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Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series

Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses a...

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Detalles Bibliográficos
Autores principales: Baumeier, Christian, Aleshcheva, Ganna, Harms, Dominik, Gross, Ulrich, Hamm, Christian, Assmus, Birgit, Westenfeld, Ralf, Kelm, Malte, Rammos, Spyros, Wenzel, Philip, Münzel, Thomas, Elsässer, Albrecht, Gailani, Mudather, Perings, Christian, Bourakkadi, Alae, Flesch, Markus, Kempf, Tibor, Bauersachs, Johann, Escher, Felicitas, Schultheiss, Heinz-Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9266869/
https://www.ncbi.nlm.nih.gov/pubmed/35805941
http://dx.doi.org/10.3390/ijms23136940
Descripción
Sumario:Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty(®) (Pfizer-BioNTech) (n = 11), Vaxzevria(®) (AstraZenica) (n = 2) and Janssen(®) (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 10). Importantly, infectious causes have been excluded in all patients. The SARS-CoV-2 spike protein has been detected sparsely on cardiomyocytes of nine patients, and differential analysis of inflammatory markers such as CD4(+) and CD8(+) T cells suggests that the inflammatory response triggered by the vaccine may be of autoimmunological origin. Although a definitive causal relationship between COVID-19 vaccination and the occurrence of myocardial inflammation cannot be demonstrated in this study, data suggest a temporal connection. The expression of SARS-CoV-2 spike protein within the heart and the dominance of CD4(+) lymphocytic infiltrates indicate an autoimmunological response to the vaccination.