Analysis of clinical presentations, adaptive and innate immune correlates of Vaccine-associated Post-Acute SARS-Coronavirus Syndrome (PASC-vac)

Post-vaccination acute sequelae of SARS-CoV-2 (PASC-vac) is a condition characterized by persistent neurological and immunological symptoms following COVID-19 vaccination. This study explores the clinical manifestations, immune correlates, and potential pathogenic mechanisms underlying PASC-vac. A cohort of 71 PASC-vac patients and 19 healthy donors was analyzed through immunological assessments, including flow cytometry, serum antibody profiling, and tissue examination. The findings indicate that PASC-vac patients frequently experience peripheral neurological symptoms such as paresthesia, dysautonomia, and vasomotor disturbances. Additionally, elevated levels of anti-idiotype antibodies and disruptions in peripheral lymphocyte subsets were detected. Analysis of inflammatory precursor cells (CD34+ DNAM-1bright CXCR4+) suggests their involvement in immune dysregulation associated with PASC-vac. The study also investigates the connection between PASC-vac and small fiber neuropathy (SFN), demonstrating reduced nerve fiber density in affected individuals. These results highlight the role of abnormal immune responses, autoantibody production, and immune dysregulation in the development of PASC-vac. Furthermore, therapeutic strategies targeting NRP1 and ACE2 receptors are proposed as potential avenues for treatment.