COVID-19 could be an autoimmune disease: what does it mean

Scientists have found evidence that COVID-19 has signs of respiratory disease, but is autoimmune. Writes about it "Ukrainian Truth".

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Autoimmune diseases are diseases in which the body’s immunity is mobilized not against a virus or antigen, but against the cells of its own body and attacks them.

Throughout the pandemic, doctors have noticed a surprising phenomenon: many people infected with the coronavirus are developing myocarditis, an inflammation of the heart that can cause long-term harm and death.

Even among people who have suffered COVID-19 mildly or asymptomatically, experts have found heart inflammation.

A July study published in JAMA Cardiology found that 60% of COVID-19 patients had active myocarditis two months after infection.

Interestingly, the study found this inflammation was as common among people who were sick at home as it was among those who needed hospitalization.

“We're still not sure what exactly causes inflammation in the heart,” says John Schwartzberg, professor emeritus of infectious diseases and vaccinology at the Berkeley School of Public Health.

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One of the hypotheses is that the autoimmune process is activated during the disease. It appears that COVID-19 has an inflammatory immune response, making it a similar autoimmune disease.

Autoimmune diseases such as lupus and multiple sclerosis are characterized by this very inflammatory process.

Regarding COVID-19 and myocarditis, Schwarzberg says the autoimmune hypothesis states that SARS-CoV-2 causes the immune system to incorrectly detect something in the heart cells as dangerous to the body. This false identification leads to inflammation.

He adds that this theory is just one of several possible explanations. The presence of inflammation, even if it continues after the virus has been cleared, is not in itself an indicator of an autoimmune disease, he says.

But other researchers have argued that COVID-19 often provokes autoimmune processes.

The authors of the study in the Journal of Immunology published evidence that SARS-CoV-2 can cause the body's immune system to attack its own cells and tissues in the heart, brain and other organs.

They believe this theory could explain how the virus is causing such widespread and unpredictable harm. Understanding these autoimmune processes could be the key to preventing this harm and saving lives.

Experts say that the immune system's response to SARS-CoV-2 can alter brain activity in ways that disrupt sleep and wakefulness.

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In October, Nature Immunology researchers examined the activity of immune cells and antibodies among people with severe COVID-19. They found some striking similarities to autoimmune diseases.

“We observed the same type of B cell activity that we see in lupus, as well as similar antibody activity,” said Ignacio Sanz, MD, co-author of the study and director of the Lowance Center for Human Immunology at Emory University.

Sanz says it's entirely possible that the events he documented are simply indicators of an aggressive immune response to the virus.

He believes that in at least some patients, elements of autoimmunity are strongly associated with the development of severe COVID-19.

How can coronavirus cause a person's immune system to mistakenly attack their own cells and tissues?

In part, this may be a process that biologists call "molecular imitation."

“There are a number of analogies between the amino acid sequences of (coronavirus) proteins and human proteins,” explains Timothy Eisengle, MD.

These similarities between proteins can confuse the immune system and cause it to attack its own healthy cells; in some people, this attack can last even after the actual cells of the virus are destroyed.

Autoimmunity may explain why a strong immune response to the virus, which includes the production of antibodies that neutralize the coronavirus, does not always correlate with a mild course of COVID-19.

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It is possible that in some patients, an immune response designed to eliminate the virus will end up attacking healthy cells.

These autoimmune events may also explain why myocarditis and other forms of inflammation or side effects appear weeks or months after a person has recovered.

If it turns out that the coronavirus is indeed an autoimmune disease, then this will allow scientists to use drugs that are used in this group of diseases in the treatment process.

Emory University's Sanz says immunosuppressive drugs, including those that have not yet been tested in people with COVID-19, may be helpful.

"But I think only some patients will benefit," he says.

He emphasizes over and over again that COVID-19 is a heterogeneous disease.

It affects different people in different ways. Outside of a vaccine, there is hardly a single treatment that works for everyone.

However, Sanz says better understanding of the autoimmune aspects of the disease, coupled with widespread adoption of essential drugs, can help improve patient outcomes in both the short and long term.

“I think auto immunity is part of the answer,” adds Sanz. “But that’s not the whole answer.”

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