SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis

Area of Science:

• Immunology
• Hepatology
• Vaccinology

Background:

• Autoimmune hepatitis is a known complication of SARS-CoV-2 infection and vaccination, but its mechanisms are not fully understood.
• This case study investigates immune correlates in a patient experiencing bimodal acute hepatitis after BNT162b2 mRNA vaccination.

Observation:

• Spatial immune profiling of liver tissue revealed a predominance of activated cytotoxic CD8 T cells.
• Enrichment of SARS-CoV-2-specific CD8 T cells was noted within the liver infiltrate compared to peripheral blood.
• Hepatitis severity correlated with the cytotoxic phenotype of peripheral SARS-CoV-2-specific CD8+ T cells.

Findings:

• COVID-19 vaccination can induce a distinct T cell-dominant immune-mediated hepatitis.
• The condition is associated with vaccination-induced antigen-specific tissue-resident immunity.
• Treatment with systemic steroids was required for remission.

Implications:

• Understanding the pathomechanism of vaccine-induced hepatitis is crucial for patient management.
• This highlights the role of antigen-specific T cells in post-vaccination liver injury.
• Further research is needed to elucidate the long-term implications and optimal treatment strategies.