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Bakos T, Mészáros T, Kozma GT, Berényi P, Facskó R, Farkas H, Dézsi L, Heirman C, de Koker S, Schiffelers R, Glatter KA, Radovits T, Szénási G, Szebeni J. mRNA-LNP COVID-19 Vaccine Lipids Induce Complement Activation and Production of Proinflammatory Cytokines: Mechanisms, Effects of Complement Inhibitors, and Relevance to Adverse Reactions. Int J Mol Sci 2024; 25:3595. [PMID: 38612407 PMCID: PMC11012056 DOI: 10.3390/ijms25073595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
A small fraction of people vaccinated with mRNA-lipid nanoparticle (mRNA-LNP)-based COVID-19 vaccines display acute or subacute inflammatory symptoms whose mechanism has not been clarified to date. To better understand the molecular mechanism of these adverse events (AEs), here, we analyzed in vitro the vaccine-induced induction and interrelations of the following two major inflammatory processes: complement (C) activation and release of proinflammatory cytokines. Incubation of Pfizer-BioNTech's Comirnaty and Moderna's Spikevax with 75% human serum led to significant increases in C5a, sC5b-9, and Bb but not C4d, indicating C activation mainly via the alternative pathway. Control PEGylated liposomes (Doxebo) also induced C activation, but, on a weight basis, it was ~5 times less effective than that of Comirnaty. Viral or synthetic naked mRNAs had no C-activating effects. In peripheral blood mononuclear cell (PBMC) cultures supplemented with 20% autologous serum, besides C activation, Comirnaty induced the secretion of proinflammatory cytokines in the following order: IL-1α < IFN-γ < IL-1β < TNF-α < IL-6 < IL-8. Heat-inactivation of C in serum prevented a rise in IL-1α, IL-1β, and TNF-α, suggesting C-dependence of these cytokines' induction, although the C5 blocker Soliris and C1 inhibitor Berinert, which effectively inhibited C activation in both systems, did not suppress the release of any cytokines. These findings suggest that the inflammatory AEs of mRNA-LNP vaccines are due, at least in part, to stimulation of both arms of the innate immune system, whereupon C activation may be causally involved in the induction of some, but not all, inflammatory cytokines. Thus, the pharmacological attenuation of inflammatory AEs may not be achieved via monotherapy with the tested C inhibitors; efficacy may require combination therapy with different C inhibitors and/or other anti-inflammatory agents.
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Affiliation(s)
- Tamás Bakos
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
| | - Tamás Mészáros
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
- SeroScience LCC., 1089 Budapest, Hungary
- Department of Cardiology, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, 1089 Budapest, Hungary
| | - Gergely Tibor Kozma
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
- SeroScience LCC., 1089 Budapest, Hungary
| | - Petra Berényi
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
- SeroScience LCC., 1089 Budapest, Hungary
| | - Réka Facskó
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
- SeroScience LCC., 1089 Budapest, Hungary
- Department of Cardiology, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, 1089 Budapest, Hungary
| | - Henriette Farkas
- Hungarian Center of Reference and Excellence, Department of Internal Medicine and Hematology, Semmelweis University, 1088 Budapest, Hungary;
| | - László Dézsi
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
| | - Carlo Heirman
- Etherna Biopharmaceuticals, 2845 Niel, Belgium; (C.H.); (S.d.K.)
| | - Stefaan de Koker
- Etherna Biopharmaceuticals, 2845 Niel, Belgium; (C.H.); (S.d.K.)
| | - Raymond Schiffelers
- Division of Laboratories and Pharmacy, University Medical Center, 3584 CX Utrecht, The Netherlands;
| | | | - Tamás Radovits
- Department of Cardiology, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
- Department of Surgical Research and Techniques, Heart and Vascular Center, Semmelweis University, 1089 Budapest, Hungary
| | - Gábor Szénási
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
| | - János Szebeni
- Nanomedicine Research and Education Center, Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.B.); (T.M.); (G.T.K.); (P.B.); (R.F.); (L.D.); (G.S.)
- SeroScience LCC., 1089 Budapest, Hungary
- Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health Sciences, Miskolc University, 3530 Miskolc, Hungary
- Translational Nanobioscience Research Center, Sungkyunkwan University, Suwon 06351, Republic of Korea
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Nowicki RJ, Grubska-Suchanek E, Porêbski G, Kowalski ML, Jahnz-Różyk K, Matuszewski T, Rudnicka L, Kulus M, Barañska-Rybak W, Czajkowski R, Doniec Z, Kowalewski C, Krêcisz B, Lange M, Narbutt J, Olszewska M, Sokołowska-Wojdyło M, Szczerkowska-Dobosz A, Śpiewak R, Trzeciak M, Wilkowska A. Angioedema. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society (PTD) and Polish Society of Allergology (PTA). Postepy Dermatol Alergol 2020; 37:445-51. [PMID: 32994763 DOI: 10.5114/ada.2020.98226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Angioedema is a non-inflammatory oedema of the subcutaneous tissue and/or mucosal membranes. It most commonly coexists with urticaria wheals and is considered to be a deep form of urticaria. Less commonly, it occurs in isolation and can take two basic forms: acquired angioedema and hereditary angioedema. Currently, there are 4 defined types of acquired angioedema and 7 types of hereditary angioedema. Treatment of angioedema depends on its form and etiological factors. Especially the genetic form, i.e. hereditary angioedema, is a considerable challenge for medical specialists, particularly dermatologists and allergists.
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Johnson NM, Phillips MA. New Treatments for Hereditary Angioedema. Skin Therapy Lett 2018; 23:6-8. [PMID: 29357215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hereditary angioedema is characterized by severe, episodic edema of the subcutaneous and mucosal tissue. The disease carries significant morbidity and mortality due to involvement of the gastrointestinal tract and upper airway. Recent advances in the treatment of hereditary angioedema include new techniques used to isolate and purify human-derived C1 inhibitor, the production of a recombinant form of C1 inhibitor, and the development of drugs that target the kallikrein-kinin pathway. This paper reviews the mechanisms, efficacy, and adverse reactions associated with these medications.
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Affiliation(s)
- Nathan M Johnson
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Carilion Clinic Dermatology & Mohs Surgery, Roanoke, VA, USA
| | - Mariana A Phillips
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Carilion Clinic Dermatology & Mohs Surgery, Roanoke, VA, USA
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Abstract
OBJECTIVE To describe 2 cases of angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema treated with C1 esterase inhibitor (human) [Berinert]. SUMMARY Case 1 is a 60-year-old Caucasian male with angioedema from lisinopril. He was initially treated with a conventional regimen of an antihistamine, methylprednisolone, epinephrine, and fresh frozen plasma. When symptoms did not resolve, intravenous C1 peptide esterase inhibitor (C1INH) was administered, with clinical improvement. Four hours later, symptoms returned and the patient underwent emergency tracheostomy. Case 2 is a 64-year-old Caucasian male who presented with angioedema due to enalapril. In the emergency department, he received conventional treatment. Endotracheal tube placement was unsuccessful. While the patient was undergoing intubation in the operating room, intravenous C1INH was administered resulting in quick improvement of symptoms. DISCUSSION Angioedema from ACEI occurs at an incidence of 0.7%. Conventional treatment may be of limited benefit due to the mechanism of the reaction. C1INHs, which are indicated for hereditary angioedema, have been utilized in treating ACEI-induced angioedema. According to the Naranjo algorithm scale, the patient in case 1 experienced angioedema that is probably related to lisinopril. C1INH was administered intravenously when symptoms progressed, despite conventional treatment. In case 2, the patient experienced angioedema, which is possibly related to enalapril, and was treated with C1INH. CONCLUSION C1INH (human) was a successful addition to the traditional management of 2 patients with angioedema due to ACEI.
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Affiliation(s)
- Maria Leibfried
- 1 Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA
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Zuraw BL, Cicardi M, Longhurst HJ, Bernstein JA, Li HH, Magerl M, Martinez‐Saguer I, Rehman SMM, Staubach P, Feuersenger H, Parasrampuria R, Sidhu J, Edelman J, Craig T. Phase II study results of a replacement therapy for hereditary angioedema with subcutaneous C1-inhibitor concentrate. Allergy 2015; 70:1319-28. [PMID: 26016741 PMCID: PMC4755045 DOI: 10.1111/all.12658] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1 inhibitor deficiency manifests as recurrent swelling attacks that can be disabling and sometimes fatal. Long-term prophylaxis with twice-weekly intravenous injections of plasma-derived C1-inhibitor (pdC1-INH) has been established as an effective treatment. Subcutaneous (SC) administration of pdC1-INH has not been studied in patients with HAE. METHODS This open-label, dose-ranging, crossover study (COMPACT Phase II) was conducted in 18 patients with type I or II HAE who received two of twice-weekly 1500, 3000, or 6000 IU SC doses of highly concentrated volume-reduced CSL830 for 4 weeks each. The mean trough plasma levels of C1-INH functional activity, C1-INH and C4 antigen levels during Week 4, and overall safety and tolerability were evaluated. The primary outcome was model-derived steady-state trough C1-INH functional activity. RESULTS After SC CSL830 administration, a dose-dependent increase in trough functional C1-INH activity was observed. C1-INH and C4 levels both increased. The two highest dose groups (3000 and 6000 IU) achieved constant C1-INH activity levels above 40% values, a threshold that was assumed to provide clinical protection against angioedema attacks. Compared with intravenous injection, pdC1-INH SC injection with CSL830 showed a lower peak-to-trough ratio and more consistent exposures. All doses were well tolerated. Mild-to-moderate local site reactions were noted with pain and swelling being the most common adverse event. CONCLUSIONS Subcutaneous volume-reduced CSL830 was well tolerated and led to a dose-dependent increase in physiologically relevant functional C1-INH plasma levels. A clinical outcome study of SC CSL830 in patients with HAE warrants further investigation.
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Affiliation(s)
- B. L. Zuraw
- Department of Medicine University of California, San Diego La Jolla CA USA
| | - M. Cicardi
- Department of Internal Medicine Universita degli Studi di Milano Ospedale L. Sacco Milan Italy
| | | | - J. A. Bernstein
- Department of Immunology/Allergy University of Cincinnati College of Medicine Cincinnati OH USA
| | - H. H. Li
- Institute for Asthma and Allergy Chevy Chase MD USA
| | - M. Magerl
- Charité, Universitätsmedizin Berlin Berlin Germany
| | | | | | | | | | | | - J. Sidhu
- CSL Limited Parkville Vic. Australia
| | | | - T. Craig
- Departments of Medicine and Pediatrics Penn State University Hershey PA USA
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Craig TJ, Schneider LC, MacGinnitie AJ. Plasma-derived C1-INH for managing hereditary angioedema in pediatric patients: A systematic review. Pediatr Allergy Immunol 2015; 26:537-44. [PMID: 26111105 DOI: 10.1111/pai.12425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/27/2022]
Abstract
Presently, medications approved for children with Hereditary Angioedema (HAE) are extremely limited. This is especially the case for children under 12 years of age. For this reason we reviewed and summarized the data on treatment of children with HAE. Available data indicate that plasma derived C1-inhibitor is a safe, effective treatment option for HAE in pediatric patients, including those below 12 years of age. Other therapies are also appear safe for the under 12 year of age, but less data are available. Importantly, home-based treatment of HAE in this age group appears to be safe and effective and can improve quality of life. These findings support current HAE consensus guidelines which strongly recommend the use of plasma derived C1-inhibitor as a first-line treatment in children and encourage home and self-treatment.
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Affiliation(s)
- Timothy J Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA
| | - Lynda C Schneider
- Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA.,Division of Immunology, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Andrew J MacGinnitie
- Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA.,Division of Immunology, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
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Abstract
Consensus guidelines on hereditary angioedema (HAE) recommend that all patients have access to on-demand treatment of acute attacks. A recent patientcentric guideline recommended that at least 2 on-demand therapies be available because patients often have heterogeneous responses to different medications. Self-administration of therapeutic agents, or administration under supervision by a health care provider in the home setting, is the preferred treatment approach. Future studies are needed to show the benefits of acute on-demand therapies at improving quality of life and reducing morbidity and mortality in patients with HAE.
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Affiliation(s)
- Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, 3255 Eden Avenue, Suite 350 ML#563, Cincinnati, OH 45267-0563, USA.
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