Awaya Toru, Hara Hidehiko, Moroi Masao
Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan.
Department of Internal Medicine, Misato Central General Hospital, Saitama 341-8526, Japan.
Diseases. 2024 Oct 1;12(10):231. doi: 10.3390/diseases12100231.
Acute adverse reactions to COVID-19 mRNA vaccines are a major concern, as autopsy reports indicate that deaths most commonly occur on the same day of or one day following vaccination. These acute reactions may be due to cytokine storms triggered by lipid nanoparticles (LNPs) and anaphylaxis induced by polyethene glycol (PEG), both of which are vital constituents of the mRNA-LNP vaccines. Kounis syndrome, in which anaphylaxis triggers acute coronary syndrome (ACS), may also be responsible for these cardiovascular events. Furthermore, COVID-19 mRNA-LNP vaccines encompass adjuvants, such as LNPs, which trigger inflammatory cytokines, including interleukin (IL)-1β and IL-6. These vaccines also produce spike proteins which facilitate the release of inflammatory cytokines. Apart from this, histamine released from mast cells during allergic reactions plays a critical role in IL-6 secretion, which intensifies inflammatory responses. In light of these events, early reduction of IL-1β and IL-6 is imperative for managing post-vaccine cytokine storms, ACS, and myocarditis. Corticosteroids can restrict inflammatory cytokines and mitigate allergic responses, while colchicine, known for its IL-1β-reducing capabilities, could also prove effective. The anti-IL-6 antibody tocilizumab also displays promising treatment of cytokine release syndrome. Aside from its significance for treating anaphylaxis, epinephrine can induce coronary artery spasms and myocardial ischemia in Kounis syndrome, making accurate diagnosis essential. The upcoming self-amplifying COVID-19 mRNA-LNP vaccines also contain LNPs. Given that these vaccines can cause a cytokine storm and allergic reactions post vaccination, it is crucial to consider corticosteroids and measure IL-6 levels for effective management.
新型冠状病毒肺炎（COVID-19）信使核糖核酸（mRNA）疫苗的急性不良反应是一个主要问题，因为尸检报告表明死亡最常发生在接种疫苗的当天或之后一天。这些急性反应可能是由于脂质纳米颗粒（LNP）引发的细胞因子风暴以及聚乙二醇（PEG）诱导的过敏反应，这两者都是mRNA-LNP疫苗的重要成分。过敏反应引发急性冠状动脉综合征（ACS）的库尼斯综合征也可能是这些心血管事件的原因。此外，COVID-19 mRNA-LNP疫苗包含佐剂，如LNP，其可引发炎性细胞因子，包括白细胞介素（IL）-1β和IL-6。这些疫苗还产生刺突蛋白，促进炎性细胞因子的释放。除此之外，过敏反应期间肥大细胞释放的组胺在IL-6分泌中起关键作用，从而加剧炎症反应。鉴于这些情况，尽早降低IL-1β和IL-6对于控制疫苗接种后细胞因子风暴、ACS和心肌炎至关重要。皮质类固醇可限制炎性细胞因子并减轻过敏反应，而以降低IL-1β能力著称的秋水仙碱也可能被证明有效。抗IL-6抗体托珠单抗在治疗细胞因子释放综合征方面也显示出前景。除了其在治疗过敏反应方面的重要性外，肾上腺素在库尼斯综合征中可诱发冠状动脉痉挛和心肌缺血，因此准确诊断至关重要。即将推出的自我扩增COVID-19 mRNA-LNP疫苗也含有LNP。鉴于这些疫苗接种后可引发细胞因子风暴和过敏反应，考虑使用皮质类固醇并测量IL-6水平以进行有效管理至关重要。
