2023
DOI: 10.1126/sciimmunol.adh3455
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Cytokinopathy with aberrant cytotoxic lymphocytes and profibrotic myeloid response in SARS-CoV-2 mRNA vaccine–associated myocarditis

Abstract: Rare immune-mediated cardiac tissue inflammation can occur after vaccination, including after SARS-CoV-2 mRNA vaccines. However, the underlying immune cellular and molecular mechanisms driving this pathology remain poorly understood. Here, we investigated a cohort of patients who developed myocarditis and/or pericarditis with elevated troponin, B-type natriuretic peptide, and C-reactive protein levels as well as cardiac imaging abnormalities shortly after SARS-CoV-2 mRNA vaccination. Contrary to early hypothes… Show more

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Cited by 42 publications
(21 citation statements)
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“…These autoantibodies might be innocent bystanders resulting from myocardial inflammation and injury, or might reflect a certain immune–genetic background that predisposes to developing hyperimmunity and myocarditis upon any trigger. However very recent findings in post mRNA vaccine myocarditis did not show evidence of cardiac targeted autoantibodies in these patients suggesting that this mechanism is unlikely to act as main pathogenic trigger [18] .…”
Section: Discussionmentioning
confidence: 66%
“…These autoantibodies might be innocent bystanders resulting from myocardial inflammation and injury, or might reflect a certain immune–genetic background that predisposes to developing hyperimmunity and myocarditis upon any trigger. However very recent findings in post mRNA vaccine myocarditis did not show evidence of cardiac targeted autoantibodies in these patients suggesting that this mechanism is unlikely to act as main pathogenic trigger [18] .…”
Section: Discussionmentioning
confidence: 66%
“…However, we found no differences in quantity, binding capacity, effector function, or neutralization capacity of anti-SARS-CoV-2 antibodies generated from individuals with post-COVID-19 vaccine myocarditis compared with matched vaccinated controls, 1 which are findings corroborated by others. 2 Additionally, we did not detect any differences in spike protein-induced T-cell immunity in our limited T-cell analyses. A separate group performed single-cell RNA sequencing on a 4-patient cohort, 2 which suggested natural killer cell and monocyte dysregulation with decreased proportions of CD4 + naïve T-cell subsets and robust expansion of cytotoxic T lymphocytes.…”
Section: Response To Letter To the Editormentioning
confidence: 62%
“…2 Additionally, we did not detect any differences in spike protein-induced T-cell immunity in our limited T-cell analyses. A separate group performed single-cell RNA sequencing on a 4-patient cohort, 2 which suggested natural killer cell and monocyte dysregulation with decreased proportions of CD4 + naïve T-cell subsets and robust expansion of cytotoxic T lymphocytes. However, this study was completed on a very small cohort.…”
Section: Response To Letter To the Editormentioning
confidence: 62%
“… 81 , 82 Immunopathology data from the United States suggest that myocarditis post-vaccination might be driven by elevation of circulating inflammatory cytokines and corresponding lymphocytes, with no evidence of cardiac-targeted autoantibodies, hypersensitivity, or hyperimmune humoral mechanisms. 88 …”
Section: Resultsmentioning
confidence: 99%