COVID-19 and Sex Differences: Mechanisms and Biomarkers
Autor
Haitao, Tu
Vermunt, Jane
Abeykoon, Jithma
Ghamrawi, Ranine
Gunaratne, Madugodaralalage
Jayachandran, Muthuvel
Narang, Kavita
Parashuram, Santosh
Suvakov, Sonja
Garovic, Vesna
Institución
Resumen
Men are consistently overrepresented in Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-CoV-2) infection, and COVID (COrona- VIrus-Disease)-19 severe outcomes, including
higher fatality rates. These differences are likely due to gender-specific behaviors, genetic and
hormonal factors, and sex differences in biological pathways related to SARS-CoV-2 infection.
Several social, behavioral and comorbid factors are implicated in the generally worse outcomes
in men as compared with women. Underlying biological sex differences and their effects on
COVID-19 outcomes, however, have received less attention. The present review summarizes
the available literature regarding proposed molecular and cellular markers of COVID-19
infection, their associations with health outcomes, and any reported modification by sex.
Biological sex differences characterized by such biomarkers exist within healthy populations
and also differ with age- and sex-specific conditions, such as pregnancy and menopause. In the
context of COVID-19, descriptive biomarker levels are often reported by sex, but data
pertaining to the effect of patient sex on the relationship between biomarkers and COVID-19
disease severity/outcomes are scarce. Such biomarkers may offer plausible explanations for the
worse COVID-19 outcomes seen in men. There is the need for larger studies with sex-specific
reporting and robust analyses to elucidate how sex modifies cellular and molecular pathways
associated with SARS-CoV-2. This will improve interpretation of biomarkers and clinical
management of COVID-19 patients by facilitating a personalized medical approach to risk
stratification, prevention, and treatment.