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Article

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

by
Christian Baumeier
1,*,
Ganna Aleshcheva
1,
Dominik Harms
1,
Ulrich Gross
1,
Christian Hamm
2,3,
Birgit Assmus
3,
Ralf Westenfeld
4,
Malte Kelm
4,
Spyros Rammos
5,
Philip Wenzel
6,
Thomas Münzel
6,
Albrecht Elsässer
7,
Mudather Gailani
8,
Christian Perings
9,
Alae Bourakkadi
10,
Markus Flesch
11,
Tibor Kempf
12,
Johann Bauersachs
12,
Felicitas Escher
1,13,14 and
Heinz-Peter Schultheiss
1
1
Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
2
Kerckhoff Heart Center, Department of Cardiology, 61231 Bad Nauheim, Germany
3
Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Gießen, Germany
4
Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
5
Onassis Cardiac Surgery Center, 176 74 Athens, Greece
6
Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
7
Department of Cardiology, Klinikum Oldenburg, 26133 Oldenburg, Germany
8
Frankenwaldklinik, 96317 Kronach, Germany
9
Department of Cardiology, St. Marien-Hospital, 44534 Lünen, Germany
10
Department of Internal Medicine, Cardiology, Geriatrics and Palliative Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, 56727 Mayen, Germany
11
Department of Cardiology, Marienkrankenhaus gGmbH, 59494 Soest, Germany
12
Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
13
Department of Cardiology, Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany
14
German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
 
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*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2022, 23(13), 6940; https://doi.org/10.3390/ijms23136940
Submission received: 8 April 2022 / Revised: 20 May 2022 / Accepted: 21 June 2022 / Published: 22 June 2022
(This article belongs to the Special Issue T-regulatory Cells in Autoimmunity and Transplantation)
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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.
Keywords: COVID-19; vaccination; SARS-CoV-2; Comirnaty; Vaxzevria; Janssen; inflammatory cardiomyopathy; myocarditis; giant cell myocarditis COVID-19; vaccination; SARS-CoV-2; Comirnaty; Vaxzevria; Janssen; inflammatory cardiomyopathy; myocarditis; giant cell myocarditis

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MDPI and ACS Style

Baumeier, C.; Aleshcheva, G.; Harms, D.; Gross, U.; Hamm, C.; Assmus, B.; Westenfeld, R.; Kelm, M.; Rammos, S.; Wenzel, P.; et al. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. Int. J. Mol. Sci. 2022, 23, 6940. https://doi.org/10.3390/ijms23136940

AMA Style

Baumeier C, Aleshcheva G, Harms D, Gross U, Hamm C, Assmus B, Westenfeld R, Kelm M, Rammos S, Wenzel P, et al. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. International Journal of Molecular Sciences. 2022; 23(13):6940. https://doi.org/10.3390/ijms23136940

Chicago/Turabian Style

Baumeier, Christian, Ganna Aleshcheva, Dominik Harms, Ulrich Gross, Christian Hamm, Birgit Assmus, Ralf Westenfeld, Malte Kelm, Spyros Rammos, Philip Wenzel, and et al. 2022. "Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series" International Journal of Molecular Sciences 23, no. 13: 6940. https://doi.org/10.3390/ijms23136940

APA Style

Baumeier, C., Aleshcheva, G., Harms, D., Gross, U., Hamm, C., Assmus, B., Westenfeld, R., Kelm, M., Rammos, S., Wenzel, P., Münzel, T., Elsässer, A., Gailani, M., Perings, C., Bourakkadi, A., Flesch, M., Kempf, T., Bauersachs, J., Escher, F., & Schultheiss, H.-P. (2022). Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. International Journal of Molecular Sciences, 23(13), 6940. https://doi.org/10.3390/ijms23136940

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