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Golino M, Harding D, Del Buono MG, Fanti S, Mohiddin S, Toldo S, Smyth J, Sanna T, Marelli-Berg F, Abbate A. Innate and adaptive immunity in acute myocarditis. Int J Cardiol 2024; 404:131901. [PMID: 38403204 DOI: 10.1016/j.ijcard.2024.131901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
Acute myocarditis is an acute inflammatory cardiomyopathy associated with cardiac damage triggered by a virus or a pathological immune activation. It may present with a wide range of clinical presentations, ranging from mild symptoms to severe forms like fulminant myocarditis, characterized by hemodynamic compromise and cardiogenic shock. The immune system plays a central role in the pathogenesis of myocarditis. In fact, while its function is primarily protective, aberrant responses can be detrimental. In this context, both innate and adaptive immunity play pivotal roles; notably, the innate system offers a non-specific and immediate defense, while the adaptive provides specialized protection with immunological memory. However, dysregulation in these systems can misidentify cardiac tissue, triggering autoimmune reactions and possibly leading to significant cardiac tissue damage. This review highlights the importance of innate and adaptive immune responses in the progression and treatment of acute myocarditis.
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Affiliation(s)
- Michele Golino
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Daniel Harding
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Fanti
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Saidi Mohiddin
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Stefano Toldo
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America
| | - James Smyth
- Fralin Biomedical Research Institute at Virginia Tech Carillion, Roanoke, VA, United States of America; Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America; Department of Biological Sciences, College of Science, Virginia Tech, Blacksburg, VA, United States of America
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Marelli-Berg
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
| | - Antonio Abbate
- Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States of America.
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2
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Abstract
Pericarditis typically presents with classic symptoms of acute sharp, retrosternal, and pleuritic chest pain. It can have several different underlying causes including viral, bacterial, and autoimmune etiologies. The mainstays of pericarditis treatment are nonsteroidal anti-inflammatory drugs and colchicine with glucocorticoids or other immunosuppressive drugs used for refractory cases and relapse. Myocarditis is an inflammatory disease of the cardiac muscle that is caused by a variety of infectious and noninfectious conditions. It mainly affects young adults (median age 30-45 years), and men more than women. The clinical manifestations of myocarditis are highly variable, so a high level of suspicion in the early stage of disease is important to facilitate diagnosis. The treatment of myocarditis includes nonspecific treatment aimed at complications such as heart failure and arrhythmia, as well as specific treatment aimed at underlying causes. Pericarditis and myocarditis associated with vaccine have been extremely rare before coronavirus disease 2019 (COVID-19). There is a small increase of incidence after COVID-19 messenger ribonucleic acid vaccine, but the relative risk for pericarditis and myocarditis due to severe acute respiratory syndrome coronavirus 2 infection is much higher. Therefore, vaccination against COVID-19 is currently recommended for everyone aged 6 years and older.
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Affiliation(s)
- Philip Hunter Spotts
- Department of Family Medicine & Community Health, Duke Student Health, Duke University, 305 Towerview Road, Second Floor, Durham, NC 27708, USA.
| | - Fan Zhou
- Department of Family Medicine & Community Health, Duke Student Health, Duke University, 305 Towerview Road, Second Floor, Durham, NC 27708, USA
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3
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Matveev AL, Pyankov OV, Khlusevich YA, Tyazhelkova OV, Emelyanova LA, Timofeeva AM, Shipovalov AV, Chechushkov AV, Zaitseva NS, Kudrov GA, Yusubalieva GM, Yussubaliyeva SM, Zhukova OA, Tikunov AY, Baklaushev VP, Sedykh SE, Lifshits GI, Tikunova NV. Novel B-Cell Epitopes of Non-Neutralizing Antibodies in the Receptor-Binding Domain of the SARS-CoV-2 S-Protein with Different Effects on the Severity of COVID-19. Biochemistry (Mosc) 2023; 88:1205-1214. [PMID: 37770389 DOI: 10.1134/s000629792309002x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
Antibodies against the receptor-binding domain of the SARS-CoV-2 spike protein (RBD S-protein) contribute significantly to the humoral immune response during coronavirus infection (COVID-19) and after vaccination. The main focus of the studies of the RBD epitope composition is usually concentrated on the epitopes recognized by the virus-neutralizing antibodies. The role of antibodies that bind to RBD but do not neutralize SARS-CoV-2 remains unclear. In this study, immunochemical properties of the two mouse monoclonal antibodies (mAbs), RS17 and S11, against the RBD were examined. Both mAbs exhibited high affinity to RBD, but they did not neutralize the virus. The epitopes of these mAbs were mapped using phage display: the epitope recognized by the mAb RS17 is located at the N-terminal site of RBD (348-SVYAVNRKRIS-358); the mAb S11 epitope is inside the receptor-binding motif of RBD (452-YRLFRKSN-459). Three groups of sera were tested for presence of antibodies competing with the non-neutralizing mAbs S11 and RS17: (i) sera from the vaccinated healthy volunteers without history of COVID-19; (ii) sera from the persons who had a mild form of COVID-19; (iii) sera from the persons who had severe COVID-19. Antibodies competing with the mAb S11 were found in each group of sera with equal frequency, whereas presence of the antibodies competing with the mAb RS17 in the sera was significantly more frequent in the group of sera obtained from the patients recovered from severe COVID-19 indicating that such antibodies are associated with the severity of COVID-19. In conclusion, despite the clear significance of anti-RBD antibodies in the effective immune response against SARS-CoV-2, it is important to analyze their virus-neutralizing activity and to confirm absence of the antibody-mediated enhancement of infection by the anti-RBD antibodies.
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Affiliation(s)
- Andrey L Matveev
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia.
| | - Oleg V Pyankov
- State Research Center of Virology and Biotechnology "VECTOR", Federal Service for the Oversight of Consumer Protection and Welfare, Koltsovo, 630559, Novosibirsk Region, Russia
| | - Yana A Khlusevich
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Olga V Tyazhelkova
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Ljudmila A Emelyanova
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Anna M Timofeeva
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Andrey V Shipovalov
- State Research Center of Virology and Biotechnology "VECTOR", Federal Service for the Oversight of Consumer Protection and Welfare, Koltsovo, 630559, Novosibirsk Region, Russia
| | - Anton V Chechushkov
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | | | - Gleb A Kudrov
- State Research Center of Virology and Biotechnology "VECTOR", Federal Service for the Oversight of Consumer Protection and Welfare, Koltsovo, 630559, Novosibirsk Region, Russia
| | - Gaukhar M Yusubalieva
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, 115682, Russia
- Federal Center of Brain Research and Neurotechnologies, FMBA of Russia, Moscow, 117513, Russia
| | | | - Oxana A Zhukova
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, 115682, Russia
| | - Artem Yu Tikunov
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, 115682, Russia
- Pulmonology Research Institute FMBA of Russia, Moscow, 115682, Russia
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, 119991, Russia
| | | | - Galina I Lifshits
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Nina V Tikunova
- Federal State Public Scientific Institution "Institute of Chemical Biology and Fundamental Medicine", Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
- Novosibirsk State University, Novosibirsk, 630090, Russia
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Root-Bernstein R, Huber J, Ziehl A, Pietrowicz M. SARS-CoV-2 and Its Bacterial Co- or Super-Infections Synergize to Trigger COVID-19 Autoimmune Cardiopathies. Int J Mol Sci 2023; 24:12177. [PMID: 37569555 PMCID: PMC10418384 DOI: 10.3390/ijms241512177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Autoimmune cardiopathies (AC) following COVID-19 and vaccination against SARS-CoV-2 occur at significant rates but are of unknown etiology. This study investigated the possible roles of viral and bacterial mimicry, as well as viral-bacterial co-infections, as possible inducers of COVID-19 AC using proteomic methods and enzyme-linked immunoadsorption assays. BLAST and LALIGN results of this study demonstrate that SARS-CoV-2 shares a significantly greater number of high quality similarities to some cardiac protein compared with other viruses; that bacteria such as Streptococci, Staphylococci and Enterococci also display very significant similarities to cardiac proteins but to a different set than SARS-CoV-2; that the importance of these similarities is largely validated by ELISA experiments demonstrating that polyclonal antibodies against SARS-CoV-2 and COVID-19-associated bacteria recognize cardiac proteins with high affinity; that to account for the range of cardiac proteins targeted by autoantibodies in COVID-19-associated autoimmune myocarditis, both viral and bacterial triggers are probably required; that the targets of the viral and bacterial antibodies are often molecularly complementary antigens such as actin and myosin, laminin and collagen, or creatine kinase and pyruvate kinase, that are known to bind to each other; and that the corresponding viral and bacterial antibodies recognizing these complementary antigens also bind to each other with high affinity as if they have an idiotype-anti-idiotype relationship. These results suggest that AC results from SARS-CoV-2 infections or vaccination complicated by bacterial infections. Vaccination against some of these bacterial infections, such as Streptococci and Haemophilus, may therefore decrease AC risk, as may the appropriate and timely use of antibiotics among COVID-19 patients and careful screening of vaccinees for signs of infection such as fever, diarrhea, infected wounds, gum disease, etc.
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Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA; (J.H.); (A.Z.); (M.P.)
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5
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Matveev A, Pyankov O, Khlusevich Y, Tyazhelkova O, Emelyanova L, Timofeeva A, Shipovalov A, Chechushkov A, Zaitseva N, Kudrov G, Yusubalieva G, Yussubaliyeva S, Zhukova O, Baklaushev V, Sedykh S, Lifshits G, Tikunov A, Tikunova N. Antibodies Capable of Enhancing SARS-CoV-2 Infection Can Circulate in Patients with Severe COVID-19. Int J Mol Sci 2023; 24:10799. [PMID: 37445984 DOI: 10.3390/ijms241310799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Antibody-dependent enhancement (ADE) has been shown previously for SARS-CoV-1, MERS-CoV, and SARS-CoV-2 infection in vitro. In this study, the first monoclonal antibody (mAb) that causes ADE in a SARS-CoV-2 in vivo model was identified. mAb RS2 against the SARS-CoV-2 S-protein was developed using hybridoma technology. mAb RS2 demonstrated sub-nanomolar affinity and ability to neutralize SARS-CoV-2 infection in vitro with IC50 360 ng/mL. In an animal model of SARS-CoV-2 infection, the dose-dependent protective efficacy of mAb RS2 was revealed. However, in post-exposure prophylaxis, the administration of mAb RS2 led to an increase in the viral load in the respiratory tract of animals. Three groups of blood plasma were examined for antibodies competing with mAb RS2: (1) plasmas from vaccinated donors without COVID-19; (2) plasmas from volunteers with mild symptoms of COVID-19; (3) plasmas from patients with severe COVID-19. It was demonstrated that antibodies competing with mAb RS2 were significantly more often recorded in sera from volunteers with severe COVID-19. The results demonstrated for the first time that in animals, SARS-CoV-2 can induce antibody/antibodies that can elicit ADE. Moreover, in the sera of patients with severe COVID-19, there are antibodies competing for the binding of an epitope that is recognized by the ADE-eliciting mAb.
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Affiliation(s)
- Andrey Matveev
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Oleg Pyankov
- State Research Center of Virology and Biotechnology "VECTOR", Rospotrebnadzor, 630559 Koltsovo, Russia
| | - Yana Khlusevich
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Olga Tyazhelkova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Lyudmila Emelyanova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Anna Timofeeva
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Andrey Shipovalov
- State Research Center of Virology and Biotechnology "VECTOR", Rospotrebnadzor, 630559 Koltsovo, Russia
| | - Anton Chechushkov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Natalia Zaitseva
- Laboratory of Molecular Epidemiology and Biodiversity of Viruses, Research Institute of Virology, Federal Research Center of Fundamental and Translational Medicine, 630117 Novosibirsk, Russia
| | - Gleb Kudrov
- State Research Center of Virology and Biotechnology "VECTOR", Rospotrebnadzor, 630559 Koltsovo, Russia
| | - Gaukhar Yusubalieva
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies FMBA of Russia, 115682 Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, FMBA of Russia, 117513 Moscow, Russia
| | - Saule Yussubaliyeva
- Department of General Medical Practice with the Course of Evidence-Based Medicine, Astana Medical University, Nur-Sultan 010000, Kazakhstan
| | - Oxana Zhukova
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies FMBA of Russia, 115682 Moscow, Russia
| | - Vladimir Baklaushev
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies FMBA of Russia, 115682 Moscow, Russia
- Pulmonology Research Institute, FMBA of Russia, 115682 Moscow, Russia
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Sergey Sedykh
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Galina Lifshits
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Artem Tikunov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Nina Tikunova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia
- Faculty of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
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Fatima M, Khan MHA, Ali MS, Osama M, Cheema HA, Ahmed A, Nisar A, Murad MW, Farooq H, Rehman MAU, Swed S, Akbar UA. Development of myocarditis and pericarditis after COVID-19 vaccination in children and adolescents: A systematic review. Clin Cardiol 2023; 46:243-259. [PMID: 36594165 PMCID: PMC10018089 DOI: 10.1002/clc.23965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023] Open
Abstract
Myocarditis and pericarditis have been reported after COVID-19 vaccine administration in children and adolescents, raising the concern about their possible association with these vaccines. The objective was to explore the incidence, clinical presentation, and association of myocarditis and pericarditis with COVID-19 vaccines in children and adolescents. We conducted a systematic literature search on three databases, that is, Cochrane, MEDLINE/PubMed, and EMBASE from inception till March 2022. A total of three case reports, four case series, and six observational studies were included in the review. For case reports and case series, the mean age of the patients was 17.4 years, with 96.9% being male. Chest pain (n = 31, 93.9%), fever (n = 18, 54.5%), myalgias (n = 15, 45.4%) and headache (n = 9, 27.2%) were the most common presentations. Out of 33 patients, 32 (96.9%) of patients received Pfizer-BioNTech whereas only one (3.03%) received Moderna (mRNA 1273). Clinical investigations revealed ST elevation (n = 32, 97%), and elevated CRP (n = 9, 27.2%) and cardiac troponin (n = 29, 87.8%). The pooled incidence of myocarditis and pericarditis from observational studies was (0.00063%) and (0.000074%) %, respectively. Myocarditis and pericarditis in children and adolescents after the COVID-19 vaccines were more prevalent among males and more commonly observed after the second dose of Pfizer. Though the overall incidence was low, however, the clinicians should consider myocarditis and pericarditis as probable diagnosis when encountering young patients, with a history of vaccine administration, presenting with suggestive findings.
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Affiliation(s)
- Maurish Fatima
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Muhammad H A Khan
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Muhammad S Ali
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Muhammad Osama
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Huzaifa A Cheema
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Aleena Ahmed
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Amna Nisar
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Muhammad W Murad
- Department of Medicine, Shanxi Medical University Yuci District, Jin Zhong City, Shanxi province, China
| | - Hareem Farooq
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Muhammad A U Rehman
- Department of Medicine, King Edward Medical University Lahore, Punjab, Pakistan
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Usman A Akbar
- Division of Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
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