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- Title:
SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis.
- Document type:
- Journal Article
- Author(s):
- Boettler, Tobias; Csernalabics, Benedikt; Salié, Henrike; Luxenburger, Hendrik; Wischer, Lara; Alizei, Elahe Salimi; Zoldan, Katharina; Krimmel, Laurenz; Bronsert, Peter; Schwabenland, Marius; Prinz, Marco; Mogler, Carolin; Neumann-Haefelin, Christoph; Thimme, Robert; Hofmann, Maike; Bengsch, Bertram
- Abstract:
- BACKGROUND & AIMS: Autoimmune hepatitis episodes have been described following SARS-CoV-2 infection and vaccination but their pathophysiology remains unclear. Herein, we report the case of a 52-year-old male, presenting with bimodal episodes of acute hepatitis, each occurring 2-3 weeks after BNT162b2 mRNA vaccination. We sought to identify the underlying immune correlates. The patient received oral budesonide, relapsed, but achieved remission under systemic steroids. METHODS: Imaging mass cytometry for spatial immune profiling was performed on liver biopsy tissue. Flow cytometry was performed to dissect CD8 T-cell phenotypes and identify SARS-CoV-2-specific and EBV-specific T cells longitudinally. Vaccine-induced antibodies were determined by ELISA. Data were correlated with clinical laboratory results. RESULTS: Analysis of the hepatic tissue revealed an immune infiltrate quantitatively dominated by activated cytotoxic CD8 T cells with panlobular distribution. An enrichment of CD4 T cells, B cells, plasma cells and myeloid cells was also observed compared to controls. The intrahepatic infiltrate showed enrichment for CD8 T cells with SARS-CoV-2-specificity compared to the peripheral blood. Notably, hepatitis severity correlated longitudinally with an activated cytotoxic phenotype of peripheral SARS-CoV-2-specific, but not EBV-specific, CD8+ T cells or vaccine-induced immunoglobulins. CONCLUSIONS: COVID-19 vaccination can elicit a distinct T cell-dominant immune-mediated hepatitis with a unique pathomechanism associated with vaccination-induced antigen-specific tissue-resident immunity requiring systemic immunosuppression. LAY SUMMARY: Liver inflammation is observed during SARS-CoV-2 infection but can also occur in some individuals after vaccination and shares some typical features with autoimmune liver disease. In this report, we show that highly activated T cells accumulate and are evenly distributed in the different areas of the liver in a patient with liver inflammation following SARS-CoV-2 vaccination. Moreover, within the population of these liver-infiltrating T cells, we observed an enrichment of T cells that are reactive to SARS-CoV-2, suggesting that these vaccine-induced cells can contribute to liver inflammation in this context.
- Journal title abbreviation:
- J Hepatol
- Year:
- 2022
- Journal volume:
- 77
- Journal issue:
- 3
- Pages contribution:
- 653-659
- Fulltext / DOI:
- doi:10.1016/j.jhep.2022.03.040
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/35461912
- Print-ISSN:
- 0168-8278
- TUM Institution:
- Institut für Allgemeine Pathologie und Pathologische Anatomie
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