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World J Gastroenterol. Mar 28, 2023; 29(12): 1838-1851
Published online Mar 28, 2023. doi: 10.3748/wjg.v29.i12.1838
Autoimmune liver diseases and SARS-CoV-2
Costantino Sgamato, Alba Rocco, Debora Compare, Stefano Minieri, Stefano Andrea Marchitto, Simone Maurea, Gerardo Nardone
Costantino Sgamato, Alba Rocco, Debora Compare, Stefano Minieri, Stefano Andrea Marchitto, Gerardo Nardone, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
Simone Maurea, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
Author contributions: Sgamato C and Rocco A drafted the manuscript; Compare D, Minieri S, and Marchitto SA participated in the acquisition, analysis, and interpretation of the literature; Maurea S and Nardone G revised the manuscript for important intellectual content; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Gerardo Nardone has served as a speaker and advisory board member for AG Pharma, Reckitt Benckiser, and has received research funding from SOFAR Spa and Alfasigma. No relevant conflicts of interest exist for the other authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alba Rocco, PhD, Doctor, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, Naples 80131, Italy. a.rocco@unina.it
Received: November 20, 2022
Peer-review started: November 20, 2022
First decision: January 2, 2023
Revised: January 12, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: March 28, 2023
Processing time: 128 Days and 1.5 Hours
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), can trigger autoimmunity in genetically predisposed individuals through hyperstimulation of immune response and molecular mimicry. Here we summarise the current knowledge about auto-immune liver diseases (AILDs) and SARS-CoV-2, focusing on: (1) The risk of SARS-CoV-2 infection and the course of COVID-19 in patients affected by AILDs; (2) the role of SARS-CoV-2 in inducing liver damage and triggering AILDs; and (3) the ability of vaccines against SARS-CoV-2 to induce autoimmune responses in the liver. Data derived from the literature suggest that patients with AILDs do not carry an increased risk of SARS-Cov-2 infection but may develop a more severe course of COVID-19 if on treatment with steroids or thiopurine. Although SARS-CoV-2 infection can lead to the development of several autoimmune diseases, few reports correlate it to the appearance of de novo manifestation of immune-mediated liver diseases such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or AIH/PBC overlap syndrome. Different case series of an AIH-like syndrome with a good prognosis after SARS-CoV-2 vaccination have been described. Although the causal link between SARS-CoV-2 vaccines and AIH cannot be definitively established, these reports suggest that this association could be more than coincidental.

Keywords: Autoimmune liver disease; SARS-CoV-2; COVID-19; COVID-19 vaccine; Autoimmune hepatitis

Core Tip: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a possible trigger of autoimmunity. Patients with autoimmune liver diseases (AILDs) were considered at higher risk of SARS-CoV-2 infection and more susceptible to severe coronavirus disease 2019 (COVID-19) due to genetic background and immunosuppressive treatments. Case reports documenting autoimmune hepatitis-like syndromes after the COVID vaccine started to emerge, raising worries about a possible risk of unwanted immunological side effects, especially in individuals predisposed to autoimmune disorders. We herein discuss the consequences of SARS-CoV-2 infection in patients with AILDs and the role of the vaccines in inducing liver autoimmunity.