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Root-Bernstein R, Huber J, Ziehl A, Pietrowicz M. SARS-CoV-2 and Its Bacterial Co- or Super-Infections Synergize to Trigger COVID-19 Autoimmune Cardiopathies. Int J Mol Sci 2023; 24:12177. [PMID: 37569555 PMCID: PMC10418384 DOI: 10.3390/ijms241512177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Autoimmune cardiopathies (AC) following COVID-19 and vaccination against SARS-CoV-2 occur at significant rates but are of unknown etiology. This study investigated the possible roles of viral and bacterial mimicry, as well as viral-bacterial co-infections, as possible inducers of COVID-19 AC using proteomic methods and enzyme-linked immunoadsorption assays. BLAST and LALIGN results of this study demonstrate that SARS-CoV-2 shares a significantly greater number of high quality similarities to some cardiac protein compared with other viruses; that bacteria such as Streptococci, Staphylococci and Enterococci also display very significant similarities to cardiac proteins but to a different set than SARS-CoV-2; that the importance of these similarities is largely validated by ELISA experiments demonstrating that polyclonal antibodies against SARS-CoV-2 and COVID-19-associated bacteria recognize cardiac proteins with high affinity; that to account for the range of cardiac proteins targeted by autoantibodies in COVID-19-associated autoimmune myocarditis, both viral and bacterial triggers are probably required; that the targets of the viral and bacterial antibodies are often molecularly complementary antigens such as actin and myosin, laminin and collagen, or creatine kinase and pyruvate kinase, that are known to bind to each other; and that the corresponding viral and bacterial antibodies recognizing these complementary antigens also bind to each other with high affinity as if they have an idiotype-anti-idiotype relationship. These results suggest that AC results from SARS-CoV-2 infections or vaccination complicated by bacterial infections. Vaccination against some of these bacterial infections, such as Streptococci and Haemophilus, may therefore decrease AC risk, as may the appropriate and timely use of antibiotics among COVID-19 patients and careful screening of vaccinees for signs of infection such as fever, diarrhea, infected wounds, gum disease, etc.
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Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA; (J.H.); (A.Z.); (M.P.)
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Wölfel A, Sättele M, Zechmeister C, Nikolaev VO, Lohse MJ, Boege F, Jahns R, Boivin-Jahns V. Unmasking features of the auto-epitope essential for β 1 -adrenoceptor activation by autoantibodies in chronic heart failure. ESC Heart Fail 2020; 7:1830-1841. [PMID: 32436653 PMCID: PMC7373925 DOI: 10.1002/ehf2.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Chronic heart failure (CHF) can be caused by autoantibodies stimulating the heart via binding to first and/or second extracellular loops of cardiac β1‐adrenoceptors. Allosteric receptor activation depends on conformational features of the autoantibody binding site. Elucidating these features will pave the way for the development of specific diagnostics and therapeutics. Our aim was (i) to fine‐map the conformational epitope within the second extracellular loop of the human β1‐adrenoceptor (β1ECII) that is targeted by stimulating β1‐receptor (auto)antibodies and (ii) to generate competitive cyclopeptide inhibitors of allosteric receptor activation, which faithfully conserve the conformational auto‐epitope. Methods and results Non‐conserved amino acids within the β1ECII loop (compared with the amino acids constituting the ECII loop of the β2‐adrenoceptor) were one by one replaced with alanine; potential intra‐loop disulfide bridges were probed by cysteine–serine exchanges. Effects on antibody binding and allosteric receptor activation were assessed (i) by (auto)antibody neutralization using cyclopeptides mimicking β1ECII ± the above replacements, and (ii) by (auto)antibody stimulation of human β1‐adrenoceptors bearing corresponding point mutations. With the use of stimulating β1‐receptor (auto)antibodies raised in mice, rats, or rabbits and isolated from exemplary dilated cardiomyopathy patients, our series of experiments unmasked two features of the β1ECII loop essential for (auto)antibody binding and allosteric receptor activation: (i) the NDPK211–214 motif and (ii) the intra‐loop disulfide bond C209↔C215. Of note, aberrant intra‐loop disulfide bond C209↔C216 almost fully disrupted the functional auto‐epitope in cyclopeptides. Conclusions The conformational auto‐epitope targeted by cardio‐pathogenic β1‐receptor autoantibodies is faithfully conserved in cyclopeptide homologues of the β1ECII loop bearing the NDPK211–214 motif and the C209↔C215 bridge while lacking cysteine C216. Such molecules provide promising tools for novel diagnostic and therapeutic approaches in β1‐autoantibody‐positive CHF.
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Affiliation(s)
- Angela Wölfel
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Rudolf-Virchow-Centre, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Rudolf-Virchow-Centre, Pierre Fabre Dermo-Kosmetik GmbH, Jechtinger Straße 13, 79111, Freiburg, Germany
| | - Mathias Sättele
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany
| | - Christina Zechmeister
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data (ibdw), University Hospital of Würzburg, Straubmühlweg 2A, D-97078, Würzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
| | - Viacheslav O Nikolaev
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Institute for Molecular Cardiology, Department of Cardiology and Pneumology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin J Lohse
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Rudolf-Virchow-Centre, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Institute Max Delbrück Center for Molecular Research, Berlin-Buch, Robert-Koch-Str. 40, 1000, Berlin, Germany
| | - Fritz Boege
- Rudolf-Virchow-Centre, Institute of Clinical Chemistry and Laboratory Diagnostics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Roland Jahns
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data (ibdw), University Hospital of Würzburg, Straubmühlweg 2A, D-97078, Würzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
| | - Valérie Boivin-Jahns
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
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Qu YS, Lazzerini PE, Capecchi PL, Laghi-Pasini F, El Sherif N, Boutjdir M. Autoimmune Calcium Channelopathies and Cardiac Electrical Abnormalities. Front Cardiovasc Med 2019; 6:54. [PMID: 31119135 PMCID: PMC6507622 DOI: 10.3389/fcvm.2019.00054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patients with autoimmune diseases are at increased risk for developing cardiovascular diseases, and abnormal electrocardiographic findings are common. Voltage-gated calcium channels play a major role in the cardiovascular system and regulate cardiac excitability and contractility. Particularly, by virtue of their localization and expression in the heart, calcium channels modulate pace making at the sinus node, conduction at the atrioventricular node and cardiac repolarization in the working myocardium. Consequently, emerging evidence suggests that calcium channels are targets to autoantibodies in autoimmune diseases. Autoimmune-associated cardiac calcium channelopathies have been recognized in both sinus node dysfunction atrioventricular block in patients positive for anti-Ro/La antibodies, and ventricular arrhythmias in patients with dilated cardiomyopathy. In this review, we discuss mechanisms of autoimmune-associated calcium channelopathies and their relationship with the development of cardiac electrical abnormalities.
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Affiliation(s)
- Yongxia Sarah Qu
- Department of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States.,VA New York Harbor Healthcare System and State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Nabil El Sherif
- VA New York Harbor Healthcare System and State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System and State University of New York Downstate Medical Center, Brooklyn, NY, United States.,NYU School of Medicine, New York, NY, United States
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Ylänen K, Poutanen T, Savukoski T, Eerola A, Vettenranta K. Cardiac biomarkers indicate a need for sensitive cardiac imaging among long-term childhood cancer survivors exposed to anthracyclines. Acta Paediatr 2015; 104:313-9. [PMID: 25393922 DOI: 10.1111/apa.12862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/26/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
AIM The role that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponins T (cTnT) and I (cTnI) play in supplementing imaging to screen for cardiac late effects remains controversial and the impact of high-sensitivity cTnT and troponin-specific autoantibodies (cTnAAbs) remains unexplored. We studied the role of cardiac biomarkers as indicators of the late effects of anthracyclines among childhood cancer survivors. METHODS We measured NT-proBNP, cTnT, high-sensitivity cTnT, cTnI and cTnAAbs in 76 childhood cancer survivors at a median of 9 years after primary diagnosis. The survivors underwent conventional and real-time three-dimensional echocardiography and 62 underwent cardiac magnetic resonance imaging (MRI). RESULTS Of the survivors, four (5.3%) without risk factors for cardiotoxicity were cTnAAb-positive with an impaired cardiac function in MRI. Another four (5.3%) had an abnormal NT-proBNP level associated with an abnormal cardiac function and risk factors for cardiotoxicity. None showed measurable cardiac troponins, determined by the three different methods, with even the high-sensitivity cTnT-levels remaining normal. CONCLUSION Elevated plasma NT-proBNP or cTnAAbs indicated that childhood cancer survivors benefitted from being evaluated with modern imaging, despite normal function in conventional echocardiography. However, troponins did not seem to provide additional information on the late cardiotoxicity of anthracyclines.
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Affiliation(s)
- Kaisa Ylänen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- University of Tampere; Tampere Finland
| | - Tuija Poutanen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- University of Tampere; Tampere Finland
| | - Tanja Savukoski
- Department of Biotechnology; University of Turku; Turku Finland
| | - Anneli Eerola
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
| | - Kim Vettenranta
- Hospital for Children and Adolescents; Helsinki Finland
- University of Helsinki; Helsinki Finland
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Pei J, Li N, Chen J, Li X, Zhang Y, Wang Z, Zhang P, Cao K, Pu J. The predictive values of beta1
-adrenergic and M2
muscarinic receptor autoantibodies for sudden cardiac death in patients with chronic heart failure. Eur J Heart Fail 2014; 14:887-94. [PMID: 22713286 DOI: 10.1093/eurjhf/hfs082] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ning Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Jingzhou Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Xian Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Yinhui Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Zengwu Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Ping Zhang
- People's Hospital; Peking University; Beijing China
| | - Kejiang Cao
- First People's Hospital of Jiangsu Province; Nanjing China
| | - Jielin Pu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital & Cardiovascular Institute; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
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Münch G, Boivin-Jahns V, Holthoff HP, Adler K, Lappo M, Truöl S, Degen H, Steiger N, Lohse MJ, Jahns R, Ungerer M. Administration of the cyclic peptide COR-1 in humans (phase I study): ex vivo measurements of anti-β1-adrenergic receptor antibody neutralization and of immune parameters. Eur J Heart Fail 2012; 14:1230-9. [PMID: 22968742 DOI: 10.1093/eurjhf/hfs118] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS A novel concept for the treatment of heart failure is the neutralization of antibodies against the β(1)-adrenergic receptor (anti-β(1)AR-ab). In a rat model of autoimmune cardiomyopathy, the cyclic peptide COR-1 (given i.v. once monthly) neutralized anti-β(1)AR-abs and prevented anti-β(1)AR-ab-induced myocardial damage, and completely reverted cardiac dysfunction over 3-6 months. METHODS AND RESULTS A clinical phase I trial was designed as a single-blinded, placebo-controlled study. Fifty human volunteers received COR-1 or matching placebo as a single i.v. administration with ascending doses (10-240 mg). Primary endpoints were safety and tolerability, while the pharmacokinetic profile of COR-1 was assessed as a secondary endpoint. All five investigated dose groups were well tolerated; no drug-related side effects occurred. Pharmacokinetics revealed a favourable profile with an almost complete plasma clearance within 60 min after administration. Pharmacodynamic investigation showed dose-dependent efficacy with almost complete scavenging of pathological anti-β(1)AR-abs ex vivo at the two highest doses. No anti-COR-1 autoantibodies occurred. No other effects on the immune system (such as an increase of crucial cytokines) were observed up to 43 days after drug administration, nor upon incubation of anti-β(1)AR-ab-positive patient blood samples with COR-1 ex vivo. CONCLUSIONS COR-1 was shown to be safe after i.v. administration in vivo; no relevant side effects occurred. Efficacy was estimated from ex vivo investigation of the potency to neutralize specific anti-β(1)-AR-abs. TRIAL REGISTRATION NCT 01043146, Eudra CT 2008-007745-31.
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Xiao H, Wang M, Du Y, Yuan J, Cheng X, Chen Z, Zou A, Wei F, Zhao G, Liao YH. Arrhythmogenic autoantibodies against calcium channel lead to sudden death in idiopathic dilated cardiomyopathy. Eur J Heart Fail 2010; 13:264-70. [PMID: 21044990 DOI: 10.1093/eurjhf/hfq198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Calcium channel plays an important role in the autoimmune pathogenesis of idiopathic dilated cardiomyopathy (DCM). Autoantibodies have emerged as a new upstream target of sudden death in DCM. We sought to validate the hypothesis that autoantibodies against l-type calcium channel (CC-AAbs) are arrhythmogenic and lead to sudden death in patients with DCM. METHODS AND RESULTS We investigated sudden death and ventricular arrhythmias in 80 patients with DCM in a prospective, case follow-up survey. During a follow-up of 32 (SD 8) months, CC-AAbs-positive patients not only had a higher incidence of ventricular tachycardia (VT) but also a higher incidence of sudden death than CC-AAbs-negative patients (for VT: 59.0 vs. 24.4%, P = 0.002 and for sudden death: 20.5 vs. 4.9%, P = 0.045). Further univariate and multivariate analyses showed that the occurrence of CC-AAbs was the strongest independent predictor for sudden death (odds ratio: 10.20, 95% confidence interval: 2.43-36.78, P = 0.0027). Experimental studies in ex vivo systems using affinity-purified CC-AAbs from patients demonstrated that CC-AAbs were able to induce VT by prolongation of action potential duration (APD) and triggered activity by early afterdepolarization (EAD). CONCLUSION Our results demonstrate for the first time to our knowledge that there is a high incidence of sudden death and VT in CC-AAbs-positive patients with DCM. Furthermore, experimental data from ex vivo systems suggest that CC-AAbs might induce VT by prolongation of APD and triggered activity by EAD.
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Affiliation(s)
- Hua Xiao
- Department of Cardiology, Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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