The Physiological Mechanisms of the Sex-Based Difference in Outcomes of COVID19 Infection

Wray, Susan ORCID: 0000-0002-0086-1359 and Arrowsmith, Sarah (2021) The Physiological Mechanisms of the Sex-Based Difference in Outcomes of COVID19 Infection. FRONTIERS IN PHYSIOLOGY, 12. 627260-.

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Official URL: http://dx.doi.org/10.3389/fphys.2021.627260

Abstract

The scale of the SARS-CoV-2 pandemic has thrust a spotlight on the sex-based differences in response to viral diseases; morbidity and mortality are greater in men than women. We outline the mechanisms by which being female offers a degree of protection from COVID19, that persists even when confounders such as comorbidities are considered. The physiological and immunological mechanisms are fascinating and range from incomplete X chromosome inactivation of immune genes, a crucial role for angiotensin converting enzyme 2 (ACE2), and regulation of both immune activity and ACE2 by sex steroids. From this flows understanding of why lung and other organs are more susceptible to COVID19 damage in men, and how their distinct immunological landscapes need to be acknowledged to guide prognosis and treatment. Pregnancy, menopause, and hormone replacement therapy bring changed hormonal environments and the need for better stratification in COVID19 studies. We end by noting clinical trials based on increasing estrogens or progesterone or anti-testosterone drugs; excellent examples of translational physiology.

Item Type:	Article
Uncontrolled Keywords:	steroid hormones, sexual dimorphism, SARS-CoV-2, pregnancy, ACE2, hormones
Depositing User:	Symplectic Admin
Date Deposited:	08 Mar 2021 08:07
Last Modified:	18 Jan 2023 22:57
DOI:	10.3389/fphys.2021.627260
Open Access URL:	http://doi.org/10.3389/fphys.2021.627260
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3116703