Autoimmune hepatitis caused by mRNA vaccine is a special case

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Autoimmune hepatitis caused by mRNA vaccine is a special case

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Autoimmune hepatitis caused by mRNA vaccine is a special case, and expansion of vaccination should not be a concern. 

On April 21, 2022, the Journal of Hepatology , an authoritative international academic journal in the field of liver disease, published a research paper entitled: SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis.

The paper pointed out that the mRNA COVID-19 vaccine (BNT162b2) developed by Pfizer/BioNTech may cause a rare T cell-mediated autoimmune hepatitis .

The Paper reported this article in Chinese and it was forwarded by many media, causing widespread social concern. So how should we look at the occurrence of autoimmune hepatitis caused by the mRNA COVID-19 vaccine, and can the mRNA vaccine continue to expand its use?

To this end, Freehand Jun conducted an exclusive interview with Niu Junqi, a professor of the Department of Hepatology of the Center for Infection and Pathogen Biology of the First Hospital of Jilin University, the editor-in-chief of the Journal of Clinical Hepatobiliary Diseases, and the consultant of the Freehand Clinical Research and Development Club, Niu Junqi .

The patient mentioned in the article is a 52-year-old male who developed autoimmune hepatitis after two doses of the mRNA COVID-19 vaccine (BNT162b2) produced by Pfizer , and underwent liver biopsy and autoimmune hepatitis-related marker tests, and Other immunization tests can basically confirm that it is autoimmune hepatitis caused by the vaccine. She improved and was discharged after treatment with immunosuppressive agents (budesonide) .

Autoimmune hepatitis caused by mRNA vaccination has also been reported before. This situation can also be seen after other types of COVID-19 vaccines, but there is no severe hepatitis and the need for liver transplantation.

The patient’s histocompatibility antigen test result was HLA-A*03, which is a high-incidence genotype of autoimmune hepatitis and is rare in China. The patient had hypothyroidism before the onset of this disease, and hypothyroidism is often caused by abnormal immune function.

Autoimmune diseases (including autoimmune hepatitis) have the characteristics that the body originally carries a susceptibility gene (such as HLA-A*03) , after bacterial or viral infection, after taking or injecting certain drugs, or other immune factors Onset after activation. This activation is equivalent to “trigger effect trigger device”.

This case can be diagnosed as drug-induced autoimmune hepatitis, or drug-induced liver injury with autoimmune features. In fact, many reasons can trigger the onset of autoimmune hepatitis. Autoimmune hepatitis can also occur after SARS-CoV-2 infection. It is not surprising that various vaccines, including the Covid-19 vaccine, induce autoimmune hepatitis.

Even if people already suffer from autoimmune diseases (rheumatic diseases) , after weighing the pros and cons, the Chinese Rheumatology Association still recommends that the COVID-19 vaccine can be vaccinated after the acute attack of the disease is under control, but it is recommended to give priority to the inactivated vaccine.

While the American College of Rheumatology recommended mRNA vaccines, the restrictions on vaccine types were later relaxed, and viral vector vaccines (eg, adenovirus vector vaccines) could also be administered .

mRNA vaccines are an important innovation in the human fight against disease and could bring about a revolution in vaccine and drug development. As a brand new vaccine, humans have a lot of misunderstandings about this new technology. However, it has played an important role in the global prevention of new coronavirus infection and is a WHO-approved vaccine.

As of April 25, 2022, 11.5 billion doses of vaccines have been vaccinated around the world, and the COVID-19 vaccine (BNT162b2) is the largest type of vaccine. The overall protection rate is very good and safe. 

But like all drugs have side effects, the safety of this mRNA vaccine is not absolute. This article has carried out very detailed basic research, which is worth learning. But autoimmune diseases, including autoimmune hepatitis, caused by the Covid-19 vaccine will not be a common problem.

At present, in the context of China’s vigorous promotion and expansion of new vaccinations against the COVID-19, I hope everyone will not worry about this special case .

references:
1. Boettler T, Csernalabics B, Salié H, Luxenburger H, Wischer L, Alizei ES, Zoldan K, Krimmel L, Bronsert P, Schwabenland M, Prinz M, Mogler C, Neumann-Haefelin C, Thimme R, Hofmann M, Bengsch B. SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis. J Hepatol. 2022 Apr 21:S0168-8278(22)00234-3. doi: 10.1016/j.jhep.2022.03.040. Epub ahead of print. PMID: 35461912.
2.Trzos K, Pydyn N, Jura J, Kotlinowski J. Selected transgenic murine models of human autoimmune liver diseases. Pharmacol Rep. 2022 Apr;74(2):263-272. doi: 10.1007/s43440-021-00351-y . Epub 2022 Jan 15. PMID: 35032321; PMCID: PMC8964654.
3. Kabaçam G, Wahlin S, Efe C. Autoimmune hepatitis triggered by COVID-19: A report of two cases. Liver Int. 2021 Oct;41(10):2527-2528. doi: 10.1111/liv.15044. Epub 2021 Sep 3. PMID: 34478591; PMCID: PMC8662284.

Autoimmune hepatitis caused by mRNA vaccine is a special case

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