Myokarditida
Aprotinin
- The trypsin inhibitor
- Suppressed pro-MMP-9 activation and cytokine release
- Alleviated myocardial inflammation
- Restored collagen metabolism during acute and chronic phases of myocarditis
- Effectively prevented ventricular dilation
- Improved cardiac function
- Results suggest that ectopic trypsin in the myocardium promoted DCM through chronic activation of pro-MMP-9, persistent induction of cytokines, and mediation of collagen remodeling.
- Pharmacological inhibition of trypsin activity
- Might be a promising approach for the prevention of viral cardiomyopathy.
- journals.physiology.org/doi/full/10.1152/ajpheart.00076.2014
Myocarditis
- Inflammatory cardiac disorder
- Induced by a wide spectrum of infectious agents, including
- Viruses, bacteria,
- Chlamydia, rickettsia,
- Fungi,
- Protozoans.
- Eosinophilic myocarditis
- Includes types associated with systemic disease
- Hypereosinophilic syndrome,
- Churg-Strauss syndrome,
- Malignancies
- Parasitic infections
- Toxocara canis,
- Idiopathic acute necrotizing eosinophilic myocarditis
- Hypersensitivity myocarditis
- Hypersensitivity reactions to a variety of drugs
- Including vaccines with their components
- Atopic individuals are predominantly prone to develop this type of myocarditis
Post vaccination following the first dose of mRNA COVID-19 vaccination
- (Comirnaty, Pfizer, New York, NY, USA)
Kazuistika
- 21-year-old man with a previous history of atopic asthma in childhood, pollen, and pet allergy
- Developed chest discomfort lasting about 3 hours following the first dose of mRNA COVID-19 vaccination
- Coronary computed tomography angiography
- Normal coronary arteries,
- Cardiac magnetic resonance imaging revealed
- Increased signal intensity on T2-weighted images
- Increased values on both T1 and T2 mapping
- Presence of diffuse subepicardial late gadolinium enhancement
- Compatible with typical active myocarditis
Myocarditis following COVID-19 vaccination
- Chest pain, usually 2–3 days after the second dose of mRNA vaccination
Very late-onset myocarditis after the second dose of mRNA vaccination
- Has also been induced
- Myocarditis has been induced following the mRNA-1273 COVID-19 (Moderna, Cambridge, MA, USA) and AstraZeneca vaccines.
- So far, no reports have associated the Johnson & Johnson vaccine with myocarditis.
Direct damage to the cardiac myocytes
Interferon-mediated immune response
- Leading to systemic inflammation might be potential mechanisms
Inflammatory cell infiltrate
- Is of paramount importance for elucidating the mechanism of myocarditis
mRNA vaccines contains
- Pfizer-BioNTech
- Polyethylene glycol (PEG)
- MRNA-1273 vaccine (Moderna)
- Polyethylene glycol (PEG)
- Tromethamine
- Excipient of gadolinium-based contrast agents
- That can induce hypersensitivity reactions
- Gadolinium is a substance used in cardiac magnetic resonance imaging for diagnosing myocarditis
Endomyocardial biopsies
- Eosinophils and other interacting and interrelated inflammatory cells, such as
- Macrophages,
- T-cells,
- B-cells
- Compatible with Hypersensitivity myocarditis
Hypersensitivity myocarditis
- Atopic pacient history of asthma, pollen, and pet allergy, therefore
- Induced myocarditis was presumably hypersensitivity myocarditis
- This type of myocarditis is particularly difficult to recognize
- Clinical features characteristic of a drug hypersensitivity reaction
- Including non-specific skin rash, malaise, fever, and eosinophilia — are absent in most cases
Terapie - Hypersensitivity myocarditis
- Most patients respond well to steroid administration or drug removal
- Seen in 3% to 10% of cardiac explants and patients on ventricular assist devices
- PEG excipient contained in mRNA vaccines is also part of
- Creams, ointments,
- Lotions, cosmetics,
- Dental materials,
- Might have sensitized their users.
- 1%–5.4% of the population is already sensitized to cosmetics or dental materials.
- USA
- 2-5% of the population have experienced hypersensitivity or anaphylaxis
- Most commonly to drugs, food, or insect stings
- Hypersensitivity to the above COVID-19 excipients
- Could induce hypersensitivity and consequently hypersensitivity myocarditis
Prevention of thrombotic and cardiovascular events
- May be achieved by alternative agents that
- Reduce immunogenicity,
- Improve stability,
- Suppress oxidative damage
- journals.viamedica.pl/kardiologia_polska/article/view/KP.a2021.0166/65686
