Immune mechanisms associated with sex-based differences in severe COVID-19 clinical outcomes

Although biological males and females are equally likely to become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence has mounted that males experience higher severity and fatality compared to females. MAIN: The objective of this review is to examine the existing li...

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Bibliographic Details
Published in:Biology of sex differences 2022-03, Vol.13 (1), p.7-5, Article 7
Main Authors: Arnold, Cosby G, Libby, Anne, Vest, Alexis, Hopkinson, Andrew, Monte, Andrew A
Format: Article
Language:English
Subjects:
Antibodies
B cells
Coronaviruses
COVID-19
Female
Gender
Humans
Immune response
Immunity
Male
Mortality
Patient outcomes
Review
SARS-CoV-2
Severe acute respiratory syndrome
Sex
Sex Characteristics
Sex Factors
Testosterone
Viral antibodies
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Summary:Although biological males and females are equally likely to become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence has mounted that males experience higher severity and fatality compared to females. MAIN: The objective of this review is to examine the existing literature on biological mechanisms underlying sex-based differences that could contribute to SARS-CoV-2 infection clinical outcomes. Sex-based differences in immunologic response and hormonal expression help explain the differences in coronavirus disease 2019 (COVID-19) outcomes observed in biological males and females. X inactivation facilitates a robust immune response to COVID-19 in females, who demonstrate a more profound antibody response and faster recovery when compared to males. Low testosterone levels also help explain the dysregulated inflammatory response and poor outcomes observed in some males with COVID-19. Gender differences in health expression and behaviors further compound these observed differences. Understanding the biology of sex-based differences in COVID-19 severity and mortality could help inform preventative measures, treatment decisions, and development of personalized, sex-specific therapies.
ISSN:2042-6410
2042-6410
DOI:10.1186/s13293-022-00417-3