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

Authors :
Christian Baumeier
Ganna Aleshcheva
Dominik Harms
Ulrich Gross
Christian Hamm
Birgit Assmus
Ralf Westenfeld
Malte Kelm
Spyros Rammos
Philip Wenzel
Thomas Münzel
Albrecht Elsässer
Mudather Gailani
Christian Perings
Alae Bourakkadi
Markus Flesch
Tibor Kempf
Johann Bauersachs
Felicitas Escher
Heinz-Peter Schultheiss
Source :
International Journal of Molecular Sciences, Vol 23, Iss 13, p 6940 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

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.

Details

Language :
English
ISSN :
14220067 and 16616596
Volume :
23
Issue :
13
Database :
Directory of Open Access Journals
Journal :
International Journal of Molecular Sciences
Publication Type :
Academic Journal
Accession number :
edsdoj.88d30bab0f094e2e994babec1e087e21
Document Type :
article
Full Text :
https://doi.org/10.3390/ijms23136940