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The antigen is delivered to megakaryocyte cells, which act as part of the primary immune system and distribute the antigen within progeny platelets, also a key component of the immune system. The interaction of the antigen induces preformed antiplatelet factor 4 (PF4) antibodies to bind to PF4\u2013heparan sulfate complexes in the absence of exogenous heparin, at sites where the heparan sulfate concentration in the vascular glycocalyx is optimal for complex formation, causing thrombosis and thrombocytopenia as observed clinically. This hypothesis is testable in cell culture and animal models, and potentially <jats:italic>in\u2009vivo<\/jats:italic>, and if proven correct has significant implications for vaccine development and our understanding of the links between the coagulation and immune systems.<\/jats:p>","DOI":"10.1111\/imcb.12505","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T09:02:59Z","timestamp":1634806979000},"page":"1006-1010","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Vaccine\u2010induced immune thrombosis and thrombocytopenia syndrome following adenovirus\u2010vectored severe acute respiratory syndrome coronavirus 2 vaccination: a novel hypothesis regarding mechanisms and implications for future vaccine 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