Biofunctional roles of estrogen in coronavirus disease 2019: Beyond a steroid hormone

Abstract

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), epidemic poses a major global public health threat with more than one million daily new infections and hundreds of deaths. To combat this global pandemic, efficient prevention and management strategies are urgently needed. Together with the main characteristics of COVID-19, impaired coagulation with dysfunctions of the immune response in COVID-19 pathophysiology causes high mortality and morbidity. From recent clinical observations, increased expression of specific types of estrogen appears to protect patients from SARS-CoV-2 infection, thereby, reducing mortality. COVID-19 severity is less common in women than in men, particularly in menopausal women. Furthermore, estrogen levels are negatively correlated with COVID-19 severity and mortality. These findings suggest that estrogen plays a protective role in the pathophysiology of COVID-19. In this review, we discuss the potential roles of estrogen in blocking the SARS-CoV-2 from invading alveolar cells and replicating, and summarize the potential mechanisms of anti-inflammation, immune modulation, reactive oxygen species resistance, anti-thrombosis, vascular dilation, and vascular endothelium protection. Finally, the potential therapeutic effects of estrogen against COVID-19 are reviewed. This review provides insights into the role of estrogen and its use as a potential strategy to reduce the mortality associated with COVID-19, and possibly other viral infections and discusses the possible challenges and pertinent questions.

General Hospitalization and Intensive Care Unit-Related Factors of COVID-19 Patients in Northeastern Colombia: Baseline Characteristics of a Cohort Study

“…This finding was also reported in other Colombian cohorts in which men had higher risk of mortality, ICU admission, and mechanical ventilation [8,9]. Both behavioral and biological factors related to the immune response and the anti-inflamatorry and antithrombotic effects of estrogen may be responsibles for these events [18]. Estrogen is known to promote innate and adaptive immune responses, which leads to faster removal of the virus and fewer symptoms in the acute stage of the illness.…”

“…Estrogen is known to promote innate and adaptive immune responses, which leads to faster removal of the virus and fewer symptoms in the acute stage of the illness. In addition, it has the potential to decrease the expression of ACE2 receptors on type 2 alveolar epithelial cells, reduce the attachment between SARS-CoV-2 and ACE2 receptors, and inhibit the entry of SARS-CoV-2 into host cells [18]. Considering this, estrogens and ACE inhibitors could be a potential target for the tratment of other viral infections with a similar pathophysiology of COVID-19 [19].…”