Journal
JOURNAL OF NEUROIMMUNE PHARMACOLOGY
Volume 16, Issue 1, Pages 38-47Publisher
SPRINGER
DOI: 10.1007/s11481-020-09974-z
Keywords
COVID-19; Gender; ACE-2; TMPRSS2; Hypertension
Categories
Funding
- NIH [AG050431, AG069229, NS108025, AT010980, ZEN-17-438829]
- Alzheimer's Association [ZEN-17-438829]
- US Department of Veterans Affairs [1I01BX003033, 1I01BX005002]
- Department of Veterans Affairs [1IK6 BX004982]
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Sex differences in ACE2 receptor and TMPRSS2 expression, as well as immunological responses, may explain the disparities in COVID-19 severity and fatality between males and females. Behaviors such as smoking and comorbidities may also contribute to gendered differences in clinical outcomes of COVID-19 infections. An understanding of these sex and gender sensitivities is crucial for the development of effective treatments and therapies for the virus.
While clinical characteristics exhibit that susceptibility to COVID-19 infection is equally likely between males and females, clinical outcomes show that males experience both a higher severity and fatality for COVID-19 infection than females. This review examines the evidence for these sex and gender differences and aims to illustrate possible mechanisms behind such sensitivity. Successful entry of SARS-CoV-2 into the body is dependent on the angiotensin-converting enzyme 2 (ACE2) receptor and the transmembrane protease serine 2 (TMPRSS2). Thus, sex-based differences in the expression of the ACE2 receptor and TMPRSS2 may explain the disparities in COVID-19 severity and fatality. Furthermore, these disparities may also be attributed to sex-based difference in immunological responses. Finally, the differences in clinical outcomes of COVID-19 infections between men and women may be due to gendered differences in behaviors, such as smoking, and prevalence to comorbidities. An understanding of the sex and gender sensitivities of COVID-19 infection is a necessary component towards the creation of effective treatment options and therapies for the virus.
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