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Year 2023, Volume: 19 Issue: 2, 121 - 130, 29.06.2023

Abstract

References

  • Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV- 2 variants in the United States: prospective observational study. BMJ [Internet]. 2022 Mar 9 [cited 2022 Apr 21];376:e069761. Available from: https://www.bmj.com/content/376/bmj-2021-069761.
  • Rahimi F, Talebi Bezmin Abadi A. The Omicron subvariant BA.2: Birth of a new challenge during the COVID-19 pandemic [Internet]. Vol. 99, International Journal of Surgery. Elsevier; 2022 [cited 2022 Apr 21]. p. 106261. Available from: /pmc/articles/PMC8837492.
  • Fiedler K, Lazzaro S, Lutz J, Rauch S, Heidenreich R. mRNA cancer vaccines. In: Recent Results in Cancer Research [Internet]. Springer, Cham; 2016 [cited 2022 Apr 21]. p. 61–85. Available from: https://link.springer.com/chapter/10.1007/978-3-319-42934-2_5.
  • Rausch S, Schwentner C, Stenzl A, Bedke J. mRNA vaccine CV9103 and CV9104 for the treatment of prostate cancer. Hum Vaccines Immunother [Internet]. 2014 Nov 1 [cited 2022 Apr 21];10(11):3146–52. Available from: https://www.tandfonline.com/doi/abs/10.4161/hv.29553.
  • Brazzoli M, Magini D, Bonci A, Buccato S, Giovani C, Kratzer R, et al. Induction of Broad-Based Immunity and Protective Efficacy by Self-amplifying mRNA Vaccines Encoding Influenza Virus Hemagglutinin. J Virol [Internet]. 2016 Jan 14 [cited 2022 Apr 21];90(1):332–44. Available from: https://journals.asm.org/doi/full/10.1128/JVI.01786-15
  • Maruggi G, Chiarot E, Giovani C, Buccato S, Bonacci S, Frigimelica E, et al. Immunogenicity and protective efficacy induced by self-amplifying mRNA vaccines encoding bacterial antigens. Vaccine. 2017 Jan 5;35(2):361–8.
  • Liu J, Chandrashekar A, Sellers D, Barrett J, Jacob-Dolan C, Lifton M, et al. Vaccines elicit highly conserved cellular immunity to SARS- CoV-2 Omicron. Nature [Internet]. 2022 Mar 17 [cited 2022 Apr 21];603(7901):493–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35102312/
  • Tarke A, Coelho CH, Zhang Z, Dan JM, Yu ED, Methot N, et al. SARS-CoV-2 vaccination induces immunological T cell memory able to cross-recognize variants from Alpha to Omicron. Cell [Internet]. 2022 Mar 3 [cited 2022 Apr 21];185(5):847-859.e11. Available from: https://pubmed.ncbi.nlm.nih.gov/35139340/
  • Ng YL, Salim CK, Chu JJH. Drug repurposing for COVID-19: Approaches, challenges and promising candidates [Internet]. Vol. 228, Pharmacology and Therapeutics. Pharmacol Ther; 2021 [cited 2022 Apr 21]. Available from: https://pubmed.ncbi.nlm.nih.gov/34174275/
  • Chakraborty C, Sharma AR, Bhattacharya M, Agoramoorthy G, Lee SS. The Drug Repurposing for COVID-19 Clinical Trials Provide Very Effective Therapeutic Combinations: Lessons Learned From Major Clinical Studies. Vol. 12, Frontiers in Pharmacology. Frontiers Media S.A.; 2021. p. 2942.
  • Li L, Huang S. Newly synthesized Mpro inhibitors as potential oral anti-SARS-CoV-2 agents. Signal Transduct Target Ther [Internet]. 2021 Mar 31 [cited 2022 Apr 21];6(1):1–2. Available from: https://www.nature.com/articles/s41392-021-00560-0
  • Yayli N, Kiliç G, Celik G, Kahriman N, Kanbolat S, Bozdeveci A, et al. Synthesis of hydroxy benzoin/benzil analogs and investigation of their antioxidant, antimicrobial, enzyme inhibition, and cytotoxic activities. Turkish J Chem [Internet]. 2021 [cited 2022 Apr 21];45(3):788–804. Available from: /pmc/articles/PMC8326476/
  • Zimmermann MT, Oberg AL, Grill DE, Ovsyannikova IG, Haralambieva IH, Kennedy RB, et al. System-Wide Associations between DNA-Methylation, Gene Expression, and Humoral Immune Response to Influenza Vaccination. PLoS One [Internet]. 2016 Mar 31 [cited 2023 Jun 12];11(3). Available from: https://pubmed.ncbi.nlm.nih.gov/27031986/
  • Lu Y, Cheng Y, Yan W, Nardini C. Exploring the molecular causes of hepatitis B virus vaccination response: an approach with epigenomic and transcriptomic data. BMC Med Genomics [Internet]. 2014 Mar 11 [cited 2023 Jun 12];7(1). Available from: https://pubmed.ncbi.nlm.nih.gov/24612962/
  • Cheng Q, Zhao B, Huang Z, Su Y, Chen B, Yang S, et al. Epigenome-wide study for the offspring exposed to maternal HBV infection during pregnancy, a pilot study. Gene [Internet]. 2018 Jun 5 [cited 2023 Jun 12];658:76–85. Available from: https://pubmed.ncbi.nlm.nih.gov/29526602/
  • Pfizer Inc., New York N 10017. Pfizer-BioNTech COVID-19 Vaccine | Pfizer [Internet]. 2022 [cited 2022 Apr 5]. Available from: https://www.pfizer.com/products/product-detail/pfizer-biontech- covid-19-vaccine
  • Abbott A. Scientists bust myth that our bodies have more bacteria than human cells. Nature. 2016 Jan 8.
  • Uzuner SÇ, Birinci E, Tetikoğlu S, Birinci C, Kolaylı S. Distinct Epigenetic Reprogramming, Mitochondrial Patterns, Cellular Morphology, and Cytotoxicity after Bee Venom Treatment. Recent Pat Anticancer Drug Discov. 2021;16(3):377–92.
  • Arts RJW, Blok BA, Aaby P, Joosten LAB, de Jong D, van der Meer JWM, et al. Long-term in vitro and in vivo effects of γ-irradiated BCG on innate and adaptive immunity. J Leukoc Biol [Internet]. 2015 Dec 1 [cited 2023 Jun 12];98(6):995–1001. Available from: https://pubmed.ncbi.nlm.nih.gov/26082519/
  • Strober W, Watanabe T. NOD2, an intracellular innate immune sensor involved in host defense and Crohn’s disease. Mucosal Immunol 2011 45 [Internet]. 2011 Jul 13 [cited 2023 Jun 12];4(5):484–95. Available from: https://www.nature.com/articles/mi201129
  • Gensous N, Franceschi C, Blomberg BB, Pirazzini C, Ravaioli F, Gentilini D, et al. Responders and non-responders to influenza vaccination: A DNA methylation approach on blood cells. Exp Gerontol [Internet]. 2018 May 1 [cited 2023 Jun 12];105:94–100. Available from: https://pubmed.ncbi.nlm.nih.gov/29360511/
  • Cheong J-G, Ravishankar A, Sharma S, Parkhurst CN, Nehar- Belaid D, Ma S, et al. Epigenetic Memory of COVID-19 in Innate Immune Cells and Their Progenitors. bioRxiv [Internet]. 2022 Feb 10 [cited 2022 Apr 21];2022.02.09.479588. Available from: https://www.biorxiv.org/content/10.1101/2022.02.09.479588v1
  • Zimmermann MT, Oberg AL, Grill DE, Ovsyannikova IG, Haralambieva IH, Kennedy RB, et al. System-wide associations between DNA-methylation, gene expression, and humoral immune response to influenza vaccination. PLoS One [Internet]. 2016 Mar 31 [cited 2022 Apr 21];11(3). Available from: /pmc/articles/PMC4816338/
  • Kaufman J, Graf BA, Leung EC, Pollock SJ, Koumas TM, Reddy SY, et al. Fibroblasts as sentinel cells: Role of the CD40-CD40 ligand system in fibroblast activation and lung inflammation and fibrosis. Chest. 2001;120(1):53S-55S.
  • Bustos-Arriaga J, García-Machorro J, León-Juárez M, García- Cordero J, Santos-Argumedo L, Flores-Romo L, et al. Activation of the innate immune response against denv in normal non-transformed human fibroblasts. PLoS Negl Trop Dis [Internet]. 2011;5(12). Available from: https://pubmed.ncbi.nlm.nih.gov/22206025/
  • Hamada A, Torre C, Drancourt M, Ghigo E. Trained immunity carried by non-immune cells. Vol. 10, Frontiers in Microbiology. Frontiers; 2019. p. 3225.
  • Pillon NJ, Bilan PJ, Fink LN, Klip A. Cross-talk between skeletal muscle and immune cells: Muscle-derived mediators and metabolic implications [Internet]. Vol. 304, American Journal of Physiology - Endocrinology and Metabolism. American Physiological Society Bethesda, MD; 2013 [cited 2022 Apr 21]. p. 453–65. Available from: https://journals.physiology.org/doi/full/10.1152/ajpendo.00553.2012
  • Liu Q, Yang L, Gong C, Tao G, Huang H, Liu J, et al. Effects of long-term low-dose formaldehyde exposure on global genomic hypomethylation in 16HBE cells. Toxicol Lett [Internet]. 2011 Sep 10 [cited 2022 Apr 17];205(3):235–40. Available from: https://pubmed.ncbi.nlm.nih.gov/21745553/
  • Johnson W. Final Report on the Safety Assessment of Octoxynol- 1,-3,-5,-6,-7,-8,-9, -10,-11,-12,-13,-16,-20,-25,-30,-33,-40,-70,-9 Carboxylic Acid, Octoxynol-20 Carboxylic Acid, Potassium Octoxynol-12 Phosphate, Sodium Octoxynol-2 Ethane Sulfonate, Sodium Octoxynol-2 [Internet]. Vol. 23, International Journal of Toxicology. Int J Toxicol; 2004 [cited 2022 Apr 17]. p. 59–111. Available from: https://pubmed.ncbi.nlm.nih.gov/15162838/
  • Chen J, Wang J, Zhang J, Ly H. Advances in Development and Application of Influenza Vaccines. Vol. 12, Frontiers in Immunology. Frontiers Media S.A.; 2021. p. 2740.

Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines

Year 2023, Volume: 19 Issue: 2, 121 - 130, 29.06.2023

Abstract

The importance of vaccination has come up again with a new form of coronavirus disease, COVID-19, which appeared in late 2019. This virus spread very fast around the globe, and it has numerous variants determined so far. Many studies focus on the effects of COVID-19 in humans and clinical-follow up after vaccination for the understanding whether the disease has been taken under control. Other studies mostly focus on omics analyses and molecular characteristics of COVID-19 itself. However, this is not clear whether COVID-19 vaccines induce epigenetic differences in the host tissues. This study aimed to reveal whether in vitro treatment of muscle cells with mRNA-based vaccine for COVID-19 and/or attenuated vaccines (whole virus attenuated for COVID-19 or split virion for quadrivalent influenza) can result in the changes in the global levels of DNA methylation (5meC) and/or DNA hydroxymethylation (5hmC). DNA methylation and DNA hydroxymethylation were individually detected by immunofluorescence and global patterns of epigenetic marks were analysed by fluorescence microscopy in rat muscle cells after the incubation with vaccines for 24h or 48h. Results showed that each type of attenuated vaccine induced epigenetic changes by different patterns, but the mRNA-based vaccine affected both global levels of 5meC and 5hmC in a similar manner. Findings indicate that vaccines can affect epigenome. These preliminary results suggest that epigenetic profiles of specific genes across different human tissues after vaccination may add further information, therefore, reveal biological significance in detail.

References

  • Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV- 2 variants in the United States: prospective observational study. BMJ [Internet]. 2022 Mar 9 [cited 2022 Apr 21];376:e069761. Available from: https://www.bmj.com/content/376/bmj-2021-069761.
  • Rahimi F, Talebi Bezmin Abadi A. The Omicron subvariant BA.2: Birth of a new challenge during the COVID-19 pandemic [Internet]. Vol. 99, International Journal of Surgery. Elsevier; 2022 [cited 2022 Apr 21]. p. 106261. Available from: /pmc/articles/PMC8837492.
  • Fiedler K, Lazzaro S, Lutz J, Rauch S, Heidenreich R. mRNA cancer vaccines. In: Recent Results in Cancer Research [Internet]. Springer, Cham; 2016 [cited 2022 Apr 21]. p. 61–85. Available from: https://link.springer.com/chapter/10.1007/978-3-319-42934-2_5.
  • Rausch S, Schwentner C, Stenzl A, Bedke J. mRNA vaccine CV9103 and CV9104 for the treatment of prostate cancer. Hum Vaccines Immunother [Internet]. 2014 Nov 1 [cited 2022 Apr 21];10(11):3146–52. Available from: https://www.tandfonline.com/doi/abs/10.4161/hv.29553.
  • Brazzoli M, Magini D, Bonci A, Buccato S, Giovani C, Kratzer R, et al. Induction of Broad-Based Immunity and Protective Efficacy by Self-amplifying mRNA Vaccines Encoding Influenza Virus Hemagglutinin. J Virol [Internet]. 2016 Jan 14 [cited 2022 Apr 21];90(1):332–44. Available from: https://journals.asm.org/doi/full/10.1128/JVI.01786-15
  • Maruggi G, Chiarot E, Giovani C, Buccato S, Bonacci S, Frigimelica E, et al. Immunogenicity and protective efficacy induced by self-amplifying mRNA vaccines encoding bacterial antigens. Vaccine. 2017 Jan 5;35(2):361–8.
  • Liu J, Chandrashekar A, Sellers D, Barrett J, Jacob-Dolan C, Lifton M, et al. Vaccines elicit highly conserved cellular immunity to SARS- CoV-2 Omicron. Nature [Internet]. 2022 Mar 17 [cited 2022 Apr 21];603(7901):493–6. Available from: https://pubmed.ncbi.nlm.nih.gov/35102312/
  • Tarke A, Coelho CH, Zhang Z, Dan JM, Yu ED, Methot N, et al. SARS-CoV-2 vaccination induces immunological T cell memory able to cross-recognize variants from Alpha to Omicron. Cell [Internet]. 2022 Mar 3 [cited 2022 Apr 21];185(5):847-859.e11. Available from: https://pubmed.ncbi.nlm.nih.gov/35139340/
  • Ng YL, Salim CK, Chu JJH. Drug repurposing for COVID-19: Approaches, challenges and promising candidates [Internet]. Vol. 228, Pharmacology and Therapeutics. Pharmacol Ther; 2021 [cited 2022 Apr 21]. Available from: https://pubmed.ncbi.nlm.nih.gov/34174275/
  • Chakraborty C, Sharma AR, Bhattacharya M, Agoramoorthy G, Lee SS. The Drug Repurposing for COVID-19 Clinical Trials Provide Very Effective Therapeutic Combinations: Lessons Learned From Major Clinical Studies. Vol. 12, Frontiers in Pharmacology. Frontiers Media S.A.; 2021. p. 2942.
  • Li L, Huang S. Newly synthesized Mpro inhibitors as potential oral anti-SARS-CoV-2 agents. Signal Transduct Target Ther [Internet]. 2021 Mar 31 [cited 2022 Apr 21];6(1):1–2. Available from: https://www.nature.com/articles/s41392-021-00560-0
  • Yayli N, Kiliç G, Celik G, Kahriman N, Kanbolat S, Bozdeveci A, et al. Synthesis of hydroxy benzoin/benzil analogs and investigation of their antioxidant, antimicrobial, enzyme inhibition, and cytotoxic activities. Turkish J Chem [Internet]. 2021 [cited 2022 Apr 21];45(3):788–804. Available from: /pmc/articles/PMC8326476/
  • Zimmermann MT, Oberg AL, Grill DE, Ovsyannikova IG, Haralambieva IH, Kennedy RB, et al. System-Wide Associations between DNA-Methylation, Gene Expression, and Humoral Immune Response to Influenza Vaccination. PLoS One [Internet]. 2016 Mar 31 [cited 2023 Jun 12];11(3). Available from: https://pubmed.ncbi.nlm.nih.gov/27031986/
  • Lu Y, Cheng Y, Yan W, Nardini C. Exploring the molecular causes of hepatitis B virus vaccination response: an approach with epigenomic and transcriptomic data. BMC Med Genomics [Internet]. 2014 Mar 11 [cited 2023 Jun 12];7(1). Available from: https://pubmed.ncbi.nlm.nih.gov/24612962/
  • Cheng Q, Zhao B, Huang Z, Su Y, Chen B, Yang S, et al. Epigenome-wide study for the offspring exposed to maternal HBV infection during pregnancy, a pilot study. Gene [Internet]. 2018 Jun 5 [cited 2023 Jun 12];658:76–85. Available from: https://pubmed.ncbi.nlm.nih.gov/29526602/
  • Pfizer Inc., New York N 10017. Pfizer-BioNTech COVID-19 Vaccine | Pfizer [Internet]. 2022 [cited 2022 Apr 5]. Available from: https://www.pfizer.com/products/product-detail/pfizer-biontech- covid-19-vaccine
  • Abbott A. Scientists bust myth that our bodies have more bacteria than human cells. Nature. 2016 Jan 8.
  • Uzuner SÇ, Birinci E, Tetikoğlu S, Birinci C, Kolaylı S. Distinct Epigenetic Reprogramming, Mitochondrial Patterns, Cellular Morphology, and Cytotoxicity after Bee Venom Treatment. Recent Pat Anticancer Drug Discov. 2021;16(3):377–92.
  • Arts RJW, Blok BA, Aaby P, Joosten LAB, de Jong D, van der Meer JWM, et al. Long-term in vitro and in vivo effects of γ-irradiated BCG on innate and adaptive immunity. J Leukoc Biol [Internet]. 2015 Dec 1 [cited 2023 Jun 12];98(6):995–1001. Available from: https://pubmed.ncbi.nlm.nih.gov/26082519/
  • Strober W, Watanabe T. NOD2, an intracellular innate immune sensor involved in host defense and Crohn’s disease. Mucosal Immunol 2011 45 [Internet]. 2011 Jul 13 [cited 2023 Jun 12];4(5):484–95. Available from: https://www.nature.com/articles/mi201129
  • Gensous N, Franceschi C, Blomberg BB, Pirazzini C, Ravaioli F, Gentilini D, et al. Responders and non-responders to influenza vaccination: A DNA methylation approach on blood cells. Exp Gerontol [Internet]. 2018 May 1 [cited 2023 Jun 12];105:94–100. Available from: https://pubmed.ncbi.nlm.nih.gov/29360511/
  • Cheong J-G, Ravishankar A, Sharma S, Parkhurst CN, Nehar- Belaid D, Ma S, et al. Epigenetic Memory of COVID-19 in Innate Immune Cells and Their Progenitors. bioRxiv [Internet]. 2022 Feb 10 [cited 2022 Apr 21];2022.02.09.479588. Available from: https://www.biorxiv.org/content/10.1101/2022.02.09.479588v1
  • Zimmermann MT, Oberg AL, Grill DE, Ovsyannikova IG, Haralambieva IH, Kennedy RB, et al. System-wide associations between DNA-methylation, gene expression, and humoral immune response to influenza vaccination. PLoS One [Internet]. 2016 Mar 31 [cited 2022 Apr 21];11(3). Available from: /pmc/articles/PMC4816338/
  • Kaufman J, Graf BA, Leung EC, Pollock SJ, Koumas TM, Reddy SY, et al. Fibroblasts as sentinel cells: Role of the CD40-CD40 ligand system in fibroblast activation and lung inflammation and fibrosis. Chest. 2001;120(1):53S-55S.
  • Bustos-Arriaga J, García-Machorro J, León-Juárez M, García- Cordero J, Santos-Argumedo L, Flores-Romo L, et al. Activation of the innate immune response against denv in normal non-transformed human fibroblasts. PLoS Negl Trop Dis [Internet]. 2011;5(12). Available from: https://pubmed.ncbi.nlm.nih.gov/22206025/
  • Hamada A, Torre C, Drancourt M, Ghigo E. Trained immunity carried by non-immune cells. Vol. 10, Frontiers in Microbiology. Frontiers; 2019. p. 3225.
  • Pillon NJ, Bilan PJ, Fink LN, Klip A. Cross-talk between skeletal muscle and immune cells: Muscle-derived mediators and metabolic implications [Internet]. Vol. 304, American Journal of Physiology - Endocrinology and Metabolism. American Physiological Society Bethesda, MD; 2013 [cited 2022 Apr 21]. p. 453–65. Available from: https://journals.physiology.org/doi/full/10.1152/ajpendo.00553.2012
  • Liu Q, Yang L, Gong C, Tao G, Huang H, Liu J, et al. Effects of long-term low-dose formaldehyde exposure on global genomic hypomethylation in 16HBE cells. Toxicol Lett [Internet]. 2011 Sep 10 [cited 2022 Apr 17];205(3):235–40. Available from: https://pubmed.ncbi.nlm.nih.gov/21745553/
  • Johnson W. Final Report on the Safety Assessment of Octoxynol- 1,-3,-5,-6,-7,-8,-9, -10,-11,-12,-13,-16,-20,-25,-30,-33,-40,-70,-9 Carboxylic Acid, Octoxynol-20 Carboxylic Acid, Potassium Octoxynol-12 Phosphate, Sodium Octoxynol-2 Ethane Sulfonate, Sodium Octoxynol-2 [Internet]. Vol. 23, International Journal of Toxicology. Int J Toxicol; 2004 [cited 2022 Apr 17]. p. 59–111. Available from: https://pubmed.ncbi.nlm.nih.gov/15162838/
  • Chen J, Wang J, Zhang J, Ly H. Advances in Development and Application of Influenza Vaccines. Vol. 12, Frontiers in Immunology. Frontiers Media S.A.; 2021. p. 2740.
There are 30 citations in total.

Details

Primary Language English
Subjects Engineering
Journal Section Articles
Authors

Selcen Çelik Uzuner 0000-0002-9558-7048

Publication Date June 29, 2023
Published in Issue Year 2023 Volume: 19 Issue: 2

Cite

APA Çelik Uzuner, S. (2023). Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines. Celal Bayar Üniversitesi Fen Bilimleri Dergisi, 19(2), 121-130.
AMA Çelik Uzuner S. Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines. CBUJOS. June 2023;19(2):121-130.
Chicago Çelik Uzuner, Selcen. “Epigenetic Alterations in Mouse Muscle Cells After in Vitro Treatments With COVID-19 and Influenza Vaccines”. Celal Bayar Üniversitesi Fen Bilimleri Dergisi 19, no. 2 (June 2023): 121-30.
EndNote Çelik Uzuner S (June 1, 2023) Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines. Celal Bayar Üniversitesi Fen Bilimleri Dergisi 19 2 121–130.
IEEE S. Çelik Uzuner, “Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines”, CBUJOS, vol. 19, no. 2, pp. 121–130, 2023.
ISNAD Çelik Uzuner, Selcen. “Epigenetic Alterations in Mouse Muscle Cells After in Vitro Treatments With COVID-19 and Influenza Vaccines”. Celal Bayar Üniversitesi Fen Bilimleri Dergisi 19/2 (June 2023), 121-130.
JAMA Çelik Uzuner S. Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines. CBUJOS. 2023;19:121–130.
MLA Çelik Uzuner, Selcen. “Epigenetic Alterations in Mouse Muscle Cells After in Vitro Treatments With COVID-19 and Influenza Vaccines”. Celal Bayar Üniversitesi Fen Bilimleri Dergisi, vol. 19, no. 2, 2023, pp. 121-30.
Vancouver Çelik Uzuner S. Epigenetic alterations in mouse muscle cells after in vitro treatments with COVID-19 and influenza vaccines. CBUJOS. 2023;19(2):121-30.