Schinas Georgios, Polyzou Eleni, Dimakopoulou Vasiliki, Tsoupra Stamatia, Gogos Charalambos, Akinosoglou Karolina
Department of Medicine, University of Patras, Patras 26504, Greece.
Department of Internal Medicine, University of Patras, Patras 26504, Greece.
World J Virol. 2023 Mar 25;12(2):100-108. doi: 10.5501/wjv.v12.i2.100.
Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019 (COVID-19) vaccination protocols. All three most widely distributed severe acute respiratory syndrome coronavirus 2 vaccine formulations, , BNT162b2, mRNA-1273, and ChAdOx1-S, can induce liver injury that may involve immune-mediated pathways and result in autoimmune hepatitis-like presentation that may require therapeutic intervention in the form of corticosteroid administration. Various mechanisms have been proposed in an attempt to highlight immune checkpoint inhibition and thus establish causality with vaccination. The autoimmune features of such a reaction also prompt an in-depth investigation of the newly employed vaccine technologies. Novel vaccine delivery platforms, , mRNA-containing lipid nanoparticles and adenoviral vectors, contribute to the inflammatory background that leads to an exaggerated immune response, while patterns of molecular mimicry between the spike (S) protein and prominent liver antigens may account for the autoimmune presentation. Immune mediators triggered by vaccination or vaccine ingredients per se, including autoreactive antibodies, cytokines, and cytotoxic T-cell populations, may inflict hepatocellular damage through well-established pathways. We aim to review available data associated with immune-mediated liver injury associated with COVID-19 vaccination and elucidate potential mechanisms underlying its pathogenesis.
疫苗接种继发的肝损伤是一种罕见的不良事件，由于2019冠状病毒病（COVID-19）疫苗接种方案广泛实施后持续的药物警戒，最近受到了关注。三种分布最广泛的严重急性呼吸综合征冠状病毒2疫苗制剂，即BNT162b2、mRNA-1273和ChAdOx1-S，均可诱发肝损伤，可能涉及免疫介导途径，并导致类似自身免疫性肝炎的表现，可能需要以使用皮质类固醇的形式进行治疗干预。人们提出了各种机制，试图突出免疫检查点抑制作用，从而确定与疫苗接种的因果关系。这种反应的自身免疫特征也促使人们对新采用的疫苗技术进行深入研究。新型疫苗递送平台，如含mRNA的脂质纳米颗粒和腺病毒载体，促成了导致过度免疫反应的炎症背景，而刺突（S）蛋白与主要肝脏抗原之间的分子模拟模式可能解释了自身免疫表现。疫苗接种或疫苗成分本身触发的免疫介质，包括自身反应性抗体、细胞因子和细胞毒性T细胞群体，可能通过既定途径造成肝细胞损伤。我们旨在综述与COVID-19疫苗接种相关的免疫介导肝损伤的现有数据，并阐明其发病机制的潜在机制。
