{"id":2515,"date":"2022-10-26T13:25:45","date_gmt":"2022-10-26T11:25:45","guid":{"rendered":"https:\/\/www.newslab.sk\/slabe-miesta-vakcin-dokazeme-im-predchadzat-pripadova-studia-sars-cov-2\/"},"modified":"2022-10-26T13:29:36","modified_gmt":"2022-10-26T11:29:36","slug":"slabe-miesta-vakcin-dokazeme-im-predchadzat-pripadova-studia-sars-cov-2","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/slabe-miesta-vakcin-dokazeme-im-predchadzat-pripadova-studia-sars-cov-2\/","title":{"rendered":"Vaccine vulnerabilities: can we prevent them? – SARS-CoV-2 case study"},"content":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens<\/strong><\/span><\/p>\n

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V s\u00fa\u010dasnosti v odbornej, ale aj laickej verejnosti rezonuj\u00fa inform\u00e1cie o aktu\u00e1lne zn\u00e1mych typoch vakc\u00edn, pri\u010dom ako prv\u00e9 sa stali dostupn\u00fdmi tie na b\u00e1ze mRNA (Pfizer BioNTech, Moderna), v s\u00fa\u010dasnosti s\u00fa u\u017e dostupn\u00e9 aj adenov\u00edrusov\u00e9 <\/em>(AstraZeneca, Sputnik, Johnson Johnson), inaktivovan\u00e9 (Sinopharm) alebo peptidov\u00e9 vakc\u00edny (Sinovac). Existuj\u00fa pomerne presn\u00e9 d\u00e1ta o ich efekt\u00edvnej ochrane, u mnoh\u00fdch z nich presahuj\u00fac viac ako 90 % (proti p\u00f4vodn\u00e9mu wuchansk\u00e9mu kme\u0148u SARS-CoV-2), \u010do je v\u00fdrazne viac ako minim\u00e1lnych 50 %, aby vakc\u00edna mohla by\u0165 registrovan\u00e1 regula\u010dn\u00fdmi autoritami ako EMA (European Medicines Agency) v Eur\u00f3pe alebo FDA (Food and Drug Administration) v USA. Od vypuk- nutia pand\u00e9mie v z\u00e1vere roka 2019 sme sa do\u010dkali objavenia nov\u00fdch variantov v\u00edrusu \u2013 alfa (B.1.1.7), beta (B.1.351), delta (B.1.617.2) a\u017e po s\u00fa\u010dasn\u00fa pand\u00e9miu najinfek\u010dnej\u0161ieho variantu SARS-CoV-2 omikron (BA.1 a BA.2). Vakc\u00edny, ktor\u00e9 sa za\u010dali p\u00f4vodne vyv\u00edja\u0165, vych\u00e1dzali z genetickej inform\u00e1cie p\u00f4vodn\u00e9ho kme\u0148a, ktor\u00fd sa roz\u0161\u00edril do sveta z \u010d\u00ednskeho Wu-chanu. Medzit\u00fdm sme mali na konci roku 2020 dominantne roz\u0161\u00edren\u00fd \u201eanglick\u00fd\u201c variant alfa, o pol roka sme st\u00e1li pred pand\u00e9miou delta variantu, ktor\u00fd sa roz\u0161\u00edril z Indie a posledn\u00fdch p\u00e1r mesiacov suver\u00e9nne dominuje najinfek\u010dnej\u0161\u00ed omikron. Obrovsk\u00fd selek\u010dn\u00fd tlak, dlhodob\u00e1 cirkul\u00e1cia medzi neo\u010dkovan\u00fdmi \u013eu\u010fmi, ale aj dlh\u00fd \u010das, po\u010das ktor\u00e9ho interaguje s na\u0161\u00edm imunitn\u00fdm syst\u00e9mom, sp\u00f4sobuje, \u017ee sa m\u00f4\u017eu objavova\u0165 nov\u00e9 infek\u010dnej\u0161ie varianty a sila t\u00fdchto vakc\u00edn bude \u201eslabn\u00fa\u0165\u201c. U\u017e aj dnes existuj\u00fa d\u00e1ta, \u017ee prv\u00e9 \u00faspe\u0161n\u00e9 vakc\u00edny Pfizer BioNTech \u00fa\u010dinkuj\u00fa na nov\u00fd variant omikron u\u017e len na 70 %(1). Z dlhodob\u00e9ho h\u013eadiska sa preto nevyhneme v\u00fdraznej aktualiz\u00e1cii vakc\u00edn alebo aj kompletn\u00e9mu prekopaniu strat\u00e9gie, na \u010do m\u00e1 samotn\u00e1 vakc\u00edna cieli\u0165. \u010casto a dlhodobo je pr\u00e1ve sklo\u0148ovan\u00e1 a mo\u017eno a\u017e prece\u0148ovan\u00e1 tvorba protil\u00e1tok proti SARS-CoV-2 ako hlavn\u00fd cie\u013e vakcin\u00e1cie proti kovidu, a to napriek v\u0161eobecne zn\u00e1memu faktu, \u017ee dominantn\u00e9 postavenie pri boji s akouko\u013evek v\u00edrusovou infekciou m\u00e1 spr\u00e1vne funguj\u00faca bunkov\u00e1 imunita. Tvorba protil\u00e1tok je nepochyb- ne d\u00f4le\u017eit\u00e1 pri elimin\u00e1cii ak\u00e9hoko\u013evek infek\u010dn\u00e9ho ochorenia, ale efektivita z\u00edskanej imunity by sa mala viac zameriava\u0165 na posilnenie bunkovej imunity ako protil\u00e1tkovej, ktor\u00e1 je \u201ezranite\u013enej\u0161ia\u201c pr\u00e1ve pri r\u00fdchlo sa meniacich heterol\u00f3gnych RNA v\u00edrusoch. Molekul\u00e1rna detekcia protil\u00e1tok je pomerne jednoduch\u00fd proces, preto\u017ee protil\u00e1tky sa via\u017eu priamo na antig\u00e9ny. Naproti tomu T-bunky rozpozn\u00e1vaj\u00fa a via\u017eu sa na procesovan\u00e9 antig\u00e9ny, ktor\u00e9 s\u00fa vystaven\u00e9 na povrchu buniek zn\u00e1mych ako bunky prezentuj\u00face antig\u00e9n (APC) prostredn\u00edctvom molek\u00fal hlavn\u00e9ho histokompatibiln\u00e9ho komplexu (MHC). Vzh\u013eadom na vysok\u00fa inter- aj intradruhov\u00fa variabilitu molek\u00fal peptid-MHC je meranie reakcie epitopovo \u0161pecifick\u00fdch T-buniek ve\u013emi n\u00e1ro\u010dn\u00e9.<\/p>\n

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Infekcia bunky v\u00edrusom SARS-CoV-2<\/h1>\n

V\u00edrusov\u00e1 infekcia sa za\u010d\u00edna prichyten\u00edm v\u00edrusovej \u010dastice k cytoplazmatickej membr\u00e1ne bunky. V\u00edrusov\u00fd povrchov\u00fd prote\u00edn S (spike) SARS-CoV-2 v\u00edrusu sa via\u017ee na \u0161pecifick\u00fd ACE2 (enz\u00fdm 2 konvertuj\u00faci angiotenz\u00edn) receptor. Expresia a distrib\u00facia ACE2 receptorov v tkaniv\u00e1ch n\u00e1sledne ovplyv\u0148uj\u00fa v\u00edrusov\u00fd tropizmus a jeho patogenitu. Hostite\u013esk\u00e1 membr\u00e1nov\u00e1 ser\u00ednov\u00e1 prote\u00e1za (TMPRSS2) pom\u00e1ha f\u00fazii nukleokapsidu v\u00edrusu s membr\u00e1nou bunky, jeho vstupu do bunky a n\u00e1sledn\u00e9mu obna\u017eeniu genomickej RNA. ACE2 a TMPRSS2 s\u00fa exprimovan\u00e9 hlavne v d\u00fdchacom trakte. Gen\u00f3m v\u00edrusu tvor\u00ed v\u00fdrazne dlh\u00e1 genomick\u00e1 RNA pozit\u00edvnej polarity, ktor\u00e1 je ohrani\u010den\u00e1 5\u00b4- a 3\u00b4-neprekladan\u00fdmi oblas\u0165ami s cis <\/em>transaktivuj\u00facimi elementmi d\u00f4le\u017eit\u00fdmi pre replik\u00e1ciu. Na 5\u00b4-konci sa nach\u00e1dzaj\u00fa dva dlh\u00e9 otvoren\u00e9 \u010d\u00edtacie r\u00e1mce ORF 1 a, b (open<\/em> reading frame<\/em>), ktor\u00e9 predstavuj\u00fa dve tretiny gen\u00f3mu. Tieto ORFs k\u00f3duj\u00fa 15-16 ne\u0161trukt\u00farnych prote\u00ednov. Tie s\u00fa po vstupe do bunky priamo prekladan\u00e9 na hostite\u013esk\u00fdch riboz\u00f3moch z v\u00edrusovej genomickej RNA. Vznikaj\u00fa ne\u0161trukt\u00farne prote\u00edny, ktor\u00e9 formuj\u00fa replika\u010dn\u00fd a transkrip\u010dn\u00fd komplex (RTC), obsahuj\u00faci v\u0161etky enz\u00fdmy potrebn\u00e9 na replik\u00e1ciu, \u00fapravu (processing<\/em>), modifik\u00e1cie (modifying<\/em>), opravu (proofreading<\/em>) RNA a inhib\u00edciu v\u010dasnej hostite\u013eskej imunitnej reakcie (interfer\u00f3n). RNA replik\u00e1cia je inicializovan\u00e1 syn- t\u00e9zou RNA vl\u00e1kna negat\u00edvnej polarity, ktor\u00fd je matricou pre genomick\u00fa ssRNA pozit\u00edvnej polarity. S\u00fa\u010dasne s produkciou vl\u00e1kna pozit\u00edvnej polarity prebieha diskontinu\u00e1lna transkripcia z 3\u00b4-konca, kde z otvoren\u00fdch \u010d\u00edtac\u00edch r\u00e1mcov vznikaj\u00fa subgenomick\u00e9 mRNA pre \u0161trukt\u00farne prote\u00edny a prote\u00edny s r\u00f4znymi doplnkov\u00fdmi funkciami, ktor\u00e9 dok\u00e1\u017eu modifikova\u0165 hostite\u013esk\u00fa imunitn\u00fa odpove\u010f a determinuj\u00fa tak v\u00edrusov\u00fa patogenicitu. Funkcie viacer\u00fdch z t\u00fdchto doplnkov\u00fdch prote\u00ednov nie s\u00fa dosia\u013e zn\u00e1me v d\u00f4sledku ch\u00fdbaj\u00facej homol\u00f3gie s in\u00fdmi prote\u00ednmi zn\u00e1mymi pri in\u00fdch koronav\u00edrusoch. Genomick\u00e1 ssRNA pozit\u00edvnej polarity je na konci replika\u010dn\u00e9ho cyklu za pomoci Golgiho komplexu a endoplazmatick\u00e9ho retikula vba\u013eovan\u00e1 do v\u00edrusov\u00fdch partik\u00fal, ktor\u00e9 sa exocyt\u00f3zou dost\u00e1vaj\u00fa von z bunky. Viacer\u00e9 z t\u00fdchto procesov predstavuj\u00fa potenci\u00e1lne terapeutick\u00e9 ciele na zabr\u00e1nenie mno\u017eenia v\u00edrusu. V prv\u00fdch f\u00e1zach v boji proti infekcii nastupuj\u00fa mechanizmy vrodenej imunity. Bunka infikovan\u00e1 v\u00edrusom produkuje interfer\u00f3n gama ako proz\u00e1palov\u00fd cytok\u00edn, ktor\u00fd atrahuje do miesta infekcie fagocytuj\u00face bunky (makrof\u00e1gy, dendritick\u00e9 bunky. Po\u010das evol\u00facie si v\u00edrusy vyvinuli mechanizmy, ako t\u00fato odpove\u010f \u00fa\u010dinne spoma\u013eova\u0165(2).<\/p>\n

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Zosilnenie<\/strong> v\u00edrusovej<\/strong> infekcie<\/strong> z\u00e1visl\u00e9<\/strong> od<\/strong> protil\u00e1tok<\/strong> \u2013 <\/strong>ADE<\/strong> (antibody<\/em><\/strong> dependent<\/em><\/strong> enhancement<\/em><\/strong>)<\/strong><\/p>\n

Na za\u010diatku pand\u00e9mie sa rozpr\u00fadila vedeck\u00e1 debata o najlep\u0161om sp\u00f4sobe v\u00fdroby vakc\u00edn proti COVID-19, aby sa zaistila ich \u00fa\u010dinnos\u0165 a bezpe\u010dnos\u0165. Niektor\u00e9 z t\u00fdchto diskusi\u00ed sa zameriavali na zriedkav\u00fd fenom\u00e9n, zn\u00e1my ako zosilnenie v\u00edrusovej infekcie sprostredkovanej protil\u00e1tkami \u2013 ADE (antibody dependent enhancement<\/em>). ADE je potenci\u00e1lne smrte\u013en\u00fd imunitn\u00fd jav, ktor\u00fd bol pozorovan\u00fd pri niektor\u00fdch v\u00edrusov\u00fdch infekci\u00e1ch a vakc\u00ednach. Po infekcii \u010dloveka jedn\u00fdm s\u00e9rotypom v\u00edrusu \u0161tandardne vznikaj\u00fa protil\u00e1tky neutralizuj\u00face v\u00edrus (via\u017eu sa na v\u00edrus a zabra\u0148uj\u00fa jeho preniknutiu do bunky), ale pri opakovanej infekcii in\u00fdm s\u00e9rotypom tohto v\u00edrusu v\u0161ak doch\u00e1dza k vzniku protil\u00e1tok, ktor\u00e9 nemusia by\u0165 neutraliza\u010dn\u00e9 alebo sa nach\u00e1dzaj\u00fa v suboptim\u00e1lnom mno\u017estve. Aj ke\u010f ADE m\u00f4\u017ee vznika\u0165 r\u00f4znymi sp\u00f4sobmi, asi najzn\u00e1mej\u0161ou je cesta \u201etr\u00f3jskeho ko\u0148a\u201c. K tomu doch\u00e1dza vtedy, ke\u010f vznikaj\u00fa protil\u00e1tky generovan\u00e9 infekciou alebo o\u010dkovan\u00edm v minulosti, ktor\u00e9 v\u0161ak nedok\u00e1\u017eu neutralizova\u0165 v\u00edrus a po op\u00e4tovnej expoz\u00edcii patog\u00e9nov ho nedok\u00e1\u017eu neutralizova\u0165. Namiesto toho p\u00f4sobia ako br\u00e1na t\u00fdm, \u017ee umo\u017e\u0148uj\u00fa v\u00edrusu z\u00edska\u0165 vstup a replikova\u0165 sa v bunk\u00e1ch, ktor\u00e9 be\u017ene neinfikuje (makrof\u00e1gy, dendritick\u00e9 bunky). Tieto bunky namiesto toho, aby v\u00edrusy eliminovali, na\u010do prim\u00e1rne sl\u00fa\u017eia, naopak, pohltia v\u00edrus, ten sa v nich za\u010dne mno\u017ei\u0165 a navy\u0161e sa krvou rozn\u00e1\u0161a \u010falej do tela. To prispieva k r\u00fdchlemu \u0161\u00edreniu infekcie a ne\u017eiaducim imunitn\u00fdm reakci\u00e1m, \u010do \u010falej zhor\u0161uje priebeh ochorenia. ADE sa m\u00f4\u017ee vyskytn\u00fa\u0165 aj vtedy, ak s\u00fa neutraliza\u010dn\u00e9 protil\u00e1tky len v n\u00edzkych hladin\u00e1ch, ktor\u00e9 nechr\u00e1nia pred infekciou. Namiesto toho m\u00f4\u017eu vytv\u00e1ra\u0165 imunitn\u00e9 komplexy s v\u00edrusov\u00fdmi \u010dasticami, \u010do n\u00e1sledne vedie k zhor\u0161eniu ochorenia(3).<\/p>\n

Klasick\u00fd pr\u00edklad ADE v \u0161t\u00fdle tr\u00f3jskeho ko\u0148a je v\u00edrus sp\u00f4sobuj\u00faci hor\u00fa\u010dku dengue (RNA flaviv\u00edrus). Tento v\u00edrus existuje v \u0161tyroch s\u00e9rotypoch. Tie s\u00fa od seba dostato\u010dne odli\u0161n\u00e9, tak\u017ee predch\u00e1dzaj\u00faca infekcia jedn\u00fdm z nich ned\u00e1va vznik protil\u00e1tkam neutralizuj\u00facim v\u00edrus, ktor\u00e9 by dostato\u010dne chr\u00e1nili pred in\u00fdm s\u00e9roptypom.<\/p>\n

V roku 2016 bola vyvinut\u00e1 vakc\u00edna proti hor\u00fa\u010dke dengue na ochranu pred v\u0161etk\u00fdmi \u0161tyrmi s\u00e9rotypmi, ktor\u00e1 bola podan\u00e1 800 000 de\u0165om na Filip\u00ednach. Medzi de\u0165mi, ktor\u00e9 boli o\u010dkovan\u00e9 a nesk\u00f4r vystaven\u00e9 hor\u00fa\u010dke dengue divok\u00e9ho typu, viacero zomrelo, pravdepodobne na z\u00e1va\u017en\u00e9 n\u00e1sledky ADE(4). V 60. rokoch minul\u00e9ho storo\u010dia sa ADE objavil v s\u00favislosti s inaktivovan\u00fdmi vakc\u00ednami proti respira\u010dn\u00e9mu syncyci\u00e1lnemu v\u00edrusu RSV (RNA pneumov\u00edrus), pri ktorom sa u det\u00ed, ktor\u00e9 dostali o\u010dkovaciu l\u00e1tku vyvinulo z\u00e1va\u017enej\u0161ie ochorenie RSV, ke\u010f sa nesk\u00f4r v komunite stretli s div\u00fdm kme\u0148om v\u00edrusu. Zomrelo nieko\u013eko det\u00ed. Vakc\u00edna bola spojen\u00e1 s tvorbou imunokomplexov, ktor\u00e9 sp\u00f4sobovali ob\u0161trukciu p\u013e\u00fac a zhor\u0161ili priebeh ochorenia, \u010do do zna\u010dnej miery zastavilo v\u00fdvoj vakc\u00edny proti RSV. Podobne sa pr\u00edpady ADE vyskytli aj pri inaktivovanej o\u010dkovacej l\u00e1tke proti os\u00fdpkam(5). Doteraz neboli hl\u00e1sen\u00e9 \u017eiadne pr\u00edpady ADE v s\u00favislosti s vakc\u00ednami proti COVID-19. Obavy sa v\u0161ak op\u00e4\u0165 za\u010dali objavova\u0165 s pr\u00edchodom nov\u00fdch variantov v\u00edrusov, kde by p\u00f4vodn\u00e9 vakc\u00edny nemuseli \u00fa\u010dinne pokr\u00fdva\u0165 nov\u0161ie varianty a, naopak, mohli by e\u0161te potenciova\u0165 ADE. Tento mechanizmus sa spom\u00edna napr\u00edklad v s\u00favislosti s multiorg\u00e1nov\u00fdm z\u00e1palov\u00fdm syndr\u00f3mom u det\u00ed, ktor\u00e9 dostali protil\u00e1tky od matky. Jednou z v\u00fdnimiek m\u00f4\u017ee by\u0165 aj inaktivovan\u00e1 celobunkov\u00e1 vakc\u00edna vyvinut\u00e1 v \u010c\u00edne (Sinopharm). T\u00e1to vakc\u00edna tie\u017e pou\u017e\u00edva kamenec ako adjuvans, ktor\u00fd bol pou\u017eit\u00fd vo vakc\u00ednach proti os\u00fdpkam a RSV, ktor\u00e9 sp\u00f4sobovali ADE v \u0161es\u0165desiatych rokoch minul\u00e9ho storo\u010dia.<\/p>\n

Napriek v\u00e1havosti oh\u013eadom relat\u00edvnej novosti mRNA a adenov\u00edrusov\u00fdch vektorov\u00fdch vakc\u00edn maj\u00fa tieto vakc\u00edny v skuto\u010dnosti lep\u0161\u00ed bezpe\u010dnostn\u00fd profil z h\u013eadiska ADE ako star\u0161ie typy vakc\u00edn z minulosti.<\/p>\n

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Vakc\u00ednou indukovan\u00e1 trombotick\u00e1 trombocytop\u00e9nia (VITT) po podan\u00ed vektorovej DNA vakc\u00edny<\/h1>\n

Imunitn\u00e1 trombotick\u00e1 trombocytop\u00e9nia (VITT) je z\u00e1va\u017enou komplik\u00e1ciou o\u010dkovania, ktor\u00fa nie je mo\u017en\u00e9 predv\u00edda\u0165 ani jej predch\u00e1dza\u0165. VITT je charakterizovan\u00fd s\u00fa\u010dasnou pr\u00edtomnos\u0165ou dvoch stavov: tromb\u00f3zy (\u010dasto na neobvykl\u00fdch miestach, ako s\u00fa mozgov\u00e9 \u017eily alebo splanchnick\u00e9 \u017eily) a trombocytop\u00e9nie. Ke\u010f sa u pacienta objav\u00ed pretrv\u00e1vaj\u00faca boles\u0165 hlavy, neurologick\u00e9 pr\u00edznaky, bolesti brucha, dyspnoe alebo bolesti\/otlaky kon\u010dat\u00edn za\u010d\u00ednaj\u00face sa 5 \u2013 30 dn\u00ed po o\u010dkovan\u00ed, mus\u00ed sa zmera\u0165 po\u010det trombocytov, hodnoty D-dim\u00e9ru a vykona\u0165 potrebn\u00e9 zobrazovacie vy\u0161etrenie na tromb\u00f3zu(6).<\/p>\n

V s\u00favislosti s pod\u00e1van\u00edm vektorov\u00fdch vakc\u00edn (AstraZeneca, Johnson & Johnson) sa objavilo nieko\u013eko pr\u00edpadov \u017eivot ohrozuj\u00facich trombembolytick\u00fdch a trombocytopenick\u00fdch pr\u00edhod v\u00e4\u010d\u0161inou u mlad\u00fdch \u017eien s medi\u00e1nom veku 36 rokov (21 \u2013 49) jeden a\u017e dva t\u00fd\u017edne po vakcin\u00e1cii, \u010do v\u00fdrazne prispelo k zn\u00ed\u017eeniu \u201epopularity\u201c tejto vakc\u00edny a dokonca a\u017e k zastaveniu jej pod\u00e1vania vo viacer\u00fdch krajin\u00e1ch, Sloven- sko nevyn\u00edmaj\u00fac. Detailn\u00fdm \u0161t\u00fadiom mo\u017enej pr\u00ed\u010diny sa zistilo, \u017ee patofyziologick\u00fd mechanizmus by mohol by\u0165 podobn\u00fd ako pri hepar\u00ednom indukovanej trombocytop\u00e9nii (HIT-heparin induced trombocytopenia). Vo\u013en\u00e1 z\u00e1porne nabit\u00e1 DNA vo vakc\u00edne sa via\u017ee na trombocyty, \u010do m\u00f4\u017ee aktivova\u0165 protil\u00e1tky proti do\u0161ti\u010dkov\u00e9mu faktoru 4 (PF-4). Tak\u00e9to protil\u00e1tky \u010das\u0165 \u013eud\u00ed najsk\u00f4r m\u00e1 (\u013eudia po oper\u00e1cii srdca, lie\u010dba hepar\u00ednom z r\u00f4znych d\u00f4vodov), v\u00fdsledkom \u010doho m\u00f4\u017ee d\u00f4js\u0165 k aktiv\u00e1cii trombocytov a k spusteniu koagula\u010dnej kask\u00e1dy ved\u00facej k trombotickej trombocytop\u00e9nii indukovanej vakc\u00ednou analogicky ako pri trombocytop\u00e9nii indukovanej hepar\u00ednom (HIT). Komer\u010dn\u00e9 testy ELISA, ktor\u00e9 deteguj\u00fa pr\u00edtomnos\u0165 protil\u00e1tok PF-4 s\u00fa \u0161iroko dostupn\u00e9 a mohli by pom\u00f4c\u0165 v identifik\u00e1cii pacientov, pre ktor\u00fdch nie je tento typ vakc\u00edny vhodn\u00fd. Z ned\u00e1vnej spr\u00e1vy v \u010dasopise Journals of the American College of Cardiology (JACC) vypl\u00fdva, \u017ee tromb\u00f3za mozgov\u00fdch \u017e\u00edl sa vyskytla u 3,6 na mili\u00f3n \u013eud\u00ed po vakc\u00edne AstraZeneca a u 0,9 na mili\u00f3n \u013eud\u00ed po vakc\u00edne Johnson & Johnson. Na porovnanie, v\u00fdskyt tromb\u00f3zy mozgov\u00fdch \u017e\u00edl sa odhaduje na 207 pr\u00edpadov na mili\u00f3n pacientov hospitalizovan\u00fdch po o\u010dkovacej l\u00e1tke proti COVID-19 a 2,4 pr\u00edpadu na mili\u00f3n pacientov v celkovej popul\u00e1cii. Treba v\u0161ak zd\u00f4razni\u0165, \u017ee riziko \u00famrtia a z\u00e1va\u017en\u00fdch n\u00e1sledkov po COVID-19 (vr\u00e1tane tromb\u00f3zy) ove\u013ea prevy\u0161uje mal\u00e9 riziko VITT(7).<\/p>\n

 <\/p>\n

Postvakcina\u010dn\u00e1 myokardit\u00edda a perikardit\u00edda<\/h1>\n

Nieko\u013eko \u0161t\u00fadi\u00ed zaznamenalo vy\u0161\u0161\u00ed v\u00fdskyt myokardit\u00eddy (MK) a perikardit\u00eddy (PK) po podan\u00ed mRNA vakc\u00edn (Moderna) alebo BNT162b2 (Pfizer BioNTech) u mlad\u00fdch mu\u017eov. Myokardit\u00edda a perikardit\u00edda s\u00fa z\u00e1palov\u00e9 ochorenia srdca. Prejavuj\u00fa sa najm\u00e4 d\u00fdchavi\u010dnos\u0165ou, boles\u0165ou na hrudn\u00edku a prudk\u00fdm tlkotom srdca, ktor\u00fd m\u00f4\u017ee by\u0165 nepravideln\u00fd. V jednej rozsiahlej \u0161t\u00fadii zaznamenali 411 pr\u00edpadov MK a PK z 15 148 369 \u013eud\u00ed vo veku od 18 do 64 rokov. Medzi mlad\u00fdmi mu\u017emi vo veku 18 \u2013 24 rokov bola incidencia komplik\u00e1ci\u00ed MK a PK po druhej d\u00e1vke 1,71 (Pfizer BioNTech) a 2,17 (Moderna) na 100 000 \u013eud\u00ed v danej vekovej skupine, \u010di\u017ee mierne v neprospech vakc\u00edny Moderna, ale nie \u0161tatisticky v\u00fdznamne. Tieto negat\u00edvne prejavy sa dostavili pribli\u017ene t\u00fd\u017ede\u0148 po druhej vakcin\u00e1cii a nasledovalo ochorenie v\u00e4\u010d\u0161inou s ben\u00edgnym priebehom a kr\u00e1tkou hospitaliz\u00e1ciou(8). In\u00e1 men\u0161ia \u0161t\u00fadia potvrdzuje rovnak\u00e9 z\u00e1very v pr\u00edpade podania mRNA vakc\u00edn, ale s nezanedbate\u013en\u00fdm trendom vy\u0161\u0161ieho v\u00fdskytu MK a PK u mu\u017eov a \u017eien aj vo vy\u0161\u0161\u00edch vekov\u00fdch skupin\u00e1ch(9). Na z\u00e1klade t\u00fdchto vedeck\u00fdch poznatkov odporu\u010dila EMA zaradi\u0165 myokardit\u00eddu a perikardit\u00eddu na zoznam negat\u00edvnych ved\u013eaj\u0161\u00edch prejavov po podan\u00ed mRNA vakc\u00edn. Pod\u013ea \u00fadajov na str\u00e1nkach \u0160\u00daKL (\u0160t\u00e1tny \u00fastav pre kontrolu lie\u010div) bolo nieko\u013eko pr\u00edpadov postvakcin\u010dn\u00e9ho z\u00e1palov\u00e9ho ochorenia srdca hl\u00e1sen\u00fdch aj na Slovensku.<\/p>\n

 <\/p>\n

Reaktiv\u00e1cia v\u00edrusu kiahn\u00ed (Varicella zoster, VZV)<\/h1>\n

Z viacer\u00fdch kraj\u00edn boli hl\u00e1sen\u00e9 sporadick\u00e9 pr\u00edpady (okolo 100) reaktiv\u00e1cie v\u00edrusu Varicella zoster (DNA alfaherpesv\u00edrus) pribli\u017ene t\u00fd\u017ede\u0148 po podan\u00ed r\u00f4znych vakc\u00edn proti ochoreniu COVID-19. Pribli\u017ene 13 % z tejto skupiny tvorili pacienti s autoimunitn\u00fdm ochoren\u00edm, naj\u010dastej\u0161ie s reumatoidnou artrit\u00eddou, 10 % boli pacienti u\u017e\u00edvaj\u00faci imunosupres\u00edvnu lie\u010dbu (predniz\u00f3n, JAK inhib\u00edtory), hypertenzia bola naj\u010dastej\u0161ia komorbidita u 18 % pacientov a zvy\u0161ok skupiny predstavovala imunokompetentn\u00e1 v\u00e4\u010d\u0161ina. Dve tretiny pacientov dostali vakc\u00ednu na b\u00e1ze mRNA (Pfizer BioNTech, Moderna) ani jeden pr\u00edpad nebol op\u00edsan\u00fd v s\u00favislosti s jednod\u00e1vkovou vakc\u00ednou Janssen od firmy Johnson. Po\u010das trvania klinick\u00fdch \u0161t\u00fadi\u00ed sa neobjavil ani jedin\u00fd pr\u00edpad reaktiv\u00e1cie latentn\u00e9ho VZV. U viac ako polovice pacientov do\u0161lo k reaktiv\u00e1cii po prvej d\u00e1vke vakc\u00edny. Herpes zoster ako ko\u017en\u00e9 bolestiv\u00e9 ochorenie s bolestiv\u00fdm v\u00fdsevom vodnat\u00fdch vyr\u00e1\u017eok na ko\u017ei je sp\u00f4soben\u00e9 reaktiv\u00e1ciou neurotropn\u00e9ho v\u00edrusu VZV (Varicella zoster virus VZV, \u013eudsk\u00fd herpesv\u00edrus 3, HHV3), ktor\u00fd pretrv\u00e1va v latentnej forme v dorz\u00e1lnych nervov\u00fdch gangli\u00e1ch po prekonan\u00ed primoinfekcie varicellou, \u013eudovo ov\u010d\u00edmi kiah\u0148ami. K reaktiv\u00e1cii oby\u010dajne doch\u00e1dza, ke\u010f zlyhaj\u00fa imunologick\u00e9 mechanizmy, hlavne bunkov\u00e1 imunita kontroluj\u00faca v\u00edrusov\u00fa latenciu. Hlavn\u00fdmi rizikov\u00fdmi faktormi je starnutie imunitn\u00e9ho syst\u00e9mu s pokro\u010dil\u00fdm vekom, imunosupres\u00edvna lie\u010dba, imunokompromituj\u00face ochorenie, napr. HIV alebo automimunitn\u00e9 ochorenie. O\u010dkovanie sa doteraz nepova\u017eovalo za potenciuj\u00faci faktor, hoci extr\u00e9mne zriedkav\u00e9 pr\u00edpady boli op\u00edsan\u00e9 aj pri podan\u00ed vakc\u00edn proti chr\u00edpke, besnote a hepatit\u00edde A. Bunkov\u00e1 imunita hr\u00e1 d\u00f4le\u017eit\u00fa \u00falohu v prevencii reaktiv\u00e1cie VZV.<\/p>\n

Pokles bunkami sprostredkovanej imunity s vekom alebo s poklesom VZV \u0161pecifick\u00fdch T-buniek nar\u00fa\u0161a imunitn\u00fd doh\u013ead a zvy\u0161uje riziko reaktiv\u00e1cie.<\/p>\n

Z\u00e1va\u017en\u00fd priebeh ochorenia COVID-19, ale aj in\u00e9ho v\u00edrusov\u00e9ho ochorenia je \u010dasto spojen\u00fd s v\u00fdrazn\u00fdm poklesom T-lymfocytov alebo jednoducho \u201evyhoren\u00edm\u201c T-buniek, \u0161pecificky CD4+ a CD8+, \u010do vedie k stavu ozna\u010dovan\u00e9mu ako lymfop\u00e9nia, \u010do m\u00f4\u017ee potenci\u00e1lne vies\u0165 k reaktiv\u00e1cii v\u00edrusu(10).<\/p>\n

Na druhej strane stimul\u00e1cia imunitn\u00e9ho syst\u00e9mu vakc\u00ednou by mala, naopak, vies\u0165 k silnej T-bunkovej odpovedi, ktor\u00e1 pretrv\u00e1va dlh\u00fd \u010das. Pre tento paradox sa objavila presved\u010div\u00e1 hypot\u00e9za, ktor\u00e1 nazna\u010duje, \u017ee CD8+ bunky \u0161pecifick\u00e9 pre VZV nie s\u00fa do\u010dasne schopn\u00e9 kontrolova\u0165 latentn\u00fd VZV po mas\u00edvnom presune naivn\u00fdch CD8+ buniek v r\u00e1mci o\u010dkovania proti SARS-CoV-2. \u010eal\u0161\u00edm potenci\u00e1lne vysvet\u013euj\u00facim mechanizmom m\u00f4\u017ee by\u0165 aktiv\u00e1cia vrodenej imunity cez toll like <\/em>receptory (TLR), ktor\u00e1 sa \u010dasto podie\u013ea na procese reaktiv\u00e1cie herpetick\u00fdch v\u00edrusov ako udr\u017eiavacieho mechanizmu v hostite\u013eovi. Najm\u00e4 naru\u0161enie expresie TLR medzi o\u010dkovan\u00fdmi jedincami bolo spojen\u00e9 s v\u00fdraznou indukciou tvorby interfer\u00f3nu typu I (IFN) a proz\u00e1palov\u00fdch cytok\u00ednov, ktor\u00e9 aj ke\u010f podporuj\u00fa T-bunkov\u00fa aktiv\u00e1ciu a iniciuj\u00fa odpove\u010f pam\u00e4\u0165ov\u00fdch B-buniek na vylu\u010dovanie protil\u00e1tok, m\u00f4\u017eu z\u00e1rove\u0148 negat\u00edvne modulova\u0165 expresiu antig\u00e9nu, pri\u010dom potenci\u00e1lne pri- spieva\u0165 k reaktiv\u00e1cii VZV(11).<\/p>\n

 <\/p>\n

Postvakcina\u010dn\u00fd Guillainov-Barr\u00e9ho syndr\u00f3m<\/h1>\n

V s\u00favislosti s o\u010dkovan\u00edm vektorovou (AstraZeneca) aj mRNA (vakc\u00ednou Pfizer BioNTech) proti kovidu sa za\u010dali objavova\u0165 sporadick\u00e9 pr\u00edpady rozvoja Guillainovho-Barr\u00e9ho syndr\u00f3mu (GBS) v kr\u00e1tkom \u010dase po vakcin\u00e1cii. GBS je ak\u00fatna perif\u00e9rna neuropatia sp\u00f4soben\u00e1 autoimunitnou odpove\u010fou jedinca po predch\u00e1dzaj\u00facej infekcii gastrointestin\u00e1lneho alebo respira\u010dn\u00e9ho traktu. Ochorenie je zriedkav\u00e9 a objavuje sa pribli\u017ene u 1 a\u017e 2 \u013eud\u00ed na 100 000, pri\u010dom dve tretiny maj\u00fa hist\u00f3riu infek\u010dn\u00e9ho ochorenia. Doposia\u013e bolo ochorenie op\u00edsan\u00e9 v s\u00favislosti s infekciou Camplylobacter jejuni, EBV, CMV, Mycobacterium pneumoniae, Haemophilus influenze, <\/em>v\u00edrusom hepatit\u00eddy E a zika v\u00edrusom(12). Pod\u013ea najnov\u0161\u00edch inform\u00e1ci\u00ed sa m\u00f4\u017ee vyvin\u00fa\u0165 GBS aj u pacientov po prekonan\u00ed ochorenia COVID-19, prekvapuj\u00faco relat\u00edvne \u010dastej\u0161ie u mu\u017eov s miernym priebehom bez zn\u00e1mok pneum\u00f3nie, dokonca asymptomatick\u00fdch pacientov. K dne\u0161n\u00e9mu d\u0148u bolo op\u00edsan\u00fdch nieko\u013eko desiatok pr\u00edpadov GBS v s\u00favislosti s o\u010dkovan\u00edm. Elektrodiagnostick\u00e1 klasifik\u00e1cia GBS po COVID-19 bola vo v\u00e4\u010d\u0161ine pr\u00edpadov demyeliniza\u010dn\u00e9ho typu nasledovanan\u00e1 axon\u00e1lnym typom GBS(13).<\/p>\n

Pravdepodobn\u00fd patofyziologick\u00fd mechanizmus je zalo\u017een\u00fd na molekul\u00e1rnom mimikry, ke\u010f protil\u00e1tky vytvoren\u00e9 proti infek\u010dn\u00e9mu agensu za\u010dn\u00fa rozpozn\u00e1va\u0165 telu vlastn\u00e9 \u0161trukt\u00fary, v tomto pr\u00edpade myel\u00ednov\u00fd obal nervovej bunky.<\/p>\n

Po\u010fakovanie:<\/em><\/strong><\/p>\n

T\u00e1to publik\u00e1cia vznikla v\u010faka podpore v r\u00e1mci Opera\u010dn\u00e9ho programu Integrovan\u00e1 infra\u0161trukt\u00fara pre projekt: Z\u00e1va\u017en\u00e9 civiliza\u010dn\u00e9 ochorenia a COVID-19, k\u00f3d ITMS: 313011AVH7, spolufinancovan\u00fd zo zdrojov Eur\u00f3pskeho fondu region\u00e1lneho rozvoja.<\/em><\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/strong><\/p>\n

    \n
  1. Collie S, Champion J, Moultrie H, Bekker LG, Gray Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa. N Engl J Med. 2022 Feb 3;386(5):494-496. doi: 10.1056\/NEJMc2119270. Epub 2021 Dec 29. PMID: 34965358; PMCID: PMC8757569.<\/li>\n
  2. Bhardwaj A, Sapra L, Saini C, Azam Z, Mishra PK, Verma B, Mishra GC, Srivastava COVID-19: Immunology, Immunopathogenesis and Potential Therapies. Int Rev Immunol. 2021 Feb 27:1-36. doi: 10.1080\/08830185.2021.1883600. Epub ahead of print. PMID: 33641587; PMCID: PMC7919479.<\/li>\n
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  4. Ulrich H, Pillat MM, T\u00e1rnok Dengue Fever, COVID-19 (SARS-CoV-2), and Antibody-Dependent Enhancement (ADE): A Perspective. Cytometry<\/li>\n
  5. 2020 Jul;97(7):662-667. doi: 10.1002\/cyto.a.24047. Epub 2020 Jun 7. PMID: 32506725; PMCID: PMC7300451.<\/li>\n
  6. Smatti MK, Al Thani AA, Yassine HM. Viral-Induced Enhanced Disease Illness. Front Microbiol. 2018 Dec 5;9:2991. doi: 10.3389\/ fmicb.2018.02991. PMID: 30568643; PMCID: PMC6290032.<\/li>\n
  7. Iba T, Levy JH, Warkentin Recognizing Vaccine-Induced Immune Thrombotic Thrombocytopenia. Crit Care Med. 2022 Jan 1;50(1):e80-e86. doi: 10.1097\/CCM.0000000000005211. PMID: 34259661; PMCID: PMC8670081.<\/li>\n
  8. Bikdeli B, Chatterjee S, Arora S, Monreal M, Jimenez D, Krumholz HM, Goldhaber SZ, Elkind MSV, Piazza Cerebral Venous Sinus Thrombosis in the U.S. Population, After Adenovirus-Based SARS-CoV-2 Vaccination, and After COVID-19. J Am Coll Cardiol. 2021 Jul 27;78(4):408-411. doi: 10.1016\/j.jacc.2021.06.001. Epub 2021 Jun 8. PMID: 34116145; PM- CID: PMC8186447.<\/li>\n
  9. Wong HL, Hu M, Zhou CK, Lloyd PC, Amend KL, Beachler DC, Secora A, McMahill-Walraven CN, Lu Y, Wu Y, Ogilvie RP, Reich C, Djibo DA, Wan Z, Seeger JD, Akhtar S, Jiao Y, Chillarige Y, Do R, Hornberger J, Obidi J, Forshee R, Shoaibi A, Anderson SA. Risk of myocarditis and pericarditis after the COVID-19 mRNA vaccination in the USA: a cohort study in claims data- Lancet. 2022 Jun 11;399(10342):2191-2199. doi: 10.1016\/S0140- 6736(22)00791-7. PMID: 35691322; PMCID: PMC9183215.<\/li>\n
  10. Le Vu S, Bertrand M, Jabagi MJ, Botton J, Drouin J, Baricault B, Weill A, Dray-Spira R, Zureik Age and sex-specific risks of myocarditis and pericarditis following Covid-19 messenger RNA vaccines. Nat Commun. 2022 Jun 25;13(1):3633. doi: 10.1038\/s41467-022-31401-5. PMID: 35752614; PMCID: PMC9233673.<\/li>\n
  11. van Dam CS, Lede I, Schaar J, Al-Dulaimy M, R\u00f6sken R, Smits Herpes zoster after COVID vaccination. Int J Infect Dis. 2021 Oct;111:169-doi: 10.1016\/j.ijid.2021.08.048. Epub 2021 Aug 21. PMID: 34428545; PMCID: PMC8379763.<\/li>\n
  12. Katsikas Triantafyllidis K, Giannos P, Mian IT, Kyrtsonis G, Kechagias Varicella Zoster Virus Reactivation Following COVID-19 Vaccination: A Systematic Review of Case Reports. Vaccines (Basel). 2021 Sep 11;9(9):1013. doi: 10.3390\/vaccines9091013. PMID: 34579250; PMCID: PMC8471236.<\/li>\n
  13. Rao SJ, Khurana S, Murthy G, Dawson ET, Jazebi N, Haas A case of Guillain-Barre syndrome following Pfizer COVID-19 vaccine. J Community Hosp Intern Med Perspect. 2021 Sep 20;11(5):597- 600. doi: 10.1080\/20009666.2021.1954284. PMID: 34567447; PMCID: PMC8462911.<\/li>\n
  14. Kim JE, Min YG, Shin JY, Kwon YN, Bae JS, Sung JJ, Hong Guillain-Barr\u00e9 Syndrome and Variants Following COVID-19 Vaccination: Report of 13 Cases. Front Neurol. 2022 Jan 27;12:820723. doi: 10.3389\/ fneur.2021.820723. PMID: 35153993; PMCID: PMC8833101.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    *A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens   V s\u00fa\u010dasnosti v odbornej, ale aj laickej verejnosti rezonuj\u00fa inform\u00e1cie o aktu\u00e1lne zn\u00e1mych typoch vakc\u00edn, pri\u010dom ako prv\u00e9 sa stali dostupn\u00fdmi tie na b\u00e1ze mRNA (Pfizer BioNTech, Moderna), v s\u00fa\u010dasnosti s\u00fa u\u017e dostupn\u00e9 aj<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[291],"tags":[1946,1727,1949,1947,1948],"class_list":["post-2515","post","type-post","status-publish","format-standard","hentry","category-imunology","tag-ade-en","tag-covid-19","tag-mrna-vaccines-covid-19","tag-mrna-vakciny-en","tag-vitt-en","typ_clanku-review-article"],"acf":{"abstrakt":"

    The discovery of antibiotics by Alexander Fleming and the introduction of vaccination are undoubtedly among the most remarkable medical milestones in modern human history. In the past, humankind has managed to cope with vast pandemics of plague, smallpox and cholera, however, at the cost of the extinction of a third of Europe. We have now been facing a global SARS-CoV-2 coronavirus pandemic for more than two years, unprecedented- ly in modern history, resulting in more than 6 million deaths and trillions of dollars in economic damage. How- ever, unlike in the past, we also face different challenges, thanks to scientific and technological advances and knowledge in the life sciences. One of these is the adverse effects of vaccination arising from the nature of vaccines and the individual specificities of our immunity, which also discourages a significant proportion of the public from being vaccinated, slowing down the process of acquiring collective immunity. Understanding how our immune system responds to a virus or why and under what circumstances it responds inadequately during natural infection or vaccination can help to individualise the administration of vaccines to different groups of people or steer the development of new vaccines in an optimal direction. In addition to the body\u2019s normal reactions to a vaccine, which are expected and essentially benign, there are generally rare adverse reactions that can occur after vaccination.<\/p>\n

    Keywords: <\/strong>mRNA vaccines; COVID 19, antibody-dependent enhancement-ADE, vaccine-induced thrombotic thrombocytopenia-VITT<\/p>\n","casopis":[{"ID":2437,"post_author":"7","post_date":"2022-10-26 08:29:25","post_date_gmt":"2022-10-26 06:29:25","post_content":"newslab 1\/2022<\/strong>\r\n

      \r\n \t
    • Using immunohistochemistry to examine MMR protein expression in endometrial tumours is a suitable method for the primary selection of potential cases with Lynch syndrome<\/li>\r\n \t
    • Metabolomics: a\u00a0potential tool for an individual approach to depressive diseases<\/li>\r\n \t
    • The role of epigenetics in endometrial cancer<\/li>\r\n \t
    • Vaccine vulnerabilities: can we prevent them?\r\n\u2013 SARS-CoV-2 case study<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-9","to_ping":"","pinged":"","post_modified":"2022-10-26 08:32:07","post_modified_gmt":"2022-10-26 06:32:07","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.newslab.sk\/casopis\/newslab-9\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"42-46","upload_clanok":{"ID":2513,"id":2513,"title":"NEWSLAB 1-2022_H\u00fdblov\u00e1","filename":"NEWSLAB-1-2022_Hyblova.pdf","filesize":722024,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2022\/10\/NEWSLAB-1-2022_Hyblova.pdf","link":"https:\/\/www.newslab.sk\/en\/slabe-miesta-vakcin-dokazeme-im-predchadzat-pripadova-studia-sars-cov-2\/newslab-1-2022_hyblova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-1-2022_hyblova-2","status":"inherit","uploaded_to":2515,"date":"2022-10-26 11:12:06","modified":"2022-10-26 11:12:06","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=2515"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2515\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=2515"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=2515"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=2515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}