{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:24:10Z","timestamp":1793258650007,"version":"4.5.0"},"reference-count":166,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Less than a year after the global emergence of the coronavirus SARS-CoV-2, a novel vaccine platform based on mRNA technology was introduced to the market. Globally, around 13.38 billion COVID-19 vaccine doses of diverse platforms have been administered. To date, 72.3% of the total population has been injected at least once with a COVID-19 vaccine. As the immunity provided by these vaccines rapidly wanes, their ability to prevent hospitalization and severe disease in individuals with comorbidities has recently been questioned, and increasing evidence has shown that, as with many other vaccines, they do not produce sterilizing immunity, allowing people to suffer frequent re-infections. Additionally, recent investigations have found abnormally high levels of IgG4 in people who were administered two or more injections of the mRNA vaccines. HIV, Malaria, and Pertussis vaccines have also been reported to induce higher-than-normal IgG4 synthesis. Overall, there are three critical factors determining the class switch to IgG4 antibodies: excessive antigen concentration, repeated vaccination, and the type of vaccine used. It has been suggested that an increase in IgG4 levels could have a protecting role by preventing immune over-activation, similar to that occurring during successful allergen-specific immunotherapy by inhibiting IgE-induced effects. However, emerging evidence suggests that the reported increase in IgG4 levels detected after repeated vaccination with the mRNA vaccines may not be a protective mechanism; rather, it constitutes an immune tolerance mechanism to the spike protein that could promote unopposed SARS-CoV2 infection and replication by suppressing natural antiviral responses. Increased IgG4 synthesis due to repeated mRNA vaccination with high antigen concentrations may also cause autoimmune diseases, and promote cancer growth and autoimmune myocarditis in susceptible individuals.<\/jats:p>","DOI":"10.3390\/vaccines11050991","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T02:04:05Z","timestamp":1684289045000},"page":"991","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["IgG4 Antibodies Induced by Repeated Vaccination May Generate Immune Tolerance to the SARS-CoV-2 Spike Protein"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4037-5857","authenticated-orcid":false,"given":"Vladimir","family":"Uversky","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and USF Health Byrd Alzheimer\u2019s Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8246-0075","authenticated-orcid":false,"given":"Elrashdy","family":"Redwan","sequence":"additional","affiliation":[{"name":"Biological Science Department, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia"},{"name":"Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg EL-Arab, Alexandria 21934, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Makis","sequence":"additional","affiliation":[{"name":"Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2978-5107","authenticated-orcid":false,"given":"Alberto","family":"Rubio-Casillas","sequence":"additional","affiliation":[{"name":"Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico"},{"name":"Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jconrel.2021.03.043","article-title":"The dawn of mRNA vaccines: The COVID-19 case","volume":"333","author":"Verbeke","year":"2021","journal-title":"J. Control. Release"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e069761","DOI":"10.1136\/bmj-2021-069761","article-title":"Clinical severity of, and effectiveness of mRNA vaccines against, COVID-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: Prospective observational study","volume":"376","author":"Lauring","year":"2022","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"459","DOI":"10.15585\/mmwr.mm7112e1","article-title":"Effectiveness of mRNA vaccination in preventing COVID-19\u2013associated invasive mechanical ventilation and death\u2014United States, March 2021\u2013January 2022","volume":"71","author":"Tenforde","year":"2022","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"549","DOI":"10.15585\/mmwr.mm7115e2","article-title":"Effectiveness of COVID-19 mRNA vaccination in preventing COVID-19\u2013associated hospitalization among adults with previous SARS-CoV-2 infection\u2014United States, June 2021\u2013February 2022","volume":"71","author":"Plumb","year":"2022","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2738","DOI":"10.3389\/fpubh.2022.873596","article-title":"The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis","volume":"10","author":"Rahmani","year":"2022","journal-title":"Front. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1001\/jama.2021.19499","article-title":"Association between mRNA vaccination and COVID-19 hospitalization and disease severity","volume":"326","author":"Tenforde","year":"2021","journal-title":"JAMA"},{"key":"ref_7","unstructured":"(2022, May 16). Rates of COVID-19 Cases and Deaths by Vaccination Status. Centers for Disease Control. COVID-19 Data Tracker, Available online: https:\/\/covid.cdc.gov\/covid-data-tracker\/#rates-by-vaccine-status."},{"key":"ref_8","unstructured":"Deaths by Vaccination Status in England (2023, May 14). Office for National Statistics, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/datasets\/deathsbyvaccinationstatusengland."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.21276\/apjhs.2023.10.1.6","article-title":"Is There a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?","volume":"10","author":"Aarstad","year":"2023","journal-title":"Asian Pac. J. Health Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1038\/s41564-020-00813-8","article-title":"Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans","volume":"5","author":"Seow","year":"2020","journal-title":"Nat. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1038\/s41586-021-03324-6","article-title":"mRNA vaccine-elicited antibodies to SARS-CoV-2 and circulating variants","volume":"592","author":"Wang","year":"2021","journal-title":"Nature"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"eabn9243","DOI":"10.1126\/scitranslmed.abn9243","article-title":"Omicron variant Spike-specific antibody binding and Fc activity are preserved in recipients of mRNA or inactivated COVID-19 vaccines","volume":"14","author":"Bartsch","year":"2022","journal-title":"Sci. Transl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1007\/s10654-021-00808-7","article-title":"Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States","volume":"36","author":"Subramanian","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s12275-022-1525-1","article-title":"SARS-CoV-2-mediated evasion strategies for antiviral interferon pathways","volume":"60","author":"Oh","year":"2022","journal-title":"J. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3810","DOI":"10.1038\/s41467-020-17665-9","article-title":"Activation and evasion of type I interferon responses by SARS-CoV-2","volume":"11","author":"Lei","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"198350","DOI":"10.1016\/j.virusres.2021.198350","article-title":"The ORF8 protein of SARS-CoV-2 induced endoplasmic reticulum stress and mediated immune evasion by antagonizing production of interferon beta","volume":"296","author":"Rashid","year":"2021","journal-title":"Virus Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"108234","DOI":"10.1016\/j.celrep.2020.108234","article-title":"Evasion of Type I Interferon by SARS-CoV-2","volume":"33","author":"Xia","year":"2020","journal-title":"Cell Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5376","DOI":"10.1002\/jmv.27050","article-title":"SARS-CoV-2 ORF9b antagonizes type I and III interferons by targeting multiple components of the RIG-I\/MDA-5-MAVS, TLR3-TRIF, and cGAS-STING signaling pathways","volume":"93","author":"Han","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"700926","DOI":"10.3389\/fimmu.2021.700926","article-title":"RIG-I-Like Receptor-Mediated Recognition of Viral Genomic RNA of Severe Acute Respiratory Syndrome Coronavirus-2 and Viral Escape From the Host Innate Immune Responses","volume":"12","author":"Kouwaki","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2024202118","DOI":"10.1073\/pnas.2024202118","article-title":"The ORF8 protein of SARS-CoV-2 mediates immune evasion through down-regulating MHC-I","volume":"118","author":"Zhang","year":"2021","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6602","DOI":"10.1038\/s41467-021-26910-8","article-title":"SARS-CoV-2 inhibits induction of the MHC class I pathway by targeting the STAT1-IRF1-NLRC5 axis","volume":"12","author":"Yoo","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3794","DOI":"10.1038\/s41598-022-07867-0","article-title":"An intra-cytoplasmic route for SARS-CoV-2 transmission unveiled by Helium-ion microscopy","volume":"12","author":"Merolli","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"eabo0171","DOI":"10.1126\/sciadv.abo0171","article-title":"Tunneling nanotubes provide a route for SARS-CoV-2 spreading","volume":"29","author":"Pepe","year":"2022","journal-title":"Sci. Adv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1038\/s41586-021-04266-9","article-title":"Enhanced fusogenicity and pathogenicity of SARS-CoV-2 Delta P681R mutation","volume":"602","author":"Saito","year":"2022","journal-title":"Nature"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/s41586-021-03944-y","article-title":"SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion","volume":"599","author":"Mlcochova","year":"2021","journal-title":"Nature"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1038\/s41586-022-04474-x","article-title":"Altered TMPRSS2 usage by SARS-CoV-2 Omicron impacts infectivity and fusogenicity","volume":"603","author":"Meng","year":"2022","journal-title":"Nature"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17642","DOI":"10.1038\/s41598-021-95045-z","article-title":"Assessment of avidity related to IgG subclasses in SARS-CoV-2 Brazilian infected patients","volume":"11","author":"Moura","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ejim.2021.09.012","article-title":"Serum IgG4 level predicts COVID-19 related mortality","volume":"93","author":"Lanzillotta","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"eade2798","DOI":"10.1126\/sciimmunol.ade2798","article-title":"Class switch towards non-inflammatory, spike-specific IgG4 antibodies after repeated SARS-CoV-2 mRNA vaccination","volume":"8","author":"Irrgang","year":"2022","journal-title":"Sci. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7835","DOI":"10.3389\/fimmu.2022.1020844","article-title":"mRNA vaccines against SARS-CoV-2 induce comparably low long-term IgG Fc galactosylation and sialylation levels but increasing long-term IgG4 responses compared to an adenovirus-based vaccine","volume":"13","author":"Buhre","year":"2023","journal-title":"Front. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1084\/jem.120.2.253","article-title":"H chain subgroups of myeloma proteins and normal 7S \u03b3-globulin","volume":"120","author":"Grey","year":"1964","journal-title":"J. Exp. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1126\/science.146.3642.400","article-title":"Subclasses of human \u03b32-globulin based on differences in the heavy polypeptide chains","volume":"146","author":"Terry","year":"1964","journal-title":"Science"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"671","DOI":"10.4049\/jimmunol.130.2.671","article-title":"IgG subclass expression by human B lymphocytes and plasma cells: B lymphocytes precommitted to IgG subclass can be preferentially induced by polyclonal mitogens with T cell help","volume":"130","author":"Mayumi","year":"1983","journal-title":"J. Immunol."},{"key":"ref_35","unstructured":"Abbas, A.K., Lichtman, A.H., and Pober, J.S. (1991). Cellular and Molecular Immunology, Saunders."},{"key":"ref_36","unstructured":"Meulenbroek, A. (2002). Human IgG Subclasses: Useful Diagnostic Markers for Immunocompetence, CLB."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/0022-1759(84)90376-4","article-title":"Measurement of serum IgG4 levels by a competitive immunoenzymatic assay with monoclonal antibodies","volume":"74","author":"Aucouturier","year":"1984","journal-title":"J. Immunol. Methods"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1046\/j.0019-2805.2001.01341.x","article-title":"IgG4 breaking the rules","volume":"105","author":"Aalberse","year":"2002","journal-title":"Immunology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1365-2222.2009.03207.x","article-title":"Immunoglobulin G4: An odd antibody","volume":"39","author":"Aalberse","year":"2009","journal-title":"Clin. Exp. Allergy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/BOR.0b013e3283412fd4","article-title":"What is IgG4? A review of the biology of a unique immunoglobulin subtype","volume":"23","author":"Nirula","year":"2011","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jaut.2013.07.007","article-title":"T helper subsets in Sj\u00f6gren\u2019s syndrome and IgG4-related dacryoadenitis and sialoadenitis: A critical review","volume":"51","author":"Moriyama","year":"2014","journal-title":"J. Autoimmun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/BOR.0b013e3283418057","article-title":"A clinical overview of IgG4-related systemic disease","volume":"23","author":"Khosroshahi","year":"2011","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4002","DOI":"10.1002\/jps.24620","article-title":"Comprehensive analysis of the therapeutic IgG4 antibody pembrolizumab: Hinge modification blocks half molecule exchange in vitro and in vivo","volume":"104","author":"Yang","year":"2015","journal-title":"J. Pharm. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1046\/j.1365-2567.1999.00845.x","article-title":"Normal human immunoglobulin G4 is bispecific: It has two different antigen-combining sites","volume":"97","author":"Schuurman","year":"1999","journal-title":"Immunology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1126\/science.1144603","article-title":"Anti-inflammatory activity of human IgG4 antibodies by dynamic Fab arm exchange","volume":"317","author":"Schuurman","year":"2007","journal-title":"Science"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/nyas.13561","article-title":"IgG4-mediated autoimmune diseases: A niche of antibody-mediated disorders","volume":"1413","author":"Huijbers","year":"2018","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/jnci\/58.2.189","article-title":"IgG4 subclass in malignant melanoma","volume":"58","author":"Daveau","year":"1977","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1172\/JCI65579","article-title":"IgG4 subclass antibodies impair antitumor immunity in melanoma","volume":"123","author":"Karagiannis","year":"2013","journal-title":"J. Clin. Investig."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1034\/j.1398-9995.2000.00120.x","article-title":"Mechanisms of allergen-specific immunotherapy","volume":"55","author":"Akdis","year":"2000","journal-title":"Allergy"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.coi.2006.06.003","article-title":"Healthy immune response to allergens: T regulatory cells and more","volume":"18","author":"Akdis","year":"2006","journal-title":"Curr. Opin. Immunol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1038\/nri1934","article-title":"Immunological mechanisms of allergen-specific immunotherapy","volume":"6","author":"Akdis","year":"2006","journal-title":"Nat. Rev. Immunol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1056\/NEJM199908123410702","article-title":"Long-term clinical efficacy of grass-pollen immunotherapy","volume":"341","author":"Durham","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/cei.12641","article-title":"Immunology of IgG4-related disease","volume":"181","author":"Lanzillotta","year":"2015","journal-title":"Clin. Exp. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1136\/gut.2004.047142","article-title":"Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: Relevance for diagnosis of autoimmune pancreatitis","volume":"54","author":"Aparisi","year":"2005","journal-title":"Gut"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1093\/ndt\/gfl672","article-title":"Anti-carbonic anhydrase II antibody in autoimmune pancreatitis and tubulointerstitial nephritis","volume":"22","author":"Nishi","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1136\/gut.2004.049064","article-title":"Serum antibodies to carbonic anhydrase IV in patients with autoimmune pancreatitis","volume":"54","author":"Nishimori","year":"2005","journal-title":"Gut"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/01.mpa.0000226881.48204.fd","article-title":"Identification of a novel autoantibody against pancreatic secretory trypsin inhibitor in patients with autoimmune pancreatitis","volume":"33","author":"Asada","year":"2006","journal-title":"Pancreas"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"732","DOI":"10.2337\/db08-0493","article-title":"Amylase \u03b1-2A autoantibodies: Novel marker of autoimmune pancreatitis and fulminant type 1 diabetes","volume":"58","author":"Endo","year":"2009","journal-title":"Diabetes"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1056\/NEJMoa0903068","article-title":"Identification of a novel antibody associated with autoimmune pancreatitis","volume":"361","author":"Frulloni","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1136\/gutjnl-2012-302886","article-title":"Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: The Mayo Clinic experience","volume":"62","author":"Hart","year":"2013","journal-title":"Gut"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1136\/gutjnl-2015-310336","article-title":"Pathogenicity of IgG in patients with IgG4-related disease","volume":"65","author":"Shiokawa","year":"2016","journal-title":"Gut"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"520","DOI":"10.3389\/fimmu.2014.00520","article-title":"IgG subclasses and allotypes: From structure to effector functions","volume":"5","author":"Vidarsson","year":"2014","journal-title":"Front. Immunol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1749-6632.2012.06808.x","article-title":"Pathogenic IgG4 subclass autoantibodies in MuSK myasthenia gravis","volume":"1275","author":"Plomp","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1038\/ki.2010.34","article-title":"Membranous nephropathy: Recent travels and new roads ahead","volume":"77","author":"Salant","year":"2010","journal-title":"Kidney Int."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1056\/NEJM198205203062001","article-title":"Induction of pemphigus in neonatal mice by passive transfer of IgG from patients with the disease","volume":"306","author":"Anhalt","year":"1982","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1080\/03009740410006439","article-title":"Elevated IgG4 concentrations in serum of patients with Mikulicz\u2019s disease","volume":"33","author":"Yamamoto","year":"2004","journal-title":"Scand. J. Rheumatol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s00535-011-0386-x","article-title":"Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease","volume":"46","author":"Okazaki","year":"2011","journal-title":"J. Gastroenterol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1002\/acr.20215","article-title":"Riedel\u2019s thyroiditis and multifocal fibrosclerosis are part of the IgG4-related systemic disease spectrum","volume":"62","author":"Dahlgren","year":"2010","journal-title":"Arthritis Care Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1097\/PAS.0b013e3181bd535b","article-title":"IgG4-related lung and pleural disease: A clinicopathologic study of 21 cases","volume":"33","author":"Zen","year":"2009","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1148\/radiol.2511080965","article-title":"Immunoglobulin G4\u2013related lung disease: CT findings with pathologic correlations","volume":"251","author":"Inoue","year":"2009","journal-title":"Radiology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s10157-007-0464-9","article-title":"Tubulointerstitial nephritis associated with IgG4-related systemic disease","volume":"11","author":"Saeki","year":"2007","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1038\/ki.2010.271","article-title":"Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis","volume":"78","author":"Saeki","year":"2010","journal-title":"Kidney Int."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/modpathol.2009.17","article-title":"Systemic IgG4-related lymphadenopathy: A clinical and pathologic comparison to multicentric Castleman\u2019s disease","volume":"22","author":"Sato","year":"2009","journal-title":"Mod. Pathol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1440-1827.2010.02524.x","article-title":"IgG4-related disease: Historical overview and pathology of hematological disorders","volume":"60","author":"Sato","year":"2010","journal-title":"Pathol. Int."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1016\/S0140-6736(02)08359-9","article-title":"Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis","volume":"359","author":"Hamanou","year":"2002","journal-title":"Lancet"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1097\/PAS.0b013e3181b72882","article-title":"Retroperitoneal fibrosis: A clinicopathologic study with respect to immunoglobulin G4","volume":"33","author":"Zen","year":"2009","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3139","DOI":"10.1002\/art.24798","article-title":"IgG4-related systemic disease and lymphoplasmacytic aortitis","volume":"60","author":"Stone","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1093\/brain\/awg223","article-title":"Clinical correlates with anti-MuSK antibodies in generalized seronegative myasthenia gravis","volume":"126","author":"Evoli","year":"2003","journal-title":"Brain"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1093\/brain\/awl095","article-title":"MRI and clinical studies of facial and bulbar muscle involvement in MuSK antibody-associated myasthenia gravis","volume":"129","author":"Farrugia","year":"2006","journal-title":"Brain"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/ana.20061","article-title":"Detection and characterization of MuSK antibodies in seronegative myasthenia gravis","volume":"55","author":"McConville","year":"2004","journal-title":"Ann. Neurol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jneuroim.2008.01.013","article-title":"Clinical fluctuations in MuSK myasthenia gravis are related to antigen-specific IgG4 instead of IgG1","volume":"195","author":"Niks","year":"2008","journal-title":"J. Neuroimmunol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1111\/j.1468-1331.2007.01870.x","article-title":"Clinical and experimental features of MuSK antibody positive MG in Japan","volume":"14","author":"Ohta","year":"2007","journal-title":"Eur. J. Neurol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1002\/ana.21371","article-title":"Anti-MuSK patient antibodies disrupt the mouse neuromuscular junction","volume":"63","author":"Cole","year":"2008","journal-title":"Ann. Neurol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"3217","DOI":"10.1113\/jphysiol.2010.190298","article-title":"Patient autoantibodies deplete postsynaptic muscle-specific kinase leading to disassembly of the ACh receptor scaffold and myasthenia gravis in mice","volume":"588","author":"Cole","year":"2010","journal-title":"J. Physiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1093\/brain\/aws025","article-title":"Muscle-specific kinase myasthenia gravis IgG4 autoantibodies cause severe neuromuscular junction dysfunction in mice","volume":"135","author":"Klooster","year":"2012","journal-title":"Brain"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1212\/01.WNL.0000128048.23930.1D","article-title":"Are MuSK antibodies the primary cause of myasthenic symptoms?","volume":"62","author":"Selcen","year":"2004","journal-title":"Neurology"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"328rv324","DOI":"10.1126\/scitranslmed.aad7118","article-title":"PD-L1 (B7-H1) and PD-1 pathway blockade for cancer therapy: Mechanisms, response biomarkers, and combinations","volume":"8","author":"Zou","year":"2016","journal-title":"Sci. Transl. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/nrc3239","article-title":"The blockade of immune checkpoints in cancer immunotherapy","volume":"12","author":"Pardoll","year":"2012","journal-title":"Nat. Rev. Cancer"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1056\/NEJMoa1200690","article-title":"Safety, activity, and immune correlates of anti\u2013PD-1 antibody in cancer","volume":"366","author":"Topalian","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1056\/NEJMoa1200694","article-title":"Safety and activity of anti\u2013PD-L1 antibody in patients with advanced cancer","volume":"366","author":"Brahmer","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1056\/NEJMoa1003466","article-title":"Improved survival with ipilimumab in patients with metastatic melanoma","volume":"363","author":"Hodi","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"9999","DOI":"10.1073\/pnas.1822001116","article-title":"PD-1+ regulatory T cells amplified by PD-1 blockade promote hyperprogression of cancer","volume":"116","author":"Kamada","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1158\/1078-0432.CCR-16-1741","article-title":"Hyperprogressive Disease Is a New Pattern of Progression in Cancer Patients Treated by Anti-PD-1\/PD-L1Hyperprogressive Disease with Anti-PD-1\/PD-L1 Therapy","volume":"23","author":"Champiat","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"4242","DOI":"10.1158\/1078-0432.CCR-16-3133","article-title":"Hyperprogressors after Immunotherapy: Analysis of Genomic Alterations Associated with Accelerated Growth RateGenomics of Immunotherapy-Associated Hyperprogressors","volume":"23","author":"Kato","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1038\/s41571-018-0111-2","article-title":"Hyperprogressive disease: Recognizing a novel pattern to improve patient management","volume":"15","author":"Champiat","year":"2018","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/hep.25627","article-title":"Significance of immunoglobulin G4 (IgG4)-positive cells in extrahepatic cholangiocarcinoma: Molecular mechanism of IgG4 reaction in cancer tissue","volume":"56","author":"Harada","year":"2012","journal-title":"Hepatology"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/0970-9371.107513","article-title":"A case of pancreatic ductal adenocarcinoma with marked infiltration with IgG4-positive cells","volume":"30","author":"Yoneda","year":"2013","journal-title":"J. Cytol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2783","DOI":"10.4049\/jimmunol.165.5.2783","article-title":"Proinflammatory effects of IL-10 during human endotoxemia","volume":"165","author":"Lauw","year":"2000","journal-title":"J. Immunol."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Nagata, K., and Nishiyama, C. (2021). IL-10 in mast cell-mediated immune responses: Anti-inflammatory and proinflammatory roles. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22094972"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"eabc8433","DOI":"10.1126\/science.abc8433","article-title":"Structure-based decoupling of the pro-and anti-inflammatory functions of interleukin-10","volume":"371","author":"Saxton","year":"2021","journal-title":"Science"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e000661","DOI":"10.1136\/jitc-2020-000661","article-title":"An immune evasion mechanism with IgG4 playing an essential role in cancer and implication for immunotherapy","volume":"8","author":"Wang","year":"2020","journal-title":"J. ImmunoTherapy Cancer"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1111\/1556-4029.13633","article-title":"Fatal myocarditis following treatment with the PD-1 inhibitor nivolumab","volume":"63","author":"Matson","year":"2018","journal-title":"J. Forensic Sci."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.2174\/0929867324666170407125017","article-title":"Immune checkpoint inhibitors and cardiac toxicity: An emerging issue","volume":"25","author":"Varricchi","year":"2018","journal-title":"Curr. Med. Chem."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s40425-016-0152-y","article-title":"Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy","volume":"4","author":"Heinzerling","year":"2016","journal-title":"J. Immunother. Cancer"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1056\/NEJMoa1609214","article-title":"Fulminant myocarditis with combination immune checkpoint blockade","volume":"375","author":"Johnson","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40425-015-0057-1","article-title":"Acute heart failure due to autoimmune myocarditis under pembrolizumab treatment for metastatic melanoma","volume":"3","author":"Balmelli","year":"2015","journal-title":"J. Immunother. Cancer"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e003514","DOI":"10.1161\/CIRCHEARTFAILURE.116.003514","article-title":"Acute lymphocytic myocarditis with anti-PD-1 antibody nivolumab","volume":"9","author":"Tadokoro","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1080\/21645515.2018.1527496","article-title":"The effect of antigen dose on T cell-targeting vaccine outcome","volume":"15","author":"Billeskov","year":"2019","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"14852","DOI":"10.1073\/pnas.1403271111","article-title":"Antigen affinity and antigen dose exert distinct influences on CD4 T-cell differentiation","volume":"111","author":"Keck","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s40259-012-0009-y","article-title":"Reduced-Antigen, Combined Diphtheria, Tetanus, and Acellular Pertussis Vaccine, Adsorbed (Boostrix\u00ae) A Guide to Its Use as a Single-Dose Booster Immunization against Pertussis","volume":"27","author":"Scott","year":"2013","journal-title":"BioDrugs"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.2165\/11209630-000000000-00000","article-title":"Reduced-Antigen, Combined Diphtheria, Tetanus and Acellular Pertussis Vaccine, Adsorbed (Boostrix\u00ae): A Review of its Properties and Use as a Single-Dose Booster Immunization","volume":"72","author":"McCormack","year":"2012","journal-title":"Drugs"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"105479","DOI":"10.1016\/j.isci.2022.105479","article-title":"Extended SARS-CoV-2 RBD booster vaccination induces humoral and cellular immune tolerance in mice","volume":"25","author":"Gao","year":"2022","journal-title":"Iscience"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"228ra238","DOI":"10.1126\/scitranslmed.3007736","article-title":"Polyfunctional Fc-effector profiles mediated by IgG subclass selection distinguish RV144 and VAX003 vaccines","volume":"6","author":"Chung","year":"2014","journal-title":"Sci. Transl. Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1089\/aid.2016.0204","article-title":"Comparison of antibody responses induced by RV144, VAX003, and VAX004 vaccination regimens","volume":"33","author":"Karnasuta","year":"2017","journal-title":"AIDS Res. Hum. Retrovir."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1128\/CVI.05523-11","article-title":"Age-dependent IgG subclass responses to Plasmodium falciparum EBA-175 are differentially associated with incidence of malaria in Mozambican children","volume":"19","author":"Quelhas","year":"2012","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.mehy.2007.02.011","article-title":"Immunity to blood stages of Plasmodium falciparum is dependent on a specific pattern of immunoglobulin subclass responses to multiple blood stage antigens","volume":"69","author":"Eisenhut","year":"2007","journal-title":"Med. Hypotheses"},{"key":"ref_117","first-page":"30","article-title":"Interleukin-21 is associated with IgG1 and IgG3 antibodies to erythrocyte-binding antigen-175 peptide 4 of Plasmodium falciparum in Gabonese children with acute falciparum malaria","volume":"19","author":"Mewono","year":"2008","journal-title":"Eur. Cytokine Netw."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1182\/blood.V84.5.1594.1594","article-title":"Merozoite surface protein-3: A malaria protein inducing antibodies that promote Plasmodium falciparum killing by cooperation with blood monocytes","volume":"84","author":"Oeuvray","year":"1994","journal-title":"Blood"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Roussilhon, C., Oeuvray, C., M\u00fcller-Graf, C., Tall, A., Rogier, C., Trape, J.-F., Theisen, M., Balde, A., P\u00e9rignon, J.-L., and Druilhe, P. (2007). Long-term clinical protection from falciparum malaria is strongly associated with IgG3 antibodies to merozoite surface protein 3. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040320"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1128\/IAI.01129-08","article-title":"Immunoglobulin G subclass-specific responses against Plasmodium falciparum merozoite antigens are associated with control of parasitemia and protection from symptomatic illness","volume":"77","author":"Stanisic","year":"2009","journal-title":"Infect. Immun."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1128\/IAI.68.3.1252-1258.2000","article-title":"High immunoglobulin G2 (IgG2) and low IgG4 levels are associated with human resistance to Plasmodium falciparum malaria","volume":"68","author":"Aucan","year":"2000","journal-title":"Infect. Immun."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/0923-2494(90)90021-P","article-title":"Opsonization as an effector mechanism in human protection against asexual blood stages of Plasmodium falciparum: Functional role of IgG subclasses","volume":"141","author":"Groux","year":"1990","journal-title":"Res. Immunol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1128\/CDLI.9.3.693-697.2002","article-title":"Comparison of immunoglobulin G subclass profiles induced by measles virus in vaccinated and naturally infected individuals","volume":"9","author":"Isa","year":"2002","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/infdis\/169.1.83","article-title":"Epitope-specific distribution of IgG subclasses against antigenic domains on glycoproteins of human cytomegalovirus","volume":"169","author":"Urban","year":"1994","journal-title":"J. Infect. Dis."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Diks, A.M., Versteegen, P., Teodosio, C., Groenland, R.J., de Mooij, B., Buisman, A.M., Torres-Valle, A., P\u00e9rez-Andr\u00e9s, M., Orfao, A., and Berbers, G.A.M. (2022). Age and Primary Vaccination Background Influence the Plasma Cell Response to Pertussis Booster Vaccination. Vaccines, 10.","DOI":"10.3390\/vaccines10020136"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3389\/fimmu.2018.00051","article-title":"Whole-Cell or Acellular Pertussis Primary Immunizations in Infancy Determines Adolescent Cellular Immune Profiles","volume":"9","author":"Hendrikx","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/j.bbadis.2017.07.038","article-title":"On the role of IgG4 in inflammatory conditions: Lessons for IgG4-related disease","volume":"1864","author":"Trampert","year":"2018","journal-title":"Biochim. Biophys. Acta (BBA) Mol. Basis Dis."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1046\/j.1365-2222.2001.01161.x","article-title":"Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study","volume":"31","author":"Pajno","year":"2001","journal-title":"Clin. Exp. Allergy"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1038\/s41419-020-03151-z","article-title":"Age-severity matched cytokine profiling reveals specific signatures in COVID-19 patients","volume":"11","author":"Angioni","year":"2020","journal-title":"Cell Death Dis."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1136\/annrheumdis-2020-218122","article-title":"Interleukin-6 blockade with sarilumab in severe COVID-19 pneumonia with systemic hyperinflammation: An open-label cohort study","volume":"79","author":"Campochiaro","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"108490","DOI":"10.1016\/j.clim.2020.108490","article-title":"Treating COVID-19 with colchicine in community healthcare setting","volume":"217","author":"Kusanovic","year":"2020","journal-title":"Clin. Immunol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"675678","DOI":"10.3389\/fimmu.2021.675678","article-title":"Respiratory impairment predicts response to IL-1 and IL-6 blockade in COVID-19 patients with severe pneumonia and hyper-inflammation","volume":"12","author":"Lanzillotta","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_133","first-page":"e0241955","article-title":"The altered entry pathway and antigenic distance of the SARS-CoV-2 Omicron variant map to separate domains of spike protein","volume":"15","author":"Peacock","year":"2022","journal-title":"biorxiv"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.medj.2022.03.004","article-title":"Reduced pathogenicity of the SARS-CoV-2 Omicron variant in hamsters","volume":"3","author":"McMahan","year":"2022","journal-title":"Med"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1038\/s41564-022-01143-7","article-title":"SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway","volume":"7","author":"Willett","year":"2022","journal-title":"Nat. Microbiol."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1038\/s41586-022-04442-5","article-title":"Attenuated replication and pathogenicity of SARS-CoV-2 B. 1.1. 529 Omicron","volume":"603","author":"Shuai","year":"2022","journal-title":"Nature"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0140-6736(22)00017-4","article-title":"Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: A data linkage study","volume":"399","author":"Wolter","year":"2022","journal-title":"Lancet"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1093\/cid\/ciac262","article-title":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) naturally acquired immunity versus vaccine-induced immunity, reinfections versus breakthrough infections: A retrospective cohort study","volume":"75","author":"Gazit","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"2100822","DOI":"10.2807\/1560-7917.ES.2021.26.39.2100822","article-title":"Nosocomial outbreak caused by the SARS-CoV-2 Delta variant in a highly vaccinated population, Israel, July 2021","volume":"26","author":"Shitrit","year":"2021","journal-title":"Eurosurveillance"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1016\/j.cmi.2021.06.036","article-title":"BNT162b2 vaccine breakthrough: Clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel","volume":"27","author":"Chowers","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/S0140-6736(22)00089-7","article-title":"Risk of infection, hospitalisation, and death up to 9 months after a second dose of COVID-19 vaccine: A retrospective, total population cohort study in Sweden","volume":"399","author":"Ballin","year":"2022","journal-title":"Lancet"},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1038\/s41421-021-00329-3","article-title":"Comprehensive investigations revealed consistent pathophysiological alterations after vaccination with COVID-19 vaccines","volume":"7","author":"Liu","year":"2021","journal-title":"Cell Discov."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Ivanova, E.N., Devlin, J.C., Buus, T.B., Koide, A., Shwetar, J., Cornelius, A., Samanovic, M.I., Herrera, A., Mimitou, E.P., and Zhang, C. (2021). SARS-CoV-2 mRNA vaccine elicits a potent adaptive immune response in the absence of IFN-mediated inflammation observed in COVID-19. MedRxiv.","DOI":"10.1101\/2021.04.20.21255677"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"113008","DOI":"10.1016\/j.fct.2022.113008","article-title":"Innate immune suppression by SARS-CoV-2 mRNA vaccinations: The role of G-quadruplexes, exosomes, and MicroRNAs","volume":"164","author":"Seneff","year":"2022","journal-title":"Food Chem. Toxicol."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/imm.12349","article-title":"Viral (hepatitis C virus, hepatitis B virus, HIV) persistence and immune homeostasis","volume":"143","author":"Zhou","year":"2014","journal-title":"Immunology"},{"key":"ref_146","doi-asserted-by":"crossref","unstructured":"Tsumiyama, K., Miyazaki, Y., and Shiozawa, S. (2009). Self-organized criticality theory of autoimmunity. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0008382"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1586\/eci.11.54","article-title":"Cause of systemic lupus erythematosus: A novel self-organized criticality theory of autoimmunity","volume":"7","author":"Shiozawa","year":"2011","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"3267","DOI":"10.1111\/trf.16672","article-title":"Severe autoimmune hemolytic anemia following receipt of SARS-CoV-2 mRNA vaccine","volume":"61","author":"Gadi","year":"2021","journal-title":"Transfusion"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jhep.2021.04.003","article-title":"Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: Causality or casualty?","volume":"75","author":"Bril","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Watad, A., De Marco, G., Mahajna, H., Druyan, A., Eltity, M., Hijazi, N., Haddad, A., Elias, M., Zisman, D., and Naffaa, M.E. (2021). Immune-mediated disease flares or new-onset disease in 27 subjects following mRNA\/DNA SARS-CoV-2 vaccination. Vaccines, 9.","DOI":"10.3390\/vaccines9050435"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"2794","DOI":"10.1182\/bloodadvances.2021004957","article-title":"Autoimmune-and complement-mediated hematologic condition recrudescence following SARS-CoV-2 vaccination","volume":"5","author":"Portuguese","year":"2021","journal-title":"Blood Adv."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"102706","DOI":"10.1016\/j.jaut.2021.102706","article-title":"Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?","volume":"123","author":"Ghielmetti","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"102710","DOI":"10.1016\/j.jaut.2021.102710","article-title":"Autoimmune hepatitis triggered by SARS-CoV-2 vaccination","volume":"123","author":"Montani","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1007\/s00392-021-01916-w","article-title":"Occurrence of acute infarct-like myocarditis following COVID-19 vaccination: Just an accidental co-incidence or rather vaccination-associated autoimmune myocarditis?","volume":"110","author":"Chamling","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_155","first-page":"1249","article-title":"Comment to the letter of Bril F et al. \u201cAutoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: Causality or casualty?\u201d","volume":"75","author":"Schneider","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jpeds.2021.06.035","article-title":"Recurrence of acute myocarditis temporally associated with receipt of the mRNA coronavirus disease 2019 (COVID-19) vaccine in a male adolescent","volume":"238","author":"Minocha","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"102941","DOI":"10.1016\/j.autrev.2021.102941","article-title":"Autoimmunity roots of the thrombotic events after COVID-19 vaccination","volume":"20","author":"Elrashdy","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"102741","DOI":"10.1016\/j.jaut.2021.102741","article-title":"Autoimmune hepatitis after COVID-19 vaccine\u2013more than a coincidence","volume":"125","author":"Garrido","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/imm.13443","article-title":"New-onset autoimmune phenomena post-COVID-19 vaccination","volume":"165","author":"Chen","year":"2022","journal-title":"Immunology"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"23247096211073258","DOI":"10.1177\/23247096211073258","article-title":"Autoimmune hemolytic anemia after mRNA COVID vaccine","volume":"10","author":"Fatima","year":"2022","journal-title":"J. Investig. Med. High Impact Case Rep."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"872683","DOI":"10.3389\/fimmu.2022.872683","article-title":"COVID-19 vaccines and the rate of autoimmune adverse events: Insights from a literature review","volume":"13","author":"Mahroum","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/ane.13550","article-title":"Neurological side effects of SARS-CoV-2 vaccinations","volume":"145","author":"Finsterer","year":"2022","journal-title":"Acta Neurol. Scand."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s10072-021-05662-9","article-title":"Spectrum of neurological complications following COVID-19 vaccination","volume":"43","author":"Garg","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/ene.15147","article-title":"Neurological autoimmune diseases following vaccinations against SARS-CoV-2: A case series","volume":"29","author":"Kaulen","year":"2022","journal-title":"Eur. J. Neurol."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s10072-021-05790-2","article-title":"Autoimmune encephalitis following ChAdOx1-S SARS-CoV-2 vaccination","volume":"43","author":"Kwon","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1007\/s40618-022-01863-x","article-title":"SARS-CoV-2 vaccine may trigger thyroid autoimmunity: Real-life experience and review of the literature","volume":"45","author":"Ruggeri","year":"2022","journal-title":"J. Endocrinol. 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