Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study
Laura Benjamin, Ross W. Paterson, Rachel Moll, Charis Pericleous, Rachel Brown, Puja R. Mehta, Dilan Athauda, Oliver J. Ziff, Judith Heaney, Anna M. Checkley, Catherine Houlihan, Michael Chou, Amanda Heslegrave, Arvind Chandratheva, Benedict Michael, Kaj Blennow, Vinojini Vivekanandam, Alexander Foulkes, Catherine Mummery, Michael P. Lunn, Stephen Keddie, Moira Spyer, Tom McKinnon, Melanie Hart, Francesco Carletti, Hans Rolf Jäger, Hadi Manji, Michael S. Zandi, David J. Werring, Eleni Nastouli, Robert Simister, Tom Solomon, Henrik Zetterberg, Jonathan M. Schott, Hannah Cohen, Maria Efthymiou
Abstract
BACKGROUND: A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear. METHODS: GPI (aD1β2GPI) IgG. FINDINGS: . INTERPRETATION: Our findings show that aPS/PT IgG is associated with COVID-19-associated ADEM. In contrast, aCL IgA and IgG are seen much more frequently in non-neurological hospitalised patients with COVID-19. Characterisation of antiphospholipid antibody persistence and potential longitudinal clinical impact are required to guide appropriate management. FUNDING: This work is supported by UCL Queen Square Biomedical Research Centre (BRC) and Moorfields BRC grants (#560441 and #557595). LB is supported by a Wellcome Trust Fellowship (222102/Z/20/Z). RWP is supported by an Alzheimer's Association Clinician Scientist Fellowship (AACSF-20-685780) and the UK Dementia Research Institute. KB is supported by the Swedish Research Council (#2017-00915) and the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986). HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG-720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), and theUK Dementia Research Institute at UCL. BDM is supported by grants from the MRC/UKRI (MR/V007181/1), MRC (MR/T028750/1) and Wellcome (ISSF201902/3). MSZ, MH and RS are supported by the UCL/UCLH NIHR Biomedical Research Centre and MSZ is supported by Queen Square National Brain Appeal.