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Sex differences in severity and mortality from COVID-19: are males more vulnerable?
Örebro University, School of Science and Technology. (Biology, The Life Science Center)ORCID iD: 0000-0003-3302-7106
Örebro University, School of Science and Technology. (Biology, The Life Science Center)ORCID iD: 0000-0001-7336-6335
2020 (English)In: Biology of Sex Differences, ISSN 2042-6410, Vol. 11, no 1, article id 53Article, review/survey (Refereed) Published
Abstract [en]

Coronavirus disease 2019 (COVID-19) has shown high infection and mortality rates all over the world, and despite the global efforts, there is so far no specific therapy available for COVID-19. Interestingly, while the severity and mortality of COVID-19 are higher in males than in females, the underlying molecular mechanisms are unclear. In this review, we explore sex-related differences that may be contributing factors to the observed male-biased mortality from COVID-19. Males are considered the weaker sex in aspects related to endurance and infection control. Studies show that viral RNA clearance is delayed in males with COVID-19. A recent study has indicated that the testis can harbor coronavirus, and consequently, males show delayed viral clearance. However, the role of testis involvement in COVID-19 severity and mortality needs further research. Males and females show a distinct difference in immune system responses with females eliciting stronger immune responses to pathogens. This difference in immune system responses may be a major contributing factor to viral load, disease severity, and mortality. In addition, differences in sex hormone milieus could also be a determinant of viral infections as estrogen has immunoenhancing effects while testosterone has immunosuppressive effects. The sex-specific severity of COVID-19 infections indicates that further research on understanding the sex differences is needed. Inclusion of both males and females in basic research and clinical trials is required to provide critical information on sex-related differences that may help to better understand disease outcome and therapy.

Place, publisher, year, edition, pages
BioMed Central, 2020. Vol. 11, no 1, article id 53
Keywords [en]
Coronavirus, Gender, Immune system, Pathogenesis, Sex hormones
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-85861DOI: 10.1186/s13293-020-00330-7ISI: 000573623000001PubMedID: 32948238Scopus ID: 2-s2.0-85091323992OAI: oai:DiVA.org:oru-85861DiVA, id: diva2:1470021
Funder
Swedish Research Council, 2019-04455Knowledge Foundation, 20170231
Note

Funding Agency:

Örebro University

Available from: 2020-09-23 Created: 2020-09-23 Last updated: 2020-10-14Bibliographically approved

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Pradhan, AjayOlsson, Per-Erik

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