Institute for Informatics (I2), Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Sci Rep. 2022 Jun 8;12(1):9462. doi: 10.1038/s41598-022-13585-4.
Although vaccines have been evaluated and approved for SARS-CoV-2 infection prevention, there remains a lack of effective treatments to reduce the mortality of COVID-19 patients already infected with SARS-CoV-2. The global data on COVID-19 showed that men have a higher mortality rate than women. We further observed that the proportion of mortality of females increases starting from around the age of 55 significantly. Thus, sex is an essential factor associated with COVID-19 mortality, and sex related genetic factors could be interesting mechanisms and targets for COVID-19 treatment. However, the associated sex factors and signaling pathways remain unclear. Here, we propose to uncover the potential sex associated factors using systematic and integrative network analysis. The unique results indicated that estrogens, e.g., estrone and estriol, (1) interacting with ESR1/2 receptors, (2) can inhibit SARS-CoV-2 caused inflammation and immune response signaling in host cells; and (3) estrogens are associated with the distinct fatality rates between male and female COVID-19 patients. Specifically, a high level of estradiol protects young female COVID-19 patients, and estrogens drop to an extremely low level in females after about 55 years of age causing the increased fatality rate of women. In conclusion, estrogen, interacting with ESR1/2 receptors, is an essential sex factor that protects COVID-19 patients from death by inhibiting inflammation and immune response caused by SARS-CoV-2 infection. Moreover, medications boosting the down-stream signaling of ESR1/ESR2, or inhibiting the inflammation and immune-associated targets on the signaling network can be potentially effective or synergistic combined with other existing drugs for COVID-19 treatment.
虽然疫苗已被评估并批准用于预防 SARS-CoV-2 感染,但仍缺乏有效的治疗方法来降低已感染 SARS-CoV-2 的 COVID-19 患者的死亡率。全球 COVID-19 数据显示,男性死亡率高于女性。我们进一步观察到,女性死亡率的比例从大约 55 岁开始显著增加。因此,性别是与 COVID-19 死亡率相关的重要因素,性别相关的遗传因素可能是 COVID-19 治疗的有趣机制和靶点。然而,相关的性别因素和信号通路仍不清楚。在这里,我们建议使用系统和综合网络分析来发现潜在的与性别相关的因素。独特的结果表明,雌激素,例如雌酮和雌三醇,(1)与 ESR1/2 受体相互作用,(2)可以抑制宿主细胞中 SARS-CoV-2 引起的炎症和免疫反应信号,(3)雌激素与男性和女性 COVID-19 患者之间的死亡率存在差异有关。具体而言,高水平的雌二醇可保护年轻的女性 COVID-19 患者,而女性在 55 岁左右后雌激素水平降至极低水平,导致女性死亡率增加。总之,雌激素与 ESR1/2 受体相互作用是一种重要的性别因素,通过抑制 SARS-CoV-2 感染引起的炎症和免疫反应来保护 COVID-19 患者免于死亡。此外,增强 ESR1/ESR2 下游信号的药物,或抑制信号网络上与炎症和免疫相关的靶点,与其他现有 COVID-19 治疗药物联合使用可能具有有效性或协同作用。