Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands.
Department of Immunology, Erasmus Medical Center, Rotterdam, Netherlands.
Front Immunol. 2021 May 13;12:684142. doi: 10.3389/fimmu.2021.684142. eCollection 2021.
Lung histopathology demonstrates vasculopathy in a subset of deceased COVID19 patients, which resembles histopathology observed in antibody-mediated lung transplant rejection. Autoantibodies against angiotensin II type 1 receptor (AT1R) and Endothelin receptor Type A (ETAR) have been demonstrated in antibody-mediated rejection and may also be associated with severe COVID19 infection. Objective To assess AT1R and ETAR auto-antibodies in COVID19 patients and controls, and explore their association with disease course.
65 hospitalized patients with COVID19 infection were included. Clinical and laboratory findings were retrospectively assessed. Patients with unfavorable disease course, admitted at the intensive care unit and/or deceased during hospital admission (n=33) were compared to admitted COVID19 patients with favorable disease course (n=32). The presence of antinuclear antibodies (ANA) and auto-antibodies against AT1R or ETAR in peripheral blood were compared between COVID19 with unfavorable and favorable disease course and age matched controls (n=20).
The presence of ANA was not significantly different between COVID19 patients with unfavorable (n=7/33; 21%) and favorable disease course (n=6/32; 19%) (p= 0.804) and controls (n=3/20; 15%). Auto-antibodies against AT1R were significantly increased in unfavorable disease course (median 14.59 U/mL, IQR 11.28 - 19.89) compared to favorable disease course (median 10.67 U/mL, IQR 8.55 - 13.0, p< 0.01). ETAR antibody titers were also significantly increased in unfavorable disease course (median 7.21, IQR 5.0 - 10.45) as compared to favorable disease course (median 4.0, IQR 3.0 - 6.0, p <0.05).
Auto-antibodies against AT1R and ETAR are significantly increased in COVID19 patients with an unfavorable disease course.
肺组织病理学显示，在一部分 COVID19 死亡患者中存在血管病变，其类似于抗体介导的肺移植排斥反应中的组织病理学表现。已在抗体介导的排斥反应中发现了针对血管紧张素 II 型 1 受体（AT1R）和内皮素受体 A 型（ETAR）的自身抗体，并且这些自身抗体也可能与严重的 COVID19 感染相关。目的：评估 COVID19 患者和对照组中 AT1R 和 ETAR 自身抗体，并探讨其与疾病过程的关系。
纳入了 65 例住院的 COVID19 感染患者。回顾性评估了临床和实验室发现。将疾病预后不良的患者（入住重症监护病房和/或住院期间死亡，n=33）与疾病预后良好的患者（n=32）进行比较。比较了疾病预后不良和良好的 COVID19 患者与年龄匹配的对照组（n=20）外周血中抗核抗体（ANA）和针对 AT1R 或 ETAR 的自身抗体的存在情况。
疾病预后不良的 COVID19 患者（n=7/33；21%）与疾病预后良好的患者（n=6/32；19%）（p=0.804）和对照组（n=3/20；15%）之间，ANA 的存在并无显著差异。与疾病预后良好的患者相比，疾病预后不良的患者 AT1R 自身抗体（中位数 14.59 U/mL，IQR 11.28-19.89）明显升高（p<0.01）。与疾病预后良好的患者相比，疾病预后不良的患者 ETAR 抗体滴度（中位数 7.21，IQR 5.0-10.45）也明显升高（p<0.05）。
疾病预后不良的 COVID19 患者中，AT1R 和 ETAR 的自身抗体明显升高。
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