Severe Blood Abnormalities: Kitonsa et al. reported severe hematological issues in 93% of trial participants, potentially causing chronic anemia, thrombocytopenia, or clotting disorders due to saRNA’s immune activation or lipid nanoparticle (LNP) toxicity.

Excessive Inflammation: saRNA’s self-replication produces dsRNA, triggering strong cytokine responses (e.g., IFN-α, IL-6), risking chronic inflammation, cytokine storms, or tissue damage (e.g., myocarditis, hepatitis) due to prolonged protein expression (30–60 days).

Autoimmune Disorders: Sustained antigen production may cause molecular mimicry or immune overstimulation, potentially leading to conditions like lupus or myocarditis, especially in susceptible individuals.

Genomic Integration: Though saRNA operates in the cytoplasm, rare reverse transcription could lead to genomic integration, posing risks of mutations or cancer.

Viral Recombination: Alphavirus-based saRNA could recombine with wild RNA viruses, creating novel strains. Though unlikely, this risks new pathogens in mass vaccination scenarios.

LNP Toxicity: LNPs may distribute to organs (heart, liver), causing inflammation or damage. Long-term risks include cardiomyopathy or hepatotoxicity from repeated exposure.

Immune Exhaustion: Prolonged antigen expression may overstimulate T/B cells, leading to immune tolerance or increased infection susceptibility.

Neurological Effects: LNPs may reach the brain, potentially causing neuroinflammation or rare conditions like Guillain-Barré syndrome, as seen with mRNA vaccines.

Oncogenic Potential: Chronic inflammation or theoretical integration could promote cancer.

Shedding: Amplified RNA could theoretically be released via exosomes, affecting unvaccinated individuals.

Immunosuppression: In immunocompromised individuals, prolonged saRNA activity may weaken immune responses, increasing infection or cancer risks.

Allergic Reactions: LNPs may trigger anaphylaxis or chronic hypersensitivity.