oktober 30, 2022 10064 37
De wereldberoemde microbioloog en viroloog professor Sucharit Bhakdi MD heeft vele medische en wetenschappelijke prijzen gewonnen en heeft meer dan 300 peer reviewed wetenschappelijk onderzoek papers. Dr. Bhakdi was een van de eerste topartsen ter wereld die waarschuwde voor de dodelijke en slopende effecten van het COVID-19 vaccin. Hij had gelijk. Dr. Bhakdi zegt dat er bewijs is dat als de injecties het hart of de hersenen bereiken, deze onherstelbaar beschadigd worden, schrijft Greg Hunter.
Dr. Bhakdi haalt
een autopsie aan waarbij dit werd vastgesteld en legt uit:
“In meerdere delen
van de hersenen van deze overleden man vond de arts hetzelfde… Hij vond de
vervloekte spike-eiwitten in de kleinste haarvaten van de hersenen… Er is geen
herstel mogelijk, want wat de dokter vond was dat deze kleine vaatjes werden
aangevallen door het immuunsysteem en vernietigd. De dokter vond onweerlegbaar
bewijs van schade aan hersencellen of cellen die dood en stervend zijn. Deze
arme man stierf omdat zijn hersencellen stierven… Dezelfde patiënt die stierf…
had deze multifocale, dat wil zeggen op veel verschillende plaatsen,
necrotiserende, dat wil zeggen stervende, encefalitis.
Hij had typische
dingen die nu worden gezien bij mensen na een vax. Ze verliezen hun
persoonlijkheid. Ze verliezen hun verstand. Ze verliezen hun vermogen om te
denken. Ze worden dement. Ze kunnen niet meer horen. Ze kunnen niet spreken. Ze
kunnen niet zien. Ze zijn niet langer de mensen die ze waren. Het zijn
vernietigde mensen. Hun hersenen zijn vernietigd. De dokter vond iets zo
verschrikkelijks dat hij het meteen publiceerden. Dit werd gepubliceerd op 1
oktober 2022, in “Vaccine,” een toonaangevend wetenschappelijk tijdschrift.
Het is peer reviewed, en het werd meteen geaccepteerd… Het kan door iedereen
gelezen worden. Ik smeek u het zelf te lezen.
De arts die de autopsie deed,
ontdekte dat behalve deze vreselijke dingen die met de hersenen gebeuren,
dezelfde dingen in het hart gebeuren. Het gebeurde in het hart van dezelfde
patiënt. Hij zag dezelfde vervloekte door de duivel ontworpen spike-eiwitten.
Dit betekent dat de genen die de daders bij miljarden mensen hebben ingespoten,
de vaten van de hersenen en het hart bereiken. Ze doden mensen. Ze doden mensen
op de meest verschrikkelijke, angstaanjagende en kwellende manier.
Dr. Ryan Cole, dr.
Mike Yeadon en ik zeggen altijd hetzelfde. U moet beseffen dat we elkaar niet
kenden totdat Covid kwam, en er zijn nog zoveel anderen. Ze zijn niet dom, en
het zijn geweldige en intelligente mensen, en als iedereen hetzelfde zegt, moet
je gaan denken dat we misschien gelijk hebben. Als wij gelijk hebben, en ik zeg
dat ik niet alleen ben, ik ben een van de duizenden, en die duizenden hebben
misschien gelijk, dan vermoord je jezelf en je kinderen en je geliefden. Waarom
doet u dit? Waarom?”
Dr. Bhakdi vindt
dat de wereld nu moet stoppen met de injecties. …en dat Covid een “crimineel
bedrog” is.
Tot slot zegt Dr.
Bhakdi:
“Ik ben bang om het
te zeggen, maar tot anderhalf jaar geleden was ik een wetenschapper. Nu, nu ik
zie wat er aan de hand is. Moet ik toegeven dat de collega’s en vrienden van
mij die mij hebben verteld dat dit genocide is, misschien gelijk hebben. Ik
weet het niet, maar ik heb het gevoel dat er geen andere agenda is. Er is geen
andere verklaring. Er is geen andere verklaring omdat het duidelijk is dat deze
op genen gebaseerde vaccins niet nodig zijn omdat we niet te maken hebben met
een dodelijk virus dat de mensheid vernietigt. Iedereen die iets anders
beweert, liegt in je gezicht. Ten tweede is het duidelijk dat deze zogenaamde
vaccins nooit bescherming konden bieden tegen besmetting… Ten derde, en dat is
het ergste, zijn deze op genen gebaseerde vaccins de meest verschrikkelijke
instrumenten die ooit in het menselijk lichaam zijn gebracht om mensen te
vernietigen… Deze vaccins zullen de mensheid vernietigen.”
Er staat nog veel
meer in het 53 minuten durende interview.
Video Link on Rumble: https://rumble.com/v1qhs6k-cv19-vax-destroys-hearts-and-brains-of-billions-of-people-dr-sucharit-bhakd.html
Na het interview:
Dr. Bhakdi zegt dat
de Duitse regering hem vervolgt met totaal valse beschuldigingen van
antisemitisme, maar dat hij in werkelijkheid wordt gestraft omdat hij zich
uitspreekt tegen het COVID-19 vaccin. Reeds van het begin vertelde hij mensen
dat ze de COVID-19 injecties niet moesten nemen. Als Dr. Bhakdi wordt
veroordeeld, hangt hem 5 jaar gevangenisstraf boven het hoofd. Zijn proces is
in 2023.
Copyright © 2022 vertaling door Frontnieuws.
A Case Report: Multifocal Necrotizing Encephalitis and
Myocarditis after BNT162b2 mRNA Vaccination against COVID-19
By
Michael Mörz
Institute
of Pathology ’Georg Schmorl’, The Municipal Hospital Dresden-Friedrichstadt,
Friedrichstrasse 41, 01067 Dresden, Germany
Academic
Editor: Sung Ryul Shim
Vaccines 2022, 10(10), 1651; https://doi.org/10.3390/vaccines10101651
Received:
31 August 2022 / Revised: 25 September 2022 / Accepted: 27
September 2022 / Published: 1 October 2022
(This
article belongs to the Special Issue Adverse Events of COVID-19 Vaccines)
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Abstract
The current report presents the case of
a 76-year-old man with Parkinson’s disease (PD) who died three weeks after
receiving his third COVID-19 vaccination. The patient was first vaccinated in
May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the
BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased
requested an autopsy due to ambiguous clinical signs before death. PD was
confirmed by post-mortem examinations. Furthermore, signs of aspiration
pneumonia and systemic arteriosclerosis were evident. However,
histopathological analyses of the brain uncovered previously unsuspected
findings, including acute vasculitis (predominantly lymphocytic) as well as
multifocal necrotizing encephalitis of unknown etiology with pronounced
inflammation including glial and lymphocytic reaction. In the heart, signs of
chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and
vasculitis were present. Although there was no history of COVID-19 for this
patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid
proteins) was performed. Surprisingly, only spike protein but no nucleocapsid
protein could be detected within the foci of inflammation in both the brain and
the heart, particularly in the endothelial cells of small blood vessels. Since
no nucleocapsid protein could be detected, the presence of spike protein must
be ascribed to vaccination rather than to viral infection. The findings
corroborate previous reports of encephalitis and myocarditis caused by
gene-based COVID-19 vaccines.
Keywords: COVID-19 vaccination; necrotizing encephalitis; myocarditis; detection of spike protein; detection of nucleocapsid protein; autopsy
1. Introduction
The emergence of the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 with the subsequent
worldwide spread of COVID-19 gave rise to a perceived need for halting the
progress of the COVID-19 pandemic through the rapid development and deployment
of vaccines. Recent advances in genomics facilitated gene-based strategies for
creating these novel vaccines, including DNA-based nonreplicating viral
vectors, and mRNA-based vaccines, which were furthermore developed on an
aggressively shortened timeline [1,2,3,4].
The WHO Emergency Use Listing Procedure
(EUL), which determines the acceptability of medicinal products based on
evidence of quality, safety, efficacy, and performance [5], permitted these vaccines to be
marketed as soon as 1–2 years after development had begun. Published results of
the phase 3 clinical trials described only a few severe side effects [2,6,7,8]. However, it has since become clear
that severe and even fatal adverse events may occur; these include in
particular cardiovascular and neurological manifestations [9,10,11,12,13]. Clinicians should take note of such
case reports for the sake of early detection and management of such adverse
events among their patients. In addition, a thorough post-mortem examination of
deaths in connection with COVID-19 vaccination should be considered in
ambiguous circumstances, including histology. This report presents the case of
a senior aged 76 years old, who had received three doses overall of two
different COVID-19 vaccines, and who died three weeks after the second dose of
the mRNA-BNT162b-vaccine. Autopsy and histology revealed unexpected necrotizing
encephalitis and mild myocarditis with pathological changes in small blood
vessels. A causal connection of these findings to the preceding COVID-19
vaccination was established by immunohistochemical demonstration of SARS-CoV-2
spike protein. The methodology introduced in this study should be useful for
distinguishing between causation by COVID-19 vaccination or infection in
ambiguous cases.
2. Materials and
Methods
2.1.
Routine Histology
Formalin-fixed tissues were routinely
processsed and paraffin-embedded tissues were cut into 5 μm
sections and stained with hematoxylin and eosin (H&E) for histopathological
examination.
2.2.
Immunohistochemistry
Immunohistochemical staining was
performed on the heart and brain, using a fully automated immunostaining system
(Ventana Benchmark, Roche). An antigen retrieval (Ultra CC1, Roche Ventana) was
used for every antibody. The target antigens and dilution factors for the
antibodies used are summarized in Table 1. Incubation with the primary antibody
was carried out for 30 min in each case. Tissues from SARS-CoV-2-positive
COVID-19 patients were used as a control for the antibodies against SARS-CoV-2-spike
and nucleocapsid (Figure 1). Cultured cells that had been
transfected in vitro (see hereafter) served as a positive control for the
detection of vaccine-induced spike protein expression and as a negative control
for the detection of nucleocapsid protein. The slides were examined with a
light microscope (Nikon ECLIPSE 80i) and representative images were captured by
the camera system Motic® Europe
Motic MP3.
Figure 1. Nasal smear from a person with
acute symptomatic SARS-CoV-2-infection (confirmed by PCR). Note the presence of
ciliated epithelium. Immunohistochemistry for two SARS-CoV-2 antigens (spike
and nucleocapsid protein) revealed a positive reaction for both as to be
expected after infection. (a) Detection of the spike protein. Positive
control for spike subunit 1 SARS-CoV-2 protein detection. Several ciliated
epithelia of the nasal mucosa show brownish granular deposits of DAB (red
arrow). Compared to nucleocapsid, the DAB-granules are fewer and less densely
packed granular deposits of DAB. (b) Detection of nucleocapsid protein.
Positive control for nucleocapsid SARS-CoV-2 protein detection. Several
ciliated epithelia of the nasal mucosa show dense brownish granular deposits of
DAB in immunohistochemistry (examples red arrows). Compared to spike detection,
the granules of DAB are finer and more densely packed. Magnification: 400x.
Table 1. Primary antibodies used for
immunohistochemistry. Tissue sections were incubated 30 min with the antibody
in question, diluted as stated in the table.
2.3.
Preparation of Positive Control Samples for the Immunohistochemical Detection
of the Vaccine-Induced Spike Protein
Cell culture and transfection: Ovarian
cancer cell lines (OVCAR-3 and SK-OV3, CSL cell Lines Service, Heidelberg,
Germany) were grown to 70% confluence in flat bottom 75 cm2 cell culture flasks (Cell star) in
DMEM/HAMS-F12 medium supplemented with Glutamax (Sigma-Aldrich, St. Louis, MO,
USA), 10% FCS (Gibco, Shanghai, China) and Gentamycin (final concentration 20 μg/mL,
Gibco), at 37 °C, 5% CO2 in
a humidified cell incubator. For transfection, the medium was completely
removed, and cells were incubated for 1 h with 2 mL of fresh medium containing
the injection solutions directly from the original bottles, diluted 1:500 in
the case of BNT162b2 (Pfizer/Biotech), and 1:100 in cases of mRNA-1273
(Moderna), Vaxzevria (AstraZeneca), and Jansen (COVID-19 vaccine Jansen). Then,
another 15 mL of fresh medium was added to the cell cultures and cells were
grown to confluence for another 3 days.
Preparation of tissue blocks from
transfected cells: The cell culture medium was removed from transfected cells,
and the monolayer was washed twice with PBS, then trypsinized by adding 1 mL of
0.25% Trypsin-EDTA (Gibco), harvested with 10 mL of PBS/10% FCS, and washed 2×
with PBS and centrifugation at 280× g for
10 min each. Cell pellets were fixed overnight in 2 mL in PBS/4% Formalin at 8
°C and then washed in PBS once. The cell pellets remaining after centrifugation
were suspended in 200 μL PBS each, mixed with 400 μL
2% agarose in PBS solution (precooled to around 40 °C), and immediately
transferred to small (1 cm) dishes for fixation. The fixed and agarose-embedded
cell pellets were stored in 4% Formalin/PBS till subjection to routine paraffin
embedding in parallel to tissue samples.
2.4.
Case Presentation and Description
2.4.1. Clinical History
This report presents the case of a
76-year-old male with a history of Parkinson’s disease (PD) who passed away
three weeks after his third COVID-19 vaccination. On the day of his first
vaccination in May 2021 (ChAdOx1 nCov-19 vector vaccine), he experienced
pronounced cardiovascular side effects, for which he repeatedly had to consult
his doctor. After the second vaccination in July 2021 (BNT162b2 mRNA
vaccine/Comirnaty), the family noted obvious behavioral and psychological
changes (e.g., he did not want to be touched anymore and experienced increased
anxiety, lethargy, and social withdrawal even from close family members).
Furthermore, there was a striking worsening of his PD symptoms, which led to
severe motor impairment and a recurrent need for wheelchair support. He never
fully recovered from these side effects after the first two vaccinations but
still got another vaccination in December 2021. Two weeks after the third
vaccination (second vaccination with BNT162b2), he suddenly collapsed while
taking his dinner. Remarkably, he did not show coughing or any signs of food
aspiration but just fell down silently. He recovered from this more or less,
but one week later, he again suddenly collapsed silently while taking his meal.
The emergency unit was called, and after successful, but prolonged
resuscitation attempts (over one hour), he was transferred to the hospital and
directly put into an artificial coma but died shortly thereafter. The clinical
diagnosis was death due to aspiration pneumonia. According to his family, there
was no history of a clinical or laboratory diagnosis of COVID-19 in the past.
2.4.2. Autopsy
The autopsy was requested and consented
to by the family of the patient because of the ambiguity of symptoms before his
death. The autopsy was performed according to standard procedures including
macroscopic and microscopic investigation. Gross brain tissue was prepared for
histological examination including the brain (frontal cortex, Substantia nigra,
and Nucleus ruber) as well as the heart (left and right ventricular cardiac tissue).
3. Results
3.1.
Autopsy Findings
Anatomical Specifications: Body weight,
height, and specifications of body organs were summarized in Table 2.
Table 2. Anatomical Specifications.
Brain: A
macroscopic examination of brain tissue revealed a circumscribed segmental
cerebral parenchymal necrosis at the site of the right hippocampus. Substantia
nigra showed a loss of pigmented neurons. Microscopically, several areas with
lacunar necrosis were detected with inflammatory debris reaction on the left
frontal side (Figure 2). Staining of Nucleus ruber with
H&E showed neuronal cell death, microglia, and lymphocyte infiltration (Figure 3). Furthermore, there were microglial
and lymphocytic reactions as well as predominantly lymphocytic vasculitis,
sometimes with mixed infiltrates including neutrophilic granulocytes (Figure 4) in the frontal cortex, paraventricular,
Substantia nigra, and Nucleus ruber on both sides. In some places with
inflammatory changes in brain capillaries, there were also signs of apoptotic
cell death within the endothelium (Figure 4). Meninges’ findings were unremarkable.
The collective findings were suggestive of multifocal necrotizing encephalitis.
Furthermore, chronic arteriosclerotic lesions of varying degrees were noted in
large brain vessels, which are described in detail in section “Vascular
system”.
Figure 2. Frontal brain. Already in the
overview image (a), prominent vacuolations with increased parenchymal
cellularity are evident, indicative of degenerative and inflammatory processes.
At higher magnification (b), acute brain damage is visible with diffuse
and zonal neuronal and glial cell death, activation of microglia, and
inflammatory infiltration by granulocytes and lymphocytes. 1: neuronal deaths
(cells with red cytoplasm); 2: microglial proliferation; 3: lymphocytes.
H&E stain. Magnification 40× (a) and 200× (b).
Figure 3. Brain, Nucleus ruber. In the
overview image (a), note pronounced focal necrosis with increased
cellularity, indicative of ongoing inflammation and glial reaction. At higher
magnification (b), death of neuronal cells is evident and associated
with an increased number of glial cells. Note activation of microglia and
presence of inflammatory cell infiltrates, predominantly lymphocytic. 1:
neuronal death with hypereosinophilia and destruction of cell nucleus with
signs of karyolysis (nuclear content being distributed into the cytoplasm); 2:
microglia (example); 3: lymphocyte (example). H&E
stain. Magnification 40× (a) and 400× (b).
Figure 4. Brain, periventricular vasculitis.
Cross section through a capillary vessel showing prominent signs of vasculitis.
The endothelial cells (5) show swelling and vacuolation and are increased in
number with enlargement of nuclei, indicative for activation. Furthermore,
presence of mixed inflammatory cell infiltrates within the endothelial layer,
consisting of lymphocytes (1), granulocytes (2), and histiocytes (4). The
adjacent brain tissue also shows signs of inflammation (encephalitis) with
presence of lymphocytes as well and activated microglia (3). H&E.
Magnification: 200× (a) and 400× (b).
Parkinson’s disease (PD): Macroscopic and histological examination of brain
tissue revealed bilateral pallor of the substantia nigra with loss of pigmented
neurons. In addition, pigment-storing macrophages as well as scattered neuronal
necrosis with glial debris reaction were noted. These findings were suggestive
of PD, confirming the clinical diagnosis.
Thoracic cavity: An examination of the chest showed a funnel-shaped chest with serial
rib fractures (extending from the second to fifth ribs on the right, and from
the second to sixth ribs on the left); which is a common picture of a patient
who underwent cardiopulmonary resuscitation. An endotracheal tube was properly
inserted. There was evidence of regular placement of a central venous catheter
in the left femoral vein. There was evidence of regular placement of an
arterial catheter in the left radial artery. The urinary catheter was inserted
as well. There was a 9 cm long skin scar on the front of the right shoulder.
Lungs:
Macroscopical lung examination revealed cloudy secretion and purulent spots
with notably brittle parenchyma. The pleura showed bilateral serous effusion,
amounting to 450 mL of fluid on the right side and 400 mL on the left side.
Bilateral mucopurulent tracheobronchitis was evident with copious purulent
secretion in the trachea and bronchi. Bilateral chronic destructive pulmonary
emphysema was detected. Bilateral bronchopneumonia was noted in the lower lung
lobes at multiple stages of development and lobe-filling with secretions and
fragile parenchyma. Furthermore, chronic arteriosclerotic lesions of varying
degrees were noted, which are described in detail in the section “Vascular
system”.
Heart:
Macroscopic cardiac examination revealed manifestations of acute and chronic
cardiovascular insufficiency, including ectasia of the atria and ventricles.
Furthermore, left ventricular hypertrophy was noted (wall thickness: 18 mm,
heart weight: 410 g, body weight: 60 kg, height: 1.75 m). There was evidence of
tissue congestion (presumably due to cardiac insufficiency) in the form of
pulmonary edema, cerebral edema, brain congestion, chronic hepatic congestion,
renal tissue edema, and pituitary tissue edema. Moreover, there was evidence of
shock kidney disorder. Histological examination of the heart revealed mild
myocarditis with fine-spotted fibrosis and lympho-histiocytic infiltration (Figure 5). Furthermore, there were chronic
arteriosclerotic lesions of varying degrees, which are described in detail
under “Vascular system”. In addition to these, there were more acute myocardial
and vascular changes in the heart. They consisted of mild signs of myocarditis,
characterized by infiltrations with foamy histiocytes and lymphocytes as well
as hypereosinophilia and some hypercontraction of cardiomyocytes. Furthermore,
mild acute vascular changes were observed in the capillaries and other small
blood vessels of the heart. They consisted of mild lympho-histiocytic
infiltrates, prominent endothelial swelling and vacuolation, multifocal
myocytic degeneration and coagulation necrosis as well as karyopyknosis of
single endothelial cells and vascular muscle cells (Figure 5). Occasionally, adhering plasma
coagulates/fibrin clots were present on the endothelial surface, indicative of
endothelial damage (Figure 5).
Figure 5. Heart left ventricle. (a):
Mild lympho-histiocytic myocarditis.Pronounced interstitial edema (7) and mild
lympho-histiocytic infiltrates (2 + 4). Signs of cardiomyocytic degeneration
(5) with cytoplasmic hypereosinophilia and single contraction bands. (d):
Arteriole with signs of acute degeneration and associated inflammation,
associated by lymphocytic infiltrates (2) within the vascular wall, endothelial
swelling and vacuolation (3), and vacuolation of vascular myocytes with signs
of karyopyknosis (1). Within the vascular lumen (d), note plasma
coagulation/fibrin clots adhering to the endothelial surface, indicative of
endothelial damage. 1: pyknotic vascular myocytes, 2: lymphocytes, 3: swollen
endothelial cells, 4: macrophages, 5: necrotic cardiomyocytes, 6: eosinophilic
granulocytes, 7 (blue line): interstitial edema. H&E stain. Magnification:
200× (a) and (c), 40× (b), and detailed enlargement (d).
Vascular system (large blood vessels):
The pulmonary arteries showed ectasia and lipidosis. The kidney showed slight
diffuse glomerulosclerosis and arteriosclerosis with renal cortical scars (up
to 10 mm in diameter). The findings are suggestive of generalized
atherosclerosis and systemic hypertension. Major arteries including the aorta
and its branches as well as the coronary arteries showed variable degrees of
arteriosclerosis and mild to moderate stenosis. Furthermore, examination
revealed mild nodular arteriosclerosis of cervical arteries. Ascending aorta,
aortic arch, and thoracic aorta showed moderate, nodular, and partially
calcified arteriosclerosis. The cerebral basilar artery showed mild
arteriosclerosis. Nodular and calcified arteriosclerosis were of high grade in
the abdominal aorta and iliac arteries and moderate grade with moderate
stenosis in the right coronary arteries. Coronary artery examination showed
variable degrees of arteriosclerosis and stenosis more on the left coronary
arteries. The left anterior descending coronary artery (the anterior
interventricular branch of the left coronary artery; LAD) showed high-grade and
moderately stenosed arteriosclerosis. The arteriosclerosis and stenosis of the
left circumflex artery (the circumflex branch of the left coronary artery) were
mild. Mild cerebral basal artery sclerosis. High-grade nodular and calcified
arteriosclerosis of the abdominal aorta and the iliac arteries. Moderate
stenosed arteriosclerosis of the right coronary artery. Lymphocytic
periarteritis was detected as well.
3.2.
Other Findings
-
- Oral cavity: tongue bite was detected with
bleeding under the tongue muscle (tongue bite is common with epileptic
seizures).
- Adrenal
glands: bilateral mild cortical hyperplasia.
- Colon: the elongated sigmoid colon was
elongated with fecal impaction.
- Kidneys: slight diffuse glomerulosclerosis
and arterio-sclerosis, renal cortical scars (up to 10 mm in diameter),
bilateral mild active nephritis and urocystitis as well as evidence of shock
kidney disorder.
- Liver: slight lipofuscinosis.
- Spleen: mild acute splenitis.
- Stomach: mild diffuse gastric mucosal
bleeding.
- Thyroid gland: bilateral nodular goiter with
chocolate cysts (up to 0.5 cm in diameter).
- Prostate gland: benign nodular prostatic
hyperplasia and chronic persistent prostatitis.
3.3.
Immunohistochemical Analyses
Immunohistochemical staining for the
presence of SARS-CoV-2 antigens (spike protein and nucleocapsid) was studied in
the brain and heart. In the brain, SARS-CoV-2 spike protein subunit 1 was
detected in the endothelia, microglia, and astrocytes in the necrotic areas (Figure 6 and Figure 7). Furthermore, spike protein could be
demonstrated in the areas of lymphocytic periarteritis, present in the thoracic
and abdominal aorta and iliac branches, as well as a cerebral basal artery (Figure 8). The SARS-CoV-2 subunit 1 was found in
macrophages and in the cells of the vessel wall, in particular the endothelium
(Figure 9), as well as in the Nucleus ruber (Figure 10). In contrast, the nucleocapsid protein
of SARS-CoV-2 could not be detected in any of the corresponding tissue sections
(Figure 11 and Figure 12). In addition, SARS-CoV-2 spike protein
subunit 1 was detected in the cardiac endothelial cells that showed lymphocytic
myocarditis (Figure 13). Immunohistochemical staining did not
detect the SARS-CoV-2 nucleocapsid protein (Figure 14).
Figure 6. Frontal brain.
Immunohistochemistry for CD68 (expressed by monocytic cells). Note map-like
tissue destruction with the presence of CD68-positive microglial cells.
Furthermore zonal activation of microglia (brown granules). Activation of the
microglia means that tissue destruction has taken place in the brain, which is
cleared/removed by macrophages (called microglia in the brain). Brown granules: macrophages/microglia. Magnification: 40×.
Figure 7. Brain. Nucleus ruber.
Immunohistochemistry for CD68 (expressed by monocytic cells) shows abundant
positive cells, indicative of zonal activation of microglia (brown granules). Magnification: 40×.
Figure 8. Frontal brain.
Immunohistochemistry for CD3 (expressed by T-Lymphocytes) shows numerous
CD3-positive lymphocytes (brown granules, red arrow highlights an example), particularly
within the endothelium, but also in the brain tissue, indicative of lymphocytic
vasculitis and encephalitis. Blue dotted lines: blood
vessels. Magnification: 200×.
Figure 9. Frontal brain. Positive reaction
for SARS-CoV-2 spike protein. Cross section through a capillary vessel (same
vessel as shown in Figure 11, serial sections of 5 to 20 µm).
Immunohistochemical reaction for SARS-CoV-2 spike subunit 1 detectable as brown
granules in capillary endothelial cells (red arrow) and individual glial cells
(blue arrow). Magnification: 200×.
Figure 10. Brain, Nucleus ruber. The abundant
presence of SARS-CoV-2 spike protein in swollen endothelium of a capillary
vessel shows acute signs of inflammation with sparse mononuclear inflammatory
cell infiltrates (same vessel as shown in Figure 12, serial sections of 5 to 20 µm).
Immunohistochemical demonstration for SARS-CoV-2 spike protein subunit 1
visible as brown granules in capillary endothelial cells (red arrow) and
individual glial cells (blue arrow). Magnification:
200×.
Figure 11. Frontal brain. Negative
immunohistochemical reaction for SARS-CoV-2 nucleocapsid protein. Cross section
through a capillary vessel (same vessel as shown in Figure 9, serial sections of 5 to 20 µm). Magnification: 200×.
Figure 12. Brain, Nucleus ruber. Negative
immunohistochemical reaction for SARS-CoV-2 nucleocapsid protein. Cross section
through a capillary vessel (same vessel as shown in Figure 11, serial sections of 5 to 20 µm). Magnification: 200×.
Figure 13. Heart left ventricle. Positive
reaction for SARS-CoV-2 spike protein. Cross section through a capillary vessel
(same vessel as shown in Figure 14, serial sections of 5 to 20 µm).
Immunohistochemical demonstration of SARS-CoV-2 spike subunit 1 as brown
granules. Note the abundant presence of spike protein in capillary endothelial
cells (red arrow) associated with prominent endothelial swelling and the
presence of a few mononuclear inflammatory cells. Magnification: 400×.
Figure 14. Heart left ventricle. Negative
immunohistochemical reaction for SARS-CoV-2 nucleocapsid protein. Cross section
through a capillary vessel (same vessel as shown in Figure 13, serial sections of 5 to 20 µm).
Magnification: 400×.
3.4.
Autopsy-Based Diagnosis
The 76-year-old deceased male patient
had PD, which corresponded to typical post-mortem findings. The main cause of
death was recurrent aspiration pneumonia. In addition, necrotizing encephalitis
and vasculitis were considered to be major contributors to death. Furthermore,
there was mild lympho-histiocytic myocarditis with fine-spotted myocardial
fibrosis as well as systemic arteriosclerosis, which will have also contributed
to the deterioration of the physical condition of the senior.
The final diagnosis was abscedating
bilateral bronchopneumonia (J18.9), Parkinson’s disease (G20.9), necrotic
encephalitis (G04.9), and myocarditis (I40.9).
Immunohistochemistry for SARS-CoV-2
antigens (spike protein and nucleocapsid) revealed that the lesions with
necrotizing encephalitis as well as the acute inflammatory changes in the small
blood vessels (brain and heart) were associated with abundant deposits of the
spike protein SARS-CoV-2 subunit 1. Since the nucleocapsid protein of
SARS-CoV-2 was consistently absent, it must be assumed that the presence of
spike protein in affected tissues was not due to an infection with SARS-CoV-2
but rather to the transfection of the tissues by the gene-based
COVID-19-vaccines. Importantly, spike protein could be only demonstrated in the
areas with acute inflammatory reactions (brain, heart, and small blood
vessels), in particular in endothelial cells, microglia, and astrocytes. This
is strongly suggestive that the spike protein may have played at least a
contributing role to the development of the lesions and the course of the
disease in this patient.
4. Discussion
This is a case report of a 76-year-old
patient with Parkinson’s disease (PD) who died three weeks after his third
COVID-19 vaccination. The stated cause of death appeared to be a recurrent
attack of aspiration pneumonia, which is indeed common in PD [14,15]. However, the detailed autopsy study
revealed additional pathology, in particular necrotizing encephalitis and
myocarditis. While the histopathological signs of myocarditis were
comparatively mild, the encephalitis had resulted in significant multifocal
necrosis and may well have contributed to the fatal outcome. Encephalitis often
causes epileptic seizures, and the tongue bite found at the autopsy suggests
that it had done so in this case. Several other cases of COVID-19
vaccine-associated encephalitis with status epilepticus have appeared
previously [16,17,18].
The clinical history of the current case
showed some remarkable events in correlation to his COVID-19 vaccinations.
Already on the day of his first vaccination in May 2021 (ChAdOx1 nCov-19 vector
vaccine), he experienced cardiovascular symptoms, which needed medical care and
from which he recovered only slowly. After the second vaccination in July 2021
(BNT162b2 mRNA vaccine), the family recognized remarkable behavioral and
psychological changes and a sudden onset of marked progression of his PD
symptoms, which led to severe motor impairment and recurrent need for
wheelchair support. He never fully recovered from this but still was again
vaccinated in December 2021. Two weeks after this third vaccination (second
vaccination with BNT162b2), he suddenly collapsed while taking his dinner.
Remarkably, he did not show any coughing or other signs of food aspiration but
just fell from his chair. This raises the question of whether this sudden
collapse was really due to aspiration pneumonia. After intense resuscitation,
he recovered from this more or less, but one week later, he again suddenly
collapsed silently while taking his meal. After successful but prolonged
resuscitation attempts, he was transferred to the hospital and directly set
into an artificial coma but died shortly thereafter. The clinical diagnosis was
death due to aspiration pneumonia. Due to his ambiguous symptoms after the
COVID-vaccinations the family asked for an autopsy.
Based on the alteration pattern in the
brain and heart, it appeared that the small blood vessels were especially
affected, in particular, the endothelium. Endothelial dysfunction is known to
be highly involved in organ dysfunction during viral infections, as it induces
a pro-coagulant state, microvascular leak, and organ ischemia [19,20]. This is also the case for severe
SARS-CoV-2 infections, where a systemic exposure to the virus and its spike
protein elicits a strong immunological reaction in which the endothelial cells
play a crucial role, leading to vascular dysfunction, immune-thrombosis, and
inflammation [21].
Although there was no history of
COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike
and nucleocapsid proteins) was performed. Spike protein could be indeed
demonstrated in the areas of acute inflammation in the brain (particularly
within the capillary endothelium) and the small blood vessels of the heart.
Remarkably, however, the nucleocapsid was uniformly absent. During an infection
with the virus, both proteins should be expressed and detected together. On the
other hand, the gene-based COVID-19 vaccines encode only the spike protein and
therefore, the presence of spike protein only (but no nucleocapsid protein) in
the heart and brain of the current case can be attributed to vaccination rather
than to infection. This agrees with the patient’s history, which includes three
vaccine injections, the third one just 3 weeks before his death, but no positive
laboratory or clinical diagnosis of the infection.
Discrimination of vaccination response
from natural infection is an important question and had been addressed already
in clinical immunology, where the combined application of anti-spike and
anti-nucleocapsid protein-based serology was proven as a useful tool [22]. In histology, however, this
immunohistochemical approach has not yet been described, but it is straightforward
and appears to be very useful for identifying the potential origin of
SARS-CoV-2 spike protein in autopsy or biopsy samples. Where additional
confirmation is required, for instance in a forensic context, rt-PCR methods
might be used to ascertain the presence of the vaccine mRNA in the affected
tissues [23,24].
Assuming that, in the current case, the
presence of spike protein was indeed driven by the gene-based vaccine, then the
question arises whether this was also the cause the accompanying acute tissue
alterations and inflammation. The stated purpose of the gene-based vaccines is
to induce an immune response against the spike protein. Such an immune response
will, however, not only results in antibody formation against the spike protein
but also lead to direct cell- and antibody-mediated cytotoxicity against the
cells expressing this foreign antigen. In addition, there are indications that
the spike protein on its own can elicit distinct toxicity, in particular, on
pericytes and endothelial cells of blood vessels [25,26].
While it is widely held that spike
protein expression, and the ensuing cell and tissue damage will be limited to
the injection site, several studies have found the vaccine mRNA and/or the
spike protein encoded by it at a considerable distance from the injection site
for up to three months after the injection [23,24,27,28,29]. Biodistribution studies in rats with
the mRNA-COVID-19 vaccine BNT162b2 also showed that the vaccine does not stay
at the injection site but is distributed to all tissues and organs, including
the brain [30]. After the worldwide roll-out of
COVID-19 vaccinations in humans, spike protein has been detected in humans as
well in several tissues distant from the injection site (deltoid muscle): for
instance in heart muscle biopsies from myocarditis patients [28], within the skeletal muscle of a
patient with myositis [23] and within the skin, where it was
associated with a sudden onset of Herpes zoster lesions after mRNA-COVID-19
vaccination [29].
The underlying diagnosis in this patient
was Parkinson’s disease, and one may ask what role, if any, this condition had
played in the causation of the encephalitis, and the myocarditis detected at
post-mortem examination. PD had been long-standing in the current case, whereas
the encephalitis was acute. Conversely, there is no plausible mechanism and no
case report of PD causing secondary necrotizing encephalitis. On the other hand,
numerous cases have been reported of autoimmune encephalitis and
encephalomyelitis after COVID-19 vaccination [12,31]. Autoimmune diseases in organs other
than the CNS have been reported as well, for example, a striking case of a
patient who after mRNA vaccination suffered multiple autoimmune disorders all
at once—acute disseminated encephalomyelitis, myasthenia gravis, and
thyroiditis [32]. In the case reported here, it may be
noted that the spike protein was primarily detected in the vascular endothelium
and sparsely in the glial cells but not in the neurons. Nevertheless, neuronal
cell death was widespread in the encephalitic foci, which suggests some
contribution of immunological bystander activation, i.e., autoimmunity, to the
observed cell and tissue damage.
A contributory role of PD in the
development of cardiomyopathy is indeed documented and cannot be ruled out with
absolute certainty. However, inflammatory myocardial changes with pathological
alterations in small blood vessels as seen in the current case are uncommon.
Instead, the most prominent cause of cardiac failure in PD patients is rather
due to cardiac autonomic dysfunction [33,34]. PD seems well to be significantly
associated with increased left ventricular hypertrophy and diastolic
dysfunction [34]. In the current case, ventricular
dilatation and hypertrophy were present but seem rather related to manifest
signs of chronic hypertension. In contrast, myocardial inflammatory reactions
had been well-linked to gene-based COVID-19 vaccinations in numerous cases [9,35,36,37]. In one case, the spike protein of
SARS-CoV-2 could also be demonstrated by immunohistochemistry in the heart of
vaccinated individuals [28].
5. Conclusions
Numerous cases of encephalitis and encephalomyelitis have been reported
in connection with the gene-based COVID-19 vaccines, with many being considered
causally related to vaccination [31,38,39]. However, this is
the first report to demonstrate the presence of the spike protein within the
encephalitic lesions and to attribute it to vaccination rather than infection.
These findings corroborate a causative role of the gene-based COVID-19
vaccines, and this diagnostic approach is relevant to potentially
vaccine-induced damage to other organs as well.
Funding
This research received no specific
funding.
Institutional Review Board Statement
According to the Saxonian State Chamber
of Medicine (Ethikkommission Landesärztekammer Sachsen), no explicit ethical
approval is required for autopsy case reports as long as informed consent was
obtained from the entitled person and all data has been anonymized.
Informed Consent Statement
The informed consent was obtained from
the entitled person for the subject involved in this case report.
Data Availability Statement
Data are available upon request.
Acknowledgments
The author wishes to thank Hany A. Salem
and David O. Fischer for supporting the preparation of this paper with valuable
comments and suggestions.
Conflicts of Interest
The author declares he has no conflict
of interest.
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