Anticardiolipin and other antiphospholipid antibodies in critically ill COVID-19 positive and negative patients
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  • Published on:
    Response to Dr. Yudong Liu
    • Marvin J. Fritzler, Professor of Medicine University of Calgary, Cumming School of Medicine
    • Other Contributors:
      • Uriel Trahtemberg, Critical Care Physician and Affiliate Scientist

    We thank Dr. Yudong Liu for commenting on our manuscript and on many of the same issues we raised 1. There are, however, some comments that require clarification and a response. It is true that anti-phospholipid antibodies (APLA) of various specificities and immunoglobulin isotypes have been reported in COVID-19 2. However, despite a historical connection of APLA with coagulopathies and anti-phospholipid syndrome (APS), to date there is no convincing evidence that APLA have this in vivo pathogenic effect in COVID-19. In our patients, despite the presence of APLA (e.g., IgG anti-cardiolipin), there was no link to thrombotic events, a finding echoed by other referenced studies 3 and recently reviewed 2,4. The recent publication by Chang et al 5 is mentioned but it is important to appreciate that their results were compared to “normal” controls and no clinical features (coagulopathy or APS) were reported, precluding any inferences to autoimmune diseases; it is a standalone description of COVID-19 findings. Like the Chang manuscript, we also reported an extensive array of autoantibodies in COVID-19, but when we used sera from contemporaneous non-COVID patients of similar disease severity as comparator controls, we did not find significant differences in the autoantibody repertoire between the COVID positive and negative cohorts 6. Many individuals displayed “certain autoimmune features” but that cannot be taken to be equivalent to autoimmune disease. Indeed, COVID-19 patients...

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    Conflict of Interest:
    None declared.
  • Published on:
    The autoimmune feature of severe COVID-19
    • Yudong Liu, MD The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital

    Dear Editor,

    I read with great interest the article by Trahtemberg et al.[1] on the clinical relevance of antiphospholipid antibodies (aPLs), in particular anticardiolipin antibodies (aCLs), in critically-ill COVID-19 positive and negative patients. Severe COVID-19 is associated with a hypercoagulable state. Early studies identified the presence of aPLs in critically-ill COVID-19 patients[2], which has attracted considerable attention as the presence of aPLs is one of the mechanisms leading to coagulopathy. Substantial efforts then tried to associate the thrombotic events seen in COVID-19 to aPLs status. The results seem negative, but a number of different types of autoantibodies were identified [3]. Chang et al. recently reported that autoantibodies were present in approximately half of the hospitalized COVID-19 patients, but in less than 15% of healthy controls [4]. In addition to aCLs and anti-beta 2 glycoprotein 1 antibodies (aβ2-GP1), they also identified autoantibodies targeting autoantigens associated with rare disorders such as myositis, systemic sclerosis and overlap syndromes as well as targeting interferons/interleukins and other cytokines[4]. These findings suggest that COVID-19, in particular patients with severe/critical conditions, displayed certain autoimmune features.

    In the well-designed study by Trahtemberg et al., the authors expanded the cohort by including COVID-19 negative patients who were admitted to intensive care unit (ICU) with ac...

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    Conflict of Interest:
    None declared.
  • Published on:
    Rujittika Mungmunpuntipantip and Viroj Wiwanitkit Response

    We thank Mungmunpuntipantip and Wiwanitkit for their response and comments on our manuscript and their local experience. Of note, the serologies of the cohort we presented were tested repeatedly during the hospitalization, not only at admission. Also, for reference, the days from symptom onset to ICU admission are presented in Table 3 of the manuscript".

    Conflict of Interest:
    None declared.
  • Published on:
    COVID-19, autoantibody and clinical outcome
    • rujittika mungmunpuntipantip, academic Private Academic Consultant, Bangkok Thailand
    • Other Contributors:
      • viroj wiwanitkit, medical professor

    COVID-19, autoantibody and clinical outcome
    Rujittika Mungmunpuntipantip1,Viroj Wiwanitkit2
    1.Private Academic Consultant, Bangkok Thailand
    2. Dr DY Patil University, Pune, India
    Rujittika Mungmunpuntipantip
    Private Academic Consultant, Bangkok Thailand

    Dear Editor, we would like to share ideas and experience on “Anticardiolipin and other antiphospholipid antibodies in critically ill COVID-19 positive and negative patients [1].” Trahtemberg et al. concluded that “Positive APLA serology was associated with more severe disease regardless of COVID-19 status [1].” In the study, the laboratory data on the day of admission are referred to. In individual patient, the period of illness before admission might be different and whether this period affects affect clinical outcome or not is an interesting question. In COVID-19, the development of COVID-19 is reported and the rate of positive autoimmunity is different in different reports [2]. In our settings, positive autoantibody is detectable after complete recovery from COVID -19 among patients with history of previously autoantibody negative. Hence, it might be difficult to interpret the clinical association of positive autoantibody at first admission.

    Conflict of interest

    1. Trahtemberg U, Rottapel R, Dos Santos CC, Slutsky AS, Baker A, Fritzler MJ. Anticardi...

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    Conflict of Interest:
    None declared.