Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination

Altman, Natasha; Berning, Amber; Saxon, Cara E.; Adamek, Kylie E.; Wagner, Jessica A; Slavov, Dobromir; Quaife, Robert A.; Gill, Edward A.; Minobe, Wayne; Jonas, Eric R.; Carroll, Ian A.; Huebler, Sophia P.; Raines, Joshua; Messenger, John C.; Ambardekar, Amrut V.; Mestroni, Luisa; Rosenberg, Rachel M.; Rove, Jessica Y.; Campbell, Thomas; Bristow, Michael R.

doi:10.1016/j.jacbts.2022.08.005

Cited by 13 publications

(40 citation statements)

References 41 publications

(66 reference statements)

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“…Results from the literature definitely show that myocarditis and pericarditis occur after COVID-19 vaccine doses and are concerning. In addition, by studying molecular characteristics of the myocarditis induced by SARS-CoV-2 (non-Omicron) and by the COVID-19 vaccines, a recent paper found a common pattern that suggests that the two conditions are induced by similar mechanisms [ 84 ].…”

Section: Safety Of Covid-19 Vaccines In People With Autoimmunity and ...mentioning

confidence: 99%

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Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases, in Patients with Cardiac Issues, and in the Healthy Population

2023

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The coronavirus disease 2019 (COVID-19) has been a challenge for the whole world since the beginning of 2020, and COVID-19 vaccines were considered crucial for disease eradication. Instead of producing classic vaccines, some companies pointed to develop products that mainly function by inducing, into the host, the production of the antigenic protein of SARS-CoV-2 called Spike, injecting an instruction based on RNA or a DNA sequence. Here, we aim to give an overview of the safety profile and the actual known adverse effects of these products in relationship with their mechanism of action. We discuss the use and safety of these products in at-risk people, especially those with autoimmune diseases or with previously reported myocarditis, but also in the general population. We debate the real necessity of administering these products with unclear long-term effects to at-risk people with autoimmune conditions, as well as to healthy people, at the time of omicron variants. This, considering the existence of therapeutic interventions, much more clearly assessed at present compared to the past, and the relatively lower aggressive nature of the new viral variants.

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Section: Safety Of Covid-19 Vaccines In People With Autoimmunity and ...mentioning

confidence: 99%

“…In this regard, the paper is interesting because it underlines an important issue to be taken into account when using these pharmacological interventions for at-risk people. In SLE, myocarditis can be present in several patients but not always diagnosed [ 84 , 87 ].…”

Section: Covid-19 Vaccines Safety In Autoimmune Patients and Patients...mentioning

confidence: 99%

Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases, in Patients with Cardiac Issues, and in the Healthy Population

2023

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“…C , Eosinophilic myocarditis, arrowheads highlight endocardial involvement by eosinophils. D , COVID-19 myocarditis, from study by Altman et al 29 Circles highlight areas of myocyte damage.…”

Section: Histopathologymentioning

confidence: 99%

“… 4 The inflammation within positive cases is similar to myocarditis associated with other viruses, with a mixed infiltrate of lymphocytes and macrophages (Figures 2 D and 3 A). 29 In a number of cases, increased interstitial macrophages without associated myocyte injury have been the most prominent finding. Immunohistochemically, a majority of the cells are CD3-positive T-lymphocytes (Figure 3 B) and CD68-positive macrophages (Figure 3 C), with a smaller component of CD20-positive B-lymphocytes; giant cells, and granulomas are absent.…”

Section: Histopathologymentioning

confidence: 99%

Vaccination-Associated Myocarditis and Myocardial Injury

Altman

Berning

Mann

et al. 2023

Circulation Research

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SARS-CoV-2 vaccine–associated myocarditis/myocardial injury should be evaluated in the contexts of COVID-19 infection, other types of viral myocarditis, and other vaccine-associated cardiac disorders. COVID-19 vaccine–associated myocardial injury can be caused by an inflammatory immune cell infiltrate, but other etiologies such as microvascular thrombosis are also possible. The clinical diagnosis is typically based on symptoms and cardiac magnetic resonance imaging. Endomyocardial biopsy is confirmatory for myocarditis, but may not show an inflammatory infiltrate because of rapid resolution or a non-inflammatory etiology. Myocarditis associated with SARS-COVID-19 vaccines occurs primarily with mRNA platform vaccines, which are also the most effective. In persons aged >16 or >12 years the myocarditis estimated crude incidences after the first 2 doses of BNT162b2 and mRNA-1273 are approximately 1.9 and 3.5 per 100 000 individuals, respectively. These rates equate to excess incidences above control populations of approximately 1.2 (BNT162b2) and 1.9 (mRNA-1273) per 100 000 persons, which are lower than the myocarditis rate for smallpox but higher than that for influenza vaccines. In the studies that have included mRNA vaccine and SARS-COVID-19 myocarditis measured by the same methodology, the incidence rate was increased by 3.5-fold over control in COVID-19 compared with 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273. However, mortality and major morbidity are less and recovery is faster with mRNA vaccine–associated myocarditis compared to COVID-19 infection. The reasons for this include vaccine-associated myocarditis having a higher incidence in young adults and adolescents, typically no involvement of other organs in vaccine-associated myocarditis, and based on comparisons to non-COVID viral myocarditis an inherently more benign clinical course.

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“…16) Interestingly, Altman, et al recently reported on the alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction in response to exposure to the SARS-CoV-2 spike protein. 17) The reported changes in gene expression might be amenable to preventative, or if diagnosed promptly, targeted therapy. Furthermore, cardiac signs/symptoms are increasingly recognized as "late" complications of SARS-CoV-2 infection.…”

Section: Article P85mentioning

confidence: 99%