Mechanisms of Inflammation in Long-COVID/Post-COVID-Vaccination Syndrome

A special issue of Vaccines (ISSN 2076-393X).

Deadline for manuscript submissions: 31 August 2026 | Viewed by 5546

Special Issue Editor

Special Issue Information

Dear Colleagues,

Long-COVID (LC) is a syndrome in which several debilitating symptoms persist for three months or more after COVID-19. Many aspects of this condition are still to be elucidated. Vaccination against COVID-19 can be, sometimes, followed by a post-vaccination syndrome, referred to as PACVS, which partly resembles LC. These pathological conditions are diffused worldwide and demand decisive clinical interventions. It has also been shown that repeated COVID-19 vaccination can induce the development of the IgG4 class of antibodies, instead of more protective classes of antibodies. Both SARS-CoV-2 infections and vaccinations can induce the development or can induce de novo autoimmune phenomena.

This Special Issue welcomes the submission of research articles or review articles that address the mechanisms of LC or the effects of COVID-19 vaccination in the long term. Studies that address the development of IgG4 in LC or in PACVS are also welcome. Moreover, this Special Issue can also include studies that analyze the incidence of LC or PACVS in people with pre-existing conditions, such as chronic diseases, including allergies. Studies that explore the incidence of side effects of vaccination against the virus Sars-CoV-2 or address strategies to improve LC and /or PACVS, via novel pharmacological interventions, will fit in this Special Issue. The effect of vaccination (either protective or non-protective) on LC development is also an issue to clarify, and studies in this field are welcome.

Dr. Loredana Frasca
Guest Editor

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Keywords

  • Long-COVID/Post-COVID-vaccination
  • syndrome
  • development of IgG4
  • side effects of vaccination

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Published Papers (1 paper)

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Review

34 pages, 2578 KB  
Review
Autoimmune Features of Post-COVID-19 Vaccination Syndrome and Their Impacts on the Renin–Angiotensin System
by Paolo Bellavite, Giuseppe Di Fede, Mauro Mantovani and Elisabetta Zanolin
Vaccines 2026, 14(4), 354; https://doi.org/10.3390/vaccines14040354 - 16 Apr 2026
Viewed by 4887
Abstract
One of the most critical aspects of post-acute COVID-19 syndrome (PACS) and post-acute COVID-19 vaccination syndrome (PACVS) is the presence of autoantibodies. These autoantibodies are directed against various receptors in the autonomic and cardiovascular systems, including those targeting proteins of the renin–angiotensin system [...] Read more.
One of the most critical aspects of post-acute COVID-19 syndrome (PACS) and post-acute COVID-19 vaccination syndrome (PACVS) is the presence of autoantibodies. These autoantibodies are directed against various receptors in the autonomic and cardiovascular systems, including those targeting proteins of the renin–angiotensin system (RAS). The RAS plays a central role in regulating vascular homeostasis, inflammation, and endothelial function. During SARS-CoV-2 infection, the interaction of the spike (S) protein with angiotensin-converting enzyme 2 (ACE2) can alter the balance of the RAS, favoring an imbalance towards the ACE/Angiotensin II/AT1R axis, known for its pro-inflammatory, pro-thrombotic, and vasoconstrictive properties. Similar pathological mechanisms also come into play in response to vaccinations that use the S protein as an antigen. Studies conducted by other groups and us on patients with PACS and PACVS have revealed the presence of autoantibodies directed against these RAS components and the mechanisms by which these antibodies can worsen the clinical situation. In particular, anti-ACE2, presumably formed by the anti-idiotype network or molecular mimicry, is correlated with PACVS symptoms in many patients. Furthermore, the presence of anti-MAS1 antibodies can reduce the efficiency of the ACE2/Angiotensin-(1–7)/MAS1 axis, which normally acts as a counter-regulator. Considering this evidence, an analysis of RAS molecules and the autoantibodies implicated in reactions to them may be useful for evaluating a state of persistent dysregulation associated with post-vaccination symptoms such as asthenia, headache, skin edema and bruising, cardiovascular alterations, and neurovegetative manifestations. Finally, we offer insights into diagnosing these multifaceted syndromes and working hypotheses to guide research into possible therapeutic approaches. Full article
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