Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.medj.2023.04.001
Title: RNase2 is a possible trigger of acute-on-chronic inflammation leading to mRNA vaccine-associated cardiac complication.
Authors: Ong, Eugenia Z 
Koh, Clara WT 
Tng, Danny JH 
Ooi, Justin SG 
Yee, Jia Xin 
Chew, Valerie SY 
Leong, Yan Shan 
Gunasegaran, Kurugulasigamoney 
Yeo, Chin Pin 
Oon, Lynette LE 
Sim, Jean XY 
Chan, Kuan Rong 
Low, Jenny G 
Ooi, Eng Eong 
Keywords: COVID-19
RNASE2
Translation to patients
cardiac complication
mRNA vaccination
severe adverse event
Issue Date: 21-Apr-2023
Publisher: Elsevier BV
Citation: Ong, Eugenia Z, Koh, Clara WT, Tng, Danny JH, Ooi, Justin SG, Yee, Jia Xin, Chew, Valerie SY, Leong, Yan Shan, Gunasegaran, Kurugulasigamoney, Yeo, Chin Pin, Oon, Lynette LE, Sim, Jean XY, Chan, Kuan Rong, Low, Jenny G, Ooi, Eng Eong (2023-04-21). RNase2 is a possible trigger of acute-on-chronic inflammation leading to mRNA vaccine-associated cardiac complication.. Med : S2666-6340(23)00104-6-. ScholarBank@NUS Repository. https://doi.org/10.1016/j.medj.2023.04.001
Abstract: BACKGROUND: Post-mRNA vaccination-associated cardiac complication is a rare but life-threatening adverse event. Its risk has been well balanced by the benefit of vaccination-induced protection against severe COVID-19. As the rate of severe COVID-19 has consequently declined, future booster vaccination to sustain immunity, especially against infection with new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, may encounter benefit-risk ratios that are less favorable than at the start of the COVID-19 vaccination campaign. Understanding the pathogenesis of rare but severe vaccine-associated adverse events to minimize its risk is thus urgent. METHODS: Here, we report a serendipitous finding of a case of cardiac complication following a third shot of COVID-19 mRNA vaccine. As this case was enrolled in a cohort study, pre-vaccination and pre-symptomatic blood samples were available for genomic and multiplex cytokine analyses. FINDINGS: These analyses revealed the presence of subclinical chronic inflammation, with an elevated expression of RNASE2 at pre-booster baseline as a possible trigger of an acute-on-chronic inflammation that resulted in the cardiac complication. RNASE2 encodes for the ribonuclease RNase2, which cleaves RNA at the 3' side of uridine, which may thus remove the only Toll-like receptor (TLR)-avoidance safety feature of current mRNA vaccines. CONCLUSIONS: These pre-booster and pre-symptomatic gene and cytokine expression data provide unique insights into the possible pathogenesis of vaccine-associated cardiac complication and suggest the incorporation of additional nucleoside modification for an added safety margin. FUNDING: This work was funded by the NMRC Open Fund-Large Collaborative Grant on Integrated Innovations on Infectious Diseases (OFLCG19May-0034).
Source Title: Med
URI: https://scholarbank.nus.edu.sg/handle/10635/241683
ISSN: 2666-6359
2666-6340
DOI: 10.1016/j.medj.2023.04.001
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