key: cord-0903425-qmyspzbs
authors: Gruel, Yves; Vayne, Caroline; Rollin, Jérôme; Pouplard, Claire
title: Reply to the letter entitled “Suggested treatment of serious complications to Covid‐19 vaccination with IdeS, a bacterial antibody‐cleaving enzyme”
date: 2021-07-30
journal: J Thromb Haemost
DOI: 10.1111/jth.15465
sha: d52eeb5d1522895b6b1d56189af3bf7ccca521c7
doc_id: 903425
cord_uid: qmyspzbs

nan

Dear Editor,

We have read with interest the letter written by Dr. Kahn and colleagues, 1 who suggest that IdeS (imlifidase), a bacterial protease that cleaves IgG and strongly inhibits the interaction of pathogenic FcγRIIA receptors. Therefore, we also proposed that IdeS injection could be a potential treatment for patients with severe HIT.

In VITT and HIT, IdeS should be effective within minutes of intravenous injection, but almost all IgG will also be cleaved and nonfunctional, which could expose treated patients at increased risk for bacterial infections. Therefore, an infusion of polyclonal IgG will be required early on to restore normal IgG levels in all IdeS-treated patients. Importantly, this protease does not appear to affect blood coagulation, with no impact on thrombin generation, as assessed in our mouse model, and should not increase thrombotic risk, which is particularly high in VITT patients.

In conclusion, our data obtained with pathogenic anti-PF4 antibodies strongly support the proposal that IdeS can be used as an emergency treatment in the most severely affected VITT patients.

Suggested treatment of serious complications to Covid-19 vaccination with IdeS, a bacterial antibodycleaving enzyme

PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Cleavage of anti-PF4/ heparin IgG by a bacterial protease and potential benefit in heparininduced thrombocytopenia