COVID-19-Induced Myocarditis: Pathophysiological Roles of ACE2 and Toll-like Receptors

Pannucci, Patrizia; Jefferson, Sophie R.; Hampshire, Jonathan; Cooper, Samantha L.; Hill, Stephen J.; Woolard, Jeanette

Abstract

The clinical manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection responsible for coronavirus disease 2019 (COVID-19) commonly include dyspnoea and fatigue, and they primarily involve the lungs. However, extra-pulmonary organ dysfunctions, particularly affecting the cardiovascular system, have also been observed following COVID-19 infection. In this context, several cardiac complications have been reported, including hypertension, thromboembolism, arrythmia and heart failure, with myocardial injury and myocarditis being the most frequent. These secondary myocardial inflammatory responses appear to be associated with a poorer disease course and increased mortality in patients with severe COVID-19. In addition, numerous episodes of myocarditis have been reported as a complication of COVID-19 mRNA vaccinations, especially in young adult males. Changes in the cell surface expression of angiotensin-converting enzyme 2 (ACE2) and direct injury to cardiomyocytes resulting from exaggerated immune responses to COVID-19 are just some of the mechanisms that may explain the pathogenesis of COVID-19-induced myocarditis. Here, we review the pathophysiological mechanisms underlying myocarditis associated with COVID-19 infection, with a particular focus on the involvement of ACE2 and Toll-like receptors (TLRs).

Citation

Pannucci, P., Jefferson, S. R., Hampshire, J., Cooper, S. L., Hill, S. J., & Woolard, J. (2023). COVID-19-Induced Myocarditis: Pathophysiological Roles of ACE2 and Toll-like Receptors. International Journal of Molecular Sciences, 24(6), Article 5374. https://doi.org/10.3390/ijms24065374

• Journal Article Type: Article
• Acceptance Date: Mar 7, 2023
• Online Publication Date: Mar 11, 2023
• Publication Date: Mar 2, 2023
• Deposit Date: Oct 23, 2023
• Publicly Available Date: Oct 24, 2023
• Journal: International Journal of Molecular Sciences
• Print ISSN: 1661-6596
• Electronic ISSN: 1422-0067
• Publisher: MDPI
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 6
• Article Number: 5374
• DOI: https://doi.org/10.3390/ijms24065374
• Keywords: Inorganic Chemistry; Organic Chemistry; Physical and Theoretical Chemistry; Computer Science Applications; Spectroscopy; Molecular Biology; General Medicine; Catalysis
• Public URL: https://nottingham-repository.worktribe.com/output/18529731
• Publisher URL: https://www.mdpi.com/1422-0067/24/6/5374