacramento
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Stephane V Rozini
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Alexandre G Vizzoni
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdiléa Veloso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patrícia T Bozza
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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Giusti B, Sticchi E, Capezzuoli T, Orsi R, Squillantini L, Giannini M, Suraci S, Rogolino AA, Cesari F, Berteotti M, Gori AM, Lotti E, Marcucci R. Whole Exome Sequencing in Vaccine-Induced Thrombotic Thrombocytopenia (VITT). BIOMED RESEARCH INTERNATIONAL 2024; 2024:2860547. [PMID: 39035772 PMCID: PMC11260508 DOI: 10.1155/2024/2860547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/11/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
Background: In February 2021, a few cases of unusual, severe thrombotic events associated with thrombocytopenia reported after vaccination with ChAdOx1 nCoV-19 (Vaxzevria) or with Johnson & Johnson's Janssen vaccine raise concern about safety. The vaccine-induced thrombotic thrombocytopenia (VITT) has been related to the presence of platelet-activating antibodies directed against platelet Factor 4. Objectives: We investigated VITT subject genetic background by a high-throughput whole exome sequencing (WES) approach in order to investigate VITT genetic predisposition. Methods: Six consecutive patients (females of Caucasian origin with a mean age of 64 years) were referred to the Atherothrombotic Diseases Center (Department of Experimental and Clinical Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence) with a diagnosis of definite VITT underwent WES analysis. WES analysis was performed on the Illumina NextSeq500 platform. Results:WES analysis revealed a total of 140,563 genetic variants. Due to VITT's rare occurrence, we focused attention on rare variants. The global analysis of all high-quality rare variants did not reveal a significant enrichment of mutated genes in biological/functional pathways common to patients analyzed. Afterwards, we focused on rare variants in genes associated with blood coagulation and fibrinolysis, platelet activation and aggregation, integrin-mediated signaling pathway, and inflammation with particular attention to those involved in vascular damage, as well as autoimmune thrombocytopenia. According to ACMG criteria, 47/194 (24.2%) rare variants were classified as uncertain significance variants (VUS), whereas the remaining were likely benign/benign. Conclusion: WES analysis identifies rare variants possibly favoring the prothrombotic state triggered by the exposure to the vaccine. Functional studies and/or extensions to a larger number of patients might allow a more comprehensive definition of these molecular pathways.
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Affiliation(s)
- Betti Giusti
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Elena Sticchi
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Tommaso Capezzuoli
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
| | - Rebecca Orsi
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
| | - Lapo Squillantini
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
| | - Marco Giannini
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
| | - Samuele Suraci
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
| | | | - Francesca Cesari
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Martina Berteotti
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Elena Lotti
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical MedicineUniversity of Florence, Florence, Italy
- Atherothrombotic Diseases CenterCareggi University Hospital, Florence, Italy
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Pombal R, Silva L, Ferreira D. Genetic Predisposition to Vaccine-Induced Immune Thrombotic Thrombocytopenia: is there a Family Link? Eur J Case Rep Intern Med 2024; 11:004546. [PMID: 38846670 PMCID: PMC11152221 DOI: 10.12890/2024_004546] [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: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare life-threatening thrombotic reaction to COVID-19 vaccines. Case description Two young male first cousins, with a family history of idiopathic thrombocytopenic purpura, developed VITT after the Ad26.COV2.S vaccine. Both had a favourable clinical and analytical outcome. We investigated the genetic factors that could be associated with a genetic predisposition to VITT. Conclusions There are no published cases where the VITT patients were relatives. The genetic study did not reveal any likely pathogenic variants, although the prevalent polymorphism c.497A>G (p.(His166Arg)) in the FCGR2A gene was found in a homozygous state. More studies are required to better understand VITT's pathophysiology and any underlying genetic predispositions. LEARNING POINTS Vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but life-threatening disease, emerged with COVID-19 vaccines.The genetic analyses revealed the FCGR2A gene in a homozygous state.These cases may raise new questions about a family predisposition to VITT.
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Affiliation(s)
- Rita Pombal
- Immunohemotherapy Department, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luciana Silva
- Internal Medicine Department, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - David Ferreira
- Immunohemotherapy Department, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal
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Mendes-de-Almeida DP, Mouta Nunes de Oliveira P, Bertollo Gomes Porto V, Saraiva Pedro R, Takey PRG, Lignani LK, Vitiello Teixeira G, Pereira TDS, Abreu DL, Xavier JR, Castro TDMD, Melo de Amorim Filho L, Sousa Maia MDLD. Vaccine-induced immune thrombotic thrombocytopenia post COVID-19 booster vaccination in Brazil: a case series. Res Pract Thromb Haemost 2023; 7:102243. [PMID: 38193064 PMCID: PMC10772875 DOI: 10.1016/j.rpth.2023.102243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background The emergence of new variants of SARS-CoV-2 has led to the administration of different booster vaccines to mitigate COVID-19. Vaccines with adenoviral vectors have been rarely associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). Objectives This study aimed to describe 15 cases of VITT after the third and fourth doses of the COVID-19 vaccine in Brazil. Methods Cases were reported after all kinds of anti-SARS-CoV-2 booster vaccinations between October 17, 2021, and September 4, 2022. Results Of the 26 suspected cases, 15 cases of VITT were analyzed. Of these, 10 were classified as definite VITT, 2 as probable, 1 as possible, and 2 as unlikely. The estimated frequency of definite, probable, or possible VITT was 0.33 cases per million. Cases were assigned to ChAdOx1 (13 cases), Ad26.COV2.S (1 case), and BNT162b2 (1 case). None of the patients received an adenoviral vaccine as a primary vaccination. The average age of participants was 34 years, and symptoms usually appeared 8 days after vaccination. Headache was the most common symptom, and cerebral veins were the most affected thrombotic site. The overall mortality risk was 53%. Anti-platelet factor 4 enzyme-linked immunosorbent assay serology was positive in 11 out of 15 patients (73.3%), negative in 2 (13.3%), and missing in 2 (13.3%). Conclusion The study confirms that VITT is linked to the first exposure to adenoviral vector vaccines. Since January 2023, Brazil has recommended preferably COVID-19 messenger RNA vaccines for individuals aged 18 to 39 years. We suggest that, in the current disease scenario, COVID-19 adenovirus vaccines should not be the first choice for individuals aged <50 years who have not received a previous dose of this type of vaccine.
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Affiliation(s)
- Daniela P. Mendes-de-Almeida
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
- Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Patrícia Mouta Nunes de Oliveira
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Victor Bertollo Gomes Porto
- General Coordination of the National Immunization Program, Brazilian Ministry of Health, Brasília, Distrito Federal, Brazil
| | - Renata Saraiva Pedro
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Paulo Roberto Gomes Takey
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Letícia Kegele Lignani
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Gabriellen Vitiello Teixeira
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Tainá dos Santos Pereira
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Debora Lima Abreu
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Janaína Reis Xavier
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Thalita da Matta de Castro
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Maria de Lourdes de Sousa Maia
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
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