Key result
SARS-CoV-2 mRNA-vaccines showed no adverse effects on inflammation and heart function in murine models of autoimmune myocarditis, but low troponin elevation occurred with ICI therapy.
Why the study?
Data were lacking on SARS-CoV-2 mRNA-vaccine safety in acute or chronic myocarditis and alongside myocarditis-inducing therapies such as immune checkpoint inhibitors.
Does SARS-CoV-2 mRNA-vaccination induce or worsen myocarditis in murine models of autoimmune myocarditis or immune checkpoint inhibitor therapy?
Does SARS-CoV-2 mRNA-vaccination induce or worsen myocarditis in murine models of autoimmune myocarditis or immune checkpoint inhibitor therapy?
SARS-CoV-2 mRNA vaccines appear safe in murine models of autoimmune myocarditis, but may induce mild myocardial inflammation when combined with immune checkpoint inhibitor therapy.
Supports mRNA vaccine safety in EAM models; leaves open mild interaction risks with checkpoint inhibitors for further study.
In the course of the SARS-CoV-2 pandemic, vaccination safety and risk factors of SARS-CoV-2 mRNA-vaccines were under consideration after case reports of vaccine-related side effects, such as myocarditis, which were mostly described in young men. However, there is almost no data on the risk and safety of vaccination, especially in patients who are already diagnosed with acute/chronic (autoimmune) myocarditis from other causes, such as viral infections, or as a side effect of medication and treatment. Thus, the risk and safety of these vaccines, in combination with other therapies that could induce myocarditis (e.g., immune checkpoint inhibitor (ICI) therapy), are still poorly assessable. Therefore, vaccine safety, with respect to worsening myocardial inflammation and myocardial function, was studied in an animal model of experimentally induced autoimmune myocarditis. Furthermore, it is known that ICI treatment (e.g., antibodies (abs) against PD-1, PD-L1, and CTLA-4, or a combination of those) plays an important role in the treatment of oncological patients. However, it is also known that treatment with ICIs can induce severe, life-threatening myocarditis in some patients. Genetically different A/J (most susceptible strain) and C57BL/6 (resistant strain) mice, with diverse susceptibilities for induction of experimental autoimmune myocarditis (EAM) at various age and gender, were vaccinated twice with SARS-CoV-2 mRNA-vaccine. In an additional A/J group, an autoimmune myocarditis was induced. In regard to ICIs, we tested the safety of SARS-CoV-2 vaccination in PD-1−/− mice alone, and in combination with CTLA-4 abs. Our results showed no adverse effects related to inflammation and heart function after mRNA-vaccination, independent of age, gender, and in different mouse strains susceptible for induction of experimental myocarditis. Moreover, there was no worsening effect on inflammation and cardiac function when EAM in susceptible mice was induced. However, in the experiments with vaccination and ICI treatment, we observed, in some mice, low elevation of cardiac troponins in sera, and low scores of myocardial inflammation. In sum, mRNA-vaccines are safe in a model of experimentally induced autoimmune myocarditis, but patients undergoing ICI therapy should be closely monitored when vaccinated.
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Zirkenbach et al. (2023) studied Experimental autoimmune myocarditis. SARS-CoV-2 mRNA-vaccine was evaluated on Myocardial inflammation and heart function. SARS-CoV-2 mRNA-vaccines showed no adverse effects on inflammation and heart function in murine models of autoimmune myocarditis, but low troponin elevation occurred with ICI therapy.
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