疫苗诱导的免疫性血栓性血小板减少症所致脑静脉血栓的免疫组化特征。
Immunohistologic Features of Cerebral Venous Thrombosis Due to Vaccine-Induced Immune Thrombotic Thrombocytopenia.
机构信息
From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2023 May 26;10(4). doi: 10.1212/NXI.0000000000200127. Print 2023 Jul.
OBJECTIVES
Vaccine-induced immune thrombotic thrombocytopenia (VITT), a recently described entity characterized by thrombosis at unusual locations such as cerebral venous sinus and splanchnic vein, has been rarely described after adenoviral-encoded COVID-19 vaccines. In this study, we report the immunohistological correlates in 3 fatal cases of cerebral venous thrombosis related to VITT analyzed at an academic medical center.
METHODS
Detailed neuropathologic studies were performed in 3 cases of cerebral venous thrombosis related to VITT after adenoviral COVID-19 vaccination.
RESULTS
Autopsy revealed extensive cerebral vein thrombosis in all 3 cases. Polarized thrombi were observed with a high density of neutrophils in the core and a low density in the tail. Endothelial cells adjacent to the thrombus were largely destroyed. Markers of neutrophil extracellular trap and complement activation were present at the border and within the cerebral vein thrombi. SARS-CoV-2 spike protein was detected within the thrombus and in the adjacent vessel wall.
DISCUSSION
Data indicate that neutrophils and complement activation associated with antispike immunity triggered by the vaccine is probably involved in the disease process.
目的
疫苗诱导的免疫性血栓性血小板减少症（VITT）是一种新近描述的疾病实体，其特征是在大脑静脉窦和内脏静脉等不常见部位发生血栓形成，在腺病毒编码的 COVID-19 疫苗接种后很少被描述。在这项研究中，我们在学术医疗中心分析了 3 例与 VITT 相关的致命性大脑静脉血栓形成病例，报告了其免疫组织化学相关性。
方法
对 3 例腺病毒 COVID-19 疫苗接种后与 VITT 相关的大脑静脉血栓形成病例进行了详细的神经病理学研究。
结果
尸检显示所有 3 例均存在广泛的大脑静脉血栓形成。在血栓的核心区域观察到密集的中性粒细胞，尾部密度较低的极化血栓。紧邻血栓的血管内皮细胞大部分被破坏。在脑静脉血栓的边界和内部存在中性粒细胞胞外诱捕网和补体激活的标志物。在血栓和相邻血管壁内检测到 SARS-CoV-2 刺突蛋白。
讨论
数据表明，与疫苗引发的抗刺突免疫相关的中性粒细胞和补体激活可能参与了疾病过程。
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