Diagnosis (Berl) . Do Sex-Specific Immunobiological Factors and Differences in Angiotensin Converting Enzyme 2 (ACE2) Expression Explain Increased Severity and Mortality of COVID-19 in Males?

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Diagnosis (Berl)


. 2020 Jun 4;/j/dx.ahead-of-print/dx-2020-0054/dx-2020-0054.xml.
doi: 10.1515/dx-2020-0054. Online ahead of print.
Do Sex-Specific Immunobiological Factors and Differences in Angiotensin Converting Enzyme 2 (ACE2) Expression Explain Increased Severity and Mortality of COVID-19 in Males?


Jens Vikse ¹ , Giuseppe Lippi ² , Brandon Michael Henry ³



Affiliations

• PMID: 32549125
• DOI: 10.1515/dx-2020-0054

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), shares similarities with the former SARS outbreak, which was caused by SARS-CoV-1. SARS was characterized by severe lung injury due to virus-induced cytopathic effects and dysregulated hyperinflammatory state. COVID-19 has a higher mortality rate in men both inside and outside China. In this opinion paper, we describe how sex-specific immunobiological factors and differences in angiotensin converting enzyme 2 (ACE2) expression may explain the increased severity and mortality of COVID-19 in males. We highlight that immunomodulatory treatment must be tailored to the underlying immunobiology at different stages of disease. Moreover, by investigating sex-based immunobiological differences, we may enhance our understanding of COVID-19 pathophysiology and facilitate improved immunomodulatory strategies.

Keywords: ACE2; COVID-19; coronavirus; gender; immunology.