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However, little is known of the prevalence or clinical significance of ACE2 autoantibodies in late convalescence or following COVID\u201019 vaccination. In this study, we measured ACE2 autoantibodies in a cohort of 182 COVID\u201019 convalescent patients, 186 COVID\u201019 vaccine recipients, and 43 adolescents with post\u2010mRNA vaccine myopericarditis using two ACE2 enzymatic immunoassays (EIAs). ACE2 IgM autoantibody EIA median optical densities (ODs) were lower in convalescent patients than pre\u2010COVID\u201019 control samples with only 2\/182 (1.1%) convalescents testing positive. Similarly, only 3\/182 (1.6%) convalescent patients tested positive for ACE2 IgG, but patients with history of moderate\u2010severe COVID\u201019 tended to have significantly higher median ODs than controls and mild COVID\u201019 patients. In contrast, ACE2 IgG antibodies were detected in 10\/186 (5.4%) COVID\u201019 vaccine recipients after two doses of vaccination. Median ACE2 IgG EIA ODs of vaccine recipients were higher than controls irrespective of the vaccine platform used (inactivated or mRNA). ACE2 IgG ODs were not correlated with surrogate neutralizing antibody levels in vaccine recipients. ACE2 IgG levels peaked at day 56 post\u2010first dose and declined within 12 months to baseline levels in vaccine recipients. Presence of ACE2 antibodies was not associated with adverse events following immunization including myopericarditis. One convalescent patient with ACE2 IgG developed Guillain\u2212Barre syndrome, but causality was not established. ACE2 autoantibodies are observed in COVID\u201019 vaccine recipients and convalescent patients, but are likely innocuous.<\/jats:p>","DOI":"10.1002\/jmv.29313","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T20:17:11Z","timestamp":1702671431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Autoantibodies against angiotensin\u2010converting enzyme 2 (ACE2) after COVID\u201019 infection or vaccination"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-637X","authenticated-orcid":false,"given":"James Yiu Hung","family":"Tsoi","sequence":"first","affiliation":[{"name":"Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Pokfulam Hong Kong 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University of Hong Kong  Pokfulam Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian Pui Chun","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Pokfulam Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Man Lung","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Pokfulam Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8948-6331","authenticated-orcid":false,"given":"Xin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Pokfulam Hong Kong 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