Clinic of Internal Medicine III, Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital, Bonn, Bonn, Germany.
Rheumatol Int. 2024 Oct;44(10):2185-2196. doi: 10.1007/s00296-024-05683-5. Epub 2024 Aug 27.
Since the introduction of mRNA vaccines against SARS-CoV-2, the induction of autoimmunity by mRNA vaccination has been discussed. Several cases of dermatomyositis (DM) associated with mRNA vaccination against SARS-CoV-2 infection have been reported. The question is whether there is a common pathomechanism for the induction of DM by this mRNA vaccination. The aim of this review is to analyse the sample of previously published case reports of DM following COVID-19 mRNA vaccination for common indicators of a possible immune pathomechanism.In this review, we summarised case reports of DM following mRNA vaccination against COVID-19. We considered this case report landscape as a cumulative sample (n = 32) and identified common clinical and molecular parameters in the intersection of case reports and statistically analysed the effect of these parameters on the development of DM.MDA-5 antibodies seem to play a role in the autoantibody signature after mRNA vaccination. MDA-5-positive DM is statistically more strongly associated with mRNA vaccination and interstitial lung disease/rapidly progressive interstitial lung disease (ILD/RP-ILD) than MDA-5-negative DM. MDA-5-positive DM seems not to be associated with an increased risk of malignancy, whereas MDA-5-negative DM is more strongly associated with malignancy.Our findings emphasize the potential role of innate antiviral signalling pathways in connecting DM to mRNA vaccination. MDA-5 autoantibodies appear to be predictive of a severe DM progression following mRNA vaccination. There seems to be an association between MDA-5 autoantibodies and paraneoplastic DM post-vaccination. Further studies are required to uncover the underlying mechanisms of autoimmunity triggered by mRNA vaccination.
自 SARS-CoV-2 的 mRNA 疫苗问世以来，mRNA 疫苗接种引发自身免疫的问题一直备受讨论。有几起因接种 SARS-CoV-2 感染 mRNA 疫苗而导致皮肌炎（DM）的病例报告。问题在于这种 mRNA 疫苗接种引发 DM 是否存在共同的发病机制。本综述的目的是分析先前发表的 COVID-19 mRNA 疫苗接种后发生 DM 的病例报告，以寻找可能的免疫发病机制的共同指标。
在本综述中，我们总结了接种 mRNA 疫苗预防 COVID-19 后发生 DM 的病例报告。我们将该病例报告景观视为累积样本（n=32），并在病例报告的交叉点识别出常见的临床和分子参数，并对这些参数对 DM 发展的影响进行了统计学分析。
MDA-5 抗体似乎在 mRNA 疫苗接种后的自身抗体特征中起作用。MDA-5 阳性 DM 在统计学上与 mRNA 疫苗接种和间质性肺病/快速进展性间质性肺病（ILD/RP-ILD）的相关性更强，而 MDA-5 阴性 DM 则较弱。MDA-5 阳性 DM 似乎与恶性肿瘤的风险增加无关，而 MDA-5 阴性 DM 与恶性肿瘤的相关性更强。
我们的研究结果强调了先天抗病毒信号通路在将 DM 与 mRNA 疫苗接种联系起来的潜在作用。MDA-5 自身抗体似乎是预测 mRNA 疫苗接种后 DM 严重进展的指标。接种疫苗后似乎存在 MDA-5 自身抗体与副肿瘤 DM 之间的关联。需要进一步的研究来揭示 mRNA 疫苗接种引发自身免疫的潜在机制。
