Pandemic influenza immunization in primary antiphospholipid syndrome (PAPS): a trigger to thrombosis and autoantibody production?

Author(s)

de Medeiros, D. Martins ^[1] ; Silva, C. A. ^{[1, 2]} ; Bueno, C. ^[1] ; Medeiros Ribeiro, A. C. ^[1] ; Viana, V. dos Santos T. ^[1] ; Carvalho, J. Freire ^[3] ; Bonfa, E. ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Div Rheumatol, BR-05403010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Pediat Rheumatol Unit, BR-05403010 Sao Paulo - Brazil

^[3] Univ Fed Bahia, Div Rheumatol, BR-41170290 Salvador, BA - Brazil

• Document type: Journal article
• Source: Lupus; v. 23, n. 13, p. 1412-1416, NOV 2014.
• Web of Science Citations: 4

Abstract

Objective The objective of this report is to conduct short- and long-term evaluation of a large panel of antiphospholipid (aPL) autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in primary antiphospholipid syndrome (PAPS) patients and healthy controls. Methods Forty-five PAPS and 33 healthy controls were immunized with H1N1 vaccine. They were prospectively assessed at pre-vaccination, and three weeks and six months after vaccination. aPL autoantibodies were determined by an enzyme-linked immunosorbent assay (ELISA) and included IgG/IgM: anticardiolipin (aCL), anti-beta2glycoprotein I (anti-2GPI); anti-annexin V, anti-phosphatidyl serine and anti-prothrombin antibodies. Anti-Sm was determined by ELISA and anti-double-stranded DNA (anti-dsDNA) by indirect immunofluorescence. Arterial and venous thrombosis were also clinically assessed. Results Pre-vaccination frequency of at least one aPL antibody was significantly higher in PAPS patients versus controls (58% vs. 24%, p=0.0052). The overall frequencies of aPL antibody at pre-vaccination, and three weeks and six months after immunization remained unchanged in patients (p=0.89) and controls (p=0.83). The frequency of each antibody specificity for patients and controls remained stable in the three evaluated periods (p>0.05). At three weeks, two PAPS patients developed a new but transient aPL antibody (aCL IgG and IgM), whereas at six months new aPL antibodies were observed in six PAPS patients and none had high titer. Anti-Sm and anti-dsDNA autoantibodies were uniformly negative and no new arterial or venous thrombosis were observed throughout the study. Conclusions This is the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short- and long-term thrombosis or a significant production of aPL-related antibodies (ClinicalTrials.gov, \#NCT01151644). (AU)

• FAPESP's process: 10/10749-0 - Anti-influenza H1N1/2009 vaccine in autoimmune rheumatic diseases patients
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Regular Research Grants