An Overview of Sex Hormones in Relation to SARS-CoV-2 Infection

Naz, Marzieh Saei Ghare; Banaei, Mojdeh; Dashti, Sareh; Tehrani, Fahimeh Ramezani

doi:10.2217/fvl-2021-0058

Cited by 15 publications

(15 citation statements)

References 111 publications

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“…Moreover, in case series from China, Europe, and the USA, COVID-19 hospitalizations, admission to ICU, invasive mechanical ventilation (IMV), and in-hospital deaths have consistently been higher in men than in women [ 29 – 34 ]. The reasons for gender differences in the consequences of COVID-19 can be as follows: (i) lifestyle differences, such as smoking, which is more common in men than in women and increases the risk of pneumonia and secondary infections after COVID-19; (ii) compared to men, the innate and acquired immune system is stronger in women; and (iii) a female sex hormone, estrogen, plays a protective role by activating the immune response and suppressing straight SARS-CoV replication [ 35 – 37 ]. The distribution of patients based on Ct of rRT-PCR was as follows: 10.4% with Ct 10–20 (Group A), 75.7% with Ct 21–30 (Group B), and 13% with Ct 31–40 (Group C).…”

Section: Discussionmentioning

confidence: 99%

A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data

Sadeghi

Pournajaf

Halaji

et al. 2022

International Journal of Clinical Practice

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Objectives. To avoid worsening from mild, moderate, and severe diseases and to reduce mortality, it is necessary to identify the subpopulation that is more vulnerable to the development of COVID-19 unfavorable consequences. This study aims to investigate the demographic information, prevalence rates of common comorbidities among negative and positive real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) patients, and the association between SARS-CoV-2 cycle threshold (Ct) at hospital admission, demographic data, and outcomes of the patients in a large population in Northern Iran. Methods. This large retrospective cross-sectional study was performed from 7 March to 20 December 2020. Demographic data, including gender, age, underlying diseases, clinical outcomes, and Ct values, were obtained from 8,318 cases suspected of COVID-19, who were admitted to four teaching hospitals affiliated to Babol University of Medical Sciences (MUBABOL), in the north of Iran. Results. Since 7 March 2020, the data were collected from 8,318 cases suspected of COVID-19 (48.5% female and 51.5% male) with a mean age of 53 ± 25.3 years. Among 8,318 suspected COVID-19 patients, 3,250 (39.1%) had a positive rRT-PCR result; 1,632 (50.2%) patients were male and 335 (10.3%) patients died during their hospital stay. The distribution of positive rRT-PCR revealed that most patients (464 (75.7%)) had a Ct between 21 and 30 (Group B). Conclusion. Elderly patients, lower Ct, patients having at least one comorbidity, and male cases were significantly associated with increased risk for COVID-19-related mortality. Moreover, mortality was significantly higher in patients with diabetes, kidney disease, and respiratory disease.

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Section: Discussionmentioning

confidence: 99%

A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data

Sadeghi

Pournajaf

Halaji

et al. 2022

International Journal of Clinical Practice

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“…Given our finding that those patients with the unusual response with regard to neutralizing antibodies, but clearly positive for S1 IgG antibodies are more likely to be female, it is of note that estrogen regulates the expression of SARS-CoV-2 receptor ACE2 in differentiated airway epithelial cells [ 22 ]. In addition, it is known that female reproductive steroids, estrogen and progesterone, and their metabolite allopregnanolone, are anti-inflammatory, reshape the competence of immune cells, stimulate antibody production, and promote proliferation and repair of respiratory epithelial cells [ 23 , 24 ]. It remains to be analyzed in more detail whether or not these sex-specific differences in the immune response to SARS-CoV-2 infection or vaccination may be also important to understand better our key findings.…”

Section: Discussionmentioning

confidence: 99%

Outliers Matter—Correlation between S1 IgG SARS-CoV-2 Antibodies and Neutralizing SARS-CoV-2 Antibodies

Hocher

Schönbrunn²,

Chen

et al. 2022

Microorganisms

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Vaccination against the SARS-CoV-2 virus or infection with SARS-CoV-2 will lead to the development of IgG antibodies against the S1 protein of the SARS-CoV-2 virus. However, even despite having high levels of IgG antibodies against the S1 protein of the SARS-CoV-2 virus, (re-)infection may occur. We thus examined 2994 consecutive blood samples of outpatients from the Berlin-Brandenburg area in Germany in which IgG antibodies against the S1 protein of the SARS-CoV-2 virus as well as neutralizing SARS-CoV-2 virus antibodies were determined from the same sample. When analyzing the entire study population (2994 outpatients), we saw that S1 IgG antibodies (women: 223.98 ± 3.81; men: 207.80 ± 4.59; p = 0.014) and neutralizing antibodies (women: 66.65 ± 0.82; men: 62.88 ± 1.01; p = 0.021) are slightly higher in women than in men. Curve fitting revealed a good non-linear relationship between S1 IgG and neutralizing SARS-CoV-2 antibodies. However, 51 out of the 2994 blood samples from individual subjects were positive with regard to the neutralizing antibodies and at the same time negative for S1 IgG antibodies, and 112 out of the 2994 blood samples from individual subjects were negative with regard to the neutralizing antibodies and at the same time positive for S1 IgG antibodies. In conclusion, our study shows that there is a relevant number of patients who, despite developing significant titers of S1 antibodies, do not have relevant amounts of neutralizing antibody titers and are probably at high risk of (re-)infection.

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“…Estrogen receptors are expressed in all immune cells and participate in transcriptional regulation ( 12 , 20 – 23 ). Estrogen receptors fall into two types: intracellular (ERα and ERβ) and membrane-bound (G-protein coupled estrogen receptor, GPER).…”

Section: Sex Hormones As Chefs D’orchestre For The...mentioning

confidence: 99%

“…Female sex hormones, including estrogens and progesterone, act as regulators of innate and adaptive immunity; hence the higher flexibility of humoral and cell-mediated immune responses in women. A number of studies have come to conclusion that women show increased resistance to viral diseases and SARS-CoV-2 infections in particular ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…Female immune system appears to produce a better coordinated and more flexible antiviral response with the overall impact on the morbidity, severity, and associated mortality. The trend may be explained by the modulatory effects of estrogens on leukocyte functionalities, both in circulating pools and resident populations of cells recruited from the bloodstream to peripheral tissues ( 12 , 20 – 23 ). However, a number of reports emphasize the lack of difference in estradiol levels between deceased and surviving patients with COVID-19 ( 24 , 25 ).…”

Section: Introductionmentioning

confidence: 99%

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Sex hormones and immune system: Menopausal hormone therapy in the context of COVID-19 pandemic

et al. 2022

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The fatal outcomes of COVID-19 are related to the high reactivity of the innate wing of immunity. Estrogens could exert anti-inflammatory effects during SARS-CoV-2 infection at different stages: from increasing the antiviral resistance of individual cells to counteracting the pro-inflammatory cytokine production. A complex relationship between sex hormones and immune system implies that menopausal hormone therapy (MHT) has pleiotropic effects on immunity in peri- and postmenopausal patients. The definite immunological benefits of perimenopausal MHT confirm the important role of estrogens in regulation of immune functionalities. In this review, we attempt to explore how sex hormones and MHT affect immunological parameters of the organism at different level (in vitro, in vivo) and what mechanisms are involved in their protective response to the new coronavirus infection. The correlation of sex steroid levels with severity and lethality of the disease indicates the potential of using hormone therapy to modulate the immune response and increase the resilience to adverse outcomes. The overall success of MHT is based on decades of experience in clinical trials. According to the current standards, MHT should not be discontinued in COVID-19 with the exception of critical cases.

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An Overview of Sex Hormones in Relation to SARS-CoV-2 Infection

Cited by 15 publications

References 111 publications

A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data

A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data

Outliers Matter—Correlation between S1 IgG SARS-CoV-2 Antibodies and Neutralizing SARS-CoV-2 Antibodies

Sex hormones and immune system: Menopausal hormone therapy in the context of COVID-19 pandemic

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