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. 2021 Aug 29;13(9):1718.
doi: 10.3390/v13091718.

A Transient Increase in the Serum ANCAs in Patients with SARS-CoV-2 Infection: A Signal of Subclinical Vasculitis or an Epiphenomenon with No Clinical Manifestations? A Pilot Study

Monica Gelzo  1   2 , Sara Cacciapuoti  3 , Biagio Pinchera  3 , Annunziata De Rosa  4 , Gustavo Cernera  1   2 , Filippo Scialò  1   5 , Marika Comegna  1   2 , Mauro Mormile  3 , Antonella Gallicchio  3 , Gabriella Fabbrocini  3 , Roberto Parrella  4 , Gaetano Corso  1   6 , Ivan Gentile  3 , Giuseppe Castaldo  1   2
Affiliations

A Transient Increase in the Serum ANCAs in Patients with SARS-CoV-2 Infection: A Signal of Subclinical Vasculitis or an Epiphenomenon with No Clinical Manifestations? A Pilot Study

Monica Gelzo et al. Viruses. .

Abstract

A relationship is emerging between SARS-CoV-2 infections and ANCA-associated vasculitis (AAV) because: (i) the pulmonary involvement of COVID-19 may mimic that observed in patients with AAV; (ii) the two diseases may occur together; (iii) COVID-19 may trigger AAV. However, few cases of AAV have been identified so far in COVID-19 patients. To define the frequency of ANCA autoimmunity in patients with SARS-CoV-2 infection, we analyzed the serum ANCAs and the serum PR3 and MPO antigens by immunoassays in 124 adult patients with a diagnosis of SARS-CoV-2 infection (16 were asymptomatic and 108 were hospitalized) and 48 control subjects. The serum ANCAs were significantly higher in the hospitalized patients compared with either the controls or the asymptomatic patients and increased with the progression of the COVID-19 severity. After one week of hospitalization, the values were significantly lower. In contrast, no differences emerged among the controls, asymptomatic and hospitalized patients for the PR3 and MPO serum levels. None of the patients had clinical signs of AAV with the exception of a severe pulmonary involvement. Further studies are necessary to define whether the increase in the serum ANCAs might mask subclinical vasculitis in a percentage of patients with SARS-CoV-2 infection or it is an epiphenomenon of SARS-CoV-2 infection with no clinical manifestations.

Keywords: ANCA; MPO; PR3; endothelial damage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The serum ANCAs (A), MPO (B) and PR3 (C) in the controls, hospitalized COVID-19 patients of the first wave at admission with WHO stages 3, 4 and 5–7, asymptomatic patients with a SARS-CoV-2 infection and hospitalized COVID-19 patients of the second wave at admission with WHO stages 3, 4 and 5–7.
Figure 2
Figure 2
The serum ANCAs in eight hospitalized COVID-19 patients at admission (basal) and after one week of hospitalization.
See this image and copyright information in PMC

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