COVID-19 and Kounis Syndrome: Deciphering Their Relationship

Kounis, Nicholas G.; Koniari, Ioanna; Gregorio, Cesare de

doi:10.5152/balkanmedj.2021.21097

Cited by 14 publications

(13 citation statements)

References 28 publications

(31 reference statements)

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“…The development of selective evasins or evasin-like peptides that may be differentially expressed that bind and even neutralize CXCL9/CXCL10 versus CXCL11 could offer an interesting therapeutic alternative to limit the pathogenic and preserve the regulatory CXCR3 functions. The early cytokine/chemokine signature featuring IL-15, IFN-g and CXCL10 may be involved in the pathogenesis of myocardial damage, myocardities and thromboses [110,121] but may also be involved to monitor effective vaccinations and as a guide to optimize the efficacy of the mRNA vaccination [111].…”

Section: Discussionmentioning

confidence: 99%

The Involvement of CXC Motif Chemokine Ligand 10 (CXCL10) and Its Related Chemokines in the Pathogenesis of Coronary Artery Disease and in the COVID-19 Vaccination: A Narrative Review

et al. 2021

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Coronary artery disease (CAD) and coronary heart disease (CHD) constitute two of the leading causes of death in Europe, USA and the rest of the world. According to the latest reports of the Iranian National Health Ministry, CAD is the main cause of death in Iranian patients with an age over 35 years despite a significant reduction in mortality due to early interventional treatments in the context of an acute coronary syndrome (ACS). Inflammation plays a fundamental role in coronary atherogenesis, atherosclerotic plaque formation, acute coronary thrombosis and CAD establishment. Chemokines are well-recognized mediators of inflammation involved in several bio-functions such as leucocyte migration in response to inflammatory signals and oxidative vascular injury. Different chemokines serve as chemo-attractants for a wide variety of cell types including immune cells. CXC motif chemokine ligand 10 (CXCL10), also known as interferon gamma-induced protein 10 (IP-10/CXLC10), is a chemokine with inflammatory features whereas CXC chemokine receptor 3 (CXCR3) serves as a shared receptor for CXCL9, 10 and 11. These chemokines mediate immune responses through the activation and recruitment of leukocytes, eosinophils, monocytes and natural killer (NK) cells. CXCL10, interleukin (IL-15) and interferon (IFN-g) are increased after a COVID-19 vaccination with a BNT162b2 mRNA (Pfizer/BioNTech) vaccine and are enriched by tumor necrosis factor alpha (TNF-α) and IL-6 after the second vaccination. The aim of the present study is the presentation of the elucidation of the crucial role of CXCL10 in the patho-physiology and pathogenesis of CAD and in identifying markers associated with the vaccination resulting in antibody development.

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Section: Discussionmentioning

confidence: 99%

The Involvement of CXC Motif Chemokine Ligand 10 (CXCL10) and Its Related Chemokines in the Pathogenesis of Coronary Artery Disease and in the COVID-19 Vaccination: A Narrative Review

et al. 2021

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“…Similarities between allergy/anaphylaxis-associated Kounis syndrome and COVID-19 immunology strongly suggest that the same key immune cells might be involved in COVID-19-induced anaphylaxis and the anaphylaxis-associated Kounis syndrome. It has been already emphasized that early immunological interventions targeting inflammatory markers predictive of adverse outcomes could be more beneficial than those targeting cytokine inhibition [119].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with Argatroban, which is a direct thrombin inhibitor together with corticosteroids (that are used for Kounis syndrome) such as dexamethasone and immunoglobulin, are recommended [118]. All this cascade of actions, reactions, interactions, together with the released mediators and inflammatory cells, constitute the pathophysiologic basis of Kounis anaphylaxis-associated thrombotic syndrome [119]. It is reasonable, therefore, to anticipate that heparin is not always required to be given externally in order to cause HIT-like thrombosis and that HIT itself behaves as a new manifestation of Kounis syndrome [120,121].…”

Section: Covid-19 Vaccine-induced Thrombotic Eventsmentioning

confidence: 99%

COVID-19 Disease, Women’s Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay

et al. 2021

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Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitute one of the deadliest pandemics in modern history demonstrating cardiovascular, gastrointestinal, hematologic, mucocutaneous, respiratory, neurological, renal and testicular manifestations and further complications. COVID-19-induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications. The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro-inflammatory cytokine release. COVID-19 relation with Kounis syndrome and post-COVID-19 vaccination correlation with heparin-induced thrombocytopenia with thrombosis (HITT), especially serious cerebral venous sinus thrombosis, were also reviewed. Methods: A current literature search in PubMed, Embase and Google databases was performed to reveal the pathophysiology, prevalence, clinical manifestation, correlation and treatment of COVID-19, anaphylaxis with profuse hypotension, Kounis acute coronary syndrome and thrombotic events post vaccination. Results: The same key immunological pathophysiology mechanisms and cells seem to underlie COVID-19 cardiovascular complications and the anaphylaxis-associated Kounis syndrome. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, plaque rupture and microthrombi formation, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. COVID-19-interrelated vaccine excipients as polysorbate, polyethelene glycol (PEG) and trometamol constitute potential allergenic substances. Conclusion: Better acknowledgement of the pathophysiological mechanisms, clinical similarities, multiorgan complications of COVID-19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention, treatment of the COVID-19 pandemic as well as post-COVID-19 vaccine adverse reactions.

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“…Kounis syndrome is a condition associated with hypersensitivity reactions caused by drugs, metals, environmental exposures, conditions, and foods. 8 In a recent report that dealt with 2 patients who developed myocarditis after getting vaccinated with Moderna and Pfizer-BioNTech, respectively, endomyocardial biopsy specimens showed inflammatory infiltrates comprising eosinophils and other interacting inflammatory cells, including T cells, B cells, plasma cells, and macrophages, indicating hypersensitivity reactions. 9 Indeed, all currently used vaccines contain excipients (constituents of a pharmaceutical form apart from the active substance) that are speculated to induce hypersensitivity reactions.…”

mentioning

confidence: 99%

Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination: Is Kounis Syndrome the Culprit?

Kounis

Koniari

Mplani

et al. 2022

The American Journal of Cardiology

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COVID-19 and Kounis Syndrome: Deciphering Their Relationship

Cited by 14 publications

References 28 publications

The Involvement of CXC Motif Chemokine Ligand 10 (CXCL10) and Its Related Chemokines in the Pathogenesis of Coronary Artery Disease and in the COVID-19 Vaccination: A Narrative Review

The Involvement of CXC Motif Chemokine Ligand 10 (CXCL10) and Its Related Chemokines in the Pathogenesis of Coronary Artery Disease and in the COVID-19 Vaccination: A Narrative Review

COVID-19 Disease, Women’s Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay

Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination: Is Kounis Syndrome the Culprit?

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