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A gendered magnifying glass on COVID-19
Lorenzo Salvati1,2, Benedetta Biagioni1,3, Emanuele Vivarelli1,4
1Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
Clinical and Molecular Allergy : CMA
|August 11, 2020
Summary
Males face higher COVID-19 mortality, especially aged 50-69. Biological sex differences in immune response, X-chromosome genes, and ACE2/TMPRSS2 expression contribute to this male vulnerability.
Area of Science:
- Immunology
- Genetics
- Epidemiology
Background:
- The COVID-19 pandemic exhibits a notable gendered disparity in mortality.
- Males, particularly those aged 50-69, experience a higher risk of death.
Purpose of the Study:
- To review the biological and immunological sex differences influencing COVID-19 morbidity and mortality.
- To explore how these differences contribute to the observed higher SARS-CoV-2 infection rates in males.
Main Methods:
- Review of existing literature on sex differences in immune response.
- Analysis of genetic factors, including X-chromosome gene expression (e.g., Toll-like receptor 7).
- Examination of the role of cytokine production (e.g., IL-6) and viral entry molecules (ACE2, TMPRSS2).
Main Results:
- Females possess a generally more efficient innate and adaptive immune response.
- X-chromosome genes, like Toll-like receptor 7, enhance antiviral defense in females.
- Females exhibit more regulated IL-6 production, mitigating severe inflammatory responses.
- Male-biased expression of ACE2 and TMPRSS2 may increase vulnerability.
Conclusions:
- Biological sex significantly impacts COVID-19 outcomes.
- Immune response variations, genetic predispositions, and viral entry molecule expression contribute to higher male mortality.
- Understanding these sex differences is crucial for targeted public health strategies.
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