Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
School of Medicine, Boston University, Boston, MA, United States.
Front Immunol. 2020 Aug 28;11:2147. doi: 10.3389/fimmu.2020.02147. eCollection 2020.
The novel severe acute respiratory syndrome coronavirus 2, the cause of the coronavirus disease 2019 (COVID-19) pandemic, has ravaged the world, with over 22 million total cases and over 770,000 deaths worldwide as of August 18, 2020. While the elderly are most severely affected, implicating an age bias, a striking factor in the demographics of this deadly disease is the gender bias, with higher numbers of cases, greater disease severity, and higher death rates among men than women across the lifespan. While pre-existing comorbidities and social, behavioral, and lifestyle factors contribute to this bias, biological factors underlying the host immune response may be crucial contributors. Women mount stronger immune responses to infections and vaccinations and outlive men. Sex-based biological factors underlying the immune response are therefore important determinants of susceptibility to infections, disease outcomes, and mortality. Despite this, gender is a profoundly understudied and often overlooked variable in research related to the immune response and infectious diseases, and it is largely ignored in drug and vaccine clinical trials. Understanding these factors will not only help better understand the pathogenesis of COVID-19, but it will also guide the design of effective therapies and vaccine strategies for gender-based personalized medicine. This review focuses on sex-based differences in genes, sex hormones, and the microbiome underlying the host immune response and their relevance to infections with a focus on coronaviruses.
新型严重急性呼吸综合征冠状病毒 2 是导致 2019 年冠状病毒病（COVID-19）大流行的病原体，它肆虐全球，截至 2020 年 8 月 18 日，全球总病例超过 2200 万，死亡人数超过 77 万。虽然老年人受影响最严重，这暗示了年龄偏见，但这种致命疾病的人口统计学中一个引人注目的因素是性别偏见，即男性的病例数、疾病严重程度和死亡率均高于女性，跨越整个生命周期。虽然预先存在的合并症以及社会、行为和生活方式因素促成了这种偏见，但宿主免疫反应的生物学因素可能是至关重要的促成因素。女性对感染和疫苗接种的免疫反应更强，寿命也比男性长。因此，免疫反应背后的基于性别的生物学因素是对感染、疾病结局和死亡率易感性的重要决定因素。尽管如此，在与免疫反应和传染病相关的研究中，性别是一个被严重低估且经常被忽视的变量，在药物和疫苗临床试验中也基本被忽略。了解这些因素不仅有助于更好地了解 COVID-19 的发病机制，还将指导针对基于性别的个体化医学的有效治疗方法和疫苗策略的设计。这篇综述重点关注宿主免疫反应背后的基因、性激素和微生物组中的性别差异及其与冠状病毒感染的相关性。
