Janssen COVID-19 Vaccine Linked to AAV-related Kidney Damage

Vanda Pinto, PhD avatar

by Vanda Pinto, PhD |

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The Johnson & Johnson COVID-19 vaccine may have triggered kidney inflammation associated with ANCA-associated vasculitis (AAV) in a 52-year-old woman, according to a recent case report.

“We believe that this is the first case report of AAV that occurred following adenovirus vector COVID-19 vaccine administration,” its scientists wrote.

“Increasing reports of rare adverse effects like AAV following COVID-19 vaccination warrants the further study,” they added. “Considering the potential severity of COVID-19 and the rarity of the above-mentioned adverse effects, COVID-19 vaccination should not be withheld.”

The report, “ANCA-associated vasculitis following Johnson and Johnson COVID-19 vaccine,” was published in the journal Annals of Medicine and Surgery.

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AAV Patients Report Pain, Fatigue Despite Being in Clinical Remission

AAV refers to a group of autoimmune diseases in which self-reactive antibodies called ANCAs bind and overactivate neutrophils — a type of white blood cell. This overactivity leads to inflammation and damage to small blood vessels. Symptoms vary depending on which blood vessels are being damaged in the body.

In about 70% of patients, AAV causes blood vessels in the kidneys to become inflamed. Inflammation and swelling in the glomeruli — the kidney’s filtration units — causes ANCA glomerulonephritis, a condition that can affect normal kidney function and possibly cause kidney failure.

Vaccination as AAV trigger in rare cases

A few case reports of AAV and ANCA glomerulonephritis have emerged following vaccination with messenger RNA (mRNA) COVID-19 vaccines (Pfizer-BioNTech and Moderna). However, AAV after an adenovirus vector vaccine has not previously been reported.

Both viral vector vaccines and mRNA vaccines provide cells with instructions to make a part of the SARS-CoV-2 virus spike protein, which triggers a protective immune response against COVID-19. In viral vector vaccines, the spike protein DNA is placed inside an altered virus, while in mRNA vaccines, an engineered mRNA molecule containing the instructions to make the viral protein is provided to cells.

Scientists in Nepal described the case of a woman who developed ANCA-associated glomerulonephritis after receiving the adenovirus vector vaccine developed by Janssen Pharmaceuticals, part of Johnson & Johnson.

The woman, who had no history of COVID-19 or kidney problems, came to their hospital complaining of fever, joint pain, and weakness in the arms and legs. Her symptoms had started 12 days after being given the Johnson & Johnson/Janssen COVID-19 vaccine in July 2021.

A blood smear analysis — a technique used to examine blood cells — revealed an abnormally high number of neutrophils and normocytic anemia, or a low number of red blood cells but cells of a normal size.

Further testing showed she had low levels of the C3 complement protein, which is associated with increased kidney damage, and the presence of perinuclear ANCA (p-ANCA) and cytoplasmic (c-ANCA) antibodies. While p-ANCAs attach to myeloperoxidase (MPO), c-ANCAs are directed against proteinase 3 (PR3). Of note, MPO and PR3 are two proteins found in neutrophils.

Other analyses came back negative for hepatitis B and C, HIV, as well as other viral and bacterial infectious agents.

High blood creatinine levels were detected (6.13 mg/dL; normal range: 0.6–1.1 mg/dL), indicating that her kidneys were not functioning properly. Blood and protein were also found in her urine, two signs of kidney disease.

Based on these findings, her doctors prescribed antibiotics, the corticosteroid methylprednisolone, and NSAIDs or medications commonly used to reduce pain, inflammation, and fever.

Her creatinine levels remained high, so a kidney biopsy was performed. She was also given cyclophosphamide, a standard immunosuppressive therapy used to induce remission in people with AAV.

Biopsy results showed necrotizing and crescentic glomerulonephritis — a type of kidney damage featuring inflammation and scarring of kidney tissue sometimes found in AAV. After 10 days in the hospital, the woman was discharged.

“[As] a lesson learnt from the past, we can speculate the neutrophilic immune response to adenovirus vector present in Johnson and Johnson vaccines, to be a potential trigger for development of AAV,” the scientists wrote.

“Although this case does not conclusively clarify the causal relationship between adenovirus vector COVID-19 vaccine and AAV, further study in the future will insight the association,” they added.

Researchers noted that people should still be vaccinated against COVID-19, given the disease’s potential severity and the rarity of side effects.